Sirdalud Tizanidine Hydrochloride Capsules and Tablets

Sirdalud®/ Sirdalud® MR

Muscle relaxants, other centrally acting agents.

 

DESCRIPTION AND COMPOSITION

Pharmaceutical forms

Tablets (scored and cross-scored) and MR capsules for oral administration.

The 2 mg tablets and the 4 mg tablets can be divided in two equal halves.

 

Active substance

5-chloro-4-(2-imidazolin-2-ylamino)- 2,1,3-benzothiadiazole (= tizanidine).

Tablets containing 2 mg, 4 mg or 6 mg tizanidine hydrochloride.

MR (modified release) capsules containing 6 mg or 12 mg tizanidine hydrochloride.

Certain dosage strengths and dosage forms may not be available in all
countries.

 

Excipients

Tablets

Colloidal anhydrous silica, stearic acid, microcrystalline cellulose, anhydrous lactose.

 

MR capsules

Ethylcellulose; shellac; talc; maize starch; sucrose; iron oxide yellow; titanium dioxide; gelatin; iron oxide black.

Pharmaceutical formulations may vary between countries.

 

INDICATIONS

Tablets

Treatment of painful muscle spasms

• Associated with static and functional disorders of the spine (cervical and lumbar syndromes).

• Following surgery, e.g. for herniated intervertebral disc or osteoarthritis of the hip.

 

Tablets and MR capsules

Treatment of spasticity due to neurological disorders

• E.g. multiple sclerosis, chronic myelopathy, degenerative spinal cord diseases, cerebrovascular accidents, and cerebral palsy.

 

DOSAGE REGIMEN AND ADMINISTRATION

Sirdalud has a narrow therapeutic index and a high inter-patient variability in tizanidine plasma concentrations which requires individualized dose adjustment. A low starting dose of 2 mg three times daily can minimize the risk for adverse effects. The dose should be carefully adjusted upward according to the needs of the individual patient.

 

Relief of painful muscle spasms Tablets

The usual dose is 2 to 4 mg three times daily in tablet form. In severe cases, an extra dose of 2 or 4 mg may be taken, preferably at night to minimize sedation.

 

Spasticity due to neurological disorders Tablets

The initial daily dose should not exceed 6 mg given in 3 divided doses. It may be increased stepwise at half-weekly or weekly intervals by 2 to 4 mg. The optimum therapeutic response is generally achieved with a daily dose of between 12 and 24 mg, administered in 3 or 4 equally spaced doses. The daily dose of 36 mg should not be exceeded.

 

MR capsules

The recommended initial dose is 1 capsule of 6 mg once daily; if necessary, the daily dosage may be increased stepwise by 1 capsule of 6 mg at half-weekly or weekly intervals. The usual dosage range is 6 to 24 mg once a day. Clinical experience has shown that 12 mg once daily, given as 2 capsules of 6 mg or 1 capsule of 12 mg, is the optimum dose for the majority of patients and that 24 mg is seldom required.

 

Special populations

Pediatric patients

Experience in patients below 18 years of age is limited and the use of Sirdalud in this population is not recommended.

 

Geriatric patients (65 years of age or older)

Experience with the use of Sirdalud in the elderly is limited. Therefore, it is recommended to start treatment at the lowest dose and increases should be done in small steps according to tolerability and efficacy.

 

Renal impairment

In patients with renal impairment (creatinine clearance <25 mL/min), it is recommended to start treatment at 2 mg once daily. Increase in dosage should be done in small steps according to tolerability and efficacy. If efficacy has to be improved, it is advisable to first increase the strength of daily dose before increasing the frequency of administration (see section WARNINGS AND PRECAUTIONS).

 

Hepatic impairment

Use of Sirdalud in patients with severe hepatic impairment is contraindicated (see section CONTRAINDICATIONS). While Sirdalud is extensively metabolized in the liver limited data are available in this population (see section CLINICAL PHARMACOLOGY [Pharmacokinetics]). Its use has been associated with reversible abnormality in liver function tests (See section WARNINGS AND PRECAUTIONS and section ADVERSE DRUG REACTIONS). Sirdalud should be used with caution in patients with moderate hepatic impairment and treatment should be started with the lowest dose. Afterwards, increase in dosage should be done carefully and according to patient tolerability.

