Patient leaflet - Atomoxetine Glenmark 100 mg hard capsules

1. What Atomoxetine Glenmark is and what it is used for

What Atomoxetine Glenmark is used for

Atomoxetine Glenmark contains atomoxetine and is used to treat attention-deficit and hyperactivity disorder (ADHD). It is used

in children over six years of age
in young people
in adults

It is used only as a part of the total treatment of the disease which also requires treatments which do not involve medicines, such as counselling and behavioural therapy.

It is not for use as a treatment for ADHD in children under 6 years of age as it is not known if the drug works or is safe in these people.

In adults, Atomoxetine Glenmark is used to treat ADHD when the symptoms are very troublesome and affect your work or social life and when you have had symptoms of the disease as a child.

How Atomoxetine Glenmark works

Atomoxetine Glenmark increases the amount of noradrenaline in the brain. This is a chemical that is produced naturally, and increases attention and decreases impulsiveness and hyperactivity in patients with ADHD. This medicine has been prescribed to help control the symptoms of ADHD.

This medicine is not a stimulant and is therefore not addictive.

It may take a few weeks after you start the medicine for your symptoms to fully improve.

About ADHD

Children and young people with ADHD find it:

hard to sit still and
hard to concentrate.

It is not their fault that they cannot do these things. Many children and young people struggle to do these things. However, with ADHD this can cause problems with everyday life. Children and young people with ADHD may have difficulty learning and doing homework. They find it hard to behave well at home, at school or in other places. ADHD does not affect the intelligence of a child or young person. Adults with ADHD find it difficult to do all the things that children find difficult; however, this may mean they have problems with:

work
relationships
low self esteem
education

2. What you need to know before you take Atomoxetine Glenmark

Do NOT take Atomoxetine Glenmark if you:

are allergic to atomoxetine or any of the other
ingredients of this medicine (listed in section 6).
took a medicine known as a monoamine oxidase
inhibitor (MAOI), for example phenelzine, in the last two weeks. An MAOI is sometimes used for depression and other mental-health problems; taking Atomoxetine Glenmark with an MAOI could cause serious side effects or be life-threatening. You also need to wait at least 14 days after you stop taking Atomoxetine Glenmark before you take an MAOI
have an eye disease called narrow-angle glaucoma
(increased pressure in your eye)
have serious problems with your heart which
may be affected by an increase in heart rate and/ or blood pressure, as this may be an effect of Atomoxetine Glenmark
have serious problems with the blood vessels
in your brain - such as a stroke, swelling and weakening of part of a blood vessel (aneurysm) or narrow or blocked blood vessels
have a tumour of your adrenal gland
(phaeochromocytoma)

Do not take Atomoxetine Glenmark if any of the above applies to you. If you are not sure, talk to your doctor or pharmacist before you take Atomoxetine Glenmark. This is because Atomoxetine Glenmark can make these problems worse.

Warnings and precautions

Serotonin syndrome

Serotonin syndrome is a potentially life-threatening condition which may occur when taking Atomoxetine Glenmark in combination with some other medicines (see section 2 “Other medicines and Atomoxetine Glenmark”). Signs and symptoms of serotonin syndrome may include a combination of the following: confusion, restlessness, incoordination and rigidity, hallucinations, coma, fast heart beat, increased body temperature, fast changes in blood pressure, sweating, flushing, tremor, overactive reflexes, nausea, vomiting and diarrhoea. Contact a doctor or go to your nearest emergency department immediately if you think serotonin syndrome is happening to you.

Both adult and children should be aware of the following warnings and precautions. Talk to your doctor or pharmacist before taking Atomoxetine Glenmark if you have:

thoughts about killing yourself or trying to kill
yourself.
problems with your heart (including heart defects)
or an increased heartbeat. Atomoxetine Glenmark can increase your heart rate (pulse). Sudden death has been reported in patients with heart defects.
high blood pressure. Atomoxetine Glenmark can
increase blood pressure.
low blood pressure. Atomoxetine Glenmark can
cause dizziness or fainting in people with low blood pressure.
problems with sudden changes in your blood
pressure or your heart rate.
cardiovascular disease or past medical history of
stroke.
liver problems. You may need a lower dose.
psychotic symptoms including hallucinations
(hearing voices or seeing things which are not there), believing things that are not true or being suspicious.
mania (feeling elated or over-excited, which
causes unusual behaviour) and agitation.
aggressive feelings.
unfriendly and angry (hostility) feelings.
a history of epilepsy or have had seizures for any
other reason. Atomoxetine Glenmark might lead to an increase in seizure frequency.
different moods than usual (mood swings) or feel
very unhappy.
hard-to-control, repeated twitching of any parts of
the body or you repeat sounds and words. Treatment with Atomoxetine Glenmark may make you feel aggressive, hostile or violent; or aggravate these symptoms if they were present before treatment. It may also cause you to have unusual changes in behaviour or mood (including physical assault, threatening behaviour and thoughts of harming others). If you or your family and/or friends notice any of these reactions, talk to your doctor or pharmacist right away.

