ZOLPIDEM TEVA-RATIOPHARM 5 mg FILM-COATED TABLETS

2. What you need to know before you take Zolpidem Teva-ratiopharm

Do not takeZolpidem Teva-ratiopharm:

• If you are allergic to zolpidem or any of the other ingredientsof this medicine (listed in section 6). Signs of an allergic reaction include: skin rash, difficulties breathing or swallowing, swelling of the lips, face, throat or tongue.
• If you have experienced sleepwalking or other unusual behaviors while sleeping (such as driving, eating, making phone calls, or having sex, etc.) without being fully awake after taking Zolpidem Teva-ratiopharm or other medicines containing zolpidem. If you have severe muscle weakness (myasthenia gravis).
• If your breathing stops for short periods while you sleep (sleep apnea syndrome).
• If you have severe respiratory weakness (in which the lungs cannot take in enough oxygen) (respiratory failure).
• If you have severe liver damage (liver failure).

Children and adolescents under 18 years should not take Zolpidem Teva-ratiopharm.

Do not take this medicine if you are in any of the above situations. If you are not sure, talk to your doctor or pharmacist.

Warnings and precautions

Talk to your doctor or pharmacist before starting to take Zolpidem Teva-ratiopharm

• if you are an elderly or weak patient.

You should take a lower dose (see section 3, How to take Zolpidem Teva-ratiopharm). Zolpidem Teva-ratiopharm has a muscle relaxant effect. For this reason, elderly patients, in particular, are at risk of falls and consequently hip fractures when getting up at night from bed.

• if you have kidney problems.

You may take longer to eliminate Zolpidem Teva-ratiopharm. Although no dose adjustment is required, caution is needed. Contact your doctor.

• if you have chronic respiratory problems(long-term).

Your problems could get worse.

• If you have ever had heart problems, including slow or irregular heartbeats
• if you have ever had a mental disorder or have abused or been dependent on alcohol or drugs. You should be carefully supervised by your doctor as there is a risk of habituation and psychological dependence during treatment with Zolpidem Teva-ratiopharm.
• if you have severe liver disease.

You should not use Zolpidem Teva-ratiopharm as there is a risk of brain damage (encephalopathy). Contact your doctor.

• if you have delirium (psychosis), depression, or anxietyrelated to depression, Zolpidem Teva-ratiopharm should not be the only treatment you receive.
• if you have had another mental illness in the past
• if you have had thoughts of harming yourself or committing suicide. Some studies have shown an increased risk of suicidal ideation, suicide attempt, and suicide in patients taking certain sedatives and hypnotics, including this medicine. However, it has not been established whether this is caused by the medicine or if there may be other reasons. If you have suicidal thoughts, contact your doctor as soon as possible for further medical advice.
• if you have recently taken zolpidem or other similar medicines for more than four weeks.

Zolpidem Teva-ratiopharm may cause drowsiness and reduce your level of alertness. This could lead to a fall and, on occasion, cause serious injury.

General

Before starting treatment with Zolpidem Teva-ratiopharm:

• The cause of the sleep disturbance should be clear.
• Underlying diseases should be treated.

If the treatment does not improve the sleep problem after 7-14 days of treatment, it may be a physical or psychiatric illness that needs to be checked. You should consult your doctor.

Psychomotor impairment the next day (see also “Driving and using machines”)

The next day after taking Zolpidem Teva-ratiopharm, the risk of psychomotor impairment, including impaired driving ability, may be increased if:

• You take this medicine with less than 8 hours of margin before performing activities that require mental alertness
• You take a higher dose than recommended
• You take zolpidem at the same time as another central nervous system depressant or another medicine that increases the concentration of zolpidem in your blood, combined with alcohol or with illegal substances.

Take the dose once and immediately before bedtime.

Do not take another dose during the same night.

Abuse and/or physical or psychological dependence

Physical or psychological dependence may develop.

The risk increases with the dose and duration of treatment and is high in patients with a history of mental disorders, alcoholism, illegal substances, or drug use. If physical dependence has developed, sudden interruption of treatment is accompanied by a withdrawal syndrome.

Memory disorders (amnesia)

Zolpidem Teva-ratiopharm may cause memory loss (amnesia). This usually occurs a few hours after taking Zolpidem Teva-ratiopharm. To minimize this risk, you should ensure that you sleep uninterrupted for at least 8 hours (see section 4, Possible side effects).

Psychiatric and “paradoxical” reactions

Reactions such as nervousness, restlessness, irritability, aggression, delirium (psychosis), anger, nightmares, hallucinations, sleepwalking, inappropriate behavior, increased sleep disturbances, and other adverse effects on behavior are known to occur.

If this happens, you should stop taking Zolpidem Teva-ratiopharm and contact your doctor. These reactions are more likely to occur in elderly patients.

