Package Leaflet: Information for the User
Besitran 20mg/ml Oral Solution Concentrate
Sertraline
Read this leaflet carefully before you start taking this medicine because it contains important information for you.
1.What Besitran is and what it is used for
2.What you need to know before taking Besitran
3.How to take Besitran
4.Possible side effects
5.Storage of Besitran
6. Contents of the pack and additional information
Besitrancontains sertraline as the active ingredient. Sertraline belongs to a group of medications called Selective Serotonin Reuptake Inhibitors (SSRIs); these medications are used to treat depression and/or anxiety disorders.
Besitrancan be used to treat:
Depression is a clinical disease with symptoms such as feelings of sadness, inability to sleep well or to enjoy life as one used to.
OCD and anxiety disorders are anxiety-related diseases with symptoms such as being constantly preoccupied with repeated ideas (obsessions) that lead to repetitive rituals (compulsions).
PTSD is a disorder that may occur after a very emotionally traumatic experience, and has some symptoms similar to depression and anxiety. Social anxiety disorder (social phobia) is an anxiety-related disease. It is characterized by intense anxiety or anguish in social situations (for example: speaking to strangers, speaking in public, eating or drinking in front of others, or worrying about behaving in a shameful manner).
Your doctor has considered that this medication is suitable for treating your disease.
If you are unsure why you have been prescribed Besitran, you should consult your doctor.
Warnings and precautions
Consult your doctor or pharmacist before starting to take Besitran.
Medicines are not always suitable for everyone. Before starting treatment with Besitran, tell your doctor if you have or have had any of the following circumstances:
Restlessness/Acatisia:
The use of sertraline has been associated with unpleasant restlessness and a need to move, often accompanied by an inability to sit or stand still (acatisia). This occurs more often during the first weeks of treatment. Increasing the dose may be harmful, so if you develop these symptoms, you should contact your doctor.
Withdrawal symptoms:
Side effects related to stopping treatment (withdrawal symptoms) are common, particularly if treatment is stopped abruptly (see section 3. If you stop taking Besitran and section 4. Possible side effects). The risk of withdrawal symptoms depends on the duration of treatment, the dose, and the rate at which the dose is reduced. Generally, these symptoms are mild or moderate. However, in some patients, they can be severe. These symptoms usually occur during the first few days after stopping treatment. In general, these symptoms usually resolve on their own and usually resolve within two weeks. In some patients, they may last longer (2-3 months or more). It is recommended that when stopping treatment with sertraline, the dose be gradually reduced over a period of several weeks or even months, and you should always agree with your doctor on the best way to stop treatment.
Thoughts of suicide and worsening of your depression or anxiety:
If you are depressed and/or have anxiety disorders, you may sometimes have thoughts of harming yourself or committing suicide. This may increase at the beginning of treatment with antidepressants, as all these medications take time to take effect, which is usually two weeks but sometimes longer.
You are more likely to experience this:
If you have thoughts of harming yourself or committing suicide at any time, contact your doctor or go to the hospital immediately.
It may be helpful for you to explain to a close family member or friend that you are depressed or have an anxiety disorder, and ask them to read this leaflet. You can also ask them to tell you if they think your depression or anxiety is getting worse, or if they are concerned about changes in your behavior.
Some medications in the group to which Besitran belongs (called ISRS) may cause symptoms of sexual dysfunction (see section 4). In some cases, these symptoms persist after stopping treatment.
Children and adolescents
Normally, sertraline should not be used to treat children and adolescents under 18 years old,except in the case of patients with obsessive-compulsive disorder (OCD). Young patients have a higher risk of side effects such as suicidal thoughts,thoughts of self-harm or suicide(suicidal ideas) and hostility (mainly aggression, confrontational behavior, and irritable reaction) when treated with this class of medications.However, your doctor may decide to prescribe Besitran to a patient under 18 years old if they consider it to be the most suitable option for the patient.If your doctor has prescribed Besitran and you are under 18 years old and want to discuss this decision, please go back to your doctor. You should inform your doctor if any of the symptoms listed above appear or worsen when you are taking Besitran. The long-term effects on safety and related to growth, maturity, and learning (cognitive development) and behavioral development of Besitranwas evaluated in a long-term study in over 900 children aged 6 to 16 years who were monitored for a period of 3 years. In general, the results of the study showed that children treated with sertraline developed normally, except for a slight increase in weight in those treated with a higher dose.
Besitran concentrated oral solution contains alcohol (ethanol) and may affect young children (see "Besitran contains alcohol (ethanol)").
Other medications and Besitran
Inform your doctor or pharmacist if you are taking, have taken recently, or may need to take any other medication.
Some medications may affect how Besitran works, or Besitran itself may reduce the effectiveness of other medications you are taking at the same time.
The use of Besitran with the following medications may cause severe side effects:
Inform your doctor if you are taking the following medications:
Taking Besitran with food, drinks, and alcohol
Besitran concentrated oral solution can be taken with or without food.
Alcohol should be avoided while taking Besitran.
Do not take sertraline with grapefruit juice, as it may increase sertraline levels in your body.
