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PACKAGE LEAFLET: INFORMATION FOR THE PATIENT

Azithromycin 200 mg/5 ml Powder for Oral Suspension

Azithromycin

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Read all of this leaflet carefully before you start taking this medicine because it contains important information for you.

•    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 only. Do not pass it on to others. It may harm them, even if their signs of illness are the same as yours.

•    If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. See section 4.

What is in this leaflet:

1.    What Azithromycin is and what it is used for

2.    What you need to know before you take Azithromycin

3.    How to take Azithromycin

4.    Possible side effects

5.    How to store Azithromycin

6.    Contents of the pack and other information

1. WHAT AZITHROMYCIN IS AND WHAT IT IS USED FOR

Azithromycin is an antibiotic. It belongs to a group of antibiotics called macrolides. It is used to treat infections caused by bacteria.

This medicine is usually prescribed to treat:

•    chest infections such as chronic bronchitis, pneumonia

•    infections of the tonsils, throat (pharyngitis) and sinuses

•    ear infections (acute otitis media)

•    skin and soft tissue infections, with exception of infected burn wounds

•    urethra and cervix infections caused by chlamydia.

2. BEFORE YOU NEED TO KNOW BEFORE YOU TAKE AZITHROMYCIN

Do not take Azithromycin if you are allergic (hypersensitive) to:

•    azithromycin

•    erythromycin

•    other macrolide or ketolide antibiotic

•    any of the other ingredients of this medicine (listed in section 6).

Warnings and precautions

Talk to your doctor or pharmacist before taking Azithromycin if you have:

•    Liver problems: your doctor may need to monitor your liver function or stop the treatment.

•    Kidney problems: if you have severe kidney problems, the dose may have to be adjusted.

•    Nervous (neurological) or mental (psychiatric) problems

•    Heart problems such as a

-    weak heart (heart failure),

-    very slow heart rate,

-    irregular heart beat, or

-    a condition called “long QT syndrome” (found by an electrocardiogram) since azithromycin may increase the risk of abnormal heart rhythm.

•    Low potassium or magnesium levels in your blood

•    Myasthenia gravis, a certain type of muscle weakness

Other medicines and Azithromycin

Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines. This includes any medicines obtained without a prescription.

It is especially important to mention that you take:

•    Theophylline (used to treat asthma): the effect of theophylline may be increased.

•    Blood-thinning medicines, such as warfarin, phenprocoumon:

concomitant use may increase the risk of bleeding. Your doctor may need to monitor more often the blood clotting parameters when Azithromycin is also being used.

•    Ergotamine, dihydroergotamine (used to treat migraine): ergotism (i.e. itching in the limbs, muscle cramps and gangrene of hands and feet due to poor blood circulation) may occur. Concomitant use is therefore not recommended.

•    Cyclosporin (used to suppress the immune system to prevent and treat rejection of an organ or bone marrow transplant): if concomitant use is required, your doctor will check cyclosporine levels in your blood and may adapt the dose.

•    Digoxin (used for heart failure):

concomitant use may increase digoxin levels. Your doctor will check its levels in your blood.

•    Antacids (used for indigestion):

may make azithromycin less effective when used concomitantly, see section 3.

•    Cisapride (used for stomach problems), terfenadine (used to treat hay fever), pimozide (used in some mental diseases), citalopram (used in depression), fluoroquinolones (antibiotics such as moxifloxacin and levofloxacin, used in bacterial infections):

concomitant use with azithromycin may cause heart disorders, therefore is not recommended.

•    Certain medicines for irregular heart beat (called anti-arrythmics, such as quinidine, amiodaron, sotalol). Concomitant use is not recommended.

-    Zidovudine (used to treat HIV infections): concomitant use can increase the risk of side effects.

•    Nelfinavir (used to treat HIV infections): concomitant use may increase the risk of side effects.

•    Alfentanil (used for narcosis) or astemizol (used to treat hay fever): concomitant use with azithromycin may increase the effect of these medicinal products.

