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ANORPHINAN 20 MG/10 MG PROLONGED-RELEASE TABLETS

Active substance(s): NALOXONE HYDROCHLORIDE DIHYDRATE / OXYCODONE HYDROCHLORIDE

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Package leaflet: Information for the user

Anorphinan 5 mg/2.5 mg prolonged-release tablets
Anorphinan 10 mg/5 mg prolonged-release tablets
Anorphinan 20 mg/10 mg prolonged-release tablets
Anorphinan 40 mg/20 mg prolonged-release tablets
oxycodone hydrochloride / naloxone hydrochloride
Read all of this leaflet carefully before you start taking this
medicine because it contains important information for you.

- 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 only. Do not pass it on
to others. It may harm them, even if their signs of illness are the
same as yours.
- If you get any side effects, talk to your doctor or pharmacist. This
includes any possible side effects not listed in this leaflet. See
section 4.
What is in this leaflet
1. What Anorphinan is and what it is used for
2. What you need to know before you take Anorphinan
3. How to take Anorphinan
4. Possible side effects
5. How to store Anorphinan
6. Contents of the pack and other information

1. What Anorphinan is and what it is used for
Anorphinan is a prolonged-release tablet, which means that its active
substances are released over an extended period. Their action lasts
for 12 hours.
Pain relief
You have been prescribed Anorphinan for the treatment of severe
pain, which can be adequately managed only with opioid analgesics.
Naloxone is added to counteract constipation.
How Anorphinan works in pain relief
Anorphinan tablets contain oxycodone and naloxone as active
substances. Oxycodone is responsible for the painrelieving effect
of Anorphinan. It is a strong analgesic (“painkiller”) that belongs
to a group of medicines called opioids. Naloxone is intended to
counteract constipation. Constipation is a typical side effect of
treatment with opioid painkillers.

2. What you need to know before you take Anorphinan
Do NOT take Anorphinan tablets
• if you are allergic to oxycodone or naloxone or any of the other
ingredients of this medicine (listed in section 6),
• if you have breathing problems, such as breathing more slowly or
weakly than expected (respiratory depression),
• if you suffer from a severe lung disease associated with
narrowing of the airways (chronic obstructive pulmonary disease
or COPD),
• if you suffer from a condition known as cor pulmonale. In this
condition the right side of the heart becomes enlarged, due to
increased pressure inside blood vessels in the lung etc. (e.g. as a
result of COPD – see above),
• if you suffer from severe bronchial asthma,
• if you have a type of bowel obstruction (paralytic ileus) not
caused by opioids,
• if you have moderate to severe liver problems.

Warnings and Precautions
Talk to your doctor or pharmacist before taking Anorphinan:
• in the case of elderly or debilitated (weak) patients,
• if you have a type of bowel obstruction (paralytic ileus) caused by
opioids,
• if you have kidney problems,
• if you have mild liver problems,
• if you have severe lung problems (i.e. reduced breathing
capacity),
• if you suffer with a condition characterised by frequent breathing
stops during the night, which may make you feel very sleepy
during the daytime (sleep apnoea),
• if you have myxoedema (a thyroid disorder, with dryness,
coldness and swelling [‘puffiness’] of the skin, affecting the face
and limbs),
• if your thyroid gland is not producing enough hormones
(underactive thyroid, or hypothyroidism),
• if your adrenal glands are not producing enough hormones
(adrenal insufficiency, or Addison’s disease),
• if you have a mental illness accompanied by a (partial) loss of
reality (psychosis), due to alcohol or intoxication with other
substances (substance-induced psychosis),
• if you suffer from gallstone problems,
• if your prostate gland is abnormally enlarged (prostate
hypertrophy),
• if you are or ever have been addicted to alcohol or drugs, or have
previously suffered from withdrawal symptoms such as agitation,
anxiety, shaking or sweating upon stopping alcohol or drugs
(delirium tremens),
• if your pancreas is inflamed (pancreatitis),
• if you have low blood pressure (hypotension),
• if you have high blood pressure (hypertension),
• if you have pre-existing heart disease,
• if you have a head injury (due to the risk of increased brain
pressure),
• if you suffer from epilepsy or are prone to fits,
• if you are also taking a type of medicine known as a MAO
inhibitor (used to treat depression or Parkinson’s disease),
e.g. medicines containing tranylcypromine, phenelzine,
isocarboxazid, moclobemide and linezolid.
• if sleepiness or episodes of suddenly falling asleep occur.
Tell your doctor if any of the above has ever applied to you in the
past. Also, please tell your doctor if you develop any of the above
disorders while you are taking Anorphinan.

