Package Insert: Information for the Patient

Dulvas 30mg Hard Gastrorresistant Capsules EFG

duloxetina

Read this package insert carefully before starting to take this medication, as it contains important information for you.

–Keep this package insert, as you may need to read it again.

–If you have any questions, consult your doctor or pharmacist.

–This medication has been prescribed only for you, and you should not give it to others who have the same symptoms as you, as it may harm them.

–If you experience any adverse effects, consult your doctor or pharmacist, even if they are not listed in this package insert. See section 4.

Dulvas contains the active ingredient duloxetina. Dulvas increases the levels of serotonin and noradrenalina in the nervous system.

Dulvas is used in adults to treat:

• depression;
• generalized anxiety disorder (chronic sensation of anxiety or nervousness);
• diabetic neuropathic pain (often described as burning, stabbing, pinching, stinging, or electric shock-like pain. There may be a loss of sensation in the affected area, or pain may occur when touching the area or exposing it to heat, cold, or pressure).

Dulvas begins to take effect in most people with depression or anxiety within two weeks of starting treatment, but it may take between 2 and 4 weeks to feel better. Inform your doctor if you do not notice improvement after this time. Your doctor may continue to give you Dulvas when you are feeling better to prevent your depression or anxiety from returning.

In people with diabetic neuropathic pain, it may take several weeks to start feeling better. Consult your doctor if you do not feel better after 2 months.

Do not take Dulvas if:

• You are allergic to duloxetine or any of the other ingredients of this medicine (listed in section 6);
• You have liver failure;
• You have severe kidney failure;
• You are taking or have taken in the last 14 days another medicine known as a monoamine oxidase inhibitor (MAOI) (see "Other medicines and Dulvas");
• You are taking fluvoxamine — which is usually used to treat depression —, ciprofloxacin or enoxacin — which are used in the treatment of some infections —;
• You are taking other medicines that contain duloxetine (see "Other medicines and Dulvas").

Consult your doctor if you have high blood pressure or a heart disease. Your doctor will tell you if you should take duloxetine.

Warnings and precautions

Duloxetine may not be suitable for you for the following reasons. Consult your doctor before taking Dulvas if:

• You are taking other medicines to treat depression (see "Other medicines and Dulvas");
• You are taking St. John's Wort, a herbal remedy (Hypericum perforatum);
• You are taking buprenorphine, a medicine to treat pain or opioid dependence;
• You have any kidney disease;
• You have had seizures (epileptic fits);
• You have had mania;
• You have bipolar disorder;
• You have eye problems, such as some types of glaucoma (increased eye pressure);
• You have had bleeding problems (tendency to develop bruises), especially if you are pregnant (see "Pregnancy and breastfeeding");
• You have a risk of low sodium levels (for example if you are taking diuretics, especially if you are an older person);
• You are being treated with other medicines that can damage the liver;
• You are taking other medicines that contain duloxetine (see "Other medicines and Dulvas").

You should also contact your doctor:

If you experience signs and symptoms of restlessness, hallucinations, loss of coordination, rapid heartbeat, increased body temperature, rapid changes in blood pressure, hyperactive reflexes, diarrhoea, coma, nausea, vomiting, as you may be suffering from a serotonin syndrome.

In its most severe form, serotonin syndrome can resemble Neuroleptic Malignant Syndrome (NMS). The symptoms of NMS can include a combination of fever, rapid heartbeat, sweating, severe muscle stiffness, confusion, increased muscle enzymes (determined by blood tests).

Some medicines in the group to which Dulvas belongs (called SSRIs/SNRIs) can cause sexual dysfunction symptoms (see section 4). In some cases, these symptoms persist after stopping treatment.

Duloxetine can cause a feeling of restlessness or inability to sit or stay still. If this happens, you should tell your doctor.

Thoughts of suicide and worsening of your depression or anxiety

If you are depressed or have anxiety disorders, you may, from time to time, have thoughts of self-harm or suicide. These thoughts may be increased at the beginning of treatment with antidepressants, as all these medicines take time to work, usually two weeks but sometimes longer.

You are more likely to have these thoughts if:

• You have had thoughts of self-harm or suicide before;
• You are a young adult. There is information from clinical trials that has shown an increased risk of suicidal behaviour in adults under 25 years old who have a psychiatric disorder and are being treated with antidepressants.

Contact your doctor or go directly to the hospital as soon as you have any thoughts of self-harm or suicide.

It may be helpful to tell a close relative or friend that you are depressed or have an anxiety disorder, and ask them to read this leaflet. They may be able to tell you if your depression or anxiety is getting worse, or if they are worried about changes in your behaviour.

