SUMMARY OF PRODUCT CHARACTERISTICS

1 NAME OF THE MEDICINAL PRODUCT

Tilolec 200/50 mg Tablets

2    QUALITATIVE AND QUANTITATIVE COMPOSITION

Each prolonged-release tablet contains 200 mg levodopa and 50 mg carbidopa (as carbidopa monohydrate).

For a full list of excipients, see section 6.1.

3    PHARMACEUTICAL FORM

Prolonged-release tablets

Appearance : Orange-brown, round, biconvex tablets

4 CLINICAL PARTICULARS

4.1 Therapeutic indications

Idiopathic Parkinson’s disease, in particular to shorten the ‘off’ period in patients who have previously been treated with immediate-release levodopa/decarboxylase inhibitors or with just levodopa and who showed motor fluctuations.

Experience with Levodopa/Carbidopa retard is limited in patients, who have not been previously treated with levodopa.

4.2. Posology and method of administration

The daily dose of Levodopa/Carbidopa should be carefully determined. Patients should be monitored closely during the period of dose adjustment, especially with regard to the occurrence or exacerbation of nausea and abnormal involuntary movements, such as dyskinesia, chorea and dystonia. Blepharospasm could be an early sign of overdosing.

The pharmacokinetic properties of the prolonged-release tablets may be altered if the tablets are broken or chewed. Therefore the tablets must be swallowed whole.

Most other medicines, used to treat Parkinson's Disease, except for levodopa, can be continued during administration of Levodopa/Carbidopa retard. However their dosage may need to be adjusted.

Sudden withdrawal of Levodopa therapy should be avoided wherever possible.

Since carbidopa prevents the reversal of levodopa effects caused by pyridoxine, Levodopa/Carbidopa retard can be administered to patients who receive supplemental pyridoxine (Vitamin B6).

• Starting dose

Patients who have never before received Levodopa therapy Levodopa/Carbidopa retard 100/25 mg is designed for use in patients, who have not previously had levodopa treatment or to aid titration in patients who receive Levodopa/Carbidopa retard 200/50 mg. The recommended starting dose is one tablet 100/25 mg two times per day.

In patients who need more levodopa a daily dose of three to four tablets of Levodopa/Carbidopa retard 100/25 mg is usually well tolerated.

For LevodopaCarbidopa retard 200/50 mg the recommended starting dose is two times per day one tablet.

The starting dose should not be higher than 600 mg levodopa per day and the doses should be administered with minimum intervals six hours.

Dose adjustments should occur with intervals of at least two to four days.

Depending of the severity of the disease, six months of treatment may be required to achieve optimal disease control.

A guide to substitution for patients who are treated with the immediate-release combination of levodopa and decarboxylase inhibitor Transferring to Levodopa/Carbidopa retard should initially occur in a dose that supplies at most about 10% more levodopa per day when higher doses are indicated (more than 900 mg daily). Levodopa and decarboxylase inhibitor should be discontinued at least 12 hours before the administration of Levodopa/Carbidopa retard. The dose interval should be prolonged by 30% to 50% at intervals of ranging from 4-12 hours. If the divided doses are not equal it is recommended to administer the lowest dose at the end of the day. The dose should be adjusted depending on the clinical reaction, as indicated below in Dose Adjustment. It could be that doses which supply maximally 30% more levodopa per day are necessary.

A guide for the substitution of Levodopa/Carbidopa prolonged-release treatment for immediate-release levodopa/carbidopa combinations is shown in the table below:

Levodopa/carbidopa	Levodopa/Carbidopa retard 100/25 mg
Daily dose Levodopa	Daily dose Levodopa	Dose schedule

(mg)	(mg)
100-200	200	1 tablet, twice daily
300-400	400	4 tablets divided in 3 or more doses
Levodopa/carbidopa	Levodopa/Carbidopa retard 200/50 mg
Daily dose Levodopa (mg)	Daily dose Levodopa (mg)	Dose schedule
300-400	400	1 tablet, twice daily
500-600	600	1 tablet, 3 times per day
700-800	800	4 tablets1
900-1000	1000	5 tablets1
1100-1200	1200	6 tablets1
1300-1400	1400	7 tablets1
1500-1600	1600	8 tablets1

*divided in 3 or more doses

Patients who are currently treated with just levodopaLevodopa must be discontinued at least twelve hours before therapy with Levodopa/Carbidopa retard tablet is started.

