PROSPECTO : INFORMATION FOR THE USER

Metamizol Tarbis 575 mg hard capsules EFG

Magnesium Metamizol

Read this prospectus carefully before starting to take this medicine, because it contains important information for you.

• Keep this prospectus, as you may need to read it again.
• If you have any doubts, consult your doctor or pharmacist.
• This medicine has been prescribed only for you and must not be given to other people even if they 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 do not appear in this prospectus.

Metamizol belongs to the group of medications known as: Other Analgesics and Antipyretics.

Metamizol Tarbis is used for the treatment of acute post-operative or post-traumatic pain, colic pain, and pain of tumor origin. It is also used in cases of high fever that does not respond to other antipyretics.

Do not take Metamizol Tarbis

• If you have previously had a significant decrease in a type of white blood cells called granulocytes, which was caused by metamizol or other similar medications called pyrazolones or pyrazolidines.
• If you have problems with your bone marrow or have a disorder that affects the way your blood cells are produced or function.

-If you have previously had allergic reactions or hematological reactions (decrease in white blood cells, red blood cells, or platelets in the blood) with medications containing metamizol or other similar compounds or allergic reactions to any of the other components of this medication (listed in section 6).

• If you have experienced symptoms of asthma, rhinitis, or urticaria (red patches or hives on the skin that can cause itching) during treatment with other analgesics such as acetylsalicylic acid, paracetamol, or nonsteroidal anti-inflammatory drugs, as in these cases there may also be sensitivity to metamizol (active substance of Metamizol Tarbis).
• If you have acute intermittent porphyria (a disorder of the metabolism of blood pigments that form part of hemoglobin).
• If you have a genetic deficiency of glucose-6-phosphate dehydrogenase.
• If you have had alterations in bone marrow function (producer of blood cells); for example, during or after receiving chemotherapy (antineoplastic) or if you have diseases related to blood cell formation.
• If you are in the last three months of pregnancy.
• If you have had severe skin reactions (such as Stevens-Johnson syndrome or toxic epidermal necrolysis) with the use of Metamizol Tarbis or another medication containing metamizol.

Warnings and precautions

Consult your doctor or pharmacist before starting to take Metamizol Tarbis.

Low white blood cell count (agranulocytosis)

Metamizol Tarbis may cause agranulocytosis, a very low level of a type of white blood cells called granulocytes, which are important for fighting infections (see section 4). You should stop taking metamizol and contact a doctor immediately if you experience the following symptoms, as they may indicate possible agranulocytosis: chills, fever, sore throat, and painful sores in the mucous membranes (moist surfaces of the body) especially in the mouth, nose, and throat or in the genital or anal area. Your doctor will perform laboratory tests to check your blood cell levels.

If you take metamizol for fever, some symptoms of agranulocytosis may be masked. Similarly, symptoms may be masked if you are taking antibiotics.

Agranulocytosis can occur at any time during the use of Metamizol Tarbis and even after you have stopped taking metamizol.

You may develop agranulocytosis even if you have used metamizol without problems in the past.

Be especially careful:

• If you experience general discomfort, infection, persistent fever, sore throat, inflammation in the mouth, nose, or throat, lesions in the mucous membranes of the mouth or genitals, bruises, bleeding, or pallor, discontinue treatment and consult your doctor immediately. These disorders may be due to a decrease in the number of white blood cells in the blood (agranulocytosis), platelets (thrombocytopenia), or failure of the production of all blood cells (aplastic anemia).
• If you experience dizziness, difficulty breathing, rhinitis, facial swelling, decreased blood pressure, sudden red patches on the skin, discontinue treatment and consult your doctor. These symptoms may be due to a severe allergic reaction called anaphylactic shock. This reaction is more likely if you have asthma or allergic disorders (atopy)
• If you have bronchial asthma (especially in the presence of nasal mucosa inflammation and nasal polyps), chronic urticaria, or if you are intolerant to dyes and/or preservatives or to alcohol, as the risk of possible severe allergic reactions is higher.
• If you have low blood pressure, or have hypovolemia (decrease in circulating blood volume or any other body fluid), dehydration, or unstable circulation, as the risk of a sudden drop in blood pressure is higher.
• If a skin rash appears that progresses to the formation of blisters or lesions in the mucous membranes, discontinue treatment and seek medical attention, as this may be due to the appearance of severe skin disorders (Stevens-Johnson syndrome or toxic epidermal necrolysis). In these cases, you should not receive metamizol-containing medications again (see section 4).
• If you have decreased liver or kidney function, as you may eliminate the medication with greater difficulty.
• If you are an elderly patient, be especially attentive to the appearance of any of the disorders described above, as they may appear more frequently.

