LEVERAXO 5 MG PROLONGED-RELEASE TABLETS - patient leaflet, side effects, dosage

Patient leaflet - LEVERAXO 5 MG PROLONGED-RELEASE TABLETS

1. what leveraxo is and what it is used for

Leveraxo is a centrally acting, strong painkiller from the group of opioids.

Leveraxo is used to treat severe pain in adults and adolescents aged 12 years and older, which can be adequately managed only with opioid analgesics.

2. what you need to know before you take leveraxo

Do not take Leveraxo:

if you are allergic to oxycodone or any of the other ingredients of this medicine (listed in section 6)
if you suffer from severely depressed breathing (respiratory depression) with too little oxygen in the blood (hypoxia) and/or too much carbon dioxide (hypercapnia) in the blood
if you suffer from severe chronic obstructive lung disease, cor pulmonale (cardiac changes due to chronic overload of lung circulation) or acute, severe bronchial asthma
if you suffer from intestinal paralysis (paralytic ileus).

Warnings and precautions

Talk to your doctor or pharmacist before taking Leveraxo if you:

are older or debilitated
have severely impaired lung, liver or kidney function

(see section 3 ‘Risk patients’)

■ suffer from myxoedema (certain illnesses of the thyroid gland), ■ or an impaired function of the thyroid gland
have poor adrenal gland function (your adrenal gland is not working properly) for example Addison’s disease
suffer from toxic psychosis (e.g. alcohol)
suffer from enlargement of the prostate (prostate hypertrophy)
suffer from alcoholism or are undergoing alcohol withdrawal with symptoms such as shaking, feeling anxious or disoriented, seeing, hearing or feeling things that are not real (hallucinations)
suffer from known opioid-dependence
suffer from inflammation of the pancreas (pancreatitis)
suffer from diseases of the biliary tract
suffer from inflammatory bowel disorders
suffer from an obstruction of the intestine
are recovering from abdominal surgery
suffer from low blood pressure
suffer from decreased blood volume (hypovolaemia)
suffer from head injury
suffer from epilepsy or have a seizure (fits) tendency
take MAO inhibitors (for the treatment of depression).

Long term treatment and abuse

Leveraxo has primary dependence potential. When used for a long time tolerance to the effects may develop and progressively higher doses may be required to maintain pain control.

Chronic use of Leveraxo may lead to physical dependence and a withdrawal syndrome may occur upon abrupt cessation of therapy. When a patient no longer requires therapy with oxycodone hydrochloride, it may be advisable to taper the dose gradually to prevent symptoms of withdrawal.

When used as directed in patients suffering from chronic pain the risk of developing physical or psychological dependence is markedly reduced and needs to be weighed against the potential benefit. Please discuss this with your doctor.

Leveraxo is for oral use only. In case of abusive injection (injection in a vein) the other tablet ingredients may lead to destruction (necrosis) of the local tissue, change of lung tissue (granulomas of the lung) or other serious, potentially lethal events.

Anti-doping warning

Athletes should be aware that this medicine may cause a positive reaction to “anti-doping tests”. Use of Leveraxo as a doping agent may become a health hazard.

Children under 12 years of age

Leveraxo should not be used in children under 12 years of age because of safety and efficacy concerns.

Elderly patients

In elderly patients without impairment of kidney and/or liver function a dose adjustment is usually not necessary.

Other medicines and Leveraxo

Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines:

