INVEGA 6 mg PROLONGED-RELEASE TABLETS

Introduction

Package Leaflet: Information for the User

INVEGA 3 mg prolonged-release tablets

INVEGA 6 mg prolonged-release tablets

INVEGA 9 mg prolonged-release tablets

INVEGA 12 mg prolonged-release tablets

Paliperidone

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, pharmacist, or nurse.
• 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, pharmacist, or nurse. This includes any possible side effects not listed in this leaflet. See section 4.

Contents of the pack:

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

1. What is INVEGA and what is it used for

INVEGA contains the active substance paliperidone, which belongs to a class of medicines called antipsychotics.

INVEGA is used to treat schizophrenia in adults and adolescents aged 15 years and older.

Schizophrenia is a disorder that causes symptoms such as hearing, seeing, or feeling things that do not exist, having false beliefs, being overly suspicious, being withdrawn, having disorganized speech, and a flattening of emotions and behavior. People with this disorder may also feel depressed, anxious, guilty, or tense.

INVEGA is also used to treat schizoaffective disorder in adults.

Schizoaffective disorder is a mental condition where a person experiences several of the symptoms of schizophrenia (listed in the previous paragraph) in addition to symptoms of mood disorder (feeling euphoric, sad, agitated, distracted, having insomnia, being talkative, losing interest in daily activities, sleeping too much or too little, eating too much or too little, and having recurring thoughts of suicide).

INVEGA can help alleviate the symptoms of your illness and prevent them from coming back.

2. What you need to know before you take INVEGA

Do not take INVEGA

• if you are allergic to paliperidone, risperidone, or any of the other ingredients of this medicine (listed in section 6).

Warnings and precautions

Talk to your doctor, pharmacist, or nurse before you start taking INVEGA.

• Patient with schizoaffective disorder treated with this medicine should be closely monitored for a possible shift of manic symptoms to depressive symptoms.
• This medicine has not been studied in elderly patients with dementia. However, elderly patients with dementia who are treated with other similar medicines may have an increased risk of stroke or death (see section 4, Possible side effects).
• if you have Parkinson's disease or dementia.
• if you have ever been diagnosed with a disease whose symptoms are high temperature and muscle stiffness (also known as Neuroleptic Malignant Syndrome).
• if you have ever experienced abnormal movements of the tongue or face (Tardive Dyskinesia).
• You should know that these two disorders can be caused by this type of medicine.
• if you have had low white blood cell counts in the past (which may or may not have been caused by other medicines)
• if you are diabetic or have a tendency to diabetes.
• if you have heart disease or are being treated for heart diseases that may make you more prone to a drop in blood pressure.
• if you have epilepsy.
• if you have any disorder of swallowing, stomach, or intestine that reduces your ability to swallow food or digest it with normal intestinal movements.
• if you have diseases associated with diarrhea.
• if you have kidney problems.
• if you have liver problems.
• if you have a prolonged and/or painful erection.
• if you have difficulty controlling your body temperature or are overheated.
• if you have an abnormally high level of the hormone prolactin in your blood or if you have a tumor that may be dependent on prolactin.
• if you or someone in your family has a history of blood clots, as antipsychotics are associated with the formation of blood clots.

If you have any of these diseases, please consult your doctor, as it may be necessary to adjust your dose or keep you under observation for a while.

Because it has been rarely observed in patients treated with INVEGA a dangerously low number of a type of white blood cells necessary to fight infections in the blood, your doctor may check your white blood cell count.

INVEGA may cause you to gain weight. Significant weight gain can negatively affect your health. Your doctor will regularly monitor your weight.

In patients treated with INVEGA, diabetes mellitus or worsening of pre-existing diabetes mellitus has been observed, your doctor should check for signs of high blood sugar. In patients with pre-existing diabetes mellitus, blood sugar should be regularly monitored.

During eye surgery for cataracts, the pupil (the black circle in the center of the eye) may not increase in size as needed. Additionally, the iris (the colored part of the eye) may become flaccid during surgery, which can cause damage to the eye. If you are considering eye surgery, make sure to inform your ophthalmologist that you are using this medicine.

Children and adolescents

INVEGA should not be administered to children and adolescents under 15 years of age for the treatment of schizophrenia.

INVEGA should not be administered to children and adolescents under 18 years of age for the treatment of schizoaffective disorder.

