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TURGEON 52.5 MICROGRAMS/H TRANSDERMAL PATCH

Active substance(s): BUPRENORPHINE

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Package leaflet: Information for the user
TURGEON 35 micrograms/h, 52.5 micrograms/h, 70 micrograms/h TRANSDERMAL PATCH
buprenorphine
Read all of this leaflet carefully before you start using 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 Turgeon is and what it is used for
2.
What you need to know before you use Turgeon
3.
How to use Turgeon
4.
Possible side effects
5.
How to store Turgeon
6.
Contents of the pack and other information
1.

What Turgeon is and what it is used for

The active substance of Turgeon is buprenorphine.
Turgeon is an analgesic (a pain-relieving medicine) intended to relieve moderate to severe cancer
pain and severe pain that has not responded to other types of painkillers. Turgeon acts through the
skin. Buprenorphine is an opioid (strong pain reliever), which reduces pain by acting on the central
nervous system (specific nerve cells in the spinal cord and in the brain). The effect of the transdermal
patch lasts for up to four days. Turgeon is not suitable for the treatment of acute (short-lasting) pain.

2.

What you need to know before you use Turgeon

Do not use Turgeon if you:

are allergic to buprenorphine or any of the other ingredients of this medicine (listed in section 6)

are dependent on strong pain relievers (opioids)

suffer from a disease in which you have or may have great difficulty breathing

are taking monoamine oxidase (MAO) inhibitors (certain medicines used to treat depression) or
you have taken this type of medicine in the last two weeks (see " Other medicines and Turgeon")

suffer from myasthenia gravis (a certain type of severe muscle weakness)

suffer from delirium tremens (confusion and trembling caused by abstinence from alcohol
following habitual excessive drinking or occurring during an episode of heavy alcohol
consumption)

are pregnant.
Turgeon must not be used to treat withdrawal symptoms in drug-dependent persons.
Warnings and precautions
Talk to your doctor or pharmacist before using Turgeon if you:

if you have recently drunk a lot of alcohol

if you suffer from seizures or convulsions (fits)

if your consciousness is disturbed (feeling light-headed or faint) for an unknown reason

if you are in a state of shock (cold sweat might be a sign of it)
 if the pressure in your skull is increased (for instance after head injury or in brain
disease), and artificial respiration is not possible

if you have difficulty breathing or are taking other medicines that may make you breathe




more slowly or weakly (see " Other medicines and Turgeon")
if your liver does not work properly
if you are inclined to abuse medicines or drugs.

Also, please be aware of the following precautions:

some people may become dependent on strong pain relievers such as Turgeon when they
use them over a long period of time. They may have withdrawal effects when they stop using
them (see “If you stop using Turgeon”)

fever and external heat may lead to larger quantities of buprenorphine in the blood than
normal. Also, external heat may prevent the transdermal patch from sticking properly.
Therefore, do not expose yourself to external heat (e.g. sauna, infra-red lamps, electric
blankets, hot water bottles) and consult your doctor if you have fever.
Athletes should be aware that this medicine may cause a positive reaction to sports doping control
tests.
Children and adolescents
Turgeon should not be used in persons below the age of 18 years, because no experience has so far
been gained in this age group.
Other medicines and Turgeon
Tell your doctor or pharmacist if you are taking, have recently taken or might take any other
medicines.






Turgeon must not be used together with monoamine oxidase (MAO) inhibitors (certain
medicines used to treat depression), or if you have taken this type of medicine for the last 2
weeks
Turgeon may make some people feel drowsy, sick, or faint or make them breathe more
slowly or weakly. These side effects may be intensified if other medicines that may produce
the same effects are taken at the same time. These other medicines include other strong pain
relievers (opioids), certain sleeping pills, anaesthetics, and medicines used to treat certain
psychological diseases such as tranquillizers, anti-depressants, and neuroleptics
if Turgeon is used together with some medicines, the effects of the transdermal patch
may be increased. These medicines include e.g. certain anti-infectives/anti-fungals (e.g.
containing erythromycin or ketoconazole) or HIV medicines (e.g. containing ritonavir)
if Turgeon is used together with other medicines, the effects of the transdermal patch may be
reduced. These medicines include certain products, e.g. dexamethasone; medicines to treat
epilepsy (e.g. containing carbamazepine, or phenytoin) or medicines for tuberculosis (e.g.
rifampicin).