medicines that dampen the activity of the central nervous system, e.g.
* sleeping pills or tranquillisers (sedatives, hypnotics)
* other medicines that act on the nervous system (phenothiazines, neuroleptics, anaesthetics, antidepressants, muscle relaxants)
* other opioids or alcohol can enhance the side effects of oxycodone, in particular depressed breathing (respiratory depression)
* concomitant use with sedative medicines such as benzodiazepines, e.g. diazepam, or related medicines increases the risk of drowsiness, difficulties in breathing (respiratory depression), coma and may be life-threatening. Because of this, concomitant use should only be considered when other treatment options are not possible
* however, if your doctor does prescribe Leveraxo together with sedative medicines the dose and duration of concomitant treatment should be limited by your doctor
* please tell your doctor about all sedative medicines you are taking, and follow your doctor’s dose recommendation closely. It could be helpful to inform friends or relatives to be aware of the signs and symptoms stated above. Contact your doctor when experiencing such symptoms.
the risk of side effects increases, if you use antidepressants (such as citalopram, duloxetine, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline, venlafaxine). These medicines may interact with oxycodone and you may experience symptoms such as involuntary, rhythmic contractions of muscles, including the muscles that control movement of the eye, agitation, excessive sweating, tremor, exaggeration of reflexes, increased muscle tension, body temperature above 38°C. Contact your doctor when experiencing such symptoms.
medicines with an anticholinergic effect, e.g.
* other medicines that act against parasympathetic and cholinergic nerve fibres on the central nervous system (psychotropic medicines)
* medicines used to treat allergies (antihistamines) or vomiting (antiemetics)
* medicines used to treat Parkinson’s disease can enhance certain side effects of oxycodone (e.g. constipation, dry mouth or urinary disturbances).
inhibitors of CYP3A4, such as macrolide antibiotics (e.g. clarithromycin, erythromycin, telithromycin), azole antifungals (e.g. ketoconazole, voriconazole, itraconazole, posaconazole), protease inhibitors (e.g. boceprevir, ritonavir, indinavir, nelfinavir, saquinavir), cimetidine and grapefruit juice may cause a reduced clearance of oxycodone that could cause an increase of the plasma concentrations of oxycodone. The influence of other medicines that can markedly affect the metabolism of oxycodone has not been investigated
strong inhibitors of CYP2D6 (such as paroxetine, quinidine) may affect the elimination of oxycodone. The influence of other isoenzyme inhibitors that can markedly affect the metabolism of oxycodone is not known
CYP3A4 inducers such as rifampicin, carbamazepine, phenytoin and St John's Wort may induce the metabolism of oxycodone and cause an increased clearance of oxycodone that could cause a reduction of the plasma concentrations of oxycodone
monoamine oxidase inhibitors (MAOIs) such as tranylcypromine, phenelzine, isocarboxazid, moclobemide and linezolid
in individuals a clinically relevant increase or decrease of blood clotting have been observed if anticoagulants of the coumarin type (medicinal products against blood clotting) are co-applied with Leveraxo.

Leveraxo with alcohol

Drinking alcohol whilst taking Leveraxo may make you feel more sleepy or increase the risk of serious side effects such as shallow breathing with a risk of stopping breathing, and loss of consciousness. It is recommended not to drink alcohol while you are taking Leveraxo.

Pregnancy and breast-feeding

If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, ask your doctor or pharmacist for advice before taking this medicine.

Pregnancy

Leveraxo should not be used in pregnancy unless clearly necessary. There are limited data regarding the use of oxycodone in pregnant women. Oxycodone crosses the placenta into the blood circulation of the baby.

Prolonged use of oxycodone during pregnancy can cause withdrawal symptoms in newborns (see section 4 ‘Possible side effects’). Use of oxycodone during delivery can cause breathing problems (respiratory depression) in the newborn.

Breast-feeding

Breast-feeding should be discontinued during treatment with Leveraxo. Oxycodone passes into breast milk and may affect your suckling child, especially following the intake of multiple doses.

Driving and using machines

Oxycodone impairs alertness and reactivity to such an extent that the ability to drive and operate machinery is affected or ceases altogether. In these circumstances Leveraxo has moderate to major influence on the ability to drive and use machines.

With stable therapy, a general ban on driving a vehicle may be not necessary. In these circumstances Leveraxo has minor influence on the ability to drive and use machines. The treating physician must assess the individual situation. Please discuss with your doctor whether or under what conditions you can drive a vehicle.

Leveraxo contains sucrose and sodium

If you have been told by your doctor that you have an intolerance to some sugars, contact your doctor before taking this medicine. This medicine also contains less than 1 mmol sodium (23 mg) per dosage unit, that is to say essentially ‘sodium-free’.

3. how to take leveraxo

Always take this medicine exactly as your doctor or pharmacist has told you. Check with your doctor or pharmacist if you are not sure. For doses not realisable/practicable with this medicine, other strengths and medicines are available.

The recommended dose is

Adults and adolescents (aged 12 years and older)

The usual initial dose is 10 mg of oxycodone hydrochloride in 12 hourly intervals. Some patients may benefit from a starting dose of 5 mg to minimise the incidence of adverse reactions.

Further determination ofthe daily dose, the division into the single doses and any dose adjustments during the further course of therapy are performed by the treating physician and depend on the previous dosage. Patients who have already taken opioids can start treatment with higher dosages taking into account their experience with opioid treatment.

