1. What Neuroplex is and what it is used for

Neuroplex belongs to a group of medicines used to treat epilepsy and peripheral neuropathic pain (long lasting pain caused by damage to the nerves).

The active substance in Neuroplex is gabapentin.

Neuroplex is used to treat:

- Various forms of epilepsy (seizures that are initially limited to certain parts of the brain, whether the seizure spreads to other parts of the brain or not). Your doctor will prescribe Neuroplex for you to help treat your epilepsy when your current treatment is not fully controlling your condition. You should take Neuroplex in addition to your current treatment unless told otherwise. Neuroplex can also be used on its own to treat adults and children over 12 years of age or in combination with other medicines to treate epilepsy in adults and children aged 6 years and over.

- Peripheral neuropathic pain (long lasting pain caused by damage to the nerves). A variety of different diseases can cause peripheral neuropathic pain (primarily occurring in the legs and/or arms), such as diabetes or shingles. Pain sensations may be described as hot, burning, throbbing, shooting, stabbing, sharp, cramping, aching, tingling, numbness, pins and needles etc. 

2. Before you take Neuroplex

Do not take Neuroplex

- If you are allergic (hypersensitive) to gabapentin or any of the other ingredients of Neuroplex.

Warnings and precautions

Take special care with Neuroplex

Talk to your doctor or pharmacist before taking Neuroplex.

- If you suffer from kidney problems your doctor may prescribe a different dosing schedule.

- If you are on hemodialysis (to remove waste products because of kidney failure), tell your doctor if you develop muscle pain and/or weakness.

- If you develop signs such as persistent stomach pain, feeling sick and being sick, contact your doctor immediately as these may be symptoms of acute pancreatitis (an inflamed pancreas).

- If you have nervous system disorders, respiratory disorders, or you are more than 65 years old, your doctor may prescribe you a different dosing regimen.

Cases of abuse and dependence have been reported for gabapentin from the post-marketing experience. Talk to your doctor if you have a history of abuse or dependence.

A small number of people being treated with anti-epileptics such as gabapentin have had thoughts of harming or killing themselves. If at any time you have these thoughts, immediately contact your doctor.

Important information about potentially serious reactions A small number of people taking Neuroplex get an allergic reaction or potentially serious skin reaction, which may develop into more serious problems if they are not treated. You need to know these symptoms to look out for while you are taking Neuroplex. Muscle weakness, tenderness or pain and particularly, if at the same time, you feel unwell or have a high temperature it may be caused by an abnormal muscle breakdown which can be life-threatening and lead to kidney problems. You may also experience discoloration of your urine, and a change in blood test results (notably blood creatine phosphokinase increased). If you experience any of these signs or symptoms, please contact your doctor immediately.

FDA is warning that serious breathing difficulties may occur in patients using gabapentin or pregabalin who have respiratory risk factors. These include the use of opioid medicines and other drugs that depress the central nervous system, and conditions such as chronic obstructive pulmonary disease that reduce lung function. The elderly are also at high risk. 
Patients and caregivers should seek medical attention immediately if any symptoms of respiratory problems appear, because these can be life-threatening. Symptoms to watch for include: Confusion or disorientation, unusual dizziness or lightheadedness, extreme sleepiness or lethargy, slowed, shallow or difficult breathing, unresponsiveness and bluish-colored or tinted skin, especially on the lips, fingers and toes. 
Health care professionals should start gabapentiniods at the lowest dose and monitor patients for symptoms of respiratory depression and sedation when co-prescribing gabapentiniods with an opioid or other central nervous system depressant such as benzodiazepine.

Taking other medicines

Please tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines. In particular, tell your doctor (or pharmacist) if you are taking or have been recently taking any medicines for convulsions, sleeping disorders, depression, anxiety, or any other neurological or psychiatric problems.

Medicines containing opioids such as morphine

If you are taking any medicines containing opioids (such as morphine), please tell your doctor or pharmacist as opioids may increase the effect of Neuroplex. In addition, combination of Neuroplex with opioids may cause symptoms like sleepiness and/or decrease in breathing.

Antacids for indigestion

If Neuroplex and antacids containing aluminium and magnesium are taken at the same time, absorption of Neuroplex from the stomach may be reduced. It is therefore recommended that Neuroplex is taken at the earliest two hours after taking an antacid. Neuroplex:

- Is not expected to interact with other antiepileptic drugs or the oral contraceptive pill.

- May interfere with some laboratory tests, if you require a urine test tell your doctor or hospital what you are taking.

Taking Neuroplex with food and drink

Neuroplex can be taken with or without food.

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 taking this medicine.

