Package Leaflet: Information for the PatientPatient

Quetiapine Teva-ratio 200 mg Film-Coated Tablets

quetiapine

Read this leaflet carefully before you start taking this medicine,because it contains important information for you.

• Keep this leaflet, as you may need to read it again.
• If you have any questions, ask your doctor or pharmacist.
• This medicine has been prescribed for you. Do not pass it on to others even if their symptoms are the same as yours. It may harm them.
• If you experience any side effects, talk to your doctor or pharmacist. This includes very rare side effects. See section 4.

1. What Quetiapine Teva-ratio is and what it is used for

2. What you need to know before taking Quetiapine Teva-ratio

3. How to take Quetiapine Teva-ratio

4. Possible side effects

5. Storage of Quetiapine Teva-ratio

6. Contents of the pack and additional information

Quetiapina Teva-ratiocontains a substance called quetiapine. It belongs to a group of medicines called antipsychotics.Quetiapina Teva-ratiocan be used to treat various illnesses, such as:

• Bipolar depression: by which you feel sad. You may find that you feel depressed, guilty, lacking in energy, lose your appetite or cannot sleep.
• Mania: by which you may feel very excited, euphoric, agitated, enthusiastic or hyperactive or present poor judgment which includes being aggressive or violent.
• Schizophrenia: by which you may hear or feel things that are not there, believe things that are not true or feel abnormally suspicious, anxious, confused, guilty, tense or depressed.

Your doctor may continue prescribingQuetiapina Teva-ratioeven when you are feeling better.

Do not takeQuetiapina Teva-ratio:

• if you are allergic (hypersensitive) to quetiapine or to any of the other ingredients ofQuetiapina Teva-ratiofilm-coated tablets(listed in section 6).

• if you are taking any of the following medicines:
• • Some medicines for HIV
  • Azole-type medicines (for fungal infections)
  • Erythromycin or clarithromycin (for infections)
  • Nefazodone (for depression).

If you are unsure, consult your doctor or pharmacist before takingQuetiapina Teva-ratio.

Warnings and precautions

Consult your doctor or pharmacist before starting to takeQuetiapina Teva-ratio:

• if you, or a family member, have or have had any heart problems, for example, irregular heart rhythm, heart muscle weakness or heart inflammation, or if you are taking any medicine that may affect your heart rhythm.
• if you have low blood pressure.
• if you have had a stroke, especially if you are elderly.
• if you have liver problems.
• if you have ever had a seizure (convulsion).
• if you are depressed or have other conditions that are treated with antidepressants. The use of these medicines with quetiapine may cause serotonin syndrome, a potentially life-threatening condition (see “Use of Quetiapina Teva-ratio with other medicines”).
• if you have diabetes or are at risk of developing diabetes. Your doctor may monitor your blood sugar levels while you are taking quetiapine.
• if you know that you have had low white blood cell counts (which may or may not have been caused by other medicines).
• if you are an elderly person with dementia (loss of brain function). If this is the case, do not takequetiapinebecause the group of medicines to whichQuetiapina Teva-ratiobelongs may increase the risk of stroke or, in some cases, death, in these people.
• if you are an elderly person with Parkinson’s disease/parkinsonism.
• if you or a family member has a history of blood clots, as medicines like these have been associated with the formation of blood clots.
• if you have or have had a condition in which your breathing is interrupted by short periods of time during normal sleep at night (called “sleep apnoea”) and are taking medicines that decrease the normal activity of the brain (“depressants”).
• if you have or have had a condition in which you cannot completely empty your bladder (urinary retention), have an enlarged prostate, a bowel obstruction or high pressure inside your eye. These conditions may be caused by medicines (called “anticholinergics”) that affect the way nerve cells work, to treat certain medical conditions.
• if you have a history of alcohol or drug abuse.

Inform your doctor immediately if after taking Quetiapina Teva-ratioyou experience any of the following:

• A combination of fever, intense muscle stiffness, sweating or a decrease in level of consciousness (a condition called “neuroleptic malignant syndrome”). You may need immediate medical treatment.
• Fast or irregular heartbeats, even when at rest, palpitations, breathing problems, chest pain or unexplained fatigue. Your doctor should examine your heart and, if necessary, refer you to a cardiologist immediately.
• Uncontrolled movements, mainly of your face or tongue.
• Dizziness or feeling very drowsy. This may increase the risk of accidental injuries (falls) in elderly patients.
• Seizures (convulsions).
• A prolonged and painful erection (priapism).