•    Rifabutin (used to treat tuberculosis):

Your doctor may check your blood and blood levels of the medicines.

•    Statins (such as atorvastatin, used to lower lipids in blood): concomitant use may cause muscle disorders.

Azithromycin with food and drink

This medicine may be taken with or without food.

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 or any other medicine.

You should not use this medicine during pregnancy and when you are breast-feeding unless your doctor has specifically recommended it.

This medicine is excreted into human breast milk. So, you should stop breastfeeding until 2 days after you have finished taking this medicine.

Driving and using machines

Azithromycin is unlikely to impair the ability to drive and operate machinery.

However, if side effects like dizziness, sleepiness or convulsions occur, be careful when driving or operating machinery.

Azithromycin contains sucrose and aspartame

This medicine contains 3.7 gram sucrose per 5 ml suspension. This should be taken into account in patients with diabetes mellitus.

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

This medicine contains aspartame. This is a source of phenylalanine and may be harmful for people with phenylketonuria.

3. HOWTO TAKE AZITHROMYCIN

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

Adults and children weighing more than 45 kg:

Azithromycin is taken as a 3 or 5 day course

•    3 day course: Take 12.5 ml (500 mg) once each day

•    5 day course:

-    Take 12.5 ml (500 mg) on Day 1

-    Take 6.25 ml (250 mg) on Days 2, 3, 4 and 5

For urethra and cervix infections caused by Chlamydia, it is taken as a 1 day course:

•    1 day course: 25 ml (1,000 mg).

The dosage for the treatment of sore throat is an exception. Your doctor may prescribe a different dosage.

Children weighing less than 45 kg:

Azithromycin is not suitable for use in children under the age of 1 year.

Azithromycin is taken as a 3 or 5 day course. The daily amount is worked out according to the weight of the child.

The following tables provide a guide to usual doses:

3-day therapy

5-day therapy

Patients with kidney or liver problems

You should tell your doctor if you have kidney or liver problems as your doctor may need to alter the normal dose.

Dosage for elderly

For elderly the same dosage as for adults applies.

Take this medicine once daily. You may take it with or without food.

A bitter after-taste can be avoided by drinking fruit juice directly after swallowing.

Taking Azithromycin with medicines for indigestion

If you need to take a medicine for indigestion, such as an antacid, take Azithromycin at least one hour before or two hours after the antacid.

How to measure the dose

A 10 ml syringe marked at each 0.25 ml is provided with this medicine. It comes with an adaptor which fits onto the bottle.

To measure the medicine:

•    Shake the bottle

•    Put the adaptor into the mouth of the bottle

•    Put the end of the syringe into the adaptor

•    Turn the bottle upside-down

•    Pull the plunger to measure the dose you need

•    Turn the bottle upright, remove the syringe, leave the adaptor on the bottle and close the bottle.

Ask you doctor or pharmacist if you need advice on how to measure out the medicine.

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Giving the medicine using the syringe

•    Make sure the child is supported in an upright position

•    Put the tip of the syringe carefully into the child's mouth. Point the tip of the syringe towards the inside of the cheek

•    Slowly push down the plunger of the syringe: Do not squirt it out quickly. The medicine will trickle into the child's mouth

•    Allow the child time to swallow the medicine.

How to prepare this medicine

A doctor, nurse or pharmacist will prepare this medicine for you. To open the medicine bottle, you need to press the childproof top down and then turn it.

If you need to prepare this medicine yourself, you should shake the dry powder loose and add the right amount of cold water. With the 10 ml syringe you can measure the right amount of water. The right amount of water depends on the bottle size and is provided below:

•    For 15 ml suspension (600 mg) add 8.0 ml of water

•    For 20 ml suspension (800 mg) add 10.5 ml of water

• For 22.5 ml suspension (900 mg) add 11 ml of water

• For 30 ml suspension (1,200 mg) add 15 ml of water

•    For 37.5 ml suspension (1,500 mg) add 18.5 ml of water

Shake the bottle well as soon as you have added the right amount of water. You only need to prepare the suspension once, at the beginning of your course.