Pregnancy

Neuroplex should not be taken during pregnancy, unless you are told otherwise by your doctor. Effective contraception must be used by women of child-bearing potential. There have been no studies specifically looking at the use of gabapentin in pregnant women, but other medications used to treat seizures have reported an increased risk of harm to the developing baby, particularly when more than one seizure medication is taken at the same time. Therefore, whenever possible, you should try to take only one seizure medication during pregnancy and only under the advice of your doctor. Contact your doctor immediately if you become pregnant, think you might be pregnant or are planning to become pregnant while taking Neuroplex. Do not suddenly discontinue taking this medicine as this may lead to a breakthrough seizure, which could have serious consequences for you and your baby.

Breast feeding

Gabapentin, the active substance of Neuroplex, is passed on through human milk. Because the effect on the baby is unknown, it is not recommended to breast-feed while using Neuroplex.

Fertility

There is no effect on fertility in animal studies.

Driving and using machines

Neuroplex may produce dizziness, drowsiness and tiredness. You should not drive, operate complex machinery or take part in other potentially hazardous activities until you know whether this medication affects your ability to perform these activities.

Important information about some of the ingredients of Neuroplex

Neuroplex capsules contain lactose (a type of sugar). If you have been told by your doctor that you have an intolerance to some sugars, contact your doctor before taking this medicinal product.

3. How to take Neuroplex

Always take  Neuroplex exactly as your doctor has told you. You should check with your doctor or pharmacist if you are not sure.

Your doctor will determine what dose is appropriate for you. Epilepsy, the recommended dose is

Adults and adolescents:

Take the number of capsules as instructed by your doctor. Your doctor will usually build up your dose gradually. The starting dose will generally be between 300 mg and 900 mg each day.

Thereafter, the dose may be increased progressively up to a maximum of 3600 mg each day. Your doctor will tell you to take the dose in 3 divided doses, i.e. once in the morning, once in the afternoon and once in the evening.

Children aged 6 years old and older:

The dose to be given to your child will be decided by your doctor as it is calculated against your child’s weight. The treatment is started with a low initial dose which is gradually increased over a period of approximately 3 days.

The usual dose to control epilepsy is 25-35 mg/kg/day.

It is usually given in 3 divided doses, by taking the capsule(s) each day, usually once in the morning, once in the afternoon and once in the evening.

Neuroplex is not recommended for use in children under 6 years old. If you take Neuroplex to relieve peripheral neuropathic pain:

Adults

Take the number of capsules as instructed by your doctor. Your doctor will usually build up your dose gradually. The starting dose will generally be between 300 mg and 900 mg each day.

Thereafter, the dose may be increased progressively up to a maximum of 3600 mg each day. Your doctor will tell you to take the dose in 3 divided doses, i.e. once in the morning, once in the afternoon and once in the evening.

If you have kidney problems or are receiving haemodialysis

Your doctor may prescribe a different dosing schedule and/or dose if you have problems with your kidneys or are undergoing haemodialysis.

If you are an elderly patient (over 65 years of age)

you should take the normal dose of Neuroplex unless you have problems with your kidneys. Your doctor may prescribe a different dosing schedule and/or dose if you have problems with your kidneys.

If you have the impression that the effect of Neuroplex is too strong or too weak, talk to your doctor or pharmacist as soon as possible.

Method of administration

Neuroplex is for oral use. Always swallow the capsules whole with plenty of water.

Continue taking Neuroplex until your doctor tells you to stop. 

If you take more Neuroplex than you should

Higher than recommended doses may result in an increase in side effects including loss of consciousness, dizziness, double vision, slurred speech, drowsiness and diarrhea. Call your doctor or go to the nearest hospital emergency unit immediately if you take more Neuroplex than your doctor prescribed. Take along any capsules that you have not taken, together with the container and the label so that the hospital can easily tell what medicine you have taken.

If you forget to take Neuroplex

If you forget to take a dose, take it as soon as you remember unless it is time for your next dose. Do not take a double dose to make up for a forgotten dose.

If you stop taking Neuroplex

Do not stop taking Neuroplex unless your doctor tells you to. If your treatment is stopped it should be done gradually over a minimum of 1 week. If you stop taking Neuroplex suddenly or before your doctor tells you, there is an increased risk of seizures.

If you have any further questions on the use of this medicine, ask your doctor or pharmacist. 

4. Possible side effects

Like all medicines, Neuroplex can cause side effects, although not everybody gets them.

Contact your doctor immediately if you experience any of the following symptoms after taking this medicine as they can be serious:

- Severe skin reactions that require immediate attention, swelling of the lips and face, skin rash and redness and/or hair loss (these may be symptoms of a serious allergic reaction).

