ZYTRAM 200 mg PROLONGED-RELEASE TABLETS

Introduction

Package Leaflet: Information for the Patient

Zytram 200 mg prolonged-release tablets

Tramadol, hydrochloride

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 Zytram and what is it used for
2. What you need to know before taking Zytram
3. How to take Zytram
4. Possible side effects
5. Storage of Zytram
6. Package contents and additional information

1. What is Zytram and what is it used for

These tablets have been prescribed to you by your doctor for the treatment of moderate to severe pain for a period of 24 hours. The tablets contain tramadol as the active ingredient, which is a potent analgesic (or pain reliever), belonging to a group of medications called opioids.

These tablets are for use in adults and adolescents over 12 years of age only.

2. What you need to know before taking Zytram

Do not take Zytram

• If you are allergic to tramadol or any of the other ingredients of this medication (listed in section 6);
• If you have taken excessive alcohol or higher-than-recommended doses of sleep medications, analgesics, or psychotropic medications (used to treat psychiatric or mental illnesses);
• If you are taking monoamine oxidase inhibitors (such as tranilcipromine, phenelzine, isocarboxazide, moclobemide, and linezolid), or if you have taken this type of medication in the last two weeks;
• To treat withdrawal syndrome caused by stopping another potent analgesic.

Warnings and precautions

Consult your doctor or pharmacist before starting to take these tablets if:

• You have or have had any type of addiction to alcohol or drugs;
• You have or have had epilepsy, seizures, tremors, or convulsions;
• You have or have had severe headaches, or feel unwell due to a head injury, or if you have increased intracranial pressure (e.g., due to a brain condition). The tablets may worsen symptoms or mask a head injury;
• You have severe liver or kidney disease;
• You are in shock (suddenly feel very dizzy, tired, cold, trembling, and pale);
• You have slow and weaker-than-normal breathing (respiratory depression);
• You suffer from depression and are taking antidepressants, as some may interact with tramadol (see "Other medications and Zytram prolonged-release tablets").
• You suffer from constipation.

Respiratory disorders related to sleep

Zytram tablets may cause sleep-related respiratory disorders, such as central sleep apnea (pauses in breathing during sleep) and sleep-related hypoxemia (low oxygen levels in the blood). These symptoms may include pauses in breathing during sleep, nighttime awakenings due to difficulty breathing, difficulty maintaining sleep, or excessive daytime sleepiness. If you or someone else observes these symptoms, consult your doctor. Your doctor may consider reducing the dose.

Tolerance, dependence, and addiction

This medication contains tramadol, which is an opioid medication. Repeated use of opioids can make the medication less effective (you get used to it, which is known as tolerance). Repeated use of Zytram can also lead to dependence, abuse, and addiction, which can cause a potentially fatal overdose. The risk of these side effects may increase with higher doses and longer treatment duration.

Dependence or addiction can make you feel like you no longer have control over the amount of medication you need to take or how often you need to take it.

The risk of becoming dependent or addicted varies from person to person. You may be at higher risk of becoming dependent or addicted to Zytram if:

• You or a family member have a history of alcohol or drug abuse.
• You are a smoker.
• You have ever had problems with your mood (depression, anxiety, or personality disorder) or have received psychiatric treatment for other mental illnesses.

If you notice any of the following signs while taking Zytram, it could be a sign that you have become dependent or addicted:

• You need to take the medication for longer than recommended by your doctor.
• You need to take more doses than recommended.
• You are using the medication for reasons other than those prescribed, such as "to calm down" or "to help you sleep".
• You have made repeated attempts to stop or control the use of the medication without success.
• You do not feel well when you stop taking the medication, and you feel better when you take it again ("withdrawal symptoms").

If you notice any of these signs, talk to your doctor to discuss the best treatment strategy for your case, including when it is appropriate to stop taking it and how to do so safely (see section 3, "If you stop taking Zytram").

