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Package leaflet: Information for the user

Allegron® 25mg Tablets

(nortriptyline hydrochloride)

Read all of this leaflet carefully before you start taking this medicine.

Keep this leaflet. You may need to read it again.

If you have any further questions, ask your doctor or pharmacist.

This medicine has been prescribed for you. Do not pass it on to others. It may harm them, even if their symptoms are the same as yours.

If any of the side effects gets serious, or if you notice any side effects not listed in this leaflet, please tell your doctor or pharmacist.

This medicine is also available in other strengths.

This medicine is known as Allegron 25mg Tablets, but will be referred to here as Allegron tablets throughout the leaflet.

In this leaflet:

1.    What Allegron tablets are and what they are used for

2.    Before you take Allegron tablets

3.    How to take Allegron tablets

4.    Possible side effects

5.    How to store Allegron tablets

6.    Further information

1    What Allegron tablets are and what they are used for

Allegron tablets contain the active ingredient nortriptyline hydrochloride, which is a tricyclic antidepressant. Allegron relieves the symptoms of depression.

Allegron may also be used for the treatment of bed-wetting in children 6 years and older.

2    Before you take Allegron tablets

Do not take Allegron tablets if

you are allergic (hypersensitive) to nortriptyline or any of the other ingredients of Allegron tablets (see list of ingredients in Section 6). An allergic reaction may include rash, itching, difficulty breathing or swelling of the face, lips, throat or tongue;

you have had a recent heart attack or

heartbeat disorder;

you have severe liver disease;

you suffer from mania (abnormally raised mood);

you are breast-feeding;

the child is under 6 years of age;

you are taking, or have taken in the last two weeks, monoamine oxidase inhibitors (another type of antidepressant); you are taking adrenaline-like drugs

including ephedrine, isoprenaline, noradrenaline, phenylephrine and phenylpropanolamine. These drugs are often contained in cough and cold remedies.

Take special care with Allegron tablets if you feel suicidal or aggressive - tell your doctor;

you are agitated, overactive, or suffer

from schizophrenia;

you have heart disease;

you have a thyroid condition;

you have a history of epilepsy;

you have high pressure in the eyes

(glaucoma);

you have an enlarged prostate; your child taking Allegron has a change in behaviour;

you are going to have electroconvulsive therapy (electric shock); you are diabetic;

you are going to receive an anaesthetic, e.g. for an operation - tell your doctor; you have had an allergic reaction to another tricyclic antidepressant in the

past;

you are pregnant, think you might be pregnant or planning to become pregnant or breast-feeding you should not take Allegron unless your doctor tells you to.

Thoughts of suicide and worsening of your depression or anxiety disorder

If you are depressed and/or have anxiety disorders you can sometimes have thoughts of harming or killing yourself. These may be increased when first starting antidepressants, since these medicines all take time to work, usually about two weeks but sometimes longer.

You may be more likely to think like this:

If you have previously had thoughts about killing or harming yourself;

If you are a young adult. Information from clinical trials has shown an increased risk of suicidal behaviour in adults aged less than 25 years with psychiatric conditions who were treated with an antidepressant.

If you have thoughts of harming or killing yourself at any time, contact your doctor or go to hospital straight away.

You may find it helpful to tell a relative or close friend that you are depressed or have an anxiety disorder, and ask them to read this leaflet. You might ask them to tell you if they think your depression or anxiety is getting worse, or if they are worried about changes in your behaviour.

If any of the above apply to you, tell your doctor or pharmacist.

Taking other medicines

You should tell your doctor if you are taking or have taken any medicines, including medicines obtained without a prescription.

The following medicines may interact with your Allegron tablets:

guanethidine, debrisoquine, bethanidine, clonidine (used to treat high blood pressure);

barbiturates (used for anxiety or to make you feel sleepy);

alcohol (you should not drink alcohol); fluoxetine (another antidepressant); cimetidine (for heartburn and ulcers); phenothiazines (for mental illness); carbamazepine (for epilepsy); propafenone, flecainide, encainide, quinidine (for heartbeat disorders).

