Duloxetine Pensa 30 mg and 60 mg hard enteric capsules 
duloxetine (as hydrochloride)

Read all of this leaflet carefully before you start taking this medicine. It contains information that is important to you.

  • Save this information, you may need to read it again.
  • If you have any further questions, ask your doctor or pharmacist.
  • This medicine has been prescribed for you only. Do not give it to others. It can harm them, even if they show signs of illness similar to yours.
  • If you get any side effects, talk to your doctor or pharmacist. This also applies to any side effects not mentioned in this information. See section 4.

In this leaflet: 
1. What Duloxetine Pensa is and what it is used for 
2. What you need to know before taking Duloxetine Pensa 
3. How to take Duloxetine Pensa 
4. Possible side effects 
5. How to store Duloxetine Pensa 
6. Contents of the packaging and other information 

1. What Duloxetine Pensa is and what it is used for

Duloxetine Pensa contains the active substance duloxetine. Duloxetine Pensa increases the amount of serotonin and norepinephrine in the nervous system.

Duloxetine Pensa is used in adults to treat:

  • Depression
  • generalized anxiety disorder (constant feeling of anxiety or worry)
  • painful diabetic neuropathy (usually described as burning, stinging, stinging, stabbing, or excruciating pain or as an electric shock ). Pain can be caused by touch, heat, cold, or pressure but the affected area can also be completely numb).

In most people with depression or anxiety, Duloxetine Pensa starts working within two weeks of starting treatment, but it may take 2-4 weeks before you feel better. Talk to your doctor if you do not start to feel better after this time. Your doctor may continue to give you Duloxetine Pensa even when you are feeling better to prevent relapse into depression or anxiety.

For most people who have painful diabetic neuropathy, it can take a few weeks before they feel better. Talk to your doctor if you do not feel better after 2 months.

Duloxetine contained in Duloxetine Pensa may also be approved for the treatment of other conditions not mentioned in this leaflet. Ask your doctor, pharmacist, or another healthcare professional if you have any further questions, and always follow their instructions.

What you need to know before you take Duloxetine Pensa

Do not take Duloxetine Pensa if you:

  • is allergic to duloxetine or any of the other ingredients of this medicine (listed in section 6)
  • have liver disease
  • have severe kidney disease
  • taking or during the last 14 days taking medicine that belongs to the group monoamine oxidase inhibitors ( MAOIs ), see “Other medicines and Duloxetine Pensa”)
  • taking fluvoxamine which is usually used to treat depression, ciprofloxacin or enoxacin which are used to treat certain infections you
  • take other medicines that contain duloxetine (see “Other medicines and Duloxetine Pensa”).

Talk to your doctor if you have high blood pressure or heart disease. Your doctor will tell you if you should take Duloxetine Pensa.

Warnings and cautions

If you suffer from any of the following, Duloxetine Pensa may not be for you. Talk to your doctor before using Duloxetine Pensa if you:

  • taking other medicines for depression (see “Other medicines and Duloxetine Pensa”)
  • takes St. John’s wort, a herbal medicine (Hypericum perforatum)
  • have kidney disease
  • have had seizures (seizures)
  • have had mania
  • have bipolar disorder
  • have eye problems, such as a certain type of glaucoma (increased pressure in the eye)
  • have previously had bleeding disorders (tendency to get bruises), especially if you are pregnant (see “Pregnancy and breast-feeding”)
  • is at risk for low sodium levels (for example, if you are taking diuretics, especially if you are older)
  • while being treated with another medicine that may cause liver damage
  • taking other medicines containing duloxetine (see “Other medicines and Duloxetine Pensa”)

Duloxetine Pensa may cause a feeling of restlessness and difficulty sitting or standing still. If this happens, tell your doctor.

Drugs such as Duloxetine Pensa ( SSRIs / SNRIs) may cause symptoms of sexual dysfunction (see section 4). In some cases, these symptoms persist after discontinuation of treatment.

If you start to feel worse and have thoughts of harming yourself

You who are depressed and/or suffer from worry/anxiety may sometimes have thoughts of harming yourself or committing suicide. These symptoms may worsen when you start using antidepressants, as it takes time for this type of medicine to take effect, usually about 2 weeks, sometimes longer.

