Prospecto: information for the user

Fentanilo Aurovitas Spain 25 micrograms/h transdermal patches EFG

Read this prospect carefully before starting to use this medicine, as it contains important information for you.

• Keep this prospect, as you may need to read it again.
• If you have any doubts, consult your doctor, pharmacist or nurse.
• This medicine has been prescribed only for you (or your child), and should not be given to other people even if they have the same symptoms as you, as it may harm them.
• If you experience any adverse effects, consult your doctor, pharmacist or nurse, even if they are not listed in this prospect. See section 4.

1. What isFentanilo Aurovitas Spainand for what it is used

2. What you need to know before starting to useFentanilo Aurovitas Spain

3. How to useFentanilo Aurovitas Spain

4. Possible adverse effects

5. Storage ofFentanilo Aurovitas Spain

6. Contents of the package and additional information

This medicine is called Fentanilo Aurovitas Spain.

The patches help to relieve very strong and long-lasting pain:

• in adults who need continuous pain treatment.
• in children over 2 years of age who are already using opioid medication and need continuous pain treatment.

Fentanilo Aurovitas Spain contains a medicine called fentanilo. It belongs to a group of strong pain-relieving medicines called opioids.

No use Fentanilo Aurovitas Spain:

• If you are allergic to fentanyl or any of the other components of this medication (listed in section 6).
• If you have pain that lasts only a short time, such as sudden pain or pain after surgery.
• If you have difficulty breathing, with slow or weak breathing.

Do not use this medication if you or your child is in any of the above circumstances. If you are unsure, consult your doctor or pharmacist before using fentanyl.

Warnings and Precautions

If the patch sticks to another person

The patch should only be used on the skin of the people for whom the doctor has prescribed it. There have been some cases where a patch has accidentally stuck to another family member by close physical contact or sharing the same bed with the person wearing the patch. If the patch accidentally sticks to another person (particularly a child), the medication from the patch can pass through the skin of the other person and may cause serious adverse effects, such as difficulty breathing, with slow or weak breathing that can be fatal. In the event that the patch sticks to the skin of another person, it should be immediately removed and the person should seek medical attention.

Be especially careful with Fentanilo Aurovitas Spain

Consult your doctor or pharmacist beforeusing this medicationif you are in any of the following circumstances. Your doctor will have to monitor you more closely:

• If you have ever had respiratory or breathing problems.
• If you have ever had heart, liver, or kidney problems, or low blood pressure.
• If you have ever had a brain tumor.
• If you have ever had persistent headaches or a head trauma.
• If you are elderly, as you may be more sensitive to the effects of this medication.
• If you have a condition called "myasthenia gravis", in which your muscles become weak and easily fatigued.

If you meet any of the above conditions (or if you are unsure), consult your doctor or pharmacist before using fentanyl.

While using the patch, report to your doctor if you have breathing problems while sleeping.

Opioids like fentanyl can cause sleep-related breathing disorders such as sleep apnea (pauses in breathing while sleeping) and sleep-related hypoxemia (low oxygen levels in the blood). Talk to your doctor if you, your partner, or caregiver observe any of the following symptoms:

• pauses in breathing while sleeping
• waking up at night due to lack of air
• difficulty staying asleep
• excessive daytime sleepiness.

Your doctor may decide to modify the dose.

While using the patch, report to your doctor if you notice a change in the pain you feel.If you feel:

• that the patch no longer relieves the pain
• an increase in pain
• a change in the way you feel the pain (for example, you feel pain in another part of your body)
• pain when you come into contact with your body that should not cause pain.

Do not change the dose on your own. Your doctor may decide to modify the dose or change the treatment.

Adverse effects and Fentanilo Aurovitas Spain

• Fentanyl may make you feel exceptionally sleepy and slow or weak breathing. In rare cases, these breathing problems can be life-threatening or even fatal, especially in people who have not used strong prescription painkillers (such as fentanyl or morphine) before. If you, or your partner or caregiver, observe that the person wearing the patch is unusually sleepy, with slow or weak breathing:
• Remove the patch.
• Call a doctor or go to the nearest hospital immediately.
• Have the person move and talk as much as possible.
• If you have a fever while using fentanyl, talk to your doctor. This can increase the amount of medication that passes through your skin.
• Fentanyl may cause constipation; talk to your doctor or pharmacist for advice on how to prevent or relieve constipation.