Children and adolescents under 18 years

Duloxetine is usually not used in children and adolescents under 18 years old. You should also know that patients under 18 years old who take this class of medicines have an increased risk of side effects such as suicidal thoughts, suicidal behaviour and hostility (mainly aggression, oppositional behaviour and irritability). Despite this, your doctor may prescribe duloxetine to patients under 18 years old because they decide that it may be beneficial for the patient. If your doctor has prescribed duloxetine to a patient under 18 years old and you want to talk about it, please go back to your doctor. You should tell your doctor if any of the symptoms mentioned above appear or get worse in patients under 18 years old who are taking duloxetine. Also, in this age group, the long-term safety effects of duloxetine related to growth, maturation and development of cognitive and behavioural functions have not yet been demonstrated.

Other medicines and Dulvas

Inform your doctor or pharmacist if you are taking, have taken recently or may need to take any other medicine, including those bought without a prescription.

The main component of Dulvas, duloxetine, is used in other medicines for other treatments:

• diabetic neuropathic pain, depression, anxiety and urinary incontinence

You should avoid using more than one of these medicines at the same time. Check with your doctor if you are already using other medicines that contain duloxetine.

Your doctor will decide if you can take duloxetine with other medicines.Do not start or stop using any medicine, including those bought without a prescription and herbal remedies, without first consulting your doctor.

You should also tell your doctor if you are taking any of the following medicines:

• Monoamine oxidase inhibitors (MAOIs): Do not take duloxetine if you are taking, or have taken in the last 14 days, another antidepressant known as a monoamine oxidase inhibitor (MAOI). Examples of MAOIs include moclobemide (an antidepressant) and linezolid (an antibiotic). Taking an MAOI with many prescription medicines, including duloxetine, can cause serious side effects, even life-threatening. You should wait at least 14 days after stopping treatment with an MAOI before taking Dulvas. You should also wait at least 5 days after stopping treatment with duloxetine before starting treatment with an MAOI.
• Medicines that cause drowsiness: This includes prescription medicines such as benzodiazepines, powerful analgesics, antipsychotics, phenobarbital and antihistamines.
• Medicines that increase serotonin levels: Buprenorphine, triptans, tramadol, tryptophan, selective serotonin reuptake inhibitors (SSRIs, such as paroxetine and fluoxetine), serotonin-norepinephrine reuptake inhibitors (SNRIs, such as venlafaxine), tricyclic antidepressants (such as clomipramine, amitriptyline), petidina, St. John's Wort and MAOIs (such as moclobemide and linezolid). These medicines increase the risk of side effects; if you observe any unusual symptoms when using any of these medicines with duloxetine, you should tell your doctor.
• Oral anticoagulants or antiplatelet agents: Medicines that thin the blood or prevent the formation of blood clots in the blood. These medicines may increase the risk of bleeding.

Taking Dulvas with food, drinks and alcohol

Dulvas can be taken with or without food. You should be careful if you take alcohol while taking duloxetine.

Pregnancy and breastfeeding

If you are pregnant or breastfeeding, consult your doctor or pharmacist before using this medicine.

• Inform your doctor if you become pregnant or if you are trying to become pregnant while taking duloxetine. You should only use duloxetine after discussing the potential benefits and any potential risks to the foetus with your doctor.

• Make sure your midwife and/or doctor know that you are taking duloxetine. Other similar medicines (SSRIs), taken during pregnancy, may increase the risk of a serious condition in babies, called persistent pulmonary hypertension of the newborn (PPHN), which makes the baby breathe more rapidly and turn blue. These symptoms usually start within the first 24 hours after the baby's birth. If this happens to your baby, you should contact your midwife and/or doctor immediately.

• If you take Dulvas towards the end of your pregnancy, your baby may have some symptoms when it is born. These usually start at birth or within the first few days after the baby's birth. These symptoms may include weak muscles, trembling, restlessness, difficulty feeding, breathing problems and convulsions. If your baby has any of these symptoms when it is born or if you are concerned about your baby's health, contact your doctor or midwife for advice.

• If you take duloxetine towards the end of your pregnancy, there is a higher risk of excessive vaginal bleeding after birth, especially if you have had bleeding problems. Your doctor or midwife should know that you are taking duloxetine so they can advise you.

-The available data on the use of duloxetine during the first three months of pregnancy do not show a general increase in the risk of birth defects in the baby. If you take duloxetine during the second half of pregnancy, there may be a higher risk of the baby being born prematurely (6 extra premature births per 100 women taking duloxetine in the second half of pregnancy), especially between weeks 35 and 36 of pregnancy.

• Inform your doctor if you are breastfeeding. Duloxetine is not recommended during breastfeeding. Ask your doctor or pharmacist for advice.

Driving and operating machines

During treatment with duloxetine, you may feel drowsy or dizzy. Do not drive or operate tools or machines until you know how duloxetine affects you.

