RIVAROXABAN CIPLA 2.5 mg FILM-COATED TABLETS

Introduction

Package Leaflet: Information for the Patient

Rivaroxaban Cipla 2.5 mg film-coated tablets EFG

Read the entire package leaflet carefully before starting to take this medication, as it contains important information for you.

• Keep this package leaflet, as you may need to read it again.
• If you have any questions, consult your doctor or pharmacist.
• This medication has been prescribed to you only, 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 side effects, consult your doctor or pharmacist, even if they are not listed in this package leaflet. See section 4.

Contents of the Package Leaflet

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

1. What is Rivaroxaban Cipla and what is it used for

You have been prescribed this medication because

• you have been diagnosed with acute coronary syndrome (a group of disorders that include myocardial infarction and unstable angina, a type of severe chest pain) and your blood test results show elevated levels of certain heart tests. Rivaroxaban reduces the risk of having another myocardial infarction in adults or reduces the risk of death due to heart or blood vessel disease. You will be prescribed rivaroxaban along with another medication. Your doctor will also instruct you to take:
• • aspirin, or
  • aspirin plus clopidogrel or ticlopidine

or

• you have been diagnosed with a high risk of blood clot formation due to coronary artery disease or peripheral arterial disease that causes symptoms. Rivaroxaban reduces the risk of blood clot formation (atherothrombotic events) in adults. You will be prescribed rivaroxaban along with another medication. Your doctor will also instruct you to take aspirin. In some cases, if you are given this medication after an intervention to open a narrowed or blocked artery in the leg to restore blood flow, your doctor may also prescribe clopidogrel for you to take in addition to aspirin for a short period of time.

This medication contains the active substance rivaroxaban, which belongs to a group of medications called antithrombotic agents. It works by blocking a clotting factor (factor Xa) and thus reducing the tendency of blood to form clots.

2. What you need to know before taking Rivaroxaban Cipla

Do not take Rivaroxaban Cipla

• if you are allergic to rivaroxaban or any of the other ingredients of this medication (listed in section 6).
• if you have excessive bleeding.
• if you have a disease or problem in an organ of the body that increases the risk of severe bleeding (e.g., stomach ulcer, injury or bleeding in the brain, or recent brain or eye surgery).
• if you are taking medications to prevent blood clot formation (e.g., warfarin, dabigatran, apixaban, or heparin), except when switching to another anticoagulant treatment or while receiving heparin through a venous or arterial catheter, to prevent it from becoming blocked.
• if you have acute coronary syndrome and have previously had a bleeding or blood clot in the brain (stroke).
• if you have coronary artery disease or peripheral arterial disease and have previously had a bleeding in the brain (stroke) or an obstruction of the small arteries that supply blood to the deep tissues of the brain (lacunar stroke) or if you have had a blood clot in the brain (non-lacunar ischemic stroke) in the past month.
• if you have a liver disease that may increase the risk of bleeding.
• if you are pregnant or breastfeeding.

Do not take rivaroxaban and inform your doctorif any of these circumstances apply to you.

Warnings and precautions

Consult your doctor or pharmacist before starting to take this medication.

This medication should not be used in combination with other medications that reduce blood clotting, other than aspirin and clopidogrel/ticlopidine, such as prasugrel or ticagrelor.

Be careful with Rivaroxaban

• if you have an increased risk of bleeding, as may occur in the following situations:
• • severe kidney failure, as kidney function may affect the amount of medication that works in your body.
  • if you are taking other medications to prevent blood clot formation (e.g., warfarin, dabigatran, apixaban, or heparin), when switching to another anticoagulant treatment or while receiving heparin through a venous or arterial catheter, to prevent it from becoming blocked (see section "Other medications and Rivaroxaban Cipla").
  • bleeding disorder.
  • very high blood pressure, not controlled by medical treatment.
  • diseases of the stomach or intestine that may cause bleeding, such as inflammation of the stomach or intestine, inflammation of the esophagus (throat), e.g., due to gastroesophageal reflux disease (a disease in which stomach acid rises up into the esophagus), or tumors located in the stomach, intestines, genital tract, or urinary tract.
  • a problem in the blood vessels of the back of your eyes (retinopathy)
  • a lung disease in which the bronchi are dilated and filled with pus (bronchiectasis) or you have had a previous bleeding in the lungs.
  • you are over 75 years old.
  • if you weigh less than 60 kg.
  • you have coronary artery disease with severe symptomatic heart failure.