This is because it is unknown whether INVEGA is safe or effective in this age group.

Taking INVEGA with other medicines

Tell your doctor or pharmacist if you are using or have recently used other medicines.

Abnormalities in heart function may appear when taking this medicine with other medicines for heart rhythm control or other medicines such as antihistamines, antimalarials, or antipsychotics.

Since this medicine acts mainly on the brain, it may interfere with other medicines (or alcohol) that also act on it, due to the sum of effects on brain function.

This medicine may lower blood pressure, so you should be careful if you take this medicine with other medicines that also lower blood pressure.

This medicine may reduce the effect of medicines for Parkinson's disease and restless legs syndrome (e.g., levodopa).

The effects of this medicine may be affected if you take medicines that influence the speed of intestinal movement (e.g., metoclopramide).

A reduction in the dose of this medicine should be considered when it is administered at the same time as valproate.

The use of oral risperidone with this medicine is not recommended, as this combination may cause an increase in side effects.

INVEGA should be used with caution with medicines that increase the activity of the central nervous system (psychostimulants such as methylphenidate).

INVEGA with alcohol

You should avoid consuming alcohol during treatment with this medicine.

Pregnancy and breastfeeding

If you are pregnant or breastfeeding, think you may be pregnant, or plan to become pregnant, consult your doctor or pharmacist before using this medicine.

You should not take this medicine during pregnancy unless you have discussed it with your doctor. The following symptoms may occur in newborn babies of mothers who have been treated with paliperidone in the last trimester of pregnancy (the last three months of pregnancy): tremor, stiffness and/or muscle weakness, somnolence, agitation, breathing problems, and feeding difficulties. If your baby develops any of these symptoms, you should contact your doctor.

You should not take this medicine during breastfeeding.

Driving and using machines

During treatment with this medicine, dizziness and vision problems (see section 4, possible side effects) may occur. This should be taken into account when maximum attention is required, for example, when driving or operating machinery.

The 3 mg INVEGA tablet contains lactose

The 3 mg tablet of this medicine contains lactose, a type of sugar. If your doctor has told you that you have an intolerance to some sugars, talk to them before taking this medicine.

INVEGA contains sodium

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

3. How to take INVEGA

Follow exactly the administration instructions of this medicine given by your doctor, pharmacist, or nurse.

Use in adults

The recommended dose in adults is 6 mg once daily in the morning. Your doctor may increase or decrease it within the dosage range of 3 mg to 12 mg once daily in the case of schizophrenia or 6 mg to 12 mg once daily in the case of schizoaffective disorder. This depends on how well the medicine works for you.

Use in adolescents

The recommended starting dose for the treatment of schizophrenia in adolescents aged 15 years and older is 3 mg once daily taken in the morning.

For adolescents who weigh 51 kg or more, the dose may be increased within the range of 6 mg to 12 mg once daily.

For adolescents who weigh less than 51 kg, the dose may be increased to 6 mg once daily.

Your doctor will decide how much you should take. The amount you take depends on how well the medicine works for you.

How and when to take INVEGA

This medicine should be taken by mouth, swallowed whole with water or other liquids. It should not be chewed, broken, or crushed.

This medicine should be taken in the mornings with breakfast or on an empty stomach, but each day in the same way. Do not alternate between taking the medicine one day with breakfast and the next day on an empty stomach.

The active substance, paliperidone, is dissolved once swallowed, and the tablet coating is eliminated from the body through the feces.

Patient with kidney problems

Your doctor may adjust your dose of this medicine according to your renal function.

Elderly

Your doctor may reduce your dose of medicine if your renal function is reduced.

If you take more INVEGA than you should

Contact your doctor immediately. You may experience somnolence, fatigue, abnormal body movements, problems standing and walking, dizziness due to low blood pressure, and changes in heartbeats.

If you forget to take INVEGA

Do not take a double dose to make up for forgotten doses. If you forget a dose, take the next dose the next day. If you forget two doses or more, contact your doctor.

If you stop taking INVEGA

Do not stop taking this medicine, as you will lose the effects of the medicine. You should not stop taking this medicine unless your doctor tells you to, as your symptoms may come back.