See section 4 for the complete list of possible adverse effects.

When wearing the patch, do not expose it to direct heat, such as heating pads, electric blankets, hot water bottles, hot tubs, or heat lamps or tanning beds. Do not take the sun or long hot baths and do not use saunas or hot tubs. If you do, it may increase the amount of medication released from the patch.

Long-term use and tolerance

This medication contains fentanyl, an opioid. Repeated use of opioid painkillers can make the medication less effective (your body becomes accustomed to it, known as pharmacological tolerance). It is also possible that you will become more sensitive to pain when using the fentanyl transdermal patch. This is known as hyperalgesia. Increasing the dose of the patches may continue to reduce pain for a while, but it may also be harmful. If you notice that the medication is losing its effectiveness, consult your doctor. Your doctor will decide whether it is better to increase the dose or gradually reduce the use of the fentanyl transdermal patch.

Dependence and addiction

The repeated use of fentanyl can also cause dependence, abuse, and addiction, which could lead to a potentially fatal overdose. The risk of these adverse effects may be higher with a higher dose and longer use. Dependence or addiction may cause you to feel a lack of control over the amount of medication you should use or how often you should use it. You may feel the need to continue using the medication even if it no longer helps to relieve pain.

The risk of dependence or addiction varies from person to person. The risk of becoming dependent or addicted to the fentanyl transdermal patch may be higher if:

• You or any member of your family have abused alcohol or experienced dependence on it, prescription medications, or illegal drugs ("addiction").
• You smoke.
• You have ever had mood problems (depression, anxiety, or a personality disorder) or have been treated by a psychiatrist for other mental health conditions.

If you notice any of the following symptoms while using the fentanyl transdermal patch, it could be a sign of dependence or addiction.

• You need to use the medication for a longer period than recommended by your doctor.
• You need to use a higher dose than recommended.
• You are using the medication for reasons other than those prescribed, such as "to stay calm" or "to help you sleep".
• You have made repeated and unsuccessful attempts to stop using the medication or control its use.
• You feel unwell when you stop using the medication, and you feel better once you take it again ("withdrawal symptoms").

If you notice any of these signs, consult your doctor to determine the best course of treatment for you, when it is appropriate to stop the medication, and how to do it safely.

Withdrawal symptoms from stopping Fentanilo Aurovitas Spain

Do not stop using this medication abruptly. Withdrawal symptoms such as restlessness, difficulty sleeping, irritability, agitation, anxiety, feeling your heartbeat (palpitations), increased blood pressure, feeling or being sick, diarrhea, loss of appetite, tremors, chills, or sweating may occur. If you want to stop using this medication, talk to your doctor first. Your doctor will advise you on how to do it, usually the dose will be gradually reduced to minimize unpleasant withdrawal symptoms.

Other medications and Fentanilo Aurovitas Spain

Inform your doctor or pharmacist if you are using, have used recently, or may need to use any other medication.Here, this includes over-the-counter medications and herbal remedies. You should also inform your pharmacist that you are using fentanyl if you buy any medication at the pharmacy.

Your doctor will know which medications can be taken safely with fentanyl. You may need to be closely monitored if you are taking any of the types of medications listed below or if you stop taking any of the types of medications listed, as this may affect the dose of fentanyl you need.

Especially, inform your doctor or pharmacist if you are taking:

