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Rufzel contains a medicine called Rufinamide. It belongs to a group of medicines called antiepileptics, which are used to treat epilepsy (a condition where someone has seizures or fits).
Rufzel is used with other medicines to treat seizures associated with Lennox-Gastaut syndrome in adults, adolescents and children from 1 year of age. Lennox-Gastaut syndrome is the name given to a group of severe epilepsies in which you may experience repeated seizures of various types.
Rufzel has been given to you by your doctor to reduce the number of your seizures or fits.
1. Do not take Rufzel :
- if you are allergic to Rufinamide or triazole derivatives or any of the other ingredients of Rufzel (listed in section 6).
Warnings and precautions
Talk to your doctor or pharmacist if:
- you have Congenital Short QT Syndrome or a family history of such a syndrome (electrical disturbance of the heart), as taking Rufinamide could make it worse.
- you suffer from liver problems. There is limited information on the use of Rufinamide in this group, so the dose of your medicine may need to be increased more slowly. If your liver disease is severe the doctor may decide Rufzel is not recommended for you.
- you get a skin rash or fever. These could be signs of an allergic reaction. See the doctor immediately as very occasionally this may become serious.
- you suffer an increase in the number or severity or duration of your seizures, you should contact the doctor immediately if this happens.
- you experience difficulty walking, abnormal movement, dizziness or sleepiness inform the doctor, if any of these happen.
- if you take this medicine and have thoughts of harming or killing yourself at any time, contact your doctor or go to a hospital straight away (see section 4).
Consult the doctor, even if these events occurred at any time in the past.
Children
Rufzel should not be given to children younger than 1 year of age since there is not enough information on its use in this age group.
Other medicines and Rufzel
Tell the doctor or pharmacist if you are taking or have recently taken any other medicines, including medicines obtained without a prescription. If you are taking the following medicines: phenobarbital, fosphenytoin, phenytoin or primidone, you may need to be carefully monitored for two weeks at the start of, or after the end of treatment with Rufinamide, or after any marked change in the dose. A change in the dose of the other medicines may be needed as they may become slightly less effective when given with Rufinamide.
Antiepileptic medicines and Rufzel
If the doctor prescribes or recommends an additional treatment for epilepsy (e.g., valproate) you must tell the doctor you are taking Rufzel as the dose may need adjusting.
Adults and children taking valproate at the same time as Rufinamide will result in high levels of Rufinamide in the blood. Tell your doctor if you are taking valproate as the dose of Rufzel may need to be reduced by your doctor.
Tell the doctor if you are taking hormonal/oral contraceptives, e.g., “The pill”. Rufzel may make the pill not effective at preventing pregnancy. Therefore, it is recommended that you use an additional safe and effective contraceptive method (such as a barrier method, e.g., condoms) when taking Rufzel .
Tell the doctor if you are taking the blood thinner – warfarin. The doctor may need to adjust the dose.
Tell the doctor if you are taking digoxin (a medicine used to treat heart conditions). The doctor may need to adjust the dose.
Rufzel with food and drink
See section 3 – ‘How to use Rufzel ’ for advice on taking Rufzel with food and drink.
Pregnancy, breast-feeding and fertility
If you are pregnant, or think you might be pregnant, or are planning to get pregnant, ask the doctor or pharmacist for advice before taking Rufzel . You must only take Rufzel during your pregnancy if the doctor tells you to.
You are advised not to breast-feed while taking Rufzel , as it is not known if Rufinamide will be present in breast milk.
If you are a woman of childbearing age, you must use contraceptive measures while taking Rufzel . Ask the doctor or pharmacist for advice before taking any medicine at the same time as Rufzel .
Driving and using machines
Rufzel may make you feel dizzy, drowsy and affect your vision, particularly at the beginning of treatment or after a dose increase. If this happens to you, do not drive or operate machinery.
Rufzel contains lactose
If you have been told by the doctor that you have an intolerance to some sugars, contact the doctor before taking this medicinal product.
Always take this medicine exactly as your doctor has told you. Check with the doctor or pharmacist if you are not sure.
It may take a while to find the best dose of Rufzel for you. The dose will be calculated for you by the doctor and will depend on your age, weight and whether you are taking Rufzel with another medicine called valproate.
Children aged between 1 and 4 years of age
The recommended starting dose is 10 mg for each kilogram of body weight, each day. Taken in two equal doses, half in the morning and the other half in the evening. The dose will be calculated for you by the doctor and may be increased by 10 mg for each kilogram of body weight, every third day.
The maximum daily dose will depend on whether or not you are also taking valproate. Maximum daily dose not taking valproate is 45 mg for each kilogram of body weight, each day. Maximum daily dose taking valproate is 30 mg for each kilogram of body weight, each day.
Children 4 years of age or older weighing less than 30 kg
The recommended starting dose is 200 mg a day. Taken in two equal doses, half in the morning and the other half in the evening. The dose will be calculated for you by the doctor and may be increased by 200
mg every third day.
The maximum daily dose will depend on whether or not you are also taking valproate. Maximum daily dose not taking valproate is 1,000 mg each day. Maximum daily dose taking valproate is 600 mg each day.
Adults, adolescents and children weighing 30 kg or over
The recommended starting dose is 400 mg a day. Taken in two equal doses, half in the morning and the other half in the evening. The dose will be calculated for you by the doctor and may be increased by 400 mg every other day.
The maximum daily dose will depend on whether or not you are also taking valproate. Maximum daily dose not taking valproate is no more than 3,200 mg, depending on body weight. Maximum daily dose taking valproate is no more than 2,200 mg, depending on body weight.
Some patients may respond to lower doses and your doctor may adjust the dose depending on how you respond to the treatment.
If you experience side effects, your doctor may increase the dose more slowly.
Rufzel tablets must be taken twice daily with water, in the morning and in the evening. Rufzel should be taken with food. If you have difficulty swallowing, you can crush the tablet, then mix the powder in about half a glass (100 ml) of water and drink immediately. You can also break the tablets into two equal halves and swallow with water.
Do not reduce the dose or stop this medicine unless the doctor tells you to.
If you take more Rufzel than you should
If you may have taken more Rufzel than you should, tell the doctor or pharmacist immediately, or contact your nearest hospital casualty department, taking the medicine with you.
If you forget to take Rufzel
If you forget to take a dose, continue taking the medicine as normal. Do not take a double dose to make up for forgotten dose. If you miss taking more than one dose, seek advice from the doctor.
If you stop taking Rufzel
If the doctor advises stopping treatment, follow their instructions concerning the gradual reduction of Rufzel in order to lower the risk of an increase in seizures.
If you have any further questions on the use of this product, ask the doctor or pharmacist.
Like all medicines, Rufzel can cause side effects, although not everybody gets them. The following side effects can be very serious:
Rash and/or fever. These could be signs of an allergic reaction. If they happen to you tell your doctor or go to a hospital immediately:
Change in the types of seizures you experience/more frequent seizures which last a long time (called status epilepticus). Tell your doctor immediately.