Tramadol is metabolized 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 should stop taking this medication and consult a doctor immediately: slow or shallow breathing, confusion, drowsiness, constricted pupils, general malaise, or vomiting, constipation, loss of appetite.

There is a small risk that you may experience a serotonin syndrome that can occur after taking tramadol in combination with certain antidepressants or tramadol alone. Consult a doctor immediately if you experience any symptoms related to this serious syndrome (see section 4 "Possible side effects").

Consult your doctor or pharmacist if you experience any of the following symptoms while taking Zytram: extreme fatigue, loss of appetite, severe abdominal pain, nausea, vomiting, or low blood pressure. This may indicate that you have adrenal insufficiency (low cortisol levels). If you experience any of these symptoms, inform your doctor, who will decide whether you need to take a hormonal supplement.

Occasionally, an increase in sensitivity to pain (hyperalgesia) may occur, which does not respond to an increase in the dose of tramadol, especially at high doses. It may be necessary to reduce the dose of tramadol or switch to an alternative opioid.

Children and adolescents

Use in children with respiratory problems

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

Other medications and Zytram prolonged-release tablets

Tell your doctor or pharmacist if you are taking or have recently taken or may need to take any other medication. If you are taking other medications with these tablets, the effect of these tablets or the other medication may be altered.

Concomitant use of Zytram and sedative medications such as benzodiazepines or related medications increases the risk of drowsiness, breathing difficulties (respiratory depression), coma, and can be fatal. Due to this, concomitant use should only be considered when other treatment options are not possible.

However, if your doctor prescribes Zytram with sedative medications, your doctor should limit the dose and duration of concomitant treatment.

Tell your doctor about all sedative medications you are taking and follow your doctor's recommendations regarding the dose. It may be helpful to inform friends or family members so they are aware of the signs and symptoms mentioned above. Inform your doctor when you experience such symptoms.

These tablets should not be used in conjunction with a monoamine oxidase inhibitor (MAOI) or if you have taken this type of medication in the last two weeks (see section 2, "Do not take Zytram").

The risk of side effects increases:

• If you are taking medications that can cause seizures, such as certain antidepressants or antipsychotics. The risk of having a seizure may increase if you take Zytram tablets at the same time. Your doctor will inform you if Zytram tablets are suitable for you.
• If you are taking certain antidepressants. Zytram tablets may interact with these medications, and you may experience a serotonin syndrome (see section 4 "Possible side effects").

Tell your doctor or pharmacist if you are taking:

• Sleep medications (tranquilizers, hypnotics, or sedatives);
• Carbamazepine to treat seizures, tremors, convulsions, and some types of pain;
• Medications for depression;
• Medications for treating psychiatric or mental illnesses;
• Ritonavir to treat HIV;
• Digoxin to treat heart failure or arrhythmias;
• Other potent analgesics (buprenorphine, nalbuphine, and pentazocine);
• Certain morphine-like medications, for example, to treat cough or to treat withdrawal syndrome;
• Barbiturates to treat seizures or to sleep;
• Benzodiazepines to treat anxiety or to sleep;
• Gabapentin or pregabalin to treat epilepsy or pain due to nerve problems (neuropathic pain);
• Certain medications to prevent blood clotting or to thin the blood (cumulative anticoagulants, such as warfarin);
• Ondansetron to treat nausea or general malaise.

Taking Zytram tablets with alcohol

Consult your doctor or pharmacist if you drink or plan to drink alcohol while taking this medication.

Pregnancy, breastfeeding, and fertility

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

Pregnancy

Do not take this medication if you are pregnant. Depending on the dose and duration of treatment with tramadol, the newborn may experience slow and shallow breathing (respiratory depression) or withdrawal symptoms.

Breastfeeding

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

Babies born to mothers who have used Zytram prolonged-release tablets during pregnancy may experience withdrawal symptoms, including loud crying, irritability, and restlessness, agitation (shaking), feeding difficulties, and sweating.