Sleepwalking and associated behaviors

Sleepwalking and associated behaviors such as “sleep-driving”, preparing and eating food, making phone calls, or having sex, without memories of the episode, have been reported in patients who had taken zolpidem and were not fully awake. The use of alcohol and other central nervous system depressants with Zolpidem Teva-ratiopharm appears to increase the risk of these behaviors, or if the maximum recommended dose is exceeded. If you experience any of these events, inform your doctor immediately, as these sleep behaviors can put you and others at serious risk of injury. Your doctor may recommend that you stop treatment.

Other medicines and Zolpidem Teva-ratiopharm

Tell your doctor or pharmacist if you are taking, have recently taken, or might take any other medicines. This includes medicines that you buy without a prescription, including herbal medicines.

Zolpidem Teva-ratiopharm may affect other medicines. In turn, these medicines may affect the action of Zolpidem Teva-ratiopharm

If you take zolpidem with the following medicines, effects such as drowsiness or psychomotor impairment the next day, including impaired driving ability, may be increased:

• Medicines for certain mental disorders (antipsychotics)
• Medicines for sleep problems (hypnotics)
• Medicines to relieve or reduce anxiety
• Muscle relaxants (e.g., baclofen), as it may increase its muscle relaxant effect
• Medicines for depression
• Medicines for moderate to severe pain (narcotic analgesics)
• Medicines for epilepsy
• Anesthetic medicines
• Medicines for seasonal allergic rhinitis, skin rash, or other allergies that may cause drowsiness (sedating antihistamines).

Zolpidem Teva-ratiopharm may interact with medicines used to treat a variety of fungal infections, such as itraconazole and ketoconazole. Taking ketoconazole with Zolpidem Teva-ratiopharm may increase the sedative effect.

The concomitant use of zolpidem and opioids (strong painkillers, substitution therapy medicines, and some cough medicines) increases the risk of drowsiness, difficulty breathing (respiratory depression), and coma, and may put your life in danger. Therefore, concomitant use should only be considered when other treatment options are not possible.

However, if your doctor prescribes zolpidem hemitartrate with opioids, the dose and duration of concomitant treatment should be limited by your doctor.

Tell your doctor about all opioid medicines you are taking and strictly follow the dose recommended by your doctor. It may be useful to inform friends or family to alert them to the signs and symptoms described above. Contact your doctor if you experience these symptoms.

If you take Zolpidem Teva-ratiopharm with antidepressants, including bupropion, desipramine, fluoxetine, sertraline, and venlafaxine, you may see things that are not real (hallucinations).

It is not recommended to take Zolpidem Teva-ratiopharm with fluvoxamine or ciprofloxacin.

Medicines that greatly increase the activity of certain liver enzymes may reduce the effect of Zolpidem Teva-ratiopharm, e.g., rifampicin (an antibiotic used to treat infections), carbamazepine, and phenytoin (medicines used to treat seizures), and St. John's Wort (a herbal medicine for mood changes and depression). Concomitant use is not recommended.

Taking Zolpidem Teva-ratiopharm with alcohol

You should not drink alcoholduring treatment. Alcohol may increase the effects of zolpidem and make you sleep deeply, so you do not breathe properly or have difficulty waking up.

Drinking alcohol during treatment may affect your ability to drive or operate machinery.

Pregnancy and breastfeeding

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

Zolpidem Teva-ratiopharm should not be taken during pregnancy and breastfeeding,especially during the first three months of pregnancy, as there is not enough information available to guarantee the safety of Zolpidem Teva-ratiopharm during pregnancy and breastfeeding.

Fetal movement reduction and fetal heart rate variability may occur after taking zolpidem during the second and/or third trimester of pregnancy

If zolpidem is taken at the end of pregnancy or during delivery, your baby may show muscle weakness, a decrease in body temperature, difficulty feeding, and breathing problems (respiratory depression).

Zolpidem Teva-ratiopharm should not be taken during pregnancy and breastfeeding,especially during the first three months of pregnancy, as there is not enough information available to guarantee the safety of Zolpidem Teva-ratiopharm during pregnancy and breastfeeding.

However, if the benefit to the mother is greater than the risk to the baby, your doctor may decide to treat you with Zolpidem Teva-ratiopharm. If you take Zolpidem Teva-ratiopharm for a longer period during the last months of pregnancy, your baby may develop symptoms of physical dependence and may be at risk of developing withdrawal symptoms such as agitation or tremor. In this case, the newborn should be closely monitored during the postnatal period.

Zolpidem passes into breast milk in small amounts, so Zolpidem Teva-ratiopharm should not be taken during breastfeeding.

Ask your doctor or pharmacist for advice before taking any medicine.

