METAMIZOLE TARBIS 575 mg HARD CAPSULES

Introduction

PACKAGE LEAFLET: INFORMATION FOR THE USER

Metamizol Tarbis 575 mg hard capsules EFG

Metamizol magnesium

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.

Contents of the pack:

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

1. What is Metamizol Tarbis and what is it used for

Metamizol belongs to a group of medicines called: Other analgesics and antipyretics.

Metamizol Tarbis is used to treat acute post-operative or post-traumatic pain, colic pain, and pain of tumor origin. It is also used in cases of high fever that does not respond to other antipyretics.

2. What you need to know before you take Metamizol Tarbis

Do not take Metamizol Tarbis

• If you have previously had a significant decrease in a type of white blood cell called granulocytes, which was caused by metamizol or other similar medicines called pyrazolones or pyrazolidines.
• If you have bone marrow problems or have a disorder that affects the way your blood cells are produced or function.

• If you have previously had allergic reactions or hematological reactions (decrease in white blood cells, red blood cells, or platelets in the blood) with medicines containing metamizol or other similar compounds or allergic reactions to any of the other components of this medicine (listed in section 6).
• If you have had symptoms of asthma, rhinitis, or urticaria (red patches or hives on the skin that can cause itching) during treatment with other analgesics such as acetylsalicylic acid, paracetamol, or non-steroidal anti-inflammatory drugs, as you may also be sensitive to metamizol (the active substance of Metamizol Tarbis).
• If you have acute intermittent porphyria (a disorder of the metabolism of blood pigments that form part of hemoglobin).
• If you have a genetic deficiency of glucose-6-phosphate dehydrogenase.
• If you have had alterations in bone marrow function (blood cell formation); for example, during or after receiving antitumor chemotherapy (antineoplastic) or if you have had diseases related to blood cell formation.
• If you are in the last three months of pregnancy.
• If you have had severe skin reactions (such as Stevens-Johnson syndrome or toxic epidermal necrolysis) with previous use of Metamizol Tarbis or another medicine that contained metamizol.

Warnings and precautions

Consult your doctor or pharmacist before starting to take Metamizol Tarbis.

Low white blood cell count (agranulocytosis).

Metamizol Tarbis may cause agranulocytosis, a very low level of a type of white blood cell called granulocytes, which are important for fighting infections (see section 4). You should stop taking metamizol and contact a doctor immediately if you experience any of the following symptoms, as they may indicate possible agranulocytosis: chills, fever, sore throat, and painful sores in the mucous membranes (wet surfaces of the body) especially in the mouth, nose, and throat or in the genital or anal area. Your doctor will perform laboratory tests to check your blood cell levels.

If you take metamizol for fever, some symptoms of agranulocytosis may go unnoticed. Similarly, symptoms may be masked if you are taking antibiotics.

Agranulocytosis can occur at any time during the use of Metamizol Tarbis and even shortly after stopping metamizol.

You can develop agranulocytosis even if you have used metamizol without problems in the past.

Be especially careful:

• If you experience general discomfort, infection, persistent fever, sore throat, inflammation in the mouth, nose, or throat, lesions in the mucous membranes of the mouth or genitals, bruising, bleeding, or paleness, you should stop treatment and consult your doctor immediately. These disorders may be due to a decrease in the number of white blood cells in the blood (agranulocytosis), platelets (thrombocytopenia), or a failure in the production of all blood cells (aplastic anemia).
• If you experience dizziness, difficulty breathing, rhinitis, swelling of the face, decreased blood pressure, sudden onset of red patches on the skin, stop treatment and consult your doctor. These symptoms may be due to a severe allergic reaction called anaphylactic shock. This reaction is more likely if you have asthma or allergic disorders (atopy).
• If you have bronchial asthma (especially in the presence of nasal mucosa inflammation and nasal polyps), chronic urticaria, or if you are intolerant to colorants and/or preservatives or alcohol, as the risk of severe allergic reactions is higher.
• If you have low blood pressure, hypovolemia (decrease in circulating blood volume or any other body fluid), dehydration, or unstable circulation, as the risk of a sudden drop in blood pressure is higher.
• If a skin rash progresses to blistering or mucous membrane lesions, you should interrupt treatment and consult your doctor, as this may be due to severe skin disorders (Stevens-Johnson syndrome or toxic epidermal necrolysis). In these cases, you should not receive medicines containing metamizol again.
• If you have impaired kidney or liver function, as you may have difficulty eliminating the medicine.
• If you are an elderly patient, be especially alert to the appearance of any of the disorders described above, as they may occur more frequently.