Some patients who receive Leveraxo according to a fixed schedule need rapidly acting painkillers as rescue medication to control breakthrough pain. Leveraxo is not intended for the treatment of breakthrough pain.

For the treatment of non-cancer pain a daily dose of 40 mg of oxycodone hydrochloride is generally sufficient, but higher dosages may be necessary. Patients with cancer pain usually require dosages from 80 to 120 mg of oxycodone hydrochloride which may be increased up to 400 mg in individual cases.

The treatment needs to be controlled regularly with regard to pain relief and other effects in order to achieve the best pain therapy possible as well as to be able to treat any occurring side effects in good time and to decide whether treatment should be continued.

Risk patients

If you have impaired kidney and/or liver function or if you have a low body weight your doctor may prescribe a lower starting dose.

Route and method of administration

Oral use. It is not recommended to take Leveraxo with alcoholic beverages.

Swallow the prolonged-release tablets with a sufficient amount of liquid (V2 glass of water) with or without food in the morning and in the evening following a fixed schedule (e.g. at 8 a.m. and 8 p.m.).

Leveraxo 5 mg prolonged-release tablets must be swallowed whole and must not be divided, broken, chewed or crushed as this leads to rapid oxycodone release due to the damage of the prolonged-release properties. The administration of divided, broken, chewed or crushed Leveraxo leads to a rapid release and absorption of a potentially fatal dose of oxycodone (see section ‘If you take more Leveraxo than you should’).

Leveraxo 10 mg, 20 mg, 30 mg, 40 mg, 60 mg, 80 mg prolonged-release tablets can be divided into equal doses.

However, do not chew or crush the tablet as this leads to rapid oxycodone release due to the damage of the prolonged-release properties. The administration of chewed or crushed Leveraxo leads to a rapid release and absorption of a potentially fatal dose of oxycodone (see section ‘If you take more Leveraxo than you should’).

Opening instructions for the blister

This medicine is packed in a child-resistant perforated unit dose blister. You cannot press out the prolonged-release tablets through the blister. Please observe the following opening instruction for the blister:

1. Tear off a single dose along the perforation line of the blister.
2. Hereby an unsealed area is accessible which is located at the position, where the perforation lines have crossed.
3. Pull at the unsealed ‘strap’ to peel off the cover seal.

Your doctor will adjust the dosage depending on the pain intensity and how you respond to the treatment. Take the number of prolonged-release tablets determined by your doctor twice daily.

If you take more Leveraxo than you should

If you have taken more Leveraxo as prescribed you should inform your doctor or your local poison control centre immediately. The following symptoms may occur: constricted pupils (miosis), depressed breathing (respiratory depression), skeletal muscle flaccidity and drop in blood pressure. In severe cases circulatory collapse, mental and motor inactivity (torpor), unconsciousness (coma), slowing of the heart rate and accumulation of water in the lungs (non-cardiogenic lung oedema) may occur; abuse of high doses of strong opioids such as oxycodone can be fatal. In no case you should expose yourself to situations requiring elevated concentration e.g. driving a car.

If you forget to take Leveraxo

If you use a smaller dose of Leveraxo than directed or you miss the intake of Leveraxo, pain relief will consequently be insufficient or cease altogether.

You can make up for a forgotten dose if the next regular intake is not due for at least another 8 hours. You can then continue to take your recommended dose as directed.

You should also take Leveraxo if the time to the regular next intake is shorter, but postpone the next intake by 8 hours. In principle, you should not take Leveraxo more than once every 8 hours.

Do not take a double dose to make up for a forgotten dose.

If you stop taking Leveraxo

Do not stop treatment without informing your doctor.

When a patient no longer requires therapy with Leveraxo, it may be advisable to taper the dose gradually to prevent symptoms of withdrawal.

A withdrawal syndrome may occur upon abrupt cessation of therapy. For symptoms of the withdrawal syndrome see section 4. 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.

If you experience any of the following side effects, stop taking Leveraxo and contact your doctor immediately:

depressed breathing. This is the most significant risk induced by opioids and is most likely to occur in elderly or debilitated patients. As a consequence, in predisposed patients opioids can cause severe drops in blood pressure
constricted pupils, bronchial spasms and spasms in smooth muscles or suppression of the cough reflex
serious allergic reaction with symptoms that include feeling dizzy or faint, rash, itchy skin, swelling of the face, lips, tongue or throat that may cause difficulty breathing or swallowing
obstruction of the gut (ileus) with symptoms such as persistent constipation, abdominal swelling and vomiting
blockage of the bile duct (cholestasis) with symptoms such as abdominal pain, tenderness and swelling, vomiting
inability to pass urine or empty the bladder (urinary retention)
black tar-like stools

Other possible side effects:

Very common (may affect more than 1 in 10 people): sedation (tiredness to drowsiness), dizziness, headache constipation, feeling or being sick
itching.