Driving and using machines

Zolpidem Teva-ratiopharm has a significant effect on the ability to drive and use machines. On days when you take Zolpidem Teva-ratiopharm (as with other hypnotics), you should consider the following:

• You may feel drowsy, sleepy, dizzy, or confused
• You may take longer to make decisions
• You may experience blurred or double vision
• Your alertness may be reduced

In order to reduce these effects, a minimum interval of 8 hours is recommended between taking Zolpidem Teva-ratiopharm and driving, using machinery, or performing any work at heights.

Do not consume alcohol or any other psychoactive substance while taking Zolpidem Teva-ratiopharm, as this may increase the aforementioned effects.

For more information on possible side effects that could affect your ability to drive, see section 4 of this leaflet.

Zolpidem Teva-ratiopharm containslactose

Zolpidem Teva-ratiopharm contains the milk sugar lactose. If your doctor has told you that you have an intolerance to certain sugars, consult them before taking this medicine.

Zolpidem Teva-ratiopharm containssodium

This medicine contains less than 1 mmol of sodium (23 mg per film-coated tablet); this is essentially “sodium-free”.

3. How to take Zolpidem Teva-ratiopharm

Follow exactly the administration instructions of this medication indicated by your doctor or pharmacist. In case of doubt, consult your doctor or pharmacist again.

Zolpidem Teva-ratiopharm should be taken:

• as a single intake,
• right before bedtime
• Make sure you have a period of at least 8 hours after taking this medication before engaging in activities that require you to be alert.
• Do not exceed 10 mg per 24 hours.
• Administer the medication orally
• Swallow the tablet with a glass of water.

The recommended dose is:

Adults

The recommended dose is 10 mg per 24 hours. A lower dose may be prescribed to some patients.

Elderly patients, debilitated patients, or patients with hepatic insufficiency

A lower dose of 5 mg per day is recommended at the start of treatment (one whole 5 mg tablet). Your doctor may increase your dose to 10 mg (2 film-coated tablets of Zolpidem tartrate 5 mg) if the effect is insufficient and if the medication is well tolerated.

Use in children and adolescents

Zolpidem Teva-ratiopharm should not be used in children or adolescents under 18 years of age.

Maximum dose

Do not take more than 10 mg (2 film-coated tablets of Zolpidem Teva-ratiopharm 5 mg or 1 film-coated tablet of Zolpidem Teva-ratiopharm 10 mg) per 24 hours.

There are Zolpidem tartrate tablets of 10 mg.

Duration of treatment

The sleep-inducing effect (hypnotic) may be reduced after repeated treatment for several weeks.

The duration of treatment should be as short as possible. It can range from a few days to 2 weeks, and should not exceed four weeks.

In certain situations, it may be necessary to take Zolpidem Teva-ratiopharm for a longer period. Your doctor will inform you when and how to stop the treatment.

If you take moreZolpidem Teva-ratiopharmthan you should

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 ingested. Do not go to the hospital alone, ask someone to accompany you. Bring this leaflet with you and any remaining tablets to show them to the doctor.

This is so the doctor knows what you have taken. Taking too much zolpidem can be very dangerous. The following effects may occur: feeling drowsy, confused, deeply asleep, and possibly suffering a fatal coma.

If you forget to takeZolpidem Teva-ratiopharm

Do not take a double dose to make up for forgotten doses. Take the tablet if you will be able to sleep for 8 hours. If it is not possible, do not take the tablet until you go to bed the next day.

If you stop taking Zolpidem Teva-ratiopharm

Continue taking Zolpidem Teva-ratiopharm until your doctor tells you to stop. Do not stop taking Zolpidem Teva-ratiopharm suddenly, but inform your doctor if you want to stop it. Your doctor should reduce your dose and suspend your tablets over a period of time.

If you stop taking Zolpidem Teva-ratiopharm suddenly, your sleep problems may reappear, and you may experience a "withdrawal effect". If this happens, you may suffer some of the effects listed below.

Consult a doctor immediately if you experience any of the following effects:

• Feeling anxious, restless, irritable, or confused
• Headache
• Faster or irregular heartbeats (palpitations)
• Nightmares, seeing or hearing things that are not real (hallucinations)
• Being more sensitive to light, noise, and touch than usual.
• Losing touch with reality
• Feeling distant from your body or feeling "like a puppet"
• Numbness and tingling in hands and feet
• Muscle pain
• Stomach problems
• Sleep problems get worse than before
• In rare cases, seizures (convulsions) may also occur

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

4. Possible side effects

Like all medications, this medication can cause side effects, although not all people experience them. These effects seem to be related to individual sensitivity and seem to be more frequent after the first hour of taking the tablet if you do not go to bed or sleep immediately.

Side effects occur more frequently in elderly patients.

Stop taking Zolpidem Teva-ratiopharm and consult a doctor or go to the hospital immediately if:

• You have an allergic reaction. The signs may include: rash, swallowing or breathing problems, swelling of lips, face, throat, or tongue.