Turgeon with food, drink and alcohol
You should not drink alcohol while using Turgeon. Alcohol may intensify certain side effects
of the transdermal patch and you may feel unwell.
Pregnancy, breast-feeding and fertility
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 using this medicine.
There is insufficient experience regarding the use of Turgeon in pregnant women. Therefore, you
must not use Turgeon during pregnancy.
Buprenorphine, the active substance contained in the transdermal patch, inhibits milk formation
and passes into breast milk. Therefore, you should not use Turgeon if you are breast-feeding.
Driving and using machines
Turgeon may make you feel dizzy or drowsy or experience blurred or double vision and affect your
reactions to such an extent that you may not react adequately or quickly enough in the event of
unexpected or sudden occurrences. This applies particularly


at the beginning of treatment

when your dose is changed

when you switch to Turgeon from another pain reliever

if you also use other medicines that act on the brain

if you drink alcohol.
If you are affected, you should not drive or operate machinery whilst using Turgeon. This applies
also at the end of treatment with Turgeon. Do not drive or operate machinery for at least 24 hours
after the patch has been removed.
Discuss with your doctor or pharmacist if you are unsure about anything.
3.

How to use Turgeon

Always use this medicine exactly as your doctor has told you. Check with your doctor or pharmacist
if you are not sure.
Turgeon is available in three strengths: Turgeon 35 micrograms/h transdermal patch, Turgeon 52.5
micrograms/h transdermal patch and Turgeon 70 micrograms/h transdermal patch.
The choice of which strength of Turgeon will suit you best will be made by your doctor. During
treatment your doctor may change which transdermal patch you use to a smaller or larger one if
necessary.
The recommended dose is:
Adults
Unless your doctor has told you differently, attach one Turgeon transdermal patch (as described
in detail below) and change it after 4 days at the latest. For convenience of use, you can change the
transdermal patch twice a week at the same days, e.g. always on Monday mornings and
Thursday evenings. To help you remember when to change your transdermal patch, you should
make a note on the calendar on the outer packaging. If your doctor has advised you to take
other pain relievers in addition to the transdermal patch, strictly follow the doctor's instructions,
otherwise you will not fully benefit from treatment with Turgeon.
Elderly patients
No dosage adjustment is needed for elderly patients.
Patients with kidney disease / dialysis patients
In patients with kidney disease and in dialysis patients, no dosage adjustment is necessary.
Patients with liver disease
In patients with liver disease, the intensity and duration of action of Turgeon may be affected. If this
applies to you, your doctor will check on you more closely.
Use in children and adolescents
Turgeon should not be used in persons below the age of 18 years, because no experience has so far
been gained in this age group.
Route of administration
The patch is for transdermal use.
When the transdermal patch is applied to the skin, the active substance buprenorphine passes
through the skin into the blood.
Method of administration
Before applying the transdermal patch







choose an area of skin
which is flat, clean, free
from cuts or scars and
hairless on your upper
body, preferably on the
chest below the collarbone or on the upper part
of the back (see adjacent
illustrations). Call
assistance if you cannot
apply the transdermal
patch yourself

if the chosen area has hairs, cut them off with a pair of scissors. Do not shave them off!
avoid skin which is red, irritated or has any other blemishes, for instance large scars
the area of skin you choose must be dry and clean. If necessary, wash it with cold or lukewarm
water. Do not use soap or other detergents. After a hot bath or shower, wait until your skin is
completely dry and cool. Do not apply lotion, cream or ointment to the chosen area. This might
prevent your transdermal patch from sticking properly.

Applying the transdermal patch


Step 1: Each transdermal patch is sealed in a
sachet. Just before use, cut the sachet along the
sealed edge with scissors. Take out the transdermal
patch.



