Aryzalera contains the active substance aripiprazole and belong to a group of medicines called antipsychotics. It is used to treat adults and adolescents aged 15 years and older who suffer from a disease characterised by symptoms such as hearing, seeing or sensing things which are not there, suspiciousness, mistaken beliefs, incoherent speech and behaviour and emotional flatness. People with this condition may also feel depressed, guilty, anxious or tense.

Aryzalera is used to treat adults and adolescents aged 13 years and older who suffer from a condition with symptoms such as feeling "high", having excessive amounts of energy, needing much less sleep than usual, talking very quickly with racing ideas and sometimes severe irritability. In adults it also prevents this condition from returning in patients who have responded to the treatment with Aryzalera.

Do not take Aryzalera:

-             if you are allergic to aripiprazole or any of the other ingredients of this medicine (listed in section 6).

Warnings and precautions

Talk to your doctor before taking Aryzalera.

Suicidal thoughts and behaviours have been reported during aripiprazole treatment. Tell your doctor immediately if you are having any thoughts or feelings about hurting yourself.

Before treatment with Aryzalera, tell your doctor if you suffer from

-             high blood sugar (characterised by symptoms such as excessive thirst, passing of large amounts of urine, increase in appetite and feeling weak) or family history of diabetes

-             fits (seizures) since your doctor may want to monitor you more closely

-             involuntary, irregular muscle movements, especially in the face

-             cardiovascular diseases (diseases of the heart and circulation), family history of cardiovascular disease, stroke or "mini" stroke, abnormal blood pressure

-             blood clots, or family history of blood clots, as antipsychotics have been associated with formation of blood clots

-             past experience with excessive gambling

If you notice you are gaining weight, develop unusual movements, experience somnolence that interferes with normal daily activities, any difficulty in swallowing or allergic symptoms, please tell your doctor.

If you are an elderly patient suffering from dementia (loss of memory and other mental abilities), you or your carer/relative should tell your doctor if you have ever had a stroke or "mini" stroke.

Tell your doctor immediately if you are having any thoughts or feelings about hurting yourself. Suicidal thoughts and behaviours have been reported during aripiprazole treatment.

Tell your doctor immediately if you suffer from muscle stiffness or inflexibility with high fever, sweating, altered mental status, or very rapid or irregular heartbeat.

Tell your doctor if you or your family/carer notices that you are developing urges or cravings to behave in ways that are unusual for you and you cannot resist the impulse, drive or temptation to carry out certain activities that could harm yourself or others. These are called impulse control disorders and can include behaviours such as addictive gambling, excessive eating or spending, an abnormally high sex drive or preoccupation with an increase in sexual thoughts or feelings.

Your doctor may need to adjust or stop your dose.

Children and adolescents

Do not use this medicine in children and adolescents under 13 years of age. It is not known if it is safe and effective in these patients.

Other medicines and Aryzalera

Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines, including medicines obtained without a prescription.

Blood pressure-lowering medicines: Aryzalera tablets may increase the effect of medicines used to lower the blood pressure. Be sure to tell your doctor if you take a medicine to keep your blood pressure under control.

Taking Aryzalera tablets with some medicines may mean the doctor will need to change your dose of Aryzalera or the other medicines. It is especially important to mention the following to your doctor:

-             medicines to correct heart rhythm (such as quinidine, amiodarone, flecainide)

-             antidepressants or herbal remedy used to treat depression and anxiety (such as fluoxetine, paroxetine, venlafaxine, St. John's Wort)

-             antifungal medicines (such as ketoconazole, itraconazole)

-             certain medicines to treat HIV infection (such as efavirenz, nevirapine, an protease inhibitors e.g. indinavir, ritonavir)

-             anticonvulsants used to treat epilepsy (such as carbamazepine, phenytoin, phenobarbital)

-             certain antibiotics used to treat tuberculosis (rifabutin, rifampicin)

These medicines may increase the risk of side effects or reduce the effect of Aryzalera; if you get any unusual symptom taking any of these medicines together with Aryzalera, you should see your doctor.