These thoughts may be common if you:

  • have previously had thoughts of harming yourself or committing suicide
  • is younger than 25 years. Studies have shown that young adults (younger than 25 years) with mental illness who are treated with antidepressant drugs have an increased risk of suicidal thoughts and thoughts of harming themselves.

Contact a doctor as soon as possible or see the nearest hospital if you have thoughts of injuring yourself or committing suicide.

It may be helpful to tell a relative or close friend that you are depressed and / or suffering from anxiety. Feel free to ask them to read this leaflet. You can also ask them to tell you if they think you are feeling worse or if they think your behavior is changing.

Children and young people under 18 years of age

Duloxetine Pensa should not normally be used in the treatment of children and adolescents under 18 years of age. The risk of side effects such as suicide attempts, suicidal thoughts and hostility (mainly aggression, defiance and anger) is greater in patients under 18 years of age when taking this type of drug. Despite this, Duloxetine Pensa can be prescribed by a doctor to patients under 18 years of age if the doctor deems it appropriate. If you are under 18 years of age and want to discuss why you were given this medicine, consult your doctor again. You should also tell your doctor if you notice any of the above symptoms or if they get worse. In addition, the long-term effects on growth, maturity, and development of intellect and behavior have not yet been determined for this age group.

Other medicines and Duloxetine Pensa

Tell your doctor or pharmacist if you are taking or have recently taken or might take any other medicines, including medicines obtained without a prescription.

The active ingredient in Duloxetine Pensa, duloxetine, is used in other medicines for other conditions:

  • painful diabetic neuropathy, depression, anxiety, and urine leakage.

The use of more than one of these medicines at the same time should be avoided. Contact your doctor if you are already taking other medicines that contain duloxetine.

Your doctor will decide if you can take Duloxetine Pensa with other medicines. Check with your doctor before starting or stopping any medications, including over-the-counter and herbal remedies.

Tell your doctor if you are taking any of the following:

Monoamine oxidase inhibitors ( MAOIs ): Duloxetine Pensa should not be taken if you are taking or have taken another antidepressant calledMAOIsin the last 14 days. Examples ofMAO inhibitorsare moclobemide (an antidepressant drug) and linezolid (an antibiotic). Many prescription drugs, including Duloxetine Pensa, if taken with an MAOI, can cause serious or even life-threatening side effects. Before you can take Duloxetine Pensa, at least 14 days must have passed since treatment with anMAOIcompleted. Likewise, at least 5 days must have elapsed after stopping treatment with Duloxetine Pensa before you can start taking an MAOI.

Drugs that can cause drowsiness: Such drugs include prescription drugs such as benzodiazepines, strong painkillers, drugs for psychosis, phenobarbital, and antihistamine s.

Drugs that increase the level of serotonin: Triptans, tramadol, tryptophan, SSRIs -läkemedel (e.g. paroxetine and fluoxetine ), SNRIs -läkemedel (e.g. venlafaxine ),tricyclic antidepressants (e.g. clomipramine, amitriptyline), pethidine, wort and MAOIs (eg moclobemide and linezolid). These drugs increase the risk of side effects. Contact your doctor if you experience any unusual symptoms while taking any of these medicines with Duloxetine Pensa.

Oral anticoagulants or antiplatelet agents: Blood thinners or blockers that prevent blood clots from forming. These agents may increase the risk of bleeding.

Duloxetine Pensa with food, drink, and alcohol

Duloxetine Pensa can be taken with or without food. You should be careful with alcohol while taking Duloxetine Pensa.

Pregnancy and breastfeeding

If you are pregnant or breast-feeding, think you may be pregnant, or are planning to have a baby, ask your doctor or pharmacist for advice before taking this medicine.

  • Tell your doctor if you become pregnant or plan to become pregnant during treatment with Duloxetine Pensa. You should only use Duloxetine Pensa after consulting your doctor regarding the possible benefits of the treatment and any risks to the fetus.
    Tell your midwife or doctor that you are using Duloxetine Pensa. When similar drugs ( SSRIs ) are used during pregnancy, the risk of a serious condition called persistent pulmonary hypertension in the newborn (PPHN) may increase. This condition causes the baby to breathe faster and look blue. The symptoms usually appear within 24 hours of the baby being born. If this affects your baby, contact a midwife or doctor immediately.

