Information för alternativet: Estalis 50 Mikrogram/250 Mikrogram/24 Timmar Depotplåster, visa andra alternativ

Välj alternativ:

1. Estalis 50 Mikrogram/250 Mikrogram/24 Timmar Depotplåster
2. Estalis 50 Mikrogram/250 Mikrogram/24 Timmar Depotplåster Estalis 25/125 Mikrogram/24 Timmar Depotplåster Estalis 50/140 Mikrogram/24 Timmar Depotplåster Estalis 50 Mikrogram/250 Mikrogram/24 Timmar Depotplåster

Document: Estalis transdermal patch ENG SmPC change

• Estalis transdermal patch SmPC
• Estalis transdermal patch ENG SmPC

---

Estalis 50 micrograms/250 micrograms/24 hours,transdermal patch

Each Estalis 50 μg/250 μg/24 hours transdermal patch contains estradiol hemihydrate equivalent to 0.51 mg estradiol and 4.80 mg norethisterone acetate in a patch of 16 cm², releasing nominal 50 micrograms estradiol and 250 micrograms norethisterone acetate per 24 hours.

For the full list of excipients, see section 6.1.

Transdermal patch.

Translucent round patches with a polymeric backing layer on one side and an adhesive layer, releasing the active substances on the other side, packed individually in heat-sealed pouches.

Estalis 50 μg/250 μg/24 hours is indicated for:

• Hormone replacement therapy (HRT) for oestrogen deficiency symptoms in postmenopausal women.

• Prevention of osteoporosis in postmenopausal women at high risk of future fractures who are intolerant of, or contraindicated for, other medicinal products approved for the prevention of osteoporosis. (see also section 4.4)

Treatment is intended for women with at least 12 months since their last menses.

The experience of treating women older than 65 years is limited.

Estalis 50 μg/250 μg/24 hours is a continuous combined hormone replacement therapy for transdermal use.

For initiation and continuation of treatment of postmenopausal symptoms, the lowest effective dose for the shortest duration (see section 4.4) should be used.

Initiation of therapy

The treatment regimen may be initiated at any convenient time for menopausal women who are not currently using any oestrogen/progestagen therapy.

Women who are already using continuous combined oestrogen/progestagen therapy may be switched to Estalis 50 μg/250 μg/24 hours directly.

Women currently using cyclic or sequential oestrogen/progestagen therapy should complete the on-going treatment cycle before treatment with Estalis 50 μg/250 μg/24 hours is initiated. The appropriate time to begin treatment with Estalis 50 μg/250 μg/24 hours would be the first day of a withdrawal bleeding or seven days after finishing the previous treatment cycle.

Estalis regimen

Estalis 50 μg/250 μg/24 hours is used as a continuous treatment (uninterrupted application twice weekly). One transdermal patch is applied to the skin of the abdomen every 3 to 4 days.

Estalis 50 μg/250 μg/24 hours is less suitable to women who are close to menopause as the risk for irregular bleeding is then increased.

Women should be advised that irregular bleeding may occur in the first few months of treatment, usually before amenorrhoea is established.

Method of administration

Care should be exercised when applying Estalis 50 μg/250 μg/24 hours. It must never be placed on or near the breasts. It should be placed on a clean, dry area of the abdomen which is not irritated or abraded and not oily (i.e. should not be used with any moistening cream, lotion or oil). The waistline should be avoided, since tight clothing may rub the patch off.

The sites of application should be changed with an interval of at least one week allowed between applications to a particular site.

After opening the pouch, remove one half of the protective liner, taking care not to touch the adhesive part of the transdermal patch with the fingers. Apply the transdermal patch to the skin immediately. Remove the second half of the protective liner. Press the transdermal patch firmly to the skin with the palm of the hand for at least 10 seconds, carefully smoothing down the edges.

Care should be taken during bathing and other activities to ensure that the patch does not become dislodged. If the transdermal patch falls off (after strenuous physical activity, excessive sweating or friction from tight clothing), the same transdermal patch may be reapplied to another area. The original treatment should be thereafter followed, i.e. the transdermal patch should be exchanged on the same days as before.

Once in place, the patch should not be exposed to the sun for prolonged periods of time.

