Ropinirole 2 Mg Film-Coated Tablets
SUMMARY OF PRODUCT CHARACTERISTICS
1 NAME OF THE MEDICINAL PRODUCT
Ropinirole 2mg Film-Coated Tablets
2 QUALITATIVE AND QUANTITATIVE COMPOSITION
Each film-coated tablet contains 2.28 mg ropinirole hydrochloride, equivalent to 2 mg ropinirole
Excipient(s) with known effect:
Lactose and lecithin (soya) E322:
103.19 mg lactose & 0.1575 mg lecithin
For the full list of excipients, see section 6.1.
3 PHARMACEUTICAL FORM
Film-coated tablet
Pink, round slightly arched film-coated tablets, debossed “R 2” on one side and plain on the other.
4 CLINICAL PARTICULARS
4.1 Therapeutic indications
Ropinirole is indicated for:
• The treatment Parkinson’s disease under the following conditions:
• Initial treatment as monotherapy, in order to delay the introduction of levodopa.
• In combination with levodopa, over the course of the disease, when the effect of levodopa wears off or becomes inconsistent and fluctuations in the therapeutic effect occur ("end of dose" or "on-off" type fluctuations).
• The symptomatic treatment of moderate to severe idiopathic Restless Legs Syndrome (see section 5.1).
4.2 Posology and method of administration
Posology
Adults
Parkinson’s Disease
Ropinirole should be taken three times a day (t.i.d.), preferably with meals to improve gastrointestinal tolerance.
Treatment initiation
The initial dose should be 0.25 mg three times daily for 1 week. Thereafter, the dose can be increased in 0.25 mg t.i.d increments, according to the following regimen.
Week
|
1 |
2 |
3 |
4 | |
|
Unit dose (mg) |
0.25 |
0.5 |
0.75 |
1.0 |
|
Total daily dose (mg) |
0.75 |
1.5 |
2.25 |
3.0 |
Therapeutic regimen
After the initial titration, weekly increments of 0.5 to 1 mg t.i.d (1.5 to 3 mg/day) of ropinirole may be given.
A therapeutic response may be seen between 3 and 9 mg/day of ropinirole. If sufficient symptomatic control is not achieved, or maintained after the initial titration as described above the dose of ropinirole may be increased up to a maximum of 24 mg/day.
Doses above 24 mg/day have not been studied.
If treatment is interrupted for one day or more re-initiation by dose titration should be considered (see above).
When ropinirole is administered as adjunct therapy to Levodopa, the concurrent dose of Levodopa may be reduced gradually according to the symptomatic response. In clinical trials, the levodopa dose was reduced gradually by around 20% in patients treated with ropinirole as adjunct therapy.. In patients with advanced Parkinson's disease receiving ropinirole in combination with Levodopa, dyskinesias can occur during the initial titration of ropinirole. In clinical trials it was shown that a reduction of the Levodopa dose may ameliorate dyskinesia (see also section 4.8).
When switching treatment from another dopamine agonist to ropinirole, the manufacturer's guidance on discontinuation should be followed before initiating ropinirole.
As with other dopamine agonists, it is necessary to discontinue ropinirole treatment gradually by reducing the number of daily doses over the period of one week.
For doses not realisable/practicable with this medicinal product other strengths of this medicinal product are available
Restless Legs Syndrome
Ropinirole should be taken just before bedtime; however the dose can be taken up to 3 hours before retiring. Ropinirole may be taken with food, to improve gastrointestinal tolerance.
Treatment initiation (week 1)
The recommended initial dose is 0.25 mg once daily for 2 days (administered as above). If this dose is well tolerated the dose should be increased to 0.5 mg once daily for the remainder of week 1.
Therapeutic regimen (week 2 onwards)
Following treatment initiation, the daily dose should be increased until optimal therapeutic response is achieved. The average dose in clinical trials, in patients with moderate to severe Restless Legs Syndrome, was 2 mg once a day.
The dose may be increased to 1 mg once a day at week 2. The dose may then be increased by 0.5 mg per week over the next two weeks to a dose of 2 mg once a day. In some patients, to achieve optimal improvement, the dose may be increased gradually up to a maximum of 4 mg once a day. In clinical trials the dose was increased by 0.5 mg each week to 3 mg once a day and then by 1 mg up to the maximum recommended dose of 4 mg once a day as shown in the following table.