It may still be all right for you to be given Allegron tablets. Your doctor will be able to decide what is suitable for you.

Driving and using machines

Allegron may affect alertness. Use caution when driving or operating heavy machinery until you’re aware of how this drug affects you. If you feel Allegron tablets affect your ability to drive or use machines, tell your doctor immediately.

Allegron tablets contain lactose. If you are lactose intolerant, contact your doctor before taking this medicine. Allegron 25mg tablets contain sunset yellow (E110), which may cause allergic reactions.

3 How to take Allegron tablets

Always take Allegron tablets exactly as your doctor has told you. You should check with your doctor or pharmacist if you are not sure. Dosage Adults:

The usual adult dose is 25mg three or four times daily or the dose may be given once a day, usually at night.

The dose should begin at a low level, 10mg, 3-4 times daily, for example and be increased gradually as required. The maximum dose is 150mg per day.

The elderly:

The usual dose is 30 to 50mg/day in divided doses. Treatment may start with 10mg three times a day.

Adolescent patients:

The usual dose is 30 to 50mg/day in divided doses. Treatment may start with 10mg three times a day.

Lower dosages are recommended for outpatients than for patients in hospital who will be underdose supervision.

Following remission maintenance treatment may be needed longer term. This should be at the lowest dose that stops the symptoms of depression coming back.

Children (for bed-wetting only)

Age (years)

Weight

kg

lb

Dose (mg)

6-7

20-25

44-55

10

8-11

25-35

55-77

10-20

Over 11

35-54

77-119 25-35

The dose should be given thirty minutes before bedtime.

The maximum length of treatment should be three months. Another course of treatment should not be started until a full physical examination has been made.

If you take more Allegron tablets than you should

Go to the nearest casualty department or contact your doctor immediately. Take the tablet carton with you.

If you forget to take Allegron tablets

If you miss a dose, take one as soon as you can. If you have missed several doses, tell your doctor. Do not take a double dose to make up for a forgotten dose.

If you stop taking Allegron

Do not stop taking the tablets or reduce the dose without telling your doctor first.

If you suddenly stop taking the tablets you may feel sick (nausea), have a headache or feel generally unwell.

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

4 Possible side effects

Like all medicines, Allegron tablets can cause side effects, although not everybody gets them. If any of the side effects gets serious, or if you notice any side effects not listed in this leaflet, please tell your doctor or pharmacist.

All medicines can cause allergic reactions, although serious allergic reactions are very rare.

Tell your doctor straight away if you get any sudden wheeziness, difficulty in breathing, swelling of the eyelids, face or lips, rash or itching, especially affecting your whole body.

The following side effects have been reported:

low or high blood pressure fast or irregular heartbeat palpitations

heart attack (myocardial infarction) stroke

oedema (swelling of the ankles) confusion (especially in the elderly) with seeing or hearing things (hallucinations) not knowing where you are (disorientation) false beliefs (delusions) anxiety, restlessness, agitation not sleeping (insomnia)

nightmares

panic

long-lasting abnormal mood worsening of mental illness numbness, tingling, pins and needles in the hands or feet coordination problems tremors

abnormal movements fits (seizures)

altered brainwave (ECG) patterns ringing in the ears (tinnitus) dry mouth

rarely, inflamed glands under the tongue or inflammation of the gums (gingivitis) blurred vision, difficulty in focusing, dilated pupils

constipation, blockage of the digestive tract

unable to urinate or delayed urination

rash

itching

light sensitivity swelling (oedema) fever

reaction to other similar drugs

blood disorders which may cause you to

bruise easily, become anaemic or be

unable to fight off infections

feeling sick (nausea) and vomiting

not eating (anorexia)

indigestion

diarrhoea

constipation

peculiar taste

inflamed mouth

abdominal cramps

black tongue

development of breasts in men, breast enlargement and milk production in women

increased or decreased sex drive failure to have an erection (impotence) swollen testicles altered blood sugar levels yellow eyes and skin (jaundice) altered liver function

inflamed liver (hepatitis) and liver damage

weight gain or loss

sweating

flushing

urinating often and at night

sleepiness

dizziness

weakness

tiredness

headache

swollen glands

hair loss (alopecia)

An increased risk of bone fractures has been observed in patients taking this type of medicine.

