EVOREL SEQUI

Active substance: NORETHISTERONE ACETATE MICRONISED

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PACKAGE LEAFLET: INFORMATION FOR THE USER

Evorel® Sequi
Estradiol hemihydrate, norethisterone acetate
Evorel is a registered trademark

Read all of this leaflet carefully before you start using this medicine.

• Keep this leaflet. 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. Do not pass it on to others. It may harm them, even if
their symptoms are the same as yours
• If you get side effects and they become serious or if you notice any side effects not listed in this
leaflet, please tell your doctor or pharmacist

In this leaflet
1 What Evorel Sequi is and what it is used for
2 Before you use Evorel Sequi
3 Safety of HRT
4 How to use Evorel Sequi
5 Possible side effects
6 How to store Evorel Sequi
7 Further information

1 What Evorel Sequi is and what it is used for
The name of your medicine is Evorel Sequi. It belongs to a group
of medicines called hormone replacement therapy (HRT).
Evorel Sequi contains two medicines:
• An oestrogen (estradiol)
• A progestogen (norethisterone)
They are both female hormones.
Evorel Sequi comes in a ‘memory pack’. This can be used to
help you remember when to change your patches. Each pack
contains eight patches:
• Four ‘Evorel 50’ patches marked CE50 (containing estradiol only)
• Four ‘Evorel Conti’ patches marked CEN1 (containing estradiol
and norethisterone)
The hormones are spread evenly in each patch. They pass
slowly into your body through the skin.

What Evorel Sequi is used for

Evorel Sequi is used:
• For the symptoms of the menopause (see ‘What is the
menopause?’ on the next page). It is only used in women who
still have a womb. It is suitable for women who have had the
menopause (postmenopausal) or who are around the time of
the menopause (perimenopausal)

• To prevent osteoporosis (fragile bones) in women who have
had the menopause and are most likely to have bone problems.
Evorel Sequi is only used if other medicines for osteoporosis
have been tried first and they have not worked

What is the menopause?

Women produce oestrogen hormones from their ovaries
throughout their adult life. These hormones are important in
sexual development and control of the menstrual cycle.
The menopause happens when the level of hormones produced
by the ovaries goes down. This is a gradual process. During this
time, the levels of oestrogen can go up and down. This can cause:
• Hot flushes, night sweats or mood swings
• Vaginal problems such as dryness or itching
• Uncomfortable or painful sexual intercourse
You may get the same symptoms if you have had your ovaries
taken out in an operation.

How Evorel Sequi works

Evorel Sequi is known as ‘continuous sequential’ HRT. This is
because two hormones are used one after another:
• Estradiol is used by itself for two weeks
• Then estradiol and norethisterone are used together for the
next two weeks
Evorel Sequi patches replace the oestrogen that is normally
released by the ovaries. However, taking an oestrogen hormone
regularly may cause the lining of your womb to build up and get
thicker.
• This means it is necessary to add a progestogen hormone to
the oestrogen
• This helps shed the lining of the womb and stop any problems
happening. Evorel Conti patches used during weeks 3 and 4
contain this progestogen
The shedding of the lining of the womb will probably give
a ‘withdrawal bleed’. This will be like having a period each
month. The withdrawal bleed will start during week 4, before you
finish an Evorel Sequi pack.
Evorel Sequi is not a contraceptive.

2 Before you use Evorel Sequi
Do not use Evorel Sequi if:

• You are allergic to anything in the patches (listed in section 7
below)
• You have (or have ever had) or think you may have breast
cancer
• You have (or are suspected of having) or ever had a cancer
that is made worse by oestrogens (such as endometrial
cancer)
• You have a thickening of the lining of the womb which has not
been treated
• You have vaginal bleeding you cannot explain
• You have ever had blood clots in a vein (thrombosis) or a blood
clot that has travelled to your lung (pulmonary embolism)
• You have problems with your blood which increases the likelihood
of developing a blood clot (thrombosis) (such as protein C,
protein S or antithrombin deficiency)
• You have ever had blocked arteries (arterial thrombo-embolic
disease) that gave you angina or a heart attack or a stroke
• You have (or have ever had) a liver disease and your liver
function tests have not returned to normal
• You have a blood problem called “porphyria”
Do not use this medicine if any of the above applies to you.
If you are not sure, talk to your doctor or pharmacist before using
Evorel Sequi. Stop using Evorel Sequi at once if any of the above
appears for the first time and talk to your doctor immediately.
Evorel Sequi should not be used by children.

