Keral 25 mg film-coated tablets

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 Keral is and what it is used for
2. What you need to know before you take Keral
3. How to take Keral
4. Possible side effects
5. How to store Keral
6. Contents of the pack and other information

Do not take Keral:

• If you are allergic to dexketoprofen or any of the other ingredients of this medicine (listed in section 6);
• If you are allergic to acetylsalicylic acid or to other non-steroidal anti-inflammatory medicines;
• If you have asthma or have suffered attacks of asthma, acute allergic rhinitis (a short period of inflamed lining of the nose), nasal polyps (lumps within the nose due to allergy), urticaria (skin rash), angioedema (swollen face, eyes, lips, or tongue, or respiratory distress) or wheezing in the chest after taking acetylsalicylic acid or other non-steroidal anti-inflammatory medicines;
• If you have suffered from photoallergic or phototoxic reactions (a particular form of reddening and/or blistering of the skin exposed to sunlight) while taking ketoprofen (a non-steroidal anti-inflammatory drug) or fibrates (drugs used to lower the level of fats in the blood);
• If you have a peptic ulcer/stomach or bowel bleeding or if you have suffered in the past from stomach or bowel bleeding, ulceration or perforation;
• If you have chronic digestive problems (e.g. indigestion, heartburn);
• If you have suffered in the past from stomach or bowel bleeding or perforation, due to previous use of non-steroidal anti-inflammatory drugs (NSAIDs) used for pain;
• If you have bowel disease with chronic inflammation (Crohn’s disease or ulcerative colitis);
• If you have serious heart failure, moderate or serious kidney problems or serious liver problems;
• If you have a bleeding disorder or a blood clotting disorder;
• If you are severely dehydrated (have lost a lot of body fluids) due to vomiting, diarrhoea or insufficient intake of fluids;
• If you are in the third trimester of pregnancy or breast feeding.

Warnings and precautions

Talk to your doctor or pharmacist before taking Keral:

• If you suffer from allergy, or if you have had allergy problems in the past;
• If you have kidney, liver or heart problems (hypertension and/or heart failure) as well as fluid retention, or have suffered from any of these problems in the past;
• If you are taking diuretics or you suffer from very poor hydration and reduced blood volume due to an excessive loss of fluids (e.g. from excessive urination, diarrhoea or vomiting);
• If you have heart problems, previous stroke or think that you might be at risk of these conditions (for example if you have high blood pressure, diabetes or high cholesterol or are a smoker) you should discuss your treatment with your doctor or pharmacist; medicines such as Keral may be associated with a small increased risk of heart attack ("myocardial infarction") or stroke. Any risk is more likely with high doses and prolonged treatment. Do not exceed the recommended dose or duration of treatment.
• If you are elderly: you may be more likely to suffer from side effects (see section 4). If any of these occur, consult your doctor immediately;
• If you are a woman with fertility problems (Keral may impair your fertility, therefore you should not take it if you are planning to become pregnant or you are doing fertility tests);
• If you suffer from a disorder in the formation of blood and blood cells;
• If you have systemic lupus erythematosus or mixed connective tissue disease (immune system disorders that affect connective tissue);
• If you have suffered in the past from a chronic inflammatory disease of the bowel (ulcerative colitis, Crohn’s disease);
• If you have or have suffered in the past from other stomach or bowel problems;
• If you have varicella (chickenpox), since exceptionally NSAIDs could worsen the infection;
• If you are taking other medicines that increase the risk of peptic ulcer or bleeding, e.g. oral steroids, some antidepressants (those of the SSRI type, i.e. Selective Serotonin Reuptake Inhibitors), agents that prevent blood clots such as aspirin or anticoagulants such as warfarin. In such cases, consult your doctor before taking Keral: he/she may want you to take an additional medicine to protect your stomach (e.g. misoprostol or medicines that block the production of stomach acid).
• If you suffer from asthma combined with chronic rhinitis, chronic sinusitis, and/or nasal polyposis as you have a higher risk of allergy to acetylsalicylic acid and/or NSAIDs than the rest of the population. Administration of this medicine can cause asthma attacks or bronchospasm, particularly in patients allergic to acetylsalicylic acid or NSAIDs.

Children and adolescents

Keral has not been studied in children and adolescent. Therefore, safety and efficacy have not been established and the product should not be used in children and adolescents.

