Package Insert: Information for the User

Largactil 40 mg/ml Oral Drops in Solution

Clorpromazina

Read this package insert carefully before starting to take this medicine, as it contains important information for you.

• Keep this package insert, as you may need to read it again.
• If you have any questions, consult your doctor or pharmacist.
• This medicine has been prescribed only for you, and you should not give it to others, even if they have the same symptoms as you, as it may harm them.
• If you experience any adverse effects, consult your doctor or pharmacist even if they do not appear in this package insert. See section 4.

It is an antipsychotic and neurolptic medication belonging to the group of medications known as phenothiazines. Its neurolptic activity is manifested by its sedative effect, which is useful in states of agitation, aggression, and anxiety in mentally ill patients. Chlorpromazine also has marked antiemetic activity (prevents or stops vomiting) and reduces anxiety.

Under the prescription of your doctor, this medication is indicated for the treatment of:

-States of psychomotor agitation: acute psychoses, manic crises, delirious episodes, confusional syndromes, geriatric psychoprocesses, etc.

• Psychotic processes: schizophrenia, chronic delirious syndromes.
• Sleep cures.

Do not take Largactil

-if you are allergic (hypersensitive) to chlorpromazine, other phenothiazines, or any of the other components of this medication (listed in section 6).

-if you have a risk of developing increased intraocular pressure (glaucoma).

-if you have a risk of urinary retention due to problems in the urethra or prostate.

• in case of coma caused by alcohol or barbiturate intoxication.
• if you have had a disease characterized by a decrease in the number of granulocytes in the blood (agranulocytosis).
• if you are allergic or intolerant to gluten, do not take Largactil in tablets.
• if you are breastfeeding.
• if you are under one year old.
• if you are being treated with citalopram or escitalopram (see section “Taking Largactil with other medications”).
• if you are being treated with dopamine agonists (see section “Taking Largactil with other medications”).

Warnings and precautions

Consult your doctor or pharmacist before starting to take Largactil:

• If your body temperature increases inexplicably, consult your doctor immediately, due to the risk of developing a syndrome called malignant neuroleptic syndrome, described during treatment with this type of medication, whose effects include muscle rigidity, increased body temperature, and nervous system disorders.
• If you have risk factors for suffering a stroke.
• If you have Parkinson's disease.
• If you have epilepsy. Treatment should be interrupted if seizures occur.
• If you have severe heart and/or circulatory problems.

• If you have any liver or kidney problems.
• If you have a history of liver disease.
• If you have intestinal obstruction (paralytic ileus).
• Ensure the absence of some factors that favor the development of cardiac rhythm alterations (ventricular arrhythmia): bradycardia <55
• If your treatment is prolonged, your doctor may recommend an eye examination and blood test.

• In case of fever, sore throat, infection, or appearance of ulcers in the mouth, your doctor will perform a blood test to rule out a possible decrease in a type of white blood cell, granulocytes, or an increase in the number of leukocytes.
• If you suffer from seizures. It may increase the risk of their occurrence, so your doctor will subject you to special control, performing an electroencephalogram.
• This type of medication may potentiate the development of cardiac rhythm alterations (prolongation of the QT interval) that can be severe (torsades de pointes) and cause death. Therefore, your doctor will perform the necessary controls to exclude possible risk factors before starting treatment and if necessary during it.
• Older patients have a higher probability of experiencing sedation and decreased blood pressure (orthostatic hypotension).
• In older patients with dementia-related psychosis and being treated with antipsychotics (possibility of presenting a higher risk of death).
• If you have risk factors for suffering thromboembolism (formation of blood clots) (see section “4. Possible adverse effects”).

• If you or your caregiver:

• note a yellowish discoloration of the skin or eyes (jaundice) and the urine becomes darker. These may be signs of liver damage.
• suspect any allergic reaction while taking chlorpromazine.

You must immediately inform a doctor if you experience symptoms such as fatigue (asthenia), anorexia, nausea, vomiting, abdominal pain, due to the severe toxicity of this medication to the liver, which can be sometimes fatal. Your doctor should immediately initiate investigations including clinical examination and biological evaluation of liver function (see section “4. Possible adverse effects”).

• If you have diabetes mellitus or risk factors for developing it, as you must control your blood glucose levels (blood sugar levels) properly while taking Largactil.
• If you are being treated with lithium, other medications that may prolong the QT interval, dopamine agonist antiparkinsonian medications (see section “Taking Largactil with other medications”).
• Avoid consuming alcohol or medications containing alcohol (see sections “Taking Largactil with food, drinks, and alcohol” and “Taking Largactil with other medications”).
• Use in children (see section “3. How to take Largactil”).

