This information is intended for use by health professionals

1. Name of the medicinal product

Selexid 200 mg Film-coated Tablets

2. Qualitative and quantitative composition

Pivmecillinam hydrochloride 200 mg

For the full list of excipients, see section 6.1.

3. Pharmaceutical form

Film-coated tablet

A white circular film-coated convex tablet embossed with an Assyrian lion on one side and 137 on the other.

4. Clinical particulars
4.1 Therapeutic indications

Selexid is indicated for the treatment of infections due to mecillinam sensitive organisms (see section 5.1), including:

• urinary tract infections

• salmonellosis

Preliminary experience in a small number of patients suggests that Selexid tablets may be a useful alternative antibiotic in the treatment of acute typhoid fever and in some carriers of salmonellae when antibiotic treatment is considered essential.

Consideration should be given to official guidance on the appropriate use of antibacterial agents.

4.2 Posology and method of administration

Posology

Adults and children weighing more than 40 kg:

Urinary tract infections:

• Acute uncomplicated cystitis: 72 hour course of 2 tablets immediately followed by 1 tablet 3 times daily to a total of 10 tablets.

• Chronic or recurrent bacteriuria: 2 tablets three to four times daily.

Salmonellosis:

• Enteric fever: 1.2-2.4 g daily for 14 days.

• Salmonella carriers: 1.2-2.4 g daily for 2-4 weeks.

Children weighing less than 40 kg:

• Urinary tract infections: 20-40 mg/kg body weight, daily, in 3 to 4 divided doses.

• Salmonellosis: 30-60 mg/kg body weight, daily, in 3 to 4 divided doses.

Dosage in the elderly:

Renal excretion of mecillinam is delayed in the elderly, but significant accumulation of the drug is not likely at the recommended adult dosage of Selexid tablets.

Method of administration

Route of administration is oral. The tablets must be taken with at least half a glass of fluid, and preferably taken with or immediately after a meal.

4.3 Contraindications

Hypersensitivity to the active substance or to any of the excipients listed in section 6.1.

Hypersensitivity to penicillins and/or cephalosporins. Any conditions resulting in impaired transit through the oesophagus.

Genetic metabolism anomalies known to be leading to severe carnitine deficiency, such as carnitine transporter defect, methylmalonic aciduria or propionic acidaemia.

4.4 Special warnings and precautions for use

During long term use, it is advisable to carry out routine liver and kidney function tests.

Pseudomembranous colitis caused by Clostridium difficile may occur. If diarrhoea occurs after use, the possibility of pseudomembranous colitis should be considered, and appropriate actions should be taken.

Selexid tablets should be used with caution in patients with porphyria since pivmecillinam has been associated with acute attacks of porphyria.

As with other antibiotics which are excreted mainly by the kidneys, raised blood levels of mecillinam may occur if repeated doses are given to patients with impaired renal function.

Selexid tablets should be used with caution for long-term or frequently-repeated treatment, due to the possibility of carnitine depletion. Symptoms of carnitine depletion include muscle aches, fatigue, and confusion.

Concurrent treatment with valproic acid, valproate or other medication liberating pivalic acid should be avoided due to increased risk of carnitine depletion.

The tablets must be taken with at least half a glass of fluid due to risk of oesophageal ulceration.

4.5 Interaction with other medicinal products and other forms of interaction

Clearance of methotrexate from the body can be reduced by concurrent use of penicillins.

Simultaneous administration of probenecid reduces the excretion of penicillins, and hence increases blood levels of the antibiotic.

The bactericidal effect of penicillins may be hindered by concurrent administration of products with bacteriostatic effect, for instance erythromycin and tetracyclines.

Concurrent treatment with valproic acid, valproate or other medication liberating pivalic acid should be avoided due to increased risk of carnitine depletion.

4.6 Pregnancy and lactation

Pregnancy

The drug, as mecillinam, crosses the placenta. Although tests in two animal species have shown no teratogenic effects, in keeping with current practice, use during pregnancy should be avoided.

Breast-feeding

Mecillinam is excreted in human milk, but at therapeutic doses of Selexid no effects on the breast-fed newborns/infants are anticipated. Selexid can be used during breast-feeding.

Fertility

There are no clinical studies on the effect of Selexid on fertility. A pre-clinical study did not show an effect on fertility in rats.

4.7 Effects on ability to drive and use machines

Selexid has no or negligible influence on the ability to drive or use machines.

4.8 Undesirable effects

The estimation of the frequency of undesirable effects is based on an analysis of pooled data from clinical studies and spontaneous reporting.

The most frequently reported undesirable effects are nausea and diarrhoea.

Anaphylactic reactions and fatal pseudomembranous colitis (see section 4.4) have been reported.