• Other pain medications, such as other strong opioid painkillers (for example, buprenorphine, nalbuphine, or pentazocine and some pain medications for neuropathic pain (gabapentin and pregabalin)).
• Medications to help you sleep (such as temazepam, zaleplon, or zolpidem).
• Medications to help you calm down (tranquilizers, such as alprazolam, clonazepam, diazepam, hydroxyzine, or lorazepam) and medications for mental health conditions (antipsychotics, such as aripiprazole, haloperidol, olanzapine, risperidone, or phenothiazines).
• Medications to relax muscles (such as cyclobenzaprine or diazepam).
• Some medications used to treat depression called SSRIs or SNRIs (such as citalopram, duloxetine, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline, or venlafaxine) – more information is below.
• Some medications used to treat depression or Parkinson's disease called MAOIs (such as isocarboxazid, phenelzine, selegiline, or tranylcypromine). Do not use fentanyl in the 14 days following the interruption of these medications – more information is below.
• Some antihistamines, especially those that cause drowsiness (such as chlorpheniramine, clemastine, ciproheptadine, diphenhydramine, or hydroxyzine).
• Some antibiotics used to treat infections (such as erythromycin or clarithromycin).
• Medications used to treat fungal infections (such as itraconazole, ketoconazole, fluconazole, or voriconazole).
• Medications used to treat HIV infection (such as ritonavir).
• Medications used to treat irregular heartbeats (such as amiodarone, diltiazem, or verapamil).
• Medications to treat tuberculosis (such as rifampicin).
• Some medications used to treat epilepsy (such as carbamazepine, phenobarbital, or phenytoin).
• Some medications used to treat nausea or dizziness (such as phenothiazines).
• Some medications used to treat stomach acid or ulcers (such as cimetidine).
• Some medications used to treat angina (chest pain) or high blood pressure (such as nicardipine).
• Some medications used to treat blood cancer (such as idelalisib).

Using fentanyl with antidepressants

The risk of adverse effects increases if you are taking medications such as certain antidepressants. Fentanyl may interact with these medications, and you may experience changes in your mental state such as agitation, seeing, feeling, hearing, or smelling things that are not there (hallucinations), and other effects such as changes in blood pressure, rapid heartbeat, high body temperature, hyperactive reflexes, lack of coordination, muscle stiffness, nausea, vomiting, and diarrhea (which may be signs of a serotonin syndrome). If you are taking them together, your doctor may want to closely monitor you to detect these side effects, especially when starting treatment or when changing the dose of the medication.

Using with central nervous system depressants, including alcohol and some narcotics

The use of fentanyl with sedatives such as benzodiazepines or related medications increases the risk of drowsiness, difficulty breathing (respiratory depression), coma, and can be life-threatening. For this reason, concurrent use should only be considered when other treatment options are not possible.

However, if your doctor prescribes fentanyl along with sedatives, your doctor should limit the dose and duration of concurrent treatment.

Inform your doctor of all sedatives you are taking, and follow your doctor's dose recommendations strictly. It may be helpful to inform friends or family members about the signs and symptoms mentioned above. Contact your doctor if you experience these symptoms.

Do not drink alcohol while using fentanyl, unless you have talked to your doctor first.

Use in athletes

Inform athletes that this medication contains a component that may result in a positive analytical result for doping control.

Surgeries

If you think you will receive anesthesia, inform your doctor or dentist that you are using fentanyl.

Pregnancy and breastfeeding

If you are pregnant or breastfeeding, or if you think you may be pregnant, consult your doctor or pharmacist before using this medication.

Fentanyl should not be used during pregnancy, unless you have talked to your doctor.

Fentanyl should not be usedduring labor, as the medication may affect the newborn's breathing.

Prolonged use of fentanyl during pregnancy may cause withdrawal symptoms (such as loud crying, feeling restless, convulsions, poor feeding, and diarrhea) in your newborn, which can be potentially fatal if not recognized and treated. Talk to your doctor immediately if you think your newborn may have withdrawal symptoms.

Do not use fentanyl if you are breastfeeding. Do not breastfeed for 3 days after removing the fentanyl patch. This is because the medication may pass into breast milk.

Driving and using machines

Fentanylmay affect your ability to drive and use machines or tools, as it may cause drowsiness or dizziness. If this is the case, do not drive or use tools or machines. Do not drive while using this medication until you know how it affects you.

Talk to your doctor or pharmacist if you have doubts about whether it is safe for you to drive while using this medication.

Follow exactly the administration instructions of this medication as indicated by your doctor. In case of doubt, consult your doctor or pharmacist again.

Before starting treatment and regularly during it, your doctor will also explain what you can expect from the use of the fentanyl transdermal patch, when and for how long you should use it, when you should contact your doctor and when you should discontinue use (see also section 2, "Withdrawal syndrome when interrupting treatment with Fentanilo Aurovitas Spain").