Medicines that increase the level of serotonin are typically used in conditions including depression, generalised anxiety disorder, obsessive-compulsive disorder (OCD) and social phobia as well as migraine and pain:

-             triptans, tramadol and tryptophan used for conditions including depression, generalised anxiety disorder, obsessive compulsive disorder (OCD) and social phobia as well as migraine and pain

-             SSRI s (such as paroxetine and fluoxetine) used for depression, OCD, panic and anxiety

-             other anti-depressants (such as venlafaxine and tryptophan) used in major depression

-             tricyclic’s (such as clomipramine and amitriptyline) used for depressive illness

-             St John’s Wort (Hypericum perforatum) used as a herbal remedy for mild depression

-             pain killers (such as tramadol and pethidine) used for pain relief

-             triptans (such as sumatriptan and zolmitripitan) used for treating migraine

These medicines may increase the risk of side effects; if you get any unusual symptom taking any of these medicines together with Aryzalera, you should see your doctor.

Aryzalera with food, drink and alcohol

This medicine can be taken regardless of meals.

Alcohol should be avoided.

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 for advice before taking this medicine.

The following symptoms may occur in newborn babies, of mothers that have used aripiprazole in the last trimester (last three months of their pregnancy): shaking, muscle stiffness and/or weakness, sleepiness, agitation, breathing problems, and difficulty in feeding. If your baby develops any of these symptoms you may need to contact your doctor.

If you are taking Aryzalera, your doctor will discuss with you whether you should breast-feed considering the benefit to you of your therapy and the benefit to your baby of breast-feeding. You should not do both. Talk to your doctor about the best way to feed your baby if you are taking this medicine.

Driving and using machines

Dizziness and vision problems may occur during treatment with this medicine (see section 4).

This should be considered in cases where full alertness is required, e.g. when driving a car or handling machines.

Aryzalera contains lactose

If you have been told by your doctor that you have an intolerance to some sugars, contact your doctor before taking this medicine.

Do not take Aryzalera:

-             if you are allergic to aripiprazole or any of the other ingredients of this medicine (listed in section 6).

Warnings and precautions

Talk to your doctor before taking Aryzalera.

Suicidal thoughts and behaviours have been reported during aripiprazole treatment. Tell your doctor immediately if you are having any thoughts or feelings about hurting yourself.

Before treatment with Aryzalera, tell your doctor if you suffer from

-             high blood sugar (characterised by symptoms such as excessive thirst, passing of large amounts of urine, increase in appetite and feeling weak) or family history of diabetes

-             fits (seizures) since your doctor may want to monitor you more closely

-             involuntary, irregular muscle movements, especially in the face

-             cardiovascular diseases (diseases of the heart and circulation), family history of cardiovascular disease, stroke or "mini" stroke, abnormal blood pressure

-             blood clots, or family history of blood clots, as antipsychotics have been associated with formation of blood clots

-             past experience with excessive gambling

If you notice you are gaining weight, develop unusual movements, experience somnolence that interferes with normal daily activities, any difficulty in swallowing or allergic symptoms, please tell your doctor.

If you are an elderly patient suffering from dementia (loss of memory and other mental abilities), you or your carer/relative should tell your doctor if you have ever had a stroke or "mini" stroke.

Tell your doctor immediately if you are having any thoughts or feelings about hurting yourself. Suicidal thoughts and behaviours have been reported during aripiprazole treatment.

Tell your doctor immediately if you suffer from muscle stiffness or inflexibility with high fever, sweating, altered mental status, or very rapid or irregular heartbeat.

Tell your doctor if you or your family/carer notices that you are developing urges or cravings to behave in ways that are unusual for you and you cannot resist the impulse, drive or temptation to carry out certain activities that could harm yourself or others. These are called impulse control disorders and can include behaviours such as addictive gambling, excessive eating or spending, an abnormally high sex drive or preoccupation with an increase in sexual thoughts or feelings.

Your doctor may need to adjust or stop your dose.