Should a patient forget to apply a patch, she should apply a new patch as soon as possible. The subsequent patch should be applied according to the original treatment schedule. The interruption of treatment might increase the likelihood of recurrence of symptoms and irregular bleeding and spotting.

Should any adhesive remain after removal of the transdermal patch, the skin area should be gently rubbed with an oil-based cream or lotion.

Estalis 50 μg/250 μg/24 hours should not be used by women with any of the following conditions:

• Known, past or suspected breast cancer

• Known or suspected oestrogen-dependent malignant tumors (e.g. endometrial cancer)

• Undiagnosed genital bleeding

• Untreated endometrial hyperplasia

• Previous or current venous thromboembolism (deep venous thrombosis, pulmonary embolism)

• Known thrombophilic disorders (e.g. protein C, protein S, or antithrombin deficiency, see section 4.4)

• Active or recent arterial thromboembolic disease (e.g. angina, myocardial infarction)

• Hypersensitivity to the active substances or to any of the excipients listed in section 6.1

• Acute liver disease, or a history of liver disease as long as liver function tests have failed to return to normal

For the treatment of postmenopausal symptoms, HRT should only be initiated for symptoms that adversely affect quality of life. In all cases, a careful appraisal of the risks and benefits should be undertaken at least annually and HRT should only be continued as long as the benefit outweighs the risk.

Evidence regarding the risks associated with HRT in the treatment of premature menopause is limited. Due to the low level of absolute risk in younger women, however, the balance of benefits and risks for these women may be more favourable than in older women.

Medical examination/follow-up

Before initiating or reinstituting HRT, a complete personal and family medical history should be taken. Physical (including pelvic and breast) examination should be guided by this and by the sections 4.3 Contraindications and 4.4 Special warnings and precautions for use. During treatment, periodic check-ups are recommended of a frequency and nature adapted to the individual woman. Women should be advised what changes in their breasts should be reported to their doctor or nurse (see “Breast cancer” below). Investigations, including appropriate imaging tools, e.g. mammography, should be carried out in accordance with currently accepted screening practices, modified to the clinical needs of the individual.

Conditions which need supervision

If any of the following conditions are present, have occurred previously and/or have been aggravated during pregnancy or previous hormone treatment, the patient should be closely supervised. It should be taken into account that these conditions may recur or be aggravated during treatment with Estalis 50 μg/250 μg/24 hours, in particular:

• Leiomyoma (uterine fibroids) or endometriosis

• Risk factors for thromboembolic disorders (see below)

• Risks factors for oestrogen dependent tumours, e.g. 1^st degree heredity for breast cancer

• Hypertension

• Liver disorders (e.g. liver adenoma)

• Diabetes mellitus with or without vascular involvement

• Cholelithiasis

• Migraine or severe headache

• Systemic lupus erythematosus

• A history of endometrial hyperplasia (see below)

• Epilepsy

• Asthma

• Otosclerosis

Reasons for immediate withdrawal of therapy

Therapy should be discontinued in case a contraindication is discovered and in the following situations:

• Jaundice or deterioration in liver function

• Significant increase in blood pressure

• New onset of migraine-like headache

• Pregnancy

Endometrial hyperplasia and carcinoma

In women with an intact uterus the risk of endometrial hyperplasia and carcinoma is increased when oestrogens are administrated alone for prolonged periods. The reported increase in endometrial cancer risk among oestrogen-only users varies from 2-to 12-fold greater compared with non-users, depending on the duration of treatment and oestrogen dose (see section 4.8). After stopping treatment risk may remain elevated for at least 10 years.

The addition of a progestagen cyclically for at least 12 days per month/28 day cycle or continuous combined oestrogen-progestagen therapy in non-hysterectomised women prevents the excess risk associated with oestrogen-only HRT.

Break-through bleeding and spotting may occur during the first months of treatment. If break-through bleeding or spotting appears after some time on therapy, or continues after treatment has been discontinued, the reason should be investigated, which may include endometrial biopsy to exclude endometrial malignancy.

Breast cancer

The overall evidence suggests an increased risk of breast cancer in women taking combined oestrogen-progestagen and possibly also oestrogen-only HRT, that is dependent on the duration of taking HRT.

Combined oestrogen-progestagen therapy

The randomised placebo-controlled trial, the Women’s Health Initiative study (WHI), and epidemiological studies, are consistent in finding an increased risk of breast cancer in women taking combined oestrogen-progestagen for HRT that becomes apparent after about 3 years (see section 4.8).