A small number of people being treated with antiepileptics such as Rufzel have had thoughts of harming or killing themselves. If at any time you have these thoughts contact your doctor immediately (see section 2).
You may experience the following side effects with this medicine. Tell the doctor if you have any of the following:
Very common (more than 1 in 10 patients) side effects of Rufzel are: Dizziness, headache, nausea, vomiting, sleepiness, fatigue.
Common (more than 1 in a 100 patients) side effects of Rufzel are:
Problems associated with nerves including: difficulty walking, abnormal movement, convulsions/seizures, unusual eye movements, blurred vision, trembling.
Problems associated with the stomach including: stomach pain, constipation, indigestion, loose stools (diarrhoea), loss or change in appetite, weight loss.
Infections: ear infection, flu, nasal congestion, chest infection.
In addition, patients have experienced: anxiety, insomnia, nose bleeds, acne, rash, back pain, infrequent periods, bruising, head injury (as a result of accidental injury during a seizure).
Uncommon (between 1 in a 100 and 1 in a 1000 patients) side effects of Rufzel are:
Allergic reactions and an increase in markers of liver function (hepatic enzyme increase).
Reporting of side effects
• If any of the side effects gets serious, or if you notice any side effects not listed in this leaflet, please tell your doctor or pharmacist.
· Store below 30°C.
· Keep out of reach of children.
· Do not use this medicine after the expiry date which is stated on the pack after EXP. The expiry date refers to the last day of the month.
· Do not use this medicine if you notice that the appearance of the medicine has changed.
· 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.
1. What Rufzel contains.
Rufzel 200mg
The active substance is Rufinamide: HPMC (2:3) Premix. Each film coated tablet contains 200mg of Rufinamide.
The other ingredients are: Sodium Lauryl Sulfate (STEPANOL WA-100), Lactose Monohydrate (SuperTab 11SD), Crospovidone (Kollidon CL), Colloidal Silicon Dioxide (Aerosil-200) and Magnesium Stearate (LIGAMED MF-2-V).
Film Coating composition: HPMC 2910/Hypromellose, Titanium Dioxide, Macrogol/PEG, Iron oxide red, Polysorbate 80.
Rufzel 400mg
The active substance is Rufinamide: HPMC (2:3) Premix. Each film coated tablet contains 400mg of Rufinamide.
The other ingredients are: Sodium Lauryl Sulfate (STEPANOL WA-100), Lactose Monohydrate (SuperTab 11SD), Crospovidone (Kollidon CL), Colloidal Silicon Dioxide (Aerosil-200) and Magnesium Stearate (LIGAMED MF-2-V).
Film Coating composition: HPMC 2910/Hypromellose, Titanium Dioxide, Macrogol/PEG, Iron oxide red, Polysorbate 80.
Marketing Authorisation Holder
Saudi Amarox Industrial Company
Al Jamiah Street, Al Malaz District Riyadh 12629, Saudi Arabia
Tel & Fax: +966 11 226 8850
Manufacturer
Hetero Labs Limited Unit III– India
يحتوي روفزل على مادة فعالة تسمى روفيناميد. ينتمي إلى مجموعة من الأدوية تسمى مضادات الصرع ، والتي تستخدم لعلاج الصرع (حالة يصاب فيها الشخص بنوبة صرع أو نوبات).
يستخدم روفزل مع أدوية أخرى لعلاج النوبات المصاحبة لمتلازمة لينوكس غاستو لدى البالغين والمراهقين والأطفال من عمر سنة واحدة. متلازمة لينوكس غاستو هو الاسم الذي يطلق على مجموعة من الصرع الشديد التي قد تتعرض فيها لنوبات متكررة من أنواع مختلفة.
روفزل تم إعطاؤه لك من قبل طبيبك لتقليل عدد النوبات.
لا تستخدم روفزل أقراص
- إذا كنت تعاني من حساسية تجاه روفيناميد أو مشتقات التريازول أو أي من مكونات روفزل الأخرى (المدرجة في القسم 6).
التحذيرات والاحتياطات
تحدث إلى طبيبك أو الصيدلي في الحالات التالية:
- إذا كان لديك متلازمة QT الخلقية القصيرة أو لديك تاريخ عائلي لمثل هذه المتلازمة (اضطراب كهربائي للقلب) ، حيث أن تناول روفيناميد يمكن أن يزيد الأمر سوءًا.
- إذا كنت تعاني من مشاكل في الكبد. هناك معلومات محدودة عن استخدام روفيناميد في هذه المجموعة ، لذلك قد تحتاج جرعة الدواء إلى الزيادة بشكل أبطأ. إذا كان مرض الكبد لديك شديدًا ، فقد يقرر الطبيب أن روفزل غير موصى به لك.
- إذا أصبت بطفح جلدي أو حمى. يمكن أن تكون هذه علامات الحساسية. راجع الطبيب فورًا لأن ذلك قد يصبح خطيرًا في بعض الأحيان.
- إذا كنت تعاني من زيادة في عدد أو شدة أو مدّة نوباتك ، عليك الاتصال بالطبيب على الفور في حال حدوث ذلك.
- إذا كنت تواجه صعوبة في المشي ، حركة غير طبيعية ، دوار أو نعاس بلغ الطبيب في حالة حدوث أي من هذه الحالات.
- إذا كنت تتناول هذا الدواء ولديك أفكار لإيذاء نفسك أو قتل نفسك في أي وقت ، فاتصل بطبيبك أو اذهب إلى المستشفى على الفور (انظر القسم 4).
استشر الطبيب حتى لو حدثت هذه الأحداث في أي وقت في الماضي.
الأطفال
لا ينبغي إعطاء روفزل للأطفال الذين تقل أعمارهم عن سنة واحدة لأنه لا توجد معلومات كافية عن سلامة استخدامه في هذه الفئة العمرية.
الأدوية الأخرى وتناول روفزل أقراص
أخبر الطبيب أو الصيدلي إذا كنت تتناول أو تناولت مؤخرًا أي أدوية أخرى ، بما في ذلك الأدوية التي تم الحصول عليها بدون وصفة طبية.
إذا كنت تتناول الأدوية التالية: فينوباربيتال ، فوسفينيتوين ، فينيتوين أو بريميدون ، فقد تحتاج إلى المراقبة الدقيقة لمدة أسبوعين في بداية العلاج أو بعد انتهائه ، أو بعد أي تغيير ملحوظ في الجرعة. قد تكون هناك حاجة إلى تغيير جرعة الأدوية الأخرى لأنها قد تصبح أقل فعالية قليلاً عند إعطائها مع روفيناميد.
الأدوية المضادة للصرع وتناول روفزل أقراص
إذا وصف الطبيب أو أوصى بعلاج إضافي للصرع (على سبيل المثال ، فالبروات) يجب أن تخبر الطبيب بأنك تتناول روفزل لأن الجرعة قد تحتاج إلى تعديل.
