iMeds.se

Acura

Information för alternativet: Acura 10 Mg Komprimerad Sugtablett, visa andra alternativ
Document: Acura 10 mg lozenge ENG SmPC change

SUMMARY OF PRODUCT CHARACTERISTICS


1. NAME OF THE MEDICINAL PRODUCT


Acura 10 mg compressed lozenges


2. QUALITATIVE AND QUANTITATIVE COMPOSITION


One compressed lozenge contains 10 mg cetirizine dihydrochloride.


For a full list of excipients, see section 6.1.


3. PHARMACEUTICAL FORM


Compressed lozenge.


Round, white to almost white compressed lozenge with a break-mark on both sides.


The compressed lozenge can be divided into equal doses.


4. CLINICAL PARTICULARS


4.1 Therapeutic indications


In adults and paediatric patients 6 year and above:


Cetirizine is indicated for the relief of nasal and ocular symptoms of seasonal and perennial

allergic rhinitis.

Cetirizine is indicated for the relief of symptoms of chronic idiopathic urticaria.


4.2 Posology and method of administration


Children aged from 6 to 12 years: 5 mg twice daily (a half tablet twice daily).


Adults and adolescents over 12 years of age: 10 mg once daily (1 tablet).


Suck the compressed lozenge in the mouth until dissolved.


Can be taken with or without water.


Elderly patients

Data do not suggest that the dose needs to be reduced in elderly subjects provided that the renal function is normal.

Patients with moderate to severe renal impairment

There are no data to document the efficacy/safety ratio in patients with renal impairment. Since cetirizine is mainly excreted via renal route (see section 5.2), in cases no alternative treatment can be used, the dosing intervals must be individualized according to renal function. Refer to the following table and adjust the dose as indicated. To use this dosing table, an estimate of the patient’s creatinine clearance (CLcr) in ml/min is needed. The CLcr (ml/min) may be estimated from serum creatinine (mg/dl) determination using the following formula:


CLcr = [140 − age(years)] x weight (kg)

_____________________________________________ (x 0.85 for women)

72x serum creatinine (mg / dl)


Dosing adjustments for adult patients with impaired renal function


Group:

Creatinine clearance (ml/min):

Dosage and frequency:

Normal

≥80

10 mg once daily

Mild

50 – 79

10 mg once daily

Moderate

30 – 49

5 mg once daily

Severe

< 30

5 mg once every 2 days

End-stage renal disease -

< 10

Contra-indicated

Patients undergoing dialysis




In paediatric patients suffering from renal impairment, the dose will have to be adjusted on an individual basis taking into account the renal clearance of the patient, his age and his body weight.


Patients with hepatic impairment

No dose adjustment is needed in patients with solely hepatic impairment.


Patients with hepatic impairment and renal impairment

Doseadjustment is recommended (see Patients with moderate to severe renal impairment above).


4.3 Contraindications


Hypersensitivity to the active substance, to any of the excipients listed in section 6.1, to hydroxyzine or to any piperazine derivates.


Patients with severe renal impairment at less than 10 ml/min creatinine clearance.


4.4 Special warnings and precautions for use


At therapeutic doses, no clinically significant interactions have been demonstrated with alcohol (for a blood alcohol level of 0.5 g/l). Nevertheless, precaution is recommended if alcohol is taken concomitantly.


Caution should be taken in patients with predisposition factors of urinary retention (e.g. spinal cord lesion, prostatic hyperplasia) as cetirizine may increase the risk of urinary retention.


Caution in epileptic patients and patients at risk of convulsions is recommended.


Allergy skin tests are inhibited by antihistamines and a wash-out period (of 3 days) is required before performing them.


Paediatric population

The use of the compressed lozenge formulation is not recommended in children aged less than 6 years since this formulation does not allow for appropriate dose adaptation.


4.5 Interaction with other medicinal products and other forms of interaction


Due to the pharmacokinetic, pharmacodynamic and tolerance profile of cetirizine, no interactions are expected with this antihistamine. Actually, neither pharmacodynamic nor significant pharmacokinetic interaction was reported in drug-drug interactions studies performed, notably with pseudoephedrine or theophylline (400 mg/day).


The extent of absorption of cetirizine is not reduced with food, although the rate of absorption is decreased.


4.6 Fertility, pregnancy and lactation


Pregnancy

For cetirizine very rare clinical data on exposed pregnancies are available. Animal studies do not indicate direct or indirect harmful effects with respect to pregnancy, embryonal/fetal development, parturition or postnatal development. Caution should be exercised when prescribing to pregnant women.


Breast-feeding

Cetirizine is excreted in human milk at concentrations representing 25 % to 90 % of those measured in plasma, depending on sampling time after administration. Therefore, caution should be exercised when prescribing cetirizine to lactating women.


4.7 Effects on ability to drive and use machines


Objective measurements of driving ability, sleep latency and assembly line performance have not demonstrated any clinically relevant effects at the recommended dose of 10 mg.


Patients intending to drive, engaging in potentially hazardous activities or operating machinery should not exceed the recommended dose and should take their response to the medicinal product into account.