Doses above 4 mg once daily have not been investigated in Restless Legs Syndrome patients.
|
Week |
2 |
3 |
4 |
5* |
6* |
7* |
|
Dose (mg)/once daily |
1.0 |
1.5 |
2.0 |
2.5 |
3.0 |
4.0 |
* To achieve optimal improvement in some patients.
The efficacy of ropinirole treatment has not been shown beyond 12 weeks (see Section 5.1). Patient response should be evaluated after 12 weeks treatment and the need for treatment continuation reconsidered. If treatment is interrupted for more than a few days it should be re-initiated by dose titration as noted above.
The patient's response to ropinirole should be evaluated after 3 months treatment (see section 5.1). At this time the dose prescribed and the need for continued treatment should be considered. If treatment is interrupted for more than a few days it should be reinitiated by dose titration carried out as above.
General information for all therapeutic indications
Renal impairment:
In patients with mild to moderate renal impairment (creatinine clearance 30-50 ml/min) no change in the clearance of ropinirole was observed, indicating that no dosage adjustment is necessary in this population.
The use of ropinirole in patients with severe renal impairment (creatinine clearance less than 30 ml/min) without regular haemodialysis has not been studied.
Parkinson’s disease
A study into the use of ropinirole in patients with end stage renal disease (patients on haemodialysis) has shown that a dose adjustment in these patients is required as follows: the initial dose of ropinirole should be 0.25 mg three times a day. Further dose escalations should be based on tolerability and efficacy. The recommended maximum dose is 18 mg/day in patients receiving regular haemodialysis. Supplemental doses after haemodialysis are not required (see section 5.2).
Restless Legs Syndrome
A study into the use of ropinirole in patients with end stage renal disease (patients on haemodialysis) has shown that a dose adjustment in these patients is required as follows: the recommended initial dose of ropinirole is 0.25 mg once daily. Further dose escalations should be based on tolerability and efficacy. The recommended maximum dose of ropinirole is 3 mg/day in patients receiving regular haemodialysis. Supplemental doses after haemodialysis are not required (see section 5.2).
Older people:
The clearance of ropinirole is decreased by approximately 15% in patients aged 65 years or above. Although a dose adjustment is not required, ropinirole dose should be individually titrated, with careful monitoring of tolerability, to the optimal clinical response.
Children and Adolescents
Ropinirole is not recommended for use in children below 18 years due to a lack of data on safety and efficacy.
Method of administration
For oral use.
Individual dose titration against efficacy and tolerability is recommended.
4.3 Contraindications
Hypersensitivity to ropinirole, soya, peanut or to any of the excipients listed in section 6.1.
Severe renal impairment (creatinine clearance <30 ml/min) without regular haemodialysis.
Hepatic impairment.
Patients with major psychiatric or psychotic disorders, or a history of these disorders, should only be treated with dopamine agonists if the potential benefits outweigh the risks.
Ropinirole should not be used to treat neuroleptic akathisia, tasikinesia (neuroleptic-induced compulsive tendency to walk), or secondary Restless Legs Syndrome (e.g. caused by renal failure, iron deficiency anaemia or pregnancy).
Paradoxical worsening of Restless Legs Syndrome symptoms occurring with earlier onset (augmentation), and reoccurrence of symptoms in the early morning hours (early morning rebound)have been observed during treatment with ropinirole. If this occurs, the adequacy of ropinirole treatment should be reviewed and dosage adjustment or discontinuation of treatment may be considered (see section 4.8).
In Parkinson's disease, ropinirole has been associated uncommonly with somnolence and episodes of sudden sleep onset (see section 4.8) however, in Restless Legs Syndrome, this phenomenon is very rare. Sudden onset of sleep during daily activities, in some cases without awareness or warning signs, has been reported uncommonly. Patients must be informed of this phenomenon and advised to exercise caution while driving or operating machines during treatment with ropinirole. Patients who have experienced somnolence and/or an episode of sudden sleep onset must refrain from driving or operating machines. Furthermore, a reduction of dosage or termination of therapy may be considered.
Impulse control disorders
Patients should be regularly monitored for the development of impulse control disorders. Patients and carers should be made aware that behavioural symptoms of impulse control disorders including pathological gambling, hypersexuality, increased libido compulsive spending or buying, binge eating and compulsive eating can occur in patients treated with dopamine agonists including Ropinirole Teva (see section 4.8). Dose reduction/tapered discontinuation should be considered if such symptoms develop.