Dulvas contains sucrose

Dulvas contains sucrose. If your doctor has told you that you have an intolerance to certain sugars, consult them before taking this medicine.

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

Dulvas should be taken orally. Swallow the capsule whole with water.

For depression and diabetic neuropathic pain:

The recommended dose of duloxetine is 60 mg once a day, but your doctor will prescribe the dose that is best for you.

For generalized anxiety disorder:

The initial normal dose of duloxetine is 30 mg once a day, after which most patients will receive 60 mg once a day, but your doctor will prescribe the dose that is best for you. The dose can be adjusted to 120 mg per day depending on your response to duloxetine.

To avoid forgetting to take duloxetine, it may be helpful to take it at the same time every day.

Discuss with your doctor for how long you should take duloxetine. Do not stop taking duloxetine or change your dose without consulting your doctor. It is essential to treat your condition properly to help you improve. If you do not treat it, your condition may not disappear and may become more severe and harder to treat.

If you take more Dulvas than you should

Call your doctor or pharmacist immediately if you take more duloxetine than prescribed by your doctor. You can also call the Toxicology Information Service, phone 91 562 04 20, indicating the medication and the amount ingested.

Among the symptoms produced by an overdose are drowsiness, coma, serotonin syndrome (a rare reaction that can cause a feeling of intense happiness, drowsiness, clumsiness, restlessness, feeling drunk, fever, sweating, or muscle rigidity) seizures, vomiting, and high heart rate.

If you forgot to take Dulvas

If you forget to take a dose, take it as soon as you remember. However, if it is time for the next dose, skip the missed dose and take a single dose as you normally do. Do not take a double dose to compensate for the missed doses. Do not take more duloxetine than prescribed for you in a day.

If you interrupt the treatment with Dulvas

DO NOT stop taking your capsules without your doctor's advice, even if you feel better. If your doctor thinks you no longer need to take duloxetine, they will instruct you to reduce your dose for at least two weeks before stopping treatment.

Some patients who stopped treatment with duloxetine suddenly presented symptoms such as:

• dizziness, feeling of pins and needles or electric shock (especially in the head), sleep disturbances (intense dreams, nightmares, inability to sleep), fatigue, drowsiness, feeling of restlessness or agitation, feeling of anxiety, nausea or vomiting, tremors, headaches, muscle pain, feeling of irritability, diarrhea, and excessive sweating or vertigo.

These symptoms are usually not important and disappear in a few days, but if you have symptoms that are bothersome, ask your doctor for advice.

If you have any other doubts 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. These side effects are usually mild to moderate and often disappear within a few weeks.

Very common side effects (may affect more than 1 in 10 patients)

• headache, drowsiness;
• unpleasantness (nausea), dry mouth.

Common side effects (may affect up to 1 in 10 patients)

• loss of appetite;
• difficulty sleeping, feeling agitated, decreased libido, anxiety, difficulty or inability to have an orgasm, unusual dreams;
• dizziness, feeling slow, tremors, numbness, including numbness, itching, or tingling in the skin;
• blurred vision;
• tinnitus (perception of sounds in the ear when there is no sound outside);
• feeling palpitations in the chest;
• increased blood pressure, flushing;
• increased yawning;
• constipation, diarrhea, stomach pain, vomiting, heartburn, or indigestion, gas;
• increased sweating, rash;
• muscle pain, muscle spasms;
• painful urination, frequent urination;
• difficulty achieving an erection, changes in ejaculation;
• falls (mainly in older adults), fatigue;
• weight loss.

Children and adolescents under 18 years of age with depression treated with this medicine experienced a decrease in weight when they started taking this medicine. After 6 months of treatment, the weight increased to similar levels as other children and adolescents of the same age and sex.

Uncommon side effects (may affect up to 1 in 100 patients)

• throat inflammation that causes hoarseness;
• suicidal thoughts, difficulty sleeping, bruxism, feeling disoriented, lack of motivation;
• muscle spasms and involuntary muscle movements, feeling restless or inability to remain seated or still, nervousness, difficulty concentrating, changes in taste, difficulty controlling movements, for example, lack of coordination or involuntary muscle movements, restless legs syndrome, poor-quality sleep;
• pupil dilation (the black center of the eye), vision problems;
• feeling dizzy or vertigo, ear pain;
• rapid or irregular heartbeat;
• syncope, dizziness, feeling dizzy or syncope when standing up, cold hands and/or feet;
• throat spasms, nasal bleeding;
• vomiting blood, or black stools, gastroenteritis, belching, difficulty swallowing;
• liver inflammation that can cause abdominal pain and yellowing of the skin or white part of the eyes;
• night sweats, rashes, cold sweats, sensitivity to sunlight, increased tendency to bruise;
• muscle stiffness, muscle spasms;
• difficulty or inability to urinate, difficulty starting urination, need to urinate at night, need to urinate more than usual, decreased urine flow;
• abnormal vaginal bleeding, abnormal menstrual periods, including heavy, painful, irregular, or prolonged periods, occasionally light or absent periods, testicular or scrotal pain;
• chest pain, feeling cold, thirst, chills, feeling hot, gait disturbance;
• weight gain;
• Duloxetine may cause effects that you may not be aware of, such as increased liver enzymes or blood potassium levels, creatine phosphokinase, sugar, or cholesterol.