سيؤدي تناول البالغين والأطفال لفالبروات في نفس الوقت مع روفيناميد إلى ارتفاع مستويات روفيناميد في الدم. أخبر طبيبك إذا كنت تتناول فالبروات لأن جرعة روفزل قد تحتاج إلى تخفيض من قبل طبيبك.
بلغي الطبيب إذا كنت تتناولين موانع حمل هرمونية / فموية ، على سبيل المثال ، "أقراص منع الحمل". روفزل قد يجعل حبوب منع الحمل غير فعالة في منع الحمل. لذلك ، يوصى باستخدام وسيلة منع حمل إضافية آمنة وفعالة (مثل طريقة الحاجز ، على سبيل المثال ، الواقي الذكري) عند تناول روفزل .
آخبر الطبيب إذا كنت تتناول أدوية منع تجلط الدم - وارفارين. قد يحتاج الطبيب إلى تعديل الجرعة.
آخبر الطبيب إذا كنت تتناول ديجوكسين (دواء يستعمل لعلاج أمراض القلب). قد يحتاج الطبيب إلى تعديل الجرعة.
تناول روفزل مع الطعام والشراب
انظر القسم 3 - "كيفية استخدام روفزل " للحصول على نصائح حول تناول روفزل مع الطعام والشراب.
الحمل والرضاعة والخصوبة
إذا كنت حاملا ، أو تعتقدين أنك حامل ، أو تخططين للحمل ، استشيري الطبيب أو الصيدلي قبل تناول روفزل . يجب عدم تتناول روفزل أثناء الحمل إلا إذا أخبرك الطبيب بذلك.
يُنصح بعدم الإرضاع أثناء تناول روفزل ، حيث لا يُعرف ما إذا كان روفيناميد موجودًا في حليب الثدي.
إذا كنت امرأة في سن الإنجاب ، فيجب عليك استخدام وسائل منع الحمل أثناء تناول روفزل .
استشر الطبيب أو الصيدلي قبل تناول أي دواء في نفس وقت تناول روفزل .
القيادة واستخدام الآلات
قد يشعرك روفزل بالدوار والنعاس ويؤثر على رؤيتك خاصة في بداية العلاج أو بعد زيادة الجرعة. إذا حدث هذا لك ، فلا تقود أو تشغل الآلات.
محتوي روفزل من اللاكتوز
إذا قيل لك من قبل الطبيب بأنك لا تتحمل بعض السكريات ، فاتصل بالطبيب قبل تناول هذا المنتج الدوائي.
احرص دائمًا على تناول هذا الدواء تمامًا كما أخبرك طبيبك. عليك الإستيضاح من الطبيب أو الصيدلي إذا لم تكن واثقا.
قد يستغرق الأمر بعض الوقت للعثور على أفضل جرعة من روفزل لك. سيتم احتساب الجرعة لك من قبل الطبيب وستعتمد على عمرك ووزنك وما إذا كنت تتناول روفزل مع دواء آخر يسمى فالبروات.
الأطفال الذين تتراوح أعمارهم بين 1 و 4 سنوات
جرعة البدء الموصى بها هي 10 ملجرام لكل كيلوغرام من وزن الجسم يومياً. يتم تناولها على جرعتين متساويتين ، نصف في الصباح والنصف الآخر في المساء. سيحسب لك الطبيب الجرعة ويمكن زيادتها بمقدار 10 ملجرام لكل كيلوغرام من وزن الجسم كل ثالث يوم.
تعتمد الجرعة اليومية القصوى على ما إذا كنت تتناول فالبروات أم لا. الحد الأقصى للجرعة اليومية للحالات التي لا تتناول فالبروات 45 ملجرام لكل كيلوغرام من وزن الجسم يومياً. الحد الأقصى للجرعة اليومية مع تناول فالبروات 30 ملجرام لكل كيلوغرام من وزن الجسم يومياً.
الأطفال بعمر 4 سنوات أو أكبر ووزنهم أقل من 30 كغم
جرعة البدء الموصى بها هي 200 ملجرام في اليوم. يتم تناولها على جرعتين متساويتين ، نصف في الصباح والنصف الآخر في المساء. سيحسب لك الطبيب الجرعة ويمكن زيادتها بمقدار 200 ملجرام كل ثالث يوم.
تعتمد الجرعة اليومية القصوى على ما إذا كنت تتناول فالبروات أم لا. الجرعة اليومية القصوى التي للحالات لا تتناول فالبروات هي 1000 ملجرام كل يوم. الحد الأقصى للجرعة اليومية مع تناول الفالبروات هو 600 ملجرام كل يوم.
البالغون والمراهقون والأطفال بوزن 30 كغم أو أكثر
جرعة البدء الموصى بها هي 400 ملجرام في اليوم يتم تناولها على جرعتين متساويتين ، نصف في الصباح والنصف الآخر في المساء. سيتم احتساب الجرعة من أجلك من قبل الطبيب ويمكن زيادتها بمقدار 400 ملجرام كل يومين.
تعتمد الجرعة اليومية القصوى على ما إذا كنت تتناول فالبروات أم لا. الجرعة اليومية القصوى للحالات التي لا تتناول فالبروات لا تزيد عن 3200 ملجرام حسب وزن الجسم. الحد الأقصى للجرعة اليومية مع تناول فالبروات لا يزيد عن 2200 ملجرام ، حسب وزن الجسم.
قد يستجيب بعض المرضى لجرعات أقل وقد يقوم طبيبك بتعديل الجرعة اعتمادًا على كيفية استجابتك للعلاج.
إذا كنت تعاني من آثار جانبية ، فقد يقوم طبيبك بزيادة الجرعة بشكل أبطأ.
يجب تناول أقراص روفزل مرتين يوميًا مع الماء ، صباحًا ومساءً. يجب تناول روفزل مع الطعام. إذا كنت تواجه صعوبة في البلع ، يمكنك سحق القرص ثم خلط المسحوق في حوالي نصف كوب (100 مل) من الماء وشربه على الفور. يمكنك أيضًا تقسيم الأقراص إلى نصفين متساويين وابتلاعها بالماء.
لا تقلل الجرعة أو توقف هذا الدواء إلا إذا أخبرك الطبيب بذلك.
تناول جرعة زائدة من روفزل أقراص
إذا كنت قد تناولت روفزل أكثر مما ينبغي ، أخبر الطبيب أو الصيدلي على الفور ، أو اتصل بأقرب قسم إصابات في المستشفى ، وأخذ الدواء معك.
إذا نسيت تناول روفزل أقراص
إذا نسيت تناول جرعة ، فاستمر في تناول الدواء كالمعتاد. لا تتناول جرعة مضاعفة لتعويض الجرعة المنسية. إذا فاتتك تناول أكثر من جرعة واحدة ، فاطلب المشورة من الطبيب.
