Quetta XR contains a substance called quetiapine. This belongs to a group of medicines called antipsychotics.

Quetta XR can be used to treat several illnesses, such as:

• Schizophrenia: where you may hear or feel things that are not there, believe things that are not true or feel unusually suspicious, anxious, confused, guilty, tense or depressed.
• Mania: where you may feel very excited, elated, agitated, enthusiastic or hyperactive or have poor judgment including being aggressive or disruptive.
• Bipolar depression and major depressive episodes in major depressive disorder: where you may feel sad all the time or you may find that you feel depressed, feel guilty, lack energy, lose your appetite or can’t sleep.

When Quetta XR is being taken to treat major depressive episodes in major depressive disorder, it will be taken in addition to another drug being used to treat this illness.

Your doctor may continue to prescribe Quetta XR even when you are feeling better.

Do not take Quetta XR if:

·       you are allergic (hypersensitive) to quetiapine or any of the other ingredients of Quetta XR (see section 6)

·       you are taking any of the following medicines:

-       Some medicines (for HIV infection)

-       azole medicines (for fungal infections)

-       medicines for an infection (like erythromycin or clarithromycin)

-       nefazodone (for depression).

. If you are not sure, talk to your doctor or pharmacist before taking Quetta XR.

Warnings and Precautions

Before you take your medicine, tell your doctor if:

·       if you, or someone in your family, have or have had any heart problems, for example heart rhythm problems, weakening of the heart muscle or inflammation of the heart or if you are taking any medicines that may have an impact on the way your heart beats.

·       You have low blood pressure.

·       You have had a stroke, especially if you are elderly.

·       You have problems with your liver.

·       You have ever had a fit (seizure).

·       You know that you have had low levels of white blood cells in the past (which may or may not have been caused by other medicines).

·       You have diabetes or have a risk of getting diabetes. If you do, your doctor may check your blood sugar levels while you are taking Quetta XR.

·       You are an elderly person with dementia (loss of brain function). If you are, Quetta XR should not be taken because the group of medicines that Quetta XR belongs to may increase the risk of stroke, or in some cases the risk of death, in elderly people with dementia.

·       if you are an elderly person with Parkinson’s disease/parkinsonism

·       You or someone else in your family has a history of blood clots, as medicines like these have been associated with formation of blood clots.

·       if you have or have had a condition where you stop breathing for short periods during your normal nightly sleep (called “sleep apnoea”) and are taking medicines that slow down the normal activity of the brain (“depressants”).

·       if you have or have had a condition where you can’t completely empty your bladder (urinary retention), have an enlarged prostate, a blockage in your intestines, or increased pressure inside your eye. These conditions are sometimes caused by medicines (called “anti cholinergics”) that affect the way nerve cells function in order to treat certain medical conditions.

·       if you have a history of alcohol or drug abuse.

Tell your doctor immediately if you experience any of the following after taking Quetta XR:

·       A combination of fever, severe muscle stiffness, sweating or a lowered level of consciousness (a disorder called “neuroleptic malignant syndrome”). Immediate medical treatment may be needed.

·       Uncontrollable movements, mainly of your face or tongue.

·       Dizziness or a severe sense of feeling sleepy. This could increase the risk of accidental injury (fall) in elderly patients.

·       Fits (seizures).

·       A long-lasting and painful erection (Priapism).

·       have a fast and irregular heartbeat, even when you are at rest, palpitations, breathing problems, chest pain or unexplained tiredness. Your doctor will need to check your heart and if necessary, refer you to a cardiologist immediately.

These conditions can be caused by this type of medicine.

Tell your doctor as soon as possible if you have:

·       A fever, flu-like symptoms, sore throat, or any other infection, as this could be a result of a very low white blood cell count, which may require Quetta XR to be stopped and/or treatment to be given.

·       Constipation along with persistent abdominal pain, or constipation which has not responded to treatment, as this may lead to a more serious blockage of the bowel.

Thoughts of suicide and worsening of your depression

If you are depressed you may sometimes have thoughts of harming or killing yourself. These may be increased when first starting treatment, since these medicines all take time to work, usually about two weeks but sometimes longer. These thoughts may also be increased if you suddenly stop taking your medication.

