Prospecto: information for the user

TIONER RETARD 100 mg prolonged-release tablets

Tramadol hydrochloride

Read this prospect carefully before starting to take this medicine, as it contains important information for you.

• Keep this prospect, as you may need to read it again.
• If you have any doubts, consult your doctor or pharmacist.
• This medicine has been prescribed to you alone, 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 prospect. See section 4.

1.What is Tioner retard 100 mg and for what it is used

2.What you need to know before starting to take Tioner retard 100 mg

3.How to take Tioner retard 100 mg

4.Possible adverse effects

5.Storage of Tioner retard 100 mg

6.Contents of the package and additional information

Tramadol - the active ingredient of Tioner retard 100 mg - is a pain reliever belonging to the opioid group that acts on the central nervous system. It relieves pain by acting on specific nerve cells in the spinal cord and the brain.

Tioner retard 100 mg is indicated for the treatment of moderate to severe pain.

Do not take Tioner retard 100 mg

• If you are allergic to tramadol or any of the other components of this medication (listed in section 6).
• In case of acute intoxications caused by alcohol, sleep-inducing drugs, analgesics, or psychotropic drugs (medications that affect mood and emotions).
• If you are also taking MAO inhibitors (certain medications used to treat depression) or if you have taken them in the last 14 days before starting treatment with Tioner retard 100 mg (see "Other medications and Tioner retard 100 mg").
• If you have epilepsy and your seizures are not adequately controlled with treatment.
• For the treatment of withdrawal syndrome.

Warnings and precautions

Consult your doctor before starting to take Tioner retard 100 mg

• If you think you have dependence on other analgesics (opioids).
• If you have consciousness disorders (if you think you are going to faint).
• If you are in shock (a sign of this state can be cold sweat).
• If you have increased intracranial pressure (for example, after a head trauma or brain diseases).
• If you have difficulty breathing.
• If you are epileptic or have seizures, because the risk of these seizures may increase.
• If you have any liver or kidney disease.
• If you suffer from depression and are taking antidepressants, since some may interact with the tramadol (see "Other medications and Tioner retard 100 mg").

Respiratory disorders related to sleep

Tioner retard 100 mg may cause respiratory disorders related to sleep such as sleep apnea (pauses in breathing during sleep) and sleep-related hypoxemia (low oxygen levels in the blood). Among the symptoms may include pauses in breathing during sleep, nocturnal awakenings due to lack of breath, difficulty maintaining sleep or excessive daytime somnolence. If you or someone else observes these symptoms, contact your doctor. Your doctor may consider reducing the dose.

Seizures have been reported in patients taking tramadol at the recommended dose. The risk may increase when the tramadol dose exceeds the recommended maximum daily dose (400 mg).

Be aware that Tioner retard 100 mg may cause physical and psychological dependence. When Tioner retard 100 mg is used for a long period of time, its effect may decrease, requiring higher doses (development of tolerance).

In patients with a tendency to abuse medications or who have medication dependence, treatment with Tioner retard 100 mg should only be carried out for short periods of time and under strict medical supervision.

Also inform your doctor if any of the following problems occur during treatment with Tioner retard 100 mg or if they have ever occurred:

Extreme fatigue, loss of appetite, severe abdominal pain, nausea, vomiting, or low blood pressure. They may be indicators of adrenal insufficiency (low cortisol levels). If you have these symptoms, contact your doctor, who will decide if you need to take hormone supplements.

Tramadol is transformed in the liver by an enzyme. Some people have a variation of this enzyme and this may affect each person differently. In some people, it may not be possible to achieve sufficient pain relief, while others may be more likely to experience severe adverse effects. If you notice any of the following adverse effects, stop taking this medication and consult your doctor immediately: slow or shallow breathing, confusion, drowsiness, constricted pupils, general discomfort or vomiting, constipation, loss of appetite.

There is a weak risk that you may experience a serotonin syndrome that may appear after taking tramadol in combination with certain antidepressants or tramadol monotherapy. Consult your doctor immediately if you experience any of the symptoms linked to this severe syndrome (see section 4 "Possible adverse effects").

Children and adolescents

Use in children with respiratory problems

Tramadol should not be used in children with respiratory problems, as the symptoms of tramadol toxicity may worsen in these children.

Other medications and Tioner retard 100 mg

Inform your doctor or pharmacist if you are taking, have taken recently, or may need to take any other medication.

The concomitant use of Tioner retard 100 mg and sedatives such as benzodiazepines or related medications increases the risk of drowsiness, difficulty breathing (respiratory depression), coma, and may put your life at risk. Therefore, concomitant use should only be considered when no other treatment is possible.

