DULOXETINE LICONSA 90 mg GASTRO-RESISTANT HARD CAPSULES

Introduction

Package Leaflet: Information for the Patient

Duloxetine Liconsa 90 mg Hard Gastro-Resistant Capsules

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 signs of illness are the same as yours.
• If you get 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 Duloxetine Liconsa and what is it used for
2. What you need to know before you take Duloxetine Liconsa
3. How to take Duloxetine Liconsa
4. Possible side effects
5. Storage of Duloxetine Liconsa
6. Contents of the pack and other information

1. What is Duloxetine Liconsa and what is it used for

Duloxetine Liconsa contains the active substance duloxetine. Duloxetine increases the levels of serotonin and noradrenaline in the nervous system.

Duloxetine is used in adults to treat:

• depression,
• generalized anxiety disorder (a persistent feeling of anxiety or nervousness).

Duloxetine starts to work in most people with depression or anxiety within 2 weeks of starting treatment, but it may take between 2 and 4 weeks before you start to feel better. Tell your doctor if you do not feel better after this time. Your doctor may continue to give you duloxetine when you are feeling better to prevent your depression or anxiety from returning.

2. What you need to know before you take Duloxetine Liconsa

Do not take Duloxetine Liconsa if:

• you are allergic to duloxetine or any of the other ingredients of this medicine (listed in section 6),
• you have liver failure,
• you have severe kidney disease,
• you are taking or have taken within the last 14 days another medicinal product called a monoamine oxidase inhibitor (MAOI) (see "Other medicines and Duloxetine Liconsa"),
• you are taking fluvoxamine, which is usually used to treat depression, ciprofloxacin or enoxacin, which are used to treat some infections,
• you are taking other medicines that contain duloxetine (see "Other medicines and Duloxetine Liconsa").

Tell your doctor if you have high blood pressure or heart disease. Your doctor will tell you if you should take duloxetine.

Warnings and precautions

This medicine may not be suitable for you due to the following reasons. Tell your doctor or pharmacist before you start taking duloxetine if:

• you are taking other medicines for depression (see "Other medicines and Duloxetine Liconsa"),
• you are taking St. John's Wort (Hypericum perforatum), a herbal remedy,
• you have kidney disease,
• you have had seizures (fits),
• you have had mania,
• you have bipolar disorder,
• you have eye problems, such as certain types of glaucoma (increased eye pressure)
• you have had bleeding problems (a tendency to develop bruises), especially if you are pregnant (see "Pregnancy and breast-feeding"),
• you are at risk of having low sodium levels (for example if you are taking diuretics, especially if you are an elderly person),
• you are being treated with other medicines that may cause liver damage,
• you are taking other medicines that contain duloxetine (see "Other medicines and Duloxetine Liconsa").

Duloxetine may cause a feeling of restlessness or an inability to sit or stand still. If this happens, you should tell your doctor.

You should also tell your doctor:

If you experience signs and symptoms of restlessness, hallucinations, loss of coordination, rapid heartbeat, increased body temperature, rapid changes in blood pressure, overactive reflexes, diarrhea, coma, nausea, vomiting, as you may be suffering from serotonin syndrome.

In its most severe form, serotonin syndrome can resemble Neuroleptic Malignant Syndrome (NMS). The signs and symptoms of NMS can include a combination of fever, rapid heartbeat, sweating, severe muscle stiffness, confusion, increased muscle enzymes (determined by a blood test).

Some medicines of the same class as duloxetine (called SSRIs/SNRIs) may cause symptoms of sexual dysfunction (see section 4). In some cases, these symptoms persist after stopping treatment.

Suicidal thoughts and worsening of your depression or anxiety

If you are depressed and/or have anxiety disorders, you may sometimes have thoughts of harming or killing yourself. These thoughts may be increased when you first start taking antidepressants, as all these medicines take time to work, usually about two weeks, but sometimes longer.

You are more likely to have these thoughts if:

• you have had previous thoughts of self-harm or suicide,
• you are a young adult. Information from clinical trials has shown an increased risk of suicidal behavior in adults under 25 years with psychiatric conditions who were treated with an antidepressant.

Tell your doctor or go to the hospital immediately if you have any thoughts of self-harm or suicide.

It may be helpful to tell a relative or close friend that you are depressed or have an anxiety disorder, and ask them to read this leaflet. You might ask them to tell you if they think your depression or anxiety is getting worse, or if they are worried about changes in your behavior.