Tell your doctor or pharmacist if any of the above applies to you before starting treatment. This is because Atomoxetine Glenmark can make these problems worse. Your doctor will want to monitor how the medicine affects you.

Checks that your doctor will make before you start to take Atomoxetine Glenmark

These checks are to decide if Atomoxetine Glenmark is the correct medicine for you.

Your doctor will measure your

blood pressure and your heart rate (pulse) before
and during the time you take Atomoxetine Glenmark
your height and weight if you are a child or
teenager during the time you take Atomoxetine Glenmark

Your doctor will talk to you about:

any other medicines you are taking
whether there is any family history of sudden
unexplained death
- any other medical problems (such as heart problems) you or your family may have It is important that you provide as much information as you can. This will help your doctor decide if Atomoxetine Glenmark is the correct medicine for you. Your doctor may decide that other medical tests are needed before you start taking this medicine. Other medicines and Atomoxetine Glenmark

Atomoxetine Glenmark may affect or be affected by other medicines. These include:

Some anti-depressants, opioids as tramadol and medicines used to treat migraine called triptans. These medicines may interact with Atomoxetine Glenmark and can lead to serotonin syndrome, a potentially life-threatening condition. (See section 2, Warnings and Precautions, Serotonin Syndrome).

Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines. This includes non-prescription medicines. Your doctor will decide if you can take Atomoxetine Glenmark with your other medicines and in some cases your doctor may need to adjust your dose or increase your dose much more slowly.

Do not take Atomoxetine Glenmark with medicines called MAOIs (monoamine oxidase inhibitors) used for depression. See section 2 “Do not take Atomoxetine Glenmark”.

If you are taking other medicines, Atomoxetine Glenmark may affect how well they work or may cause side effects. If you are taking any of the following medicines, check with your doctor or pharmacist before taking Atomoxetine Glenmark:

medicines that increase blood pressure or are used to control blood pressure
medicines such as antidepressants, for example imipramine, venlafaxine, mirtazapine, fluoxetine and paroxetine
some cough and cold remedies which contain medicines that can affect blood pressure. It is important to check with your pharmacist when you get any of these products
some medicines used to treat mental health conditions
medicines that are known to increase the risk of seizures
some medicines that cause Atomoxetine Glenmark to stay in the body for longer than normal (such as quinidine and terbinafine)
salbutamol (a medicine to treat asthma) when taken by mouth or injected may make you feel as if your heart is racing, but this will not make your asthma worse

The medicines below may lead to an increased risk of an abnormal rhythm of the heart when taken with Atomoxetine Glenmark:

medicines used to control the rhythm of the heart
medicines which change the concentration of salts in the blood
medicines for malaria prevention and treatment
some antibiotic medicines (such as erythromycin and moxifloxacin)

If you are not sure about whether any medicines you are taking are included in the list above, ask your doctor or pharmacist before taking Atomoxetine Glenmark.

Pregnancy and breast-feeding

It is not known if this medicine can affect an unborn baby or pass into breast milk.

This medicine should not be used during pregnancy, unless your doctor has advised you to do so.
You should either avoid taking this medicine if you are breastfeeding or discontinue breastfeeding. If you are pregnant or breast-feeding, think you may be pregnant, are planning to have a baby or planning to breast-feeding your baby, ask your doctor or pharmacist for advice before taking this medicine. Driving and using machines

You may feel tired, sleepy or dizzy after taking Atomoxetine Glenmark. You should be careful if you are driving or operating machinery until you know how Atomoxetine Glenmark affects you. If you feel tired, sleepy or dizzy you should not drive or operate machinery.

Important information about the content of the capsules

Do not open Atomoxetine Glenmark capsules because the contents of the capsule can irritate the eye. If the contents of the capsules come into contact with the eye, the affected eye should be flushed immediately with water, and medical advice obtained. Hands and any other part of the body that may have come into contact with the capsule contents should also be washed as soon as possible.

3. How to take Atomoxetine Glenmark

Always take this medicine exactly as your doctor or pharmacist has told you. Check with your doctor or pharmacist if you are not sure. This is usually one or two times a day (morning and late afternoon or early evening)
Children should not take this medicine without the help from an adult.
If you are taking Atomoxetine Glenmark once a day and experience sleepiness or feel sick, your doctor may change your treatment schedule to twice a day
The capsules should be swallowed whole, either with or without food
The capsules should not be opened and the contents inside the capsules should not be removed and taken in any other way
Taking the medicine at the same time each day may help you remember to take it

How much to take

If you are a child or teenager (6 years or older):

Your doctor will tell you how much Atomoxetine Glenmark you should take and will calculate this according to your weight. He/she will normally start you on a lower dose before increasing the amount of Atomoxetine Glenmark you need to take according to your body weight.