التوقف عن تناول روفزل أقراص
إذا نصح الطبيب بوقف العلاج ، فاتبع تعليماته بخصوص التقليل التدريجي من روفزل لتقليل خطر زيادة النوبات.
إذا كانت لديك أسئلة أخرى حول استخدام هذا المنتج ، اسأل الطبيب أو الصيدلي.
مثل جميع الأدوية ، يمكن أن يسبب روفزل آثارًا جانبية ، على الرغم من عدم حدوثها لدى الجميع.
يمكن أن تكون الآثار الجانبية التالية خطيرة للغاية:
· طفح جلدي و / أو حمى. يمكن أن تكون هذه علامات الحساسية. إذا حدث لك ذلك ، فأخبر طبيبك أو توجه إلى المستشفى على الفور:
· تغيير في أنواع النوبات التي تواجهها / نوبات متكررة تستمر لفترة طويلة (تسمى الحالة الصرعية). أخبر طبيبك على الفور.
· كان لدى عدد قليل من الأشخاص الذين يعالجون بمضادات الصرع مثل روفزل أفكار لإيذاء أنفسهم أو قتلهم. إذا راودتك هذه الأفكار في أي وقت ، فاتصل بطبيبك على الفور (انظر القسم 2).
قد تواجه الآثار الجانبية التالية مع هذا الدواء. أخبر الطبيب إذا كان لديك أي مما يلي:
الأعراض الجانبية الشائعة جداً (أكثر من 1 من كل 10 مرضى) هي:
· دوار ، صداع ، غثيان ، قيء ، نعاس ، تعب.
الأعراض الجانبية الشائعة (أكثر من 1 من بين 100 مريض) هي:
· المشاكل المرتبطة بالأعصاب بما في ذلك: صعوبة المشي ، والحركة غير الطبيعية ، والتشنجات / النوبات ، وحركات العين غير العادية ، وعدم وضوح الرؤية ، والارتعاش.
· المشاكل المصاحبة للمعدة بما في ذلك: آلام في المعدة ، إمساك ، عسر هضم ، براز رخو (إسهال) ، فقدان أو تغير في الشهية ، فقدان الوزن.
· الالتهابات: التهاب الاذن ، انفلونزا ، احتقان بالأنف ، التهاب في الصدر.
· بالإضافة إلى ذلك ، عانى المرضى من: القلق ، والأرق ، ونزيف الأنف ، وحب الشباب ، والطفح الجلدي ، وآلام الظهر ، وفترات غير متكررة ، وكدمات ، وإصابة في الرأس (نتيجة إصابة عرضية أثناء النوبة).
الآثار الجانبية غير الشائعة (بين 1 في 100 و 1 من كل 1000 مريض) هي:
· تفاعلات تحسسية وزيادة في علامات وظائف الكبد (زيادة إنزيم الكبد).
الإبلاغ عن الآثار الجانبية:
إن كان لديك أعراض جانبية أو لاحظت أعراض جانبية غير مذكورة في هذه النشرة، فضلًا ابلغ الطبيب أوالصيدلي
1. كيفية تخزين روفزل أقراص
• يحفظ في درجة حرارة أقل من 30 درجة مئوية.
• احفظ هذا الدواء بعيدًا عن رؤية ومتناول أيدي الأطفال.
• لا تستخدم هذا الدواء بعد تاريخ انتهاء الصلاحية المذكور على العبوة بعد EXP. يشير تاريخ انتهاء الصلاحية إلى اليوم الأخير من الشهر.
• لا تتخلص من الأدوية في مياه الصرف الصحي أو النفايات المنزلية. اسأل الصيدلي عن كيفية التخلص من الأدوية التي لم تعد بحاجة إليها. ستساعد هذه الإجراءات في حماية البيئة.
روفزل أقراص 200 ملجرام
المادة الفعالة هي روفيناميد: HPMC (2: 3) بريمكس.
يحتوي كل قرص مغلف على 200 ملجرام من روفيناميد.
الصواغات الأخرى هي: كبريتات لوريل الصوديوم (STEPANOL WA-100) ، اللاكتوز مونوهيدرات (SuperTab 11SD) ، كروسبوفيدون (Kollidon CL) ، ثاني أكسيد السيليكون الغرواني (Aerosil-200) ، وستيرات الماغنيسيوم (LIGAMED MF-2-V).
الصواغات الأخرى لطبقة الكسوة الخارجية هي: HPMC 2910 / هيبرميلوز ، ثاني أكسيد التيتانيوم ، ماكروجول / PEG ، أكسيد الحديد الأحمر ، بولي سوربات 80.
روفزل أقراص 400 ملجرام
المادة الفعالة هي روفيناميد: HPMC (2: 3) بريمكس.
يحتوي كل قرص مغلف على 400 ملجرام من روفيناميد.
الصواغات الأخرى هي: كبريتات لوريل الصوديوم (STEPANOL WA-100) ، اللاكتوز مونوهيدرات (SuperTab 11SD) ، كروسبوفيدون (Kollidon CL) ، ثاني أكسيد السيليكون الغرواني (Aerosil-200) ، وستيرات الماغنيسيوم (LIGAMED MF-2-V).
الصواغات الأخرى لطبقة الكسوة الخارجية هي: HPMC 2910 / هيبرميلوز ، ثاني أكسيد التيتانيوم ، ماكروجول / PEG ، أكسيد الحديد الأحمر ، بولي سوربات 80.
روفزل أقراص 200 ملجرام
أقراص بيضاوية مطلية باللون الوردي ومحدبة الوجهين منقوشة بحرف "H" على أحد الجانبين مع وجود خط للتقسيم ومنقوش عليها "R" و "7" مفصولان بخط التقسيم على الجانب الآخر.
روفزل أقراص 400 ملجرام
أقراص بيضاوية مطلية باللون الوردي ، محدبة الوجهين منقوش عليها حرف "H" على جانب واحد مع خط التقسيم و "R" و "8" مفصولة بخط التقسيم على الجانب الآخر.
كيفية توفير روفزل أقراص؟:
يحتوي روفزل 200ملجرام او 400 ملجرام أقراص في عبوة بها 120 قرص
اسم وعنوان مالك رخصة التسويق والمصنع
صاحب حق التسويق:
شركة اماروكس السعودية الصناعية
شارع الجامعة ، حي الملز
الرياض 12629 ، المملكة العربية السعودية
هاتف و فاكس: +966 11 226 8850
المصنع
شركة هيترو لاب المحدودة الوحدة الثالثة، الهند
Rufzel is indicated as adjunctive therapy in the treatment of seizures associated with Lennox- Gastaut syndrome (LGS) in patients 1 year of age and older.
Treatment with Rufinamideshould be initiated by a physician specialised in paediatrics or neurology with experience in the treatment of epilepsy.
Rufzel oral suspension and Rufzel film-coated tablets may be interchanged at equal doses. Patients should be monitored during the switch over period.