Other side effects are:

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

• perception of things that are not real (hallucinations), agitation, nightmares
• depression,
• drowsiness during the next day, emotional numbness, reduced alertness, attention disorder, fatigue, headache, dizziness, difficulty remembering things, which may be associated with inappropriate behavior, (see section 2, Warnings and precautions), memory impairment, inability to remember recent past (anterograde amnesia), ataxia (loss of muscle coordination), worsening of insomnia
• feeling of dizziness with loss of balance (vertigo)
• lung or respiratory tract infection (respiratory infection)
• diarrhea, feeling of discomfort (nausea), vomiting, stomach pain
• back pain
• fatigue

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

• state of confusion, irritability
• sleepwalking or other unusual behaviors while sleeping, such as driving, cooking, and eating, making phone calls, or having sex
• feeling of euphoria or intense confidence (euphoria), feeling restless or angry
• speech difficulties, attention disorder, tremors.
• double vision, blurred vision
• change in appetite (appetite disorder)
• increase in liver enzymes
• unusual or tingling sensation on the skin, itching on the skin or skin rash, excessive sweating.
• joint or muscle pain, muscle spasms, weak muscles, neck pain.

Rare(may affect up to 1 in 1000 people)

• change in sexual desire (libido)
• liver injury (hepatocellular, cholestatic, or mixed)
• hives
• abnormal walking posture (abnormal gait).

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

• reduced ability to see (visual impairment)
• physical or psychological dependence. If you stop taking Zolpidem Teva-ratiopharm suddenly, you may experience withdrawal symptoms (see section 2, Warnings and precautions),
• thinking things that are not true (delusions)
• slower breathing (respiratory depression)

Unknown(frequency cannot be estimated from available data)

• rapid swelling under the skin in areas such as the face, throat, arms, and legs that can be life-threatening if the swelling of the throat blocks the airways (angioedema)
• a drug effect that is contrary to what is normally expected (paradoxical reaction), abnormal behavior, mental disorders (psychosis), anger, these reactions are more likely in the elderly
• it has been reported on the misuse of Zolpidem Teva-ratiopharm by drug addicts, being less aware of their surroundings.
• drug tolerance, falls (mainly in elderly patients and when Zolpidem Teva-ratiopharm is not taken as prescribed).

delirium (a sudden and severe change in mental state that makes a person appear confused or disoriented).

Reporting of side effects

If you experience any side effects, consult your doctor or pharmacist, even if it is a possible side effect that does not appear in this leaflet. You can also report them directly through 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 medication.

5. Storage of Zolpidem Teva-ratiopharm

Keep this medication out of sight and reach of children.

Do not use this medication after the expiration date that appears on the packaging and on the blister pack after EXP. The expiration date is the last day of the month indicated.

Store in the original packaging to protect it from light. This medication does not require special storage conditions.

Medicines 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 the pharmacy. If in doubt, ask your pharmacist how to dispose of the packaging and medications you no longer need. This way, you will help protect the environment.

6. Package contents and additional information

Composition of Zolpidem Teva-ratiopharm 5 mg tablets

• The active ingredient is zolpidem tartrate. Each tablet contains 5 mg of zolpidem tartrate.
• The other ingredients in the tablet core are lactose monohydrate, microcrystalline cellulose (E460), sodium starch glycolate (Type A) (derived from potato), hypromellose (E464), and magnesium stearate (E572).

The other ingredients in the tablet coating are hypromellose (E464), titanium dioxide (E171), and macrogol 400.

Appearance of the product and package contents

Zolpidem Teva-ratiopharm 5 mg film-coated tablets are white, oval, biconvex, film-coated tablets, marked with "ZIM" on one side and "5" on the other side.

The tablets are available in packages containing 10, 14, 15, 20, 28, 30, 50x1, 90, and 100 tablets.

Not all pack sizes may be marketed.

Marketing authorization holder and manufacturer

Marketing authorization holder

Teva Pharma S.L.U.

C/ Anabel Segura nº 11 Edificio Albatros B, 1ª planta

Alcobendas 28108 Madrid

Manufacturer

Synthon Hispania S.L.

Polígono Las Salinas

C/ Castelló 1

08830 Sant Boi de Llobregat

Spain

or

Synthon BV

Microweg 22, 6545 CM, Nijmegen

Netherlands

or

Merckle GmbH

Ludwig-Merckle-Straße 3

89143 Blaubeuren-Weiler

Germany

or

Teva Nederland B.V.

Swensweg 5, 2031 GA Haarlem

Netherlands

This medication is authorized in the Member States of the European Economic Area with the following names:

Date of the last revision of this leaflet:October 2023

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

You can access detailed and updated information about this medication by scanning the QR code included in the packaging with your mobile phone (smartphone). You can also access this information at the following internet address: https://cima.aemps.es/cima/dochtml/p/75795/P_75795.html

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