These conditions may be caused by this type of medicine.

Inform your doctor as soon as possible if you have:

• Fever, symptoms similar to flu, sore throat, or any other infection, as it could be a consequence of a very low white blood cell count and require discontinuation of treatment with Quetiapina Teva-ratio and/or additional treatment.
• Constipation with persistent abdominal pain, or constipation that has not responded to treatment, as it may lead to a more severe bowel obstruction.

• Thoughts of suicide and worsening of depression

If you are depressed, you may sometimes think about harming yourself or committing suicide. This may increase at the beginning of treatment, as all these medicines take time to have an effect, usually around two weeks but sometimes longer. These thoughts may also increase if you stop taking your medication abruptly. You may be more likely to think this way if you are a young adult. Information from clinical trials has shown an increased risk of thoughts of suicide and/or suicidal behaviour in young adults under 25 years with depression.

If at any time you think about harming yourself or committing suicide, contact your doctor or go to a hospital immediately. It may help to tell a close family member or friend that you are depressed, and ask them to read this leaflet. You may ask them to tell you if they think your depression is getting worse, or if they are concerned about changes in your behaviour.

Severe cutaneous adverse reactions (SCARs)

Very rarely, severe cutaneous adverse reactions (SCARs) have been reported with the use of this medicine, which may put your life at risk or be fatal. These are commonly manifested as:

• Stevens-Johnson syndrome (SSJ), a generalised rash with blisters andpeeling of the skin,particularly around the mouth, nose, eyes andgenitals
• Toxic epidermal necrolysis (NET), a more severe form that causes extensive peeling of theskin
• Drug reaction with eosinophilia and systemic symptoms (DRESS), which consists of flu-like symptoms with rash, fever,swollen lymph nodes and abnormal blood test results (includingincreased white blood cell count (eosinophilia) and elevated liver enzymes)
• Generalised Acute Exanthematous Pustulosis (AGEP), small pus-filled blisters
• Erythema multiforme (EM), skin rashes with irregular red patches thatitch

If you develop these symptoms, stop using Quetiapina Teva-ratioand contact your doctor or seek medical attention immediately.

Weight gain

Weight gain has been observed in patients taking Quetiapina Teva-ratio. You and your doctor should regularly monitor your weight.

Children and adolescents

Quetiapina Teva-ratioshould not be used in children and adolescents under 18 years of age.

Use ofQuetiapina Teva-ratiowith other medicines

Inform your doctor if you are taking, have recently taken or may need to take any other medicine.

Do not takeQuetiapina Teva-ratioif you are using any of the following medicines:

• Some medicines for HIV
• Azole-type medicines (for fungal infections)
• Erythromycin or clarithromycin (for infections)
• Nefazodone (for depression)

Inform your doctor if you are using any of the following medicines:

• Medicines for epilepsy (such as phenytoin or carbamazepine)
• Medicines for high blood pressure
• Barbiturates (for difficulty sleeping)
• Thioridazine or Lithium (other antipsychotic medicines)
• Antidepressants. These medicines may interact with Quetiapina Teva-ratio and you may experience symptoms such as involuntary and rhythmic muscle contractions, including those that control eye movement, agitation, hallucinations, coma, excessive sweating, tremor, exaggerated reflexes, increased muscle tension and body temperature above 38 °C (serotonin syndrome). Contact your doctor when you experience these symptoms
• Medicines that affect your heart rhythm, for example, medicines that may cause an imbalance of electrolytes (low potassium or magnesium levels) such as diuretics (medicines to urinate) or certain antibiotics (medicines to treat infections)
• Medicines that may cause constipation
• Medicines (called “anticholinergics”) that affect the way nerve cells work, to treat certain medical conditions

Before stopping any of your medicines, consult your doctor first.