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: www.mhra.aov.uk/vellowcard.

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

5 How to store Allegron tablets

Keep all medicines out of the sight and reach of children.

Do not use the drug after the date indicated on the carton.

Medicines should not be disposed of via wastewater or household waste. Ask your pharmacist howto dispose of medicines no longer needed. These measures will help to protect the environment.

Allegron tablets are orange, round, scored on one side and plain on the other side.

Allegron tablets are available as blister packs containing 25, 50 and 100 tablets.

Manufactured by:

Auden McKenzie (Pharma Division) Ltd. McKenzie House,

Bury Street,

Ruislip, Middlesex,

HA4 7TL, UK.

Procured from within the EU & repackaged by Product Licence holder:

Kosei Pharma UK Ltd.,

956 Buckingham Avenue,

Slough Trading Estate,

Slough,

SL1 4NL, UK.

Allegron® 25mg Tablets PL 39352/0175

POM

Leaflet date: 09.03.2015    -

Allegron® is a registered trademark of Kings Pharmaceuticals Ltd, Ireland.

6 Further information

What Allegron 25mg Tablets contain

The active substance is nortriptyline hydrochloride.

Each tablet contains the equivalent of 25mg nortriptyline (as the hydrochloride).

The other ingredients are:

Lactose, Calcium Phosphate, Magnesium Stearate, Hydroxypropylmethylcellulose, Ethylcellulose, Starch, Sunset Yellow E110, Glycerin.

Nortriptyline 25mg Tablets

(nortriptyline hydrochloride)

Read all of this leaflet carefully before you start taking this medicine.

Keep this leaflet. You may need to read it again.

If you have any further questions, ask your doctor or pharmacist.

This medicine has been prescribed for you. Do not pass it on to others. It may harm them, even if their symptoms are the same as yours.

If any of the side effects gets serious, or if you notice any side effects not listed in this leaflet, please tell your doctor or pharmacist.

This medicine is also available in other strengths.

The name of your medicine is Nortriptyline 25mg Tablets, but it will be referred as Nortriptyline tablets throughout this leaflet.

In this leaflet:

1.    What Nortriptyline tablets are and what they are used for

2.    Before you take Nortriptyline tablets

3.    How to take Nortriptyline tablets

4.    Possible side effects

5.    How to store Nortriptyline tablets

6.    Further information

1    What Nortriptyline tablets are and what they are used for

Nortriptyline tablets contain the active ingredient nortriptyline hydrochloride, which is a tricyclic antidepressant. Nortriptyline relieves the symptoms of depression. Nortriptyline may also be used for the treatment of bed-wetting in children 6 years and older.

2    Before you take Nortriptyline tablets

Do not take Nortriptyline tablets if

you are allergic (hypersensitive) to nortriptyline or any of the other ingredients of Nortriptyline tablets (see list of ingredients in Section 6). An allergic reaction may include rash, itching, difficulty breathing or swelling of the face, lips, throat or tongue;

you have had a recent heart attack or

heartbeat disorder;

you have severe liver disease;

you suffer from mania (abnormally raised mood);

you are breast-feeding;

the child is under 6 years of age;

you are taking, or have taken in the last two weeks, monoamine oxidase inhibitors (another type of antidepressant); you are taking adrenaline-like drugs

including ephedrine, isoprenaline, noradrenaline, phenylephrine and phenylpropanolamine. These drugs are often contained in cough and cold remedies.

