DUOXONA 5 mg/2.5 mg PROLONGED-RELEASE TABLETS

Introduction

Package Leaflet: Information for the User

Duoxona 5 mg/2.5 mg prolonged-release tablets EFG

Oxycodone hydrochloride / Naloxone hydrochloride

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

1. What is Duoxona and what is it used for

Duoxona is a prolonged-release tablet, which means that the active substances are released over a longer period of time. Its effect lasts 12 hours.

These tablets are for use in adults only.

Pain relief

You have been prescribed Duoxona for the treatment of severe pain, which can only be adequately managed with opioid analgesics. Naloxone hydrochloride is added to counteract constipation.

How these tablets work for pain relief

These tablets contain oxycodone hydrochloride and naloxone hydrochloride as active substances. Oxycodone hydrochloride is responsible for the analgesic effect of Duoxona; it is a potent analgesic from the opioid group.

The second active substance of Duoxona, naloxone hydrochloride, has the function of counteracting constipation. Intestinal dysfunction (e.g. constipation) is a common side effect of treatment with opioid analgesics.

2. What you need to know before you take Duoxona

Do not take Duoxona

• if you are allergic to oxycodone hydrochloride, naloxone hydrochloride or any of the other ingredients of this medicine (listed in section 6),
• if your breathing is too weak to take in enough oxygen or remove carbon dioxide from your body (respiratory depression),
• if you have severe lung disease associated with narrowing of the airways (chronic obstructive pulmonary disease or COPD),
• if you have a condition known as cor pulmonale. This condition consists of the right side of the heart becoming enlarged due to increased pressure inside the blood vessels of the lungs, etc. (e.g. as a result of COPD, see above),
• if you have severe bronchial asthma,
• if you have paralytic ileus (a type of bowel obstruction) not caused by opioids,
• if you have moderate to severe liver disease.

Consult your doctor if you have severe abdominal pain that may radiate to the back, nausea, vomiting, or fever, as these may be symptoms associated with pancreatitis and biliary tract disease.

Warnings and precautions

Consult your doctor or pharmacist before starting treatment with this medicine:

• in the case of elderly or debilitated patients (weak),
• if you have paralytic ileus (a type of bowel obstruction) caused by opioids,
• if you have kidney disorder,
• if you have mild liver disorder,
• if you have severe lung disorder (i.e. reduced breathing capacity),
• if you have a disease characterized by frequent pauses in breathing during sleep, which can make you feel very sleepy during the day (sleep apnea),
• if you have myxedema (a thyroid disorder characterized by dryness, coldness, and swelling of the skin, affecting the face and limbs),
• if your thyroid gland does not produce enough hormones (underactive thyroid, or hypothyroidism),
• if your adrenal glands do not produce enough hormones (adrenal insufficiency or Addison's disease),
• if you have a mental illness accompanied by a loss (partial) of contact with reality (psychosis), due to alcoholism or intoxication with other substances (substance-induced psychosis),
• if you have problems with gallstones,
• if you have an abnormal increase in the size of the prostate (prostate hypertrophy),
• if you have a history of alcoholism or delirium tremens,
• if you have pancreatitis,
• if you have low blood pressure (hypotension),
• if you have high blood pressure (hypertension),
• if you have a history of cardiovascular disease,
• if you have a head injury (due to the risk of increased pressure in the brain),
• if you have epilepsy or are prone to seizures,
• if you are also receiving treatment with MAO inhibitors (used to treat depression or Parkinson's disease), or have taken this type of medicine in the last two weeks, e.g. medicines containing tranylcypromine, phenelzine, isocarboxazid, moclobemide, and linezolid,
• if you experience drowsiness or sudden sleep episodes.

• Breathing disorders related to sleep

Duoxona may cause breathing disorders related to sleep such as sleep apnea (pauses in breathing during sleep) and sleep-related hypoxemia (low oxygen levels in the blood). Symptoms may include pauses in breathing during sleep, nighttime awakenings due to difficulty breathing, difficulty maintaining sleep, or excessive sleepiness during the day. If you or someone else observes these symptoms, consult your doctor. Your doctor may consider reducing the dose.