TakingQuetiapina Teva-ratiowith food, drinks and alcohol

• Quetiapina Teva-ratiocan be taken with or without food
• Be careful with the amount of alcohol you drink. This is because the combined effect ofQuetiapina Teva-ratioand alcohol may make you drowsy
• Do not take grapefruit juice while takingQuetiapina Teva-ratio. It may affect the way the medicine works

Pregnancy and breastfeeding

If you are pregnant or breastfeeding, or think you may be pregnant, consult your doctor before using this medicine. Do not takeQuetiapina Teva-ratioduring pregnancy, unless you have consulted your doctor. Do not useQuetiapina Teva-ratioif you are breastfeeding.

The following symptoms, which may represent withdrawal symptoms, may appear in newborn babies of mothers who have used quetiapine in the last trimester (last three months of their pregnancy): tremor, muscle stiffness and/or weakness, drowsiness, agitation, breathing problems, and difficulty feeding. If your newborn baby develops any of these symptoms, you may need to contact your doctor.

Driving and operating machines

This medicine may make you feel drowsy. Do not drive or operate tools or machines until you know how the tablets affect you.

Quetiapina Teva-ratiocontains lactose

If your doctor has told you that you are intolerant to certain sugars, consult them before taking this medicine.

Quetiapina Teva-ratiocontains sodium

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

Effect on drug detection tests in urine

If you are undergoing a drug detection test in urine, taking Quetiapina Teva-ratiomay produce positive results for methadone or certain antidepressants called tricyclic antidepressants (TCAs) when using some analytical methods, although you may not be taking methadone or TCAs. If this occurs, a more specific test may be performed.

Follow exactly the administration instructions of this medication as indicated by your doctor. In case of doubt, consult your doctor or pharmacist again. Your doctor will decide your initial dose. The maintenance dose (daily dose) will depend on your illness and your needs, but it will normally be between 150 mg and 800 mg.

• You will take your tablets once a day, at bedtime, or twice a day, depending on your illness.
• Swallow your tablets whole with the help of water.
• You can take the tablets with or without food.
• Do not take grapefruit juice while takingQuetiapina Teva-ratio. It may affect how the medication works.
• Do not stop taking your tablets even if you feel better, unless your doctor tells you to.

Liver problems

If you have liver problems, your doctor may change your dose.

Older adults

If you are an older adult, your doctor may change your dose.

Use in children and adolescents

Quetiapina Teva-ratioshould not be used in children and adolescents under 18 years of age.

If you take moreQuetiapina Teva-ratiothan you should

If you take moreQuetiapina Teva-ratiothan your doctor prescribed, you mayfeel drowsy, feel dizzy, and experience abnormal heartbeats. Contact your doctor or the nearest hospital immediately. Bring yourQuetiapina Teva-ratiotablets with you.

You can also call the Toxicological Information Service, Phone: 915620420, indicating the medication and the amount taken.

If you forgot to takeQuetiapina Teva-ratio

If you forget to take a dose, take it as soon as you remember. If it is almost time for your next dose, wait until then. Do not take a double dose to make up for the missed tablet.

If you interrupt treatment withQuetiapina Teva-ratio

If you stop takingQuetiapina Teva-ratioabruptly, you may be unable to fall asleep (insomnia), or you may feel nausea, or you may experience headaches, diarrhea, vomiting, dizziness, or irritability. Your doctor may suggest reducing the dose gradually before interrupting treatment.

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.

Very common:may affect more than 1 in 10 people

• Decrease in hemoglobin levels (a protein in red blood cells that carries oxygen)
• Dizziness (may lead to falls), headache, dry mouth.

• Sensation of drowsiness (which may disappear over time as you continue to take Quetiapina Teva-ratio), (may lead to falls).
• Withdrawal symptoms (symptoms that occur when you stop taking Quetiapina Teva-ratio), which include insomnia, nausea, headache, diarrhea, vomiting, dizziness, and irritability. A gradual withdrawal over a period of at least 1 to 2 weeks is recommended.
• Weight gain.
• Abnormal muscle movements. These include difficulty initiating muscle movements, tremor, feeling restless or rigid without pain.
• Changes in the amount of certain fats (triglycerides and total cholesterol).

Common:may affect up to 1 in 10 people

• Fast heart rate.
• Feeling like your heart is beating strongly, rapidly, or irregularly.