Children and adolescents under 18 years of age

This medicine should not be used in children and adolescents under 18 years. In addition, you should know that patients under 18 years who take this type of medicine have an increased risk of side effects such as suicidal attempts, suicidal thoughts, and hostility (mainly aggression, oppositional behavior, and anger). Despite this, your doctor may prescribe duloxetine to patients under 18 years because they decide it may be beneficial for the patient. If your doctor has prescribed duloxetine to a patient under 18 years and you want to discuss it, please go back to the doctor. You should tell your doctor if any of the above symptoms appear or worsen in patients under 18 years who are taking duloxetine. Also, in this age group, the long-term safety effects of duloxetine related to growth, maturation, and cognitive and behavioral development have not yet been demonstrated.

Other medicines and Duloxetine Liconsa

Tell your doctor or pharmacist if you are taking, have recently taken, or might take any other medicines, including those obtained without a prescription.

The main component of Duloxetine Liconsa, duloxetine, is used in other medicines for other treatments:

• diabetic neuropathic pain, depression, anxiety, and urinary incontinence.

It should be avoided to use more than one of these medicines at the same time. Tell your doctor if you are already taking another medicine that contains duloxetine.

Your doctor will decide if you can take duloxetine with other medicines. Do not start or stop taking any medicine, including those obtained without a prescription, and herbal remedies, without first talking to your doctor.

You should also tell your doctor if you are taking any of the following medicines:

Monoamine oxidase inhibitors (MAOIs):Do not take duloxetine if you are taking, or have taken in the last 14 days, another medicine for depression called a monoamine oxidase inhibitor (MAOI). Examples of MAOIs include moclobemide (an antidepressant) and linezolid (an antibiotic). Taking an MAOI with many prescription medicines, including duloxetine, can cause serious side effects, even life-threatening. You should wait at least 14 days after stopping an MAOI before taking duloxetine. Similarly, you should wait at least 5 days after stopping duloxetine before starting an MAOI.

Medicines that cause drowsiness: include medicines prescribed by your doctor such as benzodiazepines, strong painkillers, antipsychotics, phenobarbital, and antihistamines.

Medicines that increase serotonin levels: Triptans, tramadol, tryptophan, SSRIs (such as paroxetine and fluoxetine), SNRIs (such as venlafaxine), tricyclic antidepressants (such as clomipramine, amitriptyline), pethidine, St. John's Wort, and MAOIs (such as moclobemide and linezolid). These medicines increase the risk of side effects; if you notice any unusual symptoms when taking any of these medicines with duloxetine, you should tell your doctor.

Oral anticoagulants or antiplatelet agents: Medicines that thin the blood or prevent blood clots. These medicines may increase the risk of bleeding.

Taking Duloxetine Liconsa with food, drinks, and alcohol

This medicine can be taken with or without food. You should be careful if you drink alcohol while being treated with duloxetine.

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.

• Tell your doctor if you become pregnant or are planning to become pregnant while being treated with this medicine. You should only take duloxetine after discussing the potential benefits and risks to the fetus with your doctor.

• Make sure your midwife and/or doctor know you are taking this medicine. Other similar medicines (SSRIs), taken during pregnancy, may increase the risk of a serious condition in babies called persistent pulmonary hypertension of the newborn (PPHN), which makes the baby breathe faster and turn blue. These symptoms usually start during the first 24 hours after birth. If this happens to your baby, you should contact your midwife and/or doctor immediately.

• If you take duloxetine near the end of your pregnancy, your baby may have some symptoms when it is born. These usually start at birth or within the first few days of your baby's life. These symptoms include weak muscles, trembling, restlessness, not feeding properly, breathing problems, and seizures. If your baby has any of these symptoms when it is born, or if you are concerned about your baby's health, contact your doctor or midwife, who will be able to advise you.

• If you take duloxetine near the end of your pregnancy, there is a greater risk of excessive vaginal bleeding shortly after giving birth, especially if you have a history of bleeding disorders. Your doctor or midwife should know that you are taking duloxetine so they can advise you.

• Data available on the use of duloxetine during the first three months of pregnancy do not show an increased overall risk of birth defects in the baby. If you take duloxetine during the second half of pregnancy, there may be a greater risk that the baby will be born early (6 additional premature babies per 100 women taking duloxetine in the second half of pregnancy), especially between weeks 35 and 36 of pregnancy.

• Tell your doctor if you are breast-feeding. Duloxetine is not recommended during breast-feeding. Ask your doctor or pharmacist for advice.

Driving and using machines

While being treated with duloxetine, you may feel drowsy or dizzy. Do not drive or use tools or machines until you know how the treatment with duloxetine affects you.