Oestrogen-only therapy

The WHI trial found no increase in the risk of breast cancer in hysterectomised women using oestrogen-only HRT. Observational studies have mostly reported a small increase in risk of having breast cancer diagnosed that is substantially lower than that found in users of oestrogen-progestagen combinations (see section 4.8).

The excess risk becomes apparent within a few years of use but returns to baseline within a few (at most five) years after stopping treatment.

HRT, especially oestrogen-progestagen combined treatment, increases the density of mammographic images which may adversely affect the radiological detection of breast cancer.

Venous thromboembolism

Coronary artery disease (CAD)

Combined oestrogen-progestagen therapy

The relative risk of CAD during use of combined oestrogen-progestagen HRT is slightly increased. As the baseline absolute risk of CAD is strongly dependent on age, the number of extra cases of CAD due to oestrogen-progestagen use is very low in healthy women close to menopause, but will rise with more advanced age.

Oestrogen-only

Randomised controlled data found no increased risk of CAD in hysterectomised women using oestrogen-only therapy.

Ischaemic stroke

Ovarian cancer

Hypothyroidism

Severe anaphylactic/anaphylactoid reactions

Angioedema

Other conditions

Oestrogens may cause fluid retention and therefore patients with cardiac or renal dysfunction should be carefully observed.

Women with pre-existing hypertriglyceridemia should be followed closely during oestrogen replacement or hormone replacement therapy, since rare cases of large increases of plasma triglycerides leading to pancreatitis have been reported with oral oestrogen therapy in this condition.

Contact sensitisation is known to occur with all topical applications. Although it is extremely rare, women who develop contact sensitisation to any of the components of the patch should be warned that a severe hypersensitivity reaction may occur with continuing exposure to the causative agent.

The metabolism of oestrogens and progestagens may be increased by concomitant use of substances known to induce drug-metabolising enzymes, specifically cytochrome P450 enzymes, such as anticonvulsants (e.g. phenobarbital, phenytoin, carbamazepine) and anti-infectives (e.g. rifampicin, rifabutin, nevirapine, efavirenz).

Ritonavir, telaprevir and nelfinavir, although known as strong inhibitors, by contrast exhibit inducing properties when used concomitantly with steroid hormones.

Herbal preparations containing St. John’s wort (Hypericum Perforatum) may induce the metabolism of oestrogens and progestagens.

Estradiol is predominantly metabolized by CYP3A4, hence concomitant administration of inhibitors of CYP3A4 such as ketoconazole, erythromycin may result in increase in the exposure of estradiol.

At transdermal administration, the first-pass effect in the liver is avoided and, thus, transdermally applied oestrogens and progestagens might be less affected than oral hormones by enzyme inducers.

Clinically, an increased metabolism of oestrogens and progestagens may lead to decreased effects and changes in the uterine bleeding profile.

Some laboratory tests may be influenced by oestrogen therapy, such as tests for glucose tolerance or thyroid function.

Pregnancy

Estalis 50 μg/250 μg/24 hours is not indicated during pregnancy. If pregnancy occurs during medication with Estalis 50 μg/250 μg/24 hours treatment should be withdrawn immediately.

Clinically, data on a limited number of exposed pregnancies indicate no adverse effects of norethisterone acetate on the foetus. At doses higher than normally used in oral contraceptives and HRT formulations masculinisation of female foetuses was observed.

The results of most epidemiological studies to date relevant to inadvertent foetal exposure to combinations of oestrogens and progestagens indicate no teratogenic or foetotoxic effect.

Breast-feeding

Estalis 50 μg/250 μg/24 hours is not indicated during breast-feeding.

No known effect on the ability to drive and use machines.

Approximately one third of the women treated with Estalis 50 μg/250 μg/24 hours can be expected to experience adverse reactions. The most commonly reported adverse experiences are breast tension and pain (31%), application site reactions (20% mostly mild erythema), dysmenorrhoea (19%), irregular bleeding (12.7%), and headache (10%).

Table 1:

Within each frequency grouping, adverse drug reactions are presented in the order of decreasing seriousness. 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).