Tell your doctor if you have had any of these diseases in the past. Also, inform your doctor if you develop any of them during treatment with these tablets.

The most serious consequence of opioid overdose is respiratory depression (slow and shallow breathing). This can also cause the oxygen concentration in the blood to decrease, which can lead to fainting, etc.

Swallow the prolonged-release tablet whole, so that the slow release of oxycodone hydrochloride from the prolonged-release tablet is not affected. Do not break, chew, or crush the tablets. Taking them broken, chewed, or crushed can lead to a potentially fatal absorption of oxycodone hydrochloride (see section 3 "If you take more Duoxona than you should").

Diarrhea

If you experience severe diarrhea at the start of treatment, it may be due to the effect of naloxone. It may be a sign that bowel function is returning to normal. This diarrhea may occur in the first 3 to 5 days of treatment. If it persists beyond this 3 to 5-day period, or if you are concerned, contact your doctor.

Switching to Duoxona

If you have been receiving another opioid, you may experience withdrawal symptoms shortly after starting treatment with oxycodone/naloxone, e.g. restlessness, sweating, and muscle pain. If you experience any of these symptoms, you may need special monitoring by your doctor. This medicine is not suitable for the treatment of withdrawal syndrome.

Tolerance, dependence, and addiction

This medicine contains oxycodone, which is an opioid medicine. Repeated use of opioid analgesics may make the medicine less effective (you get used to it, which is known as tolerance). Repeated use of Duoxona can also cause dependence, abuse, and addiction, which can lead to a life-threatening overdose. The risk of these side effects may increase with higher doses and longer treatment durations.

Dependence or addiction can make you feel that you no longer have control over the amount of medicine you need to take or how often you need to take it. You may feel that you need to keep taking the medicine, even when it no longer helps to relieve your pain.

The risk of becoming dependent or addicted varies from person to person. You may have a higher risk of becoming dependent or addicted to Duoxona:

• if you or a family member have a history of abuse or dependence on alcohol, prescription drugs, or illegal substances ("addiction").
• if you smoke.
• if you have ever had problems with your mood (depression, anxiety, or personality disorder) or have received psychiatric treatment for other mental health diseases.

If you notice any of the following signs while taking Duoxona, it could be a sign that you have become dependent or addicted.

• You need to take the medicine for longer than recommended by your doctor.
• You need to take more doses than prescribed.
• You are using the medicine for reasons other than those prescribed, e.g. "to calm down" or "to help you sleep".
• You have made repeated unsuccessful attempts to stop or control the use of the medicine.
• You do not feel well when you stop taking the medicine and feel better once you take the medicine again ("withdrawal symptoms").

If you notice any of these signs, talk to your doctor to discuss the best treatment for you, including when it is appropriate to stop taking it and how to do so safely (see section 3, If you stop taking Duoxona).

Tell your doctor if you have cancer associated with peritoneal metastasis or initial intestinal obstruction in advanced stages of digestive and pelvic cancers.

Surgery

If you need to undergo surgery, tell the doctors that you are taking Duoxona.

Like other opioids, oxycodone can affect the normal production of hormones in the body, such as cortisol or sex hormones, especially if high doses are taken for long periods. If you notice persistent symptoms such as nausea (including vomiting), loss of appetite, fatigue, weakness, dizziness, changes in menstrual cycle, impotence, infertility, or decreased sexual desire, consult your doctor so that they can monitor your hormone levels.

This medicine may increase your sensitivity to pain, especially at high doses. Inform your doctor if this occurs. It may be necessary to reduce the dose or change the medicine.

You may notice remains of the prolonged-release tablet in your stool. Do not be alarmed, as the active substances (oxycodone hydrochloride and naloxone hydrochloride) have already been released in the stomach and intestine and have been absorbed by your body.

How to take Duoxona correctly

These tablets are not suitable for the treatment of withdrawal syndrome.

Abuse

Oxycodone/naloxone should never be used if you have a drug addiction. If you are addicted to substances like heroin, morphine, or methadone, you may experience severe withdrawal symptoms if you misuse Duoxona, as it contains naloxone. It can worsen pre-existing withdrawal symptoms.