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

4. Possible Adverse Effects

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

Report immediately to your doctor if:

• you have blood clots in the veins, especially in the legs (symptoms include swelling, pain, and redness of the leg), which can circulate through the blood vessels to the lungs, causing chest pain and difficulty breathing. If you notice any of these symptoms, seek medical advice immediately
• you have dementia and experience a sudden change in your mental state or sudden weakness or numbness of the face, arms, or legs, especially on one side, or have difficulty speaking even for a short period. These may be signs of a stroke
• you have fever, muscle stiffness, sweating, or a decrease in the level of consciousness (a disorder known as "Neuroleptic Malignant Syndrome"). You may need immediate medical treatment
• you are a man and experience a prolonged or painful erection. It is known as priapism. You may need immediate medical treatment
• you experience involuntary rhythmic movements of the tongue, mouth, and face. It may be necessary to withdraw paliperidone
• you have a severe allergic reaction characterized by fever, swelling of the mouth, face, lips, or tongue, difficulty breathing, itching, rash, and sometimes a drop in blood pressure (i.e., an "anaphylactic reaction").

Very common: may affect more than 1 in 10 patients

• difficulty staying or falling asleep
• parkinsonism: This disease may include slow or altered movement, feeling of stiffness or tightness of the muscles (making sudden movements) and sometimes a feeling of "freezing" of movement that then restarts. Other signs of parkinsonism include walking slowly, dragging feet, tremors while resting, increased saliva and/or drooling, and loss of facial expressiveness
• restlessness
• feeling drowsy or less attentive
• headache.

Common adverse effects: may affect up to 1 in 10 patients

• chest infection (bronchitis), symptoms of a common cold, nose infection, urinary tract infection, feeling like you have the flu
• weight gain, increased appetite, weight loss, decreased appetite
• euphoria (mania), irritability, depression, anxiety
• distonia: It is a disease that involves slow or continuous involuntary contraction of the muscles. Although any part of the body can be affected (and can cause abnormal postures), distonia often affects the muscles of the face, including abnormal movements of the eyes, mouth, tongue, or jaw
• dizziness
• dykinesia: This disease involves involuntary muscle movements and may include repetitive, spasmodic, or twisting movements, or spasms
• tremors (agitation)
• blurred vision
• disruption of conduction between the upper and lower parts of the heart, anomalies in the electrical conduction of the heart, prolongation of the QT interval in the heart, slow heartbeat, rapid heartbeat
• decrease in blood pressure when standing up (as a consequence, some people taking INVEGA may feel weakness, dizziness, or loss of consciousness when getting up or sitting down suddenly), increased blood pressure, sore throat, cough, nasal congestion
• abdominal pain or discomfort, vomiting, nausea, constipation, diarrhea, indigestion, dry mouth, toothache
• increase in liver transaminases in the blood
• itching, skin rash
• bone or muscle pain, back pain, joint pain
• loss of menstrual periods
• fever, weakness, fatigue (tiredness).

Uncommon adverse effects: may affect up to 1 in 100 patients

• pneumonia, respiratory tract infection, bladder infection, ear infection, angina
• decrease in the number of white blood cells in the blood, decrease in platelets (blood cells that help stop bleeding), anemia, decrease in the number of red blood cells in the blood
• INVEGA may increase the levels of a hormone called "prolactin" that is detected in blood tests (which may or may not cause symptoms). When symptoms of increased prolactin appear, they may include: (in men) breast swelling, difficulty having or maintaining erections or other sexual dysfunctions, (in women) breast tenderness, milk secretion from the breasts, loss of menstrual periods or other cycle problems
• diabetes or worsening of diabetes, increased blood sugar, increased waist circumference, loss of appetite that causes malnutrition and weight loss, increased triglycerides in the blood (a type of fat)
• sleep disorder, confusion, decreased sexual desire, inability to achieve orgasm, nervousness, nightmares
• tardive dyskinesia (involuntary, uncontrollable movements of the face, tongue, or other parts of the body). Report to your doctor immediately if you experience involuntary rhythmic movements of the tongue, mouth, or face. It may be necessary to withdraw INVEGA
• seizures (epileptic fits), fainting, restlessness that causes body movement, dizziness when standing up, attention disorder, speech problems, loss or alteration of taste, decreased skin sensitivity to pain or touch, tingling, pinching, or numbness of the skin
• eye hypersensitivity to light, eye infection or "red eye", dry eyes
• feeling that everything is spinning (vertigo), ringing in the ears, ear pain
• irregular heartbeat, anomaly in the electrical activity of the heart (electrocardiogram or ECG), feeling of fluttering or pounding in the chest (palpitations)
• decrease in blood pressure
• shortness of breath, wheezing, nasal bleeding
• tongue swelling, stomach or intestinal infection, difficulty swallowing, excess gas or flatulence
• increase in GGT (a liver enzyme called gamma-glutamyltransferase) in blood, increase in liver enzymes in blood
• hives (or "urticaria"), hair loss, eczema, acne
• increase in CPK (creatine phosphokinase) in blood, an enzyme that is sometimes released with muscle breakdown, muscle spasms, joint stiffness, joint swelling, muscle weakness, neck pain
• urinary incontinence (loss of bladder control), frequent urination, inability to urinate, pain when urinating
• erectile dysfunction, ejaculation disorder
• loss of menstrual periods or other cycle problems (women), milk secretion from the breasts, sexual dysfunction, breast pain, breast tenderness
• swelling of the face, mouth, eyes, or lips, swelling of the body, arms, or legs
• chills, increased body temperature
• change in gait
• feeling of thirst
• chest pain, chest discomfort, feeling of discomfort
• falls.

