TICAGRELOR SUN 90 mg FILM-COATED TABLETS

2. What you need to know before you take Ticagrelor Sun

Do not take Ticagrelor Sun if:

• You are allergic to ticagrelor or any of the other ingredients of this medicine (listed in section 6).
• You have a current bleeding disorder.
• You have had a stroke caused by bleeding in the brain.
• You have severe liver disease.
• You are taking any of the following medicines:
• • ketoconazole (used to treat fungal infections)
  • clarithromycin (used to treat bacterial infections)
  • nefazodone (an antidepressant)
  • ritonavir and atazanavir (used to treat HIV and AIDS)

Do not take ticagrelor if you are in any of the above situations. If you are unsure, consult your doctor or pharmacist before taking this medicine.

Warnings and precautions

Consult your doctor or pharmacist before taking ticagrelor if:

• You have a higher risk of bleeding due to:
• • a recent severe injury
  • a recent surgical procedure (including dental procedures, ask your dentist about this)
  • you have a disorder that affects blood clotting
  • a recent stomach or intestine bleeding (such as stomach ulcer or colon ‘polyps’)
• You are going to have surgery (including dental procedures) at any time while taking ticagrelor. This is because it increases the risk of bleeding. Your doctor may want to stop treatment with this medicine 5 days before surgery.
• Your heart rate is abnormally slow (normally less than 60 beats per minute) and you do not have a device that regulates your heart (pacemaker) implanted.
• You have asthma or other lung problems or breathing difficulties.
• You develop irregular breathing patterns, such as acceleration, slowing, or brief pauses in breathing. Your doctor will decide if you need any further evaluation.
• You have had any liver problems or have had a disease that may have affected your liver in the past.
• You have had a blood test that shows high levels of uric acid.

If any of the above applies to you (or if you are unsure), consult your doctor or pharmacist before taking this medicine.

If you are taking ticagrelor and heparin:

• Your doctor may require a blood sample for diagnostic tests if they suspect the presence of a rare blood clotting disorder caused by heparin. It is essential that you inform your doctor that you are taking ticagrelor and heparin, as ticagrelor may affect the diagnostic test.

Children and adolescents

Ticagrelor is not recommended for use in children and adolescents under 18 years of age.

Other medicines and Ticagrelor Sun

Tell your doctor or pharmacist if you are using, have recently used, or might use any other medicines. This is because ticagrelor may affect how some medicines work and some medicines may affect ticagrelor.

Tell your doctor or pharmacist if you are taking any of the following medicines:

• Rosuvastatin (a medicine to treat high cholesterol)
• more than 40 mg daily of simvastatin or lovastatin (medicines used to treat high cholesterol levels)
• rifampicin (an antibiotic)
• phenytoin, carbamazepine, and phenobarbital (used to control epileptic seizures)
• digoxin (used to treat heart failure)
• ciclosporin (used to reduce the body's immune response)
• quinidine and diltiazem (used to treat abnormal heart rhythms)
• beta-blockers and verapamil (used to treat high blood pressure)
• morphine and other opioids (used to treat acute pain)

In particular, tell your doctor or pharmacist if you are taking any of the following medicines that increase the risk of bleeding:

• ‘oral anticoagulants’, often referred to as ‘blood thinners’, including warfarin.
• Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) frequently taken as painkillers, such as ibuprofen and naproxen.
• Selective Serotonin Reuptake Inhibitors (SSRIs) taken as antidepressants, such as paroxetine, sertraline, and citalopram.
• other medicines such as ketoconazole (used to treat fungal infections), clarithromycin (used to treat bacterial infections), nefazodone (an antidepressant), ritonavir and atazanavir (used to treat HIV and AIDS), cisapride (used to treat stomach acidity), and ergot alkaloids (used to treat migraines and headaches).

Also, inform your doctor that because you are taking ticagrelor, you may have a higher risk of bleeding if your doctor administers fibrinolytics, often referred to as ‘clot dissolvers’, such as streptokinase or alteplase.