Other medicines and Keral

Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines, including medicines obtained without a prescription. There are some medicines that should not be taken together and others that may need their doses to be altered when taken together.

Always inform your doctor, dentist or pharmacist if you are using or receiving any of the following medicines in addition to Keral:

Inadvisable combinations:

• Acetylsalicylic acid, corticosteroids or other anti-inflammatory drugs
• Warfarin, heparin or other medicines used to prevent blood clots
• Lithium, used to treat certain mood disorders
• Methotrexate (anti-cancer medicine or immunosuppressant), used at high doses of 15 mg/week
• Hydantoins and phenytoin, used for epilepsy
• Sulphametoxazole, used for bacterial infections

Combinations requiring precautions:

• ACE inhibitors, diuretics and angiotensin II antagonists, used for high blood pressure and heart problems
• Pentoxifylline and oxpentifylline, used to treat chronic venous ulcers
• Zidovudine, used to treat viral infections
• Aminoglycosides antibiotics, used to treat bacterial infections
• Sulfonylureas (e.g. chlorpropamide and glibenclamide), used for diabetes
• Methotrexate, used at low doses, less than 15 mg/week

Associations to be considered carefully:

• Quinolone antibiotics (e.g. ciprofloxacin, levofloxacin) used for bacterial infections
• Cyclosporin or tacrolimus, used to treat immune system diseases and in organ transplant
• Streptokinase and other thrombolytic or fibrinolytic medicines, i.e. medicines used to break-up blood clots
• Probenecid, used in gout
• Digoxin, used to treat chronic heart failure
• Mifepristone, used as an abortifacient (to terminate a pregnancy)
• Antidepressants of the selective serotonin reuptake inhibitors type (SSRIs)
• Anti-platelet agents used to reduce platelet aggregation and the formation of blood clots
• Beta-blockers, used for high blood pressure and heart problems
• Tenofovir, deferasirox, pemetrexed

If you have any doubt about taking other medicines with Keral, consult your doctor or pharmacist.

Keral with food and drink

Take the tablets with an adequate amount of water. Take your tablets with food, as it helps to decrease the risk of stomach or bowel side effects. However, if you have acute pain, take the tablets on an empty stomach, i.e. at least 30 minutes before meals, as this helps the medicine start working a little faster.

Pregnancy, breast-feeding and fertility

Do not use Keral during the final three months of the pregnancy or when breast feeding.

If you are pregnant, think you may be pregnant or are planning to have a baby, ask your doctor or pharmacist for advice before taking this medicine, as Keral may not be right for you.

Use of Keral should be avoided by women who are planning a pregnancy or are pregnant. Treatment at any time in pregnancy should only take place as directed by a doctor.

The use of Keral is not recommended while attempting to conceive or during investigation of infertility.

With regard to potential effects on female fertility, see also section 2, “Warnings and precautions”.

Driving and using machines

Keral may slightly affect your ability to drive and handle machines, due to the possibility of dizziness or drowsiness as side effects of treatment. If you notice such effects, do not drive or use machines until the symptoms wear off. Ask your doctor for advice.

Keral contains sodium

This medicine contains less than 1 mmol sodium (23 mg) per tablet, that is to say essentially ‘sodium-free’.

Use in children and adolescents

This medicine should not be used in children and adolescents (under age 18).

If you use more Keral than you should

If you use too much of this medicine, tell your doctor or pharmacist immediately or go to the emergency department of your nearest hospital. Please remember to take this medicine pack or this leaflet with you.

If you forget to use Keral

Do not take a double dose to make up for a forgotten tablet. Take the next regular dose when it is due (according to section 3 “How to take Keral”).

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. Website: 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.

What Keral contains

• The active substance is dexketoprofen (as dexketoprofen trometamol). Each film-coated tablet contains 25 mg of dexketoprofen.
• The other ingredients are maize starch, microcrystalline cellulose, sodium starch glycollate, glycerol distearate, hypromellose, titanium dioxide, propylene glycol, macrogol 6000.

What Keral looks like and contents of the pack

White, round, scored film-coated tablet.

Keral is available in packs containing 4, 10, 20, 30, 50 and 500 film-coated tablets. Not all pack sizes may be marketed.

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