Package Insert: Information for the Patient

Paliperidona ratiopharm 3 mg prolonged-release tablets EFG

Paliperidona ratiopharm 6 mg prolonged-release tablets EFG

Paliperidona ratiopharm 9 mg prolonged-release tablets EFG

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 are not listed in this package insert. See section 4.

Paliperidone ratiopharm contains the active ingredient paliperidone which belongs to the class ofmedicamentosantipsicóticos.

Paliperidone is used to treat schizophrenia in adults and adolescents aged 15 years and older.

Schizophrenia is a disorder that causes symptoms that include hearing, seeing or feeling things thatdonotexist, having false beliefs, having an abnormal distrust, withdrawing into oneself,speaking incoherently and flattening of behavior and emotion. People with this disorder may also feeldepressed,anxious,guiltyotense.

Paliperidone is also used to treat schizoaffective disorder in adults.

Schizoaffective disorder is a mental condition in which the person experiences several of the symptoms ofschizophrenia(enumeratedin the previous paragraph) plus symptoms of mood disorder (feeling of euphoria, sadness, agitation, beingdistracted, insomnia, excessive or reduced speech, excessive or reduced appetite, excessive or reduced sleep, and recurrent thoughts ofsuicidedo).

Paliperidone may help alleviate the symptoms of your illness and prevent it from recurring.

Do not takepaliperidone

-if you are allergic to paliperidone, risperidone, or any of the other ingredients in thismedicine(listed in section6).

Warnings andprecautions

Consult your doctor or pharmacist before starting to take paliperidone.

• Patients with schizoaffective disorder treated with this medication should be closely monitored for a potential change from manic to depressive symptoms.
• This medication has not been studied in elderly patients with dementia. However, elderly patients with dementia, who are treated with similar medications, may have an increased risk of stroke or death (see section 4, Possible side effects)
• if you have Parkinson's disease or dementia.
• if you have ever been diagnosed with a condition whose symptoms are high fever and muscle rigidity (also known as neuroleptic malignant syndrome).
• if you have ever experienced abnormal movements of the tongue or face (tardive dyskinesia). You should know that these two conditions may be caused by this type of medication.
• if you have had low white blood cell counts in the past (which may or may not have been caused by other medications)
• if you are diabetic or have a tendency to develop diabetes.
• if you have any heart disease or if you are receiving treatment for heart diseases that may make you more prone to a drop in blood pressure.
• if you have epilepsy.
• if you have any disorders of swallowing, stomach, or intestines that reduce your ability to swallow food or digest it normally.
• if you have diseases associated with diarrhea.
• if you have kidney problems.
• if you have liver problems.
• if you have a prolonged and painful erection.
• if you have difficulty controlling your body temperature or are overheated.
• if you have an abnormally high level of prolactin in your blood or if you have a tumor that may be dependent on prolactin.
• if you or a family member has a history of blood clots, as antipsychotics are associated with blood clot formation.

If you have any of these conditions, please consult your doctor as you may need to adjust your dose or be monitored for a period of time.

Because, in very rare cases, a dangerously low number of a type of white blood cells necessary to fight infections in the blood has been observed in patients treated with paliperidone, your doctor may check the number of white blood cells in your blood.

Paliperidone may cause you to gain weight. Significant weight gain can negatively affect your health. Your doctor will regularly monitor your weight.

In patients treated with paliperidone, diabetes mellitus or worsening of existing diabetes mellitus has been observed. Your doctor should check for signs of increased blood sugar.In patients with pre-existing diabetes mellitus, blood sugar should be regularly monitored.

During cataract surgery in the eye, the pupil (the black circle in the middle of the eye) may not dilate as needed. Additionally, the iris (the colored part of the eye) may become flaccid during surgery and this may cause eye damage.If you are planning to have eye surgery, be sure to inform your ophthalmologist that you are taking thismedicine.

Children andadolescents

Paliperidone should not be administered to children and adolescents under 15 years of age for the treatment ofschizophrenia.

