The text only version may be available in large print, Braille or audio CD. For further information call emc accessibility on 0800 198 5000. The product code(s) for this leaflet is: PL 50414/0010.
Palexia 50 mg film-coated tablets
PALEXIA 50 mg film-coated tablets
1. What PALEXIA is and what it is used for
2. What you need to know before you take PALEXIA
3. How to take PALEXIA
4. Possible side effects
5. How to store PALEXIA
6. Contents of the pack and other information
Tapentadol - the active substance in PALEXIA - is a strong painkiller which belongs to the class of opioids. PALEXIA is used for the treatment of moderate to severe acute pain in adults that can only be adequately managed with an opioid painkiller.
Talk to your doctor or pharmacist before taking PALEXIA if you:
This medicine contains tapentadol which is an opioid medicine. Repeated use of opioid painkillers may result in the drug being less effective (you become accustomed to it). It may also lead to dependence and abuse which may result in life-threatening overdose. If you have concern that you may become dependent on PALEXIA, it is important that you consult your doctor. Use (even at therapeutic doses) may lead to physical dependence, which may result in you suffering withdrawal effects and a recurrence of your problems if you suddenly stop taking this medicine treatment.
PALEXIA may lead to physical and psychological addiction. If you have a tendency to abuse medicines or if you are dependent on medicines, you should only take these tablets for short periods and under strict medical supervision.
Sleep-related breathing disorders.
PALEXIA can cause sleep-related breathing disorders such as sleep apnoea (breathing pauses during sleep) and sleep related hypoxemia (low oxygen level in the blood). The symptoms can include breathing pauses during sleep, night awakening due to shortness of breath, difficulties to maintain sleep or excessive drowsiness during the day. If you or another person observe these symptoms, contact your doctor. A dose reduction may be considered by your doctor.
Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines.
The risk of side effects increases if you are taking medicines which may cause convulsions (fits), such as certain antidepressants or antipsychotics. The risk of having a fit may increase if you take PALEXIA at the same time. Your doctor will tell you whether PALEXIA is suitable for you.
Concomitant use of PALEXIA and sedative medicines such as benzodiazepines or related drugs (certain sleeping pills or tranquillizers (e.g. barbiturates) or pain relievers such as opioids, morphine and codeine (also as cough medicine), antipsychotics, H1-antihistamines, alcohol) increases the risk of drowsiness, difficulties in breathing (respiratory depression), coma and may be life-threatening. Because of this, concomitant use should only be considered when other treatment options are not possible. However if your doctor does prescribe PALEXIA together with sedative medicines the dose and duration of concomitant treatment should be limited by your doctor.
The concomitant use of opioids and drugs used to treat epilepsy, nerve pain or anxiety (gabapentin and pregabalin) increases the risk of opioid overdose, respiratory depression and may be life-threatening.
Please tell your doctor if you are taking gabapentin or pregabalin or any sedative medicines, and follow your doctor’s dose recommendation closely. It could be helpful to inform friends or relatives to be aware of the signs and symptoms stated above. Contact your doctor when experiencing such symptoms.
If you are taking a type of medicine that affects serotonin levels (e.g. certain medicines to treat depression), speak to your doctor before taking PALEXIA as there have been cases of “serotonin syndrome”. Serotonin syndrome is a rare, but life-threatening condition. The signs include involuntary, rhythmic contractions of muscles, including the muscles that control movement of the eye, agitation, excessive sweating, tremor, exaggeration of reflexes, increased muscle tension and body temperature above 38°C.
Your doctor may advise you on this.
Taking Palexia together with other types of medicines referred to as mixed mu-opioid agonist/antagonists (e.g. pentazocine, nalbuphine) or partial mu-opioid agonists (e.g., buprenorphine) has not been studied. It is possible that PALEXIA will not work as well if given together with one of these medicines. Tell your doctor in case you are currently treated with one of these medicines.
Taking PALEXIA together with strong inhibitors or inducers (e.g. rifampicin, phenobarbital, St John’s Wort) of certain enzymes that are necessary to eliminate tapentadol from your body, may influence how well tapentadol works or may cause side effects, especially when this other medication is started or stopped. Please keep your doctor informed about all medicines you are taking.
PALEXIA should not be taken together with MAO inhibitors (certain medicines for the treatment of depression). Tell your doctor if you are taking MAO inhibitors or have taken these during the last 14 days.
Do not drink alcohol whilst taking PALEXIA, because some side effects such as drowsiness may be increased. Food does not influence the effect of this medicine.
If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, ask your doctor or pharmacist for advice before taking this medicine.
Do not take these tablets:
PALEXIA may cause drowsiness, dizziness and blurred vision and may impair your reactions. This may especially happen when you start taking PALEXIA, when your doctor changes your dosage or when you drink alcohol or take tranquillizers. Please ask your doctor whether it is permitted to drive a car or use machines.
This medicine can affect your ability to drive.
Do not drive whilst taking this medicine until you know how this medicine affects you.
It may be an offence to drive if your ability to drive safely is affected.
There is further information for patients who are intending to drive in Great Britain - go to https://www.gov.uk/drug-driving-law.
If you have been told by your doctor that you have an intolerance to some sugars, contact your doctor before taking this medicine.
This medicine contains less than 1 mmol sodium (23 mg) per tablet, that is to say essentially ‘sodium-free’.
Always take this medicine exactly as your doctor or pharmacist has told you. Check with your doctor or pharmacist if you are not sure.
Your doctor will adjust the dosage according to the intensity of your pain and your individual pain sensitivity. In general the lowest pain-relieving dose should be taken.
The usual starting dose is 50 mg every 4 to 6 hours.
Your doctor may prescribe a different, more appropriate dose or interval of dosing, if this is necessary for you. If you feel that the effect of these tablets is too strong or too weak, talk to your doctor or pharmacist.