Liver problems

Inflammation of the liver has been reported in patients taking metamizol with symptoms developing within a few days to a few months after starting treatment.

Stop using Metamizol Tarbis and contact a doctor if you experience symptoms of liver problems, such as discomfort (nausea or vomiting), fever, feeling tired, loss of appetite, dark urine, light-colored stools, yellowing of the skin or the white part of the eyes, itching, rash, or upper abdominal pain. Your doctor will check your liver function.

Do not take Metamizol Tarbis if you have previously taken a medicine containing metamizol and had liver problems.

Severe skin reactions

Severe skin reactions, such as Stevens-Johnson syndrome, toxic epidermal necrolysis, and drug reaction with eosinophilia and systemic symptoms (DRESS), have been reported in association with metamizol treatment. Stop taking metamizol and seek medical attention immediately if you observe any of the symptoms related to these severe skin reactions described in section 4.

If you have ever had severe skin reactions, you should not restart treatment with Metamizol Tarbis at any time (see section 4).

Taking Metamizol Tarbis with food, drinks, and alcohol

Together with alcohol, the effects of both can be enhanced.

Pregnancy, breastfeeding, and fertility

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

Pregnancy

Available data on the use of metamizol during the first three months of pregnancy are limited but do not indicate harmful effects on the embryo. In selected cases when no other treatment options are available, single doses of metamizol during the first and second trimester may be acceptable after consulting your doctor or pharmacist and carefully evaluating the benefits and risks of using metamizol. However, in general, the use of metamizol is not recommended during the first and second trimester.

During the last three months of pregnancy, you should not take Metamizol Tarbis due to the increased risk of complications for the mother and the baby (bleeding, premature closure of a vital vessel for the fetus, called the ductus arteriosus, which closes naturally after birth).

Breastfeeding

Metamizol degradation products are excreted in breast milk in significant amounts, and it cannot be excluded that there is a risk for the breastfed infant. Therefore, repeated use of metamizol should be avoided during breastfeeding. If a single dose of metamizol is administered, mothers should express and discard breast milk for 48 hours after administration.

Driving and using machines

Although no adverse effects on concentration and reaction are expected, at the highest recommended doses, it should be taken into account that these abilities may be affected, and you should avoid using machines, driving vehicles, or engaging in other hazardous activities.

Taking Metamizol Tarbis with other medicines

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

If administered together with cyclosporin (a medicine that prevents transplant rejection), it may reduce cyclosporin blood levels, and these should be measured regularly.

If administered together with chlorpromazine (a medicine for the treatment of psychoses), it may cause a decrease in body temperature.

If administered together with methotrexate or other medicines for the treatment of tumors (antineoplastics), it may enhance the toxic effects on the blood of antineoplastics, especially in elderly patients.

If administered together with acetylsalicylic acid, it may reduce the effect of acetylsalicylic acid on decreasing platelet aggregation (antiplatelet) and should be used with caution in patients taking it to protect the heart (cardioprotector).

If administered together with bupropion, a medicine used for the treatment of depression and/or to help stop smoking, it may reduce bupropion blood levels, and caution should be exercised.

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

• efavirenz, a medicine used for the treatment of HIV/AIDS.
• methadone, a medicine used to treat drug dependence (opioids).
• valproate, a medicine used to treat epilepsy or bipolar disorder.
• tacrolimus, a medicine used to prevent organ rejection in transplant patients.
• sertraline, a medicine used to treat depression.

