LEVODOPA/CARBIDOPA/ENTACAPONA KERN PHARMA 200 mg /50 mg /200 mg FILM-COATED TABLETS

Introduction

Package Leaflet: Information for the User

Levodopa/Carbidopa/Entacapone Kern Pharma 200 mg/50 mg/200 mg film-coated tablets EFG

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 Levodopa/Carbidopa/Entacapone Kern Pharma and what is it used for
2. What you need to know before you take Levodopa/Carbidopa/Entacapone Kern Pharma
3. How to take Levodopa/Carbidopa/Entacapone Kern Pharma
4. Possible side effects

5 Storage of Levodopa/Carbidopa/Entacapone Kern Pharma

1. Package contents and additional information

1. What is Levodopa/Carbidopa/Entacapone Kern Pharma and what is it used for

This medicine contains three active substances (levodopa, carbidopa and entacapone) in one film-coated tablet. Levodopa/Carbidopa/Entacapone Kern Pharma is used to treat Parkinson's disease.

Parkinson's disease is due to a lack of dopamine in the brain. Levodopa increases the amount of dopamine and thereby reduces the symptoms of Parkinson's disease. Carbidopa and entacapone improve the antiparkinsonian effects of levodopa.

2. What you need to know before you take Levodopa/Carbidopa/Entacapone Kern Pharma

Do not take Levodopa/Carbidopa/Entacapone Kern Pharma if

• you are allergic to levodopa, carbidopa or entacapone, or any of the other ingredients of this medicine (listed in section 6)
• you have narrow-angle glaucoma (a condition where the pressure in the eye is increased)
• you have a tumor of the adrenal gland
• you are taking certain medicines for depression (combinations of selective MAO-A and MAO-B inhibitors, or non-selective MAO inhibitors)
• you have ever had neuroleptic malignant syndrome (NMS - a rare reaction to medicines used to treat severe mental disorders)
• you have ever had non-traumatic rhabdomyolysis (a rare muscle disorder)
• you have severe liver disease

Warnings and precautions

Consult your doctor or pharmacist before taking this medicine if you have or have had:

• a heart attack or any other heart disease, including arrhythmias, or blood vessel disease
• asthma or any other lung disease
• a liver problem, as you may need to have your dose adjusted
• any kidney disease or hormone-related disease
• stomach ulcers or convulsions
• prolonged diarrhea. Consult your doctor as it may be a sign of colon inflammation
• any severe mental disorder, such as psychosis
• open-angle glaucoma, as your dose may need to be adjusted and your intraocular pressure monitored

Tell your doctor if you are taking:

• antipsychotics (medicines for treating psychosis)
• any medicine that may cause a drop in blood pressure when standing up from a chair or bed. You should be aware that Levodopa/Carbidopa/Entacapone may worsen these reactions

Tell your doctor if, during treatment with this medicine, you:

• notice great stiffness in your muscles or that they contract violently, or if you suffer from tremors, agitation, confusion, fever, rapid pulse or large fluctuations in blood pressure. If any of these circumstances occur, contact your doctor immediately
• feel depressed, have suicidal thoughts or notice unusual changes in your behavior
• notice that you fall asleep suddenly, or feel very drowsy. If this happens to you, do not drive or operate machinery (see also the section "Driving and using machines")
• start to notice uncontrolled movements or if they get worse. If this happens, your doctor may need to adjust your dose of medication
• suffer from diarrhea; it is recommended to monitor your weight to avoid excessive weight loss
• suffer from progressive loss of appetite, asthenia (weakness, exhaustion) and weight loss over a relatively short period of time. In these cases, a complete medical evaluation, including a liver function test, should be considered
• consider that you need to stop taking this medicine; consult the section "If you stop taking Levodopa/Carbidopa/Entacapone Kern Pharma"

Tell your doctor if you or your family member/caregiver notice that you are developing desires or tendencies to behave in an unusual way for you or that you cannot resist the impulse, determination or temptation to perform certain activities that may harm you or others. These behaviors are called impulse control disorders and may include addiction to gambling, eating or excessive spending, and abnormally increased sexual drive or concern with an increase in sexual thoughts or feelings. Your doctor may need to review your treatment.

Tell your doctor if you or your family member/caregiver notice that you are developing symptoms similar to addiction, leading to a desire for high doses of Levodopa/Carbidopa/Entacapone Kern Pharma and other medicines used to treat Parkinson's disease.

During prolonged treatment with Levodopa/Carbidopa/Entacapone, your doctor may perform regular blood tests.

If you need to undergo surgery, you should inform your doctor that you are taking this medicine.