Abuse

Duoxona should never be dissolved for injection (e.g. into a blood vessel). The reason is that it contains talc, which can cause local tissue destruction (necrosis) and lung tissue changes (pulmonary granuloma). This abuse can also have other serious consequences and even lead to death.

Long-term treatment

If administered for a long time, you may develop tolerance to oxycodone/naloxone. This means that you may need higher doses to relieve pain. Long-term administration of oxycodone/naloxone can lead to physical dependence. If treatment is stopped suddenly, withdrawal symptoms (restlessness, sweating, and muscle pain) may occur. If treatment is no longer necessary, it is recommended to gradually reduce the daily dose with the help of your doctor.

Psychological dependence

The abuse profile of oxycodone hydrochloride alone is similar to that of other potent opioids (strong painkillers). There is a possibility of psychological dependence. Medicines containing oxycodone hydrochloride should be used with special caution in patients with a history of alcohol, drug, or medication abuse.

Taking Duoxona with other medicines

Tell your doctor or pharmacist if you are taking, have recently taken, or might take any other medicines.

The risk of side effects increases if you use antidepressants (such as citalopram, duloxetine, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline, venlafaxine). These medicines can interact with oxycodone and symptoms such as involuntary muscle contractions, agitation, excessive sweating, tremor, exaggerated reflexes, increased muscle tension, and body temperature above 38°C may occur. Contact your doctor if you experience these symptoms.

The concomitant use of opioids, including oxycodone/naloxone, and sedative medicines such as benzodiazepines or related medicines, increases the risk of drowsiness, breathing difficulties (respiratory depression), coma, and can be life-threatening. Due to this, concomitant use should only be considered when other treatment options are not possible.

However, if your doctor prescribes oxycodone/naloxone together with sedative medicines, your doctor should limit the dose and duration of concomitant treatment.

Inform your doctor about all sedative medicines you are taking and strictly follow your doctor's dosage recommendations. It may be useful to inform friends or family members to be aware of the signs and symptoms mentioned above. Contact your doctor when you experience such symptoms.

Some examples of sedative medicines or related medicines are:

• other strong painkillers (opioids);
• sleeping pills and tranquillizers (sedatives, hypnotics);
• medicines for treating depression (antidepressants);
• medicines used to treat allergies, dizziness, or nausea (antihistamines or antiemetics);
• medicines used to treat psychiatric or mental disorders (antipsychotics, including phenothiazines and neuroleptics).

If you take these tablets at the same time as other medicines, the effects of the tablets or the other medicines described below may change. Tell your doctor if you are taking:

• medicines that reduce the blood's ability to clot (coumarin derivatives), the clotting speed may increase or decrease;
• macrolide antibiotics (such as clarithromycin, erythromycin, or telithromycin);
• azole-type antifungal agents (such as ketoconazole, voriconazole, itraconazole, or posaconazole)
• a specific type of medicine known as a protease inhibitor used to treat HIV (e.g. ritonavir, indinavir, nelfinavir, or saquinavir);
• cimetidine (a medicine for treating stomach ulcers, indigestion, or heartburn);
• rifampicin (used to treat tuberculosis);
• carbamazepine (used to treat seizures or certain painful conditions);
• phenytoin (used to treat seizures);
• a herbal medicine called St. John's Wort (also known as Hypericum perforatum);
• quinidine (a medicine for treating arrhythmias).

No interactions are expected between oxycodone/naloxone and paracetamol, acetylsalicylic acid, or naltrexone.

Taking Duoxona with food, drinks, and alcohol

Drinking alcohol while taking this medicine can make you feel more drowsy or increase the risk of serious side effects such as shallow breathing with the risk of stopping breathing, and loss of consciousness. It is recommended not to drink alcohol while taking oxycodone/naloxone.

You should avoid drinking grapefruit juice while taking these tablets.

Pregnancy and breastfeeding

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

Pregnancy

During pregnancy, these tablets should be avoided whenever possible. If used during prolonged periods of pregnancy, oxycodone hydrochloride may cause withdrawal symptoms in the newborn. If oxycodone hydrochloride is administered during labor, the newborn may experience respiratory depression (slow and shallow breathing).