System organ class (MedDRA SOC level)	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)
Immune system disorders				Hypersensitivity		Anaphylactic reaction, anaphylactoid reaction
Psychiatric disorders		Depression*, nervousness*, affect lability		Libido disorder
Nervous system disorders	Headache*.	Dizziness*, insomnia*	Migraine, vertigo	Paraesthesia
Vascular disorders			Hypertension, varicose veins	Embolism venous
Gastrointestinal disorders		Nausea, abdominal distension*, diarrhoea*, dyspepsia*, abdominal pain	Vomiting
Hepatobiliary disorders				Gallbladder disorder, Cholelithiasis	Jaundice cholestatic
Skin and subcutaneous tissue disorders	Application site reactions†	Acne*, rash, pruritus*, dry skin	Skin discoloration			Alopecia, contact dermatitis
Musculoskeletal and connective tissue disorders		Back pain*, pain in extremity*		Myasthenia
Reproductive system and breast disorders	Breast pain*, breast tenderness, dysmenorrhoea*, menstrual disorder*	Breast enlargement*, menorrhagia*, genital discharge *, irregular vaginal bleeding, uterine spasms, vaginal infection, endometrial hyperplasia	Breast cancer	Uterine leiomyoma, fallopian tube cysts, endocervical polyps
General disorders and administration site conditions		Pain, asthenia, oedema peripheral*, weight increased*
Investigations			Transaminases increased

(^*) Adverse reactions associated to oestrogenand progestagenhave been found to be relatively less frequent with the lowest dosage strength.

(**) Reported in post-marketing experience

(†)Application site reactions includes localized bleeding, bruising, burning, discomfort, dryness, eczema, edema, erythema, inflammation, irritation, pain, papules, paraesthesia, pruritus, rash, skin discolouration, skin pigmentation, swelling, urticaria, and vesicles.

Breast cancer risk

• An up to 2-fold increased risk of having breast cancer diagnosed is reported in women taking combined oestrogen-progestagen therapy for more than 5 years.

• Any increased risk in users of oestrogen-only therapy is substantially lower than that seen in users of oestrogen-progestagen combinations.

• The level of risk is dependent on the duration of use (see section 4.4).

• Results of the largest randomised placebo-controlled trial (WHI-study) and largest epidemiological study (MWS) are presented.

Million Women study– Estimated additional risk of breast cancer after 5 years’ use

Age range (years)	Additional cases per 1000 never-users of HRT over a 5 year period*	Risk ratio	Additional cases per 1000 HRT users over 5 years (95%CI)
		Oestrogen only HRT
50-65	9-12	1.2	1-2 (0-3)
		Combined oestrogen-progestagen
50-65	9-12	1.7	6 (5-7)
#Overall risk ratio. The risk ratio is not constant but will increase with increasing duration on use Note: Since the background incidence of breast cancer differs by EU country, the number of additional cases of breast cancer will also change proportionately.

* Taken from baseline incidence ratein developed countries

US WHI studies - additional risk of breast cancer after 5 years’ use

Age range (yrs)	Incidence per 1000 women in placebo arm over 5 years	Risk ratio & 95%CI	Additional cases per 1000 HRT users over 5 years (95%CI)
		CEE oestrogen-only
50-79	21	0.8 (0.7 – 1.0)	-4 (-6 – 0)*
		CEE+MPA oestrogen & progestagen‡
50-79	17	1.2 (1.0 – 1.5)	+4 (0 – 9)

‡When the analysis was restricted to women who hadnot used HRT prior to the study there was no increased risk apparent during the first 5 years of treatment: after 5 years the risk was higher than in non-users.

* WHI study in women with no uterus, which did not show an increase in risk of breast cancer.

Endometrial cancer risk

Postmenopausal women with a uterus

The endometrial cancer risk is about 5 in every 1000 women with a uterus not using HRT.

In women with a uterus, use of oestrogen-only HRT is not recommended because it increases the risk of endometrial cancer (see section 4.4).

Depending on the duration of oestrogen-only use and oestrogen dose, the increase in risk of endometrial cancer in epidemiology studies varied from between 5 and 55 extra cases diagnosed in every 1000 women between the ages of 50 and 65.

Adding a progestagen to oestrogen-only therapy for at least 12 days per cycle can prevent this increased risk. In the Million Women Study the use of five years of combined (sequential or continuous) HRT did not increase risk of endometrial cancer (RR of 1.0 (0.8-1.2)).