Children and adolescents

Do not use this medicine in children and adolescents under 13 years of age. It is not known if it is safe and effective in these patients.

Other medicines and Aryzalera

Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines, including medicines obtained without a prescription.

Blood pressure-lowering medicines: Aryzalera tablets may increase the effect of medicines used to lower the blood pressure. Be sure to tell your doctor if you take a medicine to keep your blood pressure under control.

Taking Aryzalera tablets with some medicines may mean the doctor will need to change your dose of Aryzalera or the other medicines. It is especially important to mention the following to your doctor:

-             medicines to correct heart rhythm (such as quinidine, amiodarone, flecainide)

-             antidepressants or herbal remedy used to treat depression and anxiety (such as fluoxetine, paroxetine, venlafaxine, St. John's Wort)

-             antifungal medicines (such as ketoconazole, itraconazole)

-             certain medicines to treat HIV infection (such as efavirenz, nevirapine, an protease inhibitors e.g. indinavir, ritonavir)

-             anticonvulsants used to treat epilepsy (such as carbamazepine, phenytoin, phenobarbital)

-             certain antibiotics used to treat tuberculosis (rifabutin, rifampicin)

These medicines may increase the risk of side effects or reduce the effect of Aryzalera; if you get any unusual symptom taking any of these medicines together with Aryzalera, you should see your doctor.

Medicines that increase the level of serotonin are typically used in conditions including depression, generalised anxiety disorder, obsessive-compulsive disorder (OCD) and social phobia as well as migraine and pain:

-             triptans, tramadol and tryptophan used for conditions including depression, generalised anxiety disorder, obsessive compulsive disorder (OCD) and social phobia as well as migraine and pain

-             SSRI s (such as paroxetine and fluoxetine) used for depression, OCD, panic and anxiety

-             other anti-depressants (such as venlafaxine and tryptophan) used in major depression

-             tricyclic’s (such as clomipramine and amitriptyline) used for depressive illness

-             St John’s Wort (Hypericum perforatum) used as a herbal remedy for mild depression

-             pain killers (such as tramadol and pethidine) used for pain relief

-             triptans (such as sumatriptan and zolmitripitan) used for treating migraine

These medicines may increase the risk of side effects; if you get any unusual symptom taking any of these medicines together with Aryzalera, you should see your doctor.

Aryzalera with food, drink and alcohol

This medicine can be taken regardless of meals.

Alcohol should be avoided.

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 for advice before taking this medicine.

The following symptoms may occur in newborn babies, of mothers that have used aripiprazole in the last trimester (last three months of their pregnancy): shaking, muscle stiffness and/or weakness, sleepiness, agitation, breathing problems, and difficulty in feeding. If your baby develops any of these symptoms you may need to contact your doctor.

If you are taking Aryzalera, your doctor will discuss with you whether you should breast-feed considering the benefit to you of your therapy and the benefit to your baby of breast-feeding. You should not do both. Talk to your doctor about the best way to feed your baby if you are taking this medicine.

Driving and using machines

Dizziness and vision problems may occur during treatment with this medicine (see section 4).

This should be considered in cases where full alertness is required, e.g. when driving a car or handling machines.

Aryzalera contains lactose

If you have been told by your doctor that you have an intolerance to some sugars, contact your doctor before taking this medicine.

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

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

-             diabetes mellitus,

-             difficulty sleeping,

-             feeling anxious,

-             feeling restless and unable to keep still, difficulty sitting still,

-             uncontrollable twitching, jerking or writhing movements, restless legs,

-             trembling,

-             headache,

-             tiredness,

-             sleepiness,

-             light-headedness,

-             shaking and blurred vision,

-             decreased number of or difficulty making bowel movements,

-             indigestion,

-             feeling sick,

-             more saliva in mouth than normal,

-             vomiting,

-             feeling tired.