Pregnancy and breast-feeding

Ticagrelor should not be used if you are pregnant or may become pregnant. Women should use appropriate contraceptive methods to avoid pregnancy while taking this medicine.

Consult your doctor before taking this medicine if you are breast-feeding. Your doctor will explain the benefits and risks of taking ticagrelor during this period.

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.

Driving and using machines

Ticagrelor is unlikely to affect your ability to drive or use machines. If you feel dizzy or confused while taking this medicine, be careful while driving or using machines.

Ticagrelor Sun contains sodium and lactose

This medicine contains less than 1 mmol of sodium (23 mg) per dose, which is essentially ‘sodium-free’.

If your doctor has told you that you have an intolerance to some sugars, consult them before taking this medicine.

3. How to take Ticagrelor Sun

Follow the instructions for administration of this medicine exactly as your doctor has told you. If you are unsure, consult your doctor or pharmacist.

How much to take

Ticagrelor Sun 60 mg film-coated tablets EFG

• The usual dose is one 60 mg tablet twice a day. Keep taking ticagrelor as long as your doctor tells you.
• Take this medicine at the same time every day (e.g., one tablet in the morning and one in the evening).

Ticagrelor Sun 90 mg film-coated tablets EFG

• The initial dose is two tablets at the same time (a loading dose of 180 mg). This dose will usually be given in the hospital.
• After this initial dose, the usual dose is one 90 mg tablet twice a day for 12 months, unless your doctor tells you otherwise.
• Take this medicine at the same time every day (e.g., one tablet in the morning and one in the evening).

Taking Ticagrelor Sun with other medicines for blood clotting

Your doctor will also usually prescribe acetylsalicylic acid. This is a substance found in many medicines used to prevent blood clotting. Your doctor will tell you how much to take (usually between 75-150 mg daily).

How to take Ticagrelor Sun

• You can take this medicine with or without food.

If you have difficulty swallowing the tablet

If you have difficulty swallowing the tablet, you can crush it and mix it with water as follows:

• Crush the tablet into a fine powder
• Pour the powder into half a glass of water
• Stir and drink immediately
• To make sure you get all the medicine, rinse the empty glass with another half glass of water and drink it

If you are in the hospital, this tablet may be given to you mixed with a little water through a tube in your nose (nasogastric tube).

If you take more Ticagrelor Sun than you should

If you take more ticagrelor than you should, consult your doctor or go to the hospital immediately. Bring the medicine pack with you. You may have a higher risk of bleeding.

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

If you forget to take Ticagrelor Sun

• If you forget to take a dose, just take your next dose at the usual time.
• Do not take a double dose (two doses at the same time) to make up for forgotten doses.

If you stop taking Ticagrelor Sun

Do not stop taking this medicine without consulting your doctor. Take this medicine regularly and for as long as your doctor tells you. If you stop taking ticagrelor, you may increase the risk of having another heart attack or stroke, or of dying from a heart or blood vessel-related disease.

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

4. Possible side effects

Like all medicines, this medicine can cause side effects, although not everybody gets them. The following side effects may occur with this medicine:

Ticagrelor affects blood clotting, so most side effects are related to bleeding. Bleeding can occur anywhere in the body. Some level of bleeding is common (such as bruising and nosebleeds). Severe bleeding is uncommon but can be life-threatening.

Tell your doctor immediately if you notice any of the following - you may need urgent medical treatment:

• A bleed in the brain or inside the skull is an uncommon side effect, and can cause signs of a stroke such as:
• • • sudden numbness or weakness of the arms, legs, or face, especially if it affects only one side of the body
    • sudden confusion, difficulty speaking or understanding others
    • sudden difficulty walking or loss of balance or coordination
    • sudden feeling of dizziness or severe headache of unknown cause
  • Signs of bleeding such as:
  • • severe or uncontrolled bleeding
    • unexpected or prolonged bleeding
    • urine that is pink, red, or brown
    • vomiting blood or vomit that looks like “coffee grounds”
    • black or red stools (like tar)
    • coughing or vomiting blood
  • Fainting (syncope)
  • • temporary loss of consciousness due to a sudden drop in blood flow to the brain (common)
  • Signs of a blood clotting problem called Thrombotic Thrombocytopenic Purpura (TTP) such as:
  • • fever and purple spots (purpura) on the skin and in the mouth, with or without yellowing of the skin or eyes (jaundice), extreme unexplained tiredness or confusion.

