DABIGATRAN ETEXILATE SANDOZ 150 mg HARD CAPSULES

2. What you need to know before you take Dabigatran Etexilate Sandoz

Do not take Dabigatran Etexilate Sandoz

• if you are allergic to dabigatran etexilate or any of the other ingredients of this medicine (listed in section 6),
• if your kidney function is severely reduced,
• if you are currently bleeding,
• if you have a disease in an organ of the body that increases the risk of severe bleeding (e.g. stomach ulcer, injury or bleeding in the brain, recent brain or eye surgery),
• if you are prone to bleeding. This tendency can be inherited, of unknown cause or caused by other medicines,
• if you are taking medicines to prevent blood clotting (e.g. warfarin, rivaroxaban, apixaban or heparin), except when switching from one anticoagulant treatment to another, while having a venous or arterial catheter and being given heparin through this catheter to keep it open or while your normal heart rhythm is being restored through a procedure called cardioversion or through a procedure called catheter ablation for atrial fibrillation,
• if your liver function is severely reduced or you have a life-threatening liver disease,
• if you are taking oral ketoconazole or itraconazole, medicines used to treat fungal infections,
• if you are taking oral cyclosporin, a medicine used to prevent organ rejection after a transplant,
• if you are taking dronedarone, a medicine used to treat irregular heart rhythm,
• if you are taking a combination product of glecaprevir and pibrentasvir, an antiviral medicine used to treat hepatitis C,
• if you have been implanted with an artificial heart valve that requires permanent anticoagulant treatment.

Warnings and precautions

Talk to your doctor before starting to take dabigatran etexilate. During treatment with this medicine, you may also need to talk to your doctor if you experience any symptoms or if you are going to have surgery.

Tell your doctorif you have or have had any disorder or disease, especially any of the following:

• If you have an increased risk of bleeding, for example:

• if you have recently had bleeding,
• if you have had a tissue sample taken (biopsy) in the last month,
• if you have had a severe injury (e.g. a bone fracture, a head injury or any injury that required surgical treatment),
• if you have inflammation of the oesophagus or stomach,
• if you have problems with stomach acid flowing back into your gullet (gastro-oesophageal reflux disease),
• if you are taking medicines that may increase the risk of bleeding. See "Other medicines and Dabigatran Etexilate Sandoz" below,
• if you are using anti-inflammatory medicines such as diclofenac, ibuprofen or piroxicam,
• if you have a heart infection (bacterial endocarditis),
• if you know you have reduced kidney function or if you are dehydrated (symptoms include feeling thirsty and passing small amounts of dark coloured urine/concentrated urine with foam),
• if you are over 75 years old,
• if you are an adult patient and weigh 50 kg or less,
• only if used in children: if the child has an infection in the brain or around the brain.

• if you have had a heart attack or if you have been diagnosed with diseases that increase the risk of having a heart attack,
• if you have a liver disease associated with changes in blood tests. The use of this medicine is not recommended in this case.

Be extra careful with Dabigatran Etexilate Sandoz

• if you are going to have an operation:

In this case, dabigatran etexilate should be temporarily stopped due to an increased risk of bleeding during and shortly after an operation. It is very important that you take dabigatran etexilate before and after the operation exactly at the times your doctor has told you,

• if an operation requires the insertion of a catheter or an injection into your spine (e.g. for epidural or spinal anaesthesia or for pain relief):

• it is very important that you take dabigatran etexilate before and after the operation exactly at the times your doctor has told you,
• tell your doctor immediately if you experience numbness or weakness in your legs or bowel or bladder problems after the anaesthesia has stopped, as this situation requires urgent attention.

• if you fall or injure yourself during treatment, especially if you hit your head. Seek urgent medical help. You may need a doctor to examine you, as you may have a higher risk of bleeding,
• if you know you have a disease called antiphospholipid syndrome (a disorder of the immune system that increases the risk of blood clots), tell your doctor so that they can decide whether it may be necessary to change your treatment.

