ESOMEPRAZOL RATIOPHARM 40 mg GASTRO-RESISTANT TABLETS

2. What you need to know before taking Esomeprazol ratiopharm

Do not take Esomeprazol ratiopharm

• If you are allergic to esomeprazol or any of the other ingredients of this medicine (listed in section 6).
• If you are allergic to other proton pump inhibitors (e.g. pantoprazole, lansoprazole, rabeprazole, omeprazole).
• If you are taking a medicine containing nelfinavir (used to treat HIV infection).

If any of these apply to you, do not take Esomeprazol ratiopharm. If you are not sure, consult your doctor or pharmacist before taking Esomeprazol ratiopharm.

Warnings and precautions

Tell your doctor or pharmacist before taking Esomeprazol ratiopharm:

• If you have severe liver problems.
• If you have severe kidney problems.
• If you have ever had a skin reaction after treatment with a medicine similar to Esomeprazol ratiopharm to reduce stomach acid.
• If you are due to have a specific blood test (Chromogranin A).

Esomeprazol ratiopharm may hide the symptoms of other diseases. Therefore, if you notice any of the following before or while taking Esomeprazol ratiopharm, contact your doctor immediately:

• You lose a lot of weight without reason and have problems swallowing.
• You have stomach pain or indigestion.
• You start vomiting food or blood.
• Your stools are black (blood-stained).

If your doctor has prescribed Esomeprazol ratiopharm only when you notice symptoms, you should contact your doctor if your symptoms persist or change.

Taking proton pump inhibitors like Esomeprazol ratiopharm, especially over a period of more than one year, may slightly increase the risk of hip, wrist, and spine fractures. Consult your doctor if you have osteoporosis or if you are taking corticosteroids (which can increase the risk of osteoporosis).

Skin rash and skin symptoms

If you get a rash, especially in areas exposed to the sun, tell your doctor as soon as possible, as you may need to stop taking Esomeprazol ratiopharm. Also, mention any other symptoms you notice, such as joint pain.

Severe skin reactions have occurred in patients taking esomeprazol (see also section 4). The rash can include ulcers in the mouth, throat, nose, genitals, and conjunctivitis (red and swollen eyes). These severe skin reactions usually occur after symptoms similar to flu, such as fever, headache, and body pain. The rash can cover large areas of the body with blisters and skin peeling.

If at any time during treatment (even after several weeks) you develop a rash or any of these skin symptoms, stop taking this medicine and contact your doctor immediately.

Children under 12 years

Esomeprazol ratiopharm should not be used in children under 12 years. There are other forms of this medicine more suitable for them.

Taking Esomeprazol ratiopharm with other medicines

Tell your doctor or pharmacist if you are taking, have recently taken, or might take any other medicines, including those obtained without a prescription. This is because Esomeprazol ratiopharm may affect the way some medicines work and some medicines may affect the way Esomeprazol ratiopharm works.

Do not take Esomeprazol ratiopharm if you are taking a medicine containing nelfinavir(used to treat HIV infection).

• Atazanavir or saquinavir (used to treat HIV infection)
• Clopidogrel (used to prevent blood clots)
• Ketoconazole, itraconazole, or voriconazole (for fungal infections)
• Ertonilib (used to treat cancer)
• Digoxin (used to treat heart problems)
• Citalopram, imipramine, clomipramine (for depression)
• Diazepam (used to treat anxiety, as a muscle relaxant, or for epilepsy)
• Phenytoin (for epilepsy). If you are taking phenytoin, your doctor will need to monitor you when you start or stop taking Esomeprazol ratiopharm
• Medicines used to thin the blood, such as warfarin. Your doctor may need to monitor you when you start or stop taking Esomeprazol ratiopharm
• Cilostazol (used to treat intermittent claudication – pain in the legs when walking caused by poor blood circulation)
• Cisapride (used for indigestion and heartburn)
• Digoxin (used for heart problems)
• Methotrexate (a chemotherapy medicine used at high doses to treat cancer) - if you are taking high doses of methotrexate, your doctor may temporarily stop your treatment with Esomeprazol ratiopharm
• Tacrolimus (organ transplantation)
• Rifampicin (used to treat tuberculosis)
• St. John's Wort (Hypericum perforatum) (used to treat mild depression)

If your doctor has prescribed the antibiotics amoxicillin and clarithromycin with Esomeprazol ratiopharm to treat ulcers caused by Helicobacter pylori, it is very important that you inform your doctor if you are taking any other medicine.