These tablets are not recommended for use in patients with advanced
digestive or pelvic cancers where bowel obstruction may be a
problem.
Children and adolescents
This medicine must not be given to children or adolescents under 18
years of age as the safety and benefits have not been shown yet.
How to use Anorphinan correctly
If you experience severe diarrhoea at the start of treatment (within
the first 3-5 days) this may be due to the effect of naloxone. It may
be a sign that your bowel movements are returning to normal. If
diarrhoea persists after 3-5 days, or it gives you cause for concern,
please contact your doctor.
If you have been using high doses of another opioid, withdrawal
symptoms (such as restlessness, bouts of sweating or muscle pain)
may occur when you initially switch to taking these tablets. If you
experience withdrawal symptoms, you may need to be specially
monitored by your doctor.

If you need to undergo surgery, please tell your doctor that you are
taking this medicine.

If you have been taking this medicine for a long time, you may
become tolerant. This means you may need a higher dose to achieve
the desired effect. Long-term use of these tablets may also lead to
physical dependence. Medicines containing oxycodone should be
avoided in patients with a present or past abuse of alcohol, drugs or
medicines. Withdrawal symptoms may occur if treatment is stopped
too suddenly. If you no longer need treatment, you should reduce
your daily dose gradually, in consultation with your doctor.
As with other strong opioid painkillers, there is a risk that you may
develop a psychological dependence to oxycodone.

You may notice remains of the tablet in your stools. Do not be
alarmed, as the active substances will have already been released in
the stomach and gut, and absorbed into your body.

• other medicines which act on the nervous system (phenothiazines,
neuroleptics).
Tell your doctor if you are taking:
• medicines that decrease the blood’s clotting ability (coumarin
derivatives), this clotting time may be speeded up or slowed
down
• antibiotics of the macrolide type (such as clarithromycin)
• antifungal medicines of the –azole type (e.g. ketoconazole)
• ritonavir or other protease inhibitors (used to treat HIV)
• rifampicin (used to treat tuberculosis)
• carbamazepine (used to treat seizures, fits or convulsions and
certain pain conditions)
• phenytoin (used to treat seizures, fits or convulsions).

Anorphinan with food, drink and alcohol
Drinking alcohol whilst taking Anorphinan may make you feel
more sleepy or increase the risk of serious side effects such as
shallow breathing with a risk of stopping breathing, and loss of
consciousness. It is recommended not to drink alcohol while you are
taking Anorphinan.
You should avoid drinking grapefruit juice while you are taking this
medicine.

Pregnancy and breastfeeding
If you are pregnant or breastfeeding, think you may be pregnant or
are planning to have a baby, ask your doctor or pharmacist for advice
before taking this medicine.
Pregnancy
Use of Anorphinan during pregnancy should be avoided unless
your doctor finds treatment with this medicine is essential. If used
over prolonged periods during pregnancy, oxycodone may lead to
withdrawal symptoms in the newborn baby. If oxycodone is given
during childbirth, the baby may have breathing problems such as
slow and shallow breathing (respiratory depression).

