TRANQUILYN 10 MG TABLETS, METYLPHENIDATE HYDROCHLORIDE 10 MG TABLETS - patient leaflet, side effects, dosage

What Tranquilyn is and what it is used for

What it is used for

Tranquilyn is used to treat ‘attention deficit hyperactivity disorder’ (ADHD).

• It is used in children and young people between the ages of 6 and 18.
• It is used only after trying treatments which do not involve medicines. Such as counselling and behavioural therapy.

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

How it works

Tranquilyn improves the activity of certain parts of the brain which are under-active. The medicine can help improve attention (attention span), concentration and reduce impulsive behaviour.

The medicine is given as part of a treatment programme, which usually includes:

• psychological
• educational and
• social therapy.

It is prescribed only by doctors who have experience in children or young people’s behaviour problems. Although there is no cure for ADHD, it can be managed using treatment programmes.

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 they 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.

What you need to know before you take Tranquilyn

Do not take Tranquilyn if:

• you are allergic (hypersensitive) to methylphenidate or any of the other ingredients of Tranquilyn (listed in Section 6)
• you have a thyroid problem
• you have increased pressure in your eye (glaucoma)
• you have a tumour of your adrenal gland (phaeochromocytoma)
• you have an eating problem when you do not feel hungry or want to eat – such as ‘anorexia nervosa’
• you have very high blood pressure or narrowing of the blood vessels, which can cause pain in the arms and legs
• you have ever had heart problems – such as a heart attack, uneven heartbeat, pain and discomfort in the chest, heart failure, heart disease or were born with a heart problem
• you have had a problem with the blood vessels in your brain – such as a stroke, swelling and weakening of part of a blood vessel (aneurysm), narrow or blocked blood vessels or inflammation of the blood vessels (vasculitis)
• you have mental health problems such as:

• – a ‘psychopathic’ or ‘borderline personality’ problem

• – abnormal thoughts or visions or an illness called ‘schizophrenia’

• – signs of a severe mood problem like:

o feeling like killing yourself

o severe depression, where you feel very sad, worthless and hopeless

o mania, where you feel unusually excitable, over-active and un-inhibited.

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

Warnings and precautions

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

• have liver or kidney problems
• have had fits (seizures, convulsions, epilepsy) or any abnormal brain scans (EEGs)
• have ever abused or been dependent on alcohol, prescription medicines or street drugs
• are a girl and have started your periods (see the ‘Pregnancy, breast-feeding and fertility'sec­tion below)
• have hard-to-control, repeated twitching of any parts of the body or you repeat sounds and words
• have high blood pressure
• have a heart problem which is not in the ‘Do not take’ section above
• have a mental health problem which is not in the ‘Do not take’ section above. Other mental health problems include:

• – mood swings (from being manic to being depressed – called ‘bipolar disorder')

• – starting to be aggressive or hostile, or your aggression gets worse

• – seeing, hearing or feeling things that are not there (hallucinations)

• – believing things that are not true (delusions)

• – feeling unusually suspicious (paranoia)

• – feeling agitated, anxious or tense

• – feeling depressed or guilty.

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

During treatment, boys and adolescents may unexpectedly experience prolonged erections. This may be painful and can occur at any time. It is important to contact your doctor straight away if your erection lasts for longer than 2 hours, particularly if this is painful.

Checks that your doctor will make before you start taking Tranquilyn

These checks are to decide if methylphenidate is the correct medicine for you. 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
• how you are feeling, such as feeling high or low, having strange thoughts or if you have had any of these feelings in the past
• whether there is a family history of ‘tics’ (hard-to-control, repeated twitching of any parts of the body or repeating sounds and words)
• any mental health or behaviour problems you or other family members have ever had. Your doctor will discuss whether you are at risk of having mood swings (from being manic to being depressed – called ‘bipolar disorder’). They will check your mental health history, and check if any of your family have a history of suicide, bipolar disorder or depression.

It is important that you provide as much information as you can. This will help your doctor decide if methylphenidate 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 Tranquilyn

Please tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines, including medicines obtained without a prescription.

Do not take methylphenidate if you:

• are taking a medicine called a ‘monoamine oxidase inhibitor' (MAOI) used for depression or have taken an MAOI in the last 14 days. Taking an MAOI with methylphenidate may cause a sudden increase in your blood pressure.

If you are taking other medicines, methylphenidate 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 methylphenidate:

• other medicines for depression
• medicines for severe mental health problems
• medicines for epilepsy
• medicines used to reduce or increase blood pressure
• some cough and cold remedies which contain medicines that can affect blood pressure. It is important to check with your pharmacist when you buy any of these products
• medicines that thin the blood to prevent blood clots.