Your doctor will decide what dose of fentanyl is most suitable for you, taking into account the intensity of your pain, your general condition and the type of pain treatment you have been receiving up to this point.

How to apply and change the patches

• Each patch contains a sufficient amount of medication for3 days (72 hours).
• You should change the patch every 3 days, unless your doctor has told you otherwise.
• Always remove the used patchbeforeapplying a new one.
• Change the patch alwaysat the same timeof the day every 3 days (72 hours).
• If you are using more than one patch, change them all at the same time.
• Record the day of the week, date and time each time you apply a patch to remember when to change it.
• The following table shows when to change the patch:

Where to apply the patch

Adults

• Apply the patch to a flat area of the trunk or arm (never over a joint).

Children

• Apply the patch always to the upper back so that your child has difficulty reaching it or removing it.
• Check occasionally that the patch is still adhered to the skin.
• It is essential that the child does not remove the patch and put it in their mouth, as this could put their life in danger or be fatal.
• Keep your child under close observation for 48 hours after:
• Applying the first patch.
• Applying a patch with a higher dose.
• The patch may take some time to reach its maximum effect. Therefore, your child may need other painkillers until the patch is effective. Your doctor will explain this.

Adults and children:

Do not apply the patch to

• The same site twice in a row.
• Areas that move a lot (joints), in irritated or damaged skin.
• Areas of skin with a lot of hair. If there is hair, do not shave it (the skin irritates with shaving). Instead, cut it as close to the skin as possible.

How to apply the patch

Step 1: Prepare the skin

• Before applying the patch, check that the skin is completely dry, clean and fresh.
• If you need to wash the skin, use only cold water.
• Do not use soap or other cleaners, creams, moisturizers, oils or talc before applying the patch.
• Do not apply the patch immediately after a hot bath or shower.

Step 2: Open the package

• Each patch is sealed in its own package.
• The fentanyl patch must beremoved from the protective pouch by folding the tab first (located near the tip of the arrow on the package label) and then carefully tearing the package material. If scissors are used to open the package, cut near the sealed edge to avoid damaging the patch inside the package.
• Remove the patch and use it immediately.
• Save the empty package to dispose of the used patch later.
• Use each patch only once.
• Do not remove the patch from its package until you are ready to use it.
• Check that the patch is not damaged.
• Do not use the patch if it is divided or cut or has any damage.
• Never divide or cut the patch.

Step 3: Peel and press

• Make sure the patch will be covered by a loose garment and do not adhere it under elastic or tight clothing.
• Peel off carefully one half of the shiny plastic protective layer starting from the center of the patch. Be careful not to touch the adhesive part of the patch.
• Press this adhesive part of the patch onto the skin.
• Remove the other half of the protective layer and press the entire patch onto the skin with the palm of your hand.
• Hold for 30 seconds or more. Make sure the patch is well adhered, especially around the edges.

Step 4: Dispose of the patch

• As soon as you remove the patch, fold it in half, with the adhesive side sticking to itself.
• Put it back in the original package and dispose of it according to your pharmacist's instructions.
• Keep used patches out of sight and reach of children; although used, the patches contain medication that can harm children and even be fatal.

Step 5: Wash your hands

• Wash your hands only with water after handling the patches.

More information about the use of Fentanilo Aurovitas Spain

Activities during the use of the patches

• The patches are water-resistant.
• You can take a shower or bath with the patch on, but do not rub it.
• If your doctor agrees, you can exercise or engage in sports with the patch on.
• You can also swim with the patch on, but:
• Do not use hot tubs.
• Do not cover the patch with elastic or tight clothing.
• When wearing the patch,do not expose it to direct heat, such as heating pads, electric blankets, hot water bottles, hot tubs or heat lamps or tanning beds. Do not take long hot baths or use saunas. If you do, you may increase the amount of medication released from the patch.

How long do the patches take to act?

• The first patch may take some time to reach its maximum effect.
• Your doctor may give you additional painkillers during the first few days.
• After that, the patch should help relieve pain continuously, so you can stop taking other painkillers. However, your doctor may prescribe additional painkillers from time to time.

For how long will you have to use the patches?

• The fentanyl patches are indicated for chronic pain. Your doctor will tell you for how long you can expect to use the patches.