Driving and using machines

These tablets can cause a range of side effects, such as drowsiness, blurred vision, and dizziness, which may affect your ability to drive or use machines (see section 4 for a complete list of side effects). These effects are more noticeable when you start treatment with the tablets or when the dose is increased. If you are affected, you should not drive or use machines.

Zytram tablets contain lactose

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

3. How to take Zytram tablets

Follow the instructions for administration of this medication exactly as indicated by your doctor or pharmacist. If you are unsure, ask your doctor or pharmacist. Before starting treatment and regularly during treatment, your doctor will discuss with you what you can expect from the use of Zytram, when and for how long you should take it, when to contact your doctor, and when to stop taking it (see also section 2).

The dose should be adjusted according to the intensity of the pain and your individual sensitivity. Normally, the lowest possible dose that produces pain relief should be used.

Adults and adolescents over 12 years of age

The usual initial dose is one 150 mg tablet once a day. However, your doctor will prescribe the dose required to treat the pain you are experiencing. Do not exceed the recommended dose prescribed by your doctor. If you find that you still experience pain while taking the tablets, consult your doctor. You should not take more than 400 mg per day.

The tablets should be swallowed whole with water. Do not break, dissolve, or chew them.

Zytram tablets are designed to provide adequate treatment over 24 hours when taken whole. If the tablet is broken, crushed, or dissolved, the full 24-hour dose may be absorbed rapidly by your body, which can be dangerous and cause serious problems, including a potentially fatal overdose.

You should take the tablets at the same time every day. For example, if you take a tablet at 8 am, you should take the next tablet at 8 am the following day.

Elderly patients

In elderly patients (over 75 years of age), the elimination of tramadol may be slow. If this is your case, your doctor may recommend reducing the dose.

Patients with liver or kidney impairment/patients on dialysis

If you have severe liver or kidney disease, treatment with Zytram tablets is not recommended. If you have mild or moderate liver or kidney impairment, your doctor may recommend reducing the dose.

Children under 12 years of age

Children under 12 years of age should not take this medication.

If you take more Zytram tablets than you should or someone takes them accidentally

Contact your doctor or the nearest hospital immediately. People who have taken an overdose may experience excessive drowsiness, feel very unwell, or very dizzy. They may have seizures, tremors, or convulsions. They may also have breathing difficulties that can lead to loss of consciousness or even death and may require emergency treatment in the hospital. If you need medical attention, make sure to bring this package leaflet and the remaining tablets with you.

In case of overdose or accidental ingestion, consult the Toxicology Information Service (Tel. 91.562.04.20), indicating the product and the amount ingested.

If you forget to take Zytram tablets

If you remember within 10 hours of the time you should have taken the tablet, take the missed tablet immediately. Then take the next tablet at the usual time. If more than 10 hours have passed, it is best to consult your doctor.

Do not take a double dose to make up for the missed dose.

If you stop taking Zytram tablets

Do 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 stop taking it, which can be done by gradually reducing the dose to minimize the risk of unnecessary side effects (withdrawal symptoms). If you stop taking these tablets suddenly, you may experience withdrawal symptoms such as agitation, anxiety, nervousness, difficulty sleeping, unusual hyperactivity, tremors, or gastrointestinal disorders, e.g., upset stomach.

If you have any other questions about the use of these tablets, 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.

All medicines can cause allergic reactions, even if severe allergic reactions are rare. Contact your doctor immediately if you suddenly experience shortness of breath, difficulty breathing, swelling of the eyelids, face, or lips, or itching, especially if it affects the whole body.

The most severe adverse effect is that in which slower or weaker than usual breathing is observed (respiratory depression).

As with all potent analgesics, there is a risk of addiction or dependence on these tablets.