In patients with a mild to moderate form of the disease the recommended starting dose is 200 mg Levodopa/50 mg Carbidopa twice daily.

•    Dose Adjustment

After the treatment is established the doses and the dose frequency can be increased or decreased depending on the therapeutic response. Most patients are adequately treated with 400 mg Levodopa/100 mg Carbidopa to 1600 mg Levodopa/400 mg Carbidopa per day, administered in divided doses at intervals ranging from four to twelve hours during the waking day. Higher doses (up to 2400 mg Levodopa/600 mg Carbidopa) and shorter intervals (less than four hours) have been used, but are generally not recommended.

When doses of Levodopa/Carbidopa retard are given at intervals of less than four hours or if the divided doses are not equal, it is recommended to administer the lowest dose at the end of the day.

The effect of the first morning dose can be delayed in some patients for up to one hour compared to the usual reaction of the first morning dose of immediate-release Levodopa/Carbidopa.

Adjustments of the dosage should occur in intervals of at least three days.

•    Maintenance dose

Because Parkinson’s Disease is progressive, periodic clinical check-ups are recommended and an adjustment of the dose schedule of Levodopa/Carbidopa retard may be needed.

Anti-cholinergics, dopamine agonists and amantadine can be administered concomitantly with Levodopa/Carbidopa retard. It might be necessary to adjust the dose Levodopa/Carbidopa retard when these medications are added to an ongoing treatment of Levodopa/Carbidopa retard.

•    Interruption of the therapy

Patients should be carefully observed in case of a sudden reduction of the dose or if it is necessary to discontinue treatment with Levodopa/Carbidopa retard, particularly in the patient who is receiving anti-psychotics. (see section 4.4)

If an anaesthetic is necessary, the administration of Levodopa/Carbidopa retard can be continued as long as the patient is allowed to take oral medications. In case of a temporary interruption of the therapy, the usual dose can be administered as soon as the patient is able to take the oral medications.

•    Use in Children

The safety in patients under 18 years of age has not been established

•    Use in the elderly

There is a wide experience in the use of combinations of levodopa and carbidopa in elderly patients. The recommendations set out above reflect the clinical data derived from this experience.

•    Use in renal/hepatic impairment

No dose adjustment is necessary.

4.3. Contraindications

Levodopa/Carbidopa retard is contraindicated in:

-    patients with a hypersensitivity to levodopa, carbidopa or any of the excipients

-    patients with narrow-angle glaucoma

-    patients with severe heart failure

-    severe cardiac arrhythmia

-    acute stroke

Levodopa/Carbidopa retard should not be given, when administration of a sympathomimetics is contraindicated.

Non-selective mono-amino-oxydase (MAO) inhibitors and selective MAO type A inhibitors are contraindicated for concomitant use with Levodopa/Carbidopa retard. The administration of these inhibitors should have been discontinued at least two weeks before starting the treatment with Levodopa/Carbidopa retard. Levodopa/Carbidopa retard can be taken concomitantly with the recommended dose of an MAO inhibitor, which is selective for MAO type B (for instance selegiline-HCl) (see section 4.5).

4.4 Special warnings and precautions for use

In patients who are treated with just levodopa, treatment should have been discontinued for at 12 hours before starting with the therapy of Levodopa/Carbidopa retard.

Based on the pharmacokinetic profile of Levodopa/Carbidopa retard the onset of effect in patients with early morning dyskinesia may be slower than with immediate-release levodopa/carbidopa. The incidence of dyskinesia is greater during treatment with Levodopa/Carbidopa retard in patients with an advanced stage of motor fluctuations than it is with an immediate-release tablet with a combination levodopa/carbidopa (16.5% versus 12.2%).

Dyskinesia can occur in patients who previously were treated with just levodopa, because carbidopa makes it possible for more levodopa to reach the brain, which causes more dopamine to be formed. The occurrence of dyskinesia may make it necessary to reduce the dose (see section 4.8).

