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CUSTOMER:	PRE-PRESS NO.:	061257	Q.A.	CUSTOMER	PROOF HISTORY:	Notes: 1
PRODUCT Tegretol Retard 200mg tabs	ARTWORKER:	DT	APPROVED:	APPROVED:	v.2 - - 07/07/14	Leaflet Flat Size = 296 x 317
CODE:	DATE OF PROOF	07/07/14	DATE:	DATE:		ARIAL REGULAR FONTSIZE 8 ARIAL BOLD FONT SIZE 10
	TVT CHECKED					BRIDGED TO TRANSTEC

UK PIL DATED MARCH 2014 REPORTING OF SIDE EFFECTS

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Are you taking other medicines?

Because of the way that Tegretol works, it can affect, and be affected by, lots of other things that you might be eating or medicines that you are taking. It is very important to make sure that your doctor knows all about what else you are taking, including anything that you have bought from a chemist or health food shop. It may be necessary to change the dose of some medicines, or stop taking something altogether.

Tell the doctor if you are taking:

•    Hormone contraceptives, e.g. pills, patches, injections or implants. Tegretol affects the way the contraceptive works in your body, and you may get breakthrough bleeding or spotting. It may also make the contraceptive less effective and there will be a risk of getting pregnant. Your doctor will be able to advise you about this, and you should think about using other contraceptives.

•    Hormone Replacement Therapy (HRT). Tegretol can make HRT less effective.

•    Any medicines for depression or anxiety.

•    Corticosteroids (‘steroids'). You might be taking these for inflammatory conditions such as asthma, inflammatory bowel disease, muscle and joint pains.

•    Anticoagulants to stop your blood clotting.

•    Antibiotics to treat infections including skin infections and TB (e.g. ciprofloxacillin).

•    Antifungals to treat fungal infections.

•    Painkillers containing paracetamol, dextropropoxyphene, tramadol, methadone or buprenorphine.

•    Other medicines to treat epilepsy.

•    Medicines for high blood pressure or heart problems.

•    Antihistamines (medicines to treat allergy such as hayfever, itch, etc).

•    Diuretics (water tablets).

•    Cimetidine or omeprazole (medicines to treat gastric ulcers).

•    Isotretinoin (a medicine for the treatment of acne).

•    Metoclopramide or aprepitant (anti-sickness medications).

•    Acetazolamide (a medicine to treat glaucoma - increased pressure in the eye).

•    Danazol or gestrinone (treatments for endometriosis).

•    Theophylline or aminophylline (used in the treatment of asthma).

•    Ciclosporin, tacrolimus or sirolimus (immunosuppressants, used after transplant operations, but also sometimes in the treatment of arthritis or psoriasis).

•    Drugs to treat schizophrenia (e.g. paliperidone, aripiprazole).

•    Cancer drugs (e.g. temsirolimus, cyclophasphamide, lapatinib).

•    The anti-malarial drug, mefloquine.

•    Drugs to treat HIV.

•    Levothyroxine (used to treat hypothyroidism).

•    Tadalafil (used to treat impotence).

•    Albendazole (used to treat worms).

•    Bupropion (used to help stop smoking).

•    A herbal remedy called St John's Wort or Hypericum.

•    Drugs or supplements containing Vitamin B (nicotinamide).

Pregnancy and breastfeeding

You must discuss your epilepsy treatment with your doctor well before you become pregnant. If you do get pregnant while you're taking Tegretol Retard Tablets you must tell the doctor straightaway. It is important that your epilepsy remains well controlled, but, as with other anti-epilepsy treatments, there is a risk of harm to the foetus. Make sure you are very clear about the risks and the benefits of taking Tegretol Retard Tablets.

Mothers taking Tegretol Retard Tablets can breastfeed their babies, but you must tell the doctor as soon as possible if you think that the baby is suffering side effects such as excessive sleepiness, skin reaction or yellow skin and eyes, dark urine or pale stools.

Will there be any problems with driving or using machinery?

Tegretol Retard Tablets can make you feel dizzy or drowsy, or may cause blurred vision, double vision, or you may have a lack of muscular coordination, especially at the start of treatment or when the dose is changed. If you are affected in this way, or if your eyesight is affected, you should not drive or operate machinery.

Other special warnings

•    Drinking alcohol may affect you more than usual. Discuss whether you should stop drinking with your doctor.

•    Eating grapefruit, or drinking grapefruit juice, may increase your chance of experiencing side effects.

•    Your doctor may want you to have a number of blood tests before you start taking Tegretol and from time to time during your treatment. This is quite usual and nothing to worry about.

3. How to take Tegretol Retard Tablets

The doctor will tell you how many Tegretol Retard Tablets to take and when to take them. Always follow his/her instructions carefully. The dose will be on the pharmacist's label. Check the label carefully. It is important to take the tablets at the right times. If you are not sure, ask your doctor or pharmacist. Keep taking your tablets for as long as you have been told, unless you have any problems. In that case, check with your doctor.

Your doctor will usually start Tegretol at a fairly low dose which can then be increased to suit you individually. The dose needed varies between patients. You can take Tegretol Retard Tablets during, after or between meals. Swallow the tablets with a drink. Do not chew them. You are usually told to take a dose two or three times a day. If necessary you may break the tablets in half along the scored line.