• Constipation, indigestion.
• Sensation of weakness.

• Swelling of arms or legs.

• Low blood pressure when standing. This may cause dizziness or fainting (may lead to falls).

• Increased blood sugar levels.

• Blurred vision.

• Abnormal dreams and nightmares.
• Increased hunger.
• Feeling irritable.
• Speech and language disorders.
• Thoughts of suicide and worsening of depression.
• Shortness of breath.
• Vomiting (mainly in elderly people).
• Fever.
• Changes in the amount of thyroid hormones in the blood.
• Changes in the number of certain types of blood cells.
• Increases in liver enzymes measured in the blood.
• Increases in prolactin hormone levels in the blood. Elevated prolactin levels may, in rare cases, lead to:
• • Both men and women having breast swelling and unexpected milk production.
  • Women not having a menstrual period or having irregular periods.

Uncommon:may affect up to 1 in 100 people

• Seizures or convulsions.

• Allergic reactions that may include hives, skin swelling, and swelling around the mouth.

• Unpleasant sensations in the legs (also known as restless leg syndrome).
• Difficulty swallowing.

• Uncontrolled movements, mainly of the face or tongue.
• Sexual dysfunction.
• Diabetes.
• Change in heart activity seen on an ECG (prolongation of the QT interval).
• Slower than normal heart rate that may occur at the start of treatment and may be associated with low blood pressure and fainting.
• Difficulty urinating.
• Fainting (may lead to falls).
• Stuffy nose.
• Decrease in red blood cell count in the blood.
• Decrease in sodium levels in the blood.
• Worsening of pre-existing diabetes.
• Confusion.

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

• A combination of high temperature (fever), sweating, muscle stiffness, feeling very drowsy or dizzy (a condition called "neuroleptic malignant syndrome").

• Yellowing of the skin and eyes (jaundice).
• Inflammation of the liver (hepatitis).

• Prolonged and painful erection (priapism).
• Breast swelling and unexpected milk production (galactorrhea).
• Menstrual disorders.
• Clots in the veins, especially in the legs (symptoms include swelling, pain, and redness in the leg), which may travel through the blood vessels to the lungs, causing chest pain and difficulty breathing. If you notice any of these symptoms, seek medical attention immediately.
• Walking, talking, eating, or other activities while asleep.
• Decreased body temperature (hypothermia).
• Inflammation of the pancreas.
• A condition (called "metabolic syndrome") in which you may have a combination of 3 or more of the following effects: increased fat around your abdomen, decreased "good" cholesterol (HDL-C), increased levels of a type of fat in the blood called triglycerides, increased blood pressure, and increased blood sugar levels.

A combination of fever, symptoms similar to the flu, sore throat, or any other infection with a very low white blood cell count, which is a condition called neutropenia.

• Intestinal obstruction.
• Increased creatine phosphokinase levels in the blood (a substance found in muscles).

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

• Severe rash, blisters, or red spots on the skin.

• Severe allergic reaction (called anaphylaxis) that may cause difficulty breathing or shock.

• Quick swelling of the skin, usually around the eyes, lips, and throat (angioedema).
• A severe condition of blisters on the skin, mouth, eyes, and genitals (Stevens-Johnson syndrome). See section 2.
• Abnormal secretion of a hormone that controls urine volume.
• Rhabdomyolysis (muscle fiber rupture and muscle pain).

Not known: the frequency cannot be estimated from available data

• Rashes on the skin with irregular red spots (erythema multiforme). See section 2.
• Rapid appearance of areas of red skin with small white/yellow-filled blisters (Pustulosis Exantemática Generalizada Aguda (AGEP). See section 2.
• Severe allergic reaction with symptoms such as fever and blisters on the skin and skin peeling (toxic epidermal necrolysis). See section 2.

• Drug reaction with eosinophilia and systemic symptoms (DRESS), which consists of flu-like symptoms with rash, fever, swollen lymph nodes, and abnormal blood test results (including increased white blood cell count (eosinophilia) and elevated liver enzymes). See section 2.
• Withdrawal symptoms may occur in newborns of mothers who have used Quetiapina Teva-ratio during pregnancy.
• Cardiomyopathy (heart muscle disorder).
• Myocarditis (inflammation of the heart muscle).
• Vasculitis (inflammation of blood vessels), often with skin rash with small red or purple spots.
• Stroke.