Posology
Use in children from 1 year to less than 4 years of age
Patients not receiving valproate:
Treatment should be initiated at a dose of 10 mg/kg/day administered in two equally divided doses separated by approximately 12 hours. According to clinical response and tolerability, the dose may be increased by up to 10 mg/kg/day every third day to a target dose of 45 mg/kg/day administered in two equally divided doses separated by approximately 12 hours. For this patient population, the maximum recommended dose is 45 mg/kg/day.
Patients receiving valproate:
As valproate significantly decreases clearance of Rufinamide, a lower maximum dose of Rufzel is recommended for patients being co-administered valproate. Treatment should be initiated at a dose of 10 mg/kg/day administered in two equally divided doses separated by approximately 12 hours. According to clinical response and tolerability, the dose may be increased by up to 10 mg/kg/day every third day to a target dose of 30 mg/kg/day administered in two equally divided doses separated by approximately 12 hours. For this patient population, the maximum recommended dose is 30 mg/kg/day.
If the recommended calculated dose of Rufzel is not achievable, the dose should be given to the nearest whole 100 mg tablet.
Use in children 4 years of age or older and less than 30 kg
Patients < 30 kg not receiving valproate:
Treatment should be initiated at a daily dose of 200 mg. According to clinical response and tolerability, the dose may be increased by 200 mg/day increments, as frequently as every third day, up to a maximum recommended dose of 1,000 mg/day.
Doses of up to 3,600 mg/day have been studied in a limited number of patients. Patients < 30 kg also receiving valproate:
As valproate significantly decreases clearance of Rufinamide, a lower maximum dose of Rufzel is recommended for patients < 30 kg being co-administered valproate. Treatment should be initiated at a daily dose of 200 mg. According to clinical response and tolerability, after a minimum of 2 days the dose may be increased by 200 mg/day, to the maximum recommended dose of 600 mg/day.
Use in adults, adolescents and children 4 years of age or older of 30 kg or over
Patients > 30 kg not receiving valproate:
Treatment should be initiated at a daily dose of 400 mg. According to clinical response and tolerability, the dose may be increased by 400 mg/day increments, as frequently as every other day, up to a maximum recommended dose as indicated in the table below.
Weight range | 30.0 – 50.0 kg | 50.1 – 70.0 kg | ≥70.1 kg |
Maximum recommended dose | 1,800 mg/day | 2,400 mg/day | 3,200 mg/day |
Doses of up to 4,000 mg/day (in the 30 - -50 kg range) or 4,800 mg/day (in the over 50 kg) have been studied in a limited number of patients.
Patients > 30 kg also receiving valproate:
Treatment should be initiated at a daily dose of 400 mg. According to clinical response and tolerability, the dose may be increased by 400 mg/day increments, as frequently as every other day, up to a maximum recommended dose as indicated in the table below.
Weight range | 30.0 – 50.0 kg | 50.1 – 70.0 kg | ≥70.1 kg |
Maximum recommended dose | 1,200 mg/day | 1,600 mg/day | 2,200 mg/day |
Elderly
There is limited information on the use of Rufinamidein older people. Since the pharmacokinetics of Rufinamideare not altered in older people (see section 5.2), dosage adjustment is not required in patients over 65 years of age.
Renal impairment
A study in patients with severe renal impairment indicated that no dose adjustments are required for these patients (see section 5.2).
Hepatic impairment
Use in patients with hepatic impairment has not been studied. Caution and careful dose titration is recommended when treating patients with mild to moderate hepatic impairment. Use in patients with severe hepatic impairment is not recommended.
Discontinuation of Rufinamide
When Rufinamidetreatment is to be discontinued, it should be withdrawn gradually. In clinical trials Rufinamidediscontinuation was achieved by reducing the dose by approximately 25% every two days (see section 4.4).
In the case of one or more missed doses, individualised clinical judgement is necessary. Uncontrolled open-label studies suggest sustained long-term efficacy, although no controlled study has been conducted for longer than three months.
Paediatric population
The safety and efficacy of Rufinamidein new-born infants or infants and toddlers aged less than 1 year have not been established. No data are available (see section 5.2).
Method of administration Rufinamideis for oral use.
The tablet should be taken twice daily with water in the morning and in the evening, in two equally divided doses.
Rufzel should be administered with food (see section 5.2). If the patient has difficulty with swallowing, tablets can be crushed and administered in half a glass of water. Alternatively, use the score line to break the tablet into two equal halves.
Status epilepticus
Status epilepticus cases have been observed during treatment with Rufinamidein clinical development studies, whereas no such cases were observed with placebo. These events led to Rufinamidediscontinuation in 20% of the cases. If patients develop new seizure types and/or experience an increased frequency of status epilepticus that is different from the patient's baseline condition, then the benefit-risk ratio of the therapy should be reassessed.
Withdrawal of Rufinamide
Rufinamideshould be withdrawn gradually to reduce the possibility of seizures on withdrawal. In clinical studies discontinuation was achieved by reducing the dose by approximately 25% every
two days. There are insufficient data on the withdrawal of concomitant antiepileptic medicinal products once seizure control has been achieved with the addition of Rufinamide.
Central Nervous System reactions
Rufinamidetreatment has been associated with dizziness, somnolence, ataxia and gait disturbances, which could increase the occurrence of accidental falls in this population (see section 4.8). Patients and carers should exercise caution until they are familiar with the potential effects of this medicinal product.
Hypersensitivity reactions
Serious antiepileptic medicinal product hypersensitivity syndrome including DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms) and Stevens-Johnson syndrome have occurred in association with Rufinamidetherapy. Signs and symptoms of this disorder were diverse; however, patients typically, although not exclusively, presented with fever and rash associated with other organ system involvement. Other associated manifestations included lymphadenopathy, liver function tests abnormalities, and haematuria. As the disorder is variable in its expression, other organ system signs and symptoms not noted here may occur. The antiepileptic drug (AED) hypersensitivity syndrome occurred in close temporal association to the initiation of Rufinamidetherapy and in the paediatric population. If this reaction is suspected, Rufinamideshould be discontinued and alternative treatment started. All patients who develop a rash while taking Rufinamidemust be closely monitored.
QT shortening
In a thorough QT study, Rufinamideproduced a decrease in QTc interval proportional to concentration. Although the underlying mechanism and safety relevance of this finding is not known, clinicians should use clinical judgment when assessing whether to prescribe Rufinamideto patients at risk from further shortening their QTc duration (e.g., Congenital Short QT Syndrome or patients with a family history of such a syndrome).
Women of childbearing potential
Women of childbearing potential must use contraceptive measures during treatment with Rufzel. Physicians should try to ensure that appropriate contraception is used, and should use clinical judgement when assessing whether oral contraceptives, or the doses of the oral contraceptive components, are adequate, based on the individual patients clinical situation (see sections 4.5 a
4.6).
Lactose
Rufzel contains lactose, therefore patients with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption should not take this medicine.
