RIVAROXABAN CIPLA 20 mg FILM-COATED TABLETS

Introduction

Package Leaflet: Information for the Patient

Rivaroxaban Cipla 15 mg film-coated tablets EFG

Rivaroxaban Cipla 20 mg film-coated tablets EFG

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

• Keep this leaflet, you may need to read it again.
• If you have any further questions, ask your doctor or pharmacist.
• This medicine has been prescribed for you only. Do not pass it on to others. It may harm them, even if their signs of illness are the same as yours.
• If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. See section 4.

Contents of the pack

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

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

This medicine contains the active substance rivaroxaban.

This medicine is used in adults to:

• prevent the formation of blood clots in the brain (stroke) or in other blood vessels of the body if you have a type of irregular heart rhythm called non-valvular atrial fibrillation.
• treat blood clots in the veins of the legs (deep vein thrombosis) and in the blood vessels of the lungs (pulmonary embolism), and to prevent these blood clots from happening again in the blood vessels of the legs and/or lungs.

This medicine is used in children and adolescents under 18 years of age and with a body weight of 30 kg or more to:

• treat and prevent blood clots in the veins or in the blood vessels of the lungs after at least 5 days of initial treatment with injectable medicines used to treat blood clots.

This medicine belongs to a group of medicines called antithrombotic agents. It works by blocking a factor in the blood that is involved in blood clotting (factor Xa) and thus reduces the tendency of the blood to form clots.

2. What you need to know before you take Rivaroxaban Cipla

Do not take Rivaroxaban Cipla

• if you are allergic to rivaroxaban or any of the other ingredients of this medicine (listed in section 6).
• if you have bleeding problems.
• if you have a disease or condition that increases the risk of serious bleeding (e.g. stomach or intestinal ulcer, recent bleeding in the brain or eye, or recent surgery).
• if you are taking other medicines to prevent blood clots (e.g. warfarin, dabigatran, apixaban, or heparin), except when switching from one anticoagulant to another or when heparin is given through a vein or artery to keep it from getting blocked.
• if you have a liver disease that increases the risk of bleeding.
• if you are pregnant or breast-feeding.

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

Warnings and precautions

Talk to your doctor or pharmacist before taking this medicine.

Be careful with rivaroxaban

• if you have an increased risk of bleeding, such as in the following situations:
• • severe kidney problems in adults and moderate or severe kidney problems in children and adolescents, as kidney function may affect the amount of medicine that works in your body.
  • if you are taking other medicines to prevent blood clots (e.g. warfarin, dabigatran, apixaban, or heparin) when switching to another anticoagulant or when receiving heparin through a vein or artery to keep it from getting blocked (see section "Other medicines and Rivaroxaban Cipla").
  • bleeding disorders.
  • very high blood pressure that is not controlled by medical treatment.
  • stomach or intestinal problems that may cause bleeding, such as inflammation of the stomach or intestines, inflammation of the esophagus (e.g. due to gastroesophageal reflux disease), or tumors in the stomach, intestines, genital tract, or urinary tract.
  • problems with the blood vessels in the back of the eyes (retinopathy).
  • a lung disease in which the airways are widened and filled with pus (bronchiectasis) or previous bleeding in the lungs.
• if you have a heart valve replacement.
• if you know you have a condition called antiphospholipid syndrome (a disorder of the immune system that increases the risk of blood clots), inform your doctor to decide if it may be necessary to modify the treatment.
• if your doctor determines that your blood pressure is unstable or if you are scheduled to receive another treatment or undergo surgery to remove a blood clot from your lungs.

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

If you need to have surgery

• It is very important to take this medicine before and after surgery, exactly at the times your doctor tells you.
• If your operation requires the insertion of a catheter or injection into your spine (e.g. for epidural or spinal anesthesia, or pain relief):
• • It is very important to take this medicine before and after the injection or removal of the catheter, exactly at the times your doctor tells you.
  • Tell your doctor immediately if you experience numbness or weakness in your legs or problems with your intestines or bladder after anesthesia, as urgent attention is needed.

Children and adolescents

This medicine is not recommended in children with a body weight below 30 kg. There is not enough information about the use of this medicine in children and adolescents for the indications in adults.

Other medicines and Rivaroxaban Cipla

Tell your doctor or pharmacist if you are taking, have recently taken, or might take any other medicines, including those obtained without a prescription.