Breastfeeding

Breastfeeding should be discontinued during treatment with these tablets. Oxycodone hydrochloride passes into breast milk. It is not known whether naloxone hydrochloride also passes into breast milk. Therefore, the risk to the breastfed infant cannot be excluded, especially if the mother receives multiple doses of oxycodone/naloxone.

Driving and using machines

Duoxona may affect your ability to drive and use machines. This is especially true at the start of treatment with oxycodone/naloxone, after a dose increase, or after switching from another medicine. However, these side effects disappear once the dose of this medicine is established.

Oxycodone/naloxone has been associated with drowsiness and sudden sleep episodes. If you experience these side effects, you should not drive or use machinery. If this happens, you should inform your doctor.

Ask your doctor if you can drive or use machines during treatment with Duoxona.

Duoxona contains sodium

This medicine contains less than 1 mmol of sodium (23 mg) per tablet, which is essentially "sodium-free".

3. How to Take Duoxona

Follow the administration instructions for this medication exactly as indicated by your doctor. If in doubt, consult your doctor or pharmacist again.

Duoxona is a prolonged-release tablet, which means that the active ingredients are released over a prolonged period. Its action lasts 12 hours.

The tablet must be swallowed whole and must not be divided, broken, chewed, or crushed.

To avoid damaging the prolonged-release properties of the tablet, it cannot be crushed or chewed, as this may cause the absorption of a potentially lethal dose of oxycodone hydrochloride (see "If you take more Duoxona than you should").

Before starting treatment and periodically during treatment, your doctor will discuss with you what you can expect from using Duoxona, when and for how long you should take it, when to contact your doctor, and when to stop taking it (see also "If you stop taking Duoxona").

Unless your doctor tells you otherwise, the usual dose is:

For pain treatment

Adults

The usual initial dose is 10 mg of oxycodone hydrochloride / 5 mg of naloxone hydrochloride in prolonged-release tablets every 12 hours.

Your doctor will decide the dose you should take per day and how to divide the total daily dose between the morning and evening doses. Your doctor will also decide if it is necessary to adjust the dose during treatment. Your dose will be adapted to your degree of pain and individual sensitivity. You should receive the minimum dose necessary to relieve pain. If you have already received treatment with opioids, the initial dose of Duoxona may be higher.

The maximum daily dose is 160 mg of oxycodone hydrochloride and 80 mg of naloxone hydrochloride. If you need a higher dose, your doctor may prescribe more oxycodone hydrochloride without naloxone hydrochloride. However, the maximum daily dose of oxycodone hydrochloride should not exceed 400 mg. The beneficial effect of naloxone hydrochloride on intestinal activity may be affected if the dose of oxycodone hydrochloride is increased without increasing the dose of naloxone hydrochloride.

If you replace these tablets with another opioid analgesic, it is likely that your intestinal function will worsen.

If you experience pain between two doses of Duoxona, you may need a fast-acting analgesic. Duoxona is not suitable for treatment in this case. Discuss this with your doctor.

If you feel that the effect of these tablets is too strong or too weak, consult your doctor or pharmacist.

For pain treatment

Elderly patients

In general, it is not necessary to adjust the dose in elderly patients with normal kidney and/or liver function.

Liver or kidney disorder

If you have any degree of kidney disorder or mild liver disorder, your doctor will prescribe these tablets with special caution. If you have moderate or severe liver disorder, you should not take these tablets (see also section 2 "Do not take Duoxona" and "Warnings and precautions").

Children and adolescents under 18 years

Duoxona has not been studied in children and adolescents under 18 years. Its safety and efficacy have not been demonstrated in these patients. For this reason, the use of Duoxona is not recommended in children and adolescents under 18 years.

Method of administration

Oral route.

Take Duoxona every 12 hours, following a fixed schedule (e.g., at 8 am and 8 pm).

Swallow these tablets with sufficient liquid (half a glass of water). The tablet must be swallowed whole and must not be divided, broken, chewed, or crushed. You can take the tablets with or without food.