Due to the risk of hypotension, blood pressure monitoring is recommended, particularly at the start of treatment, in patients with severe cardiovascular disease (in particular coronary insufficiency).
This medicinal product contains lactose. Patients with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption should not take this medicine.
4.5 Interaction with other medicinal products and other forms of interaction
Neuroleptics and other centrally active dopamine antagonists, such as sulpiride or metoclopramide, may diminish the effectiveness of ropinirole and, therefore, concomitant use of these drugs with ropinirole should be avoided.
There is no pharmacokinetic interaction between ropinirole and L-dopa or domperidone which would necessitate dosage adjustment of these medicinal products. Domperidone antagonises the dopaminergic actions of ropinirole peripherally and does not cross the blood-brain barrier. Hence its value as an anti-emetic in patients treated with centrally acting dopamine agonists.
Ropinirole is principally metabolised by the cytochrome P450 isoenzyme CYP1A2. A pharmacokinetic study (with a ropinirole dose of 2 mg, three times a day in patients with Parkinson's disease revealed that ciprofloxacine increased the Cmax and AUC of ropinirole by 60% and 84% respectively, with a potential risk of adverse events. Hence, in patients already receiving ropinirole, the dose of ropinirole may need to be adjusted when medicinal products known to inhibit CYP1A2, e.g. ciprofloxacine, enoxacin or fluvoxamine, are introduced or withdrawn.
A pharmacokinetic interaction study in patients with Parkinson's disease between ropinirole (at a dose of 2mg, three times a day) and theophylline, a substrate of CYP1A2, revealed no change in the pharmacokinetics of either ropinirole or theophylline.
Increased plasma concentrations of ropinirole have been observed in patients treated with high doses of oestrogens. In patients already receiving hormone replacement therapy (HRT), ropinirole treatment may be initiated in the normal manner. However, if HRT is stopped or introduced during treatment with ropinirole, dosage adjustment may be required, in accordance with clinical response.
Based on in-vitro data, ropinirole has little potential to inhibit cytochrome P450 at therapeutic doses. Hence, ropinirole is unlikely to affect the pharmacokinetics of other medicinal products, via a cytochrome P450 mechanism.
Smoking is known to induce CYP1A2 metabolism, therefore if patients stop or start smoking during treatment with ropinirole, dose adjustment maybe required.
4.6 Fertility, pregnancy and lactation
There are no adequate data from the use of ropinirole in pregnant women.
Studies in animals have shown reproductive toxicity (see section 5.3). As the potential risk for humans is unknown, it is recommended that ropinirole is not used during pregnancy unless the potential benefit to the patient outweighs the potential risk to the foetus.
Ropinirole should not be used in nursing mothers as it may inhibit lactation.
4.7 Effects on ability to drive and use machines
Patients being treated with ropinirole and presenting with dizziness (including vertigo), somnolence and/or sudden sleep episodes must be informed to refrain from driving or engaging in activities where impaired alertness may put themselves or others at risk of serious injury or death (e.g. operating machines) until such recurrent episodes and somnolence have resolved (see also Section 4.4).
4.8 Undesirable effects
Undesirable effects are listed below by system organ class and frequency. Frequencies from clinical trials are determined as excess incidence over placebo and are defined as: very common (>1/10), common (>1/100 to <1/10), uncommon (>1/1,000 to <1/100), rare (>1/10,000 to <1/1,000), very rare (<1/10,000), not known (cannot be estimated from the available data).
Within each frequency grouping, undesirable effects are presented in order of decreasing seriousness.
Restless Legs Syndrome
In Restless Legs Syndrome clinical trials the most common adverse drug reaction was nausea (approximately 30% of patients). Undesirable effects were normally mild to moderate and experienced at the start of therapy or on increase of dose and few patients withdrew from the clinical studies due to undesirable effects.
Table below lists the adverse drug reactions reported for ropinirole in the 12 week clinical trials at >1% above the placebo rate or those reported uncommonly but known to be associated with ropinirole (ropinirole n=309, placebo n=307).
