METICEL 200 mg HARD CAPSULES

Introduction

Package Leaflet: Information for the Patient

Meticel 200 mg Hard Capsules EFG

Celecoxib

Read all of this leaflet carefully before you start taking this medicine because it contains important information for you.,as it contains important information for you..

• Keep this leaflet as 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 Meticel and what is it used for
2. What you need to know before you take Meticel
3. How to take Meticel
4. Possible side effects
5. Storing Meticel
6. Contents of the pack and other information

1. What is Meticel and what is it used for

Meticel is indicated in adults to relieve the signs and symptoms of rheumatoid arthritis, osteoarthritis, and ankylosing spondylitis.

Meticel belongs to a class of medicines called non-steroidal anti-inflammatory drugs (NSAIDs), and more specifically to the subgroup known as selective cyclooxygenase-2 (COX-2) inhibitors. Your body produces prostaglandins that can cause pain and inflammation. In conditions such as rheumatoid arthritis or osteoarthritis, your body produces them in larger quantities. Meticel works by reducing the production of prostaglandins, thus decreasing pain and inflammation.

You should expect this medicine to start taking effect within a few hours of taking the first dose, but you may not experience a complete effect for several days.

2. What you need to know before you take Meticel

Your doctor has prescribed Meticel for you. The following information will help you get better results with Meticel. If you have any other questions, please ask your doctor or pharmacist.

Do not take Meticel

Tell your doctor if any of the following circumstances apply to you, as patients with these conditions should not take Meticel.

• if you are allergic to celecoxib or any of the other ingredients of this medicine (listed in section 6)
• if you have had an allergic reaction to any medicine in the group called "sulfonamides" (e.g. some antibiotics used to treat infections)
• if you currently have a stomach or intestinal ulcer or bleeding
• if you have previously experienced any of the following symptoms after taking acetylsalicylic acid or any other anti-inflammatory medicine: asthma, nasal polyps, severe nasal congestion, or allergic symptoms such as skin rash with itching, swelling of the face, lips, tongue, or throat, difficulty breathing or wheezing
• if you are pregnant. If you can become pregnant during treatment, you should discuss the use of contraceptive methods with your doctor
• if you are breastfeeding
• if you have severe liver disease
• if you have severe kidney disease
• if you have inflammatory bowel disease such as ulcerative colitis or Crohn's disease
• if you have heart failure, diagnosed ischemic heart disease, or cerebrovascular disease, e.g. you have been diagnosed with a heart attack, stroke, or transient ischemic attack (temporary reduction of blood flow to the brain; also known as a "mini-stroke"), angina pectoris, or obstruction of the blood vessels to the heart or brain
• if you have or have had circulatory problems (peripheral arterial disease) or if you have undergone surgery on the arteries in your legs.

Warnings and precautions

Consult your doctor before starting to take Meticel:

• if you have previously had a stomach or intestinal ulcer or bleeding (do not take Meticel if you currently have a stomach or intestinal ulcer or bleeding)
• if you are taking acetylsalicylic acid (even at low doses as a cardiac protector)
• if you are taking medicines to reduce blood clotting (e.g. warfarin/anticoagulants analogous to warfarin or new oral anticoagulants, e.g. apixaban)
• if you are taking corticosteroid medicines (e.g. prednisone)
• if you are taking Meticel at the same time as other non-acetylsalicylic NSAIDs such as ibuprofen or diclofenac. The concomitant use of these medicines should be avoided
• if you are a smoker, have diabetes, high blood pressure, or high cholesterol
• if your heart, liver, or kidneys do not work well, your doctor may want to monitor you regularly
• if you have fluid retention (such as swollen feet or ankles)
• if you are dehydrated, for example, due to an illness with vomiting, diarrhea, or the use of diuretics (used to treat excess fluid in the body)
• if you have had a severe allergic reaction or a severe skin reaction to any medicine
• if you feel unwell due to an infection or think you have an infection, as taking Meticel may mask fever or other signs of infection and inflammation
• if you are over 65 years old, your doctor may want to monitor you regularly
• the consumption of alcohol and NSAIDs can increase the risk of gastrointestinal problems.

As with other anti-inflammatory medicines (e.g. ibuprofen or diclofenac), this medicine may increase your blood pressure, so your doctor may perform periodic blood pressure checks.