Ovarian cancer

Use of oestrogen-only or combined oestrogen-progestagen HRT has been associated with a slightly increased risk of having ovarian cancer diagnosed (see Section 4.4).

A meta-analysis from 52 epidemiological studies reported an increased risk of ovarian cancer in women currently using HRT compared to women who have never used HRT (RR 1.43, 95% CI 1.31-1.56). For women aged 50 to 54 years taking 5 years of HRT, this results in about 1 extra case per 2000 users. In women aged 50 to 54 who are not taking HRT, about 2 women in 2000 will be diagnosed with ovarian cancer over a 5-year period.

Risk of venous thromboembolism

HRT is associated with a 1.3-3-fold increased relative risk of developing venous thromboembolism (VTE), i.e. deep vein thrombosis or pulmonary embolism. The occurrence of such an event is more likely in the first year of using HT (see section 4.4). Results of the WHI studies are presented:

WHI Studies - Additional risk of VTE over 5 years’ use

Age range (years)	Incidence per 1000 women in placebo arm over 5 years	Risk ratio and 95%CI	Additional cases per 1000 HRT users
Oral oestrogen-only*
50-59	7	1.2 (0.6-2.4)	1 (-3 – 10)
Oral combined oestrogen-progestagen
50-59	4	2.3 (1.2 – 4.3)	5 (1 - 13)

* Study in women with no uterus.

Risk of coronary artery disease

Risk of ischaemic stroke

• The use of oestrogen-only and oestrogen - progestagen therapy is associated with an up to 1.5 -fold increased relative risk of ischaemic stroke. The risk of haemorrhagic stroke is not increased during use of HRT.

• This relative risk is not dependent on age or on duration of use, but as the baseline risk is strongly age-dependent, the overall risk of stroke in women who use HRT will increase with age, see section 4.4.

WHI studies combined - Additional risk of ischaemic stroke* over 5 years’ use

Age range (years)	Incidence per 1000 women in placebo arm over 5 years	Risk ratio and 95%CI	Additional cases per 1000 HRT users over 5 years
50-59	8	1.3 (1.1-1.6)	3 (1-5)

* No differentiation was made between ischaemic and haemorrhagic stroke.

Other adverse reactions have been reported in association with oestrogen-progestagen treatment:

• Gall bladder disease

• Skin and subcutaneous disorders: chloasma, erythema multiform, erythema nodosum, vascular purpura

• Probable dementia over the age of 65 (see section 4.4)

• Dry eyes

• Tear film composition changes.

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 [to be completed nationally].

Due to the mode of administration, overdose of estradiol or norethisterone is unlikely to occur. If signs of overdose appear the Estalis 50 μg/250 μg/24 hours transdermal patch should be removed. Symptoms of over dosage with oral oestrogens are breast tenderness, nausea, vomiting and/or metrorrhagia. Over dosage of progestagens may lead to a depressive mood, fatigue, acne and hirsutism.

Pharmacotherapeutic group: Genito urinary system and sex hormones

ATC code: G03FA01.

The active ingredient, estradiol hemihydrate, a synthetic 17β-estradiol, is chemically and biologically identical to endogenous human estradiol. It substitutes for the loss of oestrogen production in menopausal women, and alleviates menopausal symptoms.

Oestrogens prevent bone loss following menopause or ovariectomy.

As oestrogens promote the growth of the endometrium, unopposed oestrogens increase the risk of endometrial hyperplasia and cancer. The addition of norethisterone acetate, a progestagen, reduces the oestrogen-induced risk of endometrial hyperplasiain non-hysterectomised women.

Information from clinical trials

Relief of menopausal symptoms was achieved during the first few weeks of treatment.

Amenorrhoea was seen in 38 % of the women during months 10-12 treatment. Irregular bleeding and/or spotting appeared in 77 % of the women during the first three months of treatment and in 62 % during months 10-12 of treatment.

Oestrogen deficiency at menopause is associated with an increasing bone turnover and decline in bone mass. The effect of oestrogens on the bone mineral density is dose-dependent. Protection appears to be effective for as long as treatment is continued. After discontinuation of HRT, bone mass is lost at a rate similar to that in untreated women.