Organ class
Frequency
|
Organ Class System |
Frequency | ||
|
Very Common (>1/10) |
Common (>1/100 to <1/10) |
Uncommon (>1/1,000 to <1/100) | |
|
Nervous system disorders |
Syncope, somnolence and dizziness (including vertigo) | ||
|
Gastro-intestinal disorders |
Vomiting and nausea |
Abdominal pain | |
|
Vascular disorders |
Postural hypotension and hypotension | ||
|
General disorders and administration site conditions |
Fatigue | ||
|
Psychiatric disorders |
Nervousness |
Confusion | |
Adverse drug reactions reported in other Restless Legs Syndrome clinical trials
|
system |
Common (>1/100 to <1/10) |
Uncommon (>1/1,000 to <1/100) |
|
Psychiatric Disorders |
Halluciantions | |
|
Nervous system disorders |
Augmentation, Early morning rebound (see section 4.4) |
Management of undesirable effects
Dose reduction should be considered if patients experience significant undesirable effects. If the undesirable effect abates, gradual up-titration can be re-instituted. Anti-nausea medicinal products that are not centrally active dopamine antagonists, such as domperidone, may be used, if required.
Post marketing reports
Hypersensitivity reactions (including urticaria, angioedema, rash, pruritus).
Psychotic reactions (other than hallucinations) including delirium, delusion, paranoia have been reported.
Impulse control disorders including pathological gambling and hypersexuality, and increased libido, have been reported (see section 4.4).
In Parkinson’s disease, ropinirole is associated with somnolence and has been associated uncommonly (>1/1,000 to <1/100) with excessive daytime somnolence and sudden sleep onset episodes, however, in Restless Legs Syndrome, this phenomenon is very rare (<1/10,000).
Following ropinirole therapy, postural hypotension or hypotension has been reported uncommonly (>1/1,000 to <1/100), rarely severe.
Very rare cases of hepatic reactions (<1/10,000), mainly increase of liver enzymes, have been reported.
Parkinson’s Disease
|
Monotherap y or Adjunct therapy |
Frequency | ||||
|
Organ Class System |
Very Common (>1/10) |
Common (>1/100 to <1/10) |
Uncommon (>1/1,000 to <1/100) |
Not known | |
|
Immune system disorders |
Both |
Hypersen sitivity reactions (includin g urticaria, angioede ma, rash, pruritus) | |||
|
Nervous system disorders |
Both |
Somnolence |
Dizziness (including vertigo) |
Excessive daytime somnolence and sudden onset of sleep episodes | |
|
Monotherap y |
Syncope | ||||
|
Adjunct therapy |
Dyskinesia* | ||||
|
Gastro intestinal disorders |
Both |
Nausea |
Heartburn | ||
|
Monotherap y |
Vomiting, abdominal pain | ||||
|
Vascular disorders |
Both |
Postural hypotension and hypotension (rarely severe) | |||
|
General disorders and administratio n site conditions |
Monotherap y |
Leg oedema | |||
|
Heptobiliary disorders |
Both |
Hepatic reactions, mainly increased liver enzymes |
|
Psychiatric disorders |
Both |
Hallucinations |
Psychotic reactions (other than hallucinations) including delirium, delusion, and paranoia, Increased libido | ||
|
Adjunct therapy |
Confusion | ||||
|
Both: Monot |
herapy and adjunct therapy | ||||
* In patients with advanced Parkinson's disease, dyskinesias can occur during the initial titration of ropinirole. In clinical trials it was shown that a reduction of the levodopa dose may ameliorate dyskinesia (see section 4.2)
Impulse control disorders
Pathological gambling, hypersexuality and increased libido, compulsive spending or buying, binge eating and compulsive eating can occur in patients treated with dopamine agonists including Ropinirole (see section 4.4).
Lecithin (soya) may cause very rarely allergic reactions.
Reporting of suspected adverse reactions
Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via the Yellow Card Scheme at: www.mhra.gov.uk/yellowcard.
4.9 Overdose
There have been no incidences of intentional overdose with ropinirole in clinical trials. It is anticipated that the symptoms of ropinirole overdose will be related to its dopaminergic activity. These symptoms may be alleviated by appropriate treatment with dopamine antagonists such as neuroleptics or metoclopramide.
5 PHARMACOLOGICAL PROPERTIES
5.1 Pharmacodynamic properties
Pharmacotherapeutic group: Dopaminergic agents, dopamine agonists;
ATC code: N04BC04
Ropinirole is a non-ergoline D2/D3 dopamine agonist, which stimulates striatal dopamine receptors.
Ropinirole alleviates the dopamine deficiency which characterises Parkinson's disease by stimulating striatal dopamine receptors.