Some cases of severe liver reactions have been reported with celecoxib, including severe liver inflammation, liver damage, liver failure (some with a fatal outcome or requiring liver transplantation). Of the cases reported when the event started, most severe liver reactions occurred within the first month of treatment.

Meticel may make it difficult to become pregnant. You should inform your doctor if you plan to become pregnant or if you are having difficulty becoming pregnant (see section Pregnancy, breastfeeding, and fertility)

Other medicines and Meticel

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

• Dextromethorphan (used to treat coughs)
• ACE inhibitors or angiotensin II receptor antagonists, beta-blockers, and diuretics (medicines used to treat hypertension and heart failure)
• Fluconazole and rifampicin (used to treat bacterial and fungal infections)
• Warfarin or other warfarin-like medicines (agents that reduce blood clot formation), including newer medicines such as apixaban
• Lithium (used to treat some types of depression)
• Other medicines used to treat depression, sleep disorders, high blood pressure, or irregular heartbeat
• Neuroleptics (used to treat some mental disorders)
• Methotrexate (used in rheumatoid arthritis, psoriasis, and leukemia)
• Carbamazepine (used to treat epilepsy/seizures and some forms of pain or depression)
• Barbiturates (used to treat epilepsy/seizures and some sleep disorders)
• Ciclosporin and tacrolimus (used to suppress the immune system, e.g. after transplants)

Meticel can be taken with low doses of acetylsalicylic acid (75 mg daily or less). Ask your doctor for advice before taking both medicines together.

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.

PregnancyMeticel should not be used by pregnant women or women who may become pregnant (i.e. women of childbearing potential who do not use an adequate contraceptive method) during treatment. If you become pregnant during treatment with Meticel, you should stop treatment and contact your doctor for alternative treatment.

Breastfeeding

Meticel should not be used during breastfeeding.

Fertility

NSAIDs, including Meticel, may make it difficult to become pregnant. You should inform your doctor if you plan to become pregnant or if you are having difficulty becoming pregnant.

Driving and using machines

You should know how you react to Meticel before driving or using machinery. If you feel dizzy or drowsy after taking Meticel, do not drive or operate machinery until these effects have passed.

Meticel 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 Meticel

Follow exactly the administration instructions of this medicine given by your doctor. If you are unsure, consult your doctor or pharmacist again. If you think the effect of Meticel is too strong or too weak, tell your doctor or pharmacist.

Your doctor will tell you what dose to take. Since the risk of side effects associated with heart problems may increase with the dose and duration of treatment, it is important that you use the lowest dose that controls your pain and do not take Meticel for longer than necessary to control the symptoms.

Method of administration

Meticel should be taken orally. The capsules can be taken at any time of day with or without food. However, try to take each dose of Meticel at the same time every day.

If you have difficulty swallowing the capsules: you can sprinkle the entire contents of the capsule onto a spoonful of some semi-solid food (such as apple sauce, rice, yogurt, or mashed banana at room temperature or cold) and swallow it immediately with a glass of water of approximately 240 ml.

To open the capsule, hold it in a vertical position to keep the granules at the bottom; then squeeze the top and twist it to remove it, being careful not to spill the contents. Do not chew or crush the granules.

Contact your doctor if, after two weeks of treatment, you do not experience an improvement.

The recommended dose is:

The usual dose for the treatment of osteoarthritisis 200 mg per day; if necessary, your doctor may increase it up to a maximum of 400 mg.

The dose is usually:

• one 200 mg capsule once a day.

The usual dose for the treatment of rheumatoid arthritisis 200 mg per day (administered in 2 doses); if necessary, your doctor may increase it up to a maximum of 400 mg:

The dose is usually:

• one 100 mg capsule twice a day (this dose of 100 mg of celecoxib twice a day cannot be administered with this medicine. For this treatment regimen, there are other medicines with a concentration of 100 mg of celecoxib. Please consult your doctor).

The usual dose for the treatment of ankylosing spondylitisis 200 mg per day; if necessary, your doctor may increase it up to a maximum of 400 mg.

The dose is usually:

one 200 mg capsule once a day.

Kidney or liver problems:make sure your doctor knows if you have liver or kidney problems, as you may need a lower dose.

Patient over 65 years, especially those weighing less than 50 kg:your doctor may want to monitor you more closely if you are over 65 years old, especially if you weigh less than 50 kg.

Do not take more than 400 mg of celecoxib per day.

Use in children

Meticel is only for adults; it is not indicated in children.

If you take more Meticel than you should

Do not take more capsules than your doctor has told you. If you take more capsules than you should, contact your doctor, pharmacist, or hospital immediately and take the medicine with you.

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

If you forget to take Meticel

If you forget to take a capsule, take it as soon as you remember. Do not take a double dose to make up for forgotten doses.

If you stop taking Meticel

Suddenly stopping treatment with Meticel may cause your symptoms to worsen. Do not stop taking Meticel unless your doctor tells you to. Your doctor will tell you to reduce the dose over a few days before stopping treatment completely.

If you have any other questions about 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.

The adverse effects mentioned below were observed in patients with arthritis who tookcelecoxib. The adverse effects marked with an asterisk (*) occurred in patients who tookcelecoxibfor the prevention of colon polyps and have been classified taking into account the highest frequency of occurrence. The patients included in these studies tookcelecoxibat high doses and for a prolonged period of time.

If you experience any of the following adverse effects, discontinue treatment with Meticel and inform your doctor immediately:

If you have:

• an allergic reaction such as skin rash, swelling of the face, wheezing or difficulty breathing.
• heart problems such as chest pain
• severe stomach pain or any sign of bleeding in the stomach or intestines, such as dark urine or stools stained with blood, or blood in vomit.
• a skin reaction such as rash, blisters or peeling of the skin.
• liver failure (symptoms may include nausea, diarrhea, jaundice (yellowing of the skin and eyes)).

Very common adverse effects:may affect more than 1 in 10 people:

• Increased blood pressure, including worsening of existing high blood pressure*

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

• Heart attack*
• Fluid retention with swelling of ankles, legs and/or hands
• Urinary tract infection
• Difficult breathing*, sinusitis (inflammation and infection of the paranasal sinuses, obstruction or pain of the paranasal sinuses), stuffy nose or runny nose, sore throat, cough, cold, flu-like symptoms.
• Dizziness, difficulty sleeping
• Vomiting*, stomach pain, diarrhea, indigestion, gas
• Rash, itching
• Muscle stiffness
• Difficulty swallowing*
• Headache
• Nausea (feeling of discomfort)
• Pain in the joints
• Worsening of existing allergies
• Accidental injury

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

• Stroke*
• Heart failure, palpitations (perception of heartbeat), rapid heartbeat
• Abnormalities in blood tests related to the liver
• Abnormalities in blood tests related to the kidneys
• Anemia (changes in red blood cells that can cause fatigue and difficulty breathing)
• Anxiety, depression, fatigue, numbness, tingling sensation
• High levels of potassium in blood test results (can cause nausea, fatigue, muscle weakness or palpitations)
• Blurred or altered vision, ringing in the ears, mouth pain and ulcers, difficulty hearing*
• Constipation, belching, stomach inflammation (indigestion, stomach pain or vomiting), worsening of stomach or intestinal inflammation
• Leg cramps
• Rash with itching and relief (urticarial habon)
• Eye inflammation
• Difficulty breathing
• Discoloration of the skin (bruises)
• Chest pain (generalized pain not related to the heart)
• Swelling of the face

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

• Ulcers (bleeding) in the stomach, throat or intestines; or rupture of the intestine (can cause stomach pain, fever, nausea, vomiting, intestinal obstruction), dark or black stools, pancreas inflammation (can cause stomach pain), throat inflammation (can cause difficulty swallowing)
• Low sodium levels in the blood (a disease known as hyponatremia)
• Decrease in the number of white blood cells and platelets in the blood (which can increase the risk of infection and bleeding)
• Difficulty in muscular coordination of movements
• Feeling of confusion, taste disturbances
• Increased sensitivity to light
• Hair loss
• Hallucinations
• Eye bleeding
• Acute reaction that can lead to lung inflammation
• Irregular heartbeat
• Redness of the skin
• Blood clots in the blood vessels of the lungs. Symptoms may include sudden difficulty breathing, sharp chest pain or collapse.
• Stomach or intestinal bleeding (can cause stools or vomit with blood), inflammation of the intestine or colon
• Severe liver inflammation (hepatitis). Symptoms may include nausea, diarrhea, jaundice (yellowing of the skin and eyes), dark urine, pale stools, ease of bleeding, itching or chills
• Acute kidney failure
• Menstrual disorders
• Swelling of the face, lips, mouth, tongue or throat or difficulty swallowing

Very rare adverse effects: may affect up to 1 in 10,000 people:

