TRAMADOL NORMON 100 mg HARD CAPSULES

Introduction

Package Leaflet: Information for the User

Tramadol Normon 100 mg Hard Capsules

Tramadol, Hydrochloride

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

1. What is Tramadol Normon and what is it used for

Tramadol, the active substance in this medicine, is an analgesic belonging to the group of opioids that acts on the central nervous system. It relieves pain by acting on specific nerve cells in the spinal cord and brain.

Tramadol is used to treat moderate or severe pain.

2. What you need to know before you take Tramadol Normon

Do not take Tramadol Normon

• if you are allergic to tramadol or any of the other ingredients of this medicine (listed in section 6),
• in case of acute intoxication with alcohol, hypnotics, analgesics, opioids, or other psychotropic medicines (medicines that act on the mood and emotions),
• if you are taking monoamine oxidase inhibitors (MAOIs), (a certain type of medicine for the treatment of depression) or if you have taken them in the last 14 days before treatment with tramadol (see “Other medicines and tramadol”),
• 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 or pharmacist before starting to take this medicine:

• if you think you are dependent on other analgesics (opioids),
• if you have disorders of consciousness (if you think you are going to faint),
• if you are in a state of shock (a sign of this state may be cold sweat),
• if you have increased intracranial pressure (e.g. after a head injury or diseases that affect the brain),
• if you have difficulty breathing,
• if you are epileptic or have a history of seizures, as the risk of seizures may increase,
• if you have any liver or kidney disease.
• if you suffer from depression and are taking antidepressants, as some may interact with tramadol (see “Other medicines and Tramadol Normon”).

There is a weak risk that you may experience a serotonin syndrome that can occur after taking tramadol in combination with certain antidepressants or tramadol monotherapy. Consult a doctor immediately if you experience any of the symptoms associated with this serious syndrome (see section 4 “Possible side effects”)

Respiratory disorders related to sleep

Tramadol may cause respiratory disorders related to sleep, such as sleep apnea (pauses in breathing during sleep) and sleep-related hypoxemia (low oxygen level in the blood). Symptoms may include pauses in breathing during sleep, nighttime awakenings due to shortness of breath, difficulty maintaining sleep, or excessive daytime sleepiness. If you or someone else notices these symptoms, contact your doctor. Your doctor may consider a dose reduction.

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

Tolerance, dependence, and addiction

This medicine contains tramadol, which is an opioid medicine. Repeated use of opioids can make the medicine less effective (the body gets used to it, which is known as pharmacological tolerance). Repeated use of Tramadol Normon can also lead to dependence, abuse, and addiction, which could result in a potentially life-threatening overdose. The risk of these side effects may be greater with a higher dose and longer use.

Dependence or addiction can cause a lack of control over the amount of medicine you use or how often you use it.

The risk of dependence or addiction varies from person to person. The risk of becoming dependent on Tramadol Normon may be greater if:

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

If you notice any of the following symptoms while using Tramadol Normon, it could be a sign of dependence or addiction:

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

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

Tramadol is transformed in the liver by an enzyme. Some people have a variation of this enzyme, and this can affect each person differently. In some people, sufficient pain relief may not be achieved, while others are more likely to experience serious side effects. If you notice any of the following side effects, you must stop taking this medicine and consult a doctor immediately: slow or shallow breathing, confusion, drowsiness, constricted pupils, general malaise, or vomiting, constipation, loss of appetite.

Talk to your doctor if you experience any of the following symptoms while taking tramadol:

Extreme fatigue, loss of appetite, severe abdominal pain, nausea, vomiting, or low blood pressure. These 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.

Other medicines and Tramadol Normon

Tell your doctor or pharmacist if you are taking, have recently taken, or might take any other medicines.

• Gabapentin or pregabalin for treating epilepsy or pain due to nerve problems (neuropathic pain).

Concomitant treatment with tramadol and MAO inhibitors (a certain type of medicine used for the treatment of depression) should be avoided.

Both the effect and duration of pain relief produced by tramadol may be reduced if you take medicines that contain:

• Carbamazepine (for epilepsy);
• Ondansetron (to prevent nausea).

Your doctor will tell you if you should take this medicine and in what dose.

The risk of side effects increases:

• if you are taking this medicine simultaneously with other analgesics such as morphine and codeine (even when used for the treatment of cough) and alcohol. In these cases, you may feel drowsy or dizzy. If this happens, consult your doctor.

Concomitant use of tramadol with sedatives or medicines for the treatment of insomnia (such as benzodiazepines) increases the risk of drowsiness, respiratory difficulties (respiratory depression), coma, and can be potentially life-threatening. Therefore, concomitant use should only be considered when other treatment options are not possible.

However, if your doctor prescribes tramadol with sedative medicines, they will limit the dose and duration of concomitant treatment.