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

reduced appetite or loss of appetite
altered mood and personality changes (anxiety), confusional state, depression
sleeplessness, nervousness, abnormal thinking
lack of energy or enthusiasm (lethargy)
trembling (tremor)
depressed breathing (dyspnoea)
dry mouth
restlessness
hyperactivity
bellyache, diarrhoea, hiccups, upset stomach (dyspepsia)
skin disorders such as rash
pain, burning or discomfort when urinating
frequent or urgent urination
sweating including abnormally increased sweating
powerlessness.

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

hypersensitivity
lack of water in the body (dehydration)
agitation, emotional lability
euphoric mood, seeing, hearing or feeling things that are not real (hallucinations)
disturbances of sexual function (reduced sexual desire and erectile dysfunction)
reduced levels of sex hormones (hypogonadism), which may cause changes to sperm production in males or the menstrual cycle in females
withdrawal symptoms like fast or irregular heart beat (palpitations)
loss of memory (amnesia), convulsion
impaired hearing
increased heart rate
increased muscle tone, involuntary muscle contractions, reduced coordination
reduced sense of touch (hypaesthesia)
speech disorders, cough
fainting, paraesthesia, change in taste, migraine
impaired concentration
visual impairment, constriction of the pupil
vertigo
injuries from accidents
widening of the blood vessels (vasodilatation)
difficulty swallowing (dysphagia), flatulence, burping
ulcers or inflammation of the mouth, tongue or lips
increased liver enzymes
dry skin
chills, general discomfort, thirst
drug tolerance
swelling of any organ or tissue due to accumulation of excess fluid (oedema).

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

decreased blood pressure (hypotension), which may cause dizziness when standing up (orthostatic hypotension)
urticaria
blisters that develop on the lips or around the mouth (herpes simplex)
increased appetite
black tarry stools
tooth disorder
bleeding gums
increase or decrease in weight.

Frequency not known (cannot be estimated from the available data):

anaphylactic responses
aggression
increased sensitivity to pain (hyperalgesia)
dental caries
pain in the abdomen, possibly with nausea and vomiting, caused by a blockage of the bile duct (biliary colic)
absence of menstrual bleeding (amenorrhoea)
long term use of Oxycodone during pregnancy may cause life-threatening withdrawal symptoms in the new-born. Symptoms to look for in the baby include irritability, hyperactivity and abnormal sleep pattern, high pitched cry, shaking, being sick, diarrhoea and not putting on weight.

Tolerance and dependence may develop with chronic use and a withdrawal syndrome may occur upon abrupt cessation of therapy. The withdrawal syndrome is characterised by some or all of the following: restlessness, increased production of tears, runny nose, yawning, sweating, chills, muscle pain, abnormal dilatation of the pupil and sensation of irregular and forceful heartbeat. Other symptoms may also develop, including: irritability, anxiety, backache, joint pain, weakness, belly cramps, sleeplessness, feeling sick, lack of appetite, vomiting, diarrhoea, or increased blood pressure, breathing rate or heart rate.

Counteractive measures

If you observe any of the above listed side effects your doctor usually will take appropriate measures. The side effect constipation may be prevented by fibre enriched diet and increased drinking. If you are suffering from sickness or vomiting your doctor will prescribe you an appropriate medicine.

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 Yellow Card Scheme at 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 leveraxo

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

Do not use this medicine after the expiry date which is stated on the blister or label, and the carton after “EXP”. The expiry date refers to the last day of that month.

This medicinal product 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 protect the environment.

6. contents of the pack and other information

What Leveraxo contains

The active substance is oxycodone hydrochloride.

Leveraxo 5 mg prolonged-release tablets: Each prolonged-release tablet contains 5 mg oxycodone hydrochloride as active substance, equivalent to 4.5 mg oxycodone.

Other ingredients are the tablet core consisting of sugar spheres (sucrose, maize starch), hypromellose, talc, ethyl cellulose, hydroxypropylcellulose, propylene glycol, carmellose sodium, cellulose microcrystalline, magnesium stearate (Ph. Eur.), silica colloidal anhydrous and the tablet coating consisting of polyvinyl alcohol, titanium dioxide (E171), macrogol 3350, talc.