Take special care with Evorel Sequi

Before taking HRT, your doctor should ask about you and your
family’s medical history. Your doctor may decide to examine your
breasts or your tummy and may do an internal examination.
They will only do this if it is necessary for you or if you have any
special concerns.
Once you have started on HRT, see your doctor for regular
check-ups (at least once a year). At these check-ups, your doctor
may discuss the benefits and risks of continuing to take HRT.

Tell your doctor if you have ever had any of the following.
You may need to have checks more often.
• Vaginal bleeding which you could not explain
• A problem caused by growth of the womb lining:
- Inside the womb (fibroids)
- Outside the womb (endometriosis)
- Thickening of the lining of the womb (endometrial
hyperplasia)
• Increased risk of blood clots (see ‘Blood clots’ in section 3
below)
• A family history of increased risk of cancers related to
oestrogens (see ‘Breast cancer’ in section 3 below)
• High blood pressure (hypertension). Your doctor may tell you to
stop using Evorel Sequi if your blood pressure goes up
• Diabetes
• Gallstones
• Migraine or severe headaches
• Systemic lupus erythematosus (SLE). This is an allergic
condition that causes joint pain, skin rashes and fever
• Epilepsy
• Asthma
• A disease affecting the eardrum and hearing (otosclerosis)
• Liver, heart or kidney problems
• High levels of triglycerides (a type of fat) in your blood as you
may have a higher risk of pancreatitis (inflammation of the
pancreas, which causes severe pain in the abdomen and back)
• Any breast problems
• History of sudden swelling of the face or throat, which may
cause difficulty in swallowing or breathing, rapid swelling of the
hands and feet and stomach cramps
You may still be able to use Evorel Sequi, but you should
discuss this with your doctor first. Also tell your doctor if these
illnesses return or get worse while you are using Evorel Sequi.
If you have had a premature menopause the risk of using HRT
may be different. Talk to your doctor about the risks.

Make sure that you:

Other conditions:

Medical check-ups

®

Evorel Sequi
© J-C 2014
GB - AW_94375

• Go for regular breast screening and cervical smear tests
• Regularly check your breasts for any changes such as
dimpling of the skin, changes in the nipple or any lumps you
can see or feel

• If you have brown patches on your face or body (chloasma) or
have a history of them, you may need to keep out of the sun or
away from sunbeds (these patches may not completely
disappear again)

Taking other medicines

Please tell your doctor or pharmacist if you are taking or have
recently taken any other medicines. This includes medicines that
you buy without a prescription or herbal medicines.
In particular, tell your doctor or pharmacist if you are
taking any of the following:
• Medicines for epilepsy such as phenobarbital, phenytoin or
carbamazepine
• Certain medicines for infections such as rifampicin, rifabutin,
nevirapine, efavirenz, ritonavir or nelfinavir
• Bosentan - for high blood pressure in the blood vessels of the
lungs
• St. John’s Wort - for depression
Taking these medicines with Evorel Sequi can stop it from
working as well. Because of this you may get some bleeding like
a period, when you are not expecting it.
• A medicine for epilepsy called lamotrigine. Using Evorel Sequi
with lamotrigine could affect control of your epilepsy

Operations or tests

Tell your doctor if you are going to have surgery. You may need
to stop taking HRT about 4 to 6 weeks before the operation to
reduce the risk of a blood clot. Your doctor will tell you when you
can start taking HRT again.
If you visit a hospital or your family doctor for a blood or urine
test, tell them that you are taking Evorel Sequi. This is because
this medicine may affect the results of the tests.

Pregnancy and breast-feeding

Do not use this medicine if you are pregnant, think you may be
pregnant or might become pregnant. This is because it may
affect the baby. If you become pregnant, contact your doctor
straight away and remove the patch.
Do not use this medicine if you are breast-feeding.
Ask your doctor or pharmacist for advice before taking any
medicine if you are pregnant or breast-feeding.

Driving or using machines

There is no information about whether Evorel Sequi affects your
ability to drive or use machines. See how this medicine affects
you before you drive or use any tools or machines.

3 Safety of HRT
As well as benefits, HRT has some risks. Consider the following
when deciding to take or continue HRT.

Heart disease

HRT is not recommended for women who have had heart
disease recently. If you have ever had heart disease, talk to your
doctor to see if you should be taking HRT.
HRT will not help to prevent heart disease.
Studies of HRT (containing oestrogen and progestogen) have
shown that women may be slightly more likely to get heart disease.
If you get a pain in your chest that spreads to your arm and neck:
• See a doctor as soon as possible
• Do not use any more HRT until your doctor says you can
This pain may be a sign of heart disease.

Stroke

Research suggests that HRT slightly increases the risk of having
a stroke. Other things that can increase the risk of stroke include:
• Getting older
• High blood pressure
• Smoking
• Drinking too much alcohol
• An irregular heartbeat
If you are worried about any of these things or if you have had
a stroke in the past, talk to your doctor to see if you should take HRT.
How likely is a stroke?
Looking at women in their 50s, on average, over 5 years:
• In women not taking HRT - 3 in 1000 would be expected to
have a stroke
• In women taking HRT - 4 in 1000 would be expected to have
a stroke
Looking at women in their 60s, on average, over 5 years:
• In women not taking HRT - 11 in 1000 would be expected to
have a stroke
• In women taking HRT - 15 in 1000 would be expected to
have a stroke
If you get migraine-type headaches which you cannot explain:
• See a doctor as soon as possible
• Do not use any more HRT until your doctor says you can
These headaches may be an early warning sign of a stroke.

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Blood clots

HRT is not recommended for women who have ever had
a blood clot.
HRT may increase the risk of blood clots in the veins (also called
deep vein thrombosis or DVT), especially during the first year of
taking it.
These blood clots are not always serious. However, if a clot travels
to the lungs, it can cause chest pain, breathlessness, collapse
or even death. This is called pulmonary embolism or PE.
You are more likely to get a blood clot if:
• You are very overweight (BMI > 30 kg/m2)
• You have had a blood clot before
• Any of your close family have had blood clots
• You have had one or more miscarriages
• You have any blood clotting problem that needs treatment with
a medicine such as warfarin
• You are off your feet for a long time because of major surgery,
injury or illness
• You are going on a long journey and will not be moving about
for some time
• You have a rare illness called SLE (Systemic Lupus
Erythematosus)
• You have cancer
If any of these things apply to you, talk to your doctor to see if
you should take HRT.
How likely is a blood clot?
Looking at women in their 50s, on average, over 5 years:
• In women not taking HRT - 3 in 1000 would be expected to
get a blood clot
• In women taking HRT - 7 in 1000 would be expected to get
a blood clot
Looking at women in their 60s, on average, over 5 years:
• In women not taking HRT - 8 in 1000 would be expected to
get a blood clot
• In women taking HRT - 17 in 1000 would be expected to get
a blood clot
If you get painful swelling in your leg, sudden chest pain or have
difficulty breathing:
• See a doctor as soon as possible
• Do not use any more HRT until your doctor says you can
These may be signs of a blood clot.

Breast cancer

Women who have breast cancer or have had breast cancer
in the past should not take HRT.
Taking HRT slightly increases the risk of breast cancer. The risk
is also slightly increased if you have a later menopause.
• Postmenopausal women taking oestrogen-only HRT for 5 years the risk is about the same as for a woman of the same age
who is still having periods over that time and not taking HRT
• Women taking oestrogen plus progestogen HRT - the risk is
higher than for oestrogen-only HRT. However, oestrogen
plus progestogen HRT is beneficial for the endometrium
(see ‘Endometrial cancer’)
For all kinds of HRT, the extra risk of breast cancer goes up the
longer you take it. However, it returns to normal within about 5 years
after stopping HRT.
Your risk of breast cancer is also higher if:
• You have a close relative (mother, sister or grandmother) who
has had breast cancer
• You are very overweight
How likely is breast cancer?
Looking at women aged 50, on average, over the next 15 years:
• In women not taking HRT - 32 in 1000 will get breast cancer
• In women taking oestrogen-only HRT at age 50 and take it
for 5 years, between 33 and 34 in 1000 will get breast cancer
• In women taking oestrogen-only HRT for 10 years - 37 in
1000 will get breast cancer
• In women taking oestrogen plus progestogen HRT at age
50 and take it for 5 years - 38 in 1000 will get breast cancer
• In women taking oestrogen plus progestogen HRT for
10 years - 51 in 1000 will get breast cancer
If you notice any changes in your breast, such as:
• Dimpling of the skin
• Changes in the nipple
• Any lumps you can see or feel
Make an appointment to see your doctor as soon as possible.

3 Safety of HRT (continued)
Endometrial cancer (cancer of the lining of the
womb)

HRT is not recommended for women who have ever had cancer
of the lining of the womb.
Taking oestrogen-only HRT for a long time can increase
the risk of cancer of the lining of the womb (the endometrium).
Taking a progestogen as well as the oestrogen helps to lower
the extra risk.
If you still have your womb, your doctor will usually prescribe
a progestogen as well as oestrogen. These may be prescribed
separately or as a combined HRT product.
If you have had your womb removed (a hysterectomy),
your doctor will discuss with you whether you can safely take
oestrogen without a progestogen.
If you have had your womb removed because of
endometriosis, any endometrium left in your body may be at
risk of cancer. This means your doctor may prescribe HRT that
includes a progestogen as well as an oestrogen.

Your product, Evorel Sequi, contains a progestogen. Evorel
Sequi is only used in women who still have a womb (see Section
1 ‘What Evorel Sequi is used for’).
How likely is endometrial cancer?
Looking at women aged 50 who still have a womb, on average,
over the next 15 years:
• In women not taking HRT - 5 in 1000 will get endometrial
cancer
• In women taking oestrogen-only HRT, the number will be
2 to 12 times higher, depending on the dose and how long
you take it for
The addition of a progestogen to oestrogen-only HRT
substantially reduces the risk of endometrial cancer.
If you get breakthrough bleeding or spotting, it is usually
nothing to worry about, especially during the first few months of
taking HRT.

But if the bleeding or spotting:
• Carries on for more than the first few months
• Starts after you have been on HRT for a while
• Carries on even after you’ve stopped taking HRT
Make an appointment to see your doctor as soon as possible.
It could be a sign that your endometrium has become thicker.

Ovarian cancer

Ovarian cancer (cancer of the ovaries) is rare, but it is serious. It can
be difficult to diagnose. This is because there are often no obvious
signs of the disease. Some studies have suggested that taking
HRT for more than 5 years may increase the risk of ovarian cancer.

Dementia

Evorel Sequi and medicines like it will not stop memory loss
(dementia). Women who start using medicines like Evorel Sequi
after the age of 65 may have a small increase in the risk of dementia.

4 How to use Evorel Sequi
Always use Evorel Sequi exactly as your doctor has told you.
You should check with your doctor or pharmacist if you are not
sure. Your doctor will aim to reduce your symptoms with the
lowest possible dose for the shortest amount of time.

When to start using Evorel Sequi

You may put an Evorel 50 patch on at any time if:
• You have not used HRT before your menopause and no longer
have menstrual periods
• Your menstrual cycles are not regular and you are not pregnant
• You are changing from HRT that does not give you a withdrawal
bleed
Put an Evorel 50 patch on within 5 days of the start of
bleeding if:
• You are not currently using HRT and still having regular periods
Put an Evorel 50 patch on at the end of a treatment cycle
or one week after you finish using another HRT product if:
• You are changing from an HRT medicine that gives you
a withdrawal bleed
If you are using another type of HRT:
• The day you start will depend on the type of HRT you have
been using
Talk to your doctor if you are not sure which type of HRT you are
using.

To help you remember your two “patch change" days, mark them
here or on the pack. They are written on the pack like this:

If you forget to change the patch

Where to apply the patch

If you use more Evorel Sequi than you should

Stick the patch onto a hairless area of skin below the waist.
Most women prefer to wear the patch on the thigh or bottom.
• Do not apply on or near the breasts
• Do not put it on top of cuts, spots or anywhere the skin is irritated
• Do not use cream, moisturizer or talc before applying the patch
• Do not apply the patch on the same area of skin twice in a row
• It can be worn under loose areas of clothing
• Do not wear a patch under elasticated areas or a tight
waistband
• Apply the patch to clean, dry, cool skin as soon as you open
the protective pouch

Putting a patch on

Using the patches

Weeks 1 and 2
Use the four Evorel 50 patches one at a time.

Step 1: Open and Peel
• Using the notches as a guide, tear along two
edges of the pouch. Remove the patch
• With the protective backing facing you, bend
and peel off half the backing. Don’t touch the
sticky side - it may not stick properly if you do

Weeks 3 and 4
Use the four Evorel Conti patches one at a time. As soon as
you remove your fourth Evorel 50 patch, replace it with the first
Evorel Conti patch.
Start a new pack of Evorel Sequi as soon as you finish one.
Do not leave a break between packs.

Changing your patches

• You must change the patches twice a week to give your body
a steady supply of hormones. There is enough hormone in
each patch to last for several days
• Change your patch on the same two days every week. This will
mean that one patch is on for three days and the next patch for
four days
• For example, if you apply your first patch on a Monday, change
it on Thursday and again on the following Monday. You can work
out your two days from the following table, starting from the
first day of use:
If you put your
first patch on:
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday









Change on:
Thursday
Friday
Saturday
Sunday
Monday
Tuesday
Wednesday

&
&
&
&
&
&
&

Change again on:
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

It is unlikely that you will have too much of the hormones in
Evorel Sequi. The most common symptoms of having too much
oestrogen or progestogen in your body are:
• Tender breasts
• Feeling sick (nausea) or being sick
• Unexpected vaginal bleeding
• Stomach pain or bloating
Removing the patch can reverse the effects of too much oestrogen
and/or progestogen. Talk to your doctor or pharmacist before
using any more patches.

Contraception while using Evorel Sequi

The levels of hormone from the patches are too low to act as
a contraceptive. Use non-hormonal contraceptive methods
(such as a condom, diaphragm or coil) until your periods have
completely stopped.

Do not use a patch if its protective pouch is
already open.

The patches need to be changed twice a week. You must use the
patches in the right order.

Change it as soon as you remember and then keep to your
original ‘patch change’ days. You may get some bleeding and
spotting like a period during this time.

Everyday activities

• You can have a bath or shower as normal. Do not scrub too
hard as this can loosen the edges of the patch
• You can go swimming. The patch will not be affected
• You can exercise and play sports. However, do not wear the
patch under tight clothing or waist bands
• You can sunbathe. However, keep the patch covered, out of
direct sunlight
If you have any further questions on the use of this product,
ask your doctor or pharmacist.

Step 2: Apply and Press
• Apply the open half of the patch to your skin
• Remove the remaining backing and press
down the rest of the patch
• Press the patch with the palm of your hand
to make sure it is firmly stuck

Removing a patch

• Peel an edge of the patch smoothly away
from the skin
• Fold the patch in half, so that the sticky side
sticks to itself
• Put it in with the household rubbish, safely
out of the reach of children and pets
• Do not flush used patches down the toilet
When you remove the patch some glue may remain on your
skin. It will disappear with time or you can use baby oil to
remove it.

If a patch falls off

Apply a new patch of the same type. If you have just had a bath
or shower, wait until your skin cools before applying the new
patch.
It is always useful to keep a spare pack that you can use to
replace patches that have fallen off. Talk to your doctor if you
need more patches.

5 Possible side effects
Like all medicines, Evorel Sequi can cause side effects,
although not everybody gets them.
Take off the patch and tell your doctor straight away if you
notice or suspect any of the following. You may need urgent
medical treatment.
• Blood clots (thrombosis), or stroke (frequency not known)
• Yellowing of the skin or whites of the eyes (jaundice) or other
liver problems
• Migraine-type headaches for the first time or more frequent
(affects less than 1 in 10 people)
• An increase in blood pressure (affects less than 1 in 10 people)
• Breast or ovarian cancer, endometrial cancer or hyperplasia
(long, heavy or irregular vaginal bleeding)Widespread rash
with peeling skin and blistering in the mouth, eyes and genitals
(Stevens-Johnson syndrome) (frequency not known)
• Convulsions or fits (frequency not known)

Tell your doctor if you notice any of the following side
effects while using Evorel Sequi:
Very common (affects more than 1 in 10 people)
• Irritated, itchy, red skin where the patch is applied
Common (affects less than 1 in 10 people)
• Feeling depressed or nervous
• Inappropriate signs of emotion
• Being unable to sleep
• Headache
• Itchy skin or red rash
• Feeling sick (nausea), or having stomach pain wind or other
stomach upsets
• Diarrhoea
• Pain including pain in the back, muscles, joints
• Breast pain
• Feeling generally unwell
• Weight gain
• Heavy vaginal bleeding, painful periods
• Water retention or build-up of fluid under the skin (oedema)

Uncommon (affects less than 1 in 100 people)
• Concentration problems
• Feeling dizzy
• More or less interest in sex than usual
• Allergic reaction (hypersensitivity)
• A fungal infection called thrush
• Feeling tired
• Being aware of your heartbeat (palpitations)
• Numb or tingling hands or feet, less skin sensitivity
• Breast lumps (non-cancerous)
• Fuller breasts
• Irregular vaginal bleeding
• Thickening of the lining of the womb
Frequency not known
• Mood swings
• Bloated feeling
• Gallstones
• Swelling of the hands and feet (peripheral oedema)
• Puffy skin where the patch is applied
If any of the side effects gets serious, or if you notice any other side
effects not listed in this leaflet, please tell your doctor or pharmacist.

Do not use Evorel Sequi after the expiry date which is stated on
the label. The expiry date refers to the last day of that month.

Do not use a patch if its protective pouch is open.

Both types of patch are square with rounded corners. They are
clear with a sticky backing that can be stuck to the skin. Each patch
comes in a protective sealed pouch and has a surface area of
16 sq cm.

For information in large print,
tape, CD or Braille, telephone
0800 7318450.

6 How to store Evorel Sequi
Keep out of the sight and reach of children. It should be stored
at room temperature (do not store above 25°C).

7 Further information
The active substances in Evorel Sequi are estradiol
hemihydrate and norethisterone acetate.
Each Evorel 50 patch contains 3.2 mg of estradiol hemihydrate.
Each Evorel 50 patch delivers 50 micrograms of estradiol a day.
Each Evorel Conti patch contains 3.2 mg of estradiol hemihydrate
and 11.2 mg of norethisterone acetate. Each Evorel Conti patch
delivers 50 micrograms of estradiol and 170 micrograms of
norethisterone a day.
The other ingredients are Duro-Tak 387-2287 (this makes the
patches sticky), guar gum and Hostaphan MN19 (backing film).

What Evorel Sequi looks like and contents of the
pack

Evorel Sequi comes in a memory pack containing four Evorel 50
patches (marked CE50) and four Evorel Conti patches (marked
CEN1).

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The product licence is held by:
JANSSEN-CILAG LTD, 50-100 Holmers Farm Way, High
Wycombe, Buckinghamshire HP12 4EG, UK
Evorel Sequi is made by:
Janssen Pharmaceutica NV, Turnhoutseweg 30, B-2340 Beerse,
Belgium
OR
McGregor Cory Ltd, Middleton Close, Banbury, Oxfordshire
OX16 4RS, UK

This leaflet was last approved in August 2014

L

JANSSEN-CILAG

Graphic Services
Tel. Inge Vermeiren: +32 14606915 - E-mail: ivermei1@its.jnj.com
Tel. François Vermeylen: +32 14606865 - E-mail: fvermeyl@its.jnj.com
INSERT EVOREL SEQUI
Article Number : AW_94375
Format Name : B/I/019/V3 (340x500)
Technical Info/Spec: Pointsize : 8pt
File Name : AW_94375.indd (CS5_PC)

AW_94375.pdf - Page 3 of 3 - August 8, 2014 - 07:01:22

Market : GB
Mat. ID Code : Operator : Syed

■ Black

A

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Date: 1. 18-06-2014
2. 08-08-2014
3.
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Source: Medicines and Healthcare Products Regulatory Agency

Disclaimer: Every effort has been made to ensure that the information provided here is accurate, up-to-date and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. This information has been compiled for use by healthcare practitioners and consumers in the United States. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate that the drug or combination is safe, effective or appropriate for any given patient. If you have questions about the substances you are taking, check with your doctor, nurse or pharmacist.

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