Other medicines and Dabigatran Etexilate Sandoz

Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines. In particular, you must tell your doctor before taking dabigatran etexilate if you are taking any of the following medicines:

• medicines to reduce blood clotting (e.g. warfarin, phenprocoumon, acenocoumarol, heparin, clopidogrel, prasugrel, ticagrelor, rivaroxaban, acetylsalicylic acid),
• medicines for the treatment of fungal infections (e.g. ketoconazole, itraconazole), except if they are only applied to the skin,
• medicines used in the treatment of irregular heart rhythm (e.g. amiodarone, dronedarone, quinidine, verapamil). If you are taking medicines that contain verapamil, your doctor may tell you to use a reduced dose of dabigatran etexilate depending on the disease for which you have been prescribed it. See section 3,
• medicines for the prevention of organ rejection after a transplant (e.g. tacrolimus, cyclosporin),
• a combination product of glecaprevir and pibrentasvir (an antiviral medicine used to treat hepatitis C),
• anti-inflammatory and pain-relieving medicines (e.g. acetylsalicylic acid, ibuprofen, diclofenac),
• St. John's Wort, a herbal medicine for depression,
• antidepressant medicines called selective serotonin reuptake inhibitors or selective serotonin and norepinephrine reuptake inhibitors,
• rifampicin or clarithromycin (two antibiotics),
• antiviral medicines for HIV (e.g. ritonavir),
• certain medicines for the treatment of epilepsy (e.g. carbamazepine, phenytoin).

Pregnancy andbreast-feeding

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

The effects of dabigatran etexilate on pregnancy and the unborn child are not known. You should not take this medicine if you are pregnant unless your doctor advises you to. If you are of childbearing potential, you should avoid becoming pregnant during treatment with dabigatran etexilate.

Breast-feeding is not recommended during treatment with dabigatran etexilate.

Driving and using machines

Dabigatran etexilate has no known effects on the ability to drive or use machines.

Dabigatran Etexilate Sandozcontainssodium

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

3. How to take Dabigatran Etexilate Sandoz

Dabigatran etexilate capsules can be used in adults and children aged 8 years or older who are able to swallow the capsules whole. There are other pharmaceutical forms suitable for children under 12 years of age as soon as they are able to swallow soft foods.

Follow the instructions for administration of this medicine exactly as told by your doctor. If you are unsure, ask your doctor again.

Take Dabigatran Etexilate Sandoz as recommended for the following situations:

Prevention of stroke or systemic embolism and treatment of blood clots in the veins of your legs and lungs, including prevention of recurrence of blood clots in the veins of your legs and lungs

The recommended dose is 300 mg given as one 150 mg capsule twice daily.

If you are 80 years of age or older, the recommended dose is 220 mg given as one 110 mg capsule twice daily.

If you are using medicines that contain verapamil, you will be told to use a reduced dose of dabigatran etexilate of 220 mg given as one 110 mg capsule twice daily, as your risk of bleeding may be increased.

If you have a potentially higher risk of bleeding, your doctor may decide to prescribe a dose of 220 mg given as one 110 mg capsule twice daily.

You can continue to take this medicine if it is necessary to restore your normal heart rhythm through a procedure called cardioversion or through a procedure called catheter ablation for atrial fibrillation. Take dabigatran etexilate as told by your doctor.

If you have been implanted with a medical device (vascular endoprosthesis) in a blood vessel to keep it open in a procedure called percutaneous coronary intervention with vascular endoprosthesis, you may receive treatment with dabigatran etexilate once your doctor has decided that normal blood clotting control has been achieved. Take dabigatran etexilate as told by your doctor.

Treatment of blood clots and prevention of recurrence of blood clots in children

Dabigatran etexilate should be taken twice daily, one dose in the morning and one dose in the evening, approximately at the same time every day. The time between administrations should be as close as possible to 12 hours.