Levodopa/Carbidopa retard can, just like levodopa, cause involuntary movements and mental disturbances. Patients with a history of severe involuntary movements or psychotic episodes when treated with levodopa alone or with carbidopa-levodopa combination should be observed carefully when Levodopa/Carbidopa retard is substituted. It is suspected that these reactions are the result of the increased dopamine in the brain after administration of levodopa, and the use of Levodopa/Carbidopa retard can cause a recurrence. It may be necessary to reduce the dose. All patients should be observed carefully for the development of depression with concomitant suicidal tendencies. Patients with past or current psychosis should be treated with caution.

Levodopa/Carbidopa retard should be discontinued when there is deterioration of any pre-exiting psychotic condition.

Levodopa has been associated with somnolence and episodes of sudden sleep onset. Sudden onset of sleep during daily activities, in some cases without awareness or warning signs, has been reported very rarely. Patients must be informed of this and advised to exercise caution while driving or operating machines during treatment with levodopa. Patients who have experienced somnolence or an episode of sudden sleep onset must refrain from driving or operating machines. A reduction of dosage or termination of therapy may be considered.

Levodopa/Carbidopa retard should be administered cautiously to patients with severe cardiovascular or pulmonary disease, bronchial asthma, renal, hepatic or endocrine disease or with a history of peptic ulcer disease, haematemesis or of convulsions.

Levodopa/Carbidopa should be administered cautiously to patients who have had a recent myocardial infarction, who have residual atrial, nodal or ventricular arrhythmia. In such patients cardiac function should be monitored with particular care during the period of initial dosage administration and titration.

Patients with chronic wide-angle glaucoma may be treated cautiously with Levodopa/Carbidopa retard provided the intraocular pressure is well controlled and the patient is monitored carefully for changes in eye pressure during the therapy.

A symptom complex resembling the neuroleptic malignant syndrome, including muscular rigidity, increased body temperature, mental changes and increased serum creatine phosphokinase, has been reported when anti Parkinsonian medication was

withdrawn abruptly. Therefore patients should be carefully observed when the dose of carbidopa/levodopa combinations is abruptly reduced or discontinued, especially if the patient is receiving anti-psychotics.

The use of Levodopa/Carbidopa retard is not advised during treatment for pharmacogenic extra-pyramidal reactions or Huntingtons chorea.

Periodic evaluation of hepatic, haematopoietic, cardiovascular and renal function are recommended during extended therapy.

The safety and efficacy of Levodopa/Carbidopa retard has not been determined in infants and children and use in patients under the age of eighteen is not advised.

Impulse control disorders

Patients should be regularly monitored for the development of impulse control disorders. Patients and carers should be made aware that behavioural symptoms of impulse control disorders including pathological gambling, increased libido, hypersexuality, compulsive spending or buying, binge eating and compulsive eatingcan occur in patients treated with dopamine agonists and/or other dopaminergic treatments containing levodopa, including Levodopa/Carbidopa retard. Review of treatment is recommended if such symptoms develop.

Patients with Parkinson’s disease show a possible increased risk of melanoma but no confirmed association with levodopa therapy has been established.

Therefore caution should be exercised during treatment.

Laboratory tests

Carbidopa/levodopa preparations have given rise to abnormalities in several laboratory tests and these can also occur with Levodopa/Carbidopa retard. These include elevations of liver function tests, such as alkaline phosphatase, SGOT, SGPT, lactic acid dehydrogenase, bilirubin, blood urea nitrogen and a positive Coombs test.

Decreased haemoglobin and haematocrit, elevated serum glucose and white blood cells, bacteria and blood in the urine have also been reported with Levodopa/Carbidopa.

When a test strip is used to determine ketonuria, carbidopa/levodopa preparations can show a false positive result for urinary ketone bodies. This reaction is not altered by boiling the urine sample. False negative results can also occur in the examination of glycosuria with the use of glucose oxidase methods.

4.5. Interaction with other medicinal products and other forms of interaction

Caution is needed in concomitant administration of Levodopa/Carbidopa retard with the following medicines:

Anti-hypertensives

Symptomatic orthostatic dysregulation has occurred when levodopa is added with a decarboxylase inhibitor to certain antihypertensives. Dose adjustment of antihypertensives may be necessary during the titration phase of treatment with Levodopa/Carbidopa retard.

Anti-depressants

There have been rare reports of adverse reactions, including hypertension and dyskinesia, resulting from the concomitant administration of tricyclic antidepressants and carbidopa/levodopa preparations (see section 4.3 for patients receiving mono-amine oxidase inhibitors).