If you are in any doubt about whether any medicines you are taking are included in the list above, ask your doctor or pharmacist before taking methylphenidate.

Having an operation

Tell your doctor if you are going to have an operation. You should not take methylphenidate on the day of your surgery if a certain type of anaesthetic is used. This is because there is a chance of a sudden rise in blood pressure during the operation.

Drug testing

This medicine may give a positive result when testing for drug use. This includes testing used in sport.

Tranquilyn with food, drink and alcohol

Taking methylphenidate with food may help to stop stomach pains, feeling sick or being sick.

Do not drink alcohol while taking this medicine. Alcohol may make the side effects of this medicine worse. Remember that some foods and medicines contain alcohol.

Pregnancy, breast-feeding and contraception

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

Available data do not suggest an increased risk of overall birth defects, whilst a small increase in the risk of malformations of the heart when used during the first three months of pregnancy could not be ruled out. Your doctor will be able to give you more information about this risk. Tell your doctor or pharmacist before using methylphenidate if you or your daughter:

• is sexually active. Your doctor will discuss contraception
• is pregnant or think might be pregnant. Your doctor will decide whether methylphenidate should be taken.
• breast-feeding or planning to breast-feed. It is possible that methylphenidate is passed into human breast milk. Therefore, your doctor will decide whether you should breast-feed while taking methylphenidate.

Driving and using machines

Methylphenidate can affect your ability to drive and use machines as it may make you feel dizzy, have problems focussing or have blurred vision. Do not drive or use machines while taking this medicine until you know how it affects you. It may be also dangerous to do things such as ride a bike or horse or climb trees.

• It is an offence to drive if this medicine affects your ability to drive.
• However, you would not be committing an offence if:

o the medicine has been prescribed to treat a medical problem and

o you have taken it according to the instructions given by the prescriber or in the information turn

provided with the medicine and over

o it was not affecting your ability to drive safely.

Talk to your doctor or pharmacist if you are not sure whether it is safe for you to drive while taking this medicine.

Information for children and young people

This info is to help you learn the main things about your medicine called Tranquilyn.

If you don’t enjoy reading, someone like your mum, dad or carer (sometimes called ‘your guardian’) can read it to you and answer any questions.

It may help if you read small bits at a time.

Why have I been given this medicine?

This medicine can help children and young people with ‘ADHD’.

• ADHD can make you:

• – run about too much

• – not be able to pay attention

• – act quickly without thinking about what will happen next (impulsive).

• It affects learning, making friends and how you think about yourself. It is not your fault.

While you are taking this medicine

• As well as taking this medicine you will also get help with ways to cope with your ADHD such as talking to ADHD specialists.
• This medicine should help you. But it does not cure ADHD.
• You will need to go to your doctor several times a year for check ups. This is to make sure the medicine is working and that you are growing and developing OK.
• If you take the medicine for more than one year, your doctor may stop your medicine to see if it is still needed. This will probably happen in a school holiday.
• If you take this medicine more than once a day, you may have to remember to take it at school or college. You or your mum, dad or carer will need to find out what the school rules are about this.
• Do not drink alcohol. Alcohol may make the side effects of this medicine worse.
• If you are having sex, please talk to your doctor about contraception. Girls must tell their doctor straight away if they think they may be pregnant. We do not know how this medicine affects unborn babies.

Some people cannot have this medicine

You cannot have this medicine if:

• you have a problem with your heart
• you feel very unhappy, depressed or have a mental illness.

over

|3.|How to take Tranquilyn

• unusual hair loss or thinning

How much to take

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

• Your doctor will usually start treatment with a low dose and increase it gradually as required.
• The maximum daily dose is 60 mg.
• The tablets should be swallowed with a drink of water. It is recommended to take tablets in meals.
• The score line is only there to help you break the tablet if you have difficulty swallowing it whole.

• feeling unusually sleepy or drowsy
• loss of appetite or decreased appetite
• itching, rash or raised red itchy rashes (hives)
• cough, sore throat or nose and throat irritation
• high blood pressure, fast heart beat (tachycardia)
• feeling dizzy, movements which you cannot control, being unusually active
• feeling aggressive, agitated, anxious, depressed, irritable and abnormal behaviour

If you do not feel better after 1 month of treatment

If you do not feel better, tell your doctor. They may decide you need a different treatment.

• stomach pain, diarrhoea, feeling sick, stomach discomfort and being sick. These usually occur at the beginning of treatment and may be reduced by taking the medicine with food.
• excessive teeth grinding (bruxism)

Not using Tranquilyn properly

If Tranquilyn is not used properly, this may cause abnormal behaviour. It may also mean that you start to depend on the medicine. Tell your doctor if you have ever abused or been dependent on alcohol, prescription medicines or street drugs.