Breastfeeding
Breastfeeding should be stopped during treatment with this medicine
as oxycodone (one of the active substances of this medicine) passes
into breast milk and it is not known whether naloxone also passes
into breast milk. Therefore, a risk for the breastfed infant cannot
be excluded in particular following intake of multiple doses of this
medicine.
Driving and using machines
This medicine can affect your ability to drive or operate machines
as it may make you sleepy or dizzy. This is most likely at the start
of your treatment, after a dose increase or after switching from a
different medication. These side effects should disappear once you
are on a stable dose.

This medicine has been associated with sleepiness and episodes of
suddenly falling asleep. If you experience these side effects, you
must not drive or operate machinery. You should tell your doctor if
this occurs.
Talk to your doctor or pharmacist if you are not sure whether it is
safe for you to drive while taking this medicine.
Anorphinan contains lactose
Anorphinan 5 mg/2.5 mg and 10 mg/5 mg contain lactose (milk
sugar). If you have been told by your doctor that you have an
intolerance to some sugars, contact your doctor before taking
Anorphinan 5 mg/2.5 mg and 10 mg/5 mg.

3. How to take Anorphinan
Always take this medicine exactly as your doctor has told you.
Check with your doctor or pharmacist if you are not sure.

You must swallow the prolonged-release tablet whole, so as not to
affect the slow release of oxycodone from the tablet. Do not break,
chew or crush the prolonged-release tablets. Taking broken, chewed
or crushed tablets may result in your body absorbing a potentially
fatal dose of oxycodone (see under “If you take more Anorphinan
than you should”).
Unless otherwise prescribed by your doctor, the usual dose is:
To treat pain

Adults
The usual starting dose is one Anorphinan 10 mg/5 mg prolongedrelease tablet every 12 hours.

Your doctor will decide how much you should to take every day and
how to divide the total daily dose into morning and evening doses.
The doctor will also decide on any necessary dose adjustment during
treatment depending on your level of pain and individual sensitivity.
You should be given the lowest dose needed for pain relief. If you
have already been treated with opioids, your treatment with this
medicine may be started at a higher dose.
The maximum daily dose is 160 mg oxycodone hydrochloride and
80 mg naloxone hydrochloride. If you need a higher dose, your
doctor may give you additional oxycodone without naloxone.
However, the maximum daily dose of oxycodone should not exceed
400 mg. The beneficial effect of naloxone on bowel movements
may be affected if additional oxycodone is given without additional
naloxone.

If you experience pain between doses of Anorphinan, you may need
to take an additional fast-acting painkiller. Anorphinan is not suitable
for this. Please talk to your doctor.
If you feel that these tablets are too strong or too weak, please talk to
your doctor or pharmacist.
Elderly patients
In general, no dose adjustment is necessary for elderly patients with
normal kidney and/or liver function.

Liver or kidney problems
If you have kidney or mild liver problems your doctor will prescribe
Anorphinan with special caution. You must not take these tablets if
you have moderate or severe liver problems (see also Section 2 “Do
not take Anorphinan tablets” and “Warnings and Precautions”).
Children and adolescents below 18 years of age
No studies have been carried out to show that this medicine work
properly in children and adolescents, or are safe for them to take. It
is therefore not recommended for use in patients under 18 years of
age.

Method of administration
Swallow your tablets whole with a glass of water. You can take these
tablets with or without food. Take them every 12 hours, according to
a fixed time schedule. For instance, if you take a tablet at 8 o’clock
in the morning, you should take your next tablet at 8 o’clock in the
evening. Do not break, chew or crush the tablets.
Opening instructions

This medicinal product is in child-resistant packaging. The tablets
cannot be pressed out of the blister. Please observe the following
instructions when opening the blister.
1. Separate a single dose by carefully
tearing along the perforated lines.

2. An unsealed corner is revealed
at the intersection point of the
perforated lines.

Incorrect use of Anorphinan
Anorphinan is not suitable for withdrawal treatment.