The class of medicines to which Quetiapina Teva-ratio belongs may cause heart rhythm problems that can be serious and, in severe cases, fatal.

Some side effects are only seen when a blood test is done. These include changes in the amount of certain fats (triglycerides and total cholesterol) or blood sugar, changes in the amount of thyroid hormones in the blood, increased liver enzymes, decreased levels of certain types of blood cells, decreased red blood cell count, increased creatine phosphokinase levels in the blood (a substance found in muscles), decreased sodium levels in the blood, and increased prolactin hormone levels in the blood. Elevated prolactin levels may, in rare cases, lead to:

• Both men and women having breast swelling and unexpected milk production.
• Women not having a menstrual period or having irregular periods.

Your doctor may ask you to have blood tests from time to time.

Additional side effects in children and adolescents

The same side effects that may occur in adults may also occur in children and adolescents.

The following side effects have been observed more frequently in children and adolescents or have not been observed in adults:

Very common:may affect more than 1 in 10 people

• Increased levels of a hormone called prolactin in the blood. Elevated prolactin levels may, in rare cases, lead to:
• • Both boys and girls having breast swelling and unexpected milk production.
  • Girls not having a menstrual period or having irregular periods.
• Increased appetite.
• Vomiting.
• Abnormal muscle movements. These include difficulty initiating muscle movements, tremors, feeling restless or rigid without pain.
• Increased blood pressure.

Common:may affect up to 1 in 10 people

• Sensation of weakness, fainting (may lead to falls).
• Stuffy nose.
• Feeling irritable.

Reporting of 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 theSpanish System for 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 usethis medicationafter the expiration date that appears on the packaging after CAD.The expiration date is the last day of the month indicated.

This medication does not require special storage conditions.

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

Composition ofQuetiapina Teva-ratio

The active ingredient is quetiapine. The tablets contain 200 mg of quetiapine (as quetiapine fumarate).

The other components are:

Tablet core: dihydrate calcium phosphate, lactose monohydrate, povidone K-25, microcrystalline cellulose, almidon sodium glycolate Type A potato,anhydrous colloidal silica, magnesium stearate.

Tablet coating:hypromellose, titanium dioxide (E171), triacetin,polydextrose(E1200), macrogol 8000.

Appearance ofQuetiapina Teva-ratiofilm-coated tablets,and contents of the package

The tablets are white to off-white, round, biconvex, engraved with “200” on one side and smooth on the other.

They are presented in white opaque PVC/PE/Aclar-aluminum or white opaque PVC/PVdC-aluminum blisters, in packs of 1, 10, 20, 30, 50, 60, 90 and 100 (10 x 10) tablets and clinical packs of 50 film-coated tablets.

HDPE bottle with a white propylene child-resistant cap with a desiccant in packs of 100 and 250 tablets.

Only some pack sizes may be marketed.

Marketing authorization holder and responsible manufacturer

Marketing authorization holder

Teva Pharma, S.L.U.

C/ Anabel Segura, 11, Edificio Albatros B, 1st floor,

Alcobendas, 28108 - Madrid

Responsible manufacturer

TEVA UK Ltd.

Brampton Road, Hampden Park, Eastbourne, East Sussex, BN22 9AG

United Kingdom

Pharmachemie B.V.

Swensweg 5, Postbus 552, 2003 RN Haarlem

Netherlands

TEVA Pharmaceutical Works Private Limited Company

Pallagi út 13, 4042 Debrecen

Hungary

Teva Czech Industries s.r.o.

Ostravska 29, c.p. 305

747 70 Opava, Komarov

Czech Republic

Teva Operations Poland Sp. z o.o.

ul. Mogilska 80, 31-546 Kraków,

Poland

Merckle GmbH,

Ludwig-Merckle-Str 3,

89143 Blaubeuren

Germany

Last review date of this leaflet:July 2024

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/

You can access detailed and updated information on this medicine by scanning the QR code included in the carton with your smartphone. You can also access this information at the following internet address: https://cima.aemps.es/cima/dochtml/p/71131/P_71131.html

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