Step 2: The sticky side of the transdermal patch is
covered with a transparent protective foil. Carefully
peel off one part of the foil. Try not to touch the
sticky part of the transdermal patch.



Step 3: Stick the transdermal patch onto the area
of skin you have chosen and remove the remaining
foil.



Step 4: Press the transdermal patch against your
skin with the palm of your hand for about 30 to 60
seconds. Make sure that the whole transdermal
patch is in contact with your skin, especially at the
edges.



Step 5: Wash your hands after using the
transdermal patch. Do not use any cleansing
products.

Wearing the transdermal patch
You may wear the transdermal patch for up to 4 days. Provided that you have applied the
transdermal patch correctly, there is little risk of it coming off. You may shower, bathe or swim
while wearing it. However, do not expose the transdermal patch to extreme heat (e.g. sauna
baths, infra-red lamps, electric blankets, hot water bottles).
In the unlikely event that your transdermal patch falls off before it needs changing, do not use
the same transdermal patch again. Stick a new one on straight away (see "Changing the transdermal
patch" below).
Changing the transdermal patch
 take the old transdermal patch off
 fold it in half with the sticky side inwards
 throw it away carefully
 stick a new transdermal patch on a different skin site (as described above). Wait at least
one week before using the same site again.
Duration of treatment
Your doctor will tell you how long you may use Turgeon. Do not stop using Turgeon on your own
account, because pain may return and you may feel unwell (see also "If you stop using Turgeon"
below).
If you have the impression that the effect of the Turgeon transdermal patch is too weak or
too strong, tell your doctor or pharmacist.
If you use more Turgeon than you should
If this happens there may be signs of an overdose of the substance buprenorphine. An
overdose may intensify the side effects of buprenorphine such as drowsiness, nausea, and vomiting.
You may get pin-point pupils and breathing may become slow and weak. You may also get
cardiovascular collapse.
As soon as you discover that you have used more transdermal patches than you should, remove the
excess transdermal patches and talk to a doctor or pharmacist.
If you forget to use Turgeon
If you forget an application, stick a new transdermal patch on as soon as you remember. You will
then need to change your routine, e.g. if you usually apply your transdermal patches on Mondays
and Thursdays, but you forget and don’t stick on a new transdermal patch until Wednesday,
you will need to change your transdermal patches on Wednesdays and Saturdays from then on.
Make a note of the new pair of days on the calendar on the outer packaging. If you are very late
changing your transdermal patch, pain may return. In this case please contact your doctor.
Never apply twice the number of transdermal patches to make up for the forgotten application!
If you stop using Turgeon
If you interrupt or finish using Turgeon too soon, pain may return. If you wish to stop use on
account of unpleasant side effects, please consult your doctor. He/she will tell you what can be
done and whether you can be treated with other medicines.
Some people may experience withdrawal-effects when they have used strong pain relievers for a
long time and stop using them. The risk of having effects after you stop using Turgeon is very
low. However, if you feel agitated, anxious, nervous or shaky, if you are overactive, have difficulty
sleeping or digestion problems, tell your doctor.
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.

If you experience swelling of the hands, feet, ankles, face, lips, mouth, or throat which may cause
difficulty in swallowing or breathing, hives, fainting, yellowing of the skin and eyes (also called
jaundice), remove the transdermal patch and call your doctor immediately or seek help at the
casualty department of the nearest hospital. These can be symptoms of a very rare serious allergic
reaction.
The following side effects have been reported:
Very common: may affect more than 1 in 10 people
 nausea (feeling sick)
 redness, itching.
Common: may affect up to 1 in 10 people
dizziness, headache


shortness of breath

vomiting, constipation

skin changes (exanthema, generally on repeated use), sweating

oedema (e.g. swelling of the legs), tiredness.
Uncommon: may affect up to 1 in 100 people

confusion, sleep disorder, restlessness

various degrees of sedation (calmness), ranging from tiredness to muzziness

circulation disorders (such as low blood pressure or, rarely, even circulatory collapse)
dry mouth


rash

difficulty in passing water, urinary retention (less urine than normal)

