MIRTAZAPINE SANDOZ 15 mg FILM-COATED TABLETS

Introduction

Package Leaflet: Information for the Patient

Mirtazapine Sandoz 15 mg film-coated tablets EFG

Mirtazapine Sandoz 30 mg film-coated tablets EFG

Mirtazapine Sandoz 45 mg film-coated tablets EFG

mirtazapine

Read the entire package leaflet carefully before you start taking this medicine, as it contains important information for you.

• Keep this package 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 symptoms are the same as yours.
• If you experience any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this package leaflet. See section 4.

Contents of the package leaflet

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

1. What is Mirtazapine Sandoz and what is it used for

Mirtazapine belongs to a group of medicines called antidepressants.

Mirtazapine is used to treat depression in adults.

It may take 1 to 2 weeks before mirtazapine starts to work. After 2 to 4 weeks, you may start to feel better. You should see your doctor if you get worse or do not improve after 2 to 4 weeks.

For more information, see section 3 "When can you expect to feel better".

2. What you need to know before you take Mirtazapine Sandoz

Do not takeMirtazapine Sandoz

• if you are allergic to mirtazapine or any of the other ingredients of this medicine (listed in section 6). In this case, consult your doctor as soon as possible before taking this medicine.
• if you are taking or have taken in the last two weeks medicines called monoamine oxidase inhibitors (MAOIs).

Warnings and precautions

Consult your doctor or pharmacist before starting to take mirtazapine

Tell your doctor before taking Mirtazapine Sandoz:

If you have ever suffered from a severe skin rash, skin peeling, and/or sores in the mouth after taking mirtazapine.

Children and adolescents

Mirtazapine should not normally be used in the treatment of children and adolescents under 18 years of age because it has not been shown to be effective. At the same time, you should know that in patients under 18 years of age, there is a greater risk of adverse effects such as suicidal attempts, suicidal ideation, and hostility (mainly aggression, confrontational behavior, and irritation) when taking this class of medicines. Nevertheless, your doctor may prescribe mirtazapine to patients under 18 years of age when they decide what is best for the patient. If your doctor has prescribed mirtazapine to a patient under 18 years of age and you want to discuss this decision, please go back to your doctor. You should inform your doctor if any of the symptoms mentioned above appear or worsen in patients under 18 years of age who are taking mirtazapine. Additionally, the long-term safety effects on growth, maturity, and development of knowledge and behavior of mirtazapine in this age group are not yet known. It has also been observed that in this age group, when treated with mirtazapine, there is a more frequent and significant weight gain compared to adults.

Suicidal thoughts and worsening of depression

If you are depressed, you may sometimes have thoughts of harming yourself or of suicide. This could get worse when you first start taking antidepressants, as these medicines usually take two weeks or sometimes more to work.

You may be more likely to think this way:

• if you have previously had thoughts of suicide or of harming yourself,
• if you are a young adult. Clinical trial data have shown an increased risk of suicidal behavior in adults under 25 years of age with psychiatric disorders who are being treated with an antidepressant.

If you have thoughts of harming yourself or of suicide at any time, contact your doctor or go to a hospital immediately.

It may be helpful to tell a relative or close friendthat you are depressed, and ask them to read this package leaflet. You can ask them to tell you if they think your depression is getting worse, or if they are worried about changes in your behavior.

Also, be very careful with mirtazapine

• if you have or have ever had any of the following conditions:

Tell your doctor about these situations before taking mirtazapine, if you have not already done so.

• • seizures (epilepsy). If seizures occur or your seizures become more frequent, stop taking mirtazapine and contact your doctor immediately;
  • liver disease, including jaundice. If you develop jaundice, stop taking mirtazapine and contact your doctor immediately;
  • kidney disease;
  • heart disease or low blood pressure;
  • schizophrenia. If psychotic symptoms, such as paranoid thoughts, become more frequent or severe, contact your doctor immediately;
  • bipolar depression(alternating periods of excitement/hyperactivity and periods of depression). If you start to feel excited or overexcited, stop taking mirtazapine and contact your doctor immediately;
  • diabetes(you may need to adjust your insulin or other antidiabetic medication dose);
  • eye diseases, such as increased pressure in the eye (glaucoma);
  • difficulty urinating, which may be due to an enlarged prostate;
  • certain types of heart diseasethat can change the rhythm of your heart, a recent heart attack, heart failure, or taking certain medications that can affect heart rhythm.
• if signs of infection appear, such as unexplained high fever, sore throat, and mouth sores.

Stop taking mirtazapine and contact your doctor immediately to have a blood test.

In rare cases, these symptoms can be signs of changes in blood cell production in the bone marrow. Although rare, these symptoms usually appear between 4 and 6 weeks of treatment.