In sensitive patients, concurrent use with alcohol or other CNS depressants may cause additional reductions in alertness and impairment of performance.


4.8 Undesirable effects


Clinical studies have shown that cetirizine at the recommended dosage has minor undesirable effects on the CNS, including somnolence, fatigue, dizziness and headache. In some cases, paradoxical CNS stimulation has been reported.


Although cetirizine is a selective antagonist of peripheral H1-receptors and is relatively free of anticholinergic activity, isolated cases of micturition difficulty, eye accommodation disorders and dry mouth have been reported.


Instances of abnormal hepatic function with elevated hepatic enzymes accompanied by elevated bilirubin have been reported. Mostly this resolves upon discontinuation of the treatment with cetirizine dihydrochloride.


Clinical trials


Double blind controlled clinical trials comparing cetirizine to placebo or other antihistamines at the recommended dosage (10 mg daily for cetirizine), of which quantified safety data are available, included more than 3200 subjects exposed to cetirizine.


From this pooling, the following adverse reactions were reported for cetirizine 10 mg in the placebo-controlled trials at rates of 1.0 % or greater:


Adverse reactions

(WHO-ART)

Cetirizine 10 mg

(n= 3260)

Placebo

(n = 3061)

Body as a whole – general disorders

Fatigue

1.63 %

0.95 %

Central and peripheral nervous system disorders

Dizziness

Headache

1.10 %

7.42 %

0.98 %

8.07 %

Gastro-intestinal system disorders

Abdominal pain

Dry mouth

Nausea

0.98 %

2.09 %

1.07 %

1.08 %

0.82 %

1.14 %

Psychiatric disorders

Somnolence

9.63 %

5.00 %

Respiratory system disorders

Pharyngitis

1.29 %

1.34 %


Although statistically more common than under placebo, somnolence was mild to moderate in the majority of cases. Objective tests as demonstrated by other studies have demonstrated that usual daily activities are unaffected at the recommended daily dose in healthy young volunteers.


Adverse reactions at rates of 1 % or greater in children aged from 6 months to 12 years, included

in placebo-controlled clinical trials are:


Adverse reactions

(WHO-ART)

Cetirizine (n=1656)

Placebo

(n =1294)

Gastro-intestinal system disorders

Diarrhoea

1.0 %

0.6 %

Psychiatric disorders

Somnolence

1.8 %

1.4 %

Respiratory system disorders

Rhinitis

1.4 %

1.1 %

Body as a whole – general disorders

Fatigue

1.0 %

0.3 %


Post-marketing experience


In addition to the adverse reactions reported during clinical studies and listed above, the following undesirable effects have been reported in post-marketing experience.

Undesirable effects are described according to MedDRA System Organ Class and by estimated frequency based on post-marketing experience.


Frequencies are defined as follows: 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)

Blood and lymphatic disorders:

Very rare: thrombocytopenia


Immune system disorders:

Rare: hypersensitivity

Very rare: anaphylactic shock


Metabolism and nutrition disorders:

Not known: increased appetite


Psychiatric disorders:

Uncommon: agitation

Rare: aggression, confusion, depression, hallucination, insomnia

Very rare: tics

Not known: suicidal ideation


Nervous system disorders:

Uncommon: paraesthesia

Rare: convulsions

Very rare: dysgeusia, syncope, tremor, dystonia, dyskinesia

Not known: amnesia, memory impairment


Eye disorders:

Very rare: accommodation disorder, blurred vision, oculogyration


Ear and labyrinth disorders:

Not known: vertigo


Cardiac disorders:

Rare: tachycardia


Gastro-intestinal disorders:

Uncommon: diarrhoea


Hepatobiliary disorders:

Rare: hepatic function abnormal (increased transaminases, alkaline phosphatase, γ-GT and bilirubin)


Skin and subcutaneous tissue disorders:

Uncommon: pruritus, rash

Rare: urticaria

Very rare: angioneurotic oedema, fixed drug eruption


Renal and urinary disorders:

Very rare: dysuria, enuresis

Not known: urinary retention


General disorders and administration site conditions:

Uncommon: asthenia, malaise

Rare: oedema


Investigations:

Rare: weight increased


Reporting of suspected adverse reactions

Reporting of 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 national reporting system listed in Appendix V.


4.9 Overdose


Symptoms


Symptoms observed after an overdose of cetirizine are mainly associated with CNS effects or with effects that could suggest an anticholinergic effect.

Adverse events reported after an intake of at least 5 times the recommended daily dose are: confusion, diarrhoea, dizziness, fatigue, headache, malaise, mydriasis, pruritus, restlessness, sedation, somnolence, stupor, tachycardia, tremor, and urinary retention.


Management

There is no known specific antidote to cetirizine.

Should overdose occur, symptomatic or supportive treatment is recommended. Gastric lavage should be considered following ingestion of a short occurrence.

Cetirizine is not effectively removed by dialysis.


5. PHARMACOLOGICAL PROPERTIES


5.1 Pharmacodynamic properties


Pharmacotherapeutic group: Piperazine derivatives, ATC code: R06A E07


Cetirizine, a human metabolite of hydroxyzine, is a potent and selective antagonist of peripheral H1- receptors. In vitro receptor binding studies have shown no measurable affinity for other than H1- receptors.