Ropinirole acts in the hypothalamus and pituitary to inhibit the secretion of prolactin. Clinical efficacy in Restless Legs Syndrome
Ropinirole should only be prescribed to patients with moderate to severe idiopathic Restless Legs Syndrome. Moderate to severe idiopathic Restless Legs Syndrome is typically represented by patients who suffer with insomnia or severe discomfort in the limbs.
In the four 12-week efficacy studies, patients with Restless Legs Syndrome were randomised to ropinirole or placebo, and the effects on the IRLS scale scores at week 12 were compared to baseline. The mean dose of ropinirole for the moderate to severe patients was 2.0 mg/day. In a combined analysis of moderate to severe Restless Legs Syndrome patients from the four 12-week studies, the adjusted treatment difference for the change from baseline in IRLS scale total score at week 12 Last Observation Carried Forward (LOCF) Intention To Treat population was -4.0 points (95% CI -5.6, -2.4, p<0.0001; baseline and week 12 LOCF mean IRLS points: ropinirole 28.4 and 13.5; placebo 28.2 and 17.4).
A 12-week placebo-controlled polysomnography study in Restless Legs Syndrome patients examined the effect of treatment with ropinirole on periodic leg movements of sleep. A statistically significant difference in the periodic leg movements of sleep was seen between ropinirole and placebo from baseline to week 12.
Although sufficient data are not available to adequately demonstrate the long term efficacy of ropinirole in Restless Legs Syndrome (see section 4.2), in a 36-week study, patients who continued on ropinirole demonstrated a significantly lower relapse rate compared with patients randomised to placebo (33% versus 58%, p=0.0156).
A combined analysis of data from moderate to severe Restless Legs Syndrome patients, in the four 12-week placebo-controlled studies, indicated that ropinirole-treated patients reported significant improvements over placebo on the parameters of the Medical Outcome Study Sleep Scale (scores on 0-100 range except sleep quantity). The adjusted treatment differences between ropinirole and placebo were: sleep disturbance (-15.2, 95% CI -19.37, -10.94; p<0.0001), sleep quantity (0.7 hours, 95% CI 0.49, 0.94); p<0.0001), sleep adequacy (18.6, 95% CI 13.77, 23.45; p<0.0001) and daytime somnolence (-7.5, 95% CI -10.86, -4.23; p<0.0001).
Long term efficacy was evaluated in a randomised, double-blind, placebo-controlled clinical trial of 26 weeks. Overall results were difficult to interpret due to significant centre treatment interaction and the high proportion of missing data. No maintenance of efficacy at 26 weeks compared to placebo could be shown.
Study of the effect of ropinirole on cardiac repolarisation
A thorough QT study conducted in male and female healthy volunteers who received doses of 0.5, 1, 2 and 4 mg of ropinirole film-coated (immediate release) tablets once daily showed a maximum increase of the QT interval duration at the 1 mg dose of 3.46 milliseconds (point estimate) as compared to placebo. The upper bound of the one sided 95% confidence interval for the largest mean effect was less than 7.5 milliseconds. The effect of ropinirole at higher doses has not been systematically evaluated.
The available clinical data from a thorough QT study do not indicate a risk of QT prolongation at doses of ropinirole up to 4 mg/day. A risk of QT prolongation cannot be excluded as a thorough QT study at doses up to 24 mg/day has not been conducted.
5.2 Pharmacokinetic properties
Absorption
Bioavailability of ropinirole is approximately 50% (36-57%). Oral absorption of ropinirole film-coated (immediate-release) tablets is rapid with peak concentrations achieved at a median time of 1.5 hours post-dose. A high fat meal decreases the rate of absorption or ropinirole, as shown by a delay in median Tmax by 2.6 hours and an average 25% decrease in Cmax.
Distribution
Consistent with its high lipophilicity, ropinirole exhibits a large volume of distribution (approx. 7 l/kg). Plasma protein binding of the drug is low (10-40%).
Metabolism
Ropinirole is primarily cleared by the cytochrome P450 enzyme, CYP1A2, and its metabolites are mainly excreted in the urine. The major metabolite is at least 100 times less potent than ropinirole in animal models of dopaminergic function.
Biotransformation
Ropinirole is cleared from the systemic circulation with an average elimination halflife of approximately 6 hours. The increase in systemic exposure (Cmax and AUC) to ropinirole is approximately proportional over the therapeutic dose range. No change in the oral clearance of ropinirole is observed following single and repeated oral administration. Wide inter-individual variability in the pharmacokinetic parameters has been observed.