Taking Esomeprazol ratiopharm with food and drink

You can take the tablets with or without food.

Pregnancy, breast-feeding, and fertility

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

Your doctor will decide whether you can take Esomeprazol ratiopharm during this time.

It is not known if Esomeprazol ratiopharm passes into breast milk. Therefore, you should not take Esomeprazol ratiopharm if you are breast-feeding.

Driving and using machines

Esomeprazol ratiopharm is unlikely to affect your ability to drive or use tools or machines. However, side effects such as dizziness and blurred vision are uncommon or rare (see section 4). If you are affected, you should not drive or use machines.

Esomeprazol ratiopharm contains sucrose

This medicine contains sugar spheres that contain sucrose, a type of sugar. If your doctor has told you that you have an intolerance to some sugars, consult them before taking this medicine.

Esomeprazol ratiopharm contains sodium

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

3. How to take Esomeprazol ratiopharm

Follow the instructions for administration of this medicine exactly as told by your doctor or pharmacist. If you are not sure, ask your doctor or pharmacist again.

• If you take this medicine for a long time, your doctor will need to monitor you (especially if you take it for more than one year).
• If your doctor has told you to take this medicine only when you notice symptoms, tell your doctor if your symptoms change.

How much to take

• Your doctor will have told you how many tablets to take and when to take them. This will depend on your condition, age, and liver function.
• The recommended doses are given below.

Use in adults and adolescents from 12 years of age

For the treatment of heartburn caused by gastroesophageal reflux disease (GORD):

• If your doctor has found that your esophagus is slightly damaged, the recommended dose is one 40 mg tablet of esomeprazol once a day for 4 weeks. Your doctor may tell you to take the same dose for another 4 weeks if your esophagus has not yet healed.
• The recommended dose once the esophagus has healed is one 20 mg tablet of esomeprazol once a day.
• If your esophagus is not damaged, the recommended dose is one 20 mg tablet of esomeprazol once a day. Once the condition has been controlled, your doctor will tell you to take the medicine as needed, up to a maximum of one 20 mg tablet of esomeprazol once a day.
• If you have severe liver problems, your doctor may prescribe a lower dose.

For the treatment of ulcers caused by Helicobacter pyloriinfection and to prevent recurrence:

• The recommended dose is one 20 mg tablet of esomeprazol twice a day for one week.
• Your doctor will also prescribe antibiotics, for example amoxicillin and clarithromycin.

Use in adults from 18 years of age

For the treatment of stomach ulcers caused by NSAIDs (non-steroidal anti-inflammatory drugs):

• The recommended dose is one 20 mg tablet of esomeprazol once a day for 4 to 8 weeks.

For the prevention of stomach ulcers if you are taking NSAIDs (non-steroidal anti-inflammatory drugs)

• The recommended dose is one 20 mg tablet of esomeprazol once a day.

For the treatment of too much acid in the stomach caused by a tumor in the pancreas (Zollinger-Ellison syndrome):

• The recommended dose is one 40 mg tablet of esomeprazol twice a day.
• Your doctor will adjust the dose according to your needs and will also decide how long you need to take this medicine. The maximum dose is 80 mg twice a day.

Treatment of continuation of prevention of bleeding from stomach ulcers caused by esomeprazol intravenous:

• The recommended dose is one 40 mg tablet of esomeprazol once a day for 4 weeks.

Taking this medicine

• You can take the tablets at any time of the day.
• You can take the tablets with or without food.
• Swallow the tablets whole with a glass of water. Do not chew or crush the tablets. This is because the tablets contain coated granules that prevent the medicine from being destroyed by the acid in the stomach. It is important not to damage the granules.

What to do if you have difficulty swallowing the tablets

• If you have difficulty swallowing the tablets:

• Put the tablet in half a glass of non-fizzy water. Do not use other liquids.
• Stir until the tablet breaks up (the mixture will not be clear). Drink the mixture immediately or within 30 minutes. Stir well just before drinking.
• To make sure you take all the medicine, rinse the glass with half a glass of water and drink. The solid particles contain the medicine – do not chew or crush the granules.