Liver problems

Inflammation of the liver has been reported in patients taking metamizol with symptoms that develop within a few days to several months after starting treatment.

Stop using Metamizol Tarbis and contact a doctor if you experience symptoms of liver problems, such as nausea, vomiting, fever, fatigue, loss of appetite, dark urine, light-colored stools, yellowing of the skin or white part of the eyes, itching, rash, or upper abdominal pain. Your doctor will check your liver function.

You should not take Metamizol Tarbis if you have previously taken a medication containing metamizol and had liver problems.

Severe skin reactions

Severe skin reactions, such as Stevens-Johnson syndrome, toxic epidermal necrolysis, and drug reaction with eosinophilia and systemic symptoms (DRESS), have been reported in association with metamizol treatment. Stop taking metamizol and seek medical attention immediately if you observe any of the symptoms related to these severe skin reactions described in section 4.

If you have ever had severe skin reactions, you should not restart treatment with Metamizol Tarbis at any time (see section 4).

Taking Metamizol Tarbis with food, drinks, and alcohol

With alcohol, the effects of both the medication and the alcohol may be potentiated.

Pregnancy, breastfeeding, and fertility

If you are pregnant or breastfeeding, think you may be pregnant, or plan to become pregnant, consult your doctor or pharmacist before using this medication.

Pregnancy

The available data on the use of metamizol during the first three months of pregnancy are limited, but do not indicate harmful effects on the embryo. In selected cases where there are no other treatment options, single doses of metamizol during the first and second trimesters may be acceptable after consulting with your doctor or pharmacist and then evaluating the benefits and risks of using metamizol. However, in general, the use of metamizol during the first and second trimesters is not recommended.

During the last three months of pregnancy, you should not take Metamizol Tarbis due to the increased risk of complications for the mother and baby (bleeding, premature closure of a major blood vessel for the fetus, called the ductus arteriosus, which closes naturally after birth).

Breastfeeding

Metamizol degradation products are excreted in breast milk in significant amounts, and it cannot be ruled out that there is a risk to the infant. Therefore, repeated use of metamizol during breastfeeding should be avoided. If a single dose of metamizol is administered, mothers are recommended to express and discard breast milk for 48 hours after administration.

Driving and using machines

Although no adverse effects on concentration and reaction capacity are expected, at higher doses within the recommended range, you should be aware that these capacities may be affected and you should avoid using machines, driving vehicles, or other hazardous activities.

Taking Metamizol Tarbis with other medications

Inform your doctor or pharmacist if you are using or have used recently or may need to use any other medication.

If administered concurrentlywith cyclosporine (medication that prevents transplant rejection), it may reduce cyclosporine levels in the blood and therefore these should be measured regularly.

If administered with chlorpromazine (medication for the treatment of psychoses), it may cause a decrease in body temperature.

If administered concurrently with methotrexate or other medications for the treatment of tumors (antineoplastic), it may potentiate the toxic effects in the blood of antineoplastic medications, especially in elderly patients.

If administered concurrently with acetylsalicylic acid, it may reduce the effect of acetylsalicylic acid to decrease platelet aggregation (antiplaquetary) and therefore it should be used with caution in patients taking it for heart protection (cardioprotector).