If you take more Azithromycin than you should

If you take too much you may feel or be sick. You also may experience other side effects such as temporary deafness and diarrhoea. Tell your doctor or talk to your nearest hospital casualty department immediately. If possible, take your medicine with you to show the doctor what you have taken.

If you forget to take Azithromycin

If you forgot to take a dose, take it as soon as possible. Then go on as before. Do not take more than one dose in a single day.

If you stop taking Azithromycin

Always keep taking the oral suspension until the course is finished, even if you feel better. If you stop taking the oral suspension too soon, the infection may come back. Also, the bacteria may become resistant to the medicine and will then be more difficult to treat.

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.

Serious side effects:

If you have any of the following symptoms of a severe allergic reaction stop taking this medicine and tell your doctor immediately or go to the casualty department at your nearest hospital:

•    Sudden difficulty in breathing, speaking and swallowing

•    Swelling of the lips, tongue, face and neck

•    Extreme dizziness or collapse

•    Severe or itchy skin rash, especially if this shows blistering and there is soreness of the eyes, mouth or genital organs.

If you experience any of the following side effects contact your doctor as soon as possible:

•    Diarrhea that is serious, lasts a long time or has blood in it, with stomach pain or fever. This can be a sign of a serious bowel inflammation that can rarely happen after taking antibiotics

•    Yellowing of the skin or whites of the eyes caused by liver problems

•    Inflammation of the pancreas, which causes severe pain in the abdomen and back

•    Increased or reduced urine output, or traces of blood in your urine

•    Skin rash caused by sensitivity to sunlight

•    Unusual bruising or bleeding

•    Irregular heart beat.

These are all serious side effects. You may need urgent medical attention. Serious side effects are uncommon (may affect up to 1 in 100 people), rare (may affect up to 1 in 1,000 people), or the frequency cannot be estimated from the available data.

Other possible side effects:

Very common side effects (may affect more than 1 in 10 people):

•    diarrhea.

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

•    headache

•    nausea, vomiting, abdominal pain

•    changes in number of white blood cells (low numbers of lymphocytes, higher number of eosinophils, higher number of basophils, monocytes and neutrophils

•    decreased blood bicarbonate (what indicates too much acidic substances in blood).

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

•    Yeast and bacterial infections especially of the mouth, throat, nose, lung, stomach, bowel and vagina

•    Changes in number of white blood cells (low numbers of leukocytes, low number of neutrophils, higher number of eosinophils)

•    Swelling, allergic reactions of various severity

•    Loss of appetite (anorexia)

•    Nervousness, drowsiness, sleeplessness, dizziness, taste disturbance, tingling or numbness of the hands and/or feet

•    Visual disturbances

•    impaired hearing, spinning sensation (vertigo)

•    Pounding heart beat

•    Feeling of intense heat with sweating and rapid heartbeat (hot flush)

•    difficulty breathing, nose bleeds

•    constipation wind, indigestion, inflammation of the stomach, difficulty in swallowing, bloating, dry mouth, eructation, mouth sores, increased formation of saliva

•    Skin rash, itching, hives, skin inflammation, dry skin, sweating

•    Bones and joint inflammation, muscle, back and neck pains

•    difficulty and pain when passing urine, kidney pain

•    uterine bleeding, testis disorder

•    skin swelling, weakness, generally feeling unwell, tiredness, swelling of the face, chest pain, fever, pain, swelling of extremities

•    abnormal laboratory test values (e.g. blood, liver and kidney function test results).

•    post procedural complications

•    abnormal liver function

•    sensitivity to sunlight.