Metamizol may modify the effect of antihypertensives (medicines that reduce blood pressure) and diuretics (medicines that increase fluid elimination).

3. How to take Metamizol Tarbis

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

This medicine is for short-term use. Your doctor will indicate the duration of treatment.

This medicine should be taken orally. The capsules should be swallowed whole, without chewing, with a little liquid.

The dose is established based on the intensity of the pain or fever and the individual's sensitivity to treatment with Metamizol Tarbis. The lowest necessary dose should always be selected to control pain and fever. Your doctor will indicate how to take Metamizol Tarbis.

Adults and adolescents over 15 years:

Adults and adolescents 15 years of age or older (weighing more than 53 kg) can take 1 capsule (575 mg of metamizol) as a single dose, which can be administered up to 6 times a day, at 4- to 6-hour intervals. The maximum daily dose is 3450 mg (corresponding to 6 capsules).

The effect of the medicine usually appears between 30 and 60 minutes after oral administration.

Children and adolescents under 15 years of age

Metamizol Tarbis should not be used in children under 15 years of age. For younger children, other presentations and doses of this medicine are available; consult your doctor or pharmacist.

Elderly patients and patients with poor general health or renal impairment

The dose should be reduced in elderly patients, debilitated patients, and those with decreased renal function, as the elimination of metamizol degradation products may be delayed.

Patient with renal or hepatic impairment

Since the elimination rate decreases in cases of renal or hepatic impairment, administration of high repeated doses should be avoided. Only in short-term treatments is a dose reduction not necessary. There is no experience with long-term treatments.

If the pain persists or worsens, you should consult a doctor to investigate the cause of the symptoms.

If you take more Metamizol Tarbis than you should

Nausea, vomiting, abdominal pain, deterioration of kidney function, and, in rarer cases, dizziness, drowsiness, coma, convulsions, decreased blood pressure, or even shock and increased heart rate (tachycardia) may occur.

After administration of very high doses of metamizol, a red coloration of the urine may occur, which disappears when treatment is stopped.

In case of overdose or accidental ingestion, consult your doctor or pharmacist or call the Toxicology Information Service (Telephone 91 562 04 20), indicating the medicine and the amount taken.

Information for the doctor:No specific antidote is known. After oral overdose, gastric lavage and forced vomiting may be performed. Forced diuresis or dialysis may be considered, as metamizol is dialyzable.

In case of severe allergic reactions, other usual emergency measures should be applied, such as placing the patient on their side, keeping the airways clear, or administering oxygen. Pharmacological emergency measures include the administration of adrenaline, fluid therapy, and glucocorticoids.

Careful monitoring of vital functions and general necessary measures should be taken.

If you forget to take Metamizol Tarbis

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

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

4. Possible Adverse Effects

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

Mild allergic reactions (e.g., skin and mucous membrane reactions such as itching, burning, redness, swelling), as well as difficulty breathing and gastrointestinal discomfort, can progress to severe forms, e.g., generalized urticaria, swelling of feet, hands, lips, throat, and respiratory tract (angioedema), severe bronchospasm (constriction of the bronchial walls), heart rhythm disturbances, and decreased blood pressure (sometimes preceded by an increase in blood pressure).

In patients with analgesic asthma syndrome, these intolerance reactions are usually manifested as asthma attacks.

Rarely (may affect up to 1 in 100 patients), drug eruptions have been described, and in very rare cases (may affect up to 1 in 1,000 patients), skin reactions in the form of slightly elevated patches (maculopapular) have occurred, and very rarely (may affect up to 1 in 10,000 patients), cases of skin reactions have occurred, characterized by the appearance of vesicles or blisters (Stevens-Johnson syndrome or Lyell syndrome). Decreased blood pressure reactions may occur rarely (may affect up to 1 in 100 patients).