Rare side effects (may affect up to 1 in 1,000 patients)

• severe allergic reactions, which cause difficulty breathing or dizziness with swelling of the tongue or lips, allergic reactions;
• decreased activity of the thyroid gland, which can cause fatigue or weight gain;
• dehydration, low sodium levels in the blood (mainly in older adults; symptoms may include dizziness, weakness, confusion, sleepiness, or excessive fatigue, nausea, or vomiting, more serious symptoms are syncope, convulsions, or falls), syndrome of inappropriate antidiuretic hormone secretion (SIADH);
• suicidal behavior, mania (hyperactivity, accelerated thinking, and decreased need for sleep), hallucinations, aggression, and anger;
• "serotonin syndrome" (a rare reaction that can cause intense happiness, drowsiness, clumsiness, restlessness, feeling drunk, fever, sweating, or muscle stiffness), convulsions;
• increased pressure in the eye (glaucoma);
• cough, wheezing, and shortness of breath, which may be accompanied by high fever;
• inflammation of the mouth, bright red blood in the stool, bad breath, inflammation of the large intestine (leading to diarrhea);
• liver failure, yellowing of the skin or white part of the eyes (jaundice);
• Stevens-Johnson syndrome (a severe disease with blistering of the skin, mouth, eyes, and genitals), severe allergic reactions that cause swelling of the face or throat (angioedema);
• jaw muscle contractions;
• unusual odor of urine;
• menopausal symptoms, abnormal milk production in men or women;
• excessive vaginal bleeding shortly after birth (postpartum hemorrhage).

Very rare side effects (may affect up to 1 in 10,000 patients)

• inflammation of the skin blood vessels (cutaneous vasculitis).

Frequency not known (cannot be estimated from available data)

• signs and symptoms of a condition called "stress cardiomyopathy," which may include chest pain, difficulty breathing, dizziness, syncope, and irregular heartbeat.

Reporting of side effects

If you experience any type of side effect, consult your doctor or pharmacist, even if it is a possible side effect that does not appear in this prospectus. You can also report them directly through the Spanish System for the Vigilance of Medicines for Human Use:http://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.

Do not store at a temperature above 30°C.

Store in the original packaging to protect it from moisture.

Medicines should not be disposed of through drains or in the trash. Dispose of packaging and medications you no longer need at the SIGRE collection point of the pharmacy. If in doubt, ask your pharmacist how to dispose of packaging and medications you no longer need. By doing so, you will help protect the environment.

Composition of Dulvas

• The active ingredient is duloxetine.
  Each capsule contains 30mg of duloxetine (as hydrochloride).
• The other components are:
  Caplet content: triethyl citrate (E1505), sugar spheres (cornstarch and sucrose), hypromellose 6 cp, hypromellose phthalate, sucrose, talc (E553b).
  Caplet coating: titanium dioxide (E171), gelatin (E441), indigotin (E132), ink (shellac [E904], iron oxide black [E172]).

Appearance of the product and contents of the packaging

White or almost white pellets in a hard gelatin capsule size 3. The capsule body is white and the cap is dark blue. The capsule body bears the imprint «30» in black.

Dulvas is available in packs with 7 or 28 capsules in blisters.

Only some packaging sizes may be marketed.

Marketing authorization holder and responsible manufacturer

Marketing authorization holder

TAD Pharma GmbH, Heinz-Lohmann-Straße 5, 27472 Cuxhaven, Germany

Responsible manufacturer

KRKA, d.d., Novo mesto, Šmarješka cesta 6, 8501 Novo mesto, Slovenia

TAD Pharma GmbH, Heinz-Lohmann-Straße 5, 27472 Cuxhaven, Germany

You can request more information about this medicine by contacting the local representative of the marketing authorization holder:

KRKA Farmacéutica, S.L., C/ Anabel Segura 10, Pta. Baja, Oficina 1, 28108 Alcobendas, Madrid

Last review date of this leaflet:September 2024

The detailed information about this medicine is available on the website of the Spanish Agency for Medicines and Medical Devices (AEMPS) (http://www.aemps.gob.es/).