• if you have a heart valve prosthesis.
• if you know you have a disease called antiphospholipid syndrome (an immune system disorder that increases the risk of blood clot formation), inform your doctor to decide if it may be necessary to modify the treatment.

Tell your doctor if you have any of these situationsbefore taking this medication. Your doctor will decide if you should be treated with this medication and if you should be kept under closer observation.

If you need to undergo surgery

• It is very important to take this medication before and after the operation, exactly at the times indicated by your doctor.
• If your operation requires the placement of a catheter or injection into the spinal column (e.g., for epidural or spinal anesthesia, or pain relief):
• • It is very important to take this medication before and after the injection or removal of the catheter, exactly at the times indicated by your doctor.
  • Tell your doctor immediately if you experience numbness or weakness in your legs or problems with your intestine or bladder at the end of anesthesia, as urgent attention is necessary.

Children and adolescents

This medication is not recommended for children and adolescents under 18 years of age.There is not enough information available on its use in children and adolescents.

Other medications and Rivaroxaban Cipla

Tell your doctor or pharmacist if you are using, have recently used, or may need to use any other medication, including those obtained without a prescription.

• If you are taking
• • any medication for a fungal infection (e.g., fluconazole, itraconazole, voriconazole, posaconazole), except if only applied to the skin.
  • tablets with ketoconazole (used to treat Cushing's syndrome, in which the body produces an excess of cortisol).
  • any medication for bacterial infections (e.g., clarithromycin, erythromycin).
  • any antiviral medication for HIV/AIDS (e.g., ritonavir).
  • other medications to reduce blood clotting (e.g., enoxaparin, clopidogrel, or vitamin K antagonists, such as warfarin or acenocoumarol, prasugrel, and ticagrelor (see section "Warnings and precautions")).
  • anti-inflammatory medications and pain relievers (e.g., naproxen or aspirin).
  • dronedarone, a medication for the treatment of irregular heartbeat.
  • certain medications for the treatment of depression (selective serotonin reuptake inhibitors (SSRIs) or serotonin and norepinephrine reuptake inhibitors (SNRIs)).

If any of the above circumstances apply to you, tell your doctorbefore taking this medication, as the effect of rivaroxaban may be increased. Your doctor will decide if you should be treated with this medication and if you should be kept under closer observation.

If your doctor considers that you have a higher risk of developing a stomach or intestinal ulcer, they may recommend that you also use a preventive treatment.

• If you are taking
• • any medication for the treatment of epilepsy (phenytoin, carbamazepine, phenobarbital).
  • St. John's Wort (Hypericum perforatum), a herbal remedy for the treatment of depression.
  • rifampicin, an antibiotic.

If any of the above circumstances apply to you, tell your doctorbefore taking this medication, as the effect of rivaroxaban may be reduced. Your doctor will decide if you should be treated with this medication and if you should be kept under closer observation.

Pregnancy and breastfeeding

Do not take this medication if you are pregnant or breastfeeding. If there is any possibility that you may become pregnant, use a reliable contraceptive while taking this medication. If you become pregnant while taking this medication, inform your doctor immediately, who will decide how you should be treated.

Driving and using machines

Rivaroxaban may cause dizziness (a common side effect) or fainting (an uncommon side effect) (see section 4, "Possible side effects"). You should not drive, ride a bicycle, or use tools or machines if you are affected by these symptoms.

Rivaroxaban Cipla contains lactose and sodium

If your doctor has told you that you have an intolerance to certain sugars, consult with them before taking this medication.

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

3. How to take Rivaroxaban Cipla

Follow the instructions for administration of this medication exactly as indicated by your doctor. If you are unsure, consult your doctor or pharmacist again.

What dose to take

The recommended dose is one 2.5 mg tablet twice a day. Take rivaroxaban at the same time every day (e.g., one tablet in the morning and one in the evening). This medication can be taken with or without food.

If you have difficulty swallowing the whole tablet, consult your doctor about other ways to take rivaroxaban. The tablet can be crushed and mixed with water or apple sauce, immediately before taking it.

If necessary, your doctor may also administer the crushed rivaroxaban tablet through a gastric tube.

You will be prescribed rivaroxaban along with another medication.

Your doctor will also instruct you to take aspirin. If you receive rivaroxaban after an acute coronary syndrome, your doctor may also instruct you to take clopidogrel or ticlopidine.