Undesirable effects are listed by MedDRA SOC and the individual undesirable effects are listed starting with the most frequently reported. Within each frequency grouping, adverse reactions are presented in the order of decreasing seriousness.

Very common ≥ 1/10

Common ≥ 1/100 and < 1/10

Uncommon ≥ 1/1,000 and < 1/100

Rare ≥ 1/10,000 and < 1/1,000

Very Rare < 1/10,000

Infections and infestations

Common:

Vulvovaginal mycotic infection

Uncommon:

Clostridium difficile colitis

Blood and lymphatic system disorders

Uncommon:

Thrombocytopenia

Immune system disorders

Uncommon:

Anaphylactic reaction

Metabolism and nutrition disorders

Uncommon:

Carnitine decreased

Nervous system disorders

Uncommon:

Headache

Dizziness

Ear and labyrinth disorders

Uncommon:

Vertigo

Gastrointestinal disorders

Common:

Diarrhoea

Nausea

Uncommon:

Vomiting

Abdominal pain

Dyspepsia

Oesophageal ulcer

Oesophagitis

Mouth ulceration

Hepatobiliary disorders

Uncommon:

Hepatic function abnormal

Skin and subcutaneous tissue disorders

Uncommon:

Rash*

Urticaria

Pruritus

General disorders and administration site conditions

Uncommon:

Fatigue

*Various types of rash reactions such as erythematous, macular or maculo-papular have been reported

Class adverse reactions of beta-lactam antibiotics:

Slight reversible increase in ASAT, ALAT, alkaline phosphatase, and bilirubin

Neutropenia

Eosinophilia

Paediatric population

Frequency, type and severity of adverse reactions in children are expected to be the same as in adults, based on limited data.

Reporting of suspected adverse reactions

Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via the Yellow Card Scheme at www.mhra.gov.uk/yellowcard.

4.9 Overdose

There has been no experience of overdosage with Selexid. However, excessive doses of Selexid are likely to induce nausea, vomiting, abdominal pain and diarrhoea. Treatment should be restricted to symptomatic and supportive measures.

5. Pharmacological properties
5.1 Pharmacodynamic properties

Pharmacotherapeutic group: antibacterial products for systemic use, penicillins with extended spectrum, ATC code: J01CA08

Selexid is an orally active antibiotic. Chemically it is the pivaloyloxymethylester of the amidinopenicillanic acid, mecillinam. On oral administration it is well absorbed and subsequently hydrolysed in the body to mecillinam, the active antibacterial agent, by non-specific esterases present in blood, gastro-intestinal mucosa and other tissues.

Selexid is highly active against most enterobacteriaceae, including E. coli, Klebsiella, Proteus, Enterobacter, Serratia, Salmonella, Shigella and Yersina.

Selexid is less active against gram positive bacteria and organisms such as Pseudomonas aeruginosa and Streptococcus faecalis are practically resistant to mecillinam.

Whilst Selexid, like the penicillins and cephalosporins, interferes with the biosynthesis of the bacterial cell wall, the target of the inhibition is different. This different mode of action is probably responsible for the synergistic action which has been found, both in vitro and in vivo, between Selexid and various penicillins and cephalosporins.

5.2 Pharmacokinetic properties

Peak serum levels of mecillinam averaging 5 microgram/ml are reached after 1 hour following a dose of 10 mg/kg body weight in children and 400 mg in adults.

The serum half-life is 1.2 hours. The protein binding amounts to 5-10%. Approximately 50% of the administered dose is excreted as mecillinam in the urine within the first six hours. Mecillinam is partly excreted with bile, giving rise to biliary concentrations about 3 times the serum levels.

Concurrent administration of probenecid delays the renal excretion of mecillinam, producing more sustained serum levels. The absorption of Selexid is practically unaffected by taking the tablets with food.

5.3 Preclinical safety data

There are no pre-clinical data of relevance to the prescriber which are additional to that already included in other sections of the SPC.

6. Pharmaceutical particulars
6.1 List of excipients

Cellulose microcrystalline

Hydroxypropyl cellulose

Magnesium stearate

Hypromellose

Simethicone

Paraffin, synthetic

6.2 Incompatibilities

Not applicable.

6.3 Shelf life

3 years

6.4 Special precautions for storage

Store below 25°C in a dry place.

6.5 Nature and contents of container

Aluminium/PVC-Aluminium blister packs containing 10 or 18 tablets.

6.6 Special precautions for disposal and other handling

No special requirements for disposal.

7. Marketing authorisation holder

LEO Laboratories Limited

Horizon

Honey Lane

Hurley

Maidenhead

Berkshire

SL6 6RJ

UK

8. Marketing authorisation number(s)

PL 00043/0048

9. Date of first authorisation/renewal of the authorisation

Date of first authorisation: 20 May 1977

Date of last renewal: 29 October 2004

10. Date of revision of the text

05/08/2016