Duloxetine Liconsa contains sucrose

This medicine contains sucrose. If your doctor has told you that you have an intolerance to some sugars, contact them before taking this medicine.

Duloxetine contains sodium

This medicine contains less than 1 mmol of sodium (23 mg) per capsule; this is essentially "sodium-free".

3. How to take Duloxetine Liconsa

Take this medicine exactly as your doctor or pharmacist has told you. If you are not sure, ask your doctor or pharmacist.

Duloxetine should be taken by mouth. You should swallow the capsule whole with a glass of water. Alternatively, you can carefully open the capsule and sprinkle the contents over apple sauce. Take immediately without chewing.

For depression:

The recommended dose of duloxetine is 60 mg once a day, but your doctor will prescribe the dose that is best for you.

For generalized anxiety disorder:

The usual starting dose of duloxetine is 30 mg once a day, after which most patients are given 60 mg once a day, but your doctor will prescribe the dose that is best for you. The dose may be adjusted up to 120 mg per day depending on your response to duloxetine.

To help you remember to take duloxetine, it may be helpful to take it at the same times every day. Discuss with your doctor how long you should take this medicine. Do not stop taking duloxetine, or change your dose, without talking to your doctor. It is important to treat your condition properly to help you improve. If your condition is not treated, it may not disappear and may become more severe and more difficult to treat.

For doses that cannot be achieved with this strength, other strengths of this medicine and other products containing duloxetine are available.

If you take more Duloxetine Liconsa than you should

If you have taken more duloxetine than you should, contact your doctor or pharmacist immediately or go to the emergency department at your nearest hospital. Take the medicine pack with you.

Symptoms of overdose include drowsiness, coma, serotonin syndrome (a rare reaction that can cause a feeling of intense happiness, drowsiness, clumsiness, restlessness, feeling drunk, fever, sweating, or muscle stiffness), seizures, vomiting, and rapid heartbeat.

If you forget to take Duloxetine Liconsa

If you forget to take a dose, take it as soon as you remember. However, if it is almost time for your next dose, skip the missed dose and take a single dose as usual. Do not take a double dose to make up for a forgotten dose. Do not take more duloxetine than prescribed for you in one day.

If you stop taking Duloxetine Liconsa

Do not stop taking your capsules without the advice of your doctor, even if you feel better.If your doctor thinks you do not need to take duloxetine anymore, they will tell you to reduce your dose over at least 2 weeks before stopping treatment.

Some patients who have stopped taking duloxetine have experienced symptoms such as:

• dizziness, tingling sensations like pins and needles or electric shock-like sensations (especially in the head), sleep disturbances (vivid dreams, nightmares, inability to sleep), fatigue, drowsiness, feeling restless or agitated, feeling anxious, nausea or vomiting, tremor, headache, muscle pain, feeling irritable, diarrhea, and excessive sweating or dizziness.

These symptoms are usually not serious and disappear within a few days, but if you have symptoms that are bothersome, ask your doctor for advice.

If you have any further questions on the use of this product, 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. These effects are usually mild to moderate and disappear, often, within a few weeks.

Very Common Adverse Effects (may affect more than 1 in 10 patients)

• headache, drowsiness.
• discomfort (nausea), dry mouth.

Common Adverse Effects (may affect up to 1 in 10 patients)

• loss of appetite.
• difficulty sleeping, feeling of agitation, decreased sexual desire, anxiety, difficulty or inability to have an orgasm, unusual dreams.
• dizziness, feeling of slowness, tremors, numbness, including numbness, itching, or tingling of the skin.
• blurred vision.
• tinnitus (perception of sounds in the ear when there is no external sound).
• feeling palpitations in the chest.
• increased blood pressure, flushing.
• increased yawning.
• constipation, diarrhea, stomach pain, vomiting, heartburn or indigestion, gas.
• increased sweating, rash (itching).
• muscle pain, muscle spasms.
• pain while urinating, frequent urination.
• difficulty getting an erection, changes in ejaculation.
• falls (mostly in elderly people), fatigue.
• weight loss.

Children and adolescents under 18 years of age with depression treated with this medicine suffered a decrease in weight when they started taking this medicine. After 6 months of treatment, the weight increased to similar levels as other children and adolescents of the same age and sex.

