Patient Information Leaflet

Paliperidone Teva 50 mg prolonged-release injectable suspension EFG

Paliperidone Teva 75 mg prolonged-release injectable suspension EFG

Paliperidone Teva 100 mg prolonged-release injectable suspension EFG

Paliperidone Teva 150 mg prolonged-release injectable suspension EFG

Initial treatment pack:

Paliperidone Teva 150 mg and Paliperidone Teva 100 mg prolonged-release injectable suspension EFG

Read this leaflet carefully before you start using this medicine because

it contains important information for you.

• Keep this leaflet, as you may need to read it again.
• If you are unsure about anything, ask your doctor or nurse.
• If you experience any side effects, consult your doctor or nurse, even if they are not listed in this leaflet. See section 4.

1. What is Paliperidone Teva and what is it used for

2. What you need to know before you start using Paliperidone Teva

3. How to use Paliperidone Teva

4. Possible side effects

5. Storage of Paliperidone Teva

6. Contents of the pack and additional information

Paliperidona Teva contains the active ingredient paliperidone, which belongs to the class of antipsychotic medications and is used as maintenance treatment for symptoms of schizophrenia in adult patients who are stabilized with paliperidone or risperidone.

If you have shown a response to paliperidone or risperidone in the past and have mild or moderate symptoms, your doctor may start treatment with Paliperidona Teva without prior stabilization with paliperidone or risperidone.

Schizophrenia is a disorder with "positive" and "negative" symptoms. Positive means an excess of symptoms that are normally not present. For example, a person with schizophrenia may hear voices or see things that do not exist (known as hallucinations), have false beliefs (known as delusions) or have an abnormal distrust of others. Negative refers to the lack of behaviors or feelings that are normally present. For example, a person with schizophrenia may withdraw into themselves and not respond to any emotional stimuli or may have difficulty speaking in a clear and logical manner. People who suffer from this disorder may also feel depressed, anxious, guilty, or tense.

Paliperidona Teva may help alleviate the symptoms of your illness and prevent them from recurring.

No use paliperidonapaliperidona

• if you are allergic to paliperidona or any of the other ingredients of this medication (listed in section 6);
• if you are allergic to any other antipsychotic medication, including risperidona.

Advertencias y precauciones

Consult your doctor, pharmacist, or nurse before starting to use Paliperidona Teva.

This medication has not been studied in elderly patients with dementia. However, elderly patients with dementia being treated with similar medications may have an increased risk of stroke or death (see section 4, possible side effects).

All medications have side effects, and some side effects of this medication may worsen symptoms of other conditions. For this reason, it is essential to discuss with your doctor any of the following diseases, which may worsen during treatment with this medication:

• if you have Parkinson's disease
• if you have ever been diagnosed with a disease whose symptoms include high temperature and muscle rigidity (also known as Neuroleptic Malignant Syndrome)
• if you have ever experienced abnormal movements of the tongue or face (Tardive Dyskinesia)
• 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 had breast cancer or a tumor in the pituitary gland of the brain
• 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 low blood pressure when standing up or getting up quickly
• if you have epilepsy
• 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 someone in your family has a history of blood clots, as antipsychotics have been associated with the formation of blood clots.

If you have any of these diseases, please consult your doctor as it may be necessary to adjust your dose or keep you under observation for a while.

Because very rarely, a dangerously low number of a type of white blood cell necessary to fight infections in the blood has been observed in patients treated with this medication, your doctor may check your white blood cell count.

Even if you have previously tolerated paliperidona oral or risperidona, rare allergic reactions may occur after receiving Paliperidona Teva injections. Seek immediate medical help if you experience a skin rash, swelling of the throat, itching, or breathing problems, as these may be signs of a severe allergic reaction.

This medication 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 this medication, diabetes mellitus or worsening of pre-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 levels should be regularly monitored.

Since this medication may mask the normal response of the body to the ingestion of toxic substances or other conditions, there is a possibility that it may mask the symptoms of other conditions.

During eye surgery for cataracts, 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 cause eye damage. If you are planning to have eye surgery, be sure to inform your ophthalmologist that you are using this medication.

Niños y adolescentes

Do not use this medication in patients under 18 years old.

Otros medicamentos y Paliperidona Teva

Inform your doctor if you are using, have used recently, or may need to use any other medication.

The use of this medication with carbamazepine (an antiepileptic and mood stabilizer) may require a change in your dose of this medication.

Since this medication primarily acts on the brain, interaction with other medications that also act on it may cause an exaggeration of side effects, such as drowsiness or other effects on the brain, such as other psychiatric medications, opioids, antihistamines, and sleep medications.