If administered concurrently with bupropion,medication used for the treatment of depression and/or to help quit smoking, it may reduce bupropion levels in the blood, so it should be used with caution.

Inform your doctor or pharmacist if you are using or have used recently or may need to use any other medication such as:

• efavirenz, medication used for the treatment of HIV/AIDS.
• methadone, medication used to treat opioid dependence.
• valproate, medication used to treat epilepsy or bipolar disorder.
• tacrolimus, medication used to prevent organ rejection in transplant patients.
• sertraline, medication used to treat depression.

Metamizol may modify the effect of antihypertensive medications (medications that reduce blood pressure) and diuretics (medications that increase the elimination of fluids).

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

This medication is for short-term use. Your doctor will indicate the duration of treatment.

This medication should be taken orally. Capsules should be swallowed whole, without chewing, with a little liquid.

The dose is established based on the intensity of pain or fever and individual sensitivity to Metamizol Tarbis treatment. Always select the lowest necessary dose to control pain and fever. Your doctor will indicate how to take Metamizol Tarbis.

Adults and adolescents over 15 years old:

Adults and adolescents 15 years of age or older (who weigh more than 53 kg) can take 1 capsule (575 mg of metamizol) in a single dose, which can be administered up to 6 times a day, in intervals of 4 to 6 hours. The maximum daily dose is 3450 mg (corresponding to 6 capsules).

The effect of the medication usually appears between 30 and 60 minutes after oral administration.

Children and adolescents under 15 years of age

Metamizol Tarbis should not be used in children under 15 years of age. For smaller children, other presentations and doses of this medication are available; consult your doctor or pharmacist.

Older patients and patients with poor general health or renal insufficiency

The dose should be reduced in elderly patients, in debilitated patients, and in those with decreased renal function, as the elimination of metamizol degradation products may be delayed.

Patients with renal or hepatic insufficiency

Since in cases of renal or hepatic insufficiency the elimination rate decreases, repeated high doses should be avoided. Only in short-term treatments, a dose reduction is not necessary. No experience is available with prolonged treatments.

If pain persists or worsens, consult a doctor to investigate the cause of symptoms.

If you take more Metamizol Tarbis than you should

Nausea, vomiting, abdominal pain, kidney function deterioration, and in rare cases, dizziness, somnolence, coma, seizures, decreased blood pressure, shock, or increased heart rate (tachycardia) may appear.

After administration of very high doses of metamizol, a reddish discoloration of the urine may occur, which disappears upon discontinuation of treatment.

In case of overdose or accidental ingestion, consult your doctor or pharmacist or call the Toxicological Information Service (Telephone 91 562 04 20), indicating the medication and the amount taken.

Information for the doctor:

No specific antidote is known. After oral overdose, gastric lavage and forced vomiting may be performed. Forced diuresis or dialysis may be considered, as metamizol is dialyzable.

In case of severe allergic reactions, additional emergency measures should be applied, such as placing the patient on their side, maintaining airways free of obstruction, or administering oxygen. Pharmacological emergency measures include administering adrenaline, fluid therapy, and glucocorticoids.

Careful monitoring of vital functions, as well as taking general necessary measures, is recommended.

If you forgot to take Metamizol Tarbis

Do not take a double dose to compensate for the missed doses.

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.

Mild allergic reactions (e.g. skin and mucous membrane reactions such as itching, burning, redness, swelling), as well as difficulty breathing and gastrointestinal discomfort can progress to more severe forms, e.g. generalized urticaria, swelling of the feet, hands, lips, throat, and respiratory tract (angioedema), severe bronchospasm (narrowing of the bronchial walls), heart rhythm disturbances, and decreased blood pressure (sometimes preceded by an increase in blood pressure).

In patients with analgesic-induced asthma, these intolerance reactions typically manifest as asthma attacks.