• If you cannot swallow at all, the tablets can be dispersed in water and given through a syringe into the stomach through a nasogastric tube.

Use in children under 12 years

Esomeprazol ratiopharm is not recommended for children under 12 years. There are other forms of this medicine more suitable for them.

Elderly patients

No dose adjustment is needed in elderly patients.

If you take more Esomeprazol ratiopharm than you should

If you take more esomeprazol than your doctor has prescribed, talk to your doctor or pharmacist immediately.

In case of overdose or accidental ingestion, contact the Toxicology Information Service. Telephone 91 5620420, indicating the medicine and the amount taken.

If you forget to take Esomeprazol ratiopharm

• If you forget to take a dose, take it as soon as you remember. However, if it is almost time for your next dose, do not take the missed dose.
• Do not take a double dose (two doses at the same time) to make up for the missed dose.

If you have any other questions about 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.

If you observe any of the following serious adverse effects, stop taking Esomeprazol ratiopharm and contact a doctor immediately:

• Yellow skin, dark urine, and fatigue that can be symptoms of liver problems. These effects are rare and may affect up to 1 in 1,000 people.
• Sudden difficulty breathing, swelling of lips, tongue, and throat or body in general, skin rash, fainting, or difficulty swallowing (severe allergic reaction). These effects are rare and may affect up to 1 in 1,000 people.
• Sudden appearance of a severe skin rash or skin redness with blisters or peeling, even after several weeks of treatment. Important blisters and bleeding of the lips, eyes, mouth, nose, and genitals may also appear. Skin rashes can become severe and widespread skin damage (exfoliation of the epidermis and superficial mucous membranes) with potentially fatal consequences. This could be a "erythema multiforme", "Stevens-Johnson syndrome", "toxic epidermal necrolysis", or "drug reaction with eosinophilia and systemic symptoms". These effects are very rare and may affect up to 1 in 10,000 people.

Other adverse effects include:

Frequent (affect up to 1 in 10 people)

• Headache
• Effects on the stomach or intestine: stomach pain, constipation, diarrhea, gas (flatulence)
• Nausea or vomiting
• Benign polyps in the stomach

Infrequent (affect up to 1 in 100 people)

• Swelling of feet and ankles
• Sleep disturbance (insomnia)
• Dizziness, tingling, and numbness, drowsiness
• Vertigo sensation
• Dry mouth
• Alteration of blood tests that determine liver function
• Skin rash, hives, itching of the skin
• Fracture of the hip, wrist, and spine (if Esomeprazol ratiopharm is used at high doses or for prolonged periods)

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

• Blood disorders such as a decrease in the number of white blood cells or platelets. This can cause weakness, bruising, or increase the likelihood of infections
• Low sodium levels in the blood. This can cause weakness, vomiting, and cramps
• Agitation, confusion, or depression
• Taste alteration
• Ocular disorders such as blurred vision
• Sudden sensation of shortness of breath or difficulty breathing (bronchospasm)
• Inflammation inside the mouth
• An infection known as "candidiasis" that can affect the intestine and is caused by a fungus
• Liver problems including jaundice that can cause yellow skin, dark urine, and fatigue
• Hair loss (alopecia)
• Phototoxic dermatitis
• Joint pain (arthralgia) or muscle pain (myalgia)
• General feeling of discomfort and lack of energy
• Increased sweating

Very rare (affect up to 1 in 10,000 people)

• Changes in the number of cells in the blood, including agranulocytosis (decrease in the number of white blood cells)
• Aggressiveness
• Seeing, feeling, or hearing things that do not exist (hallucinations)
• Liver disorders that can lead to liver failure or brain inflammation
• Sudden appearance of severe skin rash, blisters, or peeling of the skin. These symptoms can be accompanied by high fever and joint pain. (Erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis, drug reaction with eosinophilia and systemic symptoms)
• Muscle weakness
• Severe kidney disorders
• Increased breast size in men

Frequency not known (cannot be estimated from available data)

