APIXABAN KERN PHARMA 5 mg FILM-COATED TABLETS

2. What you need to know before taking Apixaban Kern Pharma

Do not take Apixaban Kern Pharma if:

• you are allergicto apixaban or any of the other components of this medication (listed in section 6);
• you have excessive bleeding;
• you have a disease in an organ that increases the risk of severe bleeding (such as an active or recent stomach or intestinal ulcer, or recent cerebral hemorrhage);
• you have a liver disease that increases the risk of bleeding (hepatic coagulopathy);
• you are taking medications to prevent blood coagulation (e.g., warfarin, rivaroxaban, dabigatran, or heparin), except when switching to a different anticoagulant treatment, while having an arterial or venous line and being treated with heparin to keep the line open, or when a tube is inserted into a blood vessel (catheter ablation) to treat an irregular heartbeat (arrhythmia).

Warnings and precautions

Tell your doctor, pharmacist, or nurse before taking this medication if you have any of the following conditions:

• a increased risk of bleeding, such as:

• bleeding disorders, including situations that result in a decrease in platelet activity;
• very high blood pressurethat is not controlled by medical treatment;
• you are over 75 years old;
• you weigh 60 kg or less;

• a severe kidney disease or if you are on dialysis;
• a liver problem or history of liver problems;
• • This medication will be used with caution in patients with signs of altered liver function
• you have a heart valve prosthesis;
• if your doctor determines that your blood pressure is unstable or you are scheduled to receive another treatment or undergo surgery to remove the blood clot from your lungs.

Be careful with apixaban

If you need to undergo surgery or a procedure that may cause bleeding, your doctor will tell you to temporarily stop taking this medication for a while. If you are unsure whether a procedure may cause bleeding, consult your doctor.

Children and adolescents

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

Other medications and Apixaban Kern Pharma

Tell your doctor, pharmacist, or nurse if you are taking, have recently taken, or may need to take other medications.

Some medications may increase the effects of apixaban, and other medications may decrease its effects. Your doctor will decide if you should be treated with apixaban if you are taking these medications and if you should be monitored more closely.

The following medications may increase the effects of apixaban and increase the risk of unwanted bleeding:

• some antifungal medications(e.g., ketoconazole);
• some antiviral medications for HIV/AIDS(e.g., ritonavir);
• other medications to reduce blood coagulation(e.g., enoxaparin);
• anti-inflammatoryor pain-relieving medications(e.g., acetylsalicylic acid or naproxen). In particular, if you are over 75 years old and taking acetylsalicylic acid, there is a higher likelihood of bleeding;
• medications for high blood pressure or heart problems(e.g., diltiazem);
• antidepressantscalled selective serotonin reuptake inhibitorsor serotonin-norepinephrine reuptake inhibitors.

The following medications may reduce the ability of apixaban to prevent blood clots.

• medications for the treatment of epilepsy or seizures(e.g., phenytoin);
• St. John's Wort(a herbal medication for the treatment of depression);
• medications to treat tuberculosisor other infections(e.g., rifampicin).

Pregnancy and breastfeeding

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

Pregnancy

The effects of apixaban on pregnancy and the fetus are unknown. You should not take this medication if you are pregnant. Inform your doctor, pharmacist, or nurse immediatelyif you become pregnant while taking this medication.

Breastfeeding

It is unknown whether apixaban is excreted in human milk. Ask your doctor or pharmacist before taking this medication during breastfeeding. They will tell you whether to interrupt breastfeeding or whether to stop or not start taking this medication.

Driving and using machines

This medication has no influence on the ability to drive or use machines.

Apixaban Kern Pharma contains lactose and sodium

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.

This medication contains less than 1 mmol of sodium (23 mg) per tablet, which is essentially "sodium-free".

3. How to take Apixaban Kern Pharma

Follow the instructions for administration of this medication exactly as indicated by your doctor or pharmacist. If you are unsure, consult your doctor, pharmacist, or nurse again.

Dosage

Take the tablet with water. This medication can be taken with or without food.

Try to take the tablets at the same time each day to achieve a better treatment effect.

If you have difficulty swallowing the tablet whole, talk to your doctor about other possible ways to take this medication. The tablet can be crushed and mixed with water, 5% glucose in water, apple juice, or apple puree, immediately before taking it.

Instructions for crushing:

• Crush the tablets with a mortar.
• Transfer all the powder carefully into a suitable container, mixing the powder with a small amount, e.g., 30 ml (2 tablespoons), of water or one of the other liquids mentioned to make the mixture.
• Take the mixture.
• Rinse the mortar and pestle used to crush the tablet and the container with a small amount of water or one of the other liquids (e.g., 30 ml), and take that liquid.

If necessary, your doctor may also administer the crushed apixaban tablet mixed in 60 ml of water or 5% glucose in water through a nasogastric tube.

Take Apixaban Kern Pharma according to the following recommendations:

To prevent the formation of a blood clot in the heart in patients with an irregular heartbeat and at least one additional risk factor.

The recommended dose is one apixaban 5mgtablet twice a day.