 

Discontinuation of treatment

If Sirdalud has to be discontinued, the dosage should be slowly down titrated, particularly in patients who have received high doses for a longer period of time to avoid or minimize the risk of rebound hypertension and tachycardia (see section WARNINGS AND PRECAUTIONS).

 

CONTRAINDICATIONS

• Known hypersensitivity to tizanidine or to any of the excipients.

• Severely impaired hepatic function (see section CLINICAL PHARMACOLOGY
[Pharmacokinetics]).

• Concomitant use of tizanidine with strong inhibitors of CYP1A2 such as fluvoxamine or ciprofloxacin is contraindicated (see section INTERACTIONS).

 

WARNINGS AND PRECAUTIONS

CYP inhibitors

The concomitant use of Sirdalud with moderate CYP1A2 inhibitors is not recommended (see section INTERACTIONS).

Caution should be exercised when Sirdalud is given with drugs known to increase the QT interval (see section INTERACTIONS).

 

Hypotension

Hypotension may occur during treatment with Sirdalud (see section ADVERSE DRUG REACTIONS) and also as a result of drug interactions with CYP1A2 inhibitors and/or antihypertensive drugs (see section INTERACTIONS). Severe manifestations of hypotension such as loss of consciousness and circulatory collapse have also been observed.

 

Withdrawal syndrome

Rebound hypertension and tachycardia have been observed after sudden withdrawal of Sirdalud, when it had been used chronically, and/or in high daily dosages, and/or concomitantly with antihypertensive drugs. In extreme cases, rebound hypertension might lead to cerebrovascular accident. Sirdalud should not be stopped abruptly, but rather gradually down titrated (see section DOSAGE REGIMEN AND ADMINISTRATION and section ADVERSE DRUG REACTIONS).

 

Hepatic dysfunction

Since hepatic dysfunction has been reported in association with tizanidine, but rarely at daily doses up to 12 mg, it is recommended that liver function tests should be monitored monthly for the first four months in patients receiving doses of 12 mg and higher and in patients who develop clinical symptoms suggestive of hepatic dysfunction, such as unexplained nausea, anorexia, or tiredness. Treatment with Sirdalud should be discontinued if serum levels of SGPT or SGOT are persistently above three times the upper limit of the normal range.

 

Patients with renal impairment

In patients with renal impairment (creatinine clearance <25 mL/min) systemic exposure to tizanidine may increase up to 6 times compared to patient with normal renal function. Therefore, it is recommended to start treatment at 2 mg once daily (see section DOSAGE REGIMEN AND ADMINISTRATION and section CLINICAL PHARMACOLOGY [Pharmacokinetics]).

 

Hypersensitivity reactions

Hypersensitivity reactions including anaphylaxis, angioedema, dermatitis, rash, urticarial, pruritis and erythema have been reported in association with tizanidine. Careful observation of the patient is recommended for one to two days after the first dose is administered. If anaphylaxis or angioedema with anaphylactic shock or difficulty of breathing is observed treatment with Sirdalud should be discontinued immediately and appropriate medical treatment should be instituted.

 

Driving and using machines

Patients experiencing somnolence, dizziness or any signs or symptoms of hypotension should refrain from activities requiring a high degree of alertness, e.g. driving a vehicle or operating machines.

 

ADVERSE DRUG REACTIONS

With low doses, such as those recommended for the relief of painful muscle spasms, somnolence, fatigue, dizziness, dry mouth, blood pressure decrease, nausea, gastrointestinal disorder and transaminase increase have been reported, usually as mild and transient adverse reactions. With the higher doses recommended for the treatment of spasticity, the adverse reactions reported with low doses are more frequent and more pronounced, but seldom severe enough to require discontinuation of treatment. In addition, the following adverse reactions may occur: hypotension, bradycardia, muscular weakness, insomnia, sleep disorder, hallucination, hepatitis.