Uncommon Adverse Effects (may affect up to 1 in 100 patients)

• inflammation of the throat that causes hoarseness.
• suicidal thoughts, difficulty sleeping, grinding or clenching teeth, feeling of disorientation, lack of motivation.
• muscle spasms and involuntary movements, feeling of restlessness or inability to remain seated or still, nervousness, difficulty concentrating, changes in taste, difficulty controlling movements, e.g., lack of coordination or involuntary muscle movements, restless legs syndrome, poor quality sleep.
• dilation of the pupils (the black dot in the center of the eye), vision problems.
• feeling of dizziness or vertigo, ear pain.
• rapid and/or irregular heartbeats.
• fainting, dizziness, feeling of dizziness or fainting when standing up, coldness in the fingers of the hands and/or feet.
• throat spasms, nosebleeds.
• vomiting blood, or black-colored stools, gastroenteritis, belching, difficulty swallowing.
• liver inflammation that can cause abdominal pain and yellowing of the skin or the white part of the eyes.
• night sweats, rashes, cold sweats, sensitivity to sunlight, increased tendency to bruise.
• muscle stiffness, muscle spasms.
• difficulty or inability to urinate, difficulty starting urination, need to urinate at night, need to urinate more than usual, decreased urine flow.
• abnormal vaginal bleeding, abnormal menstrual periods, including heavy, painful, irregular, or prolonged menstrual periods, very light or absent menstrual periods, testicular or scrotal pain.
• chest pain, feeling of cold, thirst, chills, feeling of heat, alteration in gait.
• weight gain.
• Duloxetine may cause effects that you may not be aware of, such as increased liver enzymes or potassium levels in the blood, creatine phosphokinase, sugar, or cholesterol.

Rare Adverse Effects (may affect up to 1 in 1,000 patients)

• inflammation of the blood vessels in the skin (cutaneous vasculitis).

Frequency Not Known (cannot be estimated from the available data)

• signs and symptoms of a condition called "stress cardiomyopathy", which may include chest pain, difficulty breathing, dizziness, fainting, and irregular heartbeats.

Reporting 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: www.notificaRAM.es. By reporting adverse effects, you can contribute to providing more information on the safety of this medicine.

5. Storage of Duloxetine Liconsa

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

Do not use this medicine after the expiration date that appears on the box and the blister pack after "EXP". The expiration date is the last day of the month indicated.

Aluminum/Aluminum Blister Pack:

Do not store at a temperature above 30 °C.

Transparent PVC/PCTFE Aluminum Blister Pack:

Do not store at a temperature above 30 °C.

Store in the original blister pack to protect it from moisture.

Medicines should not be disposed of via wastewater or household waste. Deposit the packaging and any unused medicines in the SIGRE collection point at the pharmacy. If in doubt, ask your pharmacist how to dispose of the packaging and any unused medicines. This will help protect the environment.

6. Package Contents and Additional Information

Composition of Duloxetine Liconsa

• The active ingredientis duloxetine.

Each capsule contains duloxetine hydrochloride equivalent to 90 mg of duloxetine.

• The other ingredients(excipients) are:

• Capsule content: sugar spheres (sugar syrup, corn starch, sucrose), methacrylic acid and ethyl acrylate copolymer (1:1) dispersion 30%, hypromellose, sucrose, colloidal anhydrous silica, talc, triethyl citrate, glycerol monostearate, triethyl citrate, polysorbate 80, and water.
• Capsule shell:

• 90 mg capsules: titanium dioxide (E171), gelatin, brilliant blue FCF (E133), carmine (E132),

Appearance and Package Contents of the Product

Duloxetine Liconsa is a hard gastro-resistant capsule. Each capsule contains duloxetine hydrochloride pellets with a coating to protect them from stomach acid.

Duloxetine Liconsa 90 mg are hard gelatin capsules, approximately 21.4 - 22.0 mm in length, with a dark blue opaque cap and a light blue opaque body.

Aluminum/Aluminum Blister Pack

Duloxetine Liconsa 90 mg hard gastro-resistant capsules are available in packs of 28 and 98 capsules.

Transparent PVC/PCTFE Aluminum Blister Pack

Duloxetine Liconsa 90 mg hard gastro-resistant capsules are available in packs of 28 and 98 capsules.

Not all pack sizes may be marketed.

Marketing Authorization Holder and Manufacturer

Marketing Authorization Holder:

Laboratorios Liconsa, S.A.

Calle Dulcinea S/N

Alcalá De Henares, Madrid 28805

Spain

Manufacturer:

Laboratorios Liconsa, S.A.

Avda. Miralcampo, Nº7, Polígono Industrial Miralcampo

19200 Azuqueca de Henares (Guadalajara),

Spain

This medicine is authorized in the Member States of the European Economic Area under the following names:

Date of the last revision of this leaflet:July 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/).