Duration of use

In general, you should not take these tablets for longer than necessary. If you receive these tablets for a long time, your doctor should regularly check that you still need them.

If you take more Duoxona than you should

If you have taken more tablets than prescribed, you should inform your doctor immediately. Consult your doctor or pharmacist immediately or call the Toxicology Information Service, phone 91 562 04 20, indicating the medication and the amount used. It is recommended to take the package and the medication leaflet to the healthcare professional.

An overdose can cause:

• contraction of the pupils
• slow and shallow breathing (respiratory depression)
  • A brain disorder (known as toxic leukoencephalopathy)

• drowsiness leading to loss of consciousness
• low muscle tone (hypotonia)
• reduction in heart rate, and
• decrease in blood pressure.

In severe cases, loss of consciousness (coma), fluid accumulation in the lungs, and circulatory collapse may occur, which can be fatal in some cases.

You should avoid situations that require a high level of alertness, such as driving.

If you forget to take Duoxona

If you forget to take Duoxona or if you take a lower dose than prescribed, you may not feel the analgesic effect.

If you forget to take a dose, follow these instructions:

• If there are 8 hours or more left before the next normal dose: Take the missed prolonged-release tablet of Duoxona immediately, and continue with the normal schedule.
• If there are less than 8 hours left before the next normal dose: Take the missed prolonged-release tablet of Duoxona. Wait another 8 hours before taking the next prolonged-release tablet. Try to recover the original schedule (e.g., 8 am and 8 pm). Do not take Duoxona more than once in an 8-hour period.

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

If you stop taking Duoxona

Do not stop treatment without consulting your doctor. If you no longer need to continue treatment, you should gradually reduce the daily dose, after discussing it with your doctor. This will help you avoid withdrawal symptoms, such as restlessness, sweating, and muscle pain.

If you have any other questions about the use of this medication, ask your doctor or pharmacist.

4. Possible Side Effects

Like all medications, this medication can cause side effects, although not everyone will experience them.

Important side effects to look out for, and what to do if you experience them:

If you are already experiencing any of the following important side effects, consult your doctor immediately.

Slow and shallow breathing (respiratory depression) is the main danger of opioid overdose. It occurs mainly in elderly and debilitated patients. Opioids can also cause a significant decrease in blood pressure in susceptible patients.

Side effects are subdivided into two sections: pain treatment and treatment with only the active ingredient oxycodone hydrochloride.

The following side effects have been observed in patients receiving pain treatment

Common (may affect up to 1 in 10 patients)

• reduced or lost appetite
• insomnia, fatigue, or exhaustion
• feeling of dizziness or "spinning"
• drowsiness
• vertigo
• hot flashes
• abdominal pain, constipation, diarrhea, dry mouth, indigestion, vomiting (nausea), discomfort, flatulence (gas)
• headache
• itching, skin reactions/rashes, sweating
• feeling of weakness

Uncommon (may affect up to 1 in 100 patients)

• hypersensitivity/allergic reactions
• restlessness, abnormal thoughts, anxiety, confusion, depression, nervousness
• seizures (especially in people with seizure disorders or predisposition to convulsions), difficulty concentrating
• speech disorders, fainting, tremors
• vision disorders
• feeling of chest tightness, especially if you already have coronary heart disease, palpitations
• decrease in blood pressure, increase in blood pressure
• breathing difficulties, runny nose, cough
• bloating
• increased liver enzymes, biliary colic
• muscle cramps, muscle contractions, muscle pain
• increased need to urinate
• withdrawal symptoms such as restlessness, chest pain, chills, feeling of general discomfort, pain, swelling of hands, ankles, and feet
• weight loss
• accidental injuries
• decreased sexual desire
• lack of energy
• thirst
• taste disorders

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

• increased heart rate
• yawning
• dental disorders
• weight gain
• drug dependence

Frequency not known (cannot be estimated from available data)

• euphoria, hallucinations, nightmares
• tingling sensation, severe sedation
• sleep apnea syndrome, for more information see section 2 "Warnings and precautions"
• respiratory depression
• belching
• urination difficulties
• erectile dysfunction

It is known that the active ingredient oxycodone hydrochloride, if not combined with naloxone hydrochloride, has the following side effects, different from those listed:

Oxycodone may cause respiratory problems (respiratory depression), decreased pupil size, bronchial and smooth muscle spasms, and depression of the cough reflex.