This medicine should never be abused, particularly if you have a
drug addiction. If you are addicted to drugs such as heroin, morphine
or methadone, severe withdrawal symptoms are likely if you abuse
this medicine because it contains the ingredient naloxone. Preexisting withdrawal symptoms may be made worse.
You should never misuse the tablets by dissolving and injecting
them (e.g. into a blood vessel). They contain talc, which can cause
destruction of local tissue (necrosis) and changes in lung tissue (lung
granuloma). Misuse can also have other serious consequences which
may be fatal.
Other medicines and Anorphinan
Tell your doctor or pharmacist if you are taking, have recently taken
or might take any other medicines.

The risk of side effects is increased if you take these tablets at the
same time as medicines which affect the way the brain works. For
example, you may feel very sleepy, or breathing problems (slow and
shallow breathing) may get worse.
Examples of medicines that affect the way the brain works include:
• other strong painkillers (opioids),
• sleep medication and tranquilisers (sedatives, hypnotics),
• antidepressants,
• medicines used to treat allergies, travel sickness or nausea
(antihistamines or antiemetics),

3. Slowly peel off the foil at the marked
corner to unveil the pocket.

Duration of use
You should not take Anorphinan for any longer than you need to.
If you have been taking the medicine for a long time your doctor
should regularly check that you still need it.

If you take more Anorphinan than you should
If you have taken more than the prescribed dose, you must inform
your doctor immediately.
An overdose may result in:
• small (constricted) pupils,
• breathing more slowly or weakly than expected (respiratory
depression),
• drowsiness or loss of consciousness,
• low muscle tone (hypotonia),
• reduced pulse rate and
• a fall in blood pressure.

In severe cases, loss of consciousness (coma), fluid on the lungs and
circulatory collapse may occur, which may be fatal.
You should avoid situations which require you to be alert, e.g.
driving.

If you forget to take Anorphinan,
If you forget to take Anorphinan or if you take a lower dose than the
one prescribed, you may not feel any effect.

If you should forget to take your dose, please follow the instructions
below:
• If your next usual dose is due in 8 hours or more: Take the
forgotten dose immediately and continue with your normal
dosing schedule.
• If your next usual dose is due in less than 8 hours: Take the
forgotten dose, then, wait another 8 hours before taking your next
dose. Try to get back in your normal dosing schedule
(e.g. 8 o’clock in the morning and 8 o’clock in the evening).
Do not take more than one dose within any 8-hour period.

Do not take a double dose to make up for a forgotten dose.
If you stop taking Anorphinan

Do not stop taking your treatment without first consulting your
doctor.

If you do not require any further treatment, your doctor will advise
you how to reduce the daily dose gradually. In this way, you will
avoid withdrawal symptoms, such as restlessness, bouts of sweating
and muscle pain.
If you have any further questions on the use of this medicine, ask
your doctor or pharmacist.

4. Possible side effects
Like all medicines, this medicine can cause side effects, although not
everybody gets them.
Important side effects or signs to look out for, and what to do if
you are affected:

Stop taking Anorphinan and contact a doctor or go to your nearest
emergency department immediately if you experience any of the
following symptoms:
• A more slow or shallow breathing (respiratory depression). This
is the most serious side effect with Anorphinan and it mostly
occurs in elderly and weak patients.
• Opioids can also cause a severe drop in blood pressure in
susceptible patients.
• Swelling of the face, tongue or throat; difficulty swallowing;
hives; breathing difficulties and drop in blood pressure
(anaphylactic reaction)
Other side effects that may occur are:

The following side effects have been seen in patients being
treated for pain

Common (may affect up to 1 in 10 people)
• Abdominal pain, indigestion, constipation, diarrhoea, wind
• Dry mouth
• Vomit (be sick), feel sick
• Decreased appetite up to loss of appetite
• A feeling of dizziness or ‘spinning’, vertigo
• Headache
• Hot flushes, sweating
• General weakness, tiredness or exhaustion
• Itchy skin, skin reactions/rash
• Difficulty in sleeping, drowsiness

