1. Name Of The Medicinal Product
Faramsil 400 microgram Prolonged-release Tablets
2. Qualitative And Quantitative Composition
Each film-coated prolonged-release tablet contains 0.4 mg tamsulosin hydrochloride.
Excipient(s):
Each film-coated prolonged-release tablet contains 18.75 mg lactose monohydrate.
For a full list of excipients, see section 6.1.
3. Pharmaceutical Form
Film-coated prolonged-release tablet
Round, bi-convex, brown film-coated tablet with debossing “0.4” on one side and “SZ” on the other side.
4. Clinical Particulars
4.1 Therapeutic Indications
Treatment of lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH).
4.2 Posology And Method Of Administration
Posology
One tablet daily can be taken independently of food.
Method of administration
For oral use.
The tablet should be swallowed whole and should not be crushed or chewed as this will interfere with the prolonged release of the active ingredient.
Special populations
Renal impairment: no dose adjustment is required in patients with renal impairment
Hepatic impairment: no dose adjustment is required in patients with mild to moderate hepatic impairment (see also section 4.3)
Paediatric population
There is no relevant indication for the use of tamsulosin in the paediatric population.
4.3 Contraindications
Hypersensitivity to tamsulosin, including drug-induced angio-oedema, or to any of the excipients.
A history of orthostatic hypotension.
Severe hepatic insufficiency.
4.4 Special Warnings And Precautions For Use
As with other alpha1-blockers, a reduction in blood pressure can occur in individual cases during treatment with tamsulosin, leading in rare cases to syncope. At the first signs of orthostatic hypotension (dizziness, weakness), the patient should sit or lie down until the symptoms have disappeared.
Prior to commencement of therapy with tamsulosin, the patient should be examined in order to exclude the presence of other conditions which may produce similar symptoms to those of benign prostatic hyperplasia. Digital rectal examination and, when necessary, determination of prostate specific antigen (PSA) should be performed prior to commencement of treatment and at regular intervals afterwards.
The treatment of patients with severe renal impairment (creatinine clearance less than 10 ml/min) should be approached with caution as these patients have not been studied.
The 'Intraoperative Floppy Iris Syndrome' (IFIS, a variant of small pupil syndrome) has been observed during cataract surgery in some patients on or previously treated with tamsulosin. IFIS may lead to increased procedural complications during the operation. The initiation of therapy with tamsulosin in patients scheduled for cataract surgery is not recommended.
Discontinuing tamsulosin 1-2 weeks prior to cataract surgery has been recommended, however the benefit and duration of stopping the therapy prior to cataract surgery has not yet been established.
During pre-operative assessment, cataract surgeons and ophthalmic teams should consider whether patients scheduled for cataract surgery are being or have been treated with tamsulosin in order to ensure that appropriate measures will be in place to manage the IFIS during surgery.
Tamsulosin prolonged-release tablets contain lactose. Patients with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption should not take this medicinal product.
4.5 Interaction With Other Medicinal Products And Other Forms Of Interaction
Interaction studies have only been performed in adults. No interactions have been seen when tamsulosin was given concomitantly with atenolol, enalapril or theophylline. Concomitant cimetidine increases and concomitant furosemide lowers plasma levels of tamsulosin, however, as levels remain within the normal range, posology need not be changed. In vitro, neither diazepam nor propranolol, trichlormethiazide, chlormadinon, amitryptyline, diclofenac, glibenclamide, simvastatin and warfarin change the free fraction of tamsulosin in human plasma. Neither does tamsulosin change the free fractions of diazepam, propranolol, trichlormethiazide, and chlormadinon. No interactions at the level of hepatic metabolism have been seen during in vitro studies with liver microsomal fractions (representative of the cytochrome P450-linked drug metabolising enzyme system), involving amitriptyline, salbutamol, glibenclamide and finasteride. Diclofenac and warfarin, however, may increase the elimination rate of tamsulosin. There is a theoretical risk of enhanced hypotensive effect when given concomitantly with drugs which may reduce blood pressure, including anaesthetic agents and other alpha1- adrenoreceptors antagonists.
4.6 Pregnancy And Lactation
Not applicable, as tamsulosin is intended for male patients only.
4.7 Effects On Ability To Drive And Use Machines
No studies on the effects on the ability to drive and use machines have been performed. However patients should be aware of the fact that drowsiness, blurred vision, dizziness and syncope can occur.
4.8 Undesirable Effects
Tamsulosin prolonged-release tablets were evaluated in two double-blind placebo controlled trials. Adverse events were mostly mild and their incidence was generally low. The most commonly reported ADR was abnormal ejaculation occurring in approximately 2% of patients.
Suspected adverse reactions reported with Tamsulosin prolonged release tablets or an alternative formulation of tamsulosin, were:
Common (
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As with other alpha-blockers, drowsiness, blurred vision, dry mouth or oedema can occur.
During cataract surgery a small pupil situation, known as Intraoperative Floppy Iris Syndrome (IFIS), has been associated with therapy of tamsulosin during post-marketing surveillance (see also section 4.4).
Post-marketing experience: In addition to the adverse events listed above, atrial fibrillation, arrhythmia, tachycardia and dyspnoea have been reported in association with tamsulosin use. Because these spontaneously reported events are from the worldwide post-marketing experience, the frequency of events and the role of tamsulosin in their causation cannot be reliably determined.