To treat epilepsy the usual doses are:

Adults: 800-1,200 mg a day, although higher doses may be necessary. If you are elderly you might require a lower dose.

Children:

Aged 5-10 years: 400-600 mg a day Aged 10-15 years: 600-1,000 mg a day.

Tegretol Retard Tablets are not recommended for children under 5.

To treat trigeminal neuralgia the usual dose is: 600-800 mg a day.

The maximum dose is 1200mg a day. If you are elderly you might require a lower dose.

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What if you forget to take a dose?

If you forget to take a dose, take one as soon as you remember. If it is nearly time for your next dose, though, just take the next dose and forget about the one you missed.

What if you take too many tablets?

If you accidentally take too many Tegretol Retard Tablets, tell your doctor or your nearest hospital casualty department.

Take your medicine pack with you so that people can see what you have taken.

4. Possible side effects

Tegretol Retard Tablets do not usually cause problems, but like all medicines, they can sometimes cause side effects.

Some side effects can be serious

Stop taking Tegretol Retard Tablets and tell your doctor straight away if you notice:

•    Serious skin reactions such as rash, red skin, blistering of the lips, eyes or mouth, or skin peeling accompanied by fever. These reactions may be more frequent in patients of Chinese or Thai origin

•    Mouth ulcers or unexplained bruising or bleeding

•    Sore throat or high temperature, or both

•    Yellowing of your skin or the whites of your eyes

•    Swollen ankles, feet or lower legs

•    Any signs of nervous illness or confusion

•    Pain in your joints and muscles, a rash across the bridge of the nose and cheeks and problems with breathing (these may be the signs of a rare reaction known as lupus erythematosus)

•    Fever, skin rash, joint pain, and abnormalities in blood and liver function tests (these may be the signs of a multi-organ sensitivity disorder)

•    Bronchospasm with wheezing and coughing, difficulty in breathing, feeling faint, rash, itching or facial swelling (these may be the signs of a severe allergic reaction)

•    Pain in the area near the stomach.

The side effects listed below have also been reported.

More than 1 in 10 people have experienced:

Leucopenia (a reduced number of the cells which fight infection making it easier to catch infections); dizziness and tiredness; feeling unsteady or finding it difficult to control movements; feeling or being sick; changes in liver enzyme levels (usually without any symptoms); skin reactions which may be severe.

Up to 1 in 10 people have experienced:

Changes in the blood including an increased tendency to bruise or bleed; fluid retention and swelling; weight increase; low sodium in the blood which might result in confusion; headache; double or blurred vision; dry mouth.

Up to 1 in 100 people have reported:

Abnormal involuntary movements including tremor or tics; abnormal eye movements; diarrhoea; constipation. Up to 1 in 1,000 people have reported:

Disease of the lymph glands; folic acid deficiency; a generalised allergic reaction including rash, joint pain, fever, problems with the kidneys and other organs; hallucinations; depression; loss of appetite; restlessness; aggression; agitation; confusion; speech disorders; numbness or tingling in the hands and feet; muscle weakness; high blood pressure (which may make you feel dizzy, with a flushed face, headache, fatigue and nervousness); low blood pressure (the symptoms of which are feeling faint, light headed, dizzy, confused, having blurred vision); changes to heart beat; stomach pain; liver problems including jaundice; symptoms of lupus.

Up to 1 in 10,000 people have reported:

Changes to the composition of the blood including anaemia; porphyria; meningitis; swelling of the breasts and discharge of milk which may occur in both male and females; abnormal thyroid function tests; osteomalacia (which may be noticed as pain on walking and bowing of the long bones in the legs); osteoporosis; increased blood fat levels; taste disturbances; conjunctivitis; glaucoma; cataracts; hearing disorders; heart and circulatory problems including deep vein thrombosis (DVT), the symptoms of which could include tenderness, pain, swelling, warmth, skin discoloration and prominent superficial veins; lung or breathing problems; severe skin reactions including Stevens-Johnson syndrome (These reactions may be more frequent in patients of Chinese or Thai origin); sore mouth or tongue; liver failure; increased sensitivity of the skin to sunlight; alterations in skin pigmentation; acne; excessive sweating; hair loss; increased hair growth on the body and face; muscle pain or spasm; sexual difficulties which may include reduced male fertility, loss of libido or impotence; kidney failure; blood spots in the urine; increased or decreased desire to pass urine or difficulty in passing urine.

The following have also been reported, but the frequency cannot be estimated from the available information: Severe skin reactions, accompanied by feeling unwell and changes in blood results. Diarrhoea, abdominal pain, and fever (signs of inflammation of the colon), reactivation of herpes virus infection (can be serious when immune system is depressed), complete loss of nails, fracture, decrease in the measure of the bone density, drowsiness, memory loss, purple or reddish-purple bumps that may be itchy.

Do not be alarmed by this list. Most people take Tegretol Retard Tablets without any problems.

If any of the symptoms become troublesome, or if you notice anything else not mentioned here, please go and see your doctor. He/she may want to give you a different medicine.

There have been reports of bone disorders including osteopenia and osteoporosis (thinning of the bone) and fractures. Check with your doctor or pharmacist if you are on long-term antiepileptic medication, have a history of osteoporosis, or take steroids.

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.gov.uk/yellowcard.

To treat mood swings the usual dose is: 400-600 mg a day

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

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