Suicidal ideation
Suicidal ideation and behaviour have been reported in patients treated with antiepileptic agents in several indications. A meta-analysis of randomised placebo-controlled trials of anti-epileptic medicinal products has also shown a small increased risk of suicidal ideation and behaviour. The mechanism of this risk is not known and the available data do not exclude the possibility of an increased risk for Rufzel.
Therefore patients should be monitored for signs of suicidal ideation and behaviours and appropriate treatment should be considered. Patients (and caregivers of patients) should be advised to seek medical advice should signs of suicidal ideation or behaviour emerge.
Potential for other medicinal products to affect Rufinamide Other antiepileptic medicinal products
Rufinamideconcentrations are not subject to clinically relevant changes on co-administration with known enzyme inducing antiepileptic medicinal products.
For patients on Rufzel treatment who have administration of valproate initiated, significant increases in Rufinamideplasma concentrations may occur. Therefore, consideration should be given to a dose reduction of Rufzel in patients who are initiated on valproate therapy (see section 4.2).
The addition or withdrawal of these medicinal products or adjusting of the dose of these medicinal products during Rufinamidetherapy may require an adjustment in dosage of Rufinamide(see section 4.2).
No significant changes in Rufinamideconcentration are observed following co-administration with lamotrigine, topiramate or benzodiazepines.
Potential for Rufinamideto affect other medicinal products Other antiepileptic medicinal products
The pharmacokinetic interactions between Rufinamideand other antiepileptic medicinal products have been evaluated in patients with epilepsy, using population pharmacokinetic modelling. Rufinamideappears not to have a clinically relevant effect on carbamazepine, lamotrigine, phenobarbital, topiramate, phenytoin or valproate steady state concentrations.
Oral contraceptives
Co-administration of Rufinamide800 mg twice daily and a combined oral contraceptive (ethinyloestradiol 35 μg and norethindrone 1 mg) for 14 days resulted in a mean decrease in the ethinyl estradiol AUC0-24 of 22% and in norethindrone AUC0-24 of 14%. Studies with other oral or implant contraceptives have not been conducted. Women of child-bearing potential using hormonal contraceptives are advised to use an additional safe and effective contraceptive method (see sections 4.4 and 4.6).
Cytochrome P450 enzymes
Rufinamideis metabolised by hydrolysis, and is not metabolised to any notable degree by cytochrome P450 enzymes. Furthermore, Rufinamidedoes not inhibit the activity of cytochrome P450 enzymes (see section 5.2). Thus, clinically significant interactions mediated through inhibition of cytochrome P450 system by Rufinamideare unlikely to occur. Rufinamidehas been shown to induce the cytochrome P450 enzyme CYP3A4 and may therefore reduce the plasma concentrations of substances which are metabolised by this enzyme. The effect was modest to moderate. The mean CYP3A4 activity, assessed as clearance of triazolam, was increased by 55% after 11 days of treatment with Rufinamide400 mg twice daily. The exposure of triazolam was reduced by 36%. Higher Rufinamidedoses may result in a more pronounced induction. It may not be excluded that Rufinamidemay also decrease the exposure of substances metabolised by other enzymes, or transported by transport proteins such as P-glycoprotein.
It is recommended that patients treated with substances that are metabolised by the CYP3A4 enzyme system are to be carefully monitored for two weeks at the start of, or after the end of treatment with Rufinamide, or after any marked change in the dose. A dose adjustment of the concomitantly administered medicinal product may need to be considered. These recommendations should also be considered when Rufinamideis used concomitantly with substances with a narrow therapeutic window such as warfarin and digoxin.
A specific interaction study in healthy subjects revealed no influence of Rufinamideat a dose of 400 mg twice daily on the pharmacokinetics of olanzapine, a CYP1A2 substrate.
No data on the interaction of Rufinamidewith alcohol are available.
Pregnancy
Risk related to epilepsy and antiepileptic medicinal products in general:
It has been shown that in the offspring of women with epilepsy, the prevalence of malformations is two to three times greater than the rate of approximately 3% in the general population. In the treated population, an increase in malformations has been noted with polytherapy; however, the extent to which the treatment and/or the illness is responsible has not been elucidated.
Moreover, effective antiepileptic therapy should not be interrupted abruptly, since the aggravation of the illness is detrimental to both the mother and the foetus. AED treatment during pregnancy should be carefully discussed with the treating physician.
Risk related to Rufinamide:
Studies in animals revealed no teratogenic effect, but foetotoxicity in the presence of maternal toxicity was observed (see section 5.3). The potential risk for humans is unknown.
For Rufinamide, no clinical data on exposed pregnancies are available.
Taking these data into consideration, Rufinamideshould not be used during pregnancy, or in women of childbearing age not using contraceptive measures, unless clearly necessary.
Women of childbearing potential must use contraceptive measures during treatment with Rufinamide. Physicians should try to ensure that appropriate contraception is used, and should use clinical judgement when assessing whether oral contraceptives, or the doses of the oral contraceptive components, are adequate based on the individual patients clinical situation (see sections 4.4 and 4.5).
If women treated with Rufinamideplan to become pregnant, the continued use of this product should be carefully weighed. During pregnancy, interruption of an effective antiepileptic can be detrimental to both the mother and the foetus if it results in aggravation of the illness.
Breast-feeding
It is not known if Rufinamideis excreted in human breast milk. Due to the potential harmful effects for the breast-fed infant, breast-feeding should be avoided during maternal treatment with Rufinamide. Fertility
No data are available on the effects on fertility following treatment with Rufinamide.
Rufzel may cause dizziness, somnolence and blurred vision. Depending on the individual sensitivity, Rufinamidemay have a minor to major influence on the ability to drive and use machines. Patients must be advised to exercise caution during activities requiring a high degree of alertness, e.g., driving or operating machinery.
Summary of the safety profile
The clinical development program has included over 1,900 patients, with different types of epilepsy, exposed to Rufinamide. The most commonly reported adverse reactions overall were headache, dizziness, fatigue, and somnolence. The most common adverse reactions observed at a higher incidence than placebo in patients with Lennox-Gastaut syndrome were somnolence and vomiting. Adverse reactions were usually mild to moderate in severity. The discontinuation rate in Lennox-Gastaut syndrome due to adverse reactions was 8.2% for patients receiving Rufinamideand 0% for patients receiving placebo. The most common adverse reactions resulting in discontinuation from the Rufinamidetreatment group were rash and vomiting.
Tabulated list of adverse reactions
Adverse reactions reported with an incidence greater than placebo, during the Lennox-Gastaut syndrome double-blind studies or in the overall Rufinamide-exposed population, are listed in the table below by MedDRA preferred term, system organ class and by frequency.
Frequencies are defined as: very common (≥ 1/10), common (≥ 1/100 to < 1/10), uncommon (≥ 1/1,000 to < 1/100), rare (≥ 1/10,000 to < 1/1,000).