The recommended dose is one apixaban 2.5 mgtablet twice a day if:

• you have severely decreased kidney function;
• you have two or more of the following factors:
• • your blood test results suggest poor kidney function (creatinine serum value is 1.5 mg/dl (133 micromoles/l) or higher);
  • you are 80 years old or older;
  • your weight is 60 kg or less

The recommended dose is one tablet twice a day, for example, take one tablet in the morning and one in the evening.

Your doctor will tell you how long you should continue the treatment.

To treat blood clots in the veins of the legs and in the blood vessels of the lungs

The recommended dose is twoapixaban 5mgtablets twice a day for the first 7 days, for example, two tablets in the morning and two tablets in the evening.

After 7 days, the recommended dose is oneapixaban 5mgtablet twice a day, for example, one tablet in the morning and one in the evening.

To prevent blood clots from recurring after 6 months of treatment

The recommended dose is one apixaban 2.5mgtablet twice a day, for example, one tablet in the morning and one in the evening.

Your doctor will tell you how long you should continue the treatment.

Your doctor may change your anticoagulant treatment as follows:

• Switching from apixaban to other anticoagulant medications

Stop taking this medication. Start treatment with other anticoagulant medications (e.g., heparin) at the time you would take the next apixaban tablet.

• Switching from other anticoagulant medications to apixaban

Stop taking other anticoagulant medications. Start treatment with apixaban at the time you would take the next dose of the other anticoagulant medication, and then continue as usual.

• Switching from a treatment with anticoagulants containing vitamin K antagonists (e.g., warfarin) to apixaban

Stop taking the medication containing a vitamin K antagonist. Your doctor will need to perform blood tests and tell you when to start taking apixaban.

• Switching from apixaban to a treatment with anticoagulants containing vitamin K antagonists (e.g., warfarin).

If your doctor tells you to start taking a medication containing a vitamin K antagonist, continue taking apixaban for at least 2 days after your first dose of the medication containing a vitamin K antagonist. Your doctor will need to perform blood tests and tell you when to stop taking apixaban.

Patients undergoing cardioversion

If your heartbeat needs to be restored through a process called cardioversion, take this medication at the times your doctor indicates to prevent blood clots in the blood vessels of the brain and other blood vessels in the body.

If you take more apixaban than you should

Tell your doctor immediatelyif you have taken a dose larger than the prescribed dose of this medication. Bring the medication package to your doctor, even if there are no tablets left.

If you take more apixaban than the recommended dose, you may increase the risk of bleeding. If bleeding occurs, surgery, blood transfusions, or other treatments may be necessary to reverse the anti-factor Xa activity.

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

If you forget to take Apixaban Kern Pharma

• Take the dose as soon as you remember and:
• • take the next apixaban dose at the usual time
  • then continue taking the medication as usual.

If you are unsure what to do or if you forget to take more than one dose,ask your doctor, pharmacist, or nurse.

If you interrupt treatment with Apixaban Kern Pharma

Do not interrupt treatment with this medication without first talking to your doctor, as the risk of developing a blood clot may be higher if treatment is interrupted too soon.

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

4. Possible Adverse Effects

Like all medications, apixaban can produce adverse effects, although not all people suffer from them. The most frequent adverse effect of this medication is bleeding, which can put the patient's life at risk and requires immediate medical attention.

The following adverse effects have been reported when taking apixaban to prevent the formation of blood clots in the heart in patients with irregular heartbeats and at least one additional risk factor.

Frequent Adverse Effects (may affect up to 1 in 10people)

• Bleeding, including:
• • in the eyes;
  • in the stomach or intestine;
  • from the rectum;
  • blood in the urine;
  • from the nose;
  • from the gums;
  • bruising and swelling;

• Anemia, which can cause fatigue or paleness;
• Low blood pressure that can cause fainting or a faster heartbeat;
• Nausea (general discomfort);
• Blood tests may show:
• • an increase in gamma glutamyl transferase (GGT).

Infrequent Adverse Effects (may affect up to 1 in 100people)

• Bleeding:
• • in the brain or spinal cord;
  • in the mouth or coughing up blood;
  • in the abdomen, or vagina;
  • bright red blood in the stool;
  • bleeding after surgery, including bruising and swelling, blood or fluid secretion from the wound/surgical incision (suppuration), or at the injection site;
  • hemorrhoidal;
  • blood tests that show blood in the stool or urine;
• Decreased platelet count in the blood (which can affect coagulation);
• Blood tests may show:
• • • abnormal liver function;
    • increase in some liver enzymes;
    • increase in bilirubin, a byproduct of red blood cells, which can cause yellowing of the skin and eyes;
  • Skin rash;
  • Itching;
  • Hair loss;
  • Allergic reactions (hypersensitivity) that can cause: swelling of the face, lips, mouth, tongue, and/or throat, and difficulty breathing. Inform your doctor immediatelyif you experience any of these symptoms.

Rare Adverse Effects (may affect up to 1 in 1,000people)

• Bleeding:
• • in the lungs or throat;
  • in the space behind the abdominal cavity;
  • in a muscle.