• Severe skin reactions, including drug reaction with eosinophilia and systemic symptoms (DRESS), have been reported with the use of Largactil.

• DRESS initially presents with symptoms similar to the flu and a rash on the face, followed by a more widespread rash with increased body temperature, elevated liver enzymes in blood tests, and increased eosinophils and enlarged lymph nodes.

If you develop a severe rash or other skin symptoms, stop taking chlorpromazine and contact your doctor or seek medical attention immediately.

Taking Largactil with other medications

Inform your doctor or pharmacist if you are using, have used recently, or may need to use any other medication.

Contraindicated combinations

• Quinagolida, cabergolina (medications for treating increased prolactin levels).
• Citalopram and escitalopram(medications for treating depression).

Not recommended combinations

-Medications for treating Parkinson's disease such as amantadine, bromocriptine, cabergolina, levodopa, lisurida, pergolida, piribedil, ropinirol.

• Levodopa (medication for treating Parkinson's disease): if movement disorders occur, your doctor will not prescribe or replace levodopa with another medication.

- Medications that may prolong the QT interval (heart disorder): there is an increased risk of arrhythmias when chlorpromazine is used simultaneously with medications that prolong the QT interval (including some antiarrhythmics and other antipsychotics including sultoprida) and medications that may cause electrolyte imbalance.

-Alcohol: alcohol consumption potentiates the sedative effect of Largactil.

-Guanetidina (medication for treating hypertension): concurrent administration with guanetidina reduces the antihypertensive effect of this.

- Sultoprida (medication for treating psychosis): administering Largactil together with sultoprida may cause cardiac rhythm alterations that can be severe (torsade de pointes).

- Litio (medication for treating bipolar disorder): concurrent administration of lithium and chlorpromazine may cause confusional syndrome, increased muscle tone, and increased reflexes.

Combinations requiring caution

-Medications for treating diabetes:la administration of high doses of chlorpromazine (100 mg/day) together with antidiabetic medications may increase blood glucose levels.You may need to adjust the dose of the antidiabetic medication.

• Concurrent administration with antacids (salts, oxides, and hydroxides of aluminum, magnesium, and calcium) reduces the absorption of Largactil. Therefore, it is recommended to take them at least two hours apart.

• Administration of Largactil with CYP1A2 inhibitors increases chlorpromazine concentrations.

• There may be an interaction between CYP2D6 inhibitors, such as phenothiazines (including chlorpromazine), and CYP2D6 substrates. Concurrent administration of Largactil with amitriptyline/amitriptylinoxide may increase plasma levels of amitriptyline/amitriptylinoxide. Monitor for possible adverse reactions associated with amitriptyline/amitriptylinoxide treatment.

Combinations to be considered

-Administration of Largactil with medications used to lower blood pressure (antihypertensives) increases their effect and the risk of decreased blood pressure upon initiation, which may cause dizziness.

-Medications that act on the brain, such as: tranquilizers, morphine derivatives, barbiturates, medications for treating allergies, sleep inducers, medications for treating anxiety,benzodiazepines, other anxiolytics distinct from benzodiazepines, sedative antidepressants, medications for lowering blood pressure that act centrally,clonidina and related substances, and metadona, enhance the effect of Largactil, andmay cause changes in alertness that make it hazardous to drive or operate machinery.

-Medications for treating depression (type imipramina), medications for treating allergies that act on the brain, tranquilizers, medications for treating Parkinson's disease, for treating spasms, and disopiramida, when administered together with Largactil, increase the occurrence of the following adverse reactions: urinary retention, constipation, and dry mouth.

Taking Largactil with food, drinks, and alcohol

Avoid consuming alcoholic beverages during treatment. Alcohol consumption potentiates the sedative effect of Largactil.

Pregnancy, lactation, and fertility

Consult your doctor or pharmacist before using any medication.

Pregnancy:

Largactil is not recommended during pregnancy.

Consult your doctor before using this medication:

- if you are a fertile woman and are not using effective contraceptive methods, or

- if you are pregnant, think you may be pregnant, or intend to become pregnant.

If your doctor estimates that treatment with Largactil is necessary to ensure the mother's mental balance, treatment should be initiated and maintained at the effective dose throughout pregnancy.

The following symptoms have been reported in newborns of mothers treated with Largactil during the third trimester of pregnancy (last three months of pregnancy):shivering, muscle stiffness, or weakness, drowsiness, agitation, breathing problems, and difficulty feeding, reduced heart rate, or rapid heart rate, abdominal distension,meconium ileus (it is a blockage of the small intestine by meconium), delayed meconium excretion.If your baby develops any of these symptoms, contact your doctor.

Lactation:

If you are breastfeeding, do not take Largactil, as chlorpromazine passes into breast milk.