• If you are taking
• • any medicine for a fungal infection (e.g. fluconazole, itraconazole, voriconazole, posaconazole), unless it is only applied to the skin.
  • ketoconazole tablets (used to treat Cushing's syndrome, in which the body produces too much cortisol).
  • any medicine for bacterial infections (e.g. clarithromycin, erythromycin).
  • any antiviral medicine for HIV/AIDS (e.g. ritonavir).
  • other medicines to prevent blood clots (e.g. enoxaparin, clopidogrel, or vitamin K antagonists, such as warfarin or acenocoumarol).
  • anti-inflammatory medicines or pain relievers (e.g. naproxen or acetylsalicylic acid).
  • dronedarone, a medicine for the treatment of irregular heartbeat.
  • certain medicines for the treatment of depression (selective serotonin reuptake inhibitors (SSRIs) or serotonin and norepinephrine reuptake inhibitors (SNRIs)).

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

If your doctor thinks you are at risk of stomach or intestinal ulcers, he/she may recommend that you also take a medicine to prevent ulcers.

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

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

Pregnancy and breast-feeding

Do not take this medicine if you are pregnant or breast-feeding. If you could become pregnant, use a reliable contraceptive while taking this medicine. If you become pregnant while taking this medicine, tell your doctor immediately, who will decide how you should be treated.

Driving and using machines

Rivaroxaban may cause dizziness (common side effect) or fainting (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 some sugars, consult your doctor before taking this medicine.

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

3. How to take Rivaroxaban Cipla

Take this medicine exactly as your doctor has told you. If you are not sure, ask your doctor or pharmacist.

You should take this medicine with food.

Swallow the tablets with water, preferably.

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

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

What dose to take

• Adults
• • To prevent the formation of blood clots in the brain (stroke) or in other blood vessels of the body.
  • The recommended dose is one 20 mg rivaroxaban tablet once daily. If you have kidney problems, the dose may be reduced to one 15 mg rivaroxaban tablet once daily.

If you need to undergo a procedure to treat blocked blood vessels in your heart (called percutaneous coronary intervention - PCI with stent insertion), there is limited evidence to reduce the dose to one 15 mg rivaroxaban tablet once daily (or one 10 mg rivaroxaban tablet once daily if your kidneys do not work properly) in addition to an antiplatelet medicine like clopidogrel.

• To treat blood clots in the veins of the legs and in the blood vessels of the lungs, and to prevent these blood clots from happening again.

The recommended dose is one 15 mg rivaroxaban tablet twice daily for the first 3 weeks. For treatment after 3 weeks, the recommended dose is one 20 mg rivaroxaban tablet once daily. After at least 6 months of treatment for blood clots, your doctor may decide to continue treatment with one 10 mg tablet once daily or one 20 mg tablet once daily.

If you have kidney problems and are taking one 20 mg rivaroxaban tablet once daily, your doctor may decide to reduce the dose of treatment to one 15 mg rivaroxaban tablet once daily after 3 weeks if the risk of bleeding is higher than the risk of having another blood clot.

• Children and adolescents

The dose of rivaroxaban depends on body weight and will be calculated by your doctor.

• The recommended dose for children and adolescents with a body weight of 30 kg to less than 50 kg is one 15 mg rivaroxaban tablet once daily.
• The recommended dose for children and adolescents with a body weight of 50 kg or more is one 20 mg rivaroxaban tablet once daily.

Take each dose of rivaroxaban with a drink (e.g. water or juice) during a meal. Take the tablets every day at approximately the same time. Consider setting an alarm to remind you.

For parents or caregivers: observe the child to ensure they take the entire dose.

Since the dose of rivaroxaban is based on body weight, it is important to attend scheduled visits with your doctor, as it may be necessary to adjust the dose as the weight changes.

Never adjust the dose of rivaroxaban on your own. Your doctor will adjust the dose if necessary.

Do not split the tablet to try to get a fraction of the tablet dose. If a smaller dose is required, please use an alternative formulation of rivaroxaban.

In children and adolescents who cannot swallow the tablets whole, please use an alternative formulation of rivaroxaban.

If the alternative formulation of rivaroxaban is not available, you can crush this medicine and mix it with water or apple sauce immediately before taking it. Take some food after taking this mixture. If necessary, your doctor may also give you the crushed rivaroxaban tablet through a gastric tube.

If you spit up the dose or vomit

• less than 30 minutes after taking this medicine, take a new dose.
• more than 30 minutes after taking this medicine, do nottake a new dose. In this case, take the next dose of this medicine at the usual time.

Contact your doctor if you spit up the dose or vomit repeatedly after taking this medicine.

When to take Rivaroxaban Cipla

Take the tablet(s) every day, until your doctor tells you to stop.

Try to take the tablet(s) at the same time every day to remember when to take them. Your doctor will decide how long you should take the treatment.