Paliperidone should not be administered to children and adolescents under 18 years of age for the treatment ofschizoaffectivedisorder.

This is because the safety and efficacy of paliperidone in this age group are unknown.

Othermedications and paliperidone

Inform your doctor or pharmacist if you are using, have used recently, or may take othermedicines.

Abnormalities in heart function may occur when this medication is taken with other medications for heart rhythm control or other medications such as antihistamines, antimalarials, orantipsicótics.

Since this medication primarily acts on the brain, this medication may interfere with other medications (or alcohol) that also act on it, due to the sum of effects onbrainfunction.

This medication may lower blood pressure, so you should be careful if you take this medication with other medications that also lowerbloodpressure.

This medication may reduce the effect of medications for Parkinson's disease and restless legs syndrome (e.g.,levodopa).

The effects of this medication may be affected if you take medications that influence the speed of intestinal movement (e.g.,metoclopramida).

Reduction of this medication dose should be considered when administered withvalproato.

The use of oral risperidone with this medication is not recommended as this combination may cause an increase in adverse effects.

Paliperidone should be used with caution with medications that increase the activity of the central nervous system (psycho-stimulants such as metilphenidato).

Paliperidone and alcohol

You should avoid consuming alcohol during treatment with thismedicine.

Pregnancy andlactation

If you are pregnant or breastfeeding, or if you think you may be pregnant or plan to become pregnant, consult your doctor or pharmacist before taking thismedicine.

You should not take this medication during pregnancy unless you have discussed it with your doctor.

The following symptoms may occur in newborn babies of mothers who have been treated with paliperidone in the last trimester of pregnancy (last three months of pregnancy): tremor, rigidity, and/or muscle weakness, drowsiness, agitation, breathing problems, and difficulty feeding. If your baby develops any of these symptoms, you should contact your doctor.

You should not breastfeed your child while taking this medication.

Driving andoperatingmachinery

During treatment with this medication, dizziness and vision problems may occur (see section 4, Possible side effects). This should be taken into account when requiring maximum attention, for example, when driving or operatingmachinery.

Paliperidone ratiopharm contains sodium

This medication contains less than 1 mmol of sodium (23 mg) per tablet, which may be considered "sodium-free".

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

Use in adults

The recommended dose in adults is 6 mg once a day in the morning. Your doctor may increase or decrease it within the dosing interval of 3 mg to 12 mg once a day in case of schizophrenia or 6 mg to 12 mg once a day in case of schizoaffective disorder. This depends on how well the medication works for you.

Use in adolescents and children

The recommended starting dose for the treatment of schizophrenia in adolescents aged 15 years or older is 3 mg once a day taken in the morning.

For adolescents weighing 51 kg or more, the dose can be increased within the interval of 6 mg to 12 mg once a day.

For adolescents weighing less than 51 kg, the dose can be increased to 6 mg once a day.

Your doctor will decide how much to administer to you. The amount you take depends on how well the medication works for you.

How and when to take paliperidone

This medication should be taken by mouth, swallowed whole with water or other liquids. It should not be chewed, broken, or crushed.

This medication should be taken in the mornings with breakfast or on an empty stomach, but in the same way every day. Do not alternate between taking the medication with breakfast and on an empty stomach the next day.

The active ingredient, paliperidone, dissolves once swallowed, and the coating of the tablet is eliminated from the body by the kidneys.

Patients with kidney problems

Your doctor may adjust your dose of this medication according to your kidney function.

Patients of advanced age

Your doctor may reduce your medication dose if your kidney function is reduced.

If you take more paliperidone than you should

In case of overdose or accidental ingestion, consult your doctor, pharmacist, or go to the nearest hospital immediately, or call the Toxicological Information Service. Phone: 91 562 04 20 indicating the medication and the amount ingested. You may experience drowsiness, confusion, abnormal body movements, difficulty staying upright and walking, dizziness due to reduced blood pressure, and alterations in heartbeats.