Tell your doctor about all sedative medicines you are taking and follow your doctor's dose recommendation strictly. It may be useful to inform your friends and family about the signs and symptoms indicated above. Tell your doctor if you experience any of these symptoms;

• if you are taking medicines that can cause seizures, such as certain antidepressants or antipsychotics. The risk of seizures increases if you take tramadol simultaneously with these medicines. Your doctor will tell you if tramadol is suitable for you;
• if you are taking medicines for the treatment of depression. Tramadol may interact with these medicines, and you may experience a serotonin syndrome (see section 4 “Possible side effects”);
• if you are taking anticoagulant medicines, such as warfarin, while taking tramadol. The effect of these medicines on blood coagulation may be affected, and bleeding may occur;
• if you are taking medicines that can increase the accumulation of tramadol and, therefore, its side effects (such as ritonavir, quinidine, paroxetine, fluoxetine, sertraline, amitriptyline, isoniazid, ketoconazole, and erythromycin).

Taking Tramadol Normon with food and alcohol

Do not consume alcohol during treatment with this medicine, as its effect may be intensified.

Food does not affect the effect of tramadol.

Children and adolescents

Use in children with respiratory problems:

Tramadol is not recommended for use in children with respiratory problems, as symptoms of tramadol toxicity may worsen in these children.

Pregnancy, breast-feeding, and fertility

If you are pregnant or breast-feeding, think you may be pregnant, or are planning to have a baby, ask your doctor or pharmacist for advice before taking this medicine.

There is very little information available on the safety of tramadol in pregnant women. Therefore, you should not take this medicine if you are pregnant.

Chronic treatment during pregnancy may cause withdrawal syndrome in newborns.

Tramadol is excreted in breast milk. For this reason, you should not take tramadol more than once during breast-feeding, or if you take tramadol more than once, you should interrupt breast-feeding.

Based on human experience, tramadol is not expected to affect fertility in men and women.

Driving and using machines

Ask your doctor if you can drive or use machines while taking tramadol. It is important that before driving or using machines, you observe how this medicine affects you. Do not drive or use machines if you feel drowsy, dizzy, have blurred vision, or double vision, or have difficulty concentrating. Be especially careful at the start of treatment, after a dose increase, after a change in formulation, and/or when administering it concomitantly with other medicines.

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

3. How to take Tramadol Normon

Always take this medicine exactly as your doctor or pharmacist has told you. Check with your doctor or pharmacist if you are not sure.

Before starting treatment and regularly during treatment, your doctor will also explain what you can expect from the use of Tramadol Normon, when and for how long you should use it, when you should contact your doctor, and when you should stop using it (see also section 2).

The dose should be adjusted to the intensity of the pain and the individual patient's sensitivity. Normally, the lowest possible dose that produces pain relief should be used. Do not take more than 4 capsules per day (400 mg of tramadol hydrochloride), unless your doctor has told you to do so.

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

Adults and adolescents over 12 years

1 capsule per intake (equivalent to 100 mg tramadol hydrochloride).

Depending on the pain, the effect can last between 4-6 hours.

Normally, the initial dose is 50-100 mg of tramadol hydrochloride, depending on the patient and the intensity of the pain.

If your doctor decides to change or reduce the dose, other presentations of the medicine are available.

If you think the effect of this medicine is too strong or too weak, tell your doctor or pharmacist.

Children

This medicine is not recommended for use in children under 12 years.

Elderly patients

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

Patient with liver or kidney impairment/patients on dialysis

If you have severe liver or kidney disease, treatment with this medicine is not recommended. If you have moderate liver or kidney impairment, your doctor may prolong the intervals between each dose.

How and when should you take Tramadol Normon?

The capsules are administered orally.

Swallow the capsules whole, without dividing or chewing them, with sufficient liquid.

You can take the capsules with or without food.

For how long should you take Tramadol Normon?

This medicine should not be taken for longer than necessary. If you require prolonged treatment, your doctor will regularly check you at short intervals (if necessary with interruptions in treatment) to see if you should continue treatment with this medicine and at what dose.

If you take more Tramadol Normon than you should

If you have taken an extra dose by mistake, this will normally not have negative effects. You should continue with your next dose as prescribed.

Overdose with very high doses of tramadol can cause constricted pupils, vomiting, decreased blood pressure, increased heart rate, collapse, decreased level of consciousness up 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 Toxicology Information Service, phone 91 562 04 20, indicating the medicine and the amount taken. It is recommended to take the medicine leaflet to the healthcare professional.

If you forget to take Tramadol Normon

If you forget to use this medicine, it is likely that the pain will return. Do not take a double dose to make up for forgotten doses. Simply continue taking this medicine as you have been doing until now.

If you stop treatment with Tramadol Normon

If you stop or finish treatment with this medicine too early, it is likely that the pain will return. If you want to stop treatment due to side effects, consult your doctor.

Do not stop taking this medicine suddenly unless your doctor tells you to do so. If you want to stop taking your medicine, 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 stop it, which can be done by gradually reducing the dose to reduce the likelihood of unnecessary side effects (withdrawal symptoms).