Take special care with Nortriptyline tablets if

you feel suicidal or aggressive - tell your doctor;

you are agitated, overactive, or suffer

from schizophrenia;

you have heart disease;

you have a thyroid condition;

you have a history of epilepsy;

you have high pressure in the eyes

(glaucoma);

you have an enlarged prostate; your child taking Nortriptyline has a change in behaviour;

you are going to have electroconvulsive therapy (electric shock); you are diabetic;

you are going to receive an anaesthetic, e.g. for an operation - tell your doctor; you have had an allergic reaction to another tricyclic antidepressant in the

past;

you are pregnant, think you might be pregnant or planning to become pregnant or breast-feeding you should not take Nortriptyline unless your doctor tells you to.

Thoughts of suicide and worsening of your depression or anxiety disorder

If you are depressed and/or have anxiety disorders you can sometimes have thoughts of harming or killing yourself. These may be increased when first starting antidepressants, since these medicines all take time to work, usually about two weeks but sometimes longer.

You may be more likely to think like this:

If you have previously had thoughts about killing or harming yourself;

If you are a young adult. Information from clinical trials has shown an increased risk of suicidal behaviour in adults aged less than 25 years with psychiatric conditions who were treated with an antidepressant.

If you have thoughts of harming or killing yourself at any time, contact your doctor or go to hospital straight away.

You may find it helpful to tell a relative or close friend that you are depressed or have an anxiety disorder, and ask them to read this leaflet. You might ask them to tell you if they think your depression or anxiety is getting worse, or if they are worried about changes in your behaviour.

If any of the above apply to you, tell your doctor or pharmacist.

Taking other medicines

You should tell your doctor if you are taking or have taken any medicines, including medicines obtained without a prescription.

The following medicines may interact with your Nortriptyline tablets:

guanethidine, debrisoquine, bethanidine, clonidine (used to treat high blood pressure);

barbiturates (used for anxiety or to make you feel sleepy);

alcohol (you should not drink alcohol); fluoxetine (another antidepressant); cimetidine (for heartburn and ulcers); phenothiazines (for mental illness); carbamazepine (for epilepsy); propafenone, flecainide, encainide, quinidine (for heartbeat disorders).

It may still be all right for you to be given Nortriptyline tablets. Your doctor will be able to decide what is suitable for you.

Driving and using machines

Nortriptyline may affect alertness. Use caution when driving or operating heavy machinery until you’re aware of how this drug affects you. If you feel Nortriptyline tablets affect your ability to drive or use machines, tell your doctor immediately.

Nortriptyline tablets contain lactose. If you are lactose intolerant, contact your doctor before taking this medicine. Nortriptyline 25mg tablets contain sunset yellow (E110), which may cause allergic reactions.

3 How to take Nortriptyline tablets

Always take Nortriptyline tablets exactly as your doctor has told you. You should check with your doctor or pharmacist if you are not sure.

Dosage

Adults:

The usual adult dose is 25mg three or four times daily or the dose may be given once a day, usually at night.

The dose should begin at a low level, 10mg, 3-4 times daily, for example and be increased gradually as required. The maximum dose is 150mg per day.

The elderly:

The usual dose is 30 to 50mg/day in divided doses. Treatment may start with 10mg three times a day.

Adolescent patients:

The usual dose is 30 to 50mg/day in divided doses. Treatment may start with 10mg three times a day.

Lower dosages are recommended for outpatients than for patients in hospital who will be underdose supervision.

Following remission maintenance treatment may be needed longer term. This should be at the lowest dose that stops the symptoms of depression coming back.

Children (for bed-wetting only)

Age (years)

Weight

kg

lb

Dose (mg)

6-7

20-25

44-55

10

8-11

25-35

55-77

10-20

Over 11

35-54

77-119 25-35

The dose should be given thirty minutes before bedtime.

The maximum length of treatment should be three months. Another course of treatment should not be started until a full physical examination has been made.

If you take more Nortriptyline tablets than you should

Go to the nearest casualty department or contact your doctor immediately. Take the tablet carton with you.

