Cyklonova
SUMMARY OF PRODUCT CHARACTERISTICS
1. NAME OF THE MEDICINAL PRODUCT
Cyklonova 500 mg film-coated tablets
2. QUALITATIVE AND QUANTITATIVE COMPOSITION
Tranexamic acid 500 mg.
For the full list of excipients, see section 6.1.
3. PHARMACEUTICAL FORM
Film-coated tablet.
White, capsule shaped, scored, length 18 mm. The tablet can be divided into equal doses.
4. CLINICAL PARTICULARS
4.1 Therapeutic indications
Menorrhagia.
4.2 Posology and method of administration
Posology
Recommended dosage is as follows:
2-3 tablets (1-1.5 g) 3-4 times daily for 3-4 days. If very heavy menstrual bleeding, dosage may be increased up to 2 tablets (1 g) 6 times daily. Treatment with Cyklonova should not be initiated until menstrual bleeding has started.
Renal insufficiency
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 |
Please refer to section 5.2.
Paediatric population
Clinical experience with Cyklonova in children or adolescents under 15 years of age is not available.
4.3 Contraindications
Tranexamic acid for menorrhagia is contraindicated in women with:
- Active thromboembolic disease.
- Severe renal failure because of risk of accumulation.
- 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 tranexamic acid until the cause of irregular bleeding has been established.
If menstrual bleeding is not adequately reduced by tranexamic acid, an alternative treatment should be considered.
Patients with a previous thrombosis and a family history of thromboembolic disease (patients with thrombophilia) should use tranexamic acid only if there is a strong medical indication and under strict medical supervision.
The plasma levels are increased in patients with impaired renal function. Therefore a dose reduction is recommended (see 4.2).
In haematuria from the upper urinary tract may the forming of clots, in rare cases, cause ureteric obstruction.
4.5 Interaction with other medicinal products and other forms of interaction
Clinically relevant interactions have not been observed with tranexamic acid tablets.
Since no interaction studies have been performed concurrent treatment with anticoagulants should only be made under supervision of a doctor who specialises in coagulation.
4.6 Fertility, pregnancy and lactation
Tranexamic acid is only intended for use in menorrhagia and should therefore not be used during pregnancy.
Pregnancy
Tranexamic acid crosses the placenta. Clinical experience in pregnant women is limited.
Animal studies do not indicate increased risk of harmful effects on the foetus.
Lactation
Tranexamic acid passes into breast milk but is unlikely to affect the infant at therapeutic doses.
Fertility
There are no available data of fertility.
4.7 Effects on ability to drive and use machines
No influence on the ability to drive and use machines has been observed.
4.8 Undesirable effects
The most common undesirable effects are dose dependent gastrointestinal disorders, which usually are mild and transient. Allergic skin reactions occur but are uncommon.
Frequency of undesirable effects at the dose 4 g/day:
|
Frequency Organ class |
Common (≥1/100 to <1/10) |
Uncommon (≥1/1,000 to <1/100) |
Rare (≥1/10,000 to <1/1,000) |
|
Nervous system disorders |
Headache, dizziness. |
|
|
|
Eye disorders |
|
|
Colour vision deficiency and other visual disturbances. |
|
Vascular disorders |
|
|
Thromboembolism. |
|
Gastrointestinal disorders |
Nausea, vomiting, diarrhoea, abdominal pain. |
|
|
|
Skin and subcutaneous tissue disorders |
|
Allergic skin 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 national reporting system listed in Appendix V.
4.9 Overdose
Symptoms of overdose
Nausea, diarrhoea, dizziness, headache. Orthostatic symptoms, hypotension and myopathy may occur. There is a risk of thrombosis in predisposed individuals.
Treatment of overdose
Initiate vomiting, charcoal therapy, gastric lavage and symptomatic treatment. Maintain adequate renal excretion. Anticoagulant treatment should be considered.
Toxicity
37 g to a 17 year old person caused a mild intoxication after gastric lavage.
5. PHARMACOLOGICAL PROPERTIES
5.1 Pharmacodynamic properties
Pharmacotherapeutic group: fibrinolysis inhibitor, ATC code: B02AA02
Tranexamic acid inhibits the plasminogen activation i.e. the conversion of plasminogen to plasmin in the fibrinolytic system. The treatment of menorrhagia is symptomatic since the underlying patogenesis for menorrhagia is not affected.
5.2 Pharmacokinetic properties
The bioavailability is approximately 35 % in the dosage range 0,5-2 g and is not affected by simultaneous food intake.
Following a single dose Cmaxand urinary excretion increased linearly with doses between 0,5 g and 2,0 g. Following a single dose of 0,5 g Cmaxis approximately 5 microg/ml and after a dose of 2 g Cmaxis 15 microg/ml.
Therapeutic concentration in plasma is maintained up to 6 hours after an oral single dose of 2 g.
Plasma protein binding (plasminogen) is approximately 3 % at therapeutic levels.
Plasma clearance is approximately 7 l/h. Halflife in plasma is approximately 2 hours after an intravenous single dose. Following repeated oral dosage the halflife is longer. The terminal halflife is about 3 hours.
Approximately 95 % of absorbed dose is excreted unchanged in urine. Two metabolites have been identified: a N-acetylated and a deaminated derivative.
Impaired renal function
Impaired renal function constitutes a risk of accumulation of tranexamic acid.
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, carcinogenicity, toxicity to reproduction.
Retinal abnormalities has been observed in long term toxicity studies in dogs and cats: hyper-reflectivity, atrophy of photo receptor segments, peripheral retinal atrophy, atrophy of rod and cone cells. These ocular changes were dose related and occurred in high doses.
6. PHARMACEUTICAL PARTICULARS
6.1 List of excipients
Core:
Microcrystalline cellulose
Povidone K90
Croscarmellose sodium
Colloidal anhydrous silica
Talc
Magnesium stearate
Coating:
Methacrylate polymer (Eudragit E100)
Titanium dioxide (E 171)
Talc
Magnesium stearate
Macrogol 8000
Vanillin
6.2 Incompatibilities
Not applicable.
6.3 Shelf life
3 years.
6.4 Special precautions for storage
Do not store above 30o C.
6.5 Nature and contents of container
Blister packs (PVC/aluminium).
Pack sizes: 18, 20, 30, 50, 60 and 100 tablets.
Not all pack sizes may be marketed.
6.6 Special precautions for disposal and other handling
No special requirements.
7. MARKETING AUTHORISATION HOLDER
Alternova A/S
Lodshusvej 11
4230 Skælskør
Denmark
8. MARKETING AUTHORISATION NUMBER
22080
9. DATE OF FIRST AUTHORISATION/RENEWAL OF THE AUTHORISATION
2006-06-09
10. DATE OF REVISION OF THE TEXT
2015-07-16
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