Tell your doctor if you notice any of the following:

• Difficulty breathing- this is very common. It may be due to heart disease or another cause, or it may be a side effect of ticagrelor. Breathing difficulties related to ticagrelor are usually mild and are characterized by a sudden, unexpected need for air that usually occurs at rest and may appear in the first few weeks of treatment and in many cases may disappear. If you think your breathing difficulties have worsened or are lasting a long time, tell your doctor. They will decide if you need treatment or further investigations.

Other possible side effects

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

• High levels of uric acid in the blood (as seen in blood tests)
• Bleeding caused by blood disorders

Common (may affect up to 1 in 10 people)

• Bruising
• Headache
• Feeling dizzy or as if everything is spinning
• Diarrhea or indigestion
• Feeling sick (nausea)
• Constipation
• Rash
• Itching
• Severe pain and swelling in the joints - these are signs of gout
• Feeling dizzy or faint, or blurred vision - these are signs of low blood pressure
• Nosebleeds
• Bleeding more than usual after surgery or cuts (e.g., when shaving) and injuries
• Bleeding from the stomach wall (ulcer)
• Bleeding from the gums

Uncommon (may affect up to 1 in 100 people)

• Allergic reaction - a skin rash, itching, or swelling of the face or swelling of the lips/tongue may be signs of an allergic reaction
• Confusion
• Vision problems caused by bleeding in the eye
• Heavier or longer-than-usual vaginal bleeding, or bleeding between periods
• Bleeding into the joints and muscles that causes painful swelling
• Bleeding in the ear
• Internal bleeding, which can cause dizziness or fainting

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

• Abnormally low heart rate (normally below 60 beats per minute)

Reporting of side effects

If you experience any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via the Spanish Medicines Monitoring System for Human Use https://www.notificaRAM.es. By reporting side effects, you can help provide more information on the safety of this medicine.

5. Storing Ticagrelor Sun

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

Do not use this medicine after the expiry date which is stated on the blister and on the carton after EXP/CAD. The expiry date is the last day of the month shown.

This medicine does not require any special storage conditions.

Medicines should not be disposed of via wastewater or household waste. Return any unused medicine to a pharmacy for disposal. Ask your pharmacist how to dispose of medicines no longer required. This will help protect the environment.

6. Package Contents and Additional Information

Ticagrelor Sun Composition

• The active ingredient is ticagrelor.

Ticagrelor Sun 60 mg film-coated tablets: Each film-coated tablet contains 60 mg of ticagrelor.

Ticagrelor Sun 90 mg film-coated tablets: Each film-coated tablet contains 90 mg of ticagrelor.

• The other ingredients are:

Tablet core:lactose monohydrate, microcrystalline cellulose (E460), hydroxypropylcellulose, sodium croscarmellose (E468), magnesium stearate (E470b).

Tablet film coating:

Ticagrelor Sun 60 mg film-coated tablets: hypromellose (E464), titanium dioxide (E171), macrogol, black iron oxide (E172), red iron oxide (E172).

Ticagrelor Sun 90 mg film-coated tablets: hypromellose (E464), titanium dioxide (E171), talc (E553b), macrogol, yellow iron oxide (E172).

Product Appearance and Package Contents

Ticagrelor Sun 60 mg film-coated tablets

Film-coated tablets, round, biconvex, pink, marked with a "60" over a "T" on one side and smooth on the other.

Ticagrelor Sun 90 mg film-coated tablets

Film-coated tablets, round, biconvex, yellow, marked with a "90" over a "T" on one side and smooth on the other.

Ticagrelor Sun 60 mg film-coated tablets:

The film-coated tablets are packaged in transparent PVC-PVDC/Al blisters, in packs of 20, 56, 60, 168, and 200 film-coated tablets.