However, if your doctor prescribes Tioner retard 100 mg along with sedatives, the dose and duration of concomitant treatment should be limited by your doctor.

Inform your doctor about all sedatives you are taking, and follow your doctor's recommended dose. It may be helpful to inform friends or family members to be aware of the signs and symptoms indicated above. Consult your doctor if you experience any symptoms.

Concomitant treatment of Tioner retard 100 mg with monoamine oxidase inhibitors (MAOIs) (certain medications for depression treatment) should be avoided.

Both the analgesic effect of Tioner retard 100 mg and its duration may be reduced if you take medications containing:

• Carbamazepine (for epilepsy crises)
• Ondansetron (medication to prevent nausea)

Your doctor will indicate if you should take Tioner retard 100 mg and at what dose.

The risk of adverse effects increases:

• If you are taking tranquilizers, sleep-inducing medications, other analgesics such as morphine and codeine (also when used for cough), and alcohol while taking Tioner retard 100 mg. It may cause more sleepiness or the sensation of fainting. If this occurs, consult your doctor.
• If you are taking medications that facilitate or may cause seizures, such as certain antidepressants or antipsychotics. The risk of seizures increases if you take Tioner retard 100 mg simultaneously with these medications. Your doctor will tell you if Tioner retard 100 mg is suitable for you.
• If you are taking antidepressants, Tioner retard 100 mg may interact with these medications and you may experience a serotonin syndrome (see section 4 "Possible adverse effects").
• If you are taking anticoagulant medications, such as warfarin, along with Tioner retard 100 mg. The effect of these medications on blood coagulation may be affected and may lead to bleeding.
• Gabapentin or pregabalin for treating epilepsy or pain due to nerve problems (neuropathic pain).

Tolerance, dependence, and addiction

This medication contains tramadol, which is an opioid medication. Repeated use of opioids may make the medication less effective (the body becomes accustomed to it, known as pharmacological tolerance). Repeated use of Tioner retard 100 mg may also cause dependence, abuse, and addiction, which may lead to a potentially fatal overdose. The risk of these adverse effects may be higher with a higher dose and longer use.

Dependence or addiction may cause a sense of lack of control over the amount of medication to be used or the frequency of use.

The risk of dependence or addiction varies from person to person. The risk of becoming dependent or addicted to Tioner retard 100 mg may be higher if:

• You or any member of your family have abused alcohol or experienced dependence on it, medications with a prescription, or illegal drugs ("addiction").
• You are a smoker
• You have had any problems with mood (depression, anxiety, or personality disorder) or have followed treatment by a psychiatrist for other mental illnesses).

If you notice any of the following symptoms while using Tioner retard 100 mg, it may be a sign of dependence or addiction:

• You need to use the medication for a longer period than indicated by your doctor
• You need to use a higher dose than recommended
• You are using the medication for reasons other than those prescribed, such as "to feel calm" or "to help you sleep".
• You have made repeated and unsuccessful attempts to stop using the medication or control its use.
• You feel unwell when you stop using the medication, and you feel better once you take it again ("withdrawal symptoms").

If you notice any of these signs, consult your doctor to determine the best treatment for you, when it is appropriate to stop the medication, and how to do it safely (see section 3, if you interrupt treatment with Tioner retard).

Taking Tioner retard 100 mg with food and alcohol

Do not consume alcohol during treatment with Tioner retard 100 mg, as its effect may be intensified. Food does not affect the effect of Tioner retard 100 mg.

Pregnancy, breastfeeding, and fertility

If you are pregnant or breastfeeding, or if you think you may be pregnant, consult your doctor or pharmacist before using this medication.

There is very little information about the safety of tramadol during human pregnancy. Therefore, do not take Tioner retard 100 mg if you are pregnant.

Long-term use during pregnancy may lead to withdrawal syndrome in newborns.

Lactation

Tramadol is excreted in breast milk. Therefore, do not take Tioner retard more than once during lactation, or if you take Tioner retard more than once, you should stop breastfeeding.

Based on human experience, it is not suggested that tramadol affects male and female fertility.

Driving and using machines

Ask your doctor if you can drive or use machines during treatment with Tioner retard 100 mg. It is essential to observe how this medication affects you before driving or using machines. Do not drive or use machines if you feel drowsy, dizzy, have blurred vision, or have difficulty concentrating. Be especially careful at the beginning of treatment, after increasing the dose, after changing the formulation, and/or when taking it with other medications.

Tioner retard 100 mg contains lactose

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

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

Your doctor will also explain to you what you can expect from the use of Tioner retard, when and for how long you should use it, when you should contact your doctor, and when you should discontinue use (see also section 2).

The dose should be adjusted according to the intensity of the pain and your individual sensitivity. Normally, the lowest dose possible that produces pain relief should be used. Do not take more than 400 mg of tramadol hydrochloride per day, unless your doctor has instructed you otherwise.

Unless your doctor has given you different instructions, the recommended dose is:

Adults and adolescents over 12 years old

One Tioner retard 100 mg prolonged-release tablet twice a day (equivalent to 200 mg of tramadol hydrochloride per day), preferably in the morning and at night.

Your doctor may prescribe a different and more suitable dose of this medication if necessary.

If necessary, the dose can be increased to 150 mg or 200 mg twice a day (equivalent to 300 mg – 400 mg of tramadol hydrochloride per day).

Use in Children

Tioner retard 100 mg is not suitable for children under 12 years old.

Older Patients

In elderly patients (over 75 years old), the elimination of tramadol may be slow. If this is your case, your doctor may recommend prolonging the dosing intervals.

Patients with liver or kidney disease / patients on dialysis

If you have a severe liver or kidney disease, treatment with Tioner retard 100 mg is not recommended. If you have moderate liver or kidney disease, your doctor may prolong the dosing intervals.

How and when to take Tioner retard 100 mg?

Tioner retard 100 mg prolonged-release tablets are administered orally.

Always swallow the Tioner retard 100 mg tablets whole, not divided or chewed, with sufficient liquid, preferably in the morning and at night. You can take the tablet with an empty stomach or with meals.

For how long should you take Tioner retard 100 mg?

Tioner retard 100 mg should not be administered for longer than strictly necessary.

If you require prolonged treatment, your doctor will monitor you at short and regular intervals (if necessary, with interruptions in treatment) to see if you should continue treatment with Tioner retard 100 mg and at what dose.

If you estimate that the action of this medication is too strong or too weak, inform your doctor or pharmacist.

If you take more Tioner retard 100 mg than you should

If you have taken more Tioner retard 100 mg than you should by mistake, generally you will not have any negative effects. You should take the next dose as prescribed.

After taking very high doses, you may experience pupil constriction, vomiting, decreased blood pressure, increased heart rate, collapse, decreased level of consciousness to coma (deep unconsciousness), seizures, and difficulty breathing that can lead to respiratory arrest. In this case, call a doctor immediately!

In case of overdose or accidental ingestion, consult your doctor, pharmacist, or call the Toxicological Information Service, phone 91.562.04.20, indicating the medication and the amount taken.

It is recommended to bring the medication leaflet to the healthcare professional.

If you forget to take Tioner retard 100 mg

If you forget to take the tablets, it is likely that the pain will return. Do not take a double dose to compensate for the missed doses, simply continue treatment as instructed by your doctor.

If you interrupt treatment with Tioner retard 100 mg

If you interrupt or discontinue treatment with Tioner retard 100 mg too soon, it is likely that the pain will return. If you want to interrupt treatment due to unwanted effects, consult your doctor.

You should not stop taking this medication suddenly unless your doctor tells you to. If you want to stop taking your medication, talk to your doctor first, especially if you have been taking it for a long time. Your doctor will inform you when and how to discontinue it, which can be done by gradually reducing the dose to reduce the likelihood of unnecessary adverse effects (withdrawal symptoms).

Generally, there are no unwanted effects when discontinuing treatment with Tioner retard 100 mg. However, in rare cases, when some people who have been taking Tioner retard 100 mg for some time stop taking it suddenly, they may feel unwell. They may feel agitated, anxious, nervous, or shaky. They may feel hyperactive, have difficulty sleeping, or experience gastrointestinal or intestinal disorders. Very few people may experience panic attacks, hallucinations, unusual perceptions such as itching, tingling, and numbness, and ringing in the ears (tinnitus). Very rarely, other unusual central nervous system symptoms, such as confusion, delirium, distorted perception of one's own personality (derealization), and altered perception of reality (depersonalization), and persecutory delusions (paranoia), have been seen. If you experience any of these symptoms after stopping Tioner retard 100 mg, please consult your doctor.

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

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

You should consult your doctor immediately if you experience symptoms of an allergic reaction such as swelling of the face, tongue, and/or throat and/or difficulty swallowing and hives along with difficulty breathing.

The most common side effects during treatment with Tioner retard 100 mg are nausea and dizziness, which occur in more than 1 in 10 people.

Very common: may affect more than 1 in 10 people

• Dizziness.
• Nausea.