Since this medication may lower blood pressure, you should be careful if you use it with other medications that also lower blood pressure.

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

This medication may cause an abnormality in the electrocardiogram (ECG) that shows a prolonged period for an electrical impulse to travel through a certain part of the heart (known as "prolongation of the QT interval"). Other medications that have this effect include some medications used to treat heart rhythm or to treat infections, as well as other antipsychotics.

If you are prone to seizures, this medication may increase your chances of experiencing them. Other medications that have this effect include some medications used to treat depression or to treat infections, as well as other antipsychotics.

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

Uso de Paliperidona Teva con alcohol

Alcohol should be avoided.

Embarazo,lactancia

If you are pregnant or breastfeeding, or if you think you may be pregnant, consult your doctor or pharmacist before using this medication. Do not use 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 paliperidona in the last trimester of pregnancy (last three months of pregnancy): tremors, rigidity, and/or muscle weakness, drowsiness, agitation, breathing problems, and difficulty feeding. If your baby develops any of these symptoms, contact your doctor.

This medication may pass from mother to baby through breast milk and may harm the baby. Therefore, do not breastfeed while using this medication.

Conducción y uso de máquinas

During treatment with this medication, dizziness, extreme fatigue, and vision problems (see section 4) may occur. This should be taken into account when requiring maximum attention, such as when driving or operating machines.

Paliperidona Teva contiene sodio

This medication contains less than 1 mmol of sodium (23 mg) per dose; it is essentially "sodium-free".

Your doctor or another healthcare professional will administer this medication. Your doctor will tell you when to receive the next injection. It is essential that you do not miss any scheduled doses. If you cannot attend your appointment with your doctor, make sure to call them immediately to schedule another appointment as soon as possible.

You will receive the first injection (150 mg) and the second injection (100 mg) of this medication in the upper arm approximately one week apart. From then on, you will receive an injection (between 25 mg and 150 mg) in the upper arm or buttocks once a month.

If your doctor is switching you from long-acting risperidone injectable to this medication, you will receive the first injection of this medication (between 25 mg and 150 mg) in the upper arm or buttocks at the next scheduled injection. From then on, you will receive an injection (between 25 mg and 150 mg) in the upper arm or buttocks once a month.

Your doctor may increase or decrease the amount of medication you receive at the time of the monthly scheduled injection based on your symptoms.

Patients with kidney problems

Your doctor may adjust the dose of this medication according to your renal function. If you have mild kidney problems, your doctor may give you a lower dose. You should not use this medication if you have moderate or severe kidney problems.

Patients with advanced age

Your doctor may reduce the dose of this medication if your kidney function is decreased.

If you use more Paliperidone Teva than you should

You will receive this medication under medical supervision, so it is unlikely that you will receive an excessive dose.

Patients who have received an excessive amount of paliperidone may experience the following symptoms: drowsiness or sedation, rapid heart rate, low blood pressure, electrocardiogram abnormalities (heart tracing), or slow or abnormal movements of the face, body, arms, or legs.

If you stop treatment with Paliperidone Teva

If you stop receiving your injections, you will lose the effects of the medication. Do not stop using this medication unless your doctor tells you to, as your symptoms may return.

If you have any other questions about using this medication, ask your doctor or pharmacist.

Like all medicines, this medicine can cause side effects, although not everyone will experience them.

Inform your doctor immediately if:

• you develop 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 notice any of these symptoms, seek medical advice immediately.
• you have dementia and experience a sudden change in your mental state or sudden weakness or numbness of the face, arms, or legs, especially on one side, or have difficulty speaking even for a short period of time. These may be signs of a stroke.
• you develop fever, muscle stiffness, sweating, or a decrease in level of consciousness (a condition known as "Neuroleptic Malignant Syndrome"). You may need immediate medical treatment.
• you are a man and experience a prolonged or painful erection. This is known as priapism. You may need immediate medical treatment.
• you experience involuntary rhythmic movements of the tongue, mouth, and face. You may need the withdrawal of paliperidone.
• 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 drop in blood pressure (i.e., anaphylactic reaction). Even if you have previously tolerated risperidone orally or paliperidone orally, in rare cases, allergic reactions have occurred after receiving paliperidone injections.
• you are scheduled to undergo eye surgery, ensure that you tell your ophthalmologist that you are taking this medicine. During eye surgery for cataracts, it is possible that the iris (the colored part of the eye) will be flaccid during surgery (known as "floppy iris syndrome") which can cause eye damage.
• you experience a dangerously low number of a type of white blood cell necessary to fight blood infections.