This medicine is only for you. Do not give this medicine to anyone else, even if their symptoms seem similar.

Uncommon (affects less than 1 in 100 people)

• constipation
• chest discomfort
• blood in the urine
• shaking or trembling

If you take more Tranquilyn than you should

If you take too much medicine, talk to a doctor or call an ambulance straight away. Tell them how much has been taken.

• double vision or blurred vision
• muscle pain, muscle twitching
• shortness of breath or chest pain

Signs of overdose may include: being sick, feeling agitated, shaking, increased uncontrolled movements, muscle twitching, fits (may be followed by coma), feeling very happy, being confused, seeing, feeling or hearing things that are not real (hallucinations), sweating, flushing, headache, high fever, changes in heart beat (slow, fast or uneven), high blood pressure, dilated pupils and dry nose and mouth.

• increases in liver test results (seen in a blood test)
• anger, feeling restless or tearful, excessive awareness of surroundings, problems sleeping.

Rare (affects less than 1 in 1,000 people)

If you forget to take Tranquilyn

Do not take a double dose to make up for a forgotten dose. If you forget a dose, wait until it is time for the next dose.

• changes in sex drive
• feeling disorientated
• dilated pupils, trouble seeing

If you stop taking Tranquilyn

If you suddenly stop taking this medicine, the ADHD symptoms may come back or unwanted effects such as depression may appear. Your doctor may want to gradually reduce the amount of medicine taken each day, before stopping it completely. Talk to your doctor before stopping Tranquilyn.

• swelling of the breasts in men
• excessive sweating, redness of the skin, red raised skin rash.

Very rare (affects less than 1 in 10,000 people)

• heart attack

Things your doctor will do when you are on treatment

Your doctor will do some tests

• Before you start – to make sure that Tranquilyn 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:

• sudden death
• muscle cramps
• small red marks on the skin
• inflammation or blocked arteries in the brain
• abnormal liver function including liver failure and coma

• – checking your appetite

• – measuring height and weight

• – measuring blood pressure and heart rate

• – checking whether you have any problems with your mood, state of mind or any other unusual feelings. Or if these have got worse while taking Tranquilyn.

• changes in test results, including liver and blood tests
• suicidal attempt, abnormal thinking, lack of feeling or emotion, doing things over and over again, being obsessed with one thing
• fingers and toes feeling numb, tingling and changing colour (from white to blue, then red) when cold (‘Raynaud’s phe­nomenon’).

Other side effects (how often they happen is not known)

• migraine

Long-term treatment

Tranquilyn does not need to be taken for ever. If you take Tranquilyn for more than a year, your doctor should stop treatment for a short time, this may happen during a school holiday. This will show if the medicine is still needed.

• very high fever
• slow, fast or extra heart beats
• a major fit (‘grand mal convulsions’)
• believing things that are not true, confusion

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

• severe stomach pain, often with feeling and being sick
• problems with the blood vessels of the brain (stroke, cerebral arteritis or cerebral occlusion)

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

• excessive uncontrolled talking
• erectile dysfunction
• Prolonged erections, sometimes painful, or an increased number of erections.
• inability to control the excretion of urine (incontinence)

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

• spasm of the jaw muscles that makes it difficult to open the mouth (trismus)
• stuttering

Common (affects less than 1 in 10 people)

• uneven heartbeat (palpitations)
• mood changes or mood swings or changes in personality

Effects on growth

When used for more than a year, methylphenidate may cause reduced growth in some children. This affects less than 1 in 10 children.

• There may be lack of weight gain or height growth.
• Your doctor will carefully watch your height and weight, as well as how well you are eating.

Uncommon (affects less than 1 in 100 people)

• thinking about or feeling like killing yourself
• seeing, feeling or hearing things that are not real, these are signs of psychosis
• uncontrolled speech and body movements (Tourette’s)
• signs of allergy such as rash, itching or hives on the skin, swelling of the face, lips, tongue or other parts of the body, shortness of breath, wheezing or trouble breathing

If you are not growing as expected, then your treatment with methylphenidate may be stopped for a short time.

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.

By reporting side effects you can help provide more information on the safety of this medicine.

15.

|How to store Tranquilyn

Rare (affects less than 1 in 1,000 people)

• feeling unusually excited, over-active and un-inhibited (mania)

Make sure you keep your medicine in a safe place, so that no one else takes it, especially younger brothers or sisters. Do not use Tranquilyn after the expiry date which is stated on the label. The expiry date refers to the last day of that month. Do not store above 25° C.