Anti-cholinergics

Anti-cholinergics may act synergistically with levodopa to decrease tremor. However combined use may exacerbate abnormal involuntary movements. Anticholinergics may decrease the effects of levodopa by delaying its absorption. An adjustment of the dose of Levodopa/Carbidopa may be needed.

Other medicines

Dopamine-D2-receptor antagonists (for instance phenothiazines, butyrophenons, risperidone), benzodiazepines and isoniazide can reduce the therapeutic effect of levodopa. The beneficial effects of levodopa in Parkinson’s disease may be reduced by phenytoin and papaverine. Patients taking these medications together with Levodopa/Carbidopa retard, should be observed carefully for loss of therapeutic response.

Concomitant use of selegiline and levodopa-carbidopa may be associated with severe orthostatic hypotension (see section 4.3).

COMT inhibitors (tolcapone, entacapone)

Concomitant use of COMT (Catechol-O-Methyl Transferase) inhibitors and Levodopa/Carbidopa retard can increase the bioavailability of levodopa. The dose of Levodopa/Carbidopa may need adjusting.

Amantadine has a synergistic effect with levodopa and may increase levodopa-related side events. An adjustment of the dose of Levodopa/Carbidopa may be needed.

Metoclopramide increases gastric emptying and may increase the bioavailability of Levodopa/Carbidopa retard.

Sympathomimetics may increase cardiovascular side events related to levodopa

Concomitant use of ferrous sulphate and levodopa-carbidopa can lead to a reduction in the bioavailability of levodopa.

As levodopa competes with certain amino acids, the absorption of levodopa can be impaired in some patients who are on a protein rich diet.

The effect of administration of antacids and Levodopa/Carbidopa retard on the bioavailability of levodopa has not been studied.

4.6. Pregnancy and lactation

Pregnancy

Insufficient data on the use of levodopa/carbidopa in pregnant women. The results of animal studies have shown reproduction toxicity (see section 5.3). The potential human risk to the embryo or the foetus is not known. Levodopa/Carbidopa retard should not be used during pregnancy. Any woman of childbearing potential who is receiving Levodopa/Carbidopa retard must practise effective contraception.

Lactation

Levodopa is secreted in breast milk in significant quantities. While using Levodopa/Carbidopa retard women should not breast feed.

4.7. Effects on ability to drive and use machines

There are no known data on the effect of this product on the ability to drive. Certain side effects such as sleepiness and dizziness may influence the ability to drive or use machines.

Patients being treated with levodopa and presenting with somnolence or an episode of sudden sleep onset must be advised to refrain from driving or engaging in activities where impaired alertness may put themselves or others at risk of serious injury or death (e.g. operating machines) until such recurrent episodes and somnolence have resolved (see also section 4.4).

4.8 Undesirable effects

During controlled clinical studies in patients with moderate to severe motor fluctuations Levodopa/Carbidopa retard caused no side effects which were unique to the modified release formulation.

Blood and lymphatic system disorders

Rare (> 1/10,000 to < 1/1,000): Leukopenia, haemolytic and non-haemolytic anaemia, thrombocytopenia

Very rare (< 1/10,000): Agranulocytosis

Metabolism and nutrition disorders Common 1/100 to < 1/10): Anorexia

Uncommon ^ 1/1,000 to < 1/100): Loss of weight, increased weight Psychiatric disorders

Common ^ 1/100 to < 1/10): Hallucinations, confusion, dizziness, nightmares,

sleepiness, fatigue, sleeplessness, depression with very rare suicide attempts, euphoria,

dementia, psychotic episodes, feeling of stimulation

Rare (> 1/10,000 to < 1/1,000): Agitation, fear, reduced thinking capacity,

disorientation, headache, increased libido, numbness and convulsions

Unknown frequency: Impulse control disorders

Pathological gambling, increased libido, hypersexuality, compulsive spending or buying, binge eating and compulsive eating can occur in patients treated with dopamine agonists and/or other dopaminergic treatments containing levodopa including Levodopa/Carbidopa retard (see section 4.4).

Nervous system disorders

Common ^ 1/100 to < 1/10): Dyskinesia (a higher frequency of dyskinesia was seen with Levodopa/Carbidopa retard than with the immediate-release formulation of Levodopa/Carbidopa), chorea, dystonia, extrapyramidal and movement disorders, the “on-off’-appearance

Bradykinesia (on-off episodes) may appear some months to years after the beginning of treatment with levodopa and is probably related to the progression of the disease. The adaptation of dose schedule and dose intervals may be required.