Adverse drug reactions from clinical trials (Table 1) are listed according to the system organ class in MedDRA. Within each system organ class, the adverse drug reactions are ranked by frequency, with the most frequent reactions first. Within each frequency grouping, adverse drug reactions are presented in the order of decreasing seriousness. In addition the corresponding frequency using the following convention (CIOMS III) is also provided for each adverse drug reaction: very common (≥1/10); common (≥1/100, <1/10); uncommon (≥1/1,000, <1/100); rare (≥1/10,000, <1/1,000); very rare (<1/10,000).

 

Table 1 Adverse drug reactions

Psychiatric disorders

Common: Insomnia, sleep disorder.

Nervous system disorders

Very common: Somnolence, dizziness.

Cardiac disorders

Uncommon: Bradycardia.

Vascular disorders

Common: Hypotension.

Gastrointestinal disorders

Very common: Gastrointestinal disorder, dry mouth.

Common: Nausea.

Musculoskeletal and connective tissue disorders

Very common: Muscular weakness.

General disorders and administration site conditions

Very common: Fatigue.

Investigations

Common: Blood pressure decreased, transaminases increased.

 

Adverse drug reactions from spontaneous reports and literature cases (frequency not known)

The following adverse drug reactions have been reported during post approval use of Sirdalud via spontaneous reports and literature cases. Since these reactions are reported voluntarily from a population of uncertain size and are subject to confounding factors, it is not possible to reliably estimate their frequency (which is therefore quoted as not known). Adverse drug reactions are listed according to system organ classes in MedDRA.

 

Table 2 Adverse drug reactions from spontaneous reports and literature (frequency not known)

Immune system disorders: Hypersensitivity reactions including anaphylaxis, angioedema and urticaria
Psychiatric disorders: Hallucination, confusional state
Nervous system disorders: Vertigo
Vascular disorders: Syncope
Eye disorders: Vision blurred
Hepatobiliary disorders: Hepatitis, hepatic failure
Skin and subcutaneous tissue
disorders:
Rash, erythema, pruritus, dermatitis
General disorders and administration site conditions: Asthenia, withdrawal syndrome

 

Withdrawal syndrome

Rebound hypertension and tachycardia have been observed after sudden withdrawal of Sirdalud. In extreme cases, rebound hypertension might lead to cerebrovascular accident (see section WARNINGS AND PRECAUTIONS and section INTERACTIONS).

 

INTERACTIONS

Concomitant administration of drugs known to inhibit the activity of CYP1A2 may increase the plasma levels of tizanidine (see section CLINIAL PHARMACOLOGY [Pharmacokinetics]). The increased plasma levels of tizanidine may result in overdose symptoms such as QT(c) prolongation (see also section OVERDOSAGE). Concomitant administration of drugs known to induce the activity of CYP1A2 may decrease the plasma levels of tizanidine (see section CLINICAL PHARMACOLOGY [Pharmacokinetics]).

The decreased plasma levels of tizanidine may reduce the therapeutic effect of Sirdalud.

 

Observed interactions resulting in a contraindication

Concomitant use of Sirdalud with fluvoxamine or ciprofloxacin, both CYP1A2 inhibitors is contraindicated. Concomitant use of Sirdalud with fluvoxamine or ciprofloxacin resulted in a 33-fold and 10-fold increase in tizanidine AUC, respectively (see section CONTRAINDICATIONS). Clinically significant and prolonged hypotension may result along with somnolence, dizziness and decreased psychomotor performance (see section WARNINGS AND PRECAUTIONS). The increased plasma levels of tizanidine may result in overdose symptoms such as QT(c) prolongation (see also section OVERDOSAGE).

 

Observed interactions resulting in a concomitant use not recommended

Co-administration of Sirdalud with other inhibitors of CYP1A2 such as antiarrhythmics (amiodarone, mexiletine, propafenone), cimetidine, fluoroquinolones (enoxacin, pefloxacin, norfloxacin), rofecoxib, oral contraceptives, and ticlopidine is not recommended (see section WARNINGS AND PRECAUTIONS).