Uncommon (may affect up to 1 in 100 people)
• Abdominal bloating
• Abnormal thoughts
• Anxiety, confusion, depression, nervousness, difficulties to
concentrate
• Chest tightness especially if you already have coronary heart
disease, chest pain
• Drop in blood pressure, rise in blood pressure
• Withdrawal symptoms such as agitation
• Fainting
• Palpitations
• Biliary colic
• Generally feeling unwell
• Pain
• Swelling of the hands, ankles or feet
• Impaired speaking
• Shaking
• Restlessness
• Difficulties breathing
• Chills
• Hepatic enzymes increased
• Runny nose
• Cough
• Hypersensitivity/allergic reactions
• Weight loss
• Injuries from accidents
• Increased urge to urinate
• Muscle cramps, muscle twitches, muscle pain
• Vision impairment
• Epileptic seizures (especially in persons with epileptic disorder or
predisposition to seizures)

6. Contents of the pack and other information
What Anorphinan contains
The active substances are oxycodone hydrochloride and naloxone
hydrochloride
5 mg/2.5 mg prolonged-release tablets
Each prolonged-release tablet contains 5 mg oxycodone
hydrochloride, equivalent to 4.5 mg oxycodone and naloxone
hydrochloride dihydrate, equivalent to 2.5 mg naloxone
hydrochloride or 2.25 mg naloxone.
10 mg/5 mg prolonged-release tablets
Each prolonged-release tablet contains 10 mg oxycodone
hydrochloride, equivalent to 9.0 mg oxycodone and naloxone
hydrochloride dihydrate, equivalent to 5.0 mg naloxone
hydrochloride or 4.5 mg naloxone.

20 mg/10 mg prolonged-release tablets
Each prolonged-release tablet contains 20 mg oxycodone
hydrochloride, equivalent to 18.0 mg oxycodone and naloxone
hydrochloride dihydrate, equivalent to 10.0 mg naloxone
hydrochloride or 9.0 mg naloxone.
40 mg/20 mg prolonged-release tablets
Each prolonged-release tablet contains 40 mg oxycodone
hydrochloride, equivalent to 36.0 mg oxycodone and naloxone
hydrochloride dihydrate, equivalent to 20.0 mg naloxone
hydrochloride or 18.0 mg naloxone.
The other ingredients are:

5 mg/2.5 mg prolonged-release tablets
Tablet core: Microcrystalline cellulose, lactose monohydrate,
ammonio methacrylate copolymer, povidone, talc, triacetin, stearyl
alcohol, magnesium stearate, anhydrous colloidal silica.

Tablet coat: Hypromellose, macrogol, talc, titanium dioxide (E171),
Brilliant Blue FCF (E133).
10 mg/5 mg prolonged-release tablets
Tablet core: Microcrystalline cellulose, lactose monohydrate,
ammonio methacrylate copolymer, povidone, talc, triacetin, stearyl
alcohol, magnesium stearate, anhydrous colloidal silica.

Tablet coat: Hypromellose, macrogol, talc, titanium dioxide (E171).
20 mg/10 mg prolonged-release tablets
Tablet core: Microcrystalline cellulose, ammonio methacrylate
copolymer, povidone, talc, triacetin, stearyl alcohol, magnesium
stearate, anhydrous colloidal silica.

Tablet coat: Hypromellose, macrogol, talc, titanium dioxide (E171),
red iron oxide (E172).
40 mg/20 mg prolonged-release tablets
Tablet core: Microcrystalline cellulose, ammonio methacrylate
copolymer, povidone, talc, triacetin, stearyl alcohol, magnesium
stearate, anhydrous colloidal silica.