Levodopa/Carbidopa/Entacapone is not recommended for the treatment of extrapyramidal symptoms (e.g. involuntary movements, agitation, muscle stiffness and muscle contractions) caused by other medicines.

Children and adolescents

Experience with the use of Levodopa/Carbidopa/Entacapone in patients under 18 years of age is limited. Therefore, it is not recommended for use in children.

Taking Levodopa/Carbidopa/Entacapone Kern Pharma with other medicines

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

Do not take this medicine if you are taking certain medicines for depression (combinations of selective MAO-A and MAO-B inhibitors, or non-selective MAO inhibitors).

Levodopa/Carbidopa/Entacapone may increase the effect, and also the side effects, of certain medicines. These include:

• medicines used to treat depression, such as moclobemide, amitriptyline, desipramine, maprotiline, venlafaxine and paroxetine
• rimiterol and isoprenaline, used to treat respiratory diseases
• adrenaline, used for severe allergic reactions
• noradrenaline, dopamine and dobutamine, used to treat heart diseases and low blood pressure
• alpha-methyldopa, used to treat high blood pressure
• apomorphine, used to treat Parkinson's disease

Certain medicines may reduce the effects of Levodopa/Carbidopa/Entacapone. These medicines are:

• dopamine antagonists used to treat mental disorders, nausea and vomiting
• phenytoin, used to prevent convulsions
• papaverine, used to relax muscles

Levodopa/Carbidopa/Entacapone may interfere with the absorption of iron in the gut. Therefore, you should not take Levodopa/Carbidopa/Entacapone at the same time as iron supplements. If you take either of them, you should wait at least 2 or 3 hours before taking the other.

Taking Levodopa/Carbidopa/Entacapone Kern Pharma with food and drinks

This medicine can be taken with or without food.

It is possible that in some patients Levodopa/Carbidopa/Entacapone may not be absorbed well if taken with protein-rich foods (meat, fish, dairy products, cereals and nuts) or shortly after eating them.

Consult your doctor if you think this is happening to you.

Pregnancy, breast-feeding and fertility

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

You should not breast-feed while taking this medicine.

Driving and using machines

Levodopa/Carbidopa/Entacapone may lower your blood pressure, which can cause dizziness or fainting. Therefore, be careful when using tools or machines.

If you feel very tired or notice that you have fallen asleep suddenly, wait until you feel fully awake before driving or doing anything that requires you to be alert. Otherwise, you may put yourself and others at risk of a serious or even fatal accident.

Levodopa/Carbidopa/Entacapone Kern Pharma 200 mg/50 mg/200 mg contains lactose

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

3. How to take Levodopa/Carbidopa/Entacapone Kern Pharma

Always take this medicine exactly as your doctor or pharmacist has told you. If you are not sure, check with your doctor or pharmacist.

Adults and elderly:

• Your doctor will tell you exactly how many Levodopa/Carbidopa/Entacapone tablets to take each day.
• The tablets should not be broken or divided into smaller pieces.
• Take only one tablet at a time.
• Depending on how you respond to treatment, your doctor may ask you to increase or decrease the dose.
• If you are taking Levodopa/Carbidopa/Entacapone 200 mg/50 mg/200 mg tablets, do not take more than 7 tablets per day.

Talk to your doctor or pharmacist if you think the effect of this medicine is too strong or too weak, or if you experience side effects.

If you take more Levodopa/Carbidopa/Entacapone Kern Pharma than you should

In case of overdose or accidental ingestion, consult your doctor, pharmacist or call the Toxicology Information Service, telephone: 915 620 420, indicating the medicine and the amount taken.

You may feel dizzy or agitated, your heart rate may be slower or faster than normal, or your skin, tongue, eyes or urine may change color.

If you forget to take Levodopa/Carbidopa/Entacapone Kern Pharma

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

If it is more than 1 hour until your next dose:

Take a tablet as soon as you remember, and the next one at the usual time.

If it is less than 1 hour until your next dose:

Take a tablet as soon as you remember, wait 1 hour and take another tablet then. Then continue as usual.

There should always be an interval of 1 hour between tablets of this medicine to avoid possible side effects.

If you stop taking Levodopa/Carbidopa/Entacapone Kern Pharma

Do not stop taking this medicine unless your doctor tells you to. In that case, your doctor may need to adjust the dose of your other Parkinson's medicines, especially levodopa, to control your symptoms. If you stop taking Levodopa/Carbidopa/Entacapone and other Parkinson's medicines abruptly, you may experience unwanted side effects.

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

4. Possible side effects

Like all medicines, this medicine can cause side effects, although not everybody gets them. Many can be relieved by adjusting the dose.