Common (may affect up to 1 in 10 patients)

• mood changes and personality changes (e.g., depression, feeling of extreme happiness), decreased activity, increased activity
• hypo
• urination difficulties

Uncommon (may affect up to 1 in 100 patients)

• dehydration
• agitation, perception disorders (e.g., hallucinations, depersonalization), drug dependence
• difficulty concentrating, migraines, increased muscle tension, involuntary muscle contractions, reduced pain or touch sensitivity, coordination disorders
• hearing difficulties
• voice disorders (dysphonia)
• swallowing difficulties, intestinal dysfunction (ileus), mouth ulcers, gingivitis
• dry skin
• water retention (edema), drug tolerance
• skin redness
• increased sex hormone levels, which can affect sperm production in men or menstrual cycle in women

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

• infections such as cold sores or herpes (which can cause blisters around the mouth or genital area)
• increased appetite
• black stools (with a tar-like appearance), gum bleeding
• itchy rash (urticaria)

Frequency not known (cannot be estimated from available data)

• acute generalized allergic reactions (anaphylactic reactions)
• bile flow problems
• absence of menstrual periods
• withdrawal syndrome in newborns
• dental caries
• aggression
• increased pain sensitivity
• a problem affecting a valve in the intestine, which can cause severe abdominal pain (Oddi's sphincter dysfunction)

Reporting side effects

If you experience any side effects, consult your doctor or pharmacist, even if they are possible side effects 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 side effects, you can help provide more information on the safety of this medication.

5. Storage of Duoxona

Keep this medication out of sight and reach of children.

Store this medication in a safe and closed place, where others cannot access it.

It can cause serious harm and be fatal for people when not prescribed to them.

Do not use this medication after the expiration date shown on the box or blister pack, after "EXP". The expiration date is the last day of the month indicated.

Blister pack:

Do not store above 25°C.

Medications should not be disposed of through wastewater or household waste. Deposit the packaging and medications you no longer need at the SIGRE collection point in the pharmacy. If in doubt, ask your pharmacist how to dispose of the packaging and medications you no longer need. This will help protect the environment.

6. Package Contents and Additional Information

Duoxona Composition

The active ingredients are oxycodone hydrochloride and naloxone hydrochloride.

Each prolonged-release tablet contains 5 mg of oxycodone hydrochloride (equivalent to 4.5 mg of oxycodone) and 2.5 mg of naloxone hydrochloride (as 2.74 mg of naloxone hydrochloride dihydrate, equivalent to 2.25 mg of naloxone).

The other ingredients are:

• Tablet core: Povidone K30, polyvinyl acetate, sodium lauryl sulfate, anhydrous colloidal silica, microcrystalline cellulose, magnesium stearate.

• Tablet coating: Polyvinyl alcohol, titanium dioxide (E171), macrogol 3350, talc.

Appearance of Duoxona and Package Contents

Duoxona 5 mg/2.5 mg are white, round, biconvex prolonged-release tablets with a diameter of 4.7 mm and a height of 4.0 mm.

These tablets are available in child-resistant blister packs of 10, 14, 20, 28, 30, 50, 56, 60, 90, 98, and 100 tablets or screw-cap bottles with child-resistant caps containing 50, 100, or 250 tablets.

Not all pack sizes may be marketed.

Marketing Authorization Holder and Manufacturer

Marketing Authorization Holder

NEURAXPHARM SPAIN, S.L.U.

Avda. Barcelona, 69

08970 Sant Joan Despí

Barcelona - Spain

Manufacturer

Develco Pharma GmbH

Grienmatt 42

79650 Schopfheim

Germany

or

Neuraxpharm Arzneimittel GmbH

Elisabeth-Selbert-Str. 23

40764 Langenfeld

Germany

or

Saneca Pharmaceuticals A.S.

Nitrianska 100, Slovakia-920 27 Hlohovec

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

Date of the last revision of this leaflet: April 2025

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