• if you are an elderly patient. You may be more sensitive to the adverse effects of antidepressant medicines,
• With the use of mirtazapine, serious skin reactions have been reported, such as Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and drug reaction with eosinophilia and systemic symptoms (DRESS). Discontinue use and seek medical attention immediately if you notice any of the symptoms described in section 4 related to these serious skin reactions.

If you have ever suffered from serious skin reactions, you should not restart treatment with mirtazapine.

Other medicines andMirtazapine Sandoz

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

Do not takeMirtazapine Sandozwith:

• monoamine oxidase inhibitors (MAOIs). Also, do not take mirtazapine during the two weeks after you stop taking MAOIs. If you stop taking mirtazapine, do not take MAOIs during the following two weeks.

Examples of MAOIs are moclobemide, tranylcypromine (both are antidepressants), and selegiline (for Parkinson's disease).

Be careful ifyou take mirtazapine with:

• antidepressants such as selective serotonin reuptake inhibitors (SSRIs), venlafaxine, and L-tryptophan or triptans(used to treat migraine), buprenorphine(used to treat pain or opioid dependence), tramadol(for pain), linezolid(an antibiotic), lithium(used to treat certain psychiatric disorders), methylene blue(used to treat high levels of methemoglobin in the blood), and St. John's Wort (Hypericum perforatum)- herbal medicine for depression. In rare cases, mirtazapine alone or with these medicines can cause a condition called serotonin syndrome. Some symptoms of this syndrome are: unexplained fever, sweating, palpitations, diarrhea, muscle contractions (involuntary), shivering, exaggerated reflexes, agitation, mood changes, and loss of consciousness. If you experience a combination of these symptoms, contact your doctor immediately,
• the antidepressant nefazodone. It can increase the amount of mirtazapine in the blood. Tell your doctor if you are taking this medicine. It may be necessary to decrease the dose of mirtazapine or increase it again when stopping nefazodone,
• medicines for anxiety or insomniasuch as benzodiazepines,
• medicines for schizophreniasuch as olanzapine,
• medicines for allergiessuch as cetirizine,
• medicines for severe painsuch as morphine.

When combined with these medicines, mirtazapine can increase the drowsiness caused by these medicines,

• medicines for infections: medicines for bacterial infections (such as erythromycin), medicines for fungal infections (such as ketoconazole), and medicines for HIV/AIDS (HIV protease inhibitors) and medicines for stomach ulcers(such as cimetidine).

If taken with mirtazapine, these medicines can increase the amount of mirtazapine in the blood. Tell your doctor if you are taking these medicines. It may be necessary to decrease the dose of mirtazapine or increase it again when stopping these medicines,

• medicines for epilepsysuch as carbamazepine and phenytoin,
• medicines for tuberculosissuch as rifampicin.

If taken with mirtazapine, these medicines can decrease the amount of mirtazapine in the blood. Tell your doctor if you are taking these medicines. It may be necessary to increase the dose of mirtazapine or decrease it again when stopping these medicines,

• medicines to prevent blood clottingsuch as warfarin.

Mirtazapine can increase the effects of warfarin in the blood. Tell your doctor if you are taking this medicine. In case of taking them together, it is recommended that your doctor perform blood tests,

• medicines that can affect heart rhythm, such as certain antibiotics and some antipsychotics.

Taking Mirtazapine Sandoz with food and alcohol

You may feel drowsy if you drink alcohol while being treated with mirtazapine.

It is recommended not to drink any alcohol.

Pregnancy and breast-feeding

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

Limited experience with the administration of mirtazapine to pregnant women does not indicate an increased risk. However, caution should be exercised when used during pregnancy.

If you use mirtazapine until or shortly before delivery, your baby will be examined for possible adverse effects.

When taken during pregnancy, similar medicines (SSRIs) may increase the risk of a serious disease called persistent pulmonary hypertension in newborns (PPHN) in babies, which makes the baby breathe faster and acquire a bluish tone. These symptoms usually start during the first 24 hours after birth. If this happens to your baby, you should consult your midwife and/or doctor immediately.

Driving and using machines

Mirtazapine can affect your concentration or alertness. Make sure your abilities are not affected before driving or using machinery. If your doctor has prescribed mirtazapine to a patient under 18 years of age, make sure that concentration and alertness are not affected before cycling (for example).

Mirtazapine Sandoz contains lactose

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

3. How to take Mirtazapine Sandoz

Follow the exact instructions for administration of this medicine as indicated by your doctor or pharmacist. In case of doubt, consult your doctor or pharmacist again.