You may be more likely to think like this if you are a young adult. Information from clinical trials has shown an increased risk of suicidal thoughts and/or suicidal behavior in young adults aged less than 25 years with depression.

If you have thoughts of harming or killing yourself at any time, contact your doctor or go to a hospital straight away. You may find it helpful to tell a relative or close friend that you are depressed, and ask them to read this leaflet. You might ask them to tell you if they think your depression is getting worse, or if they are worried about changes in your behavior.

Severe cutaneous adverse reactions (SCARs)

Severe cutaneous adverse reactions (SCARs) which can be life threatening or fatal have been reported very rarely with treatment of this medicine. These are commonly manifested by:

·       Stevens-Johnson syndrome (SJS), a widespread rash with blisters and peeling skin, particularly around the mouth, nose, eyes and genitals

·       Toxic Epidermal Necrolysis (TEN), a more severe form causing extensive peeling of the skin

·       Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) consists of flu-like symptoms with a rash, fever, swollen glands, and abnormal blood test results (including increased white blood cells (eosinophilia) and liver enzymes)

·       Acute Generalized Exanthematous Pustilosis (AGEP), small blisters filled with pus

·       Erythema Multiforme (EM), skin rash with itchy-red irregular spots

Stop using Quetta XR if you develop these symptoms and contact your doctor or seek medical attention immediately.

Weight gain

Weight gain has been seen in patients taking Quetta XR. You and your doctor should check your weight regularly.

Children and adolescents

Quetta XR is not for use in children and adolescents below 18 years of age.

Other medicines and Quetta XR

Please tell your doctor if you are taking or have recently taken any other medicines.

Do not take Quetta XR if you are taking any of the following medicines:

·       Some medicines for HIV.

·       Azole medicines (for fungal infections).

·       Erythromycin or clarithromycin (for infections).

·       Nefazodone (for depression).

Tell your doctor or pharmacist if you are taking any of the following medicines:

·       Epilepsy medicines (like phenytoin or carbamazepine).

·       High blood pressure medicines.

·       Barbiturates (for difficulty sleeping).

·       Thioridazine or Lithium (other anti-psychotic medicines).

·       Medicines that have an impact on the way your heart beats, for example, drugs that can cause an imbalance in electrolytes (low levels of potassium or magnesium) such as diuretics (water pills) or certain antibiotics (drugs to treat infections).

·       Medicines that can cause constipation.

·       Medicines (called “anti-cholinergics”) that affect the way nerve cells function in order to treat certain medical conditions.

Before you stop taking any of your medicines, please talk to your doctor or pharmacist first.

Taking Quetta XR with food, drink and alcohol

·       Quetta XR can be affected by food and you should therefore take your tablets at least one hour before a meal or at bedtime.

·       Be careful how much alcohol you drink. This is because the combined effect of Quetta XR and alcohol can make you sleepy.

·       Do not drink grapefruit juice while you are taking Quetta XR. It can affect the way the medicine works.

Pregnancy and breast-feeding

If you are pregnant or breast-feeding, think you may be pregnant or planning to have a baby ask your doctor for advice before taking this medicine. You should not take Quetta XR during pregnancy unless this has been discussed with your doctor. Quetta XR should not be taken if you are breast-feeding.

The following symptoms which can represent withdrawal may occur in newborn babies of mothers that have used Quetta XR 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.

Driving and using machines

Your tablets may make you feel sleepy. Do not drive or use any tools or machines until you know how the tablets affect you.

Important information about some of the ingredients of Quetta XR

Quetta XR contains lactose which is a type of sugar. If you have been told by your doctor that you have intolerance to some sugars, talk to your doctor before taking this medicine.

Effect on Urine Drug Screens

If you are having a urine drug screen, taking Quetta XR may cause positive results for methadone or certain drugs for depression called tricyclic antidepressants (TCAs) when some test methods are used, even though you may not be taking methadone or TCAs. If this happens, a more specific test can be performed.

Always take Quetta XR exactly as your doctor has told you. You should check with your doctor or pharmacist if you are not sure. Your doctor will decide on your starting dose.