If the pain worsens

• If your pain worsens suddenly after applying the last patch, check the patch. If it no longer adheres well or has come off, replace the patch (see also the section If the patch comes off).
• If your pain worsens over time while using the patches, your doctor may try patches with a higher dose or prescribe additional painkillers (or both).
• If increasing the patch dose does not help, your doctor may decide to stop using the patches.

If you use too many patches or a patch with the wrong dose

If you have applied too many patches or a patch with the wrong dose, remove them and contact your doctor immediately or go to the hospital.

You can also call the Toxicology Information Service, phone 91 562 04 20, indicating the medication and the amount ingested or applied.

The signs of overdose include breathing difficulties or weak breathing, fatigue, extreme drowsiness, inability to think clearly or walk or speak normally, and dizziness or confusion. An overdose can also cause a brain disorder known as toxic leukoencephalopathy.

If you forget to change the patch

• If you forget to change the patch, change it as soon as you remember and note the day and time. Change the patch again after3 days (72 hours), as usual.
• If you are late, you should talk to your doctor, as you may need additional painkillers, butdo notapply additional patches.

If the patch comes off

• If the patch falls off before it should be changed, apply a new one immediately and note the day and time. Choose a new skin area:
• On the trunk or arm.
• On the upper back of your child.
• Inform your doctor about this and leave the patch on for another3 days (72 hours)or for the time your doctor tells you, before changing the patch in the usual way.
• If the patches tend to fall off, consult your doctor, pharmacist or nurse.

If you want to stop using the patches

• Do not stop using this medication abruptly. If you want to stop using this medication, talk to your doctor first. Your doctor will tell you how to do it, usually the dose will be gradually reduced so that the unpleasant effects of withdrawal are minimal. See also section 2, “Withdrawal symptoms when stopping Fentanilo Aurovitas Spain”.

• Do not use the patches again without asking your doctor first. You may need a different dose when restarting treatment.

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

Like all medicines, this medicine can cause side effects, although not everyone will experience them.

If you, or your partner or caregiver, observe any of the following signs in the person wearing the patch, remove the patch and call a doctor or go immediately to the nearest hospital. You may need urgent medical treatment.

• Unusual drowsiness, slower or weaker breathing than expected.

Follow the previous recommendations and have the person wearing the patch move and speak as much as possible. In very rare cases, these breathing difficulties can compromise life or even be fatal, especially in people who have not used strong opioid analgesics (such as fentanyl or morphine) before. (Rare, may affect up to 1 in 100 patients).

• Sharp swelling of the face or throat, severe irritation, redness, or blisters on the skin.

They can all be signs of a severe allergic reaction. (Frequency cannot be estimated from available data).

• Seizures (convulsions). (Rare, may affect up to 1 in 100 patients).

• Decreased level of consciousness or loss of consciousness. (Rare, may affect up to 1 in 100 patients).

The following side effects have also been reportedside effects

Very common (may affect more than 1 in 10 patients)

• Nausea, vomiting, constipation.
• Feeling sleepy (drowsiness).
• Feeling dizzy.
• Headache.

Common (may affect up to 1 in 10 patients)

• Allergic reaction.
• Loss of appetite.
• Difficulty sleeping.
• Depression.
• Feeling anxious or confused.
• Seeing, feeling, or hearing things that are not present (hallucinations).
• Trembling or muscle spasms.
• Strange sensation on the skin, such as tingling or prickling (paresthesia).
• Sensation of spinning (dizziness).
• Fast or irregular heartbeats (palpitations, tachycardia).
• Increased blood pressure.
• Sensation of lack of air (dyspnea).
• Diarrhea.
• Dry mouth.
• Stomach pain or indigestion.
• Excessive sweating.
• Itching, rash, or redness of the skin.
• Difficulty urinating or emptying the bladder completely.
• Intense fatigue, weakness, or general discomfort.
• Sensation of cold.
• Swelling of the hands, ankles, or feet (peripheral edema).