    If you take Duloxetine Pensa at the end of your pregnancy, your baby may experience some postpartum symptoms. These symptoms usually occur at birth or within a few days after your baby is born. Symptoms may include weak muscles, tremors, tremors, difficulty feeding, breathing problems, and seizures. If your newborn baby has any of these symptoms, or if you are concerned about your baby’s health, you should contact your doctor or midwife for advice.
    If you take Duloxetine Pensa at the end of your pregnancy, there is an increased risk of severe vaginal bleeding shortly after delivery, especially if you have previously had bleeding disorders. Your doctor or midwife should tell you to take duloxetine so that they can give you advice.
    Available data from the use of Duloxetine Pensa during the first three months of pregnancy do not indicate a generally increased risk of birth defects in the baby. If Duloxetine Pensa is taken during the second half of pregnancy, there may be an increased risk of premature birth (6 extra premature babies per 100 women taking Duloxetine Pensa during the second half of pregnancy), mostly between weeks 35 and 36 of pregnancy.
  • Tell your doctor if you are breast-feeding. The use of Duloxetine Pensa during breast-feeding is not recommended. Consult your doctor or pharmacist.

Driving and using machines

Duloxetine Pensa may make you feel drowsy or dizzy. Do not drive or use any tools or machines until you know how Duloxetine Pensa affects you.

You are responsible for assessing whether you are fit to drive a motor vehicle or perform work that requires sharpened attention. One of the factors that can affect your ability in these respects is the use of drugs due to their effects and/or side effects. Descriptions of these effects and side effects can be found in other sections. Read all the information in this leaflet for guidance. If you are not sure, talk to your doctor or pharmacist.

Duloxetine Pensa contains sucrose and sodium

Duloxetine Pensa contains sucrose. If you have been told by your doctor that you have an intolerance to some sugars, contact your doctor before taking this medicine.

Duloxetine Pensa  contains sodium 

This medicine contains less than 1 mmol (23 mg) sodium per capsule, ie essentially ‘sodium-free’.

How to take Duloxetine Pensa

Always take this medicine exactly as your doctor has told you. Ask your doctor or pharmacist if you are unsure.

Duloxetine Pensa is taken orally. Swallow the capsule whole with water.

For depression and painful diabetic neuropathy:

The recommended dose is Duloxetine Pensa 60 mg once a day, but your doctor will prescribe the dose that is right for you.

For generalized anxiety disorder:

The recommended starting dose is Duloxetine Pensa 30 mg once daily, and most patients then switch to 60 mg once daily, but your doctor will prescribe the dose that is right for you. Dose one may need to be adjusted up to 120 mg, depending on how you respond to Duloxetine Pensa.

It is easier to remember to take Duloxetine Pensa if you take it at the same time each day.

Ask your doctor how long to take Duloxetine Pensa. Do not stop taking Duloxetine Pensa, or change the dose , without first discussing it with your doctor. For you to feel better, it is important to treat your illness in the right way. If left untreated, it can persist and become more severe and difficult to treat.

If you take more Duloxetine Pensa then you should:

If you have ingested too much medicine or if e.g. a child inhaled the medicine accidentally contact a doctor, hospital, or the Poison Information Center immediately for risk assessment and advice.

Symptoms of overdose include drowsiness, coma, serotonergic syndrome (a rare reaction that can cause severe feelings of happiness, drowsiness, clumsiness, restlessness, intoxication, fever, sweating or stiff muscles), seizures, vomiting and rapid heartbeat.

If you forget to take Duloxetine Pensa

If you miss a dose, take it as soon as you remember. However, if it is time for your next dose, skip the missed dose and take only one dose as usual. Do not take a double dose to make up for a forgotten dose. Do not take more Duloxetine Pensa per day than your doctor prescribed.