Uncommon ^ 1/1,000 to < 1/100): Ataxia, increased tremor of the hands

Rare (> 1/10,000 to < 1/1,000): Malignant neuroleptic syndrome, paraesthesia, falling,

walking defects, trismus

Levodopa/carbidopa is associated with somnolence and has been associated very rarely with excessive daytime somnolence and sudden sleep onset episodes.

Eye disorders

Rare (> 1/10,000 to < 1/1,000): Hazy vision, blepharospasm, activation of a latent Horner’s syndrome, double vision, dilated pupils, and oculogyric crises

Blepharospasm can be an early sign of overdosage.

Cardiac disorders

Common ^ 1/100 to < 1/10): Palpitations, irregular heartbeat Vascular disorders

Common ^ 1/100 to < 1/10): Orthostatic hypotension, inclination to faint, syncope Uncommon 1/1,000 to < 1/100): Hypertension Rare ^ 1/10,000 to < 1/1,000): Phlebitis

Respiratory, thoracic and mediastinal disorders

Uncommon ^ 1/1,000 to < 1/100): Hoarseness, chest pain

Rare (> 1/10,000 to < 1/1,000): Dyspnoea, abnormal breathing pattern

Gastrointestinal disorders

Common ^ 1/100 to < 1/10): Nausea, vomiting, dry mouth, bitter taste Uncommon ^ 1/1,000 to < 1/100): Constipation, diarrhoea, sialorrhoea, dysphagia, flatulence

Rare ^ 1/10,000 to < 1/1,000): Dyspepsia, gastrointestinal pain, dark saliva, bruxism, hiccups, gastrointestinal bleeding, burning sensation of the tongue, duodenal ulceration

Skin and subcutaneous tissue disorders Uncommon fe. 1/1,000 to < 1/100): Oedema

Rare ^ 1/10,000 to < 1/1,000): Angioedema, urticaria, pruritus, facial redness, hair loss, exanthema, increased perspiration, dark perspiration fluid and Schonlein-Henoch purpura

Musculoskeletal, connective tissue and bone disorders Uncommon ^ 1/1,000 to < 1/100): Muscle spasms

Renal and urinary disorders

Uncommon fe. 1/1,000 to < 1/100): Dark urine

General disorders and administration site conditions Uncommon ^ 1/1,000 to < 1/100): Weakness, malaise, flare ups

4.9. Overdose

The treatment of an acute overdose of Levodopa/Carbidopa retard is in general the same as that of an acute overdose of levodopa. However, pyridoxine has no effect on the reversal of the action of Levodopa/Carbidopa retard. Electrocardiographic monitoring should be used and the patient observed carefully for the development of cardiac arrhythmias. If necessary an appropriate antiarrhythmic therapy should be given.

The possibility that the patient took other medications together with Levodopa/Carbidopa retard should be taken into consideration. To date experience with dialysis has not been reported. Therefore its value in the treatment of overdose is unknown.

5 PHARMACOLOGICAL PROPERTIES

5.1 Pharmacodynamic properties

Pharmaco-therapeutic group: levodopa: dopaminergics; carbidopa: dopadecarboxylase inhibitor ATC code: N04B A02

Levodopa/Carbidopa retard is a combination of carbidopa, an aromatic amino acid decarboxylase inhibitor, and levodopa, the metabolic precursor of dopamine, in the form of a prolonged-release tablet on a polymer base for use in the treatment of Parkinson’s Disease.

Levodopa/Carbidopa retard is particularly useful in the reduction of the “off’ period in patients previously treated with the immediate-release levodopa/decarboxylase inhibitor combination who have had dyskinesia and motor fluctuations.

Patients with Parkinson’s Disease who were treated with preparations that contained levodopa, can develop motor fluctuations which are characterized by the wearing off effect of a dose, dyskinesia in the peak dose and akinesia. The advanced form of motor fluctuations (“on-off’ phenomenon) is characterized by unpredictable fluctuations from mobility to immobility. Although the causes of the motor fluctuations are not completely clear, it has been shown that they can be reduced by treatment schedules that provide a stable plasