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PACKAGE LEAFLET: INFORMATION FOR THE USER

Tenofovir 245 mg film-coated tablets

Read all of this leaflet carefully before you start taking this medicine because it contains important information for you.

-    Keep this leaflet. You may need to read it again.

-    If you have any further questions, ask your doctor or pharmacist.

-    This medicine has been prescribed for you only. Do not pass it on to others. It may harm

them, even if their signs of illness are the same as yours.

-    If you get any side effects, talk to your doctor or pharmacist. This includes any possible

side effects not listed in this leaflet. See section 4.

What is in this leaflet

1.    What tenofovir is and what it is used for

2.    What you need to know before you take tenofovir

3.    How to take tenofovir

4.    Possible side effects

5.    How to store tenofovir

6.    Contents of the pack and other information

If tenofovir has been prescribed for your child, please note that all the information in this leaflet is addressed to your child (in this case please read “your child” instead of “you”).

1.    WHAT TENOFOVIR IS AND WHAT IT IS USED FOR

The name of your medicine is Tenofovir 245 mg film-coated tablets (called tenofovir throughout this leaflet). Tenofovir 245 mg film-coated tablets contain the active substance tenofovir disoproxil. This active substance is an antiretroviral or antiviral medicine which is used to treat HIV or HBV infection or both. Tenofovir is a nucleotide reverse transcriptase inhibitor, generally known as an NRTI and works by interfering with the normal working of enzymes (in HIV reverse transcriptase; in hepatitis B DNA polymerase) that are essential for the viruses to reproduce themselves. In HIV tenofovir should always be used combined with other medicines to treat HIV infection.

Tenofovir is a treatment for HIV (Human Immunodeficiency Virus) infection. The tablets are suitable for:

•    adults

•    adolescents aged 12 to less than 18 years who have already been treated with other HIV medicines which are no longer fully effective due to development of resistance, or have caused side effects.

Tenofovir is also a treatment for chronic hepatitis B, an infection with HBV (hepatitis B virus). The tablets are suitable for:

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•    adults

•    adolescents aged 12 to less than 18 years.

You do not have to have HIV to be treated with tenofovir for HBV.

This medicine is not a cure for HIV infection. While taking tenofovir you may still develop infections or other illnesses associated with HIV infection.

You can also pass on HIV or HBV to others, so it is important to take precautions to avoid infecting other people.

2.    WHAT YOU NEED TO KNOW BEFORE YOU TAKE TENOFOVIR

Do not take tenofovir

•    If you are allergic to tenofovir, tenofovir disoproxil fumarate or any of the other ingredients of this medicine listed in section 6.

•    If this applies to you, tell your doctor immediately and do not take tenofovir.

Warnings and precautions

Talk to your doctor or pharmacist before taking tenofovir

•    Take care not to infect other people. You can still pass on HIV when taking this medicine, although the risk is lowered by effective antiretroviral therapy. Discuss with your doctor the precautions needed to avoid infecting other people. Tenofovir does not reduce the risk of passing on HBV to others through sexual contact or blood contamination. You must continue to take precautions to avoid this.

•    Talk to your doctor or pharmacist if you have had kidney disease or if tests have shown problems with your kidneys. Tenofovir should not be given to adolescents with existing kidney problems. Before starting treatment, your doctor may order blood tests to assess your kidney function. Tenofovir may affect your kidneys during treatment. Your doctor may order blood tests during treatment to monitor how your kidneys work. If you are an adult, your doctor may advise you to take the tablets less often. Do not reduce the prescribed dose, unless your doctor has told you to do so.

Tenofovir is not usually taken with other medicines that can damage your kidneys (see other medicines and tenofovir). If this is unavoidable, your doctor will monitor your kidney function once a week.

•    Bone problems. Some adult patients with HIV taking combination antiretroviral therapy may develop a bone disease called osteonecrosis (death of bone tissue caused by loss of blood supply to the bone). The length of combination antiretroviral therapy, corticosteroid use, alcohol consumption, severe immunosuppression, higher body mass index, among others, may be some of the many risk factors for developing this disease. Signs of osteonecrosis are joint stiffness, aches and pains (especially of the hip, knee and

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shoulder) and difficulty in movement. If you notice any of these symptoms tell your doctor.

Bone problems (sometimes resulting in fractures) may also occur due to damage to kidney

tubule cells (see section 4, Possible side effects).

•    Talk to your doctor if you have a history of liver disease, including hepatitis.

Patients with liver disease including chronic hepatitis B or C, who are treated with antiretrovirals, have a higher risk of severe and potentially fatal liver complications. If you have hepatitis B infection, your doctor will carefully consider the best treatment for you. If you have a history of liver disease or chronic hepatitis B infection your doctor may conduct blood tests to monitor your liver function.

•    Look out for infections. If you have advanced HIV infection (AIDS) and have an infection, you may develop symptoms of infection and inflammation or worsening of the symptoms of an existing infection once treatment with tenofovir is started. These symptoms may indicate that your body’s improved immune system is fighting infection. Look out for signs of inflammation or infection soon after you start taking tenofovir. If you notice signs of inflammation or infection, tell your doctor at once.

In addition to the opportunistic infections, autoimmune disorders (a condition that occurs when the immune system attacks healthy body tissue) may also occur after you start taking medicines for the treatment of your HIV infection. Autoimmune disorders may occur many months after the start of treatment. If you notice any symptoms of infection or other symptoms such as muscle weakness, weakness beginning in the hands and feet and moving up towards the trunk of the body, palpitations, tremor or hyperactivity, please inform your doctor immediately to seek necessary treatment.

•    Talk to your doctor or pharmacist if you are over 65. Tenofovir have not been studied in patients over 65 years of age. If you are older than this and are prescribed tenofovir, your doctor will monitor you carefully.

Children and adolescents

Tenofovir is suitable for:

•    HIV-1 infected adolescents aged 12 to less than 18 years who weigh at least 35 kg and who have already been treated with other HIV medicines which are no longer fully effective due to development of resistance, or have caused side effects

•    HBV infected adolescents aged 12 to less than 18 years who weigh at least 35 kg.

Tenofovir is not suitable for the following groups:

•    Not for HIV-1 infected children under 12 years of age.

•    Not for HBV infected children under 12 years of age.

For dosage see section 3, How to take tenofovir.

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Other medicines and tenofovir

Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines.

•    Do not stop any anti-HIV medicines prescribed by your doctor when you start tenofovir if you have both HBV and HIV.

•    Do not take tenofovir if you are already taking other medicines containing tenofovir disoproxil fumarate. Do not take tenofovir together with medicines containing adefovir dipivoxil (a medicine used to treat chronic hepatitis B).

•    It is very important to tell your doctor if you are taking other medicines that may damage your kidneys.

These include:

-    aminoglycosides, pentamidine or vancomycin (for bacterial infection)

-    amphotericin B (for fungal infection)

-    foscarnet, ganciclovir, or cidofovir (for viral infection)

-    interleukin-2 (to treat cancer)

-    adefovir dipivoxil (for HBV)

-    tacrolimus (for suppression of the immune system)

-    non-steroidal anti-inflammatory drugs (NSAIDs, to relieve bone or muscle pains)

•    Other medicines containing didanosine (for HIV infection): Taking tenofovir with other antiviral medicines that contain didanosine can raise the levels of didanosine in your blood and may reduce CD4 cell counts. Rarely, inflammation of the pancreas and lactic acidosis (excess lactic acid in the blood), which sometimes caused death, have been reported when medicines containing tenofovir disoproxil fumarate and didanosine were taken together. Your doctor will carefully consider whether to treat you with combinations of tenofovir and didanosine.

•    It is also important to tell your doctor if you are taking ledipasvir/sofosbuvif to treat hepatitis C infection.

Tenofovir with food and drink

Take tenofovir with food (for example, a meal or a snack).

Pregnancy, breast-feeding and fertility

If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, ask your doctor or pharmacist for advice before taking this medicine.

•    You must not take tenofovir during pregnancy unless specifically discussed with your doctor. Although there are limited clinical data on the use of tenofovir in pregnant women, it is not usually used unless absolutely necessary.