 

Observed interactions to be considered

Caution should be exercised when Sirdalud is given with drugs known to prolong the QT interval (including but not limited to cisapride, amytriptyline and azithromycin) (see section WARNINGS AND PRECAUTIONS).

 

Antihypertensives

Concomitant use of Sirdalud with antihypertensives, including diuretics, may occasionally cause hypotension (see section WARNINGS AND PRECAUTIONS) and bradycardia. In some patients rebound hypertension and tachycardia have been observed upon abrupt discontinuation of Sirdalud when concomitantly used with antihypertensive drugs. In extreme cases, rebound hypertension might lead to cerebrovascular accident (see section WARNINGS AND PRECAUTIONS and section ADVERSE DRUG REACTIONS).

 

Rifampicin

Concomitant administration of Sirdalud with rifampicin results in 50 % decrease in tizanidine concentrations. Therefore, the therapeutic effects of Sirdalud may be reduced during treatment with rifampicin, which may be of clinical significance in some patients.

Long term co-administration should be avoided and if co-administration is considered a careful dose adjustment (increase) may be required.

 

Cigarette smoke

Administration of Sirdalud in smokers (>10 cigarettes per day) results in about 30% decrease in tizanidine systemic exposure. Long-term therapy with Sirdalud in heavy smokers may require higher doses than the average doses.

 

Alcohol

While on Sirdalud therapy, alcohol consumption should be minimized or avoided as it may increase the potential for adverse events (e.g. sedation and hypotension). The central nervous system depressant effects of alcohol may be enhanced by Sirdalud.

 

Anticipated interactions to be considered

Sedatives, hypnotics (e.g. benzodiazopine or baclofen), and other drug such
as antihistamines may enhance the sedative action of tizanidine.

Sirdalud should be avoided when using with other alpha-2 adrenergic agonists (such as clonidine) because of their potential additive hypotensive effect.

 

PREGNANCY, LACTATION, FEMALES AND MALES OF REPRODUCTIVE POTENTIAL

Pregnancy

Risk Summary

As there is limited experience with the use of Sirdalud in pregnant women, it should not be used during pregnancy unless the benefit clearly outweighs the risk (see section NON-CLINICAL SAFETY DATA).

 

Animal data

Reproduction studies performed in rats and rabbits did not show evidence of teratogenicity. In rats, dose levels of 10 and 30 mg/kg4/day increased gestation duration.

Prenatal and postnatal pup loss was increased and development retardation occurred. At these doses, dams showed marked signs of muscle relaxation and sedation. Based on body surface area, these doses were 2.2 and 6.7 times the maximum recommended human dose of 0.72 mg/kg/day.

 

Lactation

Risk Summary

Small amounts of tizanidine are excreted in rat milk. Since no human data are available Sirdalud should not be given to women who are breast-feeding.

 

Females and males of reproductive potential

Pregnancy testing

Sexually-active females of reproductive potential are recommended to have a pregnancy test prior to starting treatment with Sirdalud.

 

Contraception

Females of reproductive potential should be advised that animal studies have been performed showing Sirdalud to be harmful to the developing fetus. Sexually-active females of reproductive potential are recommended to use effective contraception (methods that result in less than 1% pregnancy rates) when using Sirdalud during treatment and for 1 day after stopping treatment with Sirdalud.

 

Fertility

Animal Data

No impairment of fertility was observed in male rats at a dose of 10 mg/kg/day and in female rats at a dose of 3 mg/kg/day. Fertility was reduced in male rats receiving 30 mg/kg/day and in female rats receiving 10 mg/kg/day. Based on body surface area, these doses were 6.7 and 2.2 times the maximum recommended human dose of 0.72 mg/kg. At these doses, maternal behavioural effects and clinical signs were observed including marked sedation, weight loss, and ataxia (see section NON-CLINICAL SAFETY DATA).