Your doctor should evaluate substituting breast milk with formula or interrupting treatment with Largactil.

Fertility:

Largactil may cause an increase in prolactin secretion (hyperprolactinemia) that may be associated with fertility problems in women.

Driving and operating machinery

Largactil may cause symptoms such as drowsiness, dizziness, or visual disturbances, and decrease your ability to react. These effects, as well as the underlying disease, may impair your ability to drive vehicles or operate machinery. Therefore, do not drive, operate machinery, or engage in other activities that require special attention until your doctor evaluates your response to this medication.

Largactil 40 mg/ml oral drops in solution contains alcohol

This medication contains 91.4 mg of alcohol (ethanol) in each ml of oral drops in solution, equivalent to 9.14% (v/v). The amount in one ml of oral drops in solution of this medication is equivalent to less than 2.3 ml of beer or 0.9 ml of wine.

The small amount of alcohol in this medication does not produce any perceptible effect.

Largactil 40 mg/ml oral drops in solution contains saccharose

This medication contains saccharose. If your doctor has indicated that you have an intolerance to certain sugars, consult with them before taking this medication.

It may cause tooth decay.

Follow exactly the administration instructions of this medication indicated by your doctor.

In case of doubt, consult your doctor again if you are unsure of the dose you should take..

To facilitate and obtain a correct dosing, the bottle has a built-in dropper.

You must invert the bottle to obtain the indicated dose.

Remember to take your medication.

The normal dose is:

- In adults, 75 to 150 mg of chlorpromazine are generally administered divided into 3 doses, every 24 hours, starting with low daily doses (25-50 mg) and increasing progressively to find the useful dosage. Do not exceed 300 mg of chlorpromazine per day, except in particular cases and always at the discretion of your doctor.

Patients aged 65 years or older

If you experience any adverse effect, consult your doctor as your doctor will review the dose periodically.

Use in children

- Chlorpromazine should not be administered to children under 1 year..

- The administration of chlorpromazine in the form of oral solution in children under 6 years is reserved for exceptional circumstances in a specialized unit.

- In children aged 1 to 5 years, the recommended dose is 1 mg of chlorpromazine per kilogram of body weight per day.

- From this age, the recommended dose is 1/3 or 1/2 of the adult dose, according to weight.

Never change the dose prescribed by your doctor. If you estimate that the action of Largactil is too strong or too weak, inform your doctor or pharmacist.

Your doctor will indicate the duration of your treatment with Largactil. Do not discontinue your treatment before.

If you take more Largactil than you should

Consult your doctor immediately or go to the nearest hospital.

The symptoms of Largactil overdose may be:seizures, serious parkinsonian syndrome, and even coma.

Although there is no specific antidote, in case of accidental overdose, specialized treatment will be performed in a hospital setting (gastric lavage and administration of antiparkinsonian and cardiac restorative drugs, intravenously, and respiratory and cardiac monitoring will be performed).

In case of overdose or accidental ingestion, consult the Toxicological Information Service, phone 91 562 04 20, indicating the medication and the amount ingested..

If you forgot to take Largactil

Do not take a double dose to compensate for the missed doses.

Like all medications, Largactil may produce adverse effects, although not all people will experience them.

The classification of possible adverse effects is based on the following frequency data:

Very common:may affect more than one in 10 people

Common:may affect up to one in 10 people

Uncommon:may affect up to one in 100 people

Rare:may affect up to one in 1,000 people

Very rare:may affect up to one in 10,000 people

Unknown frequency: cannot be estimated from available data

These may include:

• Blood and lymphatic system disorders

Unknown frequency:decrease in the general number of white blood cells (leucopenia), decrease in a type of white blood cell, granulocytes (agranulocytosis),eosinophilia, which is an increase in the number of eosinophils (a type of white blood cell) found in a blood test, thrombocytopenia, which is a decrease in the number of platelets (blood cells that help with clotting) found in a blood test, which may lead to bleeding and hematomas (purpura thrombocytopenica).

• Immune system disorders

Unknown frequency:chronic, autoimmune, and systemic disease that can affect almost any part of the human body (systemic lupus erythematosus),antinuclear antibodies positive (may be seen without evidence of clinical disease).

• Endocrine disorders

Common: increase in prolactin hormone levels in the blood,absence of menstrual period (amenorrhea).

Unknown frequency:inappropriate milk secretion (galactorrhea), excessive breast volume in men (gynecomastia),impotence, sexual excitement disorders in women.

• Metabolism and nutrition disorders

Very common: weight gain.

Common: glucose intolerance.

Unknown frequency:high blood glucose levels (hyperglycemia), high triglyceride levels (hypertriglyceridemia), low sodium levels in the blood (hyponatremia), inappropriate secretion of antidiuretic hormone.