Leveraxo 10 mg prolonged-release tablets: Each prolonged-release tablet contains 10 mg oxycodone hydrochloride as active substance, equivalent to 9 mg oxycodone.

Leveraxo 20 mg prolonged-release tablets: Each prolonged-release tablet contains 20 mg oxycodone hydrochloride as active substance, equivalent to 17.9 mg oxycodone.

Leveraxo 30 mg prolonged-release tablets: Each prolonged-release tablet contains 30 mg oxycodone hydrochloride as active substance, equivalent to 26.9 mg oxycodone.

Leveraxo 40 mg prolonged-release tablets: Each prolonged-release tablet contains 40 mg oxycodone hydrochloride as active substance, equivalent to 36 mg oxycodone.

Leveraxo 60 mg prolonged-release tablets: Each prolonged-release tablet contains 60 mg oxycodone hydrochloride as active substance, equivalent to 53.8 mg oxycodone.

Leveraxo 80 mg prolonged-release tablets: Each prolonged-release tablet contains 80 mg oxycodone hydrochloride as active substance, equivalent to 72 mg oxycodone.

What Leveraxo looks like and contents of the pack

Leveraxo 5 mg prolonged-release tablets

White to off-white, round, biconvex tablet. The height of the tablet is between 3.3 and 4.3 mm, the diameter is 5.2 mm.

Leveraxo 10 mg prolonged-release tablets

Pink, oblong, biconvex tablet with break scores on both sides. The height of the tablet is between 4 and 5 mm, the width is 4.8 mm and the length is 10.3 mm.

Leveraxo 20 mg prolonged-release tablets

White to off-white, oblong, biconvex tablet with break scores on both sides. The height of the tablet is between 3.3 and 4.3 mm, the width is 4.8 mm and the length is 10.3 mm.

Leveraxo 30 mg prolonged-release tablets

Yellow, oblong, biconvex tablet with break scores on both sides. The height of the tablet is between 3.8 and 4.8 mm, the width is 5.3 mm and the length is 11.3 mm.

Leveraxo 40 mg prolonged-release tablets

Pink, oblong, biconvex tablet with break scores on both sides.

The height of the tablet is between 4.8 and 5.8 mm, the width is 5.8 mm and the length is 12.4 mm.

Leveraxo 60 mg prolonged-release tablets

Dark yellow, oblong, biconvex tablet with break scores on both sides. The height of the tablet is between 5 and 6 mm, the width is 6.8 mm and the length is 14.5 mm.

Leveraxo 80 mg prolonged-release tablets

Red, oblong, biconvex tablet with break scores on both sides.

The height of the tablet is between 5.8 and 6.8 mm, the width is 7.4 mm and the length is 15.5 mm.

Pack sizes:

10×1, 14×1, 20×1, 28×1, 30×1,50×1, 56×1,60×1,98×1, 100×1 prolonged-release tablets in child resistant, white opaque perforated unit dose blister.

10, 20, 30, 50, 100 prolonged-release tablets in bottles with child-resistant closure.

Not all pack sizes may be marketed.

Marketing Authorisation Holder

Mylan,

Potters Bar,

Hertfordshire,

EN6 1TL,

United Kingdom.

Manufacturer

Develco Pharma GmbH,

Grienmatt 27, 79650 Schopfheim, Germany.

Generics [UK] Limited t/a Mylan,

Station Close,

Potters Bar,

Hertfordshire,

EN6 1TL,

United Kingdom.

Mylan UK Healthcare Limited, 20 Station Close, Potters Bar, EN6 1TL,

United Kingdom.

This leaflet was last revised in 03/2020.

LEVERAXO 5 MG PROLONGED-RELEASE TABLETS - patient leaflet, side effects, dosage

Table of contents

Patient leaflet - LEVERAXO 5 MG PROLONGED-RELEASE TABLETS

1. what leveraxo is and what it is used for

2. what you need to know before you take leveraxo

Do not take Leveraxo:

Other medicines and Leveraxo

Leveraxo with alcohol

Leveraxo contains sucrose and sodium

3. how to take leveraxo

Route and method of administration

If you forget to take Leveraxo

4. possible side effects

Counteractive measures

5. how to store leveraxo

6. contents of the pack and other information

What Leveraxo contains

Manufacturer