Population-related characteristics
Older _ people
Oral clearance of ropinirole is reduced by approximately 15% in older people (65 years or above) compared to younger patients. Dosage adjustment is not necessary in older people.
Renal Impairment
In patients with mild to moderate renal impairment (creatinine clearance between 30 and 50 ml/min), no change in the pharmacokinetics of ropinirole is observed.
In patients with end stage renal disease receiving regular haemodialysis, oral clearance of ropinirole is reduced by approximately 30%. Oral clearance of the metabolites SKF-104557 and SKF-89124 were also reduced by approximately 80% and 60%, respectively.
Parkinson’s disease
The recommended maximum dose is limited to 18mg/day in these patients with Parkinson's disease (see section 4.2).
Restless Legs Syndrome
The recommended maximum dose is limited to 3 mg/day in these patients with RLS (see section 4.2).
Paediatric _population examined_ for Restless Legs Syndrome
Limited pharmacokinetic data obtained in adolescents (12-17 years, n=9) showed that the systemic exposure following single doses of 0.125 mg and 0.25 mg was similar to that observed in adults (see also section 4.2; subparagraph “Children and adolescents”)
5.3 Preclinical safety data
Reproductive Toxicity
Administration of ropinirole to pregnant rats at maternally toxic doses resulted in decreased foetal body weight at 60 mg/kg/day (approximately twice or 15 times the AUC at the maximum dose in humans for the respective indications), increased foetal death at 90 mg/kg/day (approximately 3 times or 25 times the AUC at the maximum dose in humans for the respective indications) and digit malformations at 150 mg/kg/day (approximately 5 times or 40 times the AUC at the maximum dose in humans for the respective indications). There were no teratogenic effects in the rat at 120 mg/kg/day (approximately 4 times or 30 times the AUC at the maximum dose in humans for the respective indications) and no indication of an effect on development in the rabbit.
Toxicology
The toxicology profile is principally determined by the pharmacological activity of the drug: behavioural changes, hypoprolactinaemia, decrease in blood pressure and heart rate, ptosis and salivation. In the albino rat only, retinal degeneration was observed in a long term study at a high dose (50 mg/kg), probably associated with an increased exposure to light.
Genotoxicity
Genotoxicity was not observed in the usual battery of in vitro and in vivo tests. Carcinogenicity
From two-year studies conducted in the mouse and rat at dosages up to 50 mg/kg there was no evidence of any carcinogenic effect in the mouse. In the rat, the only drug-related lesions were Leydig cell hyperplasia and testicular adenoma resulting from the hypoprolactinaemic effect of ropinirole. These lesions are considered to be a species specific phenomenon and do not constitute a hazard with regard to the clinical use of ropinirole.
Safety Pharmacology
In vitro studies have shown that ropinirole inhibits hERG-mediated currents. The IC50 is 5fold higher than the expected maximum plasma concentration in patients treated at the highest recommended dose (24 mg/day), see section 5.1.
6 PHARMACEUTICAL PARTICULARS
6.1 List of excipients
Tablet core:
Lactose monohydrate Microcrystalline cellulose Hydroxypropylcellulose Croscarmellose sodium Magnesium stearate
Tablet coating (Opadry II 85G34363) Poly(vinyl alcohol) - partially hydrolyzed Titanium dioxide (E171)
Macrogol 3350 Talc
Lecithin (soya) (E322)
Carmine (E120)
Iron oxide yellow (E172)
Iron oxide black (E172)
6.2 Incompatibilities
Not applicable
6.3 Shelf life
18 months
6.4 Special precautions for storage
Do not store above 30°C. Store in the original container.
OPA/Alu/PVC - aluminium blisters. The pack sizes available are:
15, 21, 28, 30, 60, 84, 90, 100 and 50 unit dose blisters (hospital pack). Not all pack sizes may be marketed.
6.6 Special precautions for disposal
No special requirements.
7 MARKETING AUTHORISATION HOLDER
Teva UK Limited Brampton Road Hampden Park Eastbourne BN22 9AG United Kingdom
8 MARKETING AUTHORISATION NUMBER
PL 00289/1195
9 DATE OF FIRST AUTHORISATION/RENEWAL OF THE AUTHORISATION
13/01/2009
10 DATE OF REVISION OF THE TEXT
04/06/2015