TRAMQUEL SR 150 MG PROLONGED-RELEASE HARD CAPSULES - patient leaflet, side effects, dosage

1. what tramquel sr prolonged-release hard capsules is and what it is used for

Tramquel SR prolonged-release hard capsules belongs to a group of medicines called analgesics, commonly known as pain killers or pain relievers. The active substance, tramadol hydrochloride, interrupts the pain messages being sent to your brain, and it also acts in your brain to stop pain messages from being felt. This means that Tramquel SR prolonged-release hard capsules does not stop the pain from happening, but you will not be able to feel the pain as much.

Tramquel SR prolonged-release hard capsules is used to relieve moderate to severe pain. (for example pain after an operation, or after an injury).

• 2. Before you take Tramquel SR prolonged-release hard capsules
  
  Do not take Tramquel SR prolonged-release hard capsules:

• if you are allergic to tramadol hydrochloride or to any of the other ingredients of this medicine (listed in section 6) resulting in a skin rash, swelling of face or difficulty in breathing
• if you are taking, or you have taken in the last two weeks, monoamine oxidase inhibitors (MAOIs) to treat your depression (see section 2, “Other medicines and Tramquel SR prolonged-release hard capsules”)
• if you have epilepsy which is not controlled by treatment
• if you have drunk enough alcohol to make you feel woozy or drunk
• if you have taken more than the prescribed dose of your sleeping tablets, antipsychotics, antidepressant (antipsychotics and antidepressants are medicines that affect mood and emotions) or other pain killers, which can slow down your breathing and reactions.

Warnings and precautions

Talk to your doctor or pharmacist before taking Tramquel SR prolonged-release hard capsules, if:

• you have been taking Tramquel SR prolonged-release hard capsules or any other tramadol containing medicine for a long time.
• you are addicted to morphine.
• you have severe problems with your liver or kidneys.
• you have recently had a head injury or have a very bad headache that makes you sick.
• you have ever had convulsions (fits) or do you suffer from epilepsy.
• you have asthma or trouble breathing.
• you are going to have surgery requiring a general anaesthetic.

If any of the above apply to you, you must tell your doctor as he/she doctor may decide to alter your treatment.

• 80 mm There is rare possibility that Tramquel SR prolonged-release hard capsules may cause convulsions (fits). The risk is increased if doses above

the daily maximum are taken and if you are also taking anti-depressants or anti-psychotics.

You have a tendency to drug addiction or abuse you should take Tramquel SR prolonged-release hard capsules for short periods only. Please tell your doctor about this as he/she may want to monitor your pain control more closely.

You should not take this product for the treatment of withdrawal symptoms, if you are addicted to drugs.

Tramadol is transformed in the liver by an enzyme. Some people have a variation of this enzyme and this can affect people in different ways. In some people, they may not get enough pain relief but other people are more likely to get serious side effects. If you notice any of the following side effects, you must stop taking this medicine and seek immediate medical advice: slow or shallow breathing, confusion, sleepiness, small pupils, feeling or being sick, constipation, lack of appetite.

Children and adolescents:

Tramquel SR prolonged-release hard capsules should not be used in children under 12 years of age.

Use in children with breathing problems

• <|[ Tramadol is not recommended in children with breathing problems, since the symptoms of tramadol toxicity may be worse in these children.

o Other medicines and Tramquel SR prolonged-release hard capsules

Tell your doctor or pharmacist or dentist if you are taking, have recently taken or might take any other medicines, including those obtained without prescription.

Do not take Tramquel SR prolonged-release hard capsules at the same time, or within 14 days of taking medicines called monoamine oxidase inhibitors (moclobemide or phenelzine for depression, selegiline for Parkinson’s di­sease).

The pain relieving effect of Tramquel SR prolonged-release hard capsules may be weakened and/or shortened if you also take medicines containing:

• carbamazepine (used to treat epilepsy)
• buprenorphine, nalbuphine, or pentazocine (pain killers)
• ondansetron (prevents nausea)

Your doctor will tell you whether you should take Tramquel SR prolonged-release hard capsules, and what dose.

The risk of side effects increases if you are taking medicines which may cause convulsions (fits), such as certain antidepressants or antipsychotics. The risk of having a fit may increase if you take Tramquel SR prolonged-release hard capsules at the same time. Your doctor will tell you whether Tramquel SR prolonged-release hard capsules are suitable for you.

The risk of side effect increases, if you are taking certain antidepressants. Tramquel SR prolonged-release hard capsules may interact with these medicines 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.