System Organ Class | Very Common | Common | Uncommon | Rare |
Infections and |
| Pneumonia |
|
|
infestations |
| Influenza Nasopharyngitis Ear infection Sinusitis Rhinitis |
|
|
Immune system disorders |
|
|
Hypersensitivity* |
|
Metabolism and nutrition disorders |
| Anorexia Eating disorder Decreased appetite |
|
|
Psychiatric disorders |
| Anxiety Insomnia |
|
|
Nervous system disorders | Somnolence* Headache Dizziness* | Status epilepticus* Convulsion Coordination Abnormal* Nystagmus Psychomotor hyperactivity Tremor | ||
Eye Disorders |
| Diplopia Vision blurred |
|
|
Ear and Labyrinth disorders |
| Vertigo |
|
| |
Respiratory, thoracic and mediastinal disorders |
| Epistaxis |
|
| |
Gastrointestinal | Nausea | Abdominal pain |
|
| |
disorders | Vomiting | upper Constipation Dyspepsia Diarrhoea |
|
| |
Hepatobiliary disorders |
|
| Hepatic increase | enzyme |
|
Skin and subcutaneous tissue disorders |
| Rash* Acne |
|
| |
Musculoskeletal and connective tissue and bone disorders |
| Back pain |
|
| |
Reproductive system and breast disorders |
| Oligomenorrhoea |
|
| |
General disorders and administration site conditions | Fatigue | Gait disturbance* |
|
| |
Investigations |
| Weight decrease |
|
| |
Injury, poisoning and procedural complications |
| Head injury Contusion |
|
|
*Cross reference to section 4.4.
Additional information on special populations Paediatric Population (age 1 to less than 4 years)
In a multicentre, open-label study comparing the addition of Rufinamideto any other AED of the investigator's choice to the existing regimen of 1 to 3 AEDs in paediatric patients, 1 to less than 4 years of age with inadequately controlled LGS, 25 patients, of which 10 subjects were aged 1 to 2 years, were exposed to Rufinamideas adjunctive therapy for 24 weeks at a dose of up to 45 mg/kg/day, in 2 divided doses. The most frequently reported TEAEs in the Rufinamidetreatment group (occurring in ≥ 10% of subjects) were upper respiratory tract infection and vomiting (28.0% each), pneumonia and somnolence (20.0% each), sinusitis, otitis media, diarrhoea, cough and pyrexia (16.0% each), and bronchitis, constipation, nasal congestion, rash, irritability and decreased appetite (12.0% each). The frequency, type and severity of these adverse reactions were similar to that in children 4 years of age and older, adolescents and adults. Age characterisation in patients less than 4 years was not identified in the limited safety database due to small number of patients in the study.
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 (see details below) • Saudi Arabia:
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o SFDA Call Center: 19999 o E- mail: npc.drug@sfda.gov.sa o
Website: https://ade.sfda.gov.sa/
Other GCC States:
Please contact the relevant competent authority.
After an acute overdose, the stomach may be emptied by gastric lavage or by induction of emesis. There is no specific antidote for Rufinamide. Treatment should be supportive and may include haemodialysis (see section 5.2).
Multiple dosing of 7,200 mg/day was associated with no major signs or symptoms.
Pharmacotherapeutic group: antiepileptics, carboxamide derivatives; ATC code: N03AF03. Mechanism of action
Rufinamidemodulates the activity of sodium channels, prolonging their inactive state. Rufinamideis active in a range of animal models of epilepsy.
Clinical experience
Rufzel (Rufinamidetablets) was administered in a double blind, placebo-controlled study, at doses of up to 45 mg/kg/day for 84 days, to 139 patients with inadequately controlled seizures associated with Lennox-Gastaut Syndrome (including both atypical absence seizures and drop attacks). Male and female patients (between 4 and 30 years of age) were eligible if they had a history of multiple seizure types, which had to include atypical absence seizures and drop attacks (i.e., tonic–atonic or astatic seizures); were being treated with 1 to 3 concomitant fixed dose antiepileptic medicinal products; a minimum of 90 seizures in the month before the 28-day baseline period; an EEG within 6 months of study entry demonstrating a pattern of slow spikeand-wave complexes (2.5 Hz); a weight of at least 18 kg; and a CT scan or MRI study confirming the absence of a progressive lesion. All seizures were classified according to the International League Against Epilepsy Revised Classification of Seizures. As it is difficult for caregivers to precisely separate tonic and atonic seizures, the international expert panel of child neurologists agreed to group these seizure types and call them tonic–atonic seizures or “drop attacks”. As such, drop attacks were used as one of the primary end points. A significant improvement was observed for all three primary variables:
the percentage change in total seizure frequency per 28 days during the maintenance phase relative to baseline (-35.8% on Rufzel vs. – 1.6% on placebo, p=0.0006), the number of tonic-atonic seizures (-42.9% on Rufzel vs. 2.2% on placebo, p=0.0002), and the seizure severity rating from the Global Evaluation performed by the parent/guardian at the end of the double-blind phase (much or very much improved in 32.2% on Rufzel vs. 14.5% on the placebo arm, p=0.0041).
Additionally, Rufzel (Rufinamideoral suspension) was administered in a multicentre, open-label study comparing the addition of Rufinamideto the addition of any other AED of the investigator's choice to the existing regimen of 1 to 3 AEDs in paediatric patients, 1 to less than 4 years of age with inadequately controlled LGS. In this study, 25 patients were exposed to Rufinamideas adjunctive therapy for 24 weeks at a dose of up to 45 mg/kg/day, in 2 divided doses. A total of 12 patients received any other AED at the investigator's discretion in the control arm. The study was mainly designed for safety and not adequately powered to show a difference with regards to the seizure efficacy variables. The adverse event profile was similar to that in children 4 years of age and older, adolescents, and adults. In addition, the study investigated the cognitive development, behaviour and language development of subjects treated with Rufinamidecompared to subjects receiving any-other-AED. The Least Square mean change of the Child Behaviour Checklist (CBCL) Total Problems score after 2 years of treatment were 53.75 for the any other AED group and 56.35 for the Rufinamidegroup (LS mean difference [95% CI] +2.60 [10.5,15.7]; p=0.6928),
and the difference between treatments was -2.776 (95% CI: -13.3, 7.8, p=0.5939).
Population pharmacokinetic/pharmacodynamic modelling demonstrated that the reduction of total and tonic-atonic seizure frequencies, the improvement of the global evaluation of seizure severity and the increase in probability of reduction of seizure frequency were dependent on Rufinamideconcentrations.
Absorption
Maximum plasma levels are reached approximately 6 hours after administration. Peak concentration (Cmax) and plasma AUC of Rufinamideincrease less than proportionally with doses in both fasted and fed healthy subjects and in patients, probably due to dose-limited absorption behaviour. After single doses, food increases the bioavailability (AUC) of Rufinamideby approximately 34% and the peak plasma concentration by 56%.