How much to take

The recommended initial dose is 15 or 30 mg per day.Your doctor may recommend increasing the dose after a few days to the amount that is best for you (between 15 and 45 mg per day). The dose is usually the same for all ages. However, if you are an elderly patient or have kidney or liver disease, your doctor may change the dose.

When to take Mirtazapine Sandoz

Take mirtazapine at the same time each day.It is best to take the dose of mirtazapine once before going to bed. However, your doctor may recommend that you divide your dose of mirtazapine in the morning and before going to bed. The highest dose should be taken before going to bed.

The tablets are taken orally. Take the prescribed dose of mirtazapine without chewing, with water or juice.

Mirtazapine Sandoz 15 mg film-coated tablets EFGand Mirtazapine Sandoz 30 mg film-coated tablets EFG:

The tablet can be divided into equal doses.

When can you expect to feel better

Normally, mirtazapine will start to work after 1 or 2 weeks, and after 2 to 4 weeks, you may start to feel better.

It is important that during the first few weeks of treatment, you talk to your doctor about the effects of mirtazapine:

Between 2 and 4 weeks after starting to take mirtazapine, talk to your doctor about how this medicine has affected you.

If you still do not feel better, your doctor may prescribe a higher dose. In that case, talk to your doctor again after another 2 or 4 weeks.

Normally, you will need to take mirtazapine until the symptoms of depression have disappeared for 4 or 6 months.

If you take more Mirtazapine Sandoz than you should

If you or someone else takes too much mirtazapine, consult a doctor immediately, a pharmacist, or call the Toxicology Information Service, phone: 91 562 04 20, indicating the medicine and the amount used.

The most likely symptoms of a mirtazapine overdose (without other medicines or alcohol) are drowsiness, disorientation, and palpitations. The symptoms of a possible overdose may include changes in the rhythm of your heart (fast, irregular heartbeat) and/or fainting, which could be symptoms of a potentially life-threatening condition known as Torsades de Pointes.

In case of overdose or accidental ingestion, consult your doctor or pharmacist immediately or call the Toxicology Information Service, phone: 91 562 04 20, indicating the medicine and the amount ingested.

If you forget to take Mirtazapine Sandoz

If you have to take your dose once a day

• do not take a dose to make up for the forgotten doses. Take the next dose at the usual time.

If you have to take your dose twice a day

• if you have forgotten the morning dose, simply take it with the evening dose,
• if you have forgotten the evening dose, do not take it the next morning; skip it and continue with your normal doses in the morning and evening,
• if you have forgotten both doses, do not try to make them up. Skip both doses and the next day continue with your normal dose in the morning and evening.

If you stop taking Mirtazapine Sandoz

Only stop taking mirtazapine if you have consulted your doctor.

If you stop too soon, depression may come back. When you feel better, talk to your doctor. Your doctor will decide when you can stop treatment.

Do not stop taking mirtazapine abruptly, even if depression has disappeared. If you stop taking mirtazapine abruptly, you may feel unwell, dizzy, agitated, or anxious, and have headaches. These symptoms can be avoided by gradually stopping treatment. Your doctor will tell you how to gradually decrease the dose.

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.

If you experience any of the following serious adverse effects, stop taking mirtazapine and inform your doctor immediately.

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

• feeling of exaggerated euphoria (mania).

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

• yellowing of the eyes or skin; may suggest liver function alterations (jaundice).

Frequency Not Known(cannot be estimated from the available data):

• signs of infection such as high unexplained and sudden fever, sore throat, and mouth ulcers (agranulocytosis). In rare cases, mirtazapine can cause alterations in blood cell production (bone marrow depression). Some people become less resistant to infections because mirtazapine can cause a temporary decrease in white blood cells (granulocytopenia). In rare cases, mirtazapine can also cause a decrease in red and white blood cells and platelets (aplastic anemia), a decrease in platelets (thrombocytopenia), or an increase in the number of white blood cells in the blood (eosinophilia),
• epileptic seizure (convulsions),
• combination of symptoms such as unexplained fever, sweating, palpitations, diarrhea, muscle contractions (involuntary), chills, exaggerated reflexes, agitation, mood changes, loss of consciousness, and increased saliva production. In very rare cases, these symptoms can be signs of a disorder called "serotonin syndrome",
• thoughts of self-harm or suicide,
• severe skin reactions:
• • red patches on the torso, like circumscribed or circular macules, often with blisters in the center, 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 or drug hypersensitivity syndrome).

Other Possible Adverse Effects with Mirtazapine Are:

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

• increased appetite and weight gain,
• drowsiness,
• headache,
• dry mouth.

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

• lethargy,
• dizziness,
• agitation or tremor,
• nausea,
• diarrhea,
• vomiting,
• constipation,
• urticaria or skin eruptions (exanthema),
• joint pain (arthralgia) or muscle pain (myalgia),
• back pain,
• dizziness or fainting when standing up quickly (orthostatic hypotension),
• swelling (usually in ankles or feet) due to fluid retention (edema),
• fatigue,
• vivid dreams,
• confusion,
• anxiety,
• difficulty sleeping,
• memory problems, which in most cases were resolved when treatment was discontinued.

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

• strange sensation in the skin, such as burning, pinching, tingling, or numbness (paresthesia),
• involuntary movements of leg agitation,
• fainting (syncope),
• numbness in the mouth (oral hypoesthesia),
• low tension,
• nightmares,
• agitation,
• hallucinations,
• inability to remain still.

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

• twitching or muscle contractions (myoclonus),
• aggression,
• abdominal pain, nausea; this may indicate pancreas inflammation (pancreatitis).

Frequency Not Known(cannot be estimated from the available data):

• abnormal sensations in the mouth (oral paresthesia),
• swelling in the mouth (oral edema),
• swelling throughout the body (generalized edema),
• localized swelling,
• hyponatremia,
• inadequate secretion of antidiuretic hormone,
• severe skin reactions (bullous dermatitis, erythema multiforme),
• sleepwalking (somnambulism),
• speech disorders,
• increased creatine kinase levels in the blood,
• difficulty urinating (urinary retention),
• muscle pain, stiffness, and/or weakness, darkening or discoloration of urine (rhabdomyolysis),
• increased prolactin hormone levels in the blood (hyperprolactinemia, including symptoms of breast enlargement and/or milky discharge from the nipple).
• painful and prolonged erection of the penis.

Other Adverse Effects in Children and Adolescents

In individuals under 18 years of age, the following adverse effects were frequently observed in clinical trials: significant weight gain, urticaria, and increased triglycerides in the blood.

Reporting 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. Conservation of Mirtazapine Sandoz

Keep this medicine out of sight and reach of children.

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

No special storage conditions are required.

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

6. Package Contents and Additional Information

Composition ofMirtazapine Placasod

The active ingredient is mirtazapine.

Mirtazapine Placasod 15 mg film-coated tablets EFG

Each film-coated tablet contains 15 mg of mirtazapine.

Mirtazapine Placasod 30 mg film-coated tablets EFG

Each film-coated tablet contains 30 mg of mirtazapine.

Mirtazapine Placasod 45 mg film-coated tablets EFG

Each film-coated tablet contains 45 mg of mirtazapine.

The other components are:

Core of the tablet: lactose monohydrate, corn starch, hypromellose, anhydrous colloidal silica, magnesium stearate.

Coating: hypromellose (E 464), macrogol (E 1521), titanium dioxide (E 171).

Mirtazapine Placasod 15 mg film-coated tablets EFG

yellow iron oxide (E 172).

Mirtazapine Placasod 30 mg film-coated tablets EFG

yellow iron oxide (E 172), red iron oxide (E 172).

Appearance of the Product and Package Contents

Film-coated tablets.

Mirtazapine Placasod 15 mg film-coated tablets EFG

Film-coated tablet, yellow in color, oval, biconvex, approximately 10 mm x 6 mm, with the inscription "MH" in relief on one side and "1" and "5" on the other, separated by a score line.

Mirtazapine Placasod 30 mg film-coated tablets EFG

Film-coated tablet, reddish-brown in color, oval, biconvex, approximately 13 mm x 7 mm, with the inscription "MH" in relief on one side and "3" and "0" on the other, separated by a score line.

Mirtazapine Placasod 45 mg film-coated tablets EFG

Film-coated tablet, white in color, oval, biconvex, approximately 14 mm x 8 mm, with the inscription "MH" in relief on one side and "45" on the other.

Package sizes:

White opaque PVC/Al blister: 20, 30, 60, 100, 105 film-coated tablets.

HDPE bottle with PP cap: 250 film-coated tablets.

Not all package sizes may be marketed.

Marketing Authorization Holder and Manufacturer

Marketing Authorization Holder

Sandoz Farmacéutica, S.A.

Centro Empresarial Parque Norte

Edificio Roble

C/ Serrano Galvache, 56

28033 Madrid

Spain

Manufacturer

Pharmadox Healthcare Ltd.,

KW20A Kordin Industrial Park

Paola, PLA 3000,

Malta

or

Salutas Pharma GmbH

Otto-von-Guericke-Allee 1,

39179 Berleben, Sachsen-Anhalt

Germany

or

Lek pharmaceuticals D.D

Verovškova Ulica 57,

Ljubljana, 1526

Slovenia

Date of the Last Revision of this Prospectus:02/2024.

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