•    Try to avoid getting pregnant during treatment with tenofovir. You must use an

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effective method of contraception to avoid becoming pregnant.

•    If you become pregnant, or plan to become pregnant, ask your doctor about the potential benefits and risks of your antiretroviral therapy to you and your child.

•    If you have taken tenofovir during your pregnancy, your doctor may request regular blood tests and other diagnostic tests to monitor the development of your child. In children whose mothers took NRTIs during pregnancy, the benefit from the protection against HIVoutweighed the risk of side effects.

•    Do not breast-feed during treatment with tenofovir. This is because the active substance in this medicine passes into human breast milk.

•    If you are a woman with HIV or HBV do not breast-feed, to avoid passing the virus to the baby in breast milk.

Driving and using machines

Tenofovir can cause dizziness. If you feel dizzy while taking tenofovir, do not drive or ride a bicycle and do not use any tools or machines.

Tenofovir 245 mg film-coated tablets contain lactose monohydrate

Tenofovir 245 mg film-coated tablets contain lactose monohydrate. If you have been told by your doctor that you have an intolerance to some sugars, contact your doctor before taking this medicinal product.

3. HOW TO TAKE TENOFOVIR

Always take this medicine exactly as your doctor or pharmacist has told you. Check with your doctor or pharmacist if you are not sure.

The recommended dose is:

•    Adults: One tablet each day with food (for example, a meal or a snack).

•    Adolescents aged 12 to less than 18 years who weigh at least 35 kg: one tablet each day with food (for example, a meal or a snack).

If you have particular difficulty swallowing, you can use the tip of a spoon to crush the tablet. Then mix the powder with about 100 ml (half a glass) of water, orange juice or grape juice and drink immediately.

Always take the dose recommended by your doctor. This is to make sure that your medicine is fully effective, and to reduce the risk of developing resistance to the treatment. Do not change the dose unless your doctor tells you to.

If you are an adult and have problems with your kidneys, your doctor may advise you to take tenofovir less frequently.

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If you have HBV your doctor may offer you an HIV test to see if you have both HBV and HIV. Refer to the patient information leaflets of the other antiretrovirals for guidance on how to take those medicines.

If you take more tenofovir than you should

If you accidentally take too many tenofovir tablets, you may be at increased risk of experiencing possible side effects with this medicine (see section 4, Possible side effects). Contact your doctor or nearest emergency department for advice. Keep the tablet bottle with you so that you can easily describe what you have taken.

If you forget to take tenofovir

It is important not to miss a dose of tenofovir.

If you miss a dose of tenofovir, work out how long since you should have taken it.

•    If it is less than 12 hours after it is usually taken, take it as soon as you can, and then take your next dose at its regular time.

•    If it is more than 12 hours since you should have taken it, forget about the missed dose. Wait and take the next dose at the regular time. Do not take a double dose to make up for a forgotten tablet.

If you throw up less than 1 hour after taking tenofovir, take another tablet. You do not need to take another tablet if you were sick more than 1 hour after taking tenofovir.

If you stop taking tenofovir

•    Do not stop taking tenofovir without your doctor’s advice. Stopping treatment with tenofovir may reduce the effectiveness of the treatment recommended by your doctor.

•    If you have hepatitis B or HIV and hepatitis B together (co-infection), it is very important not to stop your tenofovir treatment without talking to your doctor first. Some patients have had blood tests or symptoms indicating that their hepatitis has got worse after stopping tenofovir. You may require blood tests for several months after stopping treatment. In some patients with advanced liver disease or cirrhosis, stopping treatment is not recommended as this may lead to worsening of your hepatitis.

•    Talk to your doctor before you stop taking tenofovir for any reason, particularly if you are experiencing any side effects or you have another illness.

•    Tell your doctor immediately about new or unusual symptoms after you stop treatment, particularly symptoms you associate with hepatitis B infection.

•    Contact your doctor before you restart taking tenofovir tablets.