4.9 Overdose
Acute overdose with 5 mg tamsulosin hydrochloride has been reported. Acute hypotension (systolic blood pressure 70 mm Hg), vomiting and diarrhoea were observed, which were treated with fluid replacement and the patient was able to be discharged the same day. In case of acute hypotension occurring after overdose, cardiovascular support should be given. Blood pressure can be restored and heart rate brought back to normal by lying the patient down. If this is insufficient then volume expanders, and when necessary, vasopressors could be employed. Renal function should be monitored and general supportive measures applied. Dialysis is unlikely to be of help, as tamsulosin is very highly bound to plasma proteins.
Measures, such as emesis, can be taken to impede absorption. When large quantities are involved, gastric lavage can be applied and activated charcoal and an osmotic laxative, such as sodium sulphate, can be administered.
5. Pharmacological Properties
5.1 Pharmacodynamic Properties
Alpha adrenoceptor antagonists.
ATC code: G04C A02. Preparations for the exclusive treatment of prostatic disease.
Mechanism of action
Tamsulosin binds selectively and competitively to postsynaptic alpha1-receptors, in particular to the subtype alpha1A, resulting in relaxation of the smooth muscle of the prostate, whereby tension is reduced.
Pharmacodynamic effects
Tamsulosin increases maximum urinary flow rate by reducing smooth muscle tension in the prostate and urethra, thereby relieving obstruction.
It also improves the complex of irritative and obstructive symptoms in which bladder instability and tension of the smooth muscles of the lower urinary tract play an important role. Alpha1-blockers can reduce blood pressure by lowering peripheral resistance. No reduction in blood pressure of any clinical significance was observed during studies with tamsulosin.
5.2 Pharmacokinetic Properties
Absorption
Tamsulosin administered as a prolonged-release tablet is absorbed from the intestine and its bioavailability is approximately 55-59% A consistent slow release of tamsulosin is maintained over the whole pH range encountered in the gastro-intestinal tract with little fluctuation over 24 hours. The rate and extent of absorption of tamsulosin administered as a prolonged release-tablet is not affected by food intake.
Tamsulosin shows linear kinetics.
Following administration of a single dose of tamsulosin in fasting state, plasma levels of tamsulosin peak at a median time of 6 hours. At steady state, which is reached by day 4 of multiple dosing, plasma levels of tamsulosin peak at 4 to 6 hours in fasting and fed state. Peak plasma levels increase from approximately 6 ng/ml after the first dose to 11 ng/ml at steady state.
As a result of the prolonged release characteristics of the tablet the trough concentration of tamsulosin in plasma amounts to 40% of the peak plasma concentration under fasting and fed conditions.
There is a considerable inter-patient variation in plasma levels, both after single and multiple dosing.
Distribution
In male patients, tamsulosin is about 99% bound to plasma proteins and the volume of distribution is small (about 0.2l/kg).
Metabolism
Tamsulosin has a low first pass effect, being metabolised slowly. Most tamsulosin is present in plasma in the form of unchanged drug. It is metabolised in the liver.
In rats, hardly any induction of microsomal liver enzymes was seen to be caused by tamsulosin.
None of the metabolites are more active than the original compound.
Elimination
Tamsulosin and its metabolites are mainly excreted in the urine. The urinary recovery of unchanged drug is estimated to be about 4-6% of the dose, administered as a prolonged release tablet
After a single dose of tamsulosin, and at steady state, elimination half-life of about 19 and 15 hours, respectively, has been measured.
5.3 Preclinical Safety Data
Single and repeat dose toxicity studies were performed in mice, rats and dogs. In addition, reproduction toxicity studies were performed in rats, carcinogenicity in mice and rats, and in vivo and in vitro genotoxicity were examined.
The general toxicity profile, as seen with high doses of tamsulosin, is consistent with the known pharmacological actions of the alpha-adrenergic blocking agents. At very high dose levels, the ECG was altered in dogs. This response is considered to be clinically irrelevant. Tamsulosin showed no relevant genotoxic properties.
Increased incidences of proliferative changes of mammary glands of female rats and mice have been reported. These findings appeared to be related to hyperprolactinaemia and only occurred at high dose levels, are regarded as irrelevant.
6. Pharmaceutical Particulars
6.1 List Of Excipients
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6.2 Incompatibilities
Not applicable.
6.3 Shelf Life
2 years
6.4 Special Precautions For Storage
Store in the original package.
6.5 Nature And Contents Of Container
Aluminium//Aluminium blisters.
Pack sizes: 10, 14, 20, 28, 30, 50, 56, 60, 80, 90, 100 and 200 film-coated prolonged-release tablets.
Not all pack sizes may be marketed.
6.6 Special Precautions For Disposal And Other Handling
No special requirements.
7. Marketing Authorisation Holder
Sandoz Ltd
Frimley Business Park,
Frimley,
Camberley,
Surrey,
GU16 7SR.
United Kingdom
8. Marketing Authorisation Number(S)
PL 04416/0987
9. Date Of First Authorisation/Renewal Of The Authorisation
14/07/2011
10. Date Of Revision Of The Text
14/07/2011
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