Very rare (affects less than 1 in 10,000 people)

• heart attack
• fits (seizures, convulsions epilepsy)
• skin peeling or purplish red patches
• muscle spasms which you cannot control affecting your eyes, head, neck, body and nervous system -due to a temporary lack of blood supply to the brain
• paralysis or problems with movement and vision, difficulties in speech (these can be signs of problems with the blood vessels in your brain)
• decrease in number of blood cells (red cells, white cells and platelets) which can make you more likely to get infections and make you bleed and bruise more easily
• a sudden increase in body temperature, very high blood pressure and severe convulsions (‘Neuroleptic Malignant Syndrome’). It is not certain that this side effect is caused by methylphenidate or other drugs that may be taken in combination with methylphenidate.

The tablets should be kept in the original package to protect them from moisture.

Medicines should not be disposed of via wastewater or household waste. Ask your pharmacist how to dispose of medicines no longer required.

These measures will help to protect the environment.

16.fcontents of the pack and other information

What Tranquilyn contains

The active substance is methylphenidate hydrochloride.

• Tranquilyn 5 mg Tablets contains 5 mg of methylphenidate hydrochloride.
• Tranquilyn 10 mg Tablets contains 10 mg of methylphenidate hydrochloride.
• Tranquilyn 20 mg Tablets contains 20 mg of methylphenidate hydrochloride.

The other ingredients are:

Other side effects (how often they happen is not known)

• unwanted thoughts that keep coming back
• unexplained fainting, chest pain, shortness of breath (these can be signs of heart problems)

Calcium hydrogen phosphate dihydrate, microcrystalline cellulose, maize starch and magnesium stearate.

What Tranquilyn looks like and contents of the pack

Tranquilyn is available in three strengths: 5 mg, 10 mg and 20 mg. Tablets are white, flat and round.

If you have any of the side effects above, see a doctor straight away.

Tranquilyn 5 mg Tablets has one side marked ‘RU’ and the reverse side marked ‘5’. Tranquilyn 10 mg Tablets has one side marked ‘RU 10’ with a breakline.

Other side effects include the following. If they get serious, please tell your doctor or pharmacist:

Tranquilyn 20 mg Tablets has one side marked ‘RU 20' with a breakline.

The medicinal product is available in packs containing 28,30,56,60 or 100 tablets. Not all pack sizes may be marketed.

Very common (affects more than 1 in 10 people)

• headache
• feeling nervous
• not being able to sleep.

Marketing Authorisation Holder and Manufacturer

Laboratorios Rubio, S.A. Industria, 29. Pol. Ind. Comte de Sert, 08755 Castellbis­bal, Barcelona (Spain).

For any further information about this medicine, please contact the local representative of the Marketing Authorization Holder.

Common (affects less than 1 in 10 people)

• joint pain
• dry mouth
• high temperature (fever)

This leaflet was last revised in September 2020

36119000/0120

Some people need to talk to their doctor before they start having this medicine

You need to talk to your doctor if:

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• having different moods than usual, not being able to get to sleep
• skin rashes, bruising easily, getting out of breath

• you have epilepsy (fits)
• you are pregnant or breastfeeding
• you are taking other medicines – your doctor needs to know about all the medicines you are taking.

• ■ the medicine can also make you sleepy. If you feel sleepy, it is important not to do outdoor sports like riding a horse or bike, swimming or climbing trees. You could hurt yourself or others.

• your heart beating faster than usual.

If you feel unwell in any way while you are taking your medicine please tell an adult you trust straight away.

How do I take my medicine (tablets)?

• Swallow your medicine with water and food.
• Your doctor will tell you how many times a day you should take your medicine.
• Do not stop taking the medicine without talking to your doctor first.

Possible side effects

Side effects are the unwanted things that can happen when you take a medicine. If any of the following happen, tell an adult you trust straight away. They can then talk to your doctor. The main things that can affect you are:

Other things to remember

• Make sure you keep your medicine in a safe place, so that no one else takes it, especially younger brothers or sisters.
• The medicine is special for you – do not let anyone else have it. It may help you, but it could hurt someone else.
• If you forget to take your medicine don’t take two tablets the next time. Just take one tablet at the next normal time.
• If you do take too much medicine, tell your mum, dad or carer right away.
• It is important not to take too much medicine or you will get ill.

• feeling or being sick or having tummy pains. These may only happen when you first start taking the medicine. It is best to take the medicine with food
• feeling worried or nervous
• feeling dizzy or getting headaches
• being very depressed and unhappy or wanting to hurt yourself

Don't stop taking your medicine until your doctor says it's OK.

Who should I ask if there is anything I don’t understand?

Your mum, dad, carer, doctor, nurse or pharmacist will be able to help you.