Rare (may affect up to 1 in 100 patients)

• Feeling agitated or disoriented.
• Sensation of being extremely happy (euphoria).
• Decreased sensation or sensitivity, especially in the skin (hypoesthesia).
• Memory loss.
• Blurred vision.
• Slow heart rate (bradycardia) or low blood pressure.
• Blue skin color caused by decreased oxygen in the blood (cyanosis).
• Loss of intestinal contractions (ileus).
• Skin rash with itching (eczema), allergic reaction, or other skin disorders where the patch is applied.
• Flu-like illness.
• Sensation of change in body temperature.
• Fever.
• Muscle contraction.
• Difficulty obtaining or maintaining an erection (impotence) or problems with sexual relations.
• Difficulty swallowing.

Rare (may affect up to 1 in 1000 patients)

• Pupil constriction (miosis).
• Occasional interruption of breathing (apnea).

Unknown frequency (cannot be estimated from available data)

• Male sex hormone deficiency (androgen deficiency).
• Delirium (symptoms may include a combination of agitation, restlessness, disorientation, confusion, fear, seeing or hearing things that are not present, sleep disturbances, nightmares).
• You may become dependent on fentanyl (see section 2).

You may notice rashes, redness, or a mild itching sensation on the skin where the patch is applied. It is usually mild and disappears after removing the patch. If not, or if the patch irritates your skin a lot, inform your doctor.

The repeated use of patches may make the medication less effective (you become accustomed to it or become more sensitive to pain) or may cause dependence.

If you switch from another analgesic to fentanyl or stop using fentanyl abruptly, you may experience withdrawal symptoms, such as dizziness, feeling sick, diarrhea, anxiety, or tremors. Inform your doctor if you notice any of these effects.

Cases of newborn babies experiencing withdrawal symptoms after their mothers used fentanily for a prolonged period during pregnancy have also been reported.

Reporting of side effects

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

Where to Store the Patches

Keep all patches (used and unused) out of sight and reach of children.

How Long Can Fentanilo Aurovitas Spain Be Stored

Do not use this medication after the expiration date that appears on the box and on the package. The expiration date is the last day of the month indicated. If the patches are expired, take them to the pharmacy.

Storage Conditions

Do not store at a temperature above 86°F (30°C).

Store this medication in a safe and protected place, to which other people cannot access. This medication can cause severe harm and even be fatal to people who use it accidentally or intentionally when not prescribed.

How to Dispose of Used or Unused Patches

Accidental exposure of another person to used and unused patches, especially in children, can result in a fatal outcome.

Used patches should be folded firmly in half, so that the adhesive side of the patch adheres to itself. Then, they should be safely discarded by placing them in the original package and storing them out of sight and reach of other people, especially children, until they are safely disposed of.

Medications should not be thrown away through drains or in the trash. Deposit the containers and medications you no longer need at the SIGRE collection point at the pharmacy.Ask your pharmacist how to dispose of containers and medications you no longer need. This will help protect the environment.

Composition ofFentanilo Aurovitas Spain

• The active ingredient is fentanil. Each patch releases 25 micrograms of fentanil per hour. Each patch of 7.5 cm2contains 4.125 mg of fentanil.
• The other components are:

Adhesive layer: acrylic adhesive layer.

Support layer: polypropylene layer, blue printing ink.

Release layer: polyethylene terephthalate layer (siliconized).

Appearance of the product and content of the container

Fentanilo Aurovitas Spainis a transparent transdermal patch, with an adhesive support to stick to the skin. The transdermal patches have a blue print that indicates the dose.

Fentanilo Aurovitas Spain is availablein containers of3, 4, 5, 8, 10, 16 or 20transdermal patches.

Only some sizes of containers may be commercially marketed.

Marketing authorization holder and responsible manufacturer

Marketing authorization holder

Aurovitas Spain, S.A.U.

Avda. de Burgos, 16-D

28036 Madrid

Spain

Responsible manufacturer

Luye Pharma AG

Am Windfeld 35

83714 Miesbach

Germany

This medicine is authorized in the member states of the European Economic Area with the following names:

GermanyFentanyl Actavis 25 Mikrogramm/h transdermal plaster

SpainFentanilo Aurovitas Spain 25 micrograms/h transdermal patches EFG

NetherlandsFentanyl Aurobindo 25 μg/ hour, patch for transdermal use

PortugalFentanilo Aurovitas

Last review date of this leaflet:March 2024

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