Infrequently (may affect up to 1 in 100 patients), drug eruptions have been described, in rare cases (may affect up to 1 in 1,000 patients), skin reactions in the form of slightly elevated patches (maculopapular), and very rarely (may affect up to 1 in 10,000 patients), cases of skin reactions with the appearance of vesicles or blisters (Stevens-Johnson syndrome or Lyell syndrome) have occurred. Infrequently (may affect up to 1 in 100 patients), hypotension reactions may occur.

Stop using Metamizol Tarbis and contact a doctor immediately if you experience any of the following symptoms:

Sensation of illness (nausea or vomiting), fever, feeling of fatigue, loss of appetite, dark urine, light-colored stools, yellow discoloration of the skin or white part of the eyes, itching, rash, or pain in the upper stomach area. These symptoms may be signs of liver damage. See also section 2 Warnings and precautions.

Other side effects that may occur with the following frequencies are:

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

- hypotension (decreased blood pressure).

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

- skin eruptions and reactions.

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

- allergic reactions that usually occur during or shortly after administration, but also hours later.

- skin eruptions and appearance of papules.

- decrease in the number of white blood cells in the blood (leucopenia)

- asthma.

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

- skin reactions with the appearance of vesicles or blisters (toxic epidermal necrolysis, Stevens-Johnson syndrome),

- kidney problems with decreased or suppressed urine elimination

- increased amount of proteins excreted in the urine

- interstitial nephritis (inflammation of the kidneys)

- severe decrease in white blood cells (agranulocytosis) that may cause death due to severe infections

- decrease in the number of platelets in the blood (thrombocytopenia), in this case, inflammatory lesions in mucous membranes, throat pain, and fever may occur.

- shock (drastic drop in blood pressure).

Frequency unknown (cannot be estimated from available data):

- sepsis (severe infection that involves a systemic inflammatory reaction and may cause death),

- aplastic anemia (failure in the production of bone marrow and blood cells),

- pancitopenia (low number of red and white blood cells and platelets simultaneously),

- anaphylactic shock (severe allergic reaction that may cause death)

- Kounis syndrome (a type of cardiac disorder),

- gastrointestinal hemorrhages

- chromaturia (abnormal coloration of the urine).

- liver inflammation, yellow discoloration of the skin and white part of the eyes, increased level of liver enzymes in the blood.

- severe skin reactions.

Stop taking metamizol and seek medical attention immediately if you observe any of the following severe side effects:

- Flat, red patches, or circular or target-shaped patches on the chest, often with central blisters, skin peeling, ulcers in the mouth, throat, nose, genitals, and eyes. These severe skin reactions may be preceded by fever and flu-like symptoms (Stevens-Johnson syndrome, toxic epidermal necrolysis).

- Generalized erythema, elevated body temperature, and enlarged lymph nodes (DRESS syndrome or drug hypersensitivity syndrome).

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 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 out of the sight and reach of children.

No special storage conditions are required.

Do not use Metamizol Tarbis after the expiration date that appears on the packaging after CAD. The expiration date is the last day of the month indicated.

Medicines should not be disposed of through drains or in the trash. Dispose of packaging and unused medicines at the SIGRE collection point of the pharmacy. If in doubt, ask your pharmacist how to dispose of unused packaging and medicines. By doing so, you will help protect the environment.

Composition of Metamizol Tarbis

• The active ingredient is metamizol. Each capsule contains 575 mg of metamizol.
• The other components are: magnesium stearate.

The capsule components are: red iron oxide (E172), erythrosine (E127), titanium dioxide (E171), gelatin.

Appearance of the product and content of the packaging

Metamizol Tarbis 575 mg are red capsules with the body and cap, marked with “M” on the cap and “575” marked in white ink on the body.

They are presented in packaging with 10 and 20 capsules.

Holder of the marketing authorization and responsible for manufacturing

Holder of the marketing authorization

TARBIS FARMA, S.L.

Gran Via Carlos III, 94

08028 Barcelona. (Spain)

Responsible for manufacturing

TEVA PHARMA, S.L.U.

Polígono Malpica c/ C 4,

50016 Zaragoza. (Spain)

Last review date of this leaflet:November 2024

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