weariness.
Rare: may affect up to 1 in 1,000 people

loss of appetite

illusions such as hallucinations, anxiety and nightmares, reduced sex drive
difficulties concentrating, speech disorder, muzziness, disturbed balance, abnormal skin

sensations (numbness, prickling or burning sensations)

visual disturbance, blurred vision, swollen eyelids

hot flushes

difficulty breathing (respiratory depression)

heartburn

hives

erection difficulties

withdrawal symptoms (see below), administration site reactions.
Very rare: may affect up to 1 in 10,000 people

serious allergic reactions (see below)
dependence, mood swings


muscle twitching, taste disorders

pin-point pupils

ear pain

abnormally rapid breathing, hiccups

retching

pustules, small blisters

chest pain.
If you notice any of the side effects listed above, tell your doctor as soon as possible.
In some cases delayed allergic reactions occurred with marked signs of inflammation. In such a

case you should stop using Turgeon after you have talked to your doctor.
Some people may have withdrawal symptoms when they have used strong pain relievers for a long
time and stop using them. The risk of having withdrawal effects when you stop using Turgeon is
low. However, if you feel agitated, anxious, nervous or shaky, if you are overactive, have difficulty
sleeping or digestion problems, tell your doctor.
Reporting of side effects
If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects
not listed in this leaflet. You can also report side effects directly via the Yellow Card Scheme at:
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 Turgeon

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 sachet after EXP.
The expiry date refers to the last day of that month.
This medicine does not require any special storage conditions.
After removing a patch, fold it in half with the sticky sides inwards and press them together. Return
the used patch to its sachet and carefully dispose the transdermal patch.
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.

6.

Contents of the pack and other information

What Turgeon contains
 the active substance is buprenorphine.
Each 35 micrograms/h transdermal patch of 25 cm2 contains 20 mg of buprenorphine and releases 35
micrograms of buprenorphine per hour.
Each 52.5 micrograms/h transdermal patch of 37.5 cm2 contains 30 mg of buprenorphine and releases
52.5 micrograms of buprenorphine per hour.
Each transdermal patch of 50 cm2 contains 40 mg of buprenorphine and releases 70 micrograms of
buprenorphine per hour.


the other ingredients are:
adhesive matrix (containing buprenorphine): povidone K90, levulinic acid, oleyl oleate,
poly[acrylic acid-co-butylacrylate-co-(2-ethylhexyl)acrylate-co-vinylacetate] (5:15:75:5)
adhesive matrix (without buprenorphine): poly[(2-ethylhexyl)acrylate-coglycidylmethacrylate-co-(2-hydroxyethyl)acrylate-co-vinylacetate] (68:0,15:5:27),
separating foil between adhesive matrices with and without buprenorphine: polyethylene
terephthalate film,
backing foil: polyester,
release liner: polyethylene terephthalate film, siliconised
blue printing ink

What Turgeon looks like and contents of the pack
Each transdermal patch is rectangular beige coloured with rounded corners and is imprinted
35 micrograms/h: “Buprenorphin” and “35 μg/h”
52.5 micrograms/h: “Buprenorphin” and “52.5 μg/h”

70 micrograms/h: “Buprenorphin” and “70 μg/h”
Each transdermal patch is sealed in one child-resistant sachet. The patches are available in packs
containing 3, 4, 5, 6, 8, 10, 12, 16, 18 or 20 transdermal patches.
Not all pack sizes may be marketed.
Marketing Authorisation Holder
TEVA UK Limited, Eastbourne, BN22 9AG, UK
Manufacturer
tesa Labtec GmbH, Heykenaukamp 10, 21147 Hamburg, Germany, 21147
*OR
Merckle GmbH, Ludwig-Merckle-Straße 3, 89143 Blaubeuren, Germany, 89143
*OR
Teva Operations Poland Sp.z.o.o, ul. Mogilska 80, 31-546 Krakow, Poland
*OR
Teva Pharma B.V., Swensweg 5, 2031 GA Haarlem, The Netherlands, 2031 GA
This leaflet was last revised in 02/2016
* Only the actual site of batch release will appear on the printed version of the leaflet

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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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