Common: may affect 1 in 10 people

• Headache, numbness.
• Fatigue.
• Vomiting, dry mouth, constipation.
• Sweating (hyperhidrosis).

Uncommon: may affect 1 in 100 people

• Effects on the heart and blood circulation (strong heartbeats and rapid heartbeats, sensation of dizziness or collapse). These side effects may occur especially in patients who are lying down or who are engaging in physical effort.
• Desire to vomit (retching), stomach problems (e.g. feeling of pressure in the stomach, swelling), diarrhea.
• Skin reactions (e.g. itching, hives).

Rare: may affect 1 in 1,000 people

• Allergic reactions (e.g. difficulty breathing, wheezing, skin swelling) and shock (sudden circulatory failure) have occurred in very rare cases.
• Slow heart rate.
• Increased blood pressure.
• Abnormal sensations (e.g. itching, tingling, numbness), tremor, seizures, muscle cramps, uncoordinated movements, transient loss of consciousness (syncope), speech disorders.
• Seizures may occur mainly after taking high doses of tramadol or when taken simultaneously with other medications that may cause seizures.
• Changes in appetite.
• Hallucinations, confusion, sleep disturbances, delirium, anxiety, and nightmares.
• Psychological problems may appear after treatment with Tioner retard 100 mg. Their intensity and nature may vary (in accordance with the patient's personality and the duration of treatment). These problems may manifest as a change in mood (usually euphoria, occasionally irritability), changes in activity (usually decreased, occasionally increased) and decreased cognitive and sensory perception (changes in senses and recognition, which may lead to judgment errors).
• Dependence on the drug may occur.
• Blurred vision, pupil constriction (miosis), excessive pupil dilation (midriasis).
• Slow breathing, shortness of breath (dyspnea).
• Worsening of asthma has been reported, however, no causal relationship with tramadol has been established. If the recommended doses are exceeded or if taken concomitantly with other medications that depress cerebral function, a decrease in respiratory frequency may occur.
• Muscle weakness.
• Difficulty or pain urinating, decreased urine output (dysuria).

Very rare: may affect 1 in 10,000 people

• Increased liver enzymes.

Frequency not known: frequency that cannot be estimated from available data

• Decreased blood sugar level.
• Hypophagia.
• Serotonin syndrome, which may manifest as changes in mental state (e.g. agitation, hallucinations, coma), and other effects, such as fever, increased heart rate, unstable blood pressure, involuntary muscle contractions, muscle rigidity, lack of coordination, and/or gastrointestinal symptoms (e.g. nausea, vomiting, diarrhea) (see section 2 "What you need to know before starting to take Tioner retard 100 mg").

If Tioner retard 100 mg is taken for a long period of time, dependence on the drug may occur, although the risk is very low.

When treatment is stopped abruptly, signs of drug withdrawal syndrome (see "If you stop taking Tioner retard 100 mg").

Reporting of side effects:

If you experience any type of side effect, consult your doctor or pharmacist, 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 for the 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.

Store this medication in a safe and protected place, to which no one else can access. This medication can cause serious harm or even be fatal to individuals who have not been prescribed it.

Do not use this medication after the expiration date that appears on the packaging after "CAD". The expiration date is the last day of the month indicated. This medication does not require special storage conditions.

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

Composition of Tioner retard 100 mg prolonged-release tablets

• The active ingredient is tramadol hydrochloride. Each tablet contains 100 mg of tramadol hydrochloride.
• The other components are:

Tablet core: microcrystalline cellulose, 100 000 mPa·s hypromellose, magnesium stearate, anhydrous colloidal silica.

Coating: 6 mPa·s hypromellose, lactose monohydrate (see section 2 “Tioner retard 100 mg contains lactose”), macrogol 6000, propylene glycol, talc, and titanium dioxide (E 171).

Appearance of the product and contents of the packaging

Tioner retard 100 mg prolonged-release tablets are white-coated, round, biconvex tablets, marked with "T1" on one side and the manufacturer's logo on the other.

Tioner retard 100 mg tablets are contained in blister strips and further packaged in boxes of 20 and 60 tablets.

Only some packaging sizes may be commercially available.

Holder of the marketing authorization and responsible manufacturer

Holder of the marketing authorization:

Aristo Pharma Iberia, S.L.

C/ Solana, 26

28850, Torrejón de Ardoz

Madrid. Spain

Responsible manufacturer:

Grünenthal GmbH

Zieglerstrasse, 6 – D-52078 Aachen (Germany)

Last review date of this leaflet: May 2024

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