Evidence from the WHI trial and meta-analysed trials shows that current use of HRT, alone or in combination with a progestagen – given to predominantly healthy women – reduces the risk of hip, vertebral, and other osteoporotic fractures. HRT may also prevent fractures in women with low bone density and/or established osteoporosis, but the evidence for that is limited.

After two years of treatment with Estalis 50 μg/250 μg/24 hours, the increase in lumbar spine bone mineral density (BMD) was 5.53% ± 0.63% (mean ± SD). The percentage of women who maintained or gained BMD in lumbar zone during treatment was 95.0%.

Estalis 50 μg/250 μg/24 hours also had an effect on hip BMD. The increase after two years was 3.07% ± 0.64% (mean ± SD) at femoral neck and 3.12% ± 0.46% (mean ± SD) at total hip.

Absorption

Transdermally delivered estradiol bypasses the first pass effect seen with orally administered oestrogen products.

Estradiol: Estalis 50 μg/250 μg/24 hours transdermal patch achieves estradiol serum levels and estrone/estradiol ratios in the range of those observed in premenopausal women at the early (estradiol >40 pg/ml) to mid-follicular phase. These features are maintained for an entire 84 to 96 hour wear period. Multiple applications of the transdermal patch resulted in steady state maximum estradiol serum concentration (C_max) of 71 pg/ml and average estradiol serum concentration (C_avg) of 52 pg/ml. At the end of the application periods, the mean estradiol serum concentrations (trough concentration) was 46 pg/ml.

Norethisterone acetate: Multiple applications of the transdermal patch resulted in steady state maximum norethisterone concentration (C_max) of 1060 pg/ml and average serum norethisterone concentration (C_avg) of 832 pg/ml. At the end of the application period, the mean norethisterone serum concentrations (trough concentration) was 681 pg/ml.

Metabolism and elimination

Estradiol: Estradiol has a short elimination half-life of approximately 2 to 3 hours, therefore, a rapid decline in serum levels is observed after the transdermal patch is removed. After removal of the transdermal patch, serum concentrations of estradiol return to untreated postmenopausal levels (<20 pg/ml) within 4 to 8 hours.

Norethisterone: The elimination half-life of norethisterone is reported to be 6 to 8 hours. After removal of the transdermal patch, norethisterone serum concentrations diminish rapidly and are less than <50 pg/ml within 48 hours.

Minimal fluctuations in serum estradiol and norethisterone concentrations demonstrate consistent deliveries over the application interval.

There is no accumulation of estradiol or norethisterone in the circulation following multiple applications.

The toxicity profiles of estradiol and norethisterone have been well established. Long-term, continuous administration of natural and synthetic oestrogens in certain animal species increases the frequency of carcinomas of the breast, uterus, cervix, vagina, testis, and liver. Long-term, continuous administration of norethisterone in certain animal species increases the frequency of tumours of the hypophysis and ovary in females, and of liver and breast in males.

Adhesive matrix:

Silicone adhesives

Acrylic adhesives

Povidone

Oleic acid

Dipropylene glycol.

The backing layer consists of a polyester film laminate. The protective (release) liner is a fluoropolymer-coated polyester film.

Not applicable.

30 months;

24 months stored in a refrigerator (2°C to 8°C) plus 6 months stored below 25°C.

Store and transport refrigerated (2°C-8°C). Do not freeze. Once dispensed to the patient, Estalis 50 μg/250 μg/24 hours may be stored below 25°C for a maximum period of 6 months. Store in the original (sealed) pouch. Each patch should be used immediately after opening the pouch.

Estalis 50 μg/250 μg/24 hours transdermal patches are packed individually in heat-sealed paper/polyethylene sachets.

Estalis 50 μg/250 μg/24 hours pack consists of 2, 8 or 24 round transdermal patches.

Not all pack sizes may be marketed.

Used transdermal patches should be folded in half with the adhesive side inwards, and discarded safely and out of the reach and sight of children. Any used or unused transdermal patches should be disposed of in accordance with local requirements or returned to the pharmacy, preferably in the original packaging.

<[To be completed nationally]>

{Name and address}

<{tel}>

<{fax}>

<{e-mail}>

<[To be completed nationally]>

<Date of first authorization: 06-03-1998

Date of last renewal: 06-03-2008

<[To be completed nationally]>

2016-05-18