 

OVERDOSAGE

In the few reports of Sirdalud overdosage received, recovery was uneventful, including by a patient who ingested 400 mg Sirdalud.

 

Symptoms

Nausea, vomiting, hypotension, QT(c) prolongation, dizziness, somnolence, miosis, restlessness, respiratory distress, coma.

 

Treatment

It is recommended to eliminate the ingested drug by repeated administration of high doses of activated charcoal. Forced diuresis is expected to accelerate the elimination of Sirdalud. Further treatment should be symptomatic.

 

CLINICAL PHARMACOLOGY

Mechanism of action (MOA)

Tizanidine is a centrally acting skeletal muscle relaxant. Its principal site of action is the spinal cord, where the evidence suggests that, by stimulating presynaptic alpha2-receptors, it inhibits the release of excitatory amino acids that stimulate N-methyl-D-aspartate (NMDA) receptors.

Polysynaptic signal transmission at spinal interneuron level, which is responsible for excessive muscle tone, is thus inhibited and muscle tone reduced. In addition to its muscle-relaxant properties, tizanidine also exerts a moderate central
analgesic effect.

 

Pharmacodynamics (PD)

Sirdalud is effective in both acute painful muscle spasms and chronic spasticity of spinal and cerebral origin. It reduces resistance to passive movements, alleviates spasms and clonus, and may improve voluntary strength.

The antispastic activity (measured by the Ashworth score and pendulum test) and adverse effects (heart rate and blood pressure) of Sirdalud are related to plasma tizanidine concentrations.

 

Pharmacokinetics (PK)

Absorption

Tizanidine is rapidly and almost completely absorbed, reaching peak plasma concentration approximately 1 hour after dosing.

Mean absolute bioavailability from the tablet formulation is about 34% (CV 38%) due to extensive first-pass metabolism. The mean maximum plasma concentration (Cmax) of tizanidine is 12.3 ng/mL (CV 10%) and 15.6 ng/mL (CV 13%) after single and repeated administration of 4 mg doses, respectively.

Concomitant food intake has no relevant influence on the pharmacokinetic profile of tizanidine (given as 4 mg tablets or 12 mg MR capsules). Although Cmax is about one-third higher after administration of the tablet under fed conditions, this is not considered to be of any clinical relevance, and absorption (AUC) is not significantly affected.

 

Distribution

Mean steady-state volume of distribution (V) following i.v. administrationis 2.6 L/kg (CV 21%). Plasma protein binding is 30%.

 

Biotransformation/Metabolism

The drug has been shown to be rapidly and extensively (about 95%) metabolized by the liver. Tizanidine is mainly metabolized by cytochrome P450 1A2 in vitro. The metabolites appear to be inactive.

 

Elimination

Tizanidine is eliminated from the systemic circulation with a mean terminal half-life of 2 to 4 hours. Excretion is primarily via the kidneys (approximately 70% of dose) in the form of metabolites, with unchanged drug accounting for only about 4.5% of urinary recovery.

 

Linearity

Tizanidine has linear pharmacokinetics over the dose range 1 to 20 mg.

 

Bioavailability of modified-release (MR) formulation

Administration of the sustained release formulation, Sirdalud MR 12 mg capsules, results in a smoother pharmacokinetic profile by avoiding high initial peaks and maintaining therapeutic plasma concentrations over 24 hours compared with Sirdalud 4 mg tablet given 3 times daily. Following administration of the Sirdalud MR 12 mg capsule the maximum mean plasma concentrations are reached within about 8.5 hours, amounting to approximately half (6.6 ng/mL, CV 5%) those obtained when Sirdalud 4 mg tablet is given 3 times daily (see absorption), whereas the total daily systemic exposure remains unchanged.

 

Special populations

Renal impairment (creatinine clearance < 25 mL/min)

Maximal mean plasma levels were found to be twice as high as in normal volunteers, and the terminal half-life was prolonged to approximately 14 hours, resulting in much higher (approximately 6-fold on average) AUC values (see section WARNINGS AND PRECAUTIONS).

