DABIGATRAN ETEXILATE KRKA 150 mg HARD CAPSULES

Introduction

Package Leaflet: Information for the Patient

Dabigatran Etexilate Krka 150 mg Hard Capsules EFG

Read all of this leaflet carefully before you start taking this medicine, because it contains important information for you.

• Keep this leaflet, you may need to read it again.
• If you have any further questions, ask your doctor or pharmacist.
• This medicine has been prescribed for you only. Do not pass it on to others. It may harm them, even if their symptoms are the same as yours.
• If you experience any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. See section 4.

Contents of the pack

1. What is Dabigatran Etexilate Krka and what is it used for
2. What you need to know before you take Dabigatran Etexilate Krka
3. How to take Dabigatran Etexilate Krka
4. Possible side effects
5. Storage of Dabigatran Etexilate Krka
6. Contents of the pack and other information

1. What is Dabigatran Etexilate Krka and what is it used for

This medicine contains the active substance dabigatran etexilate and belongs to a group of medicines called anticoagulants. It works by blocking a substance in the body involved in the formation of blood clots.

Dabigatran etexilate is used in adults to:

• prevent the formation of blood clots in the brain (stroke) and in other blood vessels of the body if you have a type of irregular heartbeat called non-valvular atrial fibrillation and have at least one additional risk factor.

• treat blood clots in the veins of your legs and lungs and to prevent them from happening again in the veins of your legs and lungs.

Dabigatran etexilate is used in children to:

• treat blood clots and prevent them from happening again.

2. What you need to know before you take Dabigatran Etexilate Krka

Do not take Dabigatran Etexilate Krka

• if you are allergic to dabigatran etexilate or any of the other ingredients of this medicine (listed in section 6).
• if your kidney function is severely reduced.
• if you are currently bleeding.
• if you have any disease in an organ of the body that increases the risk of severe bleeding (e.g. stomach ulcer, injury or bleeding in the brain, recent brain or eye surgery).
• if you are prone to bleeding. This tendency may be congenital, of unknown cause or caused by other medicines.
• if you are taking medicines to prevent blood clotting (e.g. warfarin, rivaroxaban, apixaban or heparin), except when switching from one anticoagulant treatment to another, while having a venous or arterial catheter and being given heparin through this catheter to keep it open or while your normal heartbeat is being restored through a procedure called catheter ablation for atrial fibrillation.
• if your liver function is severely reduced or you have a life-threatening liver disease.
• if you are taking oral ketoconazole or itraconazole, medicines used to treat fungal infections.
• if you are taking oral ciclosporin, a medicine used to prevent organ rejection after a transplant.
• if you are taking dronedarone, a medicine used to treat irregular heartbeat.
• if you are taking a combination product of glecaprevir and pibrentasvir, an antiviral medicine used to treat hepatitis C.
• if you have been implanted with an artificial heart valve that requires permanent anticoagulant treatment.

Warnings and precautions

Talk to your doctor before you start taking this medicine. During treatment with this medicine, you may also need to talk to your doctor if you experience any symptoms or if you need to have surgery.

Tell your doctorif you have or have had any disorder or disease, especially any of the following:

• If you have an increased risk of bleeding, for example:

• if you have recently had bleeding.
• if you have had a tissue sample taken (biopsy) in the last month.
• if you have had a severe injury (e.g. a bone fracture, a head injury or any injury that required surgical treatment).
• if you have inflammation of the oesophagus or stomach.
• if you have problems with acid reflux from the stomach into the oesophagus.
• if you are taking medicines that may increase the risk of bleeding. See “Other medicines and Dabigatran Etexilate Krka” below.
• if you are using anti-inflammatory medicines such as diclofenac, ibuprofen or piroxicam.
• if you have a heart infection (bacterial endocarditis).
• if you know you have reduced kidney function or if you are dehydrated (symptoms include feeling thirsty and passing small amounts of dark coloured urine/concentrated urine with foam).
• if you are over 75 years old.
• if you are an adult patient and weigh 50 kg or less.
• only if used in children: if the child has a brain infection or an infection around the brain.