Medicines that act on the nervous system such as hypnotics, tranquillisers, sleeping pills and pain killers may make you feel drowsier or faint when taken with Tramquel SR prolonged-release hard capsules.

Anticoagulants to thin your blood such as warfarin. The effectiveness of the medicines may be altered if you are also taking Tramquel SR prolonged-release hard capsules.

Concomitant use of Tramquel SR prolonged-release hard capsules and sedative medicines such as benzodiazepines or related drugs 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 Tramquel SR prolonged-release hard capsules 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.

Taking Tramquel SR prolonged-release hard capsules with food, drink and alcohol

Tramquel SR prolonged-release hard capsules should be taken with some water, with or without a meal. Avoid drinking alcohol while taking this medicine.

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. Please contact your doctor if you become pregnant during your treatment.

Pregnancy

You should not take Tramquel SR prolonged-release hard capsules during pregnancy, since the active substance tramadol hydrochloride passes the placenta, and its safety during pregnancy has not been established. If you suffer from severe pain, you should consult your treating physician, who has to decide, whether you can take single doses.

Breast-feeding

Tramadol is excreted into breast milk. For this reason, you should not take Tramquel SR prolonged-release hard capsules more than once during breast-feeding, or alternatively, if you take Tramquel SR prolonged-release hard capsules more than once, you should stop breastfeeding.

Driving and using machines

Tramquel SR prolonged-release capsules, hard may cause drowsiness, particularly if taken with alcohol, anti-histamines and other medicines that may cause drowsiness. Do not drive or operate heavy machinery unless you know how Tramquel SR prolonged-release capsules, hard affects you.

Tramquel SR prolonged-release hard capsules contains sucrose

If you have been told by your doctor that you have intolerance to some sugars, contact your doctor before taking this medicinal product.

3. how to take tramquel sr prolonged-release hard capsules

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

The dosage should be adjusted to the intensity of your pain and your individual pain sensitivity. In general the lowest pain-relieving dose should be taken.

Swallow the capsules whole with water without chewing.

If you have difficulty in swallowing, you may open the capsules. You must open them very carefully by pulling and twisting each end over a spoon so that all the pellets stay in the spoon. Do not chew. Swallow all the pellets with water.

Dosage for adults and adolescents from 12 years of age:

The usual initial dose is 50 – 100 mg twice daily, in the morning and in the evening. Your doctor may increase this dose up to 150– 200 mg twice daily according to your needs. You should normally take your Tramquel SR prolonged-release hard capsules every 12 hours, at the same time each morning and evening.

The maximum dose is usually 400 mg daily. Your prescribed daily dose will depend on the severity of your pain.

Use in children:

Under 12 years of age – Tramquel SR prolonged-release hard capsules should not be taken by children under 12 years of age.

Use in elderly patients:

In elderly patients (above 75 years of age) the excretion of tramadol may be delayed. If this applies to you, your doctor may recommend prolonging the dosage interval.

Use in patients with severe liver or kidney disease (insufficiency)/di­alysis patients:

Patients with severe liver and/or kidney insufficiency should not take Tramquel SR prolonged-release hard capsules. If in your case the problem is mild or moderate your doctor may recommend prolonging the dosage interval.

If you take more Tramquel SR prolonged-release hard capsules than you should

If you accidentally take more capsules than your prescribed dose, tell your doctor or pharmacist immediately and if necessary contact your nearest hospital casualty department. Remember to take the pack and any remaining medicines with you.

If you forget to take Tramquel SR prolonged-release hard capsules

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

If you stop taking Tramquel SR prolonged-release hard capsules

Do not stop taking Tramquel SR prolonged-release hard capsules, or lower the dose, without first checking with your doctor. Generally there will be no after-effects when treatment with Tramquel SR prolongedrelease hard capsules is stopped. However, on rare occasions, people who have been taking Tramquel SR prolonged-release hard capsules for some time may feel unwell if they abruptly stop taking them. They may feel agitated, anxious, nervous or shaky. They may be hyperactive, have difficulty sleeping and have stomach or bowel disorders. If you experience any of these complaints after stopping Tramquel SR prolonged-release hard capsules please consult your doctor.

You should not suddenly stop taking this medicine unless your doctor tells you to. If you want to stop taking your medicine, discuss this with your doctor first, particularly if you have been taking it for a long time. Your doctor will advise you when and how to stop, which may be by lowering the dose gradually to reduce the chance of developing unnecessary side effects (withdrawal symptoms).

