PREGABALIN ASCEND 20 MG / ML ORAL SOLUTION - patient leaflet, side effects, dosage

1. what pregabalin is and what it is used for

Pregabalin belongs to a group of medicines used to treat epilepsy and Generalised Anxiety Disorder (GAD) in adults.

Peripheral and central neuropathic pain: Pregabalin oral solution is used to treat long lasting pain caused by damage to the nerves. A variety of diseases can cause peripheral neuropathic pain, such as diabetes or shingles. Pain sensations may be described as hot, burning, throbbing, shooting, stabbing, sharp, cramping, aching, tingling, numbness, pins and needles. Peripheral and central neuropathic pain may also be associated with mood changes, sleep disturbance, fatigue (tiredness), and can have an impact on physical and social functioning and overall quality of life.

Epilepsy: Pregabalin oral solution is used to treat a certain form of epilepsy (partial seizures with or without secondary generalisation-epileptic fits starting on one specific part of the brain) in adults. Your doctor will prescribe Pregabalin oral solution for you to help treat your epilepsy when your current treatment is not controlling your condition. You should take Pregabalin oral solution in addition to your current treatment. Pregabalin oral solution is not intended to be used alone, but should always be used in combination with other anti-epileptic treatment.

Generalised Anxiety Disorder: Pregabalin oral solution is used to treat Generalised Anxiety Disorder (GAD). The symptoms of GAD are prolonged excessive anxiety and worry that are difficult to control. GAD can also cause restlessness or feeling keyed up or on edge, being easily fatigued (tired), having difficulty concentrating or mind going blank, feeling irritable, having muscle tension or sleep disturbance. This is different to the stresses and strains of everyday life.

2. what you need to know before you take pregabalin

Do not take Pregabalin

• if you are allergic to pregabalin or any of the other ingredients of this medicine (listed in section 6).

Warnings and Precautions

Talk to your doctor or pharmacist before taking Pregabalin.

• Some patients taking Pregabalin have reported symptoms suggesting an allergic reaction. These symptoms include swelling of the face, lips, tongue, and throat, as well as diffuse skin rash. Should you experience any of these reactions, you should contact your physician immediately.
• Pregabalin has been associated with dizziness and sleepiness, which could increase the occurrence of accidental injury (fall) in elderly patients. Therefore, you should be careful until you are used to any effect the medicine might have.
• Pregabalin may cause blurring or loss of vision, or other changes in eyesight, many of which are temporary. You should immediately tell your doctor if you experience any changes in your vision.
• Some patients with diabetes who gain weight while taking pregabalin may need an alteration in their diabetic medicines.
• Certain side effects may be more common, such as sleepiness, because patients with spinal cord injury may be taking other medicines to treat, for example, pain or spasticity, that have similar side effects to Pregabalin and the severity of these effects may be increased when taken together.
• There have been reports of heart failure in some patients when taking Pregabalin; these patients were mostly elderly with cardiovascular conditions. Before taking this medicine you should tell your doctor if you have a history of heart disease.
• There have been reports of kidney failure in some patients when taking Pregabalin. If while taking Pregabalin you notice decreased urination, you should tell your doctor as stopping the medicine may improve this.
• A small number of people being treated with anti-epileptics such as Pregabalin have had thoughts of harming or killing themselves. If at any time you have these thoughts, immediately contact your doctor.
• When Pregabalin is taken with other medicines that may cause constipation (such as some types of pain medicines) it is possible that gastrointestinal problems may occur (e.g. constipation, blocked or paralysed bowel). Tell your doctor if you experience constipation, especially if you are prone to this problem.
• Before taking this medicine you should tell your doctor if you have a history of alcoholism or any drug abuse or dependence. Do not take more medicine than prescribed.
• There have been reports of convulsions when taking Pregabalin or shortly after stopping Pregabalin. If you experience a convulsion, contact your doctor immediately.
• There have been reports of reduction in brain function (encephalopathy) in some patients taking Pregabalin when they have other conditions. Tell your doctor if you have a history of any serious medical conditions, including liver or kidney disease.

Children and adolescents

The safety and efficacy in children and adolescents (under 18 years of age) has not been established and therefore, pregabalin should not be used in this age group.

Other medicines and Pregabalin

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

Pregabalin and certain other medicines may influence each other (interaction). When taken with certain other medicines, Pregabalin may increase the likelihood of the side effects seen with these medicines, including respiratory failure and coma. The degree of dizziness, sleepiness and decreased concentration may be increased if Pregabalin is taken together with medicinal products containing:

• Oxycodone – (used as a pain-killer)
• Lorazepam – (used for treating anxiety)
• Alcohol

Pregabalin may be taken with oral contraceptives.

Pregabalin with food, drink and alcohol

Pregabalin may be taken with or without food.

It is advised not to drink alcohol while taking Pregabalin.

Pregnancy and breast-feeding

Pregabalin should not be taken during pregnancy or when breast-feeding, unless you are told otherwise by your doctor. Effective contraception must be used by women of child-bearing potential.

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.

Driving and using machines

Pregabalin may produce dizziness, sleepiness and decreased concentration. You should not drive, operate complex machinery or engage in other potentially hazardous activities until you know whether this medicine affects your ability to perform these activities.

Pregabalin oral solution contains

Pregabalin oral solution contains methyl parahydroxybenzoate (E218) and propyl parahydroxybenzoate (E216) which may cause allergic reactions (possibly delayed).

3. how to take pregabalin

Always take this medicine exactly as your doctor or pharmacist has told you. Check with your doctor or pharmacist if you are not sure.

Your doctor will determine what dose is appropriate for you.

Peripheral and central neuropathic pain, epilepsy or Generalised Anxiety Disorder:

• Take the solution as instructed by your doctor.
• The dose, which has been adjusted for you and your condition, will generally be between 150 mg (7.5 ml) and 600 mg (30 ml) each day.
• Your doctor will tell you to take Pregabalin either twice or three times a day. For twice a day take Pregabalin once in the morning and once in the evening, at about the same time each day. For three times a day take Pregabalin once in the morning, once in the afternoon and once in the evening, at about the same time each day.

If you have the impression that the effect of Pregabalin is too strong or too weak, talk to your doctor or pharmacist.

Use in elderly patients

If you are an elderly patient (over 65 years of age), you should take Pregabalin normally except if you have problems with your kidneys.

Use in patients with kidney problems

Your doctor may prescribe a different dosing schedule and/or dose if you have problems with your kidneys.

Administration:

Instructions for use

Pregabalin is for oral use only.

• 1. Open the bottle: Press downward on the cap and turn it counter-clockwise (Figure 1).

• 2. First time use only: After removing the cap, set the bottle upright on a table-top. There is a seal on the top of the bottle, which must be removed before using the bottle for the first time. A Press-In Bottle Adapter (PIBA) is provided with the oral syringe. This is the device that gets inserted into the neck of the bottle to make it easier to withdraw the solution using the oral syringe. If the PIBA is not already in place, remove the PIBA and 5 ml oral syringe from the plastic overwrap. With the bottle on a flat surface, insert the PIBA into the bottle neck while keeping the PIBA's flat surface facing up and pressing on it (Figure 2).

• 3. Push the syringe plunger to the bottom of the barrel of the syringe (toward its tip) to remove excess air. Attach the syringe to the PIBA with a slight twisting motion (Figure 3).

• 4. Invert the bottle (with the syringe attached) and fill the syringe with the liquid by pulling the syringe plunger down to just beyond the graduation mark corresponding to the quantity in millilitres (ml) prescribed by your doctor (Figure 4). Remove air bubbles from the syringe by pushing the plunger up to the appropriate graduation mark.

• 5. Return the bottle to an upright position with the syringe still in the PIBA/bottle (Figure 5).

• 6. Remove the syringe from the bottle/PIBA (Figure 6).

• 7. Empty the contents of the syringe directly into mouth by pushing the syringe plunger to the bottom of the syringe barrel (Figure 7).

Note: Steps 4–7 may need to be repeated up to three times to obtain the total dose (Table 1).

[For example, a 150 mg (7.5 ml) dose will require two withdrawals from the bottle to achieve the entire dose. Using the oral syringe, first withdraw 5 ml and empty contents of syringe directly into the mouth, then refill the oral syringe with 2.5 ml and empty the remaining contents into the mouth.]

• 8. Rinse the syringe by drawing water into the syringe and pushing the syringe plunger to the bottom of the syringe barrel, at least three times (Figure 8).

  300 mm

  
  

  Font : Times New Roman

  
  

Alkem Laboratories Limited

• 9. Replace the cap on the bottle (leaving the PIBA in place in the bottle neck) (Figure 9).

Table 1. Oral Syringe Withdrawals to Deliver Prescribed Dose of Pregabalin

Pregabalin Dose (mg)	Total Solution Volume (ml)	First Syringe Withdrawal (ml)	Second Syringe Withdrawal (ml)	Third Syringe Withdrawal (ml)
25	1.25	1.25	Not required	Not required
50	2.5	2.5	Not required	Not required
75	3.75	3.75	Not required	Not required
100	5	5	Not required	Not required
150	7.5	5	2.5	Not required
200	10	5	5	Not required
225	11.25	5	5	1.25
300	15	5	5	5

If you take more Pregabalin than you should

Call your doctor or go to the nearest hospital emergency unit immediately. Take your box or bottle of Pregabalin oral solution with you. You may feel sleepy, confused, agitated, or restless as a result of taking more Pregabalin than you should. Fits have also been reported.

If you forget to take Pregabalin

It is important to take your Pregabalin oral solution regularly at the same time each day. If you forget to take a dose, take it as soon as you remember unless it is time for your next dose. In that case, just carry on with the next dose as normal. Do not take a double dose to make up for a forgotten dose.

If you stop taking Pregabalin

Do not stop taking Pregabalin unless your doctor tells you to. If your treatment is stopped, it should be done gradually over a minimum of 1 week.

After stopping long and short-term Pregabalin treatment, you need to know that you may experience certain side effects. These include, trouble sleeping, headache, nausea, feeling anxious, diarrhoea, flu- like symptoms, convulsions, nervousness, depression, pain, sweating, and dizziness. These symptoms may occur more commonly or severely if you have been taking Pregabalin for a longer period of time.