If you forgot to take paliperidone

Do not take a double dose to compensate for the missed doses. If you forget a dose, take the next dose the next day. If you forget two or more doses, contact your doctor.

If you interrupt the treatment with paliperidone

Do not stop taking this medication as you will lose the effects of the medication. Do not stop taking this medication unless your doctor tells you to, as the symptoms may reappear.

If you have any other doubts about the use of this medication, ask your doctor, pharmacist, or nurse.

Like all medicines, this medicine can cause side effects, althoughnotall people experience them.

Inform your doctor immediately if you experience any of the following:

•you develop blood clots in your veins, especially in your legs (symptoms include swelling, pain, and redness of the leg), which can travel through the blood vessels to your lungs, causing chest pain and difficulty breathing. If you notice any of these symptoms, seek medical adviceimmediately.

•you have dementia and experience a sudden change in your mental state or sudden weaknessornumbness in your face, arms, or legs, especially on one side, or difficulty speaking even for a short period of time. These may be signs of a heart attackcerebral.

•you develop fever, muscle stiffness, sweating, or a decrease in your level ofconsciousness(a condition known as “Neuroleptic Malignant Syndrome”). You may needtreatmentmedical

•you are a man and experience a prolonged or painful erection. This is known as priapism.You may need medicaltreatment

•you experience involuntary rhythmic movements of your tongue, mouth, and face. You may need toretirepaliperidona

•you experience a severe allergic reaction characterized by fever, swelling of the mouth, face, lips, or tongue, difficulty breathing, hives, skin rash, and sometimes a decrease in blood pressure (i.e., anaphylacticreaction).

Very common (may affect more than 1 in 10patients)

• difficulty staying or remainingdomint
• parkinsonism: This disease may include slow or altered movement, a feeling ofrigidityor stiffness of the muscles (making sudden movements) and sometimes a feeling of “freezing” of the movement that then restarts. Other signs of parkinsonism include walking slowly dragging the feet, trembling whiledescansa,increased saliva and/or drooling, and loss of facialexpressivity
• inquietud
• feeling drowsy or lessatent
• back pain

Common side effects (may affect up to 1 in 10patients)

• chest infection (bronchitis), common cold symptoms, nasal infection, urinary tract infection, feeling like you havegripe
• weight gain, increased appetite, weight loss, decreased appetite
• euphoria (mania), irritability, depression,ansied
• dystonia: This disease involves involuntary slow or continuous muscle contraction. Although it can affect any part of the body (and may cause abnormal postures), dystonia most commonly affects the facial muscles, including abnormal movements of the eyes, mouth, tongue, ormandibular
• dizziness
• discinesia: This disease involves involuntary muscle movements and may include repetitive, spasmodic, or twisting movements, orespasms
• tremor(agitación)
• blurred vision
• interrupted conduction between the upper and lower parts of the heart, cardiac conduction anomalies, prolonged QT interval in the heart, heart rate, rapid heart rate of thecorazón
• decreased blood pressure when standing (as a result, some people taking paliperidone may feel weakness, dizziness, or loss of consciousness when standing up or sitting down suddenly), increased bloodarterial
• throat pain, cough, nasal congestion
• abdominal pain, nausea, vomiting, constipation, diarrhea, indigestion, dry mouth, jaw pain
• increased liver transaminases in thesangre
• itching, skin rash
• bone or muscle pain, back pain, joint pain
• loss of menstrual periods
• fever, weakness, fatigue(cansancio)

Rare side effects (may affect up to 1 in 100patients)

• lung infection, respiratory tract infection, urinary tract infection, ear infection,anginas
• decreased white blood cell count, decreased platelet count(células