The following side effects may occur:

Very common side effects: can affect more than 1 in 10 patients

• difficulty staying or falling asleep.

Common side effects: can affect up to 1 in 10 patients

• common cold symptoms, urinary tract infection, feeling like having the flu
• paliperidone may increase levels of a hormone called "prolactin" that is detected in blood tests (which may or may not cause symptoms). When side effects of increased prolactin occur, they may include (in men) breast swelling, difficulty getting or maintaining erections, or other sexual dysfunction; (in women) breast discomfort, milk secretion from the breasts, loss of menstrual periods, or other cycle problems.
• increased blood sugar, weight gain, weight loss, decreased appetite
• irritability, depression, anxiety
• parkinsonism: This condition may include slow or altered movement, sensation of stiffness or tension in the muscles (making sudden movements) and sometimes a sensation of "freezing" of movement that is then restarted. Other signs of parkinsonism include walking slowly dragging the feet, trembling while resting, increased saliva and/or drooling, and loss of facial expression
• restlessness, feeling drowsy or less attentive
• distonia: This is a disorder that involves involuntary slow or continuous muscle contraction. Although it can affect any part of the body (and may cause abnormal postures), distonia often affects the facial muscles, including abnormal movements of the eyes, mouth, tongue, or jaw
• dizziness
• discinesia: This disorder involves involuntary muscle movements and may include repetitive, spasmodic, or twisting movements, or spasms
• tremor (agitation)
• headache
• rapid heartbeat
• increased blood pressure
• cough, nasal congestion
• abdominal pain, vomiting, nausea, constipation, diarrhea, indigestion, toothache
• increased liver transaminases in blood
• bone or muscle pain, back pain, joint pain
• amenorrhea
• fever, weakness, fatigue (tiredness)
• a reaction at the injection site, including itching, pain, or swelling.

Uncommon side effects: can affect up to 1 in 100 patients

• bronchitis, pneumonia, respiratory tract infection, nasal infection, urinary tract infection, ear infection, fungal nail infection, tonsillitis, skin infection
• decreased white blood cell count, decreased type of white blood cell that helps fight infections, anemia
• allergic reaction
• diabetes or worsening of diabetes, increased insulin (a hormone that controls blood sugar levels) in blood
• increased appetite
• loss of appetite that causes malnutrition and weight loss
• increased triglycerides in blood (fat), increased cholesterol in blood
• sleep disorder, euphoria (mania), decreased libido, nervousness, nightmares
• 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 the tongue, mouth, or face. You may need to withdraw from this medicine.
• syncope, restlessness that causes movement of body parts, dizziness when standing up, altered attention, speech problems, loss or alteration of taste, decreased skin sensitivity to pain or touch, sensation of pins and needles, or numbness of the skin
• blurred vision, eye infection, or "red eye", dry eyes
• sensation of spinning (vertigo), tinnitus in the ears, ear pain
• interruption of blood flow between the upper and lower parts of the heart, abnormal heart activity, prolonged QT interval in the heart, rapid heartbeat when standing up, slow heartbeat, abnormal heart tracing (electrocardiogram or ECG), sensation of fluttering or pounding in the chest (palpitations)
• decreased blood pressure, low blood pressure when standing up (therefore, some people taking this medicine may feel weak, dizzy, or faint when standing up or sitting suddenly)
• interrupted breathing, sore throat, nasal bleeding
• abdominal discomfort, stomach or intestinal infection, difficulty swallowing, dry mouth
• excessive gas or flatulence
• increased GGT (a liver enzyme called gamma-glutamyltransferase) in blood, increased liver enzymes in blood
• hives (or "urticaria"), itching, rash, hair loss, eczema, dry skin, skin redness, acne, abscesses under the skin
• increased CPK (creatine phosphokinase) in blood, an enzyme that is sometimes released with muscle breakdown
• muscle spasms, joint stiffness, muscle weakness
• urinary incontinence, frequent urination, painful urination
• erectile dysfunction, ejaculation disorder, amenorrhea, or other menstrual cycle problems (women), breast development in men, sexual dysfunction, breast pain, milk secretion from the breasts
• swelling of the face, mouth, eyes, or lips, swelling of the body, arms, or legs
• increased body temperature
• change in gait
• chest pain, chest discomfort, feeling unwell
• skin hardening
• falls.