Not known (frequency cannot be estimated from the available data)

•    Low level of red blood cells which can make the skin pale yellow and cause weakness or breathlessness

•    Reduction in blood platelets, which increases risk of bleeding or bruising

•    Severe allergic reaction

•    Aggression, anxiety, severe confusion, hallucination

•    Fainting, fits, decreased skin sensitivity, feeling hyperactive, disturbed sense of smell, loss of sense of smell or taste, muscle weakness (myasthenia)

•    Poor hearing, deafness or ringing in the ears

•    Arrhythmia, abnormal electrocardiogram (ECG)

•    Low blood pressure

•    Tongue discolouration

•    Hepatic failure, serious liver inflammation

•    Joint pain

•    Renal failure, renal inflammation.

The following side effects have been reported in prophylaxis and treatment against Mycobacterium Avium Complex MAC):

Very common side-effects (may affect more than 1 in 10 people):

•    Diarrhea

•    Abdominal pain

•    Feeling sick (nausea)

•    Loose wind (flatulence)

•    Abdominal discomfort

•    Loose stools

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

•    Lack of appetite (anorexia)

•    Feeling dizzy (dizziness)

•    Headache

•    Sensations of pins and needles or numbness (paraesthesia)

•    Changes in your sense of taste (dysgeusia)

•    Visual impairment

•    Deafness

•    Skin rashes

•    Itching (pruritus)

•    Joint pain (arthralgia)

•    Fatigue

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

•    Reduced sense of touch (hypoesthesia)

•    Hearing impairment or ringing in your ears

•    Abnormality of the rhythm or rate and awareness of the heart beat (palpitations)

•    Liver problems such as hepatitis

•    Blisters/bleeding of the lips, eyes, nose, mouth and genitals, which may be caused by Stevens-Johnson syndrome

•    Allergic skin reactions such as being sensitive to sunlight, red, flaking and swollen skin

•    Weakness (asthenia)

•    General feeling of being unwell (malaise)

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: www.mhra.gov.uk/yellowcard. By reporting side effects you can help provide more information on the safety of this medicine.

5. HOW TO STORE AZITHROMYCIN

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 package after "Do not use after:" or “Exp.:”. The expiry date refers to the last day of that month.

Do not store the unopened bottle with dry powder at a temperature above 30°C.

Do not store Azithromycin suspension at a temperature above 25°C.

Do not use the reconstituted Azithromycin suspension later than 10 days.

If you get the suspension from the pharmacy: do not use later than 10 days after the date of issue. The date of issue is on the pharmacy’s label.

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 to protect the environment.

6. CONTENTS OF THE PACK AND OTHER INFORMATION

What Azithromycin contains

•    The active substance is azithromycin monohydrate equivalent to 200 mg azithromycin per 5 ml

•    The other ingredients (additives) are: sucrose, xanthan gum (E415) hydroxypropylcellulose, anhydrous trisodium phosphate, anhydrous colloidal silica, aspartame (E951), cream caramel flavour, titanium dioxide (E171).

What Azithromycin looks like and contents of the pack

Azithromycin is a white or off-white crystalline powder.

After reconstitution a white to off white coloured, homogenous suspension exists.

Azithromycin 200 mg/5 ml Powder for Oral Suspension is available in HDPE bottles with a PP/PE closure with retaining ring containing 15, 20, 22.5, 30 and 37.5 ml after reconstitution.

A plastic dosage syringe (10 ml), graduated in 0.25 ml divisions is also included.

Not all pack sizes may be marketed.

Marketing Authorisation Holder and Manufacturer

Marketing authorisation Holder: Sandoz Ltd, Frimley Business Park, Frimley, Camberley, Surrey, GU16 7SR, UK.

Manufacturer:

Sandoz S.R.L., Str. Livenzeni nr. 7A, 540472 Targu Mures, Romania or Lek Pharmaceuticals d.d., Verovskova 57,

1526 Ljubljana, Slovenia or Salutas Pharma GmbH, Otto-von-Guericke-Allee 1,39179 Barleben, Germany.

Rare side-effects (may affect up to 1 in 1,000 people): • agitation

This leaflet was last revised in 05/2015.

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