Pregnancy, breastfeeding, and fertility
If you are pregnant or breastfeeding, consult your doctor or pharmacist before using this medication.
The safety of sertraline in pregnant women has not been fully established. If you are pregnant, sertraline will only be administered to you if your doctor considers that the benefits for you outweigh any possible risk to the developing fetus.
Using Besitran in the final stages of pregnancy may increase the risk of excessive bleeding after delivery, especially if you have a history of bleeding disorders. Your doctor or midwife should know that you are taking Besitran so they can advise you. When used during pregnancy, especially during the last 3 months of pregnancy, medications like Besitran may increase the risk of a serious condition in newborns called persistent pulmonary hypertension (PPHN), which makes the baby breathe faster and appear blue. These symptoms usually start within the first 24 hours after birth. If this happens to your baby, contact your midwife and/or doctor immediately.
Besitran concentrated oral solution contains alcohol (ethanol). If you are pregnant, consult your doctor or pharmacist before taking this medication.
Your newborn baby may have other conditions, which usually manifest within the first 24 hours after birth. The symptoms include:
• difficulty breathing,
• blue skin or too hot or cold,
• blue lips,
• vomiting or feeding problems,
• excessive tiredness, unable to sleep or crying a lot,
• stiffness or decreased muscle tone,
• tremors, restlessness, or convulsions,
• increased reflexes,
• irritability,
• low blood sugar levels.
If your baby has any of these symptoms at birth, or you are concerned about your baby's health, consult your doctor or midwife for advice.
There is evidence that sertraline passes into breast milk. Therefore, sertraline can only be used by women while breastfeeding if your doctor considers that the benefits outweigh any possible risk to the baby.
Besitran concentrated oral solution contains alcohol (ethanol). If you are breastfeeding, consult your doctor or pharmacist before taking this medication.
There is evidence that some medications, such as sertraline, may reduce the quality of sperm. Theoretically, this could affect fertility, but it has not yet been determined in humans.
Driving and operating machinery
Psychotropic medications like sertraline may affect your ability to drive or operate machinery. Therefore, do not drive or operate heavy machinery, until you know how this medication affects your ability to develop these activities.
Besitran contains alcohol (ethanol)
•Each 25 mg (1.25 ml) of Besitran concentrated oral solution contains 181 mg of anhydrous ethanol, which is equivalent to less than 5 ml of beer or 2 ml of wine..
•Each 50 mg (2.5 ml) of Besitran concentrated oral solution contains 362 mg of anhydrous ethanol, which is equivalent to less than 10 ml of beer or 4 ml of wine..
•Each 200 mg (10 ml) of Besitran concentrated oral solution contains 1447 mg of anhydrous ethanol, which is equivalent to less than 37 ml of beer or 15 ml of wine..
Ifyou have a history of alcoholism, consult your doctor or pharmacist before taking this medication.
The amount of alcohol in this medication may alter the effects of other medications. Consult your doctor or pharmacist if you are taking other medications.
Besitran containsglycerol
At high dosesmay cause headaches, stomach discomfort, and diarrhea.
The packaging of this medication contains latex. It may cause severe allergic reactions.
Follow exactly the administration instructions of this medication as indicated by your doctor or pharmacist. In case of doubt, consult your doctor or pharmacist again.
The recommended dose is:
Depression and Obsessive-Compulsive Disorder:
The commonly effective dose for depression and OCD is 50mg (2.5 ml) per day. The daily dose can be increased by 50mg (2.5 ml) at intervals of at least one week, and thus for several weeks. The maximum recommended dose is 200mg (10 ml) per day.
Anxiety Disorder, Social Anxiety Disorder, and Post-Traumatic Stress Disorder:
For anxiety disorder, social anxiety disorder, and post-traumatic stress disorder, treatment should begin with a dose of 25mg (1.25 ml) per day, and increased to 50mg (2.5 ml) per day after one week.
The daily dose can be increased at intervals of 50mg (2.5 ml) over a period of several weeks. The maximum recommended dose is 200mg (10 ml) per day.
Use in children and adolescents:
Besitran should only be used to treat children and adolescents aged 6 to 17 years who have OCD.
Obsessive-Compulsive Disorder:
Children aged 6 to 12 years:The recommended starting dose is 25mg (1.25 ml) per day. After one week, your doctor may increase the dose to 50mg (2.5 ml) per day. The maximum dose is 200mg (10 ml) per day.
Adolescents aged 13 to 17 years:The recommended starting dose is 50mg (2.5 ml) per day. The maximum dose is 200mg (10 ml) per day.
If you have liver or kidney problems, inform your doctor and follow their instructions..
Administration form:
Besitran concentrated oral solution can be taken with or without food.
Take your medication once a day, either in the morning or at night.
Your doctor will indicate the duration of treatment with this medication. The duration will depend on the nature of your illness and your response to treatment. It may take several weeks for your symptoms to improve. Treatment of depression usually should continue for 6 months after improvement.
Instructions for taking Besitran correctly:
The oral concentrate solution must always be diluted before taking. Never drink the concentrate undiluted.
The first time you open the concentrate oral solution bottle, you must put the dropper in the bottle as follows:
Dose measurement:
Use the dropper to measure the dose prescribed by your doctor.