• Severe allergic reactions (including potentially fatal anaphylactic shock)
• Severe skin disorders, such as Stevens-Johnson syndrome, exfoliative dermatitis and toxic epidermal necrolysis (can cause rash, blistering or peeling of the skin) and acute generalized exanthematous pustulosis (symptoms include redness of the skin with swollen areas and numerous small pustules)
• A late-onset allergic reaction with possible symptoms such as rash, swelling of the face, fever, swollen glands and abnormalities in clinical test results (e.g. liver, blood cells (eosinophilia, a type of increase in blood cell count))
• Bleeding in the brain that causes death
• Meningitis (inflammation of the membrane that surrounds the brain and spinal cord)
• Liver failure, liver damage and severe liver inflammation (fulminant hepatitis) (sometimes with fatal outcome or requiring liver transplant). Symptoms may include nausea, diarrhea, jaundice (yellowing of the skin and eyes), dark urine, pale stools, ease of bleeding, itching or chills
• Liver problems (such as cholestasis and cholestatic hepatitis, which may be accompanied by symptoms such as discolored stools, nausea and yellowing of the skin or eyes)
• Kidney inflammation and other kidney problems (such as nephrotic syndrome and minimal change disease, which may be accompanied by symptoms such as fluid retention (edema), foamy urine, fatigue and loss of appetite)
• Worsening of epilepsy (possibly more frequent and/or severe seizures)
• Obstruction of an artery or vein in the eye that leads to partial or complete loss of vision
• Inflammation of the blood vessels (can cause fever, pain, purple spots on the skin)
• Reduction in the number of red and white blood cells and platelets (can cause fatigue, ease of bruising, frequent nosebleeds and increased risk of infection)
• Muscle pain and weakness
• Taste disturbance
• Loss of taste

Adverse effects of unknown frequency: the frequency cannot be estimated from the available data:

• Decrease in female fertility, which is normally reversible if the medication is discontinued

Adverse effects reported in clinical trials in whichcelecoxibwas administered at a dose of 400mg per day fora period of up to3 years, in patients with diseases unrelated to arthritis or other arthritic conditions,were:

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

• Heart problems: angina pectoris (chest pain)
• Stomach problems: irritable bowel syndrome (may include abdominal pain, diarrhea, indigestion and gas)
• Kidney stones (which can lead to stomach or back pain, blood in the urine), difficulty urinating
• Weight gain

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

• Deep vein thrombosis (blood clotting usually in the leg, which can cause pain, swelling or redness of the calf or breathing problems)
• Stomach problems: stomach infection (which can cause irritation or ulcers in the stomach and intestine)
• Fracture of lower limbs
• Herpes, skin infection, eczema (dry rash with itching), pneumonia (infection in the chest (possibility of cough, fever, difficulty breathing)
• Floaters in the eye that cause vision disturbance or blurred vision, vertigo due to problems in the inner ear, ulcers, inflammation or bleeding of the gums, ulcers in the mouth.
• Excessive urination at night, bleeding from hemorrhoids, frequent bowel movement
• Fat lumps on the skin or other areas, ganglion cyst (painless inflammation in the joints or tendons or around them, in the hand or foot) difficulty speaking, abnormal or heavy vaginal bleeding, chest pain
• High levels of sodium in blood test results.

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 them 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 Meticel

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

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

Do not store at a temperature above 30°C.

Medicines should not be thrown away through wastewater or household waste. Deposit the packaging and medicines that you no longer need at the SIGRE point of the pharmacy. In case of doubt, ask your pharmacist how to dispose of the packaging and medicines that you no longer need. This way, you will help protect the environment.

6. Package contents and additional information

Composition of Meticel

• The active ingredient is celecoxib. Each capsule contains 200 mg of celecoxib.
• The other ingredients are: lactose monohydrate, sodium lauryl sulfate, povidone K30, sodium croscarmellose, magnesium stearate (see section 2, Meticel contains lactose).

The capsule shell contains gelatin and titanium dioxide (E171).

Appearance of the product and package contents

Meticel is presented in the form of hard capsules.

The capsules are opaque and white in color.

The capsules are presented in PVC-aluminum blisters.

Meticel is presented in packages containing 30 capsules

Marketing authorization holder and manufacturer

Laboratorios Alter, S.A.

Mateo Inurria, 30

28036 Madrid

Spain

Date of the last revision of this prospectus: August 2018.

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/