The recommended dose depends on weight and age. Your doctor will determine the correct dose. Your doctor may adjust the dose during treatment. Continue using all your other medicines unless your doctor tells you to stop using any.

Table 1 shows the single and total daily doses of dabigatran etexilate in milligrams (mg). The doses depend on the patient's weight in kilograms (kg) and age in years.

Table 1: Dosing table for dabigatran etexilate capsules

Doses that require combinations of more than one capsule:

How to take Dabigatran Etexilate Sandoz

Dabigatran etexilate can be taken with or without food. The capsule should be swallowed whole with a glass of water, to ensure release in the stomach. Do not break, chew or empty the contents of the capsule, as this may increase the risk of bleeding.

Instructions for the blister

• Press the capsules through the blister foil.

Instructions for the bottle

• Press and turn to open.
• After removing the capsule, put the cap back on the bottle and close the bottle immediately after taking your dose.

Switching from one anticoagulant to another

Do not switch from one anticoagulant to another without specific instructions from your doctor.

If you take more Dabigatran Etexilate Sandoz than you should

Taking too much of this medicine increases the risk of bleeding. Contact your doctor immediately if you have taken too many capsules. There are specific treatment options available.

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

If you forget to take Dabigatran Etexilate Sandoz

A missed dose can be taken up to 6 hours before the next dose.

A missed dose should be omitted if the time before the next dose is less than 6 hours.

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

If you stop taking Dabigatran Etexilate Sandoz

Take dabigatran etexilate exactly as prescribed by your doctor. Do not stop your treatment with this medicine without first talking to your doctor, as the risk of developing a blood clot may be higher if you stop treatment too soon. Contact your doctor if you experience indigestion after taking dabigatran etexilate.

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.

Dabigatran etexilate acts on blood coagulation; therefore, most adverse effects are related to signs such as bruising or bleeding. Episodes of major or severe bleeding may occur, which are the most serious adverse effects and, regardless of their location, can cause disability, be potentially fatal, or even cause death. In some cases, these bleedings may not be evident.

If you experience any episode of bleeding that does not stop by itself or if you experience signs of excessive bleeding (exceptional weakness, fatigue, paleness, dizziness, headache, or unexplained swelling), consult your doctor immediately. Your doctor may decide to keep you under close observation or change your medication.

Inform your doctor immediately if you experience a severe allergic reaction that causes difficulty breathing or dizziness.

The possible adverse effects are detailed below, grouped according to their frequency of occurrence.

Prevention of vascular cerebral or systemic obstruction by blood clot formation

developed after abnormal heart rhythm

Frequent(may affect up to 1 in 10 people):

• bleeding may be from the nose, in the stomach or intestine, from the penis/vagina or urinary tract (including blood in the urine that stains the urine pink or red), or under the skin,
• decrease in the number of red blood cells in the blood,
• abdominal pain or stomach pain,
• indigestion,
• loose or liquid stools,
• feeling like vomiting

Uncommon(may affect up to 1 in 100 people):

• bleeding,
• bleeding may be from hemorrhoids, rectum, or brain,
• hematoma formation,
• coughing up blood or sputum with blood spots,
• decrease in the number of platelets in the blood,
• decrease in the amount of hemoglobin in the blood (the substance present in red blood cells),
• allergic reaction,
• sudden change in skin color and physical appearance,
• itching,
• ulcer in the stomach or intestine (including esophageal ulcer),
• inflammation of the esophagus and stomach,
• gastric juice reflux to the esophagus,
• vomiting,
• difficulty swallowing,
• abnormalities in liver function tests.