If you are given rivaroxaban after an intervention to open a narrowed or blocked artery in the leg to restore blood flow, your doctor may also prescribe clopidogrel for you to take in addition to aspirin for a short period of time.

Your doctor will indicate the dose to take (usually between 75 and 100 mg of aspirin per day, or a dose of 75 to 100 mg of aspirin plus a daily dose of 75 mg of clopidogrel or a standard daily dose of ticlopidine).

When to start treatment with Rivaroxaban Cipla

Treatment with rivaroxaban after an acute coronary syndrome should be started as soon as possible, once the acute coronary syndrome has been stabilized, i.e., from 24 hours after hospital admission and at the time when parenteral anticoagulant treatment (by injection) would be discontinued.

Your doctor will indicate when to start treatment with rivaroxaban if you have been diagnosed with coronary artery disease or peripheral arterial disease.

The doctor will decide how long you should continue taking the treatment.

Remember to carry your patient information card with you at all times. Inform the doctor and dentist treating you that you are taking rivaroxaban.

If you take more Rivaroxaban Cipla than you should

Call your doctor immediately if you have taken too many rivaroxaban tablets. Taking too much rivaroxaban increases the risk of bleeding.

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 medication and the amount ingested.

If you forget to take Rivaroxaban Cipla

Do not take more than one tablet in a single day to make up for a missed dose. If you miss a dose, take the next tablet at the usual time.

If you stop taking Rivaroxaban Cipla

Take rivaroxaban regularly for the time indicated by your doctor.

Do not stop taking rivaroxaban without talking to your doctor first. If you stop taking this medication, you may increase your risk of having another myocardial infarction, a stroke, or dying from a heart or blood vessel disease.

If you have any other questions about the use of this medication, 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.

Like other similar medicines to reduce blood clot formation, rivaroxaban can cause bleeding that can put the patient's life at risk. Excessive bleeding can cause a sudden drop in blood pressure (shock). In some cases, the bleeding may not be evident.

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

• Signs of bleeding
• • bleeding in the brain or inside the skull (symptoms may include headache, weakness on one side of the body, vomiting, seizures, decreased level of consciousness, and stiffness of the neck. This is a serious medical emergency. Seek medical attention immediately!)
  • prolonged or excessive bleeding.
  • exceptional weakness, fatigue, paleness, dizziness, headache, unexplained swelling, difficulty breathing, chest pain or angina.

Your doctor will decide whether to keep you under closer observation or change your treatment.

• Signs of severe skin reactions
• • intense skin rashes that spread, blisters, or lesions on the mucous membranes, e.g., in the mouth or eyes (Stevens-Johnson syndrome/toxic epidermal necrolysis).
  • drug reaction that causes rash, fever, inflammation of internal organs, blood abnormalities, and systemic disease (DRESS syndrome).

The frequency of these adverse effects is very rare (up to 1 in 10,000 people).

• Signs of severe allergic reactions
• • swelling of the face, lips, mouth, tongue, or throat; difficulty swallowing; hives, and difficulty breathing; sudden drop in blood pressure.

Severe allergic reactions are very rare (anaphylactic reactions, including anaphylactic shock; may affect up to 1 in 10,000 people) and uncommon (angioedema and allergic edema; may affect up to 1 in 100 people).

General list of possible adverse effects

Frequent(may affect up to 1 in 10 people)

• decrease in red blood cells that can cause paleness and weakness or difficulty breathing.
• bleeding in the stomach or intestine, urogenital hemorrhage (including blood in the urine and heavy menstrual bleeding), nasal bleeding, bleeding from the gums.
• bleeding in the eye (including bleeding in the white part of the eye).
• bleeding into a tissue or cavity of the body (hematoma, bruising).
• coughing up blood.
• bleeding from the skin or under the skin.
• bleeding after surgery.
• oozing of blood or fluid from a surgical wound.
• swelling of the limbs.
• pain in the limbs.
• alteration of kidney function (may be seen in tests performed by the doctor).
• fever.
• stomach pain, indigestion, dizziness, or feeling of dizziness, constipation, diarrhea.
• low blood pressure (symptoms may include dizziness or fainting when standing up).
• general decrease in strength and energy (weakness, fatigue), headache, dizziness.
• rash, itching of the skin.
• blood tests may show an increase in some liver enzymes.