Generally, no side effects are experienced when treatment with tramadol is stopped. However, in rare cases, people who have been taking this medicine for some time may feel unwell if they stop treatment abruptly. They may feel agitated, anxious, nervous, or trembly. They may be overactive, have difficulty sleeping, or have problems with digestion and bowel movements. Very few people may have panic attacks, hallucinations, unusual perceptions such as itching, tingling, and numbness, and ringing in the ears (tinnitus). Very rarely, unusual symptoms of the central nervous system have been detected, such as confusion, delirium, change in perception of personality (depersonalization), and change in perception of reality (derealization) and persecution delusions (paranoia). If you experience any of these symptoms after stopping treatment with this medicine, consult your doctor.

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.

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 rash along with difficulty breathing.

The most frequent adverse effects during treatment with tramadol are nausea and dizziness, occurring in more than 1 in 10 patients.

Very common: may affect more than 1 in 10 people

• Dizziness.
• Nausea.

Common: may affect 1 in 10 people

• Headache, numbness.
• Fatigue.
• Constipation, dry mouth, vomiting.
• Sweating (hyperhidrosis).

Uncommon: may affect 1 in 100 people

• Effects on the heart and circulation (strong and rapid heartbeats, feeling of dizziness or collapse). These adverse effects may occur particularly in patients who are incorporated or who make physical effort.
• Desire to vomit (retching), gastrointestinal discomfort (e.g., feeling of pressure in the stomach, bloating), diarrhea.
• Dermatological reactions (e.g., itching, skin rash).

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 heartbeat.
• Increased blood pressure.
• Abnormal sensations (e.g., itching, tingling, numbness), tremor, epileptic seizures, muscle twitches, uncoordinated movements, transient loss of consciousness (syncope), speech disorders.
• Epileptic seizures occur mainly after taking high doses of tramadol or when taken simultaneously with another medicine that may induce them.
• Changes in appetite.
• Hallucinations, confusion, sleep disturbances, delirium, anxiety, and nightmares.
• Psychological alterations may appear after treatment with tramadol. Their intensity and nature may vary (according to the patient's personality and the duration of treatment). These may appear in the form of mood changes (usually euphoria, occasionally irritability), changes in activity (usually decrease and occasionally increase), and decreased cognitive and sensory perception (alterations of the senses and perception that can lead to errors of judgment).
• It may cause dependence on the medicine. When treatment is interrupted abruptly, withdrawal syndrome may appear (see "If you stop treatment with Tramadol Normon").
• Blurred vision, pupil constriction (miosis), excessive pupil dilation (mydriasis).
• Slow breathing, shortness of breath (dyspnea).
• Cases of worsening asthma have been reported, however, it has not been established whether they were caused by tramadol. If the recommended doses are exceeded or if it is taken concomitantly with other medicines that depress brain function, a decrease in respiratory frequency may occur.
• Muscle weakness.
• Difficulty or pain when urinating, less urine than normal (dysuria).

Very rare: may affect 1 in 10,000 people

• Increased liver enzymes.

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

• Decrease in blood sugar levels.
• Hypo.

Indeterminate frequency (cannot be estimated from the available data)

Serotonin syndrome, which may manifest as changes in mental status (e.g., agitation, hallucinations, coma), and other effects, such as fever, increased heart rate, unstable blood pressure, involuntary muscle contractions, muscle stiffness, lack of coordination, and/or gastrointestinal symptoms (e.g., nausea, vomiting, diarrhea) (see section 2 "what you need to know before taking Tramadol Normon").

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 does not appear in this prospectus. You can also report them directly through the Spanish Pharmacovigilance System for human use medicines: https://www.notificaram.es. By reporting adverse effects, you can contribute to providing more information on the safety of this medicine.

5. Conservation of Tramadol Normon

Keep this medicine out of sight and reach of children.

Keep this medicine in a safe and protected place, where others cannot access it. This medicine can cause serious harm and even be fatal to people who have not been prescribed it.

Store below 30°C.

Do not use this medicine after the expiration date that appears on the packaging after CAD. The expiration date is the last day of the month indicated.

Medicines should not be thrown away through the sewers or in the trash. Deposit the packaging and medicines you no longer need in the SIGRE Point of the pharmacy. Ask your pharmacist how to dispose of the packaging and medicines you no longer need. This way, you will help protect the environment.

6. Contents of the packaging and additional information

Composition of Tramadol Normon

• The active ingredient is tramadol hydrochloride. Each hard capsule contains 100 mg of tramadol hydrochloride.
• The other components are: microcrystalline cellulose, sodium carboxymethyl starch type A (from potato), magnesium stearate, and anhydrous colloidal silica. The hard gelatin capsule is composed of: cap- gelatin, yellow iron oxide (E-172), indigo carmine lacquer (E-132), and titanium dioxide (E-171); body- gelatin, red iron oxide (E-172), and titanium dioxide (E-171).

Appearance of Tramadol Normon and contents of the packaging

Hard capsules with an opaque pink body and an opaque green cap containing white or almost white powder.

The medicine is supplied in packages of 30 and 60 capsules packaged in aluminum/PVC blisters with a prospectus.

Only some package sizes may be marketed.

Marketing authorization holder and manufacturer

LABORATORIOS NORMON, S.A.

Ronda de Valdecarrizo, 6 – 28760 Tres Cantos – Madrid (SPAIN)

Date of the last revision of this prospectus:May 2024

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