To prevent blood clots in the brain (stroke) and in other blood vessels of the body: If you need to have a procedure to restore a normal heartbeat (called cardioversion), take this medicine at the times your doctor tells you.

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

If you forget to take Rivaroxaban Cipla

• Adults, children, and adolescents:

If you are taking one 20 mg or one 15 mg tablet once daily, and you miss a dose, take it as soon as you remember. Do not take more than one tablet in one day to make up for a missed dose. Take the next tablet the next day and then continue taking one tablet every day.

• Adults:

If you are taking one 15 mg tablet twice daily, and you miss a dose, take it as soon as you remember. Do not take more than two 15 mg tablets in one day. If you miss a dose, you can take two 15 mg tablets at the same time, for a total of two tablets (30 mg) in one day. The next day, you should continue taking one 15 mg tablet twice daily.

If you take more Rivaroxaban Cipla than you should

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

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

If you stop taking Rivaroxaban Cipla

Do not stop taking rivaroxaban without first talking to your doctor, as rivaroxaban treats and prevents serious conditions.

If you have any further questions on 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.

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

Tell your doctor immediately if you or your child experience any of the following symptoms:

• Signs of bleeding
• • bleeding in the brain or inside the skull (symptoms may include headache, unilateral weakness, vomiting, seizures, decreased level of consciousness, and neck stiffness. This is a serious medical emergency. Go to the doctor 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 found in adults, children, and adolescents

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, gum bleeding.
• 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 (decrease in 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 in which 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).
• increase in pressure in the muscles of the legs or arms after bleeding, causing pain, swelling, altered sensation, numbness, or paralysis (compartment syndrome after bleeding).

Adverse effects in children and adolescents

In general, the adverse effects observed in children and adolescents treated with this medicine were similar to those observed in adults and their severity was mainly mild to moderate.

Adverse effects that were more frequently observed in children and adolescents:

Very frequent(may affect more than 1 in 10 people)

• headache.
• fever.
• nasal bleeding.
• vomiting.

Frequent(may affect up to 1 in 10 people)

• accelerated heartbeats.
• blood tests may show an increase in bilirubin (bile pigment).
• thrombocytopenia (low platelet count, cells that help blood clotting).
• heavy menstrual bleeding.

Uncommon(may affect up to 1 in 100 people)

• blood tests may show an increase in a subcategory of bilirubin (direct bilirubin, bile pigment).

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 that appears 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 puree for up to 4 hours.

Medicines should not be thrown away through wastewater or household waste. Deposit the packaging and medicines that you no longer need in the SIGRE collection point at the pharmacy. Ask your pharmacist how to dispose of the packaging and medicines that 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 15 mg or 20 mg of rivaroxaban.
• The other ingredients (excipients) are:

Core of the tablet: microcrystalline cellulose, sodium croscarmellose, lactose monohydrate, hypromellose, sodium lauryl sulfate, magnesium stearate.

See section 2 "Rivaroxaban Cipla contains lactose and sodium".

Coating material: hypromellose 2910 (E 464), titanium dioxide (E 171), macrogol (E 1521), red iron oxide (E 172). The 15 mg tablets also contain yellow iron oxide (E 172).

Appearance of the product and package contents

Rivaroxaban Cipla 15 mg film-coated tablets are beige, round, biconvex, 5.5 ± 0.20 mm in diameter, engraved with "15" on one side and smooth on the other.

They are presented in PVC/PVDC/aluminum foil blisters packaged in boxes of 10, 14, 28, 42, and 98 film-coated tablets.

Rivaroxaban Cipla 20 mg film-coated tablets are brown, round, biconvex, 6.0 ± 0.20 mm in diameter, engraved with "20" on one side and smooth on the other.

They are presented in PVC/PVDC/aluminum foil blisters packaged in boxes of 14, 28, and 98 film-coated tablets.

Not all 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 15 mg film-coated tablets

Rivaroxaban Cipla 20 mg film-coated tablets

Spain: Rivaroxaban Cipla 15 mg film-coated tablets EFG

Rivaroxaban Cipla 20 mg film-coated tablets EFG

Norway: Rivaroxaban Cipla

France: Rivaroxaban Cipla 15 mg film-coated tablets

Rivaroxaban Cipla 20 mg film-coated tablets

Italy: Rivaroxaban Cipla

Denmark: Rivaroxaban Cipla 15 mg film-coated tablets

Rivaroxaban Cipla 20 mg film-coated tablets

Ireland: Rivaroxaban Azure 15 mg film-coated tablets

Rivaroxaban Azure 20 mg film-coated tablets

Date of the last revision of this leaflet: November 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/.