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

4. POSSIBLE SIDE EFFECTS

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During HIV therapy there may be an increase in weight and in levels of blood lipids and glucose. This is partly linked to restored health and life style, and in the case of blood lipids sometimes to the HIV medicines themselves. Your doctor will test for these changes.

Like all medicines, this medicine can cause side effects, although not everybody gets them. Possible serious side effects: tell your doctor immediately

Lactic acidosis (excess lactic acid in the blood) is a rare (may affect up to 1 in 1,000 people) but serious side effect that can be fatal. The following side effects may be signs of lactic acidosis:

•    deep, rapid breathing

•    drowsiness

•    feeling sick (nausea), being sick (vomiting) and stomach pain

If you think that you may have lactic acidosis, contact your doctor immediately.

Other possible serious side effects

The following side effects are uncommon (may affect up to 1 in 100 people):

•    pain in the tummy (abdomen) caused by inflammation of the pancreas

•    damage to kidney tubule cells

The following side effects are rare (may affect up to 1 in 1,000 people):

•    inflammation of the kidney, passing a lot of urine and feeling thirsty

•    changes to your urine and back pain caused by kidney problems, including kidney failure

•    softening of the bones (with bone pain and sometimes resulting in fractures), which may occur due to damage to kidney tubule cells

•    fatty liver

If you think that you may have any of these serious side effects, talk to your doctor. Most frequent side effects

The following side effects are very common (may affect more than 1 in 10 people):

•    diarrhoea, being sick (vomiting), feeling sick (nausea), dizziness, rash, feeling weak

Tests may also show:

•    decreases in phosphate in the blood

Other possible side effects

The following side effects are common (may affect up to 1 in 10 people):

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•    headache, stomach pain, feeling tired, feeling bloated, flatulence

Tests may also show:

•    liver problems

The following side effects are uncommon (may affect up to 1 in 100 people):

•    breakdown of muscle, muscle pain or weakness

Tests may also show:

•    decreases in potassium in the blood

•    increased creatinine    in your blood

•    pancreas problems

The breakdown of muscle, softening of the bones (with bone pain and sometimes resulting in fractures), muscle pain, muscle weakness and decreases in potassium or phosphate in the blood may occur due to damage to kidney tubule cells.

The following side effects are rare (may affect up to 1 in 1,000 people):

•    pain in the tummy (abdomen) caused by inflammation of the liver

•    swelling of the face, lips, tongue or throat

Reporting of side effects

If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via the Yellow Card Scheme at: www.mhra.gov.uk/yellowcard. By reporting side effects, you can help provide more information on the safety of this medicine.

5. HOW TO STORE TENOFOVIR

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 bottle and carton after EXP. The expiry date refers to the last day of that month.

This medicinal product does not require any special storage conditions.

After first opening use the product within 30 days.

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.

6. CONTENTS OF THE PACK AND OTHER INFORMATION

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What Tenofovir 245 mg film-coated tablets contain

The active substance is tenofovir. Each Tenofovir 245 mg film-coated tablet contains 245 mg of tenofovir disoproxil (in the form of 300 mg tenofovir disoproxil fumarate).

The other ingredients are: Lactose monohydrate, Povidone K-25, Croscarmellose sodium, Microcrystalline cellulose (E-460), Magnesium stearate, Hypromellose (E-464), Titanium dioxide (E-171), Triacetin (e-1518), Indigo Carmine Aluminum Lake (E-132).

What Tenofovir 245 mg film-coated tablets look like and contents of the pack

Tenofovir 245 mg film-coated tablets are light blue, oblong biconvex-shaped, film-coated tablets.

Contents of the pack:

Outer cartons contain 1 x 30 film-coated tablets in a bottle or 3 x 10 film-coated tablets in blisters.

Not all pack sizes may be marketed.

Marketing Authorisation Holder and Manufacturer Zentiva, One Onslow Street, Guildford, Surrey, GU1 4YS

Manufacturer: ZENTIVA, k.s, U kabelovny 130, Prague 10, Dolm Mecholupy, Zip code 102 37, Czech Republic

This leaflet was last revised in June 2016.

© 2016 Zentiva

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