 

Hepatic impairment

No specific studies were conducted in this population. As tizanidine is extensively metabolized in the liver by the CYP1A2 enzyme, hepatic impairment may increase its systemic exposure. Sirdalud is contraindicated in patients with severe hepatic impairment (see section CONTRAINDICATIONS).

 

Geriatrics (65 years of age and older)

Pharmacokinetic data in this population are limited.

 

Gender

Gender has no clinically significant effect on the pharmacokinetics of tizanidine.

 

Ethnicity

Impact of ethnic sensitivity and race on the pharmacokinetics of tizanidine has not been studied.

 

CLINICAL STUDIES

No recent clinical data regarding the approved indications for Sirdalud are available.

 

NON-CLINICAL SAFETY DATA

Preclinical data reveal no special hazard for humans at the recommended therapeutic dose based on conventional studies of repeated dose toxicity, mutagenicity and carcinogenic potential.

 

Acute toxicity

The acute toxicity of tizanidine is of a low order. Signs of overdosage were seen related to the drug’s pharmacological action.

 

Repeat dose toxicity

In a 13-week oral toxicity study in rats given average daily doses of 1.7, 8 and 40 mg/kg, the major findings were related to CNS stimulation (e.g. motor excitation, aggressiveness, tremor, and convulsions), and occurred mainly at the highest dose level.

ECG changes and CNS effects were observed at daily doses of 1 mg/kg and higher in dogs in a 13-week study with dose levels of 0.3, 1 and 3 mg/kg/day given as capsules and a 52-week study with 0.15, 0.45 and 1.5 mg/kg/day. These represent exaggerated pharmacological effects. Transient increases in SGPT seen at daily doses of 1 mg/kg and above were not related to histopathological findings but indicate that the liver is a potential target organ.

 

Carcinogenicity and Mutagenicity

No evidence of mutagenic potential was found in in vitro, in vivo, or cytogenetic assays.

No indication of carcinogenic potential was seen in rats or mice given doses of up to 9 mg/kg/day and 16 mg/kg/day, respectively, in the feed.

 

Reproductive toxicity

Reproduction studies performed in rats at a dose of 3 mg/kg/day and in rabbits at 30 mg/kg/day did not show evidence of teratogenicity. Dose levels of 10 and 30 mg/kg/day increased gestation duration in female rats. Prenatal and postnatal pup loss was increased and development retardation occurred. At these doses, dams showed marked signs of muscle relaxation and sedation. (See section PREGNANCY, LACTATION, FEMALES AND MALES OF REPRODUCTIVE POTENTIAL).

 

INCOMPATIBILITIES

None known.

 

STORAGE

See folding box.

Sirdalud / Sirdalud MR should not be used after the date marked “EXP” on the pack.

Sirdalud / Sirdalud MR should be kept out of the reach and sight of children.

 

Manufacturer

See folding box.

 

International Package Leaflet

Information issued: May 2016

© = registered trademark

Novartis Pharma AG, Basel, Switzerland

Zyronax Methocarbamol Tablet

Zyronax

Methocarbamol USP 500mg Tablets

 

COMPOSITION

Each uncoated Tablet contains:

Methocarbamol USP 500 mg.

Excipients q.s.

 

PHARMACOLOGICAL CLASSIFICATION

Other Analgesics.

 

PHARMACOLOGICAL ACTION

Methocarbamaol has analgesic, anti-inflammatory, anti-pyretic and muscle-relaxant properties. Methocarbamol is a muscle relaxant whose mechanism of action in humans has not been established, but may be due to general central nervous system (CNS) depression. It has no direct action on the contractile mechanism of striated muscle, the motor end plate or the nerve fibre.

 

INDICATIONS

Methocarbamaol is indicated as an adjunct to rest, physical therapy, and other measures for the relief of muscle spasm associated with acute, painful musculoskeletal conditions.

 

CONTRAINDICATIONS

Methocarbamol is contra-indicated in patients with CNS depressed, coma or pre-coma states, brain damage, myasthenia gravis or in patients with a history of epilepsy.