Very Rare Adverse Effects (may affect up to 1 in 10,000people)

• Skin rash that can form blisters and resemble small targets (dark spots in the center surrounded by a paler area, with a dark ring around) (erythema multiforme).

Unknown Frequency (cannot be estimated from available data)

• Inflammation of blood vessels (vasculitis) that can cause skin rash, appearance of red, round, and smooth spots under the skin surface, or bruising.

• Bleeding in the kidney, sometimes with blood in the urine, which can cause the kidneys to fail to function properly (anticoagulant-related nephropathy).

The following adverse effects have been reported when taking apixaban to treat or prevent blood clots from recurring in the veins of the legs and blood vessels of the lungs.

Frequent Adverse Effects (may affect up to 1 in 10people)

• Bleeding, including:
• • • from the nose;
    • from the gums;
    • blood in the urine;
    • bruising and swelling;
    • from the stomach, intestine, or rectum;
    • in the mouth;
    • vaginal;
  • Anemia, which can cause fatigue or paleness;
  • Decreased platelet count in the blood (which can affect coagulation);
  • Nausea (general discomfort);
  • Skin rash;
  • • Blood tests may show:
    • • an increase in gamma glutamyl transferase (GGT) or alanine aminotransferase (ALT).

Infrequent Adverse Effects (may affect up to 1 in 100people)

• Low blood pressure that can cause fainting or a faster heartbeat
• Bleeding:
• • in the eyes;
  • in the mouth or coughing up blood;
  • bright red blood in the stool;
  • blood tests that show blood in the stool or urine;
  • bleeding after surgery, including bruising and swelling, blood or fluid secretion from the wound/surgical incision (suppuration), or at the injection site;
  • hemorrhoidal;
  • in a muscle;

• Itching;
• Hair loss;
• Allergic reactions (hypersensitivity) that can cause: swelling of the face, lips, mouth, tongue, and/or throat, and difficulty breathing. Contact your doctor immediatelyif you experience any of these symptoms.

• Blood tests may show:
• • abnormal liver function;
  • increase in some liver enzymes;
  • increase in bilirubin, a byproduct of red blood cells, which can cause yellowing of the skin and eyes.

Rare Adverse Effects (may affect up to 1 in 1,000people)

• Bleeding:
• • in the brain or spinal cord;
  • in the lungs.

Unknown Frequency (cannot be estimated from available data)

• Bleeding:
• • in the abdomen or the space behind the abdominal cavity.
• Skin rash that can form blisters and resemble small targets (dark spots in the center surrounded by a paler area, with a dark ring around) (erythema multiforme);
• Inflammation of blood vessels (vasculitis) that can cause skin rash, appearance of red, round, and smooth spots under the skin surface, or bruising.

• Bleeding in the kidney, sometimes with blood in the urine, which can cause the kidneys to fail to function properly (anticoagulant-related nephropathy).

Reporting Adverse Effects

If you experience any type of adverse effect, consult your doctor, pharmacist, or nurse, 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 medication.

5. Storage of Apixaban Kern Pharma

Keep this medication out of sight and reach of children.

Do not use this medication after the expiration date shown on the blister pack and carton 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 wastewater or household waste. Deposit the packaging and medications you no longer need at the SIGRE collection point in your pharmacy. If in doubt, ask your pharmacist how to dispose of the packaging and medications you no longer need. This will help protect the environment.

6. Package Contents and Additional Information

Composition ofApixaban Kern Pharma

The active ingredientis apixaban.

Apixaban Kern Pharma 5 mg: each tablet contains 5 mg of apixaban.

The other ingredientsare:

• Core of the tablet: lactose monohydrate, microcrystalline cellulose, crospovidone, povidone, sodium lauryl sulfate, and sodium stearyl fumarate.
• Coating: lactose monohydrate, hypromellose, titanium dioxide (E-171), triacetin, and red iron oxide (E-172).

Appearance of the Product and Package Contents

The film-coated tablets are oval (10 mm x 5 mm approximately), pink, and contain 5 mg of the active ingredient apixaban.

• They are presented in PVC/PVDC aluminum blisters within cartons containing 28 and 60 film-coated tablets.

Patient Information Card: Information Management

Inside the packaging of this medication, along with the leaflet, you will find a Patient Information Card or your doctor may give you a similar card.

This Patient Information Card includes useful information for you and will alert other doctors that you are being treated with apixaban. You should keep this card with you at all times.

1. Take the card.
2. Complete the following sections or ask your doctor to complete them:
   • Name:
   • Date of birth:
   • Indication:
   • Dose: ........mg twice a day
   • Doctor's name:
   • Doctor's phone number:
3. Fold the card and carry it with you at all times.

Marketing Authorization Holder

Kern Pharma, S.L.

Venus, 72 - Pol. Ind. Colón II

08228 Terrassa - Barcelona

Spain

Manufacturer

Pharmadox Healthcare Ltd.

KW20A Kordin Industrial Park,

Paola PLA 3000,

Malta

or

Adalvo Limited

Malta Life Sciences Park,

Building 1, Level 4, Sir Temi Zammit Buildings,

San Gwann, SGN 3000

Malta

Date of the Last Revision of this Leaflet: April 2025

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