Mix the measured dose with 120 ml (a glass) of liquid, which can be water, ginger ale, lemon/lime soda, lemonade, or orange juice.
Do not mix the concentrated liquid with any other liquid other than those mentioned above. The mixture should be taken immediately after preparing it. The mixture may be slightly cloudy, but this is normal.
If you take more Besitran than you should:
If you accidentally take an excessive amount of Besitran, contact your doctor or go to the nearest hospital emergency department. Always carry the medication packaging with you, whether it contains medication or not.
You can also call the Toxicology Information Service, phone 91 562 04 20, indicating the medication and the amount ingested.
The symptoms of overdose may include drowsiness, nausea, vomiting, rapid heart rate, tremors, agitation, dizziness, and in rare cases, loss of consciousness.
If you forget to take Besitran:
Do not take a double dose to compensate for the missed doses. If you forget to take a dose, do not take it when you remember. Take the next dose when it is due.
If you interrupt treatment with Besitran:
Do not interrupt treatment with Besitran unless your doctor tells you to. Your doctor will want to gradually reduce the dose of Besitran over several weeks before stopping it completely. If you stop treatment abruptly, you may experience adverse effects such as dizziness, numbness, sleep disturbances, agitation or anxiety, headaches, nausea, vomiting, and tremors. If you experience any of these adverse effects, or any other during the interruption of your treatment with Besitran, please inform your doctor.
If you have any other questions about the use of this medication, ask your doctor or pharmacist.
Like all medicines, this medicine can cause side effects, although not everyone will experience them.
The most common side effect is nausea. Side effects depend on the dose and often disappear or decrease as treatment continues.
Inform your doctor immediately:
If you experience any of the following symptoms after taking this medicine, as these symptoms can be serious.
The following side effects were observed in clinical trials in adults and after marketing.
Very common (may affect more than 1 in 10 patients):
Insomnia, dizziness, drowsiness, headache, diarrhea, feeling unwell, dry mouth, ejaculation problems, and fatigue.
Common (may affect up to 1 in 10 patients):
Uncommon (may affect up to 1 in 100 patients):
Rare (may affect up to 1 in 1,000 patients):
Frequency not known: cannot be estimated from available data:
*Side effects reported after marketing.
Other side effects in children and adolescents
In clinical trials in children and adolescents, side effects were generally similar to those reported in adults (see above). The most common side effects in children and adolescents were headache, insomnia, diarrhea, and nausea.
Symptoms that may appear when treatment is stopped
If you stop treatment with this medicine abruptly, you may experience side effects such asdizziness, numbness, sleep disturbances, agitation or anxiety, headaches, nausea, vomiting, and tremors(see section 3. If you stop treatment with Besitran).
There has been an increased risk of bone fractures in patients taking this type of medicine.
Reporting side effects
If you experience any type of side effect, consult your doctor, pharmacist, or nurse, even if it is a possible side effect that does not appear in this leaflet.You can also report them directly through the Spanish System for the Pharmacovigilance of Medicines for Human Use:https://www.notificaram.es. By reporting side effects, you can contribute to providing more information on the safety of this medicine.
Keep this medication out of the sight and reach of children.
Do not use this medication after the expiration date that appears on the packaging after CAD. The expiration date is the last day of the month indicated.
Once the packaging is opened for the first time, it can be used for 28 days (4 weeks).
Do not store at a temperature above 30°C.
Medicines should not be disposed of through drains or in the trash. Dispose of the packaging and unused medications at the SIGRE collection point at the pharmacy. If in doubt, ask your pharmacist how to dispose of the packaging and unused medications. By doing so, you will help protect the environment.
Appearance of the product and contents of the container
Besitran oral solution concentrate is a clear and colorless solution thatis presented in a 60 ml amber glass vial together with a calibrated dropper.
Marketing authorization holder and manufacturer responsible
Marketing authorization holder
Viatris Healthcare Limited
Damastown Industrial Park
Mulhuddart, Dublin 15
Dublin
Ireland
Manufacturer responsible
Farmasierra Manufacturing S.L.
Carretera de Irún, Km. 26.200
28709 San Sebastián de los Reyes
Madrid, Spain
or
Mylan Hungary Kft.
Mylan utca 1
Komárom, 2900
Hungary
You can request more information about this medication by contacting the local representative of the marketing authorization holder:
Viatris Pharmaceuticals, S.L.U.
C/ General Aranaz, 86
28027 Madrid
Spain
This medicine is authorized in the Member States of the European Economic Area and in the United Kingdom (Northern Ireland) with the following names:
Austria | Tresleen |
Belgium, Luxembourg | Serlain |
Bulgaria, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Italy, Latvia, Lithuania, Netherlands, Norway, Poland, Portugal, Romania, Slovakia, Slovenia, Sweden | Zoloft |
Ireland, United Kingdom (Northern Ireland) | Lustral |
Spain | Besitran |
Last review date of this leaflet:March2023
Detailed and updated information about this medicine is available on the website of the Spanish Agency for Medicines and Medical Devices (AEMPS) http://www.aemps.gob.es/
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