Uncommon(may affect up to 1 in 100 people)

• bleeding in the brain or inside the skull (see above, signs of bleeding),
• bleeding into a joint, causing pain and swelling,
• thrombocytopenia (low platelet count, cells that help blood clotting),
• allergic reaction, including skin allergic reaction,
• alteration of liver function (may be seen in tests performed by the doctor),
• blood tests may show an increase in bilirubin, some pancreatic or liver enzymes, or platelet count,
• fainting,
• feeling of discomfort,
• increased heart rate,
• dry mouth,
• hives.

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

• bleeding into a muscle,
• cholestasis (decreased bile flow), hepatitis, including traumatic hepatocellular injury (inflammation or liver damage),
• yellowing of the skin and eyes (jaundice),
• localized swelling,
• blood accumulation (hematoma) in the groin as a complication after cardiac surgery where a catheter is inserted into the leg artery (pseudoaneurysm).

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

• accumulation of eosinophils, a type of granulocytic white blood cells that cause inflammation in the lung (eosinophilic pneumonia).

Frequency not known(frequency cannot be estimated from available data)

• renal failure after severe bleeding,
• bleeding in the kidney, sometimes with blood in the urine, which causes the kidneys to malfunction (anticoagulant-related nephropathy),
• increased pressure in the muscles of the legs or arms after bleeding, causing pain, swelling, altered sensation, numbness, or paralysis (compartment syndrome after bleeding).

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 leaflet. You can also report them directly through the Spanish Pharmacovigilance System for Human Use Medicines: www.notificaram.es. By reporting adverse effects, you can contribute to providing more information on the safety of this medicine.

5. Storage of Rivaroxaban Cipla

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

Do not use this medicine after the expiration date stated on each blister after "CAD". The expiration date is the last day of the month indicated.

This medicine does not require special storage conditions.

Crushed tablets

Crushed tablets are stable in water or apple sauce for up to 4 hours.

Medicines should not be disposed of via wastewater or household waste. Deposit the packaging and medicines you no longer need at the SIGRE collection point in your pharmacy. Ask your pharmacist how to dispose of the packaging and medicines you no longer need. This will help protect the environment.

6. Package contents and additional information

Composition of Rivaroxaban Cipla

• The active ingredient is rivaroxaban. Each tablet contains 2.5 mg of rivaroxaban.
• The other components (excipients) are:

Tablet core: sodium croscarmellose, hypromellose, lactose monohydrate, magnesium stearate, microcrystalline cellulose, sodium lauryl sulfate. See section 2 "Rivaroxaban Cipla contains lactose and sodium".

Coating material: hypromellose 2910 (E 464), yellow iron oxide (E 172), macrogol (E 1521), titanium dioxide (E 171).

Appearance and package contents

Rivaroxaban Cipla 2.5 mg film-coated tablets are yellow, round, biconvex, 6.0 ± 0.20 mm in diameter, engraved with "2.5" on one side and smooth on the other.

They are available in PVC/PVDC/aluminum blister packs packaged in boxes of 14, 56, 98, 168, and 196 film-coated tablets.

Only some pack sizes may be marketed.

Along with the leaflet of this medicine, a patient information card is included. This patient information card includes information that will be useful for patients and will alert other doctors that the patient is taking rivaroxaban. The patient should be recommended to always carry this card with them.

Marketing authorization holder and manufacturer

Marketing authorization holder

Cipla Europe NV

De Keyserlei 58-60, Box-19,

2018, Antwerp,

Belgium

Manufacturer

Cipla Europe NV

De Keyserlei 58-60, Box-19,

2018, Antwerp,

Belgium

Or

Alterno AD D.O.O.,

Brnciceva ulica 29,

Ljubljana-Crnuce, 1231,

Slovenia

Local representative

Cipla Europe NV, branch in Spain,

C/Guzmán el Bueno, 133 Edificio Britannia,

28003, Madrid

Spain

This medicine is authorized in the Member States of the European Economic Area under the following names:

Germany: Rivaroxaban Cipla 2.5 mg Filmtabletten

Spain: Rivaroxabán Cipla 2.5 mg film-coated tablets EFG

Norway: Rivaroxaban Cipla

France: Rivaroxaban Cipla 2.5 mg Comprimé pelliculé

Italy: Rivaroxaban Cipla

Denmark: Rivaroxaban Cipla 2.5 mg filmovertrukne tabletter

Ireland: Rivaroxaban Azure 2.5 mg Film-Coated Tablets

Date of last revision of this leaflet: November 2024

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