Ticagrelor Sun 90 mg film-coated tablets:

The film-coated tablets are packaged in transparent PVC-PVDC/Al blisters, in packs of 20, 56, 60, 100, 168, and 200 film-coated tablets.

Only some pack sizes may be marketed.

Marketing Authorization Holder and Manufacturer

Marketing Authorization Holder

Sun Pharmaceutical Industries (Europe) BV

Polarisavenue 87,

2132JH Hoofddorp,

Netherlands

Manufacturer

Sun Pharmaceutical Industries (Europe) BV

Polarisavenue 87,

2132JH Hoofddorp,

Netherlands

or

Terapia SA

124 Fabricii Street,

400632, Cluj-Napoca,

Romania

For further information about this medicinal product, please contact the local representative of the marketing authorization holder:

Sun Pharma Laboratories, S.L.

Rambla de Catalunya 53-55

08007 Barcelona

Spain

Tel: +34 93 342 78 90

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

Sweden Ticagrelor SUN 60 mg film-coated tablets

Ticagrelor SUN 90 mg film-coated tablets

Austria: Ticagrelor SUN 60 mg Filmtabletten

Ticagrelor SUN 90 mg Filmtabletten

Belgium: Ticagrelor SUN 60 mg Filmtabletten, Ticagrelor SUN 90 mg Filmtabletten;

Ticagrelor SUN 60 mg film-coated tablets, Ticagrelor SUN 90 mg film-coated tablets;

Ticagrelor SUN 60 mg filmomhulde tabletten, Ticagrelor SUN 90 mg filmomhulde tabletten

Germany: Ticagrelor Basics 60 mg Filmtabletten

Ticagrelor Basics 90 mg Filmtabletten

Denmark: Ticagrelor SUN

Spain: Ticagrelor SUN 60 mg film-coated tablets EFG

Ticagrelor SUN 90 mg film-coated tablets EFG

France: TICAGRELOR SUN 60 mg, film-coated tablet

TICAGRELOR SUN 90 mg, film-coated tablet

Italy: Ticagrelor SUN

Netherlands: Ticagrelor SUN 60 mg filmomhulde tabletten

Ticagrelor SUN 90 mg filmomhulde tabletten

Norway: Ticagrelor SUN

Poland: Ticagrelor Ranbaxy

Romania: Ticagrelor Terapia 60 mg film-coated tablets

Ticagrelor Terapia 90 mg film-coated tablets

Date of the last revision of this leaflet: December 2024

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

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

Sweden Ticagrelor SUN 60 mg film-coated tablets

Ticagrelor SUN 90 mg film-coated tablets

Austria: Ticagrelor SUN 60 mg Filmtabletten

Ticagrelor SUN 90 mg Filmtabletten

Belgium: Ticagrelor SUN 60 mg Filmtabletten, Ticagrelor SUN 90 mg Filmtabletten;

Ticagrelor SUN 60 mg film-coated tablets, Ticagrelor SUN 90 mg film-coated tablets;

Ticagrelor SUN 60 mg filmomhulde tabletten, Ticagrelor SUN 90 mg filmomhulde tabletten

Germany: Ticagrelor Basics 60 mg Filmtabletten

Ticagrelor Basics 90 mg Filmtabletten

Denmark: Ticagrelor SUN

Spain: Ticagrelor SUN 60 mg film-coated tablets EFG

Ticagrelor SUN 90 mg film-coated tablets EFG

France: TICAGRELOR SUN 60 mg, film-coated tablet

TICAGRELOR SUN 90 mg, film-coated tablet

Italy: Ticagrelor SUN

Netherlands: Ticagrelor SUN 60 mg filmomhulde tabletten

Ticagrelor SUN 90 mg filmomhulde tabletten

Norway: Ticagrelor SUN

Poland: Ticagrelor Ranbaxy

Romania: Ticagrelor Terapia 60 mg film-coated tablets

Ticagrelor Terapia 90 mg film-coated tablets

Date of the last revision of this leaflet: December 2024

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