Total daily doses greater than 700 mg tapentadol on the first day of treatment and daily doses greater than 600 mg tapentadol on the following days of treatment are not recommended.
In elderly patients (above 65 years) usually no dose adjustment is necessary. However, the excretion of tapentadol may be delayed in some patients of this age group. If this applies to you, your doctor may recommend a different dosage regimen.
Patients with severe liver problems should not take these tablets. If you have moderate problems, your doctor will recommend a different dosage regimen. In case of mild liver problems, a dosage adjustment is not required.
Patients with severe kidney problems should not take these tablets. In case of mild or moderate kidney problems, a dosage adjustment is not required.
PALEXIA is not suitable for children and adolescents below the age of 18 years.
PALEXIA is for oral use.
Swallow the tablets with sufficient liquid. You may take the tablets on an empty stomach or with meals.
Do not take the tablets for longer than your doctor has told you.
After taking very high doses, the following may be experienced:
If this happens a doctor should be called immediately!
If you forget to take the tablets, your pain is likely to return. Do not take a double dose to make up for a forgotten dose; simply continue taking the tablets as before.
If you interrupt or stop treatment too soon, your pain is likely to return. If you wish to stop treatment, please tell your doctor first before stopping treatment.
Generally there will be no after-effects when treatment is stopped, however, on uncommon occasions, people who have been taking the tablets for some time may feel unwell if they abruptly stop taking them.
Symptoms may be:
If you experience any of these complaints after stopping treatment, please consult your doctor.
You should not suddenly stop taking this medicine unless your doctor tells you to. If your doctor wants you to stop taking your tablets, he/she will tell you how to do this, this may include a gradual reduction of the dose.
If you have any further questions on the use of this medicine, ask your doctor or pharmacist.
Like all medicines, this medicine can cause side effects, although not everybody gets them.
This medicine may cause allergic reactions. Symptoms may be wheeziness, difficulties in breathing, swelling of the eyelids, face or lips, rash or itching, especially those covering your whole body.
Another serious side effect is a condition where you breathe more slowly or weakly than expected. It mostly occurs in elderly and weak patients.
If you are affected by these important side effects contact a doctor immediately.
Very common (may affect more than 1 in 10 people): nausea, vomiting, dizziness, drowsiness, headache.
Common (may affect up to 1 in 10 people): decreased appetite, anxiety, confusion, hallucination, sleep problem, abnormal dreams, trembling, flushing, constipation, diarrhoea, indigestion, dry mouth, itching, increased sweating, rash, muscle cramps, feeling of weakness, fatigue, feeling of body temperature change.
Uncommon (may affect up to 1 in 100 people): depressed mood, disorientation, excitability (agitation), nervousness, restlessness, euphoric mood, disturbance in attention, memory impairment, near fainting, sedation, difficulty in controlling movements, difficulty in speaking, numbness, abnormal sensations of the skin (e.g. tingling, prickling), muscle twitches, abnormal vision, faster heartbeat, palpitations, decreased blood pressure, dangerously slow or shallow breathing (respiratory depression), less oxygen in the blood, shortness of breath, abdominal discomfort, hives, sensation of heaviness, delay in passing urine, frequent urination, drug withdrawal syndrome (see “If you stop taking PALEXIA”), accumulation of water in the tissue (oedema), feeling abnormal, feeling drunk, irritability, feeling of relaxation.
Rare (may affect up to 1 in 1,000 people): allergic reaction to medicines (including swelling beneath the skin, hives, and in severe cases difficulty breathing, a fall in blood pressure, collapse, or shock), thinking abnormal, epileptic fit, depressed level of consciousness, coordination abnormal, slower heartbeat, impaired gastric emptying.
Not known (frequency cannot be estimated from the available data): Delirium
In general, the likelihood of having suicidal thoughts and behaviour is increased in patients suffering from chronic pain. In addition, certain medicines for the treatment of depression (which have an impact on the neurotransmitter system in the brain) may increase this risk, especially at the beginning of treatment. Although tapentadol also affects neurotransmitters, data from human use of tapentadol do not provide evidence for an increased risk.
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 or search for MHRA Yellow Card in the Google Play or Apple App Store.
By reporting side effects you can help provide more information on the safety of this medicine.
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 the blister. The expiry date refers to the last day of that month.
This medicine does not require any special storage conditions.
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.
The active substance is tapentadol.
Each tablet contains 50 mg tapentadol (as 58.24 mg tapentadol hydrochloride).
The other ingredients are:
Tablet core: microcrystalline cellulose, lactose monohydrate, croscarmellose sodium, povidone K30, magnesium stearate. Tablet coat: polyvinylalcohol, titanium dioxide (E 171), macrogol 3350, talc.
White round shaped film-coated tablets of 7 mm diameter, marked with Grünenthal logo on one side and “H6” on the other side.
PALEXIA film-coated tablets are packed in blisters and are supplied in boxes of 5, 10, 10x1, 14, 14x1, 20, 20x1, 24, 28, 28x1, 30, 30x1, 40, 50, 50x1, 54, 56, 56x1, 60, 60x1, 90, 90x1, 100 and 100x1 tablets.
Not all pack sizes may be marketed.
Marketing Authorisation Holder:
This medicine is authorised in the Member States of the European Economic Area and in the United Kingdom (Northern Ireland) under the following names:
Germany: Palexia Akutschmerz
Austria, Belgium, Croatia, Cyprus, Czech Republic, Denmark, France, Greece, Ireland, Italy, Luxembourg, Netherlands, Norway, Poland, Portugal, Slovak Republic, Slovenia, Spain, Sweden, United Kingdom (Northern Ireland): PALEXIA
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This leaflet was last revised in December 2023.