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

Ask your doctor or pharmacist if:

• you are not sure how many capsules to take or when to take them
• you think that the effect is too strong or too weak

4. possible side effects

Like all medicines, Tramquel SR prolonged-release hard capsules can cause side effects, although not everybody gets them.

The most serious side effects which may occur include allergic reaction (difficulty in breathing, wheezing and swelling of the face or throat), anaphylactic reaction (an extreme allergic reaction resulting in asthma and difficulty breathing, changes in heart rate, faintness, collapse or unconsciousness due to a drop in blood pressure) or convulsions (fits). If you have any of these symptoms you must stop taking Tramquel SR prolonged-release hard capsules immediately and seek medical advice.

Other side effects:

Very Common (may affect more than 1 in 10 people)

• Dizziness
• Vomiting and nausea (being and feeling sick)

Common (may affect up to 1 in 10 people)

• Headache
• Drowsiness, sleepiness (fatigue)
• Constipation, dry mouth
• Sweating

Uncommon (may affect up to 1 in 100 people)

• Rapid heart beat, palpitation, sudden drops in blood pressure. These adverse effects may occur especially on intravenous administration and in patients who are physically stressed
• Itching, skin rash
• Retching, feeling bloated or full

Rare (may affect up to 1 in 100 people)

• Appetite changes
• Psychic effects including: changes in mood, activity, behaviour and perception, hallucinations, confusion, restlessness, sleep disturbances and nightmares
• Convulsions (fits)
• Tingling sensation and trembling
• Slow heart beat, increase in blood pressure
• Muscle weakness
• Difficulty or inability in passing urine
• Blurred vision

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

• Flushing
• Vertigo (feeling of dizziness or “spinning”)
• Elevated liver enzymes

Not known: frequency cannot be estimated from the available data

• Decrease in blood sugar level

Withdrawal symptoms including: agitation, anxiety, nervousness, difficulty sleeping, restlessness, trembling and gastro-intestinal problems (see section 3, “How to take Tramquel prolonged-release hard capsules”).

Reporting of side effects

If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via the 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 tramquel sr prolonged-release hard capsules

• – Do not store above 25 °C.

• – Store in the original package in order to protect from moisture.

• – Keep out of the sight and reach of children.

• – Do not use Tramquel SR prolonged-release hard capsules after the expiry date which is stated on the carton. The expiry date refers to the last day of that month.

• – 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 informationwhat tramquel sr prolonged-release hard capsules contains:the active substance is tramadol hydrochloride.

Tramquel SR 50 mg, 100 mg, 150 mg and 200 mg prolonged-release hard capsules contains 50 mg, 100 mg, 150 mg and 200 mg tramadol hydrochloride.

The other ingredients of the capsule contents are: sugar spheres (sucrose and maize starch), colloidal, ethylcellulose anhydrous silica, shellac, talc., gelatin, titanium dioxide (E171), iron oxide yellow (E172) iron oxide yellow (E172) iron oxide yellow (E172), indigotine (E132) indigotine (E132), iron oxide black (E172), propylene glycol, ammonium hydroxide.

What Tramquel prolonged-release hard capsules look like and the contents of the pack:

Prolonged-release hard capsules

Tramquel 50 mg prolonged-release hard capsules are dark green and marked with T50SR.

Tramquel 100 mg prolonged-release hard capsules are white and marked with T100SR.

Tramquel 150 mg prolonged-release hard capsules are dark green and marked with T150SR.

Tramquel 200 mg prolonged-release hard capsules are yellow marked with T200SR

This medicinal product is in the form of a prolonged release hard capsule. The capsules release the active ingredient over a period of time.

All the capsules are packaged in PVC/PVDC – aluminium blisters of 10 capsules. Each pack contains 1,2, 3, 5, 6 or 10 blister blisters, i.e each pack contains 10, 20, 30, 50, 60 or 100 capsules per pack. Not all pack sizes may be marketed.

Marketing Authorisation Holder Manufacturer

Mylan Temmler Pharma GmbH

Potters Bar Temmlerstrasse 2

Hertfordshire D-35039 Marburg

EN6 1TL Germany

UK

This medicinal product is authorised in the Member States of the EEA under the following names:
Germany	Amadol Retard 50/100/150/200 mg Hartkapseln, retardiert
Slovakian Republic	Adamon SR 50/100/150/200 mg, tvrde kapsule s predlzenym uvol’novamm
United Kingdom	Tramquel SR 50/100/150/200 mg prolonged-release hard capsules

This leaflet was last revised in March 2019.

(HD Mylan

51737529

56UK29909781–05