Rare side effects: can affect up to 1 in 10,000 patients

• eye infection
• skin inflammation caused by mites, scaly abscess of the scalp with itching under the skin
• increased eosinophils (a type of white blood cell) in the blood
• decreased platelets (a type of blood cell that helps stop bleeding)
• head agitation
• inadequate secretion of the hormone that controls urine volume
• sugar in the urine
• potentially fatal complications of uncontrolled diabetes
• decreased blood sugar
• excessive water intake
• lack of movement or response while awake (catatonia)
• confusion
• sleepwalking
• absence of emotions
• inability to achieve orgasm
• neuroleptic malignant syndrome (confusion, decreased or loss of consciousness, high fever, and severe muscle stiffness), problems with blood vessels in the brain, including sudden loss of blood flow to the brain (stroke or "mini" stroke), no response to stimuli, loss of consciousness, decreased level of consciousness, seizures (epileptic crises), balance disorder
• abnormal coordination
• glaucoma (increased pressure in the eyeball)
• eye movement problems, eye rotation, light sensitivity of the eyes, increased tear production, eye redness
• atrial fibrillation (abnormal heart rhythm), irregular heartbeat
• blood clots in the lungs that cause chest pain and difficulty breathing. If you notice any of these symptoms, seek medical advice immediately.
• blood clots in the veins, especially in the legs (symptoms include swelling, pain, and redness of the leg). If you experience any of these symptoms, seek medical advice immediately
• flushing
• difficulty breathing during sleep (sleep apnea)
• pulmonary congestion, respiratory tract congestion
• crepitant sounds from the lungs, wheezing
• pancreatitis, tongue swelling, fecal incontinence, hard stools
• intestinal obstruction
• cracked lips
• skin rash related to the medicine, skin thickening, dandruff
• muscle fiber rupture and muscle pain (rhabdomyolysis)
• joint swelling
• urinary incontinence
• breast discomfort, breast growth, breast development
• vaginal discharge
• prolonged erection (priapism) that may require surgical treatment, low body temperature, chills, sensation of thirst
• withdrawal symptoms from the medicine
• accumulation of pus due to infection at the injection site, deep skin infection, abscess at the injection site, bruising at the injection site.

Unknown frequency: cannot be estimated from available data

• dangerously low number of a type of white blood cell necessary to fight infections
• severe allergic reaction characterized by fever, swelling of the mouth, face, lips, or tongue, difficulty breathing, hives, skin rash, and sometimes a drop in blood pressure
• excessive water intake
• sleep-related eating disorder
• coma due to uncontrolled diabetes
• decreased oxygen in parts of the body (due to decreased blood flow)
• rapid, shallow breathing, pneumonia caused by aspiration of food, voice disorder
• absence of intestinal movement that causes obstruction
• yellow skin and eyes (jaundice)
• severe skin rash or potentially fatal skin rash with blisters and peeling of the skin that may start in and around the mouth, nose, eyes, and genitals and spread to other parts of the body (Stevens-Johnson syndrome or toxic epidermal necrolysis)
• severe allergic reaction with swelling that may affect the throat, causing difficulty breathing
• skin discoloration
• postural anomaly
• newborn babies of mothers who have been treated with paliperidone during pregnancy may experience adverse effects of the medicine and/or withdrawal symptoms, such as irritability, weak or sustained muscle contractions, agitation, drowsiness, breathing problems, or difficulty feeding
• decreased body temperature
• dead skin cells at the injection site and ulcer at the injection site

Reporting of side effects

If you experience any type of side effect, consult your doctor or nurse, even if it is a possible side effect that does not appear in this leaflet. You can also report them directly through the Spanish System of Pharmacovigilance of Medicines for Human Use:https://www.notificaRAM.es.By reporting side effects, you can contribute to providing more information on the safety of this medicine.

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

Do not use this medication after the expiration date that appears on the pre-filled syringe and on the box after “CAD or EXP”. The expiration date is the last day of the month indicated.

This medication does not require any special storage conditions.

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

Composition of Paliperidone Teva

The active ingredient is paliperidone

Each Paliperidone Teva 50 mg pre-filled syringe contains 78 mg of palmitate of paliperidone in 0.5 ml

Each Paliperidone Teva 75 mg pre-filled syringe contains 117 mg of palmitate of paliperidone in 0.75 ml

Each Paliperidone Teva 100 mg pre-filled syringe contains 156 mg of palmitate of paliperidone in 1 ml

Each Paliperidone Teva 150 mg pre-filled syringe contains 234 mg of palmitate of paliperidone in 1.5 ml

Starting treatment package:

Each Paliperidone Teva 100 mg pre-filled syringe contains 156 mg of palmitate of paliperidone in 1 ml