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

-             increased blood levels of the hormone prolactin,

-             too much sugar in the blood,

-             depression,

-             altered or increased sexual interest,

-             uncontrollable movements of mouth, tongue and limbs (tardive dyskinesia),

-             muscle disorder causing twisting movements (dystonia),

-             double vision,

-             fast heartbeat,

-             a fall in blood pressure on standing up which causes dizziness, light-headedness or fainting,

-             hiccups.

The following side effects have been reported since the marketing of oral aripiprazole but the frequency for them to occur is not known:

-             low levels of white blood cells,

-             low levels of blood platelets,

-             allergic reaction (e.g. swelling in the mouth, tongue, face and throat, itching, hives),

-             onset or worsening of diabetes, ketoacidosis (ketones in the blood and urine) or coma,

-             high blood sugar,

-             not enough sodium in the blood,

-             loss of appetite (anorexia),

-             weight loss,

-             weight gain,

-             thoughts of suicide, suicide attempt and suicide,

-             feeling aggressive,

-             agitation,

-             nervousness,

-             combination of fever, muscle stiffness, faster breathing, sweating, reduced consciousness and sudden changes in blood pressure and heart rate, fainting (neuroleptic malignant syndrome),

-             seizure,

-             serotonin syndrome (a reaction which may cause feelings of great happiness, drowsiness, clumsiness, restlessness, feeling of being drunk, fever, sweating or rigid muscles),

-             speech disorder,

-             sudden unexplained death,

-             life-threatening irregular heartbeat,

-             heart attack,

-             slower heartbeat,

-             blood clots in the veins especially in the legs (symptoms include swelling, pain and redness in the leg), which may travel through blood vessels to the lungs causing chest pain and difficulty in breathing (if you notice any of these symptoms, seek medical advice immediately),

-             high blood pressure,

-             fainting,

-             accidental inhalation of food with risk of pneumonia (lung infection),

-             spasm of the muscles around the voice box,

-             inflammation of the pancreas,

-             difficulty swallowing,

-             diarrhoea,

-             abdominal discomfort,

-             stomach discomfort,

-             liver failure,

-             inflammation of the liver,

-             yellowing of the skin and white part of eyes,

-             reports of abnormal liver tests values,

-             skin rash,

-             sensitivity to light,

-             baldness,

-             excessive sweating,

-             abnormal muscle breakdown which can lead to kidney problems,

-             muscle pain,

-             stiffness,

-             involuntary loss of urine (incontinence),

-             difficulty in passing urine,

-             withdrawal symptoms in newborn babies in case of exposure during pregnancy,

-             prolonged and/or painful erection,

-             difficulty controlling core body temperature or overheating,

-             chest pain,

-             swelling of hands, ankles or feet,

-             in blood tests: increased or fluctuating blood sugar, increased glycosylated haemoglobin.

-             Inability to resist the impulse, drive or temptation to perform an action that could be harmful to you or others, which may include:

-             strong impulse to gamble excessively despite serious personal or family consequences

-             altered or increased sexual interest and behaviour of significant concern to you or to others, for example, an increased sexual drive

-             uncontrollable excessive shopping

-             binge eating (eating large amounts of food in a short time period) or compulsive eating (eating more food than normal and more than is needed to satisfy your hunger)

-             a tendency to wander away.

Tell your doctor if you experience any of these behaviours; he/she will discuss ways of managing or reducing the symptoms.

In elderly patients with dementia, more fatal cases have been reported while taking aripiprazole. In addition, cases of stroke or "mini" stroke have been reported.

Additional side effects in children and adolescents

Adolescents aged 13 years and older experienced side effects that were similar in frequency and type to those in adults except that sleepiness, uncontrollable twitching or jerking movements, restlessness, and tiredness were very common (greater than 1 in 10 patients) and upper abdominal pain, dry mouth, increased heart rate, weight gain, increased appetite, muscle twitching, uncontrolled movements of the limbs, and feeling dizzy, especially when getting up from a lying or sitting position, were common (greater than 1 in 100 patients).

If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet.

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 packaging after EXP. The expiry date refers to the last day of that month.

Store below 30 °C.

Store in the original package.

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.