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

• bleeding may be in a joint, at the site of a surgical incision, in a wound, at the site of an injection, or at the site of a catheter in a vein,
• severe allergic reaction that causes difficulty breathing or dizziness,
• severe allergic reaction that causes swelling of the face or throat,
• skin rash with dark red, prominent, and itchy bumps, caused by an allergic reaction,
• decrease in the proportion of blood cells,
• increase in liver enzymes,
• yellowing of the skin or whites of the eyes, caused by liver or blood problems.

Frequency not known(frequency cannot be estimated from available data):

• difficulty breathing or wheezing,
• decrease in the number or even absence of white blood cells (which help fight infections),
• hair loss.

In a clinical trial, the rate of heart attacks with dabigatran etexilate was numerically higher than with warfarin. The overall incidence was low.

Treatment of blood clots in the veins of the legs and lungs, including prevention of recurrence of blood clots in the veins of the legs and/or lungs

Frequent(may affect up to 1 in 10 people):

• bleeding may be from the nose, in the stomach or intestine, from the rectum, from the penis/vagina or urinary tract (including blood in the urine that stains the urine pink or red), or under the skin,
• indigestion.

Uncommon(may affect up to 1 in 100 people):

• bleeding,
• bleeding may be in a joint or in a wound,
• bleeding may be from hemorrhoids,
• decrease in the number of red blood cells in the blood,
• hematoma formation,
• coughing up blood or sputum with blood spots,
• allergic reaction,
• sudden change in skin color and physical appearance,
• itching,
• ulcer in the stomach or intestine (including esophageal ulcer),
• inflammation of the esophagus and stomach,
• gastric juice reflux to the esophagus,
• feeling like vomiting,
• vomiting,
• abdominal pain or stomach pain,
• loose or liquid stools,
• abnormalities in liver function tests,
• increase in liver enzymes.

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

• bleeding may be at the site of a surgical incision, or at the site of an injection, or at the site of a catheter in a vein or from the brain,
• decrease in the number of platelets in the blood,
• severe allergic reaction that causes difficulty breathing or dizziness,
• severe allergic reaction that causes swelling of the face or throat,
• skin rash with dark red, prominent, and itchy bumps, caused by an allergic reaction,
• difficulty swallowing.

Frequency not known(frequency cannot be estimated from available data):

• difficulty breathing or wheezing,
• decrease in the amount of hemoglobin in the blood (the substance present in red blood cells),
• decrease in the proportion of blood cells,
• decrease in the number or even absence of white blood cells (which help fight infections),
• yellowing of the skin or whites of the eyes, caused by liver or blood problems,
• hair loss.

In the clinical trial program, the rate of heart attacks with dabigatran etexilate was higher than with warfarin. The overall incidence was low. No imbalance in the rate of heart attacks was observed in patients treated with dabigatran compared to patients treated with placebo.

Treatment of blood clots and prevention of recurrence of blood clots in children

Frequent(may affect up to 1 in 10 people):

• decrease in the number of red blood cells in the blood,
• decrease in the number of platelets in the blood,
• skin rash with dark red, prominent, and itchy bumps, caused by an allergic reaction,
• sudden change in skin color and physical appearance,
• hematoma formation,
• nasal bleeding,
• gastric juice reflux to the esophagus,
• vomiting,
• feeling like vomiting,
• loose or liquid stools,
• indigestion,
• hair loss,
• increase in liver enzymes.

Uncommon(may affect up to 1 in 100 people):

• decrease in the number of white blood cells (which help fight infections),
• bleeding may be in the stomach or intestine, from the brain, from the rectum, from the penis/vagina or urinary tract (including blood in the urine that stains the urine pink or red), or under the skin,
• decrease in the amount of hemoglobin in the blood (the substance present in red blood cells),
• decrease in the proportion of blood cells,
• itching,
• coughing up blood or sputum with blood spots,
• abdominal pain or stomach pain,
• inflammation of the esophagus and stomach,
• allergic reaction,
• difficulty swallowing,
• yellowing of the skin or whites of the eyes, caused by liver or blood problems.