Rufzel oral suspension and Rufzel film-coated tablets have been demonstrated to be bioequivalent. Distribution
In in -vitro studies, only a small fraction of Rufinamide(34%) was bound to human serum proteins with albumin accounting for approximately 80% of this binding. This indicates minimal risk of drug-drug interactions by displacement from binding sites during concomitant administration of other substances. Rufinamidewas evenly distributed between erythrocytes and plasma.
Biotransformation
Rufinamideis almost exclusively eliminated by metabolism. The main pathway of metabolism is hydrolysis of the carboxylamide group to the pharmacologically inactive acid derivative CGP 47292. Cytochrome P450-mediated metabolism is very minor. The formation of small amounts of glutathione conjugates cannot be completely excluded.
Rufinamidehas demonstrated little or no significant capacity in -vitro to act as a competitive or mechanism-based inhibitor of the following human P450 enzymes: CYP1A2, CYP2A6, CYP2C9, CYP2C19, CYP2D6, CYP2E1, CYP3A4/5 or CYP4A9/11-2.
Elimination
The plasma elimination half-life is approximately 6-10 hours in healthy subjects and patients with epilepsy. When given twice daily at 12-hourly intervals, Rufinamideaccumulates to the extent predicted by its terminal half-life, indicating that the pharmacokinetics of Rufinamideare time- independent (i.e. no autoinduction of metabolism).
In a radiotracer study in three healthy volunteers, the parent compound (Rufinamide) was the main radioactive component in plasma, representing about 80% of the total radioactivity, and the metabolite CGP 47292 constituting only about 15%. Renal excretion was the predominant route of elimination for active substance related material, accounting for 84.7% of the dose.
Linearity/non-linearity:
The bioavailability of Rufinamideis dependent on dose. As dose increases, the bioavailability decreases.
Pharmacokinetics in special patient groups Sex
Population pharmacokinetic modelling has been used to evaluate the influence of sex on the pharmacokinetics of Rufinamide. Such evaluations indicate that sex does not affect the pharmacokinetics of Rufinamideto a clinically relevant extent.
Renal impairment
The pharmacokinetics of a single 400 mg dose of Rufinamidewere not altered in subjects with chronic and severe renal failure compared to healthy volunteers. However, plasma levels were reduced by approximately 30% when haemodialysis was applied after administration of Rufinamide, suggesting that this may be a useful procedure in case of overdose (see sections 4.2 and 4.9).
Hepatic impairment
No studies have been performed in patients with hepatic impairment and therefore Rufzel should not be administered to patients with severe hepatic impairment (see section 4.2).
Elderly
A pharmacokinetic study in older healthy volunteers did not show a significant difference in pharmacokinetic parameters compared with younger adults.
Children (1-12 years)
Children generally have lower clearance of Rufinamidethan adults, and this difference is related to body size with Rufinamideclearance increasing with body weight.
A recent population PK analysis of Rufinamideon data pooled from 139 subjects (115 LGS patients and 24 healthy subjects), including 83 paediatric LGS patients (10 patients aged 1 to < 2 years, 14
patients aged 2 to < 4 years, 14 patients aged 4 to < 8 years, 21 patients aged 8 to < 12 years and 24 patients aged 12 to < 18 years) indicated that when Rufinamideis dosed on a
mg/kg/day basis in LGS subjects aged 1 to < 4 years, comparable exposure to that in LGS patients aged ≥ 4 years, in which efficacy has been demostrated, is achieved.
Studies in new-born infants or infants and toddlers under 1 year of age have not been conducted.
Conventional safety pharmacology studies revealed no special hazards at clinically relevant doses. Toxicities observed in dogs at levels similar to human exposure at the maximum recommended dose were liver changes, including bile thrombi, cholestasis and liver enzyme elevations thought
to be related to increased bile secretion in this species. No evidence of an associated risk was identified in the rat and monkey repeat dose toxicity studies.
In reproductive and developmental toxicity studies, there were reductions in foetal growth and survival, and some stillbirths secondary to maternal toxicity. However, no effects on morphology and function, including learning or memory, were observed in the offspring. Rufinamidewas not teratogenic in mice, rats or rabbits.
The toxicity profile of Rufinamidein juvenile animals was similar to that in adult animals. Decreased body weight gain was observed in both juvenile and adult rats and dogs. Mild toxicity in the liver was observed in juvenile as well as in adult animals at exposure levels lower than or similar to those reached in patients. Reversibility of all findings was demonstrated after stopping treatment.
Rufinamidewas not genotoxic and had no carcinogenic potential. An adverse effect not observed in clinical studies, but seen in animals at exposure levels similar to clinical exposure levels and with possible relevance to human use, was myelofibrosis of the bone marrow in the mouse carcinogenicity study. Benign bone neoplasms (osteomas) and hyperostosis seen in mice were considered a result of the activation of a mouse specific virus by fluoride ions released during the oxidative metabolism of Rufinamide.
Regarding the immunotoxic potential, small thymus and thymic involution were observed in dogs in a 13-week study with significant response at the high dose in male. In the 13-week study, female bone marrow and lymphoid changes are reported at the high dose with a weak incidence. In rats, decreased cellularity of the bone marrow and thymic atrophy were observed only in the carcinogenicity study.
Environmental Risk Assessment (ERA):
Environmental risk assessment studies have shown that Rufinamideis very persistent in the environment (see section 6.6).
The other ingredients are: Sodium Lauryl Sulfate (STEPANOL WA-100), Lactose Monohydrate (SuperTab 11SD), Crospovidone (Kollidon CL), Colloidal Silicon Dioxide (Aerosil-
200) and Magnesium Stearate (LIGAMED MF-2-V).
Film Coating composition: HPMC 2910/Hypromellose, Titanium Dioxide, Macrogol/PEG,
Iron oxide red, Polysorbate 80.
RufinamideTablets 400mg
The other ingredients are: Sodium Lauryl Sulfate (STEPANOL WA-100), Lactose Monohydrate (SuperTab 11SD), Crospovidone (Kollidon CL), Colloidal Silicon Dioxide (Aerosil-
200) and Magnesium Stearate (LIGAMED MF-2-V).
Film Coating composition: HPMC 2910/Hypromellose, Titanium Dioxide, Macrogol/PEG, Iron oxide red, Polysorbate 80.
Not applicable
Store below 30⁰C
6.2 Pack Size: 120’s HDPE container pack. 200mg:
Container: High Density Polyethylene container 150 cc with 38 mm Neck (Heavy weight)
Closure: Child resistant plastic caps with pulp liners 38 mm
Desiccant: Desiccant Canister 2.0 g, Silicagel 400mg:
Container: High Density Polyethylene container 300 cc with 53 mm Neck (Heavy weight) Closure: Child resistant plastic caps with pulp liners 53 mm (DMF) (Shriniwas) Desiccant: Desiccant Canister 2.0 g, Silicagel
Not applicable
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