• of the blood that help stop bleeding), anemia, decreased red blood cell count in thesangre
• Paliperidone may increase levels of a hormone called “prolactin” that is detected inlosanalisesdesangre(whichmayornotherallyorleadingtolevelsofprolactin(leadingtolevelsofprolactin)
• diabetes or worsening of diabetes, increased blood sugar, increased blood glucose, weight loss, decreased appetite leading to malnutrition and weight loss, increased triglycerides in the blood (a type ofgrasa)
• sleep disorder, confusion, decreased libido, inability to achieve orgasm, nervousness,pesadillas
• late discinesia (spasms or involuntary movements that cannot be controlled in the face, tongue, or other parts of the body). Inform your doctor immediately if you experience involuntary rhythmic movements of your tongue, mouth, or face. You may need toretirepaliperidona
• seizures (epileptic crises), fainting, restlessness causing movement of parts of the body, dizziness when standing up, altered attention, speech problems,pérdidaoalterations of taste, decreased sensitivity of the skin to pain or touch,sensaciónof pins and needles, numbness of thepiel
• light sensitivity of the eyes, eye infection, or “red eye”, dry eyes
• sensation of spinning (dizziness), ringing in the ears, ear pain
• irregular heartbeat, cardiac conduction anomalies(electrocardiogramaoECG), sensation of fluttering or pounding in the chest(palpitacions)
• decreased blood pressure
• interrupted breathing, gasping, bleedingnasales
• swelling of the tongue, stomach or intestinal infection, difficulty swallowing, excessive gas orflatulencia
• increased GGT (a liver enzyme called gamma-glutamiltransferase) in thesangre,increased liver enzymes in thesangre
• hives, hair loss, eczema,acne
• increased CPK (creatine phosphokinase) in the blood, an enzyme that sometimes is released with muscle breakdown, muscle spasms, joint stiffness, swelling of the joints, muscle weakness, muscle pain
• urinary incontinence, frequent urination, inability to urinate, painful urination
• erectile dysfunction, sexual dysfunction
• loss of menstrual periods or other menstrual cycle problems (women), milk secretion by the breasts, sexual dysfunction, breast pain, breast discomfort
• swelling of the face, mouth, eyes, or lips, swelling of the body, arms, orpiernas
• chills, increased body temperature
• change in bowel movements
• sensation ofsed
• chest pain, chest discomfort, sensation ofmalestar
• falls

Rare side effects (may affect up to 1 in 1,000patients)

• eye infection, fungal infection of the nails, skin infection, inflammation of the skin caused byácaros
• dangerously low count of a type of white blood cell necessary forcombatirinfecciones
• decreased count of a type of white blood cell that helps fightinfecciones,increased eosinophils (a type of white blood cell) in thesangre
• severe allergic reaction characterized by fever, swelling of the mouth, face, lips, or tongue, difficulty breathing, hives, skin rash, and sometimes decreased blood pressure, anaphylacticreaction).
• high blood sugar in theorina
• inappropriate secretion of a hormone that controls the volume oforina
• complications of uncontrolled diabetes with a risk tolife
• excessive water intake, dangerously low blood sugar, excessive water intake, increased cholesterol in thesangre
• sleepwalking
• lack of movement or response while awake (catatonia)
• absence ofemociones
• neuroleptic malignant syndrome (confusion, decreased or lost consciousness, high fever, and severe musclegraveressesstress
• loss of consciousness, balance, coordinationanormal
• problems in the blood vessels of the brain, coma due to uncontrolled diabetes,sinresponse to stimuli, decreased level of consciousness, agitation of thecabeza
• glaucoma (increased pressure of the eyeball), increased tear production, eye redness, eye movement problems, eyegiro
• atrial fibrillation (abnormal heart rhythm), rapid heart rate when standing up
• blood clots in the veins, especially in the legs (symptoms include swelling, pain, and redness of the leg), which can travel through the blood vessels to the lungs, causing chest pain and difficulty breathing. If you experience any of these symptoms, seek medical adviceimmediately.
• decreased oxygen in parts of the body (due to decreased blood flow), flushing
• problems with breathing during sleep (sleep apnea), rapid breathing,superficial
• lung infection caused by aspiration of food, respiratory tract congestion, voice disorder
• intestinal obstruction, fecal incontinence, hard stools, absence of intestinal movement causingobstrucción
• yellow skin and eyes(ictericia)
• inflammation of thepáncreas
• severe allergic reaction with swelling, which can affect the throat causingdificultad respiratoria
• skin thickening, skin dryness, skin redness, skin discoloration, scaly skin with itching, skin or scalpcaspa
• muscle fiber rupture and muscle pain (rhabdomyolysis), abnormal musclepostura
• prolonged erection (priapism) that may require surgicaltreatment
• development of breasts in men, breast enlargement, breast secretion, vaginal secretion
• delayed menstrual periods, breast enlargement
• very low body temperature, decreased body temperature
• withdrawal symptoms from themedicament