The maintenance dose (daily dose) will depend on your illness and needs but will usually be between 150 mg and 800 mg.

• You will take your tablets once a day.
• Swallow your tablets whole with a drink of water.
• Do not split, chew or crush the tablets.
• Take your tablets without food (at least one hour before a meal or at bedtime, your doctor will tell you when).
• Do not drink grapefruit juice while you are taking Quetta XR. It can affect the way the medicine works.
• Do not stop taking your tablets even if you feel better, unless your doctor tells you.

Liver problems

If you have liver problems your doctor may give you a lower dose.

Elderly people

If you are elderly your doctor may give you a lower dose.

Children and adolescents under 18 years

Quetta XR should not be used by children and adolescents aged less than 18 years.

If you take more Quetta XR than you should

If you take more Quetta XR than prescribed by your doctor, you may feel sleepy, feel faint or dizzy and experience abnormal heart beats. Contact your doctor or nearest hospital straight away. Take the Quetta XR tablets with you.

If you forget to take a dose of Quetta XR

If you forget to take a dose, take it as soon as you remember. If it is almost time to take the next dose, wait until then. Do not take a double dose to make up for a forgotten tablet.

If you stop taking Quetta XR

If you suddenly stop taking Quetta XR, you may be unable to sleep (insomnia), or you may feel sick (nausea) or you may experience headache, diarrhoea, being sick (vomiting), dizziness or irritability. Your doctor may suggest you reduce the dose gradually before stopping treatment.

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

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

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

• Fits or seizures
• Allergic reactions that may include raised lumps (weals), swelling of the skin and swelling around the mouth.
• Uncontrollable movements, mainly of your face or tongue (Tardive dyskinesia).
• Unpleasant sensations in the legs (also called restless legs syndrome).
• Difficulty swallowing
• Sexual dysfunction.
• Diabetes.
• Change in electrical activity of the heart seen on ECG (QT prolongation).
• A slower than normal heart rate which may occur when starting treatment and which may be associated with low blood pressure and fainting.
• Difficulty in passing urine.
• Fainting (may lead to falls).
• Stuffy nose.
• Decrease in the amount of red blood cells.
• Decrease in the amount of sodium in the blood.
• Worsening of pre-existing diabetes.
• Confusion.

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

• A combination of high temperature (fever), sweating, stiff muscles, feeling very drowsy or faint, (a disorder called “neuroleptic malignant syndrome”).
• Yellowing of the skin and eyes (jaundice).
• Inflammation of the liver (hepatitis).
• A long-lasting and painful erection (Priapism).
• 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.
• Swelling of breasts and unexpected production of breast milk (galactorrhoea).
• Menstrual disorder
• Walking, talking, eating or other activities while you are asleep.
• Body temperature decreased (hypothermia).
• Inflammation of the pancreas.
• A condition (called “metabolic syndrome”) where you may have a combination of 3 or more of the following: an increase in fat around your abdomen, a decrease in “good cholesterol” (HDL-C), an increase in a type of fat in your blood called triglycerides, high blood pressure and an increase in your blood sugar.
• Combination of fever, flu-like symptoms, sore throat, or any other infection with very low white blood cell count, a condition called agranulocytosis.
• Bowel obstruction.
• Increased blood creatine phosphokinase (a substance from the muscles).

Very rare (may affect up to 1 in 10,000 people):

• Severe allergic reaction (called anaphylaxis) that may include difficulty in breathing, dizziness, shock.

• Rapid swelling of the skin, usually around the eyes, lips and throat (angioedema).
• A serious blistering condition of the skin, mouth, eyes and genitals (Stevens-Johnson syndrome).
• Inappropriate secretion of a hormone that controls urine volume.
• Breakdown of muscle fibers and pain in muscles (rhabdomyolysis).
• Severe rash, blisters, or red patches on the skin.