Rare adverse effects: may affect up to 1 in 1,000 patients

• eye infection, fungal infection of the nails, skin infection, skin inflammation caused by mites
• dangerously low number of a type of white blood cells necessary to fight infections
• decrease in a type of white blood cells that help fight infections, increase in eosinophils (a type of white blood cell) in the blood
• severe allergic reaction characterized by fever, swelling of the mouth, face, lips, or tongue, difficulty breathing, itching, rash, and sometimes a drop in blood pressure, allergic reaction
• sugar in the urine
• inappropriate secretion of a hormone that controls urine volume
• complications of uncontrolled diabetes with life-threatening risk
• excessive water intake, decreased blood sugar, excessive water intake, increased cholesterol in the blood
• sleepwalking
• lack of movement or response while awake (catatonia)
• absence of emotions
• neuroleptic malignant syndrome (confusion, decreased or lost consciousness, high fever, and severe muscle stiffness)
• loss of consciousness, balance disorder, abnormal coordination
• problems in the blood vessels of the brain, coma due to uncontrolled diabetes, unresponsive to stimuli, decreased level of consciousness, head agitation
• glaucoma (increased eye pressure), increased tearing, eye redness, problems with eye movement, eye rotation
• atrial fibrillation (abnormal heart rhythm), rapid heartbeat when standing up
• blood clots in the veins, especially in the legs (symptoms include swelling, pain, and redness of the leg), which can circulate through the blood vessels to the lungs, causing chest pain and difficulty breathing. If you experience any of these symptoms, seek medical help immediately
• decrease in oxygen in parts of the body (due to decreased blood flow), flushing
• breathing problems during sleep (sleep apnea), rapid, shallow breathing
• aspiration pneumonia, respiratory tract congestion, voice disorder
• intestinal obstruction, fecal incontinence, very hard stools, absence of intestinal movement that causes obstruction
• yellowing of the skin and eyes (jaundice)
• pancreatitis
• severe allergic reaction with swelling, which can affect the throat, causing difficulty breathing
• thickening of the skin, dry skin, redness of the skin, skin discoloration, scaly and itchy skin or scalp, dandruff
• muscle fiber rupture and muscle pain (rhabdomyolysis), abnormal posture
• priapism (a prolonged erection that may require surgical treatment)
• breast development in men, breast enlargement, milk secretion from the breasts, vaginal discharge
• delayed menstrual periods, breast enlargement
• very low body temperature, decreased body temperature
• withdrawal symptoms from the medication.

Unknown frequency: cannot be estimated from available data

• lung congestion
• increased insulin (a hormone that controls blood sugar levels) in the blood

The following adverse effects have appeared with the use of another medicine called risperidone, which is very similar to paliperidone, so it is also expected to appear with INVEGA: sleep-related eating disorder, other types of cerebral vascular problems, crackling sounds in the lungs, and severe or fatal rash with blisters and peeling of the skin that can start inside and around the mouth, nose, eyes, and genitals and spread to other areas of the body (Stevens-Johnson syndrome/toxic epidermal necrolysis). Eye problems may also appear during cataract surgery. During cataract surgery, a condition called intraoperative floppy iris syndrome (IFIS) may occur if you are taking or have taken INVEGA. If you need to undergo cataract surgery, make sure to inform your ophthalmologist if you are taking or have taken this medication.

Additional adverse effects in adolescents

• Adolescents generally presented similar adverse effects to those found in adults, except for the following adverse effects that were detected more frequently:
• feeling drowsy or less attentive
• parkinsonism: This disease may include slow or altered movement, feeling of stiffness or tightness of the muscles (making sudden movements) and sometimes a feeling of "freezing" of movement that then restarts. Other signs of parkinsonism include walking slowly, dragging feet, tremors while resting, increased saliva and/or drooling, and loss of facial expressiveness
• weight gain
• common cold symptoms
• restlessness
• tremors (agitation)
• stomach pain
• milk secretion from the breasts in girls
• breast swelling in boys
• acne
• speech problems
• stomach or intestinal infection
• nasal bleeding
• ear infection
• high triglycerides in the blood (a type of fat)
• feeling of movement (vertigo).

Reporting adverse effects

If you experience adverse effects, consult your doctor, pharmacist, or nurse, even if they are adverse effects that do not appear in this leaflet. You can also report them directly through the national reporting system included in Appendix V. By reporting adverse effects, you can contribute to providing more information on the safety of this medicine.

5. Storage of INVEGA

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

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

Bottles: Do not store above 30°C. Keep the bottle tightly closed to protect it from moisture.

Blister packs: Do not store above 30°C. Store in the original packaging to protect it from moisture.

Medicines should not be disposed of via wastewater or household waste. Ask your pharmacist how to dispose of the packaging and any unused medicines. This will help protect the environment.

6. Container Contents and Additional Information

Composition of INVEGA

The active ingredient is paliperidone.

Each 3 mg prolonged-release tablet of INVEGA contains 3 mg of paliperidone.

Each 6 mg prolonged-release tablet of INVEGA contains 6 mg of paliperidone.

Each 9 mg prolonged-release tablet of INVEGA contains 9 mg of paliperidone.

Each 12 mg prolonged-release tablet of INVEGA contains 12 mg of paliperidone.

The other ingredients are:

Coated tablet core:

Polyethylene oxide 200K

Sodium chloride

Povidone (K29-32)

Stearic acid

Butylhydroxytoluene (E321)

Ferric oxide (Yellow) (E172) (only the 3 and 12 mg tablets)

Polyethylene oxide 7000K

Ferric oxide (Red) (E172)

Hydroxyethyl cellulose

Polyethylene glycol 3350

Cellulose acetate

Iron oxide (Black) (E172) (only the 9 mg tablets)

Colored coating:

Hypromellose

Titanium dioxide (E171)

Polyethylene glycol 400 (only the 6, 9, and 12 mg tablets)

Ferric oxide (Yellow) (E172) (only the 6 and 12 mg tablets)

Ferric oxide (Red) (E172) (only the 6 and 9 mg tablets)

Lactose monohydrate (only the 3 mg tablets)

Triacetin (only the 3 mg tablets)

Carnauba wax

Printing ink:

Iron oxide (Black) (E172)

Propylene glycol

Hypromellose

Product Appearance and Container Contents

The INVEGA prolonged-release tablets are capsule-shaped. The 3 mg tablets are white and engraved with “PAL 3”, the 6 mg tablets are beige and engraved with “PAL 6”, the 9 mg tablets are pink and engraved with “PAL 9”, and the 12 mg tablets are dark yellow and engraved with “PAL12”. All tablets are available in the following presentations:

• Bottles: The tablets are provided in a plastic bottle with a child-resistant closure. Each bottle contains 30 tablets or 350 tablets. Each bottle contains two silica gel bags to protect the tablets from moisture and keep them dry.
• Blister packs: The tablets are provided in blister packs packaged in boxes of 14, 28, 30, 49, 56, and 98 tablets.

Only certain package sizes may be marketed.

Marketing Authorization Holder

Janssen-Cilag International NV

Turnhoutseweg 30

B-2340 Beerse

Belgium

Manufacturer

Janssen-Cilag SpA

Via C. Janssen

04100 Borgo San Michele

Latina

Italy

For further information about this medicinal product, please contact the local representative of the marketing authorization holder:

Date of Last Revision of this Leaflet: MM/AAAA

Other Sources of Information

Detailed information on this medicinal product is available on the European Medicines Agency website http://www.ema.europa.eu