• If you are taking esomeprazol for more than three months, it is possible that your blood magnesium levels may decrease. Low blood magnesium levels can manifest as fatigue, involuntary muscle contractions, disorientation, convulsions, dizziness, increased heart rate. If you have any of these symptoms, contact your doctor as soon as possible. Low magnesium levels can also trigger a reduction in blood potassium or calcium levels. Your doctor may decide to perform periodic blood tests to monitor magnesium levels.
• Inflammation in the intestine (resulting in diarrhea).
• Skin rash, possibly with joint pain

In very rare cases, Esomeprazol ratiopharm can affect white blood cells, causing an immune deficiency. If you have an infection with symptoms such as fever with a severeworsening of your general condition or fever with symptoms of a local infection such as neck, throat, mouth, or difficulty urinating, you should consult your doctor as soon as possible to rule out a decrease in the number of white blood cells (agranulocytosis) through a blood test. It is important that, in this case, you report your medication.

Reporting Adverse Effects

If you experience any type of adverse effect, consult your doctor or pharmacist, even if it is a possible adverse effect that is not listed in this prospectus. You can also report them directly through the Spanish Pharmacovigilance System for Human Use Medicines Website: www.notificaram.es. By reporting adverse effects, you can contribute to providing more information on the safety of this medicine.

5. Storage of Esomeprazol ratiopharm

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

Do not store above 30°C.

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

Medicines should not be thrown away through wastewater or household waste. Deposit the packaging and medicines you no longer need at the SIGRE 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 Esomeprazol ratiopharm

• The active ingredient is esomeprazole magnesium dihydrate.

Each 20 mg Esomeprazol ratiopharm tablet contains 20 mg of esomeprazole (corresponding to 21.75 mg of esomeprazole magnesium dihydrate).

Each 40 mg Esomeprazol ratiopharm tablet contains 40 mg of esomeprazole (corresponding to 43.5 mg of esomeprazole magnesium dihydrate).

• Other components are:

Tablet content: methacrylic acid and ethyl acrylate copolymer (1:1), talc, triethyl citrate, hypromellose, sugar spheres, magnesium stearate, hydroxypropyl cellulose, glycerol, monoester 40-55, polysorbate 80, microcrystalline cellulose, povidone, macrogol 6000, crospovidone, sodium stearyl fumarate.

Tablet coating: hypromellose, titanium dioxide (E171), macrogol/PEG 400, red iron oxide (E172), yellow iron oxide (E172).

Appearance of the Product and Package Contents

Esomeprazol ratiopharm 20 mg are film-coated tablets, biconvex, elliptical in shape, light pink in color, 6.55 x 13.6 mm.

Esomeprazol ratiopharm 40 mg are film-coated tablets, biconvex, elliptical in shape, pink in color, 8.2 x 17 mm.

The tablets are presented in:

Package sizes:

Bottle: 28, 30, 60, 100, or 250 tablets.

Blister: 7, 10, 14, 28, 30, 56, 60, 90, or 100 tablets.

Only some package sizes may be marketed.

Marketing Authorization Holder

Teva Pharma, S.L.U.

C/ Anabel Segura, 11, Edificio Albatros B, 1ª planta

28108 Alcobendas, Madrid (Spain)

Manufacturer

Balkanpharma Dupnitsa AD.

3 Samakovsko Shose Str.

Dupnitsa 2600

Bulgaria

This prospectus was approved in:May 2023.

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

The following information is only for healthcare professionals:

Administration through a gastric tube

1. Put the tablets in a suitable syringe and fill the syringe with approximately 25 ml of water and approximately 5 ml of air. For some probes, dispersion in 50 ml of water is required to avoid clogging the probe.
2. Shake the syringe immediately to disperse the tablet.
3. Hold the syringe with the tip up and check that the tip is not clogged.
4. Connect the syringe to the probe while maintaining the previous position.
5. Shake the syringe and place it with the tip down. Inject immediately 5-10 ml into the probe. Invert the syringe after injection and shake (the syringe must be kept with the tip up to avoid clogging the tip).
6. Put the syringe back with the tip down and inject immediately another 5-10 ml into the probe. Repeat this procedure until the syringe is empty.
7. Fill the syringe with 25 ml of water and 5 ml of air and repeat step 5 if necessary to drag any sediment that remains in the syringe. For some probes, 50 ml of water are necessary.