In addition to its anti-H1effect, cetirizine was shown to display anti-allergic activities: at a dose of 10 mg once or twice daily, it inhibits the late phase recruitment of eosinophils, in the skin and conjunctiva of atopic subjects submitted to allergen challenge.


Studies in healthy volunteers show that cetirizine, at doses of 5 and 10 mg strongly inhibits the wheal and flare reactions induced by very high concentrations of histamine into the skin, but the correlation with efficacy is not established.


In a 35-day study in children aged 5 to 12, no tolerance to the antihistaminic effect (suppression of wheal and flare) of cetirizine was found. When a treatment with cetirizine is stopped after repeated administration, the skin recovers its normal reactivity to histamine within 3 days.


In a six-week, placebo-controlled study of 186 patients with allergic rhinitis and concomitant mild to moderate asthma, cetirizine 10 mg once daily improved rhinitis symptoms and did not alter pulmonary function. This study supports the safety of administering cetirizine to allergic patients with mild to moderate asthma.


In a placebo-controlled study, cetirizine given at the high daily dose of 60 mg for seven days did not cause statistically significant prolongation of QT interval.


At the recommended dosage, cetirizine has demonstrated that it improves the quality of life of patients with perennial and seasonal allergic rhinitis.


5.2 Pharmacokinetic properties


The steady - state peak plasma concentrations is approximately 300 ng/ml and is achieved within 1.0 ± 0.5 h. No accumulation is observed for cetirizine following daily doses of 10 mg for 10 days. The distribution of pharmacokinetic parameters such as peak plasma concentration (Cmax) and area under curve (AUC), is unimodal in human volunteers.


The extent of absorption of cetirizine is not reduced with food, although the rate of absorption is decreased. The extent of bioavailability is similar when cetirizine is given as solutions, capsules or tablets.


The apparent volume of distribution is 0.50 l/kg. Plasma protein binding of cetirizine is 93 ± 0.3 %. Cetirizine does not modify the protein binding of warfarin.


Cetirizine does not undergo extensive first pass metabolism. About two third of the dose are excreted unchanged in urine. The terminal half-life is approximately 10 hours.


Cetirizine exhibits linear kinetics over the range of 5 to 60 mg.


Special populations


Elderly: Following a single 10 mg oral dose, half-life increased by about 50 % and clearance decreased by 40 % in 16 elderly subjects compared to the normal subjects. The decrease in cetirizine clearance in these elderly volunteers appeared to be related to their decreased renal function.


Children, infants and toddlers: The half-life of cetirizine was about 6 hours in children of 6-12 years and 5 hours in children 2-6 years. In infants and toddlers aged 6 to 24 months, it is reduced to 3.1 hours.


Renally impaired patients: The pharmacokinetics of the drug were similar in patients with mild impairment (creatinine clearance higher than 40 ml/min) and healthy volunteers. Patients with moderate renal impairment had a 3-fold increase in half-life and 70 % decrease in clearance compared to healthy volunteers.


Patients on hemodialysis (creatinine clearance less than 7 ml/min) given a single oral 10 mg dose of cetirizine had a 3-fold increase in half-life and a 70 % decrease in clearance compared to normals. Cetirizine was poorly cleared by haemodialysis. Dosing adjustment is necessary in patients with moderate or severe renal impairment (see section 4.2).


Hepatically impaired patients: Patients with chronic liver diseases (hepatocellular, cholestatic, and biliary cirrhosis) given 10 or 20 mg of cetirizine as a single dose had a 50 % increase in half-life along with a 40 % decrease in clearance compared to healthy subjects. Dosing adjustment is only necessary in hepatically impaired patients if concomitant renal impairment is present.


5.3 Preclinical safety data

Non-clinical data reveal no special hazard for humans based on conventional studies of safety

pharmacology, repeated dose toxicity, genotoxicity, carcinogenic potential, toxicity to reproduction.


6. PHARMACEUTICAL PARTICULARS


6.1 List of excipients

Betadex (E459),

Povidone K-25,

Sodium cyclamate (E952),

Powdered cellulose (E460),

Monosodium citrate (E331),

Microcrystalline cellulose (E460),

Magnesium stearate (E470B),

Synthetic apple flavour.


6.2 Incompatibilities


Not applicable.


6.3 Shelf life


3 years


6.4 Special precautions for storage


Store in the original packaging in order to protect from moisture.


6.5 Nature and contents of container


Aluminium blister: 7, 10, 14, 20, 21, 28, 30, 100 compressed lozenges per pack


Not all pack sizes may be marketed.


6.6 Special precautions for disposal


No special requirements.


7. MARKETING AUTHORISATION HOLDER


to be completed nationally


8. MARKETING AUTHORISATION NUMBER(S)


to be completed nationally


9. DATE OF FIRST AUTHORISATION/RENEWAL OF THE AUTHORISATION


to be completed nationally


10. DATE OF REVISION OF THE TEXT


1 October 2014