Body weight up to 70 kg: a starting total daily dose of 0.5 mg per kg of body weight for a minimum of 7 days. Your doctor may then decide to increase this to the usual maintenance dose of about 1.2 mg per kg of body weight daily.
Body weight over 70 kg: a starting total daily dose of 40 mg for a minimum of 7 days. Your doctor may then decide to increase this to the usual maintenance dose of 80 mg daily. The maximum daily dose your doctor will prescribe is 100 mg. Adults
Atomoxetine Glenmark should be started at a total daily dose of 40 mg for a minimum of 7 days. Your doctor may then decide to increase this to the usual maintenance dose of 80 mg-100 mg daily. The maximum daily dose your doctor will prescribe is 100 mg.

If you have problems with your liver your doctor may prescribe a lower dose.

If you take more Atomoxetine Glenmark than you should contact your doctor or the nearest hospital casualty department immediately and tell them how many capsules you have taken. The most commonly reported symptoms accompanying overdoses are gastrointestinal symptoms, sleepiness, dizziness, tremor, and abnormal behaviour. Very rarely, serotonin syndrome has also been reported, a potentially life-threatening condition. (See section 2, Warnings and precautions, Serotonin Syndrome). If you forget to take Atomoxetine Glenmark

If you miss a dose, you should take it as soon as possible, but you should not take more than your total daily dose in any 24-hour period. Do not take a double dose to make up for a forgotten dose.

If you stop taking Atomoxetine Glenmark

If you stop taking Atomoxetine Glenmark there are usually no side effects but your ADHD symptoms may return. You should talk to your doctor first before you stop treatment.

Things your doctor will do when you are on treatment

Your doctor will do some tests

before you start - to make sure that Atomoxetine
Glenmark is safe and will be of benefit.
after you start - they will be done at least every 6 months, but possibly more often.

They will also be done when the dose is changed. These tests will include:

measuring height and weight in children and young people
measuring blood pressure and heart rate
checking whether you have any problems or if side effects have got worse while taking Atomoxetine Glenmark

Long-term treatment

Atomoxetine Glenmark does not need to be taken for ever. If you take Atomoxetine Glenmark for more than a year, your doctor will review your treatment, to see if the medicine is still needed.

Package leaflet: Information for the user Atomoxetine Glenmark 10 mg hard capsules Atomoxetine Glenmark 18 mg hard capsules Atomoxetine Glenmark 25 mg hard capsules Atomoxetine Glenmark 40 mg hard capsules Atomoxetine Glenmark 60 mg hard capsules Atomoxetine Glenmark 80 mg hard capsules Atomoxetine Glenmark 100 mg hard capsules

Atomoxetine

If you have any further questions on the use of this medicine, ask your doctor or pharmacist.

4. Possible side effects

Like all medicines, this medicine can cause side effects, although not everybody gets them. Although some people get side effects most people find that Atomoxetine Glenmark helps them. Your doctor will talk to you about these side effects.

Some side effects could be serious. If you have any of the side effects below, see a doctor straight away.

Uncommon (may affect up to 1 in 100 people)

feeling or having a very fast heartbeat, abnormal
rhythms of the heart
thinking about or feeling like killing yourself
feeling aggressive
feeling unfriendly and angry (hostility)
mood swings or mood changes
serious allergic reaction with symptoms of
- swelling of the face and throat
- difficulty breathing
- hives (small raised, itchy patches of skin)
seizures
psychotic symptoms including hallucinations
(hearing voices or seeing things which are not there), believing things that are not true or being suspicious

Children and young people aged under 18 have an increased risk of side effects such as:

thinking about or feeling like killing yourself
(uncommon - may affect up to 1 in 100 people)
mood swings or mood changes (common -may
affect up to 1 in 10 people)

Adults have a reduced risk (rare - may affect up to 1 in 1,000 people) of side effects such as:

seizures
psychotic symptoms including hallucinations
(hearing voices or seeing things which are not there), believing things that are not true or being suspicious

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

liver injury

You should stop taking Atomoxetine Glenmark and call your doctor immediately if you have any of the following:

dark urine
yellow skin or yellow eyes
tummy pain which is sore when you press it
(tenderness) on the right side just below your ribs
a feeling of sickness (nausea) that is unexplained
tiredness
itching
feeling that you are coming down with flu Other side effects reported include the following. If they get serious, tell your doctor or pharmacist.
Very common side effects (may affect more than 1 in 10 people) CHILDREN and
YOUNG PEOPLE over
6 years
ADULTS
- headache
- pain in the stomach
- decreased appetite (not
  feeling hungry)
- feeling or being sick
- sleepiness
- increased blood
  pressure
- increased heart rate
  (pulse)