Frequency not known(frequency cannot be estimated from available data):

• absence of white blood cells (which help fight infections),
• severe allergic reaction that causes difficulty breathing or dizziness,
• severe allergic reaction that causes swelling of the face or throat,
• difficulty breathing or wheezing,
• bleeding,
• bleeding may be in a joint or in a wound, in a surgical incision, at the site of an injection, or at the site of a catheter in a vein,
• bleeding may be from hemorrhoids,
• ulcer in the stomach or intestine (including esophageal ulcer),
• abnormalities in liver function tests.

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 leaflet. You can also report them directly through the Spanish Medicines and Health Products Agency's (AEMPS) website: https://www.notificaram.es. By reporting adverse effects, you can contribute to providing more information on the safety of this medicine.

5. Storage of Dabigatran Etexilate Sandoz

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

Do not use this medicine after the expiration date that appears on the packaging, blister, or bottle after CAD/EXP. The expiration date is the last day of the month indicated.

Blister and bottle

Store below 30°C.

Bottle

Once opened, the medicine must be used within 60 days.

Medicines should not be disposed of through wastewater or household waste. Deposit the packaging and medicines you no longer need at the pharmacy's SIGRE collection point. If in doubt, ask your pharmacist how to dispose of the packaging and medicines you no longer need. This will help protect the environment.

6. Package Contents and Additional Information

Composition of Dabigatran Etexilate Sandoz

• The active ingredient is dabigatran etexilate. Each hard capsule contains 150 mg of dabigatran etexilate (in the form of mesilate).
• Other ingredients are:

• capsule content: tartaric acid, hypromellose (E464), talc, hydroxypropylcellulose, sodium croscarmellose, magnesium stearate.
• capsule coating: titanium dioxide (E171) and hypromellose (E464).
• black printing ink: shellac (E904), propylene glycol (E1520), potassium hydroxide (E525), iron oxide black (E172).

Appearance of the Product and Package Contents

Hard capsule.

Size "0" capsule with opaque white cap with the inscription "MD" and opaque white body with the inscription "150" in black ink, containing a mixture of white to light yellow pellets and light yellow granules.

Dabigatran Etexilate Sandoz is available in:

Opaque Al/PE-Al/PE blister pack containing 10, 30, 60, 100, 180, and 200 hard capsules.

Opaque Al/PE-Al/PE blister pack containing 10 x 1, 20 x 1, 30 x 1, 50 x 1, 60 x 1, 100 x 1, 180 x 1, and 200 x 1 hard capsules in perforated unit-dose blisters.

Multiple packaging containing 3 packs of 60 x 1 hard capsules (180 hard capsules) in perforated unit-dose blisters Opa/Al/desiccant PE-Al/PE.

Multiple packaging containing 2 packs of 50 x 1 hard capsules (100 hard capsules) in perforated unit-dose blisters Opa/Al/desiccant PE-Al/PE.

Polypropylene bottle with child-resistant screw cap containing desiccant. Packs of 60 hard capsules (1 bottle), 120 hard capsules (2 bottles of 60 hard capsules), and 180 hard capsules (3 bottles of 60 hard capsules).

Do not ingest the desiccant.

Only some pack sizes may be marketed.

Marketing Authorization Holder and Manufacturer

Marketing Authorization Holder

Sandoz Farmacéutica, S.A.

Centro Empresarial Parque Norte

Edificio Roble

C/ Serrano Galvache, 56

28033 Madrid

Spain

Manufacturer

Salutas Pharma GmbH

Otto-von-Guericke-Allee 1,

Sachsen-Anhalt

39179 Barleben,

Germany

or

Pharmadox Healthcare LTD

KW20A Kordin Industrial Park,

Paola, PLA3000,

Malta

or

Lek Pharmaceuticals, d.d.

Verovskova Ulica 57,

Ljubljana, 1526,

Slovenia

Date of Last Revision of this Leaflet: 09/2024

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