 

PREGNANCY

Safe use of METHOCARBAMAOL has not been established. Not to be taken during the first or last three months of pregnancy unless prescribed by a doctor.

Nursing mothers

Nursing should not be undertaken while a patient is being treated with this medicine.

 

WARNINGS

Do not use continuously for more than 10 days without consulting your doctor.

Consult a doctor if pain or fever persists or gets worse, if new symptoms occur or if redness and swelling is present, as these could be signs of a serious condition.

To be used with caution in patients with liver or renal disease and only under the supervision of a doctor.

Toxic effects are more likely in the elderly and those suffering from dehydration, due to reduced renal function.

Do not take this product if you are presently taking a prescription medicine for anticoagulation, diabetes, gout or arthritis unless directed by a doctor.

 

DOSAGE AND DIRECTIONS FOR USE

Adults and children of 12 years of age

Two tablets four times daily.

These dosage recommendations provide respectively 3.2 g and 4.8 g of methocarbamol per day.

Elderly

Half the maximum recommended adult dose or less, may be sufficient to produce a therapeutic response in the elderly.

Children

Not Recommended.

Gastric irritation may be reduced by taking doses after food.

 

SIDE-EFFECTS AND SPECIAL PRECAUTIONS

Side-effects

Side-effects reported with methocarbamol include lightheadedness, anorexia, dizziness, drowsiness, nausea and vomiting, allergic manifestations, such as urticaria, pruritis, rash, angioneurotic oedema, conjunctivitis with nasal congestion, blurred vision, headache and fever.

Methocarbamol may rarely give rise to leucopenia, restlessness, anxiety, vertigo, tremor, confusion, and convulsions.

Special precautions

Gastrointestinal discomfort may be minimised by taking METHOCARBAMAOL with food.

METHOCARBAMAOL should be used with caution in patients with compromised cardiac function or hypertension, renal and hepatic insufficiency. Toxic effects are more likely in the elderly and those suffering from dehydration, due to reduced renal function.

Paediatric use

Safety and effectiveness in children 12 years of age and below has not been established.

Interactions

The effects of methocarbamol may be potentiated by concomitant administration of other CNS depressants and stimulants including alcohol, barbiturates, anaesthetics and appetite suppressants. The effects of anorectics, anticholinergics (e.g. atropine), and some psychotropic agents may be potentiated by methocarbamol.

 

KNOWN SYMPTOMS OF OVERDOSAGE AND PARTICULARS OF ITS TREATMENT

Symptoms of overdosage

Methocarbamol: Extreme drowsiness.

Treatment of overdosage

Gastric lavage is recommended with appropriate symptomatic and supportive therapy for at least 24 hours as methocarbamol is excreted at that time.

 

PRESENTATION

ZYRONAX 1 x 10: Each strip contain 10 tablets.

 

STORAGE INSTRUCTIONS

Store in cool, dry and dark place.

 

KEEP OUT OF REACH OF CHILDREN.

 

NAFDAC Reg. No.: B4-1959
Mfg. Lic. No.: G/25/1905

 

Manufactured by

Zota Health Care Ltd.,

Plot No. 169, Surat Special Economic Zone,

Sachin, Surat-394 230. (Gujarat) INDIA.

 

Marketed by

FAMZY NIGERIA LIMITED

Plot 1c, Chime Lane, G.R.A. Enugu,

Nigeria.

http://www.famzy.com

Surex Night Paracetamol and Diphenhydramine Hydrochloride Tablets

SUREX NIGHT ®

Paracetamol 500mg and Diphenhydramine Hydrochloride 25mg
Tablets for Oral Use

 

COMPOSITION

Each tablet contains:
Paracetamol 500mg
Diphenhydramine Hydrochloride 25mg
Excipients q.s.

 

PROPERTIES

Surex Night® is a fixed dose combination of Paracetamol and Diphenhydramine hydrochloride.