- Persistent stomach pain, feeling sick and being sick as these may be symptoms of acute pancreatitis (an inflamed pancreas).

- Breathing problems, which if severe you may need emergency and intensive care to continue breathing normally.

- Neuroplex may cause a serious or life-threatening allergic reaction that may affect your skin or other parts of your body such as your liver or blood cells. You may or may not have rash when you get this type of reaction. It may cause you to be hospitalized or to stop Neuroplex. Call your doctor right away if you have any of the following symptoms:

- Skin rash.

- Hives.

- Fever.

- Swollen glands that do not go away.

- Swelling of your lip and tongue. 

- Yellowing of your skin or of the whites of the eyes.

- Unusual bruising or bleeding.

- Severe fatigue or weakness.

- Unexpected muscle pain.

- Frequent infections.

These symptoms may be the first signs of a serious reaction.

A doctor should examine you to decide if you should continue taking Neuroplex.

If you are on hemodialysis, tell your doctor if you develop muscle pain and/or weakness.

Other side effects include:

Very common (may affect more than 1 in 10 people):

- Viral infection.

- Feeling drowsy, dizziness, lack of coordination.

- Feeling tired, fever.

Common (may affect up to 1 in 10 people):

- Pneumonia, respiratory infections, urinary tract infection, inflammation of the ear or other infections.

- Low white blood cell counts.

- Anorexia, increased appetite.

- Anger towards others, confusion, mood changes, depression, anxiety, nervousness, difficulty with thinking.

- Convulsions, jerky movements, difficulty with speaking, loss of memory, tremor, difficulty sleeping, headache, sensitive skin, decreased sensation (numbness), difficulty with coordination, unusual eye movement, increased, decreased or absent reflexes.

- Blurred vision, double vision.

- Vertigo.

- High blood pressure, flushing or dilation of blood vessels.

- Difficulty breathing, bronchitis, sore throat, cough, dry nose.

- Vomiting (being sick), nausea (feeling sick), problems with teeth, inflamed gums, diarrhea, stomach pain, indigestion, constipation, dry mouth or throat, flatulence.

- Facial swelling, bruises, rash, itch, acne.

- Joint pain, muscle pain, back pain, twitching.

- Difficulties with erection (impotence).

- Swelling in the legs and arms, difficulty with walking, weakness, pain, feeling unwell, flu-like symptoms.

- Decrease in white blood cells, increase in weight.

- Accidental injury, fracture, abrasion.

Additionally in clinical studies in children, aggressive behaviour and jerky movements were reported commonly.

Uncommon (may affect up to 1 in 100 people):

- Agitation (a state of chronic restlessness and unintentional and purposeless motions).

- Allergic reactions such as hives.

- Decreased movement.

- Racing heartbeat.

- Swelling that may involve the face, trunk and limbs.

- Abnormal blood test results suggesting problems with the liver.

- Mental impairment.

- Fall.

- Increase in blood glucose levels (most often observed in patients with diabetes).

Rare (may affect up to 1 in 1,000 people):

- Decrease in blood glucose levels (most often observed in patients with diabetes).

- Loss of consciousness.

- Trouble breathing, shallow breaths (respiratory depression).

After marketing Gabapentin the following side effects have been reported:

Decreased platelets (blood clotting cells).

Hallucinations.

Problems with abnormal movements such as writhing, jerking movements and stiffness.

Ringing in the ears.

A group of side effects that could include swollen lymph nodes (isolated small raised lumps under the skin), fever, rash, and inflammation of liver occurring together.

Yellowing of the skin and eyes (jaundice), inflammation of the liver.

Acute kidney failure, incontinence.

Increased breast tissue, breast enlargement.

Adverse events following the abrupt discontinuation of gabapentin (anxiety, difficulty sleeping, feeling sick, pain, sweating), chest pain.

Breakdown of muscle fibers (rhabdomyolysis).

Change in blood test results (creatine phosphokinase increased).

Problems with sexual functioning including inability to achieve a sexual climax, delayed ejaculation.

Low blood sodium level.

Anaphylaxis (serious, potentially life threatening allergic reaction including difficulty breathing, swelling of the lips, throat, and tongue, and hypotension requiring emergency treatment).

If any of the side effects become serious, or if you notice any side effects not listed in this leaflet, please tell your doctor or pharmacist.

5. How to store Neuroplex
Keep out of reach of children.
Store below 30°C.
Do not use beyond the expiry date or if the product shows any sign of deterioration.
Do not throw away any medicines via wastewater or household waste. Ask your pharmacist how to throw away the medicines you no longer use. These measures will help to protect environment.