Very Common:may affect more than 1 in 10 patients

• Dizziness (this effect usually subsides after a few days, however, your doctor may prescribe you some medication for dizziness if it continues to be a problem)
• Vertigo

Common:may affect up to 1 in 10 patients

• Somnolence (it is more frequent when starting to take the tablets or when the dose is increased, but it usually subsides after a few days)
• Dry mouth
• Sweating
• Vomiting (with a feeling of dizziness)

Uncommon:may affect up to 1 in 100 patients

• Headache
• Tachycardia, palpitations, or severe heart problems
• Feeling of "fainting" particularly when standing up, hypotension
• Constipation
• Abdominal pain or discomfort
• Rash, hives (urticaria), or itching

Rare:may affect up to 1 in 1,000 patients

• Numbness or tingling
• Blurred vision
• Hallucinations
• Nightmares
• Mood changes, feeling of discomfort and displeasure, or feeling of extreme happiness
• Changes in activity level
• Confusion
• Recognition problems, changes in thinking, memory, and behavior
• Seizures, tremors, or convulsions
• Hypertension
• Shortness of breath, difficulty breathing, or wheezing
• Worsening of asthma
• Lack of appetite
• Diarrhea
• Pain or difficulty urinating
• Muscle weakness
• Redness of the skin
• Bradycardia
• Fainting

Very Rare:may affect up to 1 in 10,000 patients

• Withdrawal symptoms when stopping the tablets, such as agitation, anxiety, nervousness, hyperactivity, tremors, difficulty falling asleep, stomach upset
• Worsening of liver function tests (seen in blood tests)

Frequency Not Known(frequency cannot be estimated from available data)

• Breathing problems during sleep (sleep apnea syndrome).
• • Decrease in blood sugar levels
  • Unusual feeling of weakness
  • Hiccup
  • Need to take increasingly higher doses of the tablets to achieve the same level of pain relief (tolerance).
  • Withdrawal symptoms in babies born to mothers who have used tramadol during pregnancy (see section 2 "Pregnancy, breastfeeding, and fertility").
  • Increased sensitivity to pain.
  • Serotonin syndrome, which can 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 Zytram prolonged-release tablets").

In some cases, the tablet matrix may be observed in the stool, which does not affect the efficacy of the tablets.

Reporting of Adverse Effects

If you experience any type of adverse effect, consult your doctor or pharmacist, even if it is an adverse effect that is not listed in this leaflet. 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. Storage of Zytram Tablets

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

Store this medicine in a safe place and where other people cannot access it. It can cause serious harm and be fatal to people when not prescribed to them.

Do not take these tablets after the expiration date shown on the blister pack and carton. The expiration date is the last day of the month indicated.

Do not store above 30°C.

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 the pharmacy. In case of doubt, ask your pharmacist how to dispose of the packaging and medicines you no longer need. This way, you will help protect the environment.

6. Package Contents and Additional Information

Composition of Zytram Tablets

The active ingredient is tramadol hydrochloride. Each tablet contains 200 mg of tramadol hydrochloride.

The other ingredients are:

• Hydrogenated vegetable oil
• Talc
• Magnesium stearate
• Lactose monohydrate
• Macrogol
• Hypromellose (E464)
• Titanium dioxide (E171)

Appearance of the Product and Package Contents

This medicine is presented in the form of film-coated tablets, white, oval, marked with a T followed by the dosage (200), with an approximate length of 15 mm.

Each carton contains 2, 7, 10, 14, 15, 20, 28, 30, 50, 56, 60, or 100 tablets.

Only some pack sizes may be marketed.

Marketing Authorization Holder and Manufacturer

Marketing Authorization Holder

Mundipharma Pharmaceuticals, S.L.

Bahía de Pollensa, 11

28042 Madrid

Spain

Manufacturer

Mundipharma DC B.V.

Leusderend 16

3832 RC Leusden

Netherlands

or

Zambón Switzerland LTD

Via Industria, 13 (Campedino)

CH-6814 – Switzerland

or

MEDA Pharma GmbH & Co. KG

Benzstrasse 1

61352 Bad Homburg

Germany

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

Austria Adamon® long retard - Filmtabletten

Portugal TRAVEX® Long

Spain Zytram®

Date of the Last Revision of this Leaflet: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/