 

CLINICAL PHARMACOLOGY

Paracetamol is a non-opioid analgesic and anti-pyretic agent and Diphenhydramine hydrochloride is an antihistamine that causes sleepiness or drowsiness making it useful when pain is keeping you awake.

 

INDICATIONS

Surex Night® is indicated for the treatment such as feverish cold, cough and common cold, pain with difficulty in sleeping, sore throat.

 

CONTRA-INDICATIONS

Surex Night® is contraindicated in pregnant women and breast feeding mothers.

 

DRUG INTERACTIONS

Surex Night® interacts with monoamine oxidase inhibitors (MAOIs) if taken in the last 2 weeks or tricyclic antidepressants (prescribed for depression); atropine; metoclopramide or domperidone (for nausea or vomiting); colestyramine (to lower blood cholesterol); medicines for stomach cramps (example dicycloverine) or travel sickness (e.g. hyoscine); medicines to treat anxiety or to help you sleep; medicines that make you drowsy or give you dry mouth; or blood thining drugs (anticoagulants e.g. warfarin).

 

PRECAUTIONS AND WARNING

Do not take Surex Night®:

• If you have ever had an allergic reaction to paracetamol, diphenhydramine hydrochloride.

• If you have porphyria (too much of-the pigment called porphyrin which may discolour the urine).

• If you have taken another medicine containing paracetamol in the last 4 hours.

• Do not take with any other antihistamine- containing products.

Ask your doctor before you take this medicine:

• If you have liver or kidney disease, including alcoholic liver disease.

• If you have epilepsy, or seizure disorders.

• If you have an obstruction in your stomach or gut (for example because of an ulcer).

• If you experience difficulty passing urine.

• If you have narrow glaucoma (raised pressure in the eye).

• If you have enlarged prostrate.

• If you have myasthenia gravis.

• If you have asthma, bronchitis or chronic obstructive pulmonary disease (COPD).

• If you have been told by your doctor that you have intolerance to some sugars.

 

WARNING

• Do not drive or operate machinery. Surex Night® is intended to produce drowsiness or sleepiness soon after dose is taken.

• Do not drink alcohol while using Surex Night®.

 

ADVERSE REACTIONS/EFFECTS

Like all medicines, Surex Night® can have side effects, but not everybody gets them. Older people are more prone to the side effects. These side effects may include the following;

• Drowsiness, dizziness, tiredness, blurred vision, or difficulty concentrating

• Dry mouth

• Allergic reactions which may be severe such as skin rash and itching sometimes with swelling of the mouth or face or shortness of breath.

• Chest tightness or thickening of phlegm.

• Difficulty in passing urine, headaches.

• Skin rash or peeling or mouth ulcers.

• Stomach upset.

• Breathing problems. These are more likely if you have experienced them before when taking other pain killers (such as ibuprofen and aspirin).

• Seizures or difficulty of muscle coordination.

• Changes in heart rhythm.

• Unexplained bruising or bleeding.

These reactions are rare.

If you get any side effects, even those not mentioned in this leaflet, tell your doctor or pharmacist.

 

DOSAGE AND ADMINISTRATION

Adults and children aged 12 years and over: swallow 2 tablets with water, 20 minutes before you go to bed.

• Do not take Surex Night® if you have already taken 4 doses of a paracetamol containing product during the day.

• Do not take more than 2 tablets in 24 hours.

• Do not take more than the recommended dose.

• Do not take if you are under 12 years.

 

AVAILABILITY

Surex Night® is available in a box of 10 or 100 tablets.

 

STORAGE CONDITION

Store below 30°C in a cool and dry place.

Keep all medicines out of reach and sight of children.

 

SHELF VALIDITY

3 years

 

MANUFACTURED BY

Jiangsu Ruinian Qianjin Pharmaceutical Co., Ltd.

Chuanbu Village, Yixing Economic Development Zone, Jiangsu Province, China

 

MARKETED BY

VIXA PHARMACEUTICAL CO., LTD.

13B, Sunny Jigide Street, Off Celestial way, Ogudu, Lagos, Nigeria