Unknown (frequency cannot be estimated from availabledata)

• lung congestion
• increased insulin (a hormone that controls blood sugar levels) in thesangre

The following side effects have been reported with the use of another medicine calledrisperidonathat is very similar to paliperidone, so it is also expected to occur with paliperidone:othertypes of blood vessel problems in the brain, crepitant sounds of the lungs, and severe or potentially fatal skin rash with blisters and peeling of the skin that may start in the mouth, nose, eyes, and genitals and spread to other areas of the body (Stevens-Johnson syndrome/toxic epidermal necrolysis).Eye problems may also occur during cataract surgery. During cataract surgery, a condition called intraoperative floppy iris syndrome (IFIS) may occur if you are taking or have taken paliperidone. If you need to undergo cataract surgery, make sure to inform your ophthalmologist if you are taking or have taken thismedicament

Additional side effects inadolescents

Adolescents generally experienced side effects similar to those found in adults, except for the following side effects that were detected morefrequently:

Reporting of side effects

If you experience side effects, consult your doctor, pharmacist, or nurse, even if the side effects do not appear in this leaflet. You can also report them directlyatravésoftheSistema Español de Farmacovigilancia de Medicamentos de Uso Humano:https://www.notificaram.es. By reporting side effects, you can contribute to providing more information on the safety of thismedicament

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

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

Store in the original packaging to protect it from moisture.

This medication does not require special temperature conditions for its conservation.

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

Composition of Paliperidone ratiopharm

• The active ingredient is paliperidone. Each prolonged-release tablet contains 3 mg, 6 mg or 9 mg of paliperidone.
• The other components are macrogol, butylhydroxytoluene, povidone, sodium chloride, microcrystalline cellulose, magnesium stearate, iron oxide red (E172), hydroxypropylcellulose and cellulose acetate in the tablet core and hypromellose, titanium dioxide (E171), talc and propylene glycol in the coating and lacquer, iron oxide black (E172) and propylene glycol in the printing ink.

Appearance of the product and contents of the packaging

3 mg: Film-coated, round, biconvex, white to off-white tablets with possible uneven surface and printed with the mark P3 on one side of the tablet. Diameter: approximately 9 mm.

6 mg: Film-coated, round, biconvex, yellowish-brown tablets with possible uneven surface and printed with the mark P6 on one side of the tablet. Diameter: approximately 9 mm.

9 mg: Film-coated, round, biconvex, pale pink tablets with possible uneven surface and printed with the mark P9 on one side of the tablet. Diameter: approximately 9 mm.

Paliperidone ratiopharm is available in boxes containing:

• 14x1, 28x1, 30x1, 56x1, 98x1, 112x1 or 196x1 prolonged-release tablets in perforated unit-dose blisters.

Not all packaging sizes may be marketed.

Holder of the marketing authorization and responsible manufacturer

Holder of the marketing authorization:

ratiopharm España, S.A.

c/ Anabel Segura, 11, Edificio Albatros B, 1st floor,

Alcobendas, 28108 Madrid (Spain)

Responsible manufacturer:

KRKA, d.d., Novo mesto

Šmarješka cesta 6

8501

Slovenia

Last revision date of thisleaflet:November 2024

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