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.

Very common: may affect more than 1 in 10 people

• Dizziness, drowsiness, headache
• Increased appetite
• Feeling of elation, confusion, disorientation, decrease in sexual interest, irritability
• Disturbance in attention, clumsiness, memory impairment, loss of memory, tremor, difficulty with speaking, tingling feeling, numbness, sedation, lethargy, insomnia, fatigue, feeling abnormal
• Blurred vision, double vision
• Vertigo (feeling of dizziness or “spinning”), problems with balance, fall
• Dry mouth, constipation, vomiting, flatulence, diarrhoea, nausea, swollen abdomen
• Difficulties with erection
• Swelling of the body including extremities
• Feeling drunk, abnormal style of walking
• Weight gain
• Muscle cramp, joint pain, back pain, pain in limb
• Sore throat
• Loss of appetite, weight loss, low blood sugar, high blood sugar
• Change in perception of self, restlessness, depression, agitation, mood swings, difficulty finding words, hallucinations, abnormal dreams, panic attacks, apathy, aggression, elevated mood, mental impairment, difficulty with thinking, increase in sexual interest, problems with sexual functioning including inability to achieve a sexual climax, delayed ejaculation
• Changes in eyesight, unusual eye movement, changes in vision including tunnel vision, flashes of light, jerky movements, reduced reflexes, increased activity, dizziness on standing, sensitive skin, loss of taste, burning sensation, tremor on movement, decreased consciousness, loss of consciousness, fainting, increased sensitivity to noise, feeling unwell
• Dry eyes, eye swelling, eye pain, weak eyes, watery eyes, eye irritation
• Heart rhythm disturbances, increased heart rate, low blood pressure, high blood pressure, changes in heartbeat, heart failure
• Flushing, hot flushes
• Difficulty breathing, dry nose, nasal congestion
• Increased saliva production, heartburn, numb around mouth
• Sweating, rash, chills, fever
• Muscle twitching, joint swelling, muscle stiffness, pain including muscle pain, neck pain
• Breast pain
• Difficulty with or painful urination, incontinence
• Weakness, thirst, chest tightness
• Changes in blood and liver test results (blood creatinine phosphokinase increased, alanine amino transferase increased, aspartate aminotransferase increased, platelet count decreased, neutropaenia, increase in blood creatinine, decrease in blood potassium)
• Hypersensitivity, swollen face, itchiness, hives, runny nose, nose bleed, cough, snoring
• Painful menstrual periods
• Coldness of hands and feet
• Abnormal sense of smell, swinging vision, altered perception of depth, visual brightness, vision loss
• Dilated pupils, cross eyes
• Cold sweat, tightness of the throat, swollen tongue
• Inflammation of the pancreas
• Difficulty in swallowing
• Slow or reduced movement of the body
• Difficulty with writing properly
• Increased fluid in the abdomen
• Fluid in the lungs
• Convulsions (fits)
• Changes in the recording of electrical changes (ECG) in the heart which correspond to heart rhythm disturbances
• Muscle damage
• Breast discharge, abnormal breast growth, breast growth in males
• Interrupted menstrual periods
• Kidney failure, reduced urine volume, urinary retention
• Decrease in white blood cell count
• Inappropriate behaviour
• Allergic reactions (which may include difficulty breathing, inflammation of the eyes (keratitis) and a serious skin reaction characterised by rash, blisters, peeling skin and pain)
• Jaundice (yellowing of the skin and eyes).
• Liver failure
• Hepatitis

5. how to store pregabalin

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 carton or bottle. The expiry date refers to the last day of that month.

Store below 30°C.

Do not throw away any medicines via wastewater. 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 informationwhat pregabalin oral solution containsthe active substance is pregabalin. each ml contains 20 mg of pregabalin.

The other ingredients are: methyl parahydroxy benzoate (E218), propyl parahydroxy benzoate (E216), Anhydrous Sodium Dihydrogen Phosphate, disodium phosphate anhydrous (E339), sucralose (E955), Superfex Art Maraschino cherry FL #769 {contains Flavouring ingredients in propylene glycol (E1520)}, purified water.

What Pregabalin oral solution looks like and contents of the pack

Pregabalin oral solution is a clear colourless transparent solution in a white opaque bottle containing 473 ml of oral solution, a graduated 5 ml oral syringe and a press-in bottle adapter (PIBA) are also supplied.

Marketing Authorisation Holder:

Ascend Laboratories (UK) Limited

4th floor, Elsley Court 20–22

Great Titchfield Street

London, W1W 8BE

Tel: 0800 047 0073

Manufacturer:

Ascend Laboratories (UK) Ltd.

4th floor, Cavendish House,

369 Burnt Oak

Broadway, Edgware, HA85AW

United Kingdom

and/or

Wave Pharma Limited

4th floor, Cavendish House,

369 Burnt Oak

Broadway, Edgware, HA85AW

United Kingdom

Distributed by:

Ascend Laboratories (UK) Limited

United Kingdom.

This leaflet was last revised in 07/2019.

PT 2513–05

300 mm