• Psychiatric disorders

Common: anxiety.

Unknown frequency: somnolence (drowsiness), mood changes.

• Nervous system disorders

Very common: sedation and somnolence (particularly when starting treatment), movement alterations (dyskinesia, tardive dyskinesia),movement disorder characterized by inability to remain still (akathisia),extrapyramidal syndrome.

Common: increased muscle tone (hypertonia),seizure.

Unknown frequency: movement alterations such asdyskinesias (incoordination or difficulty with movements, characterized by muscle contraction of the neck, eye, and mouth), decrease or absence of voluntary movement (akinesia), syndrome characterized by hyperactivity, lack of attention (hyperkinesia), neuroleptic malignant syndrome, which is characterized bymuscle rigidity, increased body temperature, and nervous system alterations.

• Eye disorders

Unknown frequency: eye focusing disorder,pigment deposits in the anterior segment of the eye.

• Cardiac disorders

Common: prolonged QT interval on the electrocardiogram, which may trigger abnormal heart rhythm (ventricular arrhythmia).

Unknown frequency: abnormal heart rhythm such as ventricular arrhythmias, ventricular fibrillation, ventricular tachycardia, torsades de pointes (a type of arrhythmia), cardiac arrest. There have been cases of sudden death associated with cardiac abnormalities or without apparent explanation in patients receiving this type of medication.

• Vascular disorders

Very common: decreased blood pressure upon standing (orthostatic hypotension).

Unknown frequency: formation of blood clots (venous thromboembolism) that may affect the lungs (pulmonary embolism), sometimes fatal, and deep vein thrombosis.

• Gastrointestinal disorders

Very common: dry mouth, constipation.

Unknown frequency: intestinal obstruction and other gastrointestinal diseases such as paralytic ileus, ischemic colitis, gastrointestinal necrosis (sometimes fatal), necrotizing colitis (sometimes fatal), intestinal perforation (sometimes fatal).

• Hepatobiliary disorders

Unknown frequency:hepatic damage and cholestatic jaundice. Yellowing of the skin or eyes (jaundice) and darker urine. These may be signs of liver damage.

Cases of liver damage of the hepatocellular, cholestatic, and mixed types have been reported, which sometimes may be fatal.

• Skin and subcutaneous tissue disorders

Unknown frequency: allergic dermatitis, increased skin sensitivity to the sun(erythema, pigmentation),swelling (angioedema), skin rash (urticaria).

• Renal and urinary disorders

Unknown frequency: urinary retention.

• Pregnancy, puerperium, and perinatal conditions

Unknown frequency: withdrawal syndrome in newborns.

• Reproductive and breast disorders

Unknown frequency: erection in the absence of sexual desire (priapism).

• General disorders and administration site conditions

Unknown frequency: temperature regulation disorder.

Reporting of adverse effects

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

Keep out of sight and reach of children.

Do not store at a temperature above 25°C.

Store in the original packaging to protect it from light.

Do not use this medication after the expiration date that appears on the packaging after CAD. The expiration date is the last day of the month indicated.

Medicines should not be disposed of through drains or in the trash. Dispose of the packaging and medicines you no longer need at the SIGRE collection point at the pharmacy. If in doubt, ask your pharmacist how to dispose of the packaging and medicines you no longer need. By doing so, you will help protect the environment.

Composition of Largactil 40 mg/ml oral drops in solution

• The active ingredient is chlorpromazine. Each ml of solution contains 40 mg of chlorpromazine (in the form of hydrochloride), taking into account that 1 drop of Largactil drops corresponds to 1 mg of chlorpromazine.
• The other components are:ethanol (96%), sucrose, citric acid monohydrate, glycerol, peppermint essence, ammonium glycyrrhizate, caramel colorant (E-150) and purified water.

Appearance of the product and content of the container

Largactil40 mg/ml oral drops in solutionis a brown-colored oral solution.

It is presented in glass bottles with 30 ml.

Other presentations:

Largactil 25 mg film-coated tablets: package with 50 tablets

Largactil 100 mg film-coated tablets: package with 30 tablets

Largactil 5 mg/ml injectable solution: package with 5 ampoules of 5 ml

Holder of the marketing authorization and responsible for manufacturing

Holder:

Neuraxpharm Spain, S.L.U.

Avda. Barcelona, 69

08970 Sant Joan Despí

Barcelona - Spain

Responsible for manufacturing:

A. Nattermann & Cie. GmbH

Nattermannallee 1

50829 Cologne

Germany

O

Responsible for manufacturing:

Famar Health Care Services Madrid, S.A.U.

Avda. de Leganés, 62

28923 Alcorcón (Madrid)

Spain

Last review date of this leaflet: September 2023

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