These effects may

disappear after a while in

most patients.

feeling sick
dry mouth
headache
decreased appetite (not
feeling hungry)
problems getting to
sleep, staying asleep and waking early
increased blood
pressure
increased heart rate
(pulse)

Common side effects

(may affect up to 1 in 10 people) CHILDREN and

YOUNG PEOPLE over

6 years

ADULTS

being irritable or
agitated
problems sleeping
including waking early
depression
feeling sad or hopeless
feeling anxious
tics
large pupils (the dark
centre of the eye)
dizziness
constipation
loss of appetite
upset stomach,
indigestion
swollen, reddened and
itchy skin
rash
feeling lazy (lethargy)
chest pain
tiredness
weight loss
- feeling agitated
- decreased interest in
  sex
- sleep disturbance
- depression
- feeling sad or hopeless
- feeling anxious
- dizziness
- an abnormal taste or
  change in taste that will not go away
- tremor
- tingling or numbness
  in the hands or feet
- sleepiness, drowsy,
  feeling tired
- constipation
- stomach ache
- indigestion
- wind (flatulence)
- being sick
- hot flush or flushing
- feeling or having a
  very fast heartbeat
- swollen, reddened and
  itchy skin
- increased sweating
- rash
- problems going to
  the toilet such as not be able to urinate, frequent or hesitant urinating, pain on urinating
- inflammation of
  the prostate gland (prostatitis)
- groin pain in men
- failure to obtain an
  erection
- retarded orgasm
- difficulty maintaining
  an erection
- menstrual cramps
- lack of strength or
  energy
- tiredness
- feeling lazy (lethargy)
- chills
- feeling, irritable,
  jittery
- feeling thirsty
- weight loss

Uncommon side effects (may affect up to 1 in 100 people) CHILDREN and

YOUNG PEOPLE over

6 years

ADULTS

fainting
tremor
migraine
blurred vision
abnormal skin
sensation, such as
burning, prickling,
itching, or tingling
tingling or numbness
in the hands or feet
seizure (fits)
feeling or having a
very fast heartbeat (QT
prolongation)
shortness of breath
increased sweating
itchy skin
lack of strength or
energy
- restlessness
- tics
- fainting
- migraine
- blurred vision
- heart rhythm abnormal
  (QT prolongation)
- feeling cold in fingers
  and toes
- chest pain
- shortness of breath
- raised red itchy rashes
  (hives)
- muscle spasms
- an urge to urinate
- abnormal or absence
  of orgasm
- irregular menstruation
- ejaculation failure

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

CHILDREN and

YOUNG PEOPLE over

6 years

ADULTS

poor blood circulation
which makes toes and
fingers numb and pale
(Raynaud’s disease)
problems going to the
toilet such as frequent
or
hesitant urinating, pain
on urinating
prolonged and painful
erections
groin pain in males.
- poor blood circulation
  which makes toes and fingers numb and pale (Raynaud’s disease)
- prolonged and painful
  erections

Not known

(cannot be estimated from the available data)

paediatric patients only

Involuntary teeth grinding (bruxism).

Effects on growth

Some children experience reduced growth (weight and height) when they start taking Atomoxetine Glenmark. However, with long-term treatment, children recover to the weight and height for their age range.

Your doctor will watch your child’s height and weight over time. If your child is not growing or gaining weight as expected, your doctor may change your child’s dose or decide to stop Atomoxetine Glenmark temporarily.

Reporting of side effects

If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via the Yellow Card Scheme Website: www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store. By reporting side effects you can help provide more information on the safety of this medicine.

5. How to store Atomoxetine Glenmark

Keep this medicine out of the sight and reach of children.

Do not use this medicine after the expiry date stated on the carton and blister after ‘Exp’. The expiry date refers to the last day of that month.

This medicine does not require any special storage conditions.

Do not throw away any medicines via wastewater <or household waste>. Ask your pharmacist how to throw away medicines you no longer use. These measures will help to protect the environment.

6. Contents of the pack and other information

What Atomoxetine Glenmark contains

The active substance is Atomoxetine.

Atomoxetine Glenmark 10 mg hard capsules Each hard capsule contains 10 mg atomoxetine as 11.43 mg atomoxetine hydrochloride.

The other ingredients are

Capsule content: Pregelatinized maize starch, silica colloidal anhydrous and dimeticone.

Capsule shell: Gelatin, Sodium Lauryl Sulfate , Titanium dioxide (E171)

Atomoxetine Glenmark 18 mg hard capsules Each hard capsule contains 18 mg atomoxetine as 20.57 mg atomoxetine hydrochloride.

The other ingredients are