If you stop taking Duloxetine Pensa

DO NOT STOP taking Duloxetine Pensa, even if you feel better, without talking to your doctor first. If your doctor thinks you no longer need Duloxetine Pensa, he/she will reduce the dose one for at least two weeks, before stopping treatment completely.

Some patients who abruptly stop taking Duloxetine Pensa may experience symptoms such as:

  • dizziness, tingling and numbness or sensations of electric shock (especially in the head), sleep disturbances (vivid dreams, nightmares, insomnia), fatigue, drowsiness, feeling of restlessness or worry, anxiety, nausea / vomiting (feeling sick), tremors, headache , muscle pain, irritation, diarrhea, heavy sweating or dizziness.

These problems are usually mild and disappear within a few days. Ask your doctor if the reactions are bothersome.

If you have any further questions on the use of this product, ask your doctor or pharmacist.

4. Possible side effects

Like all medicines, this medicine can cause side effects, although not everybody gets them. These are usually mild to moderate and usually disappear after a few weeks.

Very common side effects (may affect more than 1 user in 10)

  • headache, drowsiness
  • nausea, dry mouth

Common side effects (may affect up to 1 in 10 people)

  • loss of appetite
  • difficulty sleeping, feelings of upset, decreased sex drive, anxiety, difficulty getting or not having an orgasm, strange dreams
  • dizziness, feeling sluggish, tremors, numbness, which include numbness or tingling in the skin
  • dimsyn
  • tinnitus (sensation of sound in the ear without external sound source)
  • palpitation
  • high blood pressure, hemorrhage
  • yawning
  • constipation, diarrhea, abdominal pain, nausea and vomiting, heartburn or indigestion, flatulence
  • increased sweating, (itchy) rash
  • muscle pain, muscle spasm
  • painful urination, frequent bladder emptying
  • erection problems, ejaculation disorders
  • fall accidents (mostly in the elderly), fatigue
  • weight loss

Children and adolescents under the age of 18 treated with this antidepressant experienced some weight loss when starting treatment. However, the weight increased after 6 months of treatment so that it corresponded to other children and adolescents of the same age and the same sex.

Uncommon side effects (may affect up to 1 in 100 people)

  • pharyngitis causing a hoarse voice
  • suicidal thoughts, difficulty sleeping, gnashing of teeth, feeling disoriented, lack of motivation
  • sudden involuntary twitches or twitches in the muscles, a feeling of restlessness and difficulty sitting or standing still, feeling nervous, difficulty concentrating, changes in taste, difficulty controlling movements e.g. lack of coordination or involuntary movements in the muscles, restless legs (numbness and tingling sensation in the legs), poor sleep
  • large pupil er (the dark field in the middle of the eye), visual disturbances
  • dizziness and sore ears
  • fast or irregular heartbeat
  • fainting and dizziness when getting up, cold fingers and/or toes
  • feel thick in the throat, nosebleeds
  • bloody vomiting or black tarry stools, gastrointestinal inflammation, belching, difficulty swallowing
  • inflammation of the liver that can cause abdominal pain and yellowing of the skin and whites of the eyes
  • night sweats, hives, cold sweats, sensitivity to sunlight, increased tendency to bruise
  • muscle tension, muscle twitching
  • difficulty or inability to urinate, difficulty urinating, need to empty the bladder at night, need to empty the bladder more often than usual, decreased urine flow
  • abnormal vaginal bleeding, abnormal menstruation, including heavy, painful, irregular or prolonged menstruation, unusually short or absent menstruation, pain in the testicles or scrotum
  • chest pain, feeling cold, thirst, shaking, feeling hot, abnormal gait
  • weight gain
  • Duloxetine Pensa can cause effects that you do not notice, such as an increase in liver enzymes or the level of potassium, creatine phosphokinase, sug, ar, or cholesterol in the blood.