If you forget to take Nortriptyline tablets

If you miss a dose, take one as soon as you can. If you have missed several doses, tell your doctor. Do not take a double dose to make up for a forgotten dose.

If you stop taking Nortriptyline

Do not stop taking the tablets or reduce the dose without telling your doctor first.

If you suddenly stop taking the tablets you may feel sick (nausea), have a headache or feel generally unwell.

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

4 Possible side effects

Like all medicines, Nortriptyline tablets can cause side effects, although not everybody gets them. If any of the side effects gets serious, or if you notice any side effects not listed in this leaflet, please tell your doctor or pharmacist.

All medicines can cause allergic reactions, although serious allergic reactions are very rare.

Tell your doctor straight away if you get any sudden wheeziness, difficulty in breathing, swelling of the eyelids, face or lips, rash or itching, especially affecting your whole body.

The following side effects have been reported:

low or high blood pressure fast or irregular heartbeat palpitations

heart attack (myocardial infarction) stroke

oedema (swelling of the ankles) confusion (especially in the elderly) with seeing or hearing things (hallucinations) not knowing where you are (disorientation) false beliefs (delusions) anxiety, restlessness, agitation not sleeping (insomnia)

nightmares

panic

long-lasting abnormal mood worsening of mental illness numbness, tingling, pins and needles in the hands or feet coordination problems tremors

abnormal movements fits (seizures)

altered brainwave (ECG) patterns ringing in the ears (tinnitus) dry mouth

rarely, inflamed glands under the tongue or inflammation of the gums (gingivitis) blurred vision, difficulty in focusing, dilated pupils

constipation, blockage of the digestive tract

unable to urinate or delayed urination

rash

itching

light sensitivity swelling (oedema) fever

reaction to other similar drugs

blood disorders which may cause you to

bruise easily, become anaemic or be

unable to fight off infections

feeling sick (nausea) and vomiting

not eating (anorexia)

indigestion

diarrhoea

constipation

peculiar taste

inflamed mouth

abdominal cramps

black tongue

development of breasts in men, breast enlargement and milk production in women

increased or decreased sex drive failure to have an erection (impotence) swollen testicles altered blood sugar levels yellow eyes and skin (jaundice) altered liver function

inflamed liver (hepatitis) and liver damage

weight gain or loss

sweating

flushing

urinating often and at night

sleepiness

dizziness

weakness

tiredness

headache

swollen glands

hair loss (alopecia)

An increased risk of bone fractures has been observed in patients taking this type of medicine.

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: www.mhra.aov.uk/vellowcard.

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

5    How to store Nortriptyline tablets

Keep all medicines out of the sight and reach of children.

Do not use the drug after the date indicated on the carton.

Medicines should not be disposed of via wastewater or household waste. Ask your pharmacist howto dispose of medicines no longer needed. These measures will help to protect the environment.

6    Further information

What Nortriptyline 25mg Tablets contain

The active substance is nortriptyline hydrochloride.

Each tablet contains the equivalent of 25mg nortriptyline (as the hydrochloride).

The other ingredients are:

Lactose, Calcium Phosphate, Magnesium Stearate, Hydroxypropylmethylcellulose, Ethylcellulose, Starch, Sunset Yellow E110, Glycerin.

Nortriptyline tablets are orange, round, scored on one side and plain on the other side.

Nortriptyline tablets are available as blister packs containing 25, 50 and 100 tablets.

Manufactured by:

Auden McKenzie (Pharma Division) Ltd. McKenzie House,

Bury street, Ruislip,

Middlesex,

HA4 7TL, UK.

Procured from within the EU & repackaged by Product Licence holder:

Kosei Pharma UK Ltd.,

956 Buckingham Avenue,

Slough Trading Estate,

Slough,

SL1 4NL, UK.

Nortriptyline 25mg Tablets PL 39352/0175

POM

Leaflet date: 09.03.2015    -