• If you have had a heart attack or if you have been diagnosed with diseases that increase the risk of having a heart attack.
• If you have a liver disease associated with changes in blood tests. The use of this medicine is not recommended in this case.

Be careful with this medicine

• If you need to have surgery:

In this case, this medicine should be temporarily stopped due to an increased risk of bleeding during and after surgery. It is very important that you take this medicine before and after surgery exactly at the times indicated by your doctor.

• If surgery requires the insertion of a catheter or an injection into the spinal column (e.g. for epidural or spinal anaesthesia or for pain relief):
• It is very important that you take this medicine before and after surgery exactly at the times indicated by your doctor.
• Tell your doctor immediately if you experience numbness or weakness in your legs or bowel or bladder problems after the anaesthesia has ended, as this situation requires urgent attention.
• If you fall or injure yourself during treatment, especially if you hit your head. Seek urgent medical attention. You may need a doctor to examine you, as you may have a higher risk of bleeding.
• If you know you have a disease called antiphospholipid syndrome (an immune system disorder that increases the risk of blood clots), tell your doctor so that they can decide whether it may be necessary to change your treatment.

Other medicines and Dabigatran Etexilate Krka

Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines. In particular, you must tell your doctor before takingdabigatran etexilate if you are taking any of the following medicines:

• Medicines to reduce blood clotting (e.g. warfarin, phenprocoumon, acenocoumarol, heparin, clopidogrel, prasugrel, ticagrelor, rivaroxaban, acetylsalicylic acid).
• Medicines for the treatment of fungal infections (e.g. ketoconazole, itraconazole), except if they are only applied to the skin.
• Medicines used to treat irregular heartbeat (e.g. amiodarone, dronedarone, quinidine, verapamil).

If you are using medicines that contain verapamil, your doctor may tell you to use a reduced dose of this medicine, depending on the disease for which you have been prescribed. See section 3.

• Medicines for the prevention of organ rejection after a transplant (e.g. tacrolimus, ciclosporin).
• A combination product of glecaprevir and pibrentasvir (an antiviral medicine used to treat hepatitis C).
• Anti-inflammatory and pain-relieving medicines (e.g. acetylsalicylic acid, ibuprofen, diclofenac).
• St John's Wort, a herbal medicine for depression.
• Antidepressant medicines called selective serotonin reuptake inhibitors or selective serotonin and norepinephrine reuptake inhibitors.
• Rifampicin or clarithromycin (two antibiotics).
• Antiviral medicines for HIV (e.g. ritonavir).
• Certain medicines for the treatment of epilepsy (e.g. carbamazepine, phenytoin).

Pregnancy and breast-feeding

If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, ask your doctor or pharmacist for advice before taking this medicine.

The effects of this medicine on pregnancy and the unborn child are not known. You should not take this medicine if you are pregnant unless your doctor advises you to. If you are of childbearing age, you should avoid becoming pregnant during treatment with this medicine.

Breast-feeding is not recommended during treatment with this medicine.

Driving and using machines

This medicine has no known effects on the ability to drive or use machines.

3. How to take Dabigatran Etexilate Krka

This medicine can be used in adults and children aged 8 years or older who are able to swallow the capsules whole. There are other pharmaceutical forms suitable for the treatment of children under 8 years.

Follow the instructions for administration of this medicine exactly as told by your doctor. If you are unsure, ask your doctor again.

Take dabigatran etexilate as recommended for the following situations:

Prevention of vascular cerebral or systemic obstruction by blood clot formation developed after irregular heartbeat and treatment of blood clots in the veins of your legs and lungs, including prevention of them happening again in the veins of your legs and lungs

The recommended dose is 300 mg given as one 150 mg capsule twice a day.

If you are 80 years of age or older, the recommended dose is 220 mg given as one 110 mg capsule twice a day.

If you are using medicines that contain verapamil, you should be told to use a reduced dose of dabigatran etexilate of 220 mg given as one 110 mg capsule twice a day, as your risk of bleeding may be increased.

If you have a potentially higher risk of bleeding, your doctor may decide to prescribe a dose of 220 mg given as one 110 mg capsule twice a day.