Rare side effects (may affect up to 1 in 1,000 people)

  • severe allergic reactions that cause difficulty breathing or dizziness, with swollen tongue or swollen lips, allergic reactions
  • impaired thyroid function, which can cause fatigue or weight gain
  • dehydration, low sodium levels in the blood (mostly affects the elderly); the symptoms may be feeling dizzy, weak, confused, sleepy or very tired, nausea or vomiting, more serious symptoms are fainting, seizures or falls, insufficient secretion of antidiuretic hormone (SIADH)
  • suicidal behavior, mania (overactivity, thoughtlessness and decreased need for sleep), feelings of aggression and anger
  • “Serotonergic syndrome” (a rare reaction that can cause feelings of happiness, drowsiness, clumsiness, restlessness, feelings of intoxication, fever, sweating, or stiff muscles), seizures
  • increased pressure in the eye ( glaucoma )
  • Cough, wheezing, and shortness of breath that may be accompanied by high body temperature
  • inflammation of the mouth, bright red blood in the stool, bad breath, inflammation of the colon (causes diarrhea) 
  • liver problems, yellowing of the skin and whites of the eyes (jaundice)
  • Stevens-Johnson syndrome (a severe disease with blisters on the skin, mouth, eyes, and genitals), severe allergic reactions that cause swelling of the face and throat ( angioedema ).
  • cramps in the jaw muscles
  • abnormal odor on the urine
  • menopausal symptoms, abnormal production of breast milk in men and women.
  • severe vaginal bleeding shortly after delivery ( postpartum hemorrhage).

Very rare side effects (may affect up to 1 user in 10,000)

  • Inflammation of the blood vessels of the skin ( cutaneous vasculitis )

5. How to store Duloxetine Pensa

Keep this medicine out of the sight and reach of children.

Do not use this medicine after the expiry date which is stated on the carton after EXP. The expiration date is the last day of the specified month.

30 mg:

Blister Alu / Alu: No special temperature instructions. Store in the original package. Sensitive to light.

Blister PVC / PVDC-Alu: Do not store above 25 ° C.

Plastic jar : No special temperature instructions . Store in the original package. Sensitive to light.

60 mg:

Blister Alu / Alu: No special storage instructions.

Blister PVC ‑ PVDC / Alu: Do not store above 25 ° C.

Plastic jar : No special storage instructions.

Medicines should not be disposed of via wastewater or household waste. Ask your pharmacist how to dispose of medicines no longer required. These measures will help to protect the environment.

6. Contents of the packaging and other information

Content declaration

  • The active substance is duloxetine. Each capsule contains 30 or 60 mg of duloxetine (as hydrochloride).
  • Other ingredients are Capsule contents: Hypromellose, methacrylic acid-ethyl acrylate polymer, sodium lauryl sulfate, polysorbate 80, sucrose, sugar spheres (maize starch and sucrose), talc, titanium dioxide, triethyl citrate.

    Capsule shell: Gelatin, titanium dioxide (E171), indigo carmine (E132). The 60 mg capsule also contains yellow iron oxide (E172).
    Ink: shellac, propylene glycol, ammonia solution, potassium hydroxide, black iron oxide (E172).

What the medicine looks like and the contents of the pack

Duloxetine Pensa is a hard, gastric-resistant capsule. Each capsule of Duloxetine Pensa contains granules of duloxetine hydrochloride with a coating that resists acidic gastric juice.

Duloxetine Pensa is available in 2 strengths: 30 mg and 60 mg.

The 30 mg capsule is blue and white (approximately 15 mm in size) marked with the code “E127” in black print.

The 60 mg capsule is blue and green (approximately 19 mm in size) marked with the code “E129” in black print.

Duloxetine Pensa 30 mg is supplied in blister packs containing 7, 28 and 98 capsules and a plastic jar containing 500 capsules (for dose dispensing only).

Duloxetine Pensa 60 mg is supplied in blister packs containing 28 and 98 capsules and a plastic jar containing 500 capsules (for dose dispensing only).

Not all pack sizes may be marketed.

Marketing Authorization Holder and Manufacturer

Marketing Authorisation Holder:

Pensa Pharma AB

Birger Jarlsgatan 22

114 34 Stockholm

Manufacturer:

TOWA PHARMACEUTICAL EUROPE, SL

C / de Sant Martí 75-97

08107 Martorelles (Barcelona)

Spain.

This medicinal product is authorized under the European Economic Area under the names

Italy Duloxetine Pensa
Netherlands Duloxetine Pensa

Muhammad Nadeem

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