Stop using Metamizol Tarbis and contact a doctor immediately if you experience any of the following symptoms:

Feeling of illness (nausea or vomiting), fever, feeling of fatigue, loss of appetite, dark urine, light-colored stools, yellowish discoloration of the skin or the white part of the eyes, itching, rash, or pain in the upper abdominal area. These symptoms may be signs of liver damage. See also section 2 Warnings and Precautions.

Other adverse effects that may occur with the following frequencies are:

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

• hypotension (decreased blood pressure).

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

• skin eruptions and reactions.

Very rare (may affect up to 1 in 1,000 people):

• allergic reactions that usually occur during or immediately after administration but also hours later.
• skin eruptions and appearance of hives.
• decrease in the number of white blood cells in the blood (leukopenia)
• asthma.

Very rare (may affect up to 1 in 10,000 people):

• skin reactions characterized by the appearance of vesicles or blisters (toxic epidermal necrolysis, Stevens-Johnson syndrome),
• kidney problems with decreased or suppressed urine output
• increase in the amount of protein excreted in the urine
• kidney inflammation (interstitial nephritis)
• severe decrease in white blood cells (agranulocytosis) that can cause death due to severe infections
• decrease in the number of platelets in the blood (thrombocytopenia), which can cause inflammatory lesions in the mucous membranes, sore throat, and fever.
• shock (drastic drop in blood pressure).

Frequency not known (cannot be estimated from the available data):

• sepsis (severe infection that involves an inflammatory reaction of the entire body and can cause death),
• aplastic anemia (failure of the production of bone marrow and blood cells),
• pancytopenia (low number of red, white, and platelet cells simultaneously),
• anaphylactic shock (severe allergic reaction that can cause death)
• Kounis syndrome (a type of cardiac disorder),
• gastrointestinal bleeding
• chromaturia (abnormal urine coloration).
• liver inflammation, yellowish discoloration of the skin and the white part of the eyes, increased blood levels of liver enzymes.
• severe skin reactions.

Stop taking metamizol and seek medical attention immediately if you observe any of the following serious adverse effects:

- Red, non-elevated patches, or circular or target-shaped patches on the chest, often with central blisters, skin peeling, ulcers in the mouth, throat, nose, genitals, and eyes. These severe skin erythemas can be preceded by fever and flu-like symptoms (Stevens-Johnson syndrome, toxic epidermal necrolysis).

- Generalized erythema, elevated body temperature, and enlarged lymph nodes (DRESS syndrome or drug hypersensitivity syndrome).

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 that is not listed in this prospectus. You can also report it directly through the Spanish Pharmacovigilance System for Human Use Medicines: https://www.notificaram.es. By reporting adverse effects, you can contribute to providing more information on the safety of this medicine.

5. Storage of Metamizol Tarbis

Keep out of sight and reach of children.

No special storage conditions are required.

Do not use Metamizol Tarbis after the expiration date stated on the packaging after CAD. The expiration date is the last day of the month indicated.

Medicines should not be disposed of via wastewater or household waste. Deposit the packaging and unused medicines in the SIGRE Point of the pharmacy. In case of doubt, ask your pharmacist how to dispose of the packaging and unused medicines. This will help protect the environment.

6. Package Contents and Additional Information

Composition of Metamizol Tarbis

• The active ingredient is metamizol. Each capsule contains 575 mg of metamizol.
• The other components are: magnesium stearate.

The components of the capsule are: red iron oxide (E172), erythrosine (E127), titanium dioxide (E171), gelatin.

Appearance of the Product and Package Contents

Metamizol Tarbis 575 mg are capsules with a red body and cap, marked with "M" on the cap and "575" on the body in white ink.

They are available in packages of 10 and 20 capsules.

Marketing Authorization Holder and Manufacturer

Marketing Authorization Holder

TARBIS FARMA, S.L.

Gran Via Carlos III, 94

08028- Barcelona, Spain

Manufacturer

TEVA PHARMA, S.L.U.

Polígono Malpica c/ C 4,

50016 Zaragoza, Spain

Date of the Last Revision of this Prospectus:November 2024

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