If you experience any of these symptoms during treatment with this medicine, contact your doctor immediately

• Great stiffness or violent contractions of the muscles, tremors, agitation, confusion, fever, rapid pulse or large fluctuations in blood pressure. These may be symptoms of neuroleptic malignant syndrome (NMS, a rare and severe reaction to medicines used to treat central nervous system disorders) or rhabdomyolysis (a rare and severe muscle disorder)
• Allergic reaction characterized by signs such as hives, itching, rash and swelling of the face, lips, tongue or throat. This reaction can cause difficulty breathing or swallowing

Very common (may affect more than 1 in 10 people):

• uncontrolled movements (dyskinesias)
• feeling sick (nausea)
• brownish discoloration of urine (harmless)
• muscle pain
• diarrhea

Common (may affect up to 1 in 10 people):

• fainting or fainting due to low blood pressure, high blood pressure
• worsening of parkinsonian symptoms, dizziness, drowsiness
• vomiting; abdominal pain and discomfort; heartburn; dry mouth; constipation
• sleeplessness; hallucinations; confusion; abnormal dreams (with nightmares); fatigue
• changes in mental state, including memory problems, anxiety and depression (possibly with suicidal thoughts)
• heart or blood vessel disorders (e.g. chest pain), irregular heartbeats
• more frequent falls
• breathlessness
• increased sweating, rash
• muscle cramps, swelling of the legs
• blurred vision
• anemia
• decreased appetite, weight loss
• headache, joint pain
• urinary tract infections

Uncommon (may affect up to 1 in 100 people):

• heart attack
• intestinal bleeding
• changes in blood cell counts that can cause bleeding and abnormalities in liver function tests
• seizures
• feeling agitated
• psychotic symptoms
• colitis (inflammation of the colon)
• color changes other than those of urine (e.g. skin, nails, hair, sweat)
• difficulty swallowing
• inability to urinate

The following side effects have also been reported:

• hepatitis (inflammation of the liver)
• itching

You may experience the following side effects:

Inability to resist the impulse to perform an action that could be harmful, and which could include:

• a strong impulse to gamble excessively despite serious personal or family consequences
• an increased or altered interest in sex and a worrisome behavior for you or others, such as an increased sexual drive
• excessive or uncontrolled shopping or spending
• eating excessively (eating large amounts of food in short periods of time) or compulsively (eating more food than usual and more than needed to satisfy hunger)

Tell your doctor if you experience any of these behaviors, they will discuss how to manage or reduce these symptoms.

Reporting of side effects

If you experience any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via the Spanish Medicines Agency's website: www.notificaram.es.

By reporting side effects, you can help provide more information on the safety of this medicine.

5. Storage of Levodopa/Carbidopa/Entacapone Kern Pharma

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

Do not use this medicine after the expiry date which is stated on the carton after EXP. The expiry date refers to the last day of the month shown.

No special storage conditions are required.

Discard the product 175 days after opening the package.

Medicines should not be disposed of via wastewater or household waste. Ask your pharmacist how to dispose of medicines no longer required. These measures will help protect the environment.

6. Package contents and additional information

Composition of Levodopa/Carbidopa/Entacapone Kern Pharma

The active substances are levodopa, carbidopa and entacapone. Each film-coated tablet contains 200 mg of levodopa, 50 mg of carbidopa and 200 mg of entacapone.

The other ingredients are: microcrystalline cellulose, anhydrous lactose, hydroxypropylcellulose, povidone (E-1201), colloidal anhydrous silica, magnesium stearate, titanium dioxide (E-171), hypromellose, glycerol (E-422), yellow iron oxide (E-172), polysorbate 80, red iron oxide (E-172) and black iron oxide (E-172).

Appearance and package contents

The tablets are biconvex, oblong, brown, scored with "200" on one side, and smooth on the other.

Levodopa/Carbidopa/Entacapone Kern Pharma 200 mg/50 mg/200 mg is available in packs of 100 tablets.

Marketing authorization holder and manufacturer

Marketing authorization holder:

Kern Pharma, S.L.

Venus, 72 - Pol. Ind. Colón II

08228 Terrassa - Barcelona

Spain

Manufacturer:

Teva Pharmaceutical Works Private

Pallagi út 13, 4042 Debrecen

Hungary

or

Teva UK Limited

Brampton Road, Hampden Park,

Eastbourne, East Sussex, BN22 9AG,

United Kingdom

Date of last revision of this leaflet: September 2019

Detailed and up-to-date information on this medicine is available on the website of the Spanish Agency for Medicines and Health Products (AEMPS) http://www.aemps.gob.es/