Cyklo-F
SUMMARY OF PRODUCT CHARACTERISTICS
1. NAME OF THE MEDICINAL PRODUCT
Cyklo-f 500 mg film coated tablet
2. QUALITATIVE AND QUANTITATIVE COMPOSITION
One tablet contains tranexamic acid500 mg
For the full list of excipients, see section 6.1
3. PHARMACEUTICAL FORM
White, capsular, engraved with a score and with arcs above and below the letters CY.
4. CLINICAL PARTICULARS
4.1. Therapeutic indications
Menorrhagia
4.2. Posology and method of administration
Posology
Recommended dosage is 2 tablets 3 times daily as long as needed for up to 4 days. If very heavy menstrual bleeding, dosage may be increased. A total dose of 4 g daily (8 tablets) should not be exceeded. Treatment with Cyklo-f should not be initiated until menstrual bleeding has started.
By extrapolation from clearance data relating to the intravenous dosage form, the following reduction in the oral dosage is recommended for patients with mild to moderate renal insufficiency.
Serum creatinine (micromol/l) Dose tranexamic acid
120-249 15 mg/kg body weight twice daily
250-500 15 mg/kg body weight/day
Method of administration
Oral use.
4.3. Contraindications
Cyklo-f for menorrhagia
is contraindicated in women with:
Active thromboembolic disease.
Severe renal impairment (risk of accumulation).
History of convulsions.
Hypersensitivity to the active substance or to any of the excipients listed in section 6.1.
4.4. Special warnings and precautions for use
Patients with irregular menstrual bleeding should not use Cyklo-f until the cause of irregular bleeding has been established.
If menstrual bleeding is not adequately reduced by Cyklo-f, an alternative treatment should be considered.
Patients with a previous thromboembolic event and a family history of thromboembolic disease (patients with thrombophilia) should use Cyklo-f only if there is a strong medical indication and under strict medical supervision.
The blood levels are increased in patients with renal insufficiency. Therefore a dose reduction is recommended (see 4.2).
The use of tranexamic acid in cases of increased fibrinolysis due to disseminated intravascular coagulation is not recommended.
In haematuria from the upper urinary tract clot formation can, in a few cases, lead to ureteric obstruction.
Convulsions
Cases of convulsions have been reported in association with tranexamic acid treatment, most of these cases were reported following intravenous injection in high doses.
Paediatric population
Clinical experience with Cyklo-f in menorrhagic children under 15 years of age is not available.
Interaction with other medicinal products and other forms of interaction
Clinically important interactions have not been observed with tranexamic acid tablets. Due to the absence of interaction studies, simultaneous treatment with anticoagulants must be under the strict supervision of a physician experienced in coagulation.
4.6. Fertility, pregnancy and lactation
Cyklo-f is intended for treatment of menorrhagia only; it should not be used during pregnancy and lactation.
4.7. Effects on ability to drive and use machines
Adverse reactions like, for example, dizziness that can affect the ability to drive and use machines have been reported.
Dose-dependent gastrointestinal discomfort is the most commonly reported undesirable effect, but it is usually of mild and temporary nature.
Tabulated list of adverse reactions
Adverse reactions frequency is defined using the following convention:
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.
Frequency of undesirable effects at a dose of 4 g/day (MedDRA LLT):
|
Organ Class |
Frequency |
||
|
|
Common |
Uncommon |
Not known |
|
Nervous system disorders |
Dizziness, Headache |
|
Convulsions (refer to sections 4.3 and 4.4) |
|
Gastrointestinal disorders |
Vomiting, Diarrhoea, Nausea, Abdominal pain |
|
|
|
Skin and subcutaneous tissue disorders |
|
Allergic skin reaction |
|
|
Eye disorders |
|
|
Impaired colour vision and other visual disturbances |
|
Vascular disorders |
|
|
Thromboembolic events |
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 national reporting system listed in Appendix V.*
4.9. Overdose
Symptoms: Dizziness, headache, nausea, diarrhoea, hypotension. Orthostatic symptoms, myopathy and convulsions may occur. Increased risk of thrombosis in predisposed individuals.
Treatment of overdose: Initiate vomiting, then gastric lavage, charcoal therapy and symptomatic treatment. Maintain adequate diuresis. Anticoagulant treatment should be considered.
Toxicity: 37 g of tranexamic acid caused mild intoxication in a seventeen-year-old after gastric lavage.
5.1. Pharmacodynamic properties
Pharmacotherapeutic group: Antifibrinolytics, ATC code: B02A A02
Cyklo-f contains tranexamic acid, an antifibrinolytic which is an
inhibitor of the activation of plasminogen to plasmin in the
fibrinolytic system. The treatment of
menorrhagia is symptomatic since it does not affect the underlying
pathogenesis of the increased menstrual flow.
5.2. Pharmacokinetic properties
The bioavailability is approximately 35 % in the dose range of 0.5 – 2 g and it not affected by simultaneous food intake. Following a single oral dose, Cmaxand urinary excretion increased linearly with doses between 0.5 g and 2 g. Following a single oral dose of 0.5 g, Cmax is approx. 5 microg/ml and after a dose of 2 g Cmax is 15 microg/ml.
Therapeutic concentration is maintained in plasma up to 6 hours after an oral single dose of 2 g. Binding to plasma proteins (plasminogen) is approximately 3% at therapeutic plasma levels. Plasma clearance is approximately 7 l/hour. Prevailing plasma half-life is approximately 2 hours following a single intravenous dose. After repeated oral administration the half-life is longer. The terminal half-life is about 3 hours. Approximately 95% of the absorbed dose is excreted unchanged in the urine. Two metabolites have been identified: an N-acetylated and a deaminated derivative. Impaired kidney function constitutes a risk for accumulation of tranexamic acid.
5.3 Preclinical safety data
Preclinical data reveal no special hazard for humans in addition to those included in other sections of studies of safety pharmacology, repeated dose toxicity, toxicity to reproduction, genotoxicity and carcinogenicity.
Retinal abnomalities were found in long term toxicity studies in dog and cat: increased reflectivity, photoreceptor segment atrophy, peripheral retinal atrophy, atrophy of rods and cones. These ocular changes were dose related and occurred in high doses.
6. PHARMACEUTICAL PARTICULARS
List of excipients
Tablet core:
Cellulose, microcrystalline
Hyprolose
Talc
Magnesium stearate
Silica, colloidal anhydrous
Povidone
Tablet coating:
Methacrylate copolymer
Titanium dioxide (E171)
Talc
Magnesium stearate
Macrogol 8000
Vanillin
6.3. Shelf life
6.4. Special precautions for storage
No special precautions for storage.
6.5. Nature and contents of container
Carton containing 18 tablets in a blister (PVC/PVDC/Aluminium)
6.6. Special precautions for disposal and other handling
No special requirements.
7. MARKETING AUTHORISATION HOLDER
Meda AB
Box 906
170 09 Solna
8. MARKETING AUTHORISATION NUMBER
9. DATE OF FIRST AUTHORISATION/RENEWAL OF THE AUTHORISATION
Date of first authorisation: 1997-01-31
Date of latest renewal: 2007-01-31
10. DATE OF REVISION OF THE TEXT
2016-08-29