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

• Dizziness (may lead to falls), headache, dry mouth.
• Feeling sleepy (this may go away with time, as you keep taking Quetta XR) (may lead to falls).
• Discontinuation symptoms (symptoms which occur when you stop taking Quetta XR) include not being able to sleep (insomnia), feeling sick (nausea), headache, diarrhoea, being sick (vomiting), dizziness and irritability. Gradual withdrawal over a period of at least 1 to 2 weeks is advisable.
• Putting on weight.
• Abnormal muscle movements. These include difficulty starting muscle movements, shaking, feeling restless or muscle stiffness without pain.
• Changes in the amount of certain fats (triglycerides and total cholesterol).

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

• Rapid heartbeat.
• Feeling like your heart is pounding, racing or has skipped beats.
• Constipation, upset stomach (indigestion).
• Feeling weak.
• Swelling of arms or legs.
• Low blood pressure when standing up. This may make you feel dizzy or faint (may lead to falls).
• Increased levels of sugar in the blood.
• Blurred vision.
• Abnormal dreams and nightmares.
• Feeling more hungry.
• Feeling irritated.
• Disturbance in speech or language.
• Thoughts of suicide and worsening of your depression.
• Shortness of breath.
• Vomiting (mainly in the elderly).
• Fever.
• Changes in the amount of thyroid hormones in your blood.
• Decreases in the number of certain types of blood cells.
• Increases in the amount of liver enzymes measured in the blood.
• Increases in the amount of the hormone prolactin in the blood. Increases in the hormone prolactin could in rare cases lead to the following:

- Men and women to have swelling of breasts and unexpectedly produce breast milk.

- Women to have no monthly period or irregular periods.

Not known (frequency cannot be estimated from the available data):

• Skin rash with irregular red spots (erythema multiforme).

Rapid appearance of areas of red skin studded with small pustules (small blisters filled with white/yellow fluid called as Acute Generalized Exanthematous Pustulosis (AGEP).

• Serious, sudden allergic reaction with symptoms such as fever and blisters on the skin and peeling of the skin (toxic epidermal necrolysis)
• Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) consists of flu-like symptoms with a rash, fever, swollen glands, and abnormal blood test results (including increased white blood cells (eosinophilia) and liver enzymes) See section 2.
• Symptoms of withdrawal may occur in newborn babies of mothers that have used Quetta XR during their pregnancy.
• Stroke.
• Disorder of the heart muscle (cardiomyopathy)
• Inflammation of the heart muscle (myocarditis)
• Inflammation of blood vessels (Vasculitis), often with skin rash with small red or purple bumps

The class of medicines to which Quetta XR belongs can cause heart rhythm problems, which can be serious and in severe cases fatal.

Some side effects are only seen when a blood test is taken. These include changes in the amount of certain fats (triglycerides and total cholesterol) or sugar in the blood, changes in the amount of thyroid hormones in your blood, increased liver enzymes, decreases in the number of certain types of blood cells, decrease in the amount of red blood cells, increased blood creatine phosphokinase (a substance in the muscles), decrease in the amount of sodium in the blood, and increases in the amount of the hormone prolactin in the blood.

Increases in the hormone prolactin could in rare cases lead to the following:

• Men and women to have swelling of breasts and unexpectedly produce breast milk.
• Women to have no monthly period or irregular periods.      

Your doctor may ask you to have blood tests from time to time.

Additional side effects in children and adolescents

The same side effects that may occur in adults may also occur in children and adolescents.

The following side effect has been seen more often in children and adolescents or have not been seen in adults:

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

• Increase in blood pressure.

• Increase in the amount of a hormone called prolactin, in the blood. Increases in the hormone prolactin could in rare cases lead to the following:

-       boys and girls to have swelling of breasts and unexpectedly produce breast milk

-       girls to have no monthly period or irregular periods.

• Increased appetite.
• Vomiting.
• Abnormal muscle movements. These include difficulty starting muscle movements, shaking, feeling restless or muscle stiffness without pain.

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

• Feeling weak, fainting (may lead to falls).
• Stuffy nose.
• Feeling irritated.

·       Do not store above 30ͦ^o C. Store in the original package.

·       Keep out of the reach and sight of children.

·       Do not use Quetta XR after the expiry date which is stated on the container. The expiry date refers to the last day of that month.

·       Medicines should not be disposed of via wastewater or household waste. Ask your pharmacist how to dispose of medicines no longer required. These measures will help to protect the environment.