You can continue taking this medicine if you need to have your normal heartbeat restored through a procedure called cardioversion or through a procedure called catheter ablation for atrial fibrillation. Take this medicine exactly as your doctor has told you.

If you have been fitted with a medical device (vascular endoprosthesis) in a blood vessel to keep it open in a procedure called percutaneous coronary intervention with vascular endoprosthesis, you may receive treatment with this medicine once your doctor has decided that normal blood clotting control has been achieved. Take this medicine exactly as your doctor has told you.

Treatment of blood clots and prevention of them happening again in children

This medicine should be taken twice a day, one dose in the morning and one dose in the evening, approximately at the same time every day. The administration interval should be as close as possible to 12 hours.

The recommended dose depends on weight and age. Your doctor will determine the correct dose. Your doctor may adjust the dose during treatment. Continue using all your other medicines unless your doctor tells you to stop using one.

Table 1 shows the single and total daily doses of this medicine in milligrams (mg) based on the patient's weight in kilograms (kg) and age in years:

Table 1: Dosing table for dabigatran etexilate capsules

Doses that require combinations of more than one capsule:

300 mg: two 150 mg capsules or

four 75 mg capsules

260 mg: one 110 mg capsule plus one 150 mg capsule or

one 110 mg capsule plus two 75 mg capsules

220 mg: two 110 mg capsules

185 mg: one 75 mg capsule plus one 110 mg capsule

150 mg: one 150 mg capsule or

two 75 mg capsules

How to take Dabigatran Etexilate Krka

This medicine can be taken with or without food. The capsule should be swallowed whole with a glass of water, to ensure release in the stomach. Do not break, chew or open the capsule to take only its contents as this may increase the risk of bleeding.

Instructions for opening the blisters

The following images illustrate how to remove the capsules from the blister:

To remove the capsule from the blister:

1. Hold the blister by the edges and separate one unit from the rest of the blister by gently tearing along the perforated line that marks the unit.
2. Pull the edge of the foil until it is completely separated.
3. Let the capsule drop into your hand.
4. Swallow the capsules whole with a glass of water.

• Do not push the capsules through the blister foil.
• Do not remove the blister foil until the capsule is needed.

Changing anticoagulant treatment

Do not change your anticoagulant treatment without specific instructions from your doctor.

If you take more Dabigatran Etexilate Krka than you should

Taking too much of this medicine increases the risk of bleeding. Contact your doctor immediately if you have taken too many capsules. There are specific treatment options available.

In case of overdose or accidental ingestion, consult your doctor or pharmacist immediately or call the Toxicology Information Service, telephone: 915620420, indicating the medicine and the amount taken.

If you forget to take Dabigatran Etexilate Krka

A forgotten dose can be taken up to 6 hours before the next dose.

A forgotten dose should be omitted if the time before the next dose is less than 6 hours.

Do not take a double dose to make up for forgotten doses.

If you stop taking Dabigatran Etexilate Krka

Take dabigatran etexilate exactly as prescribed. Do not stop your treatment with this medicine without first talking to your doctor, as the risk of developing a blood clot may be higher if you stop treatment too soon. Contact your doctor if you experience indigestion after taking this medicine.

If you have any further questions on the use of this medicine, ask your doctor or pharmacist.

4. Possible Adverse Effects

Like all medicines, this medicine can cause adverse effects, although not all people suffer from them.

Severe Adverse Effects

This medicine acts on blood coagulation; therefore, most adverse effects are related to signs such as bruising or bleeding.

Episodes of major or severe bleeding may occur, which are the most severe adverse effects and, regardless of their location, can cause disability, be potentially fatal, or even cause death. In some cases, these bleedings may not be apparent.

If you experience any episode of bleeding that does not stop by itself or if you experience signs of excessive bleeding (exceptional weakness, fatigue, paleness, dizziness, headache, or unexplained swelling), consult your doctor immediately. Your doctor may decide to keep you under close observation or change your medication.

Inform your doctor immediately if you experience a severe allergic reaction that causes difficulty breathing or dizziness.

Other Adverse Effects

Possible adverse effects are detailed below, grouped according to their frequency of occurrence.

Prevention of vascular cerebral or systemic obstruction by blood clot formation developed after abnormal heart rhythm

Frequent (may affect up to 1 in 10 people):

• Bleeding may occur through the nose, in the stomach or intestine, from the penis/vagina or urinary tract (including blood in the urine that stains the urine pink or red), or under the skin
• Decrease in the number of red blood cells in the blood
• Abdominal pain or stomach pain
• Indigestion
• Frequent loose or liquid stools
• Feeling like vomiting

Uncommon (may affect up to 1 in 100 people):

• Bleeding
• Bleeding may occur from hemorrhoids, the rectum, or the brain
• Formation of hematomas
• Coughing up blood or sputum with blood spots
• Decrease in the number of platelets in the blood
• Decrease in the amount of hemoglobin in the blood (the substance present in red blood cells)
• Allergic reaction
• Sudden change in skin color and physical appearance
• Itching
• Ulcer in the stomach or intestine (including esophageal ulcer)
• Inflammation of the esophagus and stomach
• Gastroesophageal reflux
• Vomiting
• Difficulty swallowing
• Abnormalities in liver function tests

Rare (may affect up to 1 in 1,000 people):

• Bleeding may occur in a joint, at the site of a surgical incision, in a wound, at the site of an injection, or at the site of a catheter in a vein
• Severe allergic reaction that causes difficulty breathing or dizziness
• Severe allergic reaction that causes swelling of the face or throat
• Skin rash with dark red, prominent, and itchy bumps, caused by an allergic reaction
• Decrease in the proportion of blood cells
• Increased liver enzymes
• Yellowing of the skin or whites of the eyes, caused by liver or blood problems

Frequency not known (frequency cannot be estimated from available data):

• Difficulty breathing or wheezing
• Decrease in the number of white blood cells (which help fight infections)
• Hair loss

In a clinical trial, the rate of heart attacks with this medicine was numerically higher than with warfarin. The overall incidence was low.

Treatment of blood clots in the veins of the legs and lungs, including prevention of recurrent blood clots in the veins of the legs and/or lungs

Frequent (may affect up to 1 in 10 people):

• Bleeding may occur through the nose, in the stomach or intestine, from the rectum, penis/vagina, or urinary tract (including blood in the urine that stains the urine pink or red), or under the skin
• Indigestion

Uncommon (may affect up to 1 in 100 people):

• Bleeding
• Bleeding may occur in a joint or wound
• Bleeding may occur from hemorrhoids
• Decrease in the number of red blood cells in the blood
• Formation of hematomas
• Coughing up blood or sputum with blood spots
• Allergic reaction
• Sudden change in skin color and physical appearance
• Itching
• Ulcer in the stomach or intestine (including esophageal ulcer)
• Inflammation of the esophagus and stomach
• Gastroesophageal reflux
• Feeling like vomiting
• Vomiting
• Abdominal pain or stomach pain
• Frequent loose or liquid stools
• Abnormalities in liver function tests
• Increased liver enzymes

Rare (may affect up to 1 in 1,000 people):

• Bleeding may occur at the site of a surgical incision, or at the site of an injection, or at the site of a catheter in a vein or from the brain
• Decrease in the number of platelets in the blood
• Severe allergic reaction that causes difficulty breathing or dizziness
• Severe allergic reaction that causes swelling of the face or throat
• Skin rash with dark red, prominent, and itchy bumps, caused by an allergic reaction
• Difficulty swallowing

Frequency not known (frequency cannot be estimated from available data):

• Difficulty breathing or wheezing
• Decrease in the amount of hemoglobin in the blood (the substance present in red blood cells)
• Decrease in the proportion of blood cells
• Decrease in the number of white blood cells (which help fight infections)
• Yellowing of the skin or whites of the eyes, caused by liver or blood problems
• Hair loss

In the clinical trial program, the rate of heart attacks with this medicine was higher than with warfarin. The overall incidence was low. No imbalance in the rate of heart attacks was observed in patients treated with dabigatran compared to patients treated with placebo.

Treatment of blood clots and prevention of recurrent blood clots in children

Frequent (may affect up to 1 in 10 people):

• Decrease in the number of red blood cells in the blood
• Decrease in the number of platelets in the blood
• Skin rash with dark red, prominent, and itchy bumps, caused by an allergic reaction
• Sudden change in skin color and physical appearance
• Formation of hematomas
• Nosebleeds
• Gastroesophageal reflux
• Vomiting
• Feeling like vomiting
• Frequent loose or liquid stools
• Indigestion
• Hair loss
• Increased liver enzymes

Uncommon (may affect up to 1 in 100 people):

• Decrease in the number of white blood cells (which help fight infections)
• Bleeding may occur in the stomach or intestine, brain, rectum, penis/vagina, or urinary tract (including blood in the urine that stains the urine pink or red), or under the skin
• Decrease in the amount of hemoglobin in the blood (the substance present in red blood cells)
• Decrease in the proportion of blood cells
• Itching
• Coughing up blood or sputum with blood spots
• Abdominal pain or stomach pain
• Inflammation of the esophagus and stomach
• Allergic reaction
• Difficulty swallowing
• Yellowing of the skin or whites of the eyes, caused by liver or blood problems

Frequency not known (frequency cannot be estimated from available data):

• Lack of white blood cells (which help fight infections)
• Severe allergic reaction that causes difficulty breathing or dizziness
• Severe allergic reaction that causes swelling of the face or throat
• Difficulty breathing or wheezing
• Bleeding
• Bleeding may occur in a joint or wound, surgical incision, injection site, or catheter site in a vein
• Bleeding may occur from hemorrhoids
• Ulcer in the stomach or intestine (including esophageal ulcer)
• Abnormalities in liver function tests

Reporting of Adverse Effects

If you experience any type of adverse effect, consult your doctor or pharmacist, even if it is a possible adverse effect that is not listed in this leaflet. You can also report them directly through the Spanish Pharmacovigilance System for Human Use Medicines: https://www.notificaram.es. By reporting adverse effects, you can contribute to providing more information on the safety of this medicine.

5. Storage of Dabigatran etexilate Krka

Keep this medicine out of the sight and reach of children.

Do not use this medicine after the expiration date stated on the packaging and on the aluminum blister after CAD. The expiration date is the last day of the month indicated.

Store in the original packaging to protect it from light and moisture.

Medicines should not be disposed of via wastewater or household waste. Deposit the packaging and medicines you no longer need at the SIGRE point in the pharmacy. In case of doubt, ask your pharmacist how to dispose of the packaging and medicines you no longer need. This will help protect the environment.

6. Package Contents and Additional Information

Composition of Dabigatran etexilate Krka

• The active ingredient is dabigatran etexilate. Each hard capsule contains 150 mg of dabigatran etexilate (as dabigatran etexilate mesilate).
• The other ingredients are tartaric acid, hypromellose, hydroxypropylcellulose, and talc inside the capsule.
• The capsule ingredients are titanium dioxide (E171), carmine indigo (E132), carrageenan, potassium chloride, and hypromellose.
• The black printing ink contains shellac, iron oxide black (E172), and potassium hydroxide.

Appearance of the Product and Package Contents

Hard capsules (capsules): The capsule cap is blue and the body is white or almost white with the mark "150" printed in black longitudinally. The capsule size is 0 and the length is approximately 24 mm.

Dabigatran etexilate Krka is available in boxes containing:

• 60 x 1 hard capsules in unit-dose blisters.

Marketing Authorization Holder and Manufacturer

KKRA, d.d., Novo mesto, Šmarješka cesta 6, 8501 Novo mesto, Slovenia

You can request more information about this medicine by contacting the local representative of the marketing authorization holder:

KRKA Farmacéutica, S.L., C/ Anabel Segura 10, Pta. Baja, Oficina 1, 28108 Alcobendas, Madrid, Spain

Date of the Last Approval of this Leaflet: February 2024

Detailed information about this medicine is available on the website of the Spanish Agency for Medicines and Health Products (AEMPS): http://www.aemps.gob.es//.