Each Paliperidone Teva 150 mg pre-filled syringe contains 234 mg of palmitate of paliperidone in 1.5 ml

The other components are:

Polysorbate 20

Macrogol 4000

Citric acid monohydrate

Dipotassium phosphate

Sodium dihydrogen phosphate monohydrate

Sodium hydroxide (for pH adjustment)

Water for injection

Appearance of the product and contents of the package

Paliperidone Teva is a white to off-white prolonged-release injectable suspension, which comes in a pre-filled syringe (prolonged-release injection)

Each package contains 1 pre-filled syringe and 2 needles

Starting treatment package:

Each package contains 1 package of Paliperidone Teva 150 mg and 1 package of Paliperidone Teva 100 mg

Only some package sizes may be marketed

Holder of the marketing authorization and responsible for manufacturing

Holder of the marketing authorization

Teva B.V.

Swensweg 5

2031GA Haarlem

Netherlands

Responsible for manufacturing:

Actavis Group PTC ehf.

Dalshraun 1,

Hafnarfjörður 220.

Iceland

You can request more information about this medicine by contacting the local representative of the holder of the marketing authorization:

Teva Pharma, S.L.U

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

Alcobendas, 28108, Madrid (Spain)

This medicine is authorized in the Member States of the European Economic Area and in the United Kingdom (Northern Ireland) with the following names:

Last review date of this leaflet:February 2024

Other sources of information

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

This information is intended only for healthcare professionals and should be read in conjunction with the complete prescribing information (Product Characteristics Summary).

The injectable suspension is for single use. It should be visually inspected to detect any foreign particles before administration. Do not use the product if the syringe is not visually free of foreign particles.

The package contains a pre-filled syringe and two safety needles (one 22-gauge 1.5-inch [38.1 mm x 0.72 mm] needle and one 23-gauge 1-inch [25.4 mm x 0.64 mm] needle) for intramuscular injection. Paliperidone Teva is also available in a treatment initiation pack containing two pre-filled syringes (150 mg + 100 mg) and two additional safety needles.

1. Shake the syringe vigorously in a vertical position for at least 10 seconds to ensure a homogeneous suspension. Place the syringe with the nozzle in a vertical position.Gently tap the syringe to ensure that all air bubbles rise to the top of the syringe

1. Choose the appropriate needle.

The first dose of Paliperidone Teva (150 mg) is administered on Day 1 in the deltoid muscle using the deltoid needle. The second dose of Paliperidone Teva (100 mg) is administered also in the deltoid muscle one week later (Day 8) using the deltoid needle.

If the patient is switched from risperidone long-acting injectable to Paliperidone Teva, the first injection of Paliperidone Teva (dose range 25 mg to 150 mg) can be administered in the deltoid muscle or gluteal muscle, using the appropriate needle for the injection site, at the time of the next scheduled injection.

Subsequent monthly maintenance injections can be administered in both the deltoid muscle and gluteal muscle using the appropriate needle for the injection site.

In the case of deltoid muscle injection, if the patient weighs <90>23kg, use the 22-gauge 1.5-inch [38.1 mm x 0.72 mm] needle (needle with blue shaft); if the patient weighs?90 kg, use the 22-gauge 1.5-inch [38.1 mm x 0.72 mm] needle (needle with grey shaft).

In the case of gluteal muscle injection, use the 22-gauge 1.5-inch [38.1 mm x 0.72 mm] needle (needle with grey shaft).

1. While holding the syringe in a vertical position, remove the rubber cap from the tip with a smooth twisting motion.

1. Open the blister pack of the safety needle to the middle. Hold the needle cover in place with the plastic sheet. Hold the syringe pointing upwards. Attach the safety needle to the Luer connection of the syringe with a smooth twisting motion to avoid cracking or damage to the needle hub. Always check for signs of damage or leakage before administration.

1. Remove the cover from the needle by following a straight line. Do not twist the cover, as the needle may come loose from the syringe.

1. Place the syringe with the needle in a vertical position to proceed with the removal of air.Remove air from the syringe by gently pushing the plunger forward until 3 drops of suspension foam come out of the syringe.

1. Inject the entire contents slowly and deeply into the selected deltoid or gluteal muscle of the patient.Do not administer by intravascular or subcutaneous route.

1. Once the injection is complete, use the finger or another finger (8a, 8b) or a flat surface (8c) to activate the safety needle system. The system is fully activated when a click is heard. Dispose of the syringe with the needle properly.

8a

8b

8c

The disposal of unused medication and all materials that have come into contact with it will be carried out in accordance with local regulations.