Tablet coat: Hypromellose, macrogol, talc, titanium dioxide (E171),
red iron oxide (E172), yellow iron oxide (E172).
What Anorphinan looks like and contents of the pack
5 mg/2.5 mg prolonged-release tablets
Light blue, round, convex, blue film-coated tablets with a diameter
of 7.2 mm.

10 mg/5 mg prolonged-release tablets
White to off-white, oval, convex, film-coated tablets with a length of
13.2 mm.
20 mg/10 mg prolonged-release tablets
Pink, oval, convex, film-coated tablets with a length of 10.2 mm.

40 mg/20 mg prolonged-release tablets
Light orange to ochre, oval, convex, film-coated tablets with a length
of 13.2 mm.
The prolonged-released tablets are available in child-resistant
perforated unit dose peel-off PVC/PVDC/PVC-Alu blisters.

Pack sizes are 10 x 1, 20 x 1, 28 x 1, 30 x 1, 50 x 1, 56 x 1, 60 x 1,
98 x 1 and 100 x 1.
Not all pack sizes may be marketed.

Marketing Authorisation Holder and Manufacturer
Marketing Authorisation Holder:
Glenmark Pharmaceuticals Europe Limited
Laxmi House
2B Draycott Avenue
Kenton, Middlesex
HA3 0BU
United Kingdom
Manufacturer:
Acino AG
Am Windfeld 35
83714 Miesbach
Germany

Tel.:
+49 8025 2867-0
Fax:
+49 8025 2867-28
E-mail: info@acino-pharma.com

This leaflet was last revised in February 2016

Rare (may affect up to 1 in 1,000 people)
• Increase in pulse rate
• Dental changes
• Yawning
• Weight gain

Not known (cannot be estimated from the available data)
• Euphoric mood
• Severe drowsiness
• Erectile dysfunction
• Nightmares
• Hallucinations
• Shallow breathing
• Difficulties in passing urine
• Tingling in hands or feet
• Belching

The active substance oxycodone hydrochloride, if not combined
with naloxone hydrochloride, is known to have the following
differing side effects:
Breathing problems, such as breathing more slowly or weakly than
expected (respiratory depression), reduction in size of the pupils in
the eye, muscle cramps and decreased cough reflex.

Common (may affect up to 1 in 10 people)
• Altered mood and personality changes (e.g. depression, feeling of
extreme happiness)
• Decreased activity, increased activity
• Difficulties in passing urine
• Hiccups
Uncommon (may affect up to 1 in 100 people)
• Impaired concentration, agitation
• Migraines
• Taste anomalies
• Increased muscle tension, involuntary muscle contractions
• Drug dependence, drug tolerance
• Ileus
• Dry skin, flushing of skin
• Reduced sensitivity to pain or touch
• Abnormal coordination
• Perception disturbances (e.g. hallucination, derealisation)
• Vocal changes (dysphonia)
• Water retention
• Difficulties in hearing
• Difficulties in swallowing
• Mouth ulcers, sore gums
• Reduced sex drive
• Dehydration, thirst
Rare (may affect up to 1 in 1,000 people)
• Itching rash (urticaria)
• Herpes simplex
• Increased appetite
• Black (tarry) stools
• Gingival bleeding

Not known (frequency cannot be estimated from the available data)
• Acute generalised allergic (anaphylactic reactions)
• Absence of menstrual periods
• Problems with bile flow
Reporting of side effects
If you get any side effects talk to your doctor, pharmacist or nurse.
This includes any possible side effects not listed in this leaflet.
You can also report side effects directly via Yellow Card Scheme
Website: www.mhra.gov.uk/yellowcard. By reporting side effects,
you can help provide more information on the safety of this
medicine.

5. How to store Anorphinan
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 and blister after “EXP”. The expiry date refers to the last day
of that month.
Do not store above 25 ˚C.

Do not throw away any medicines via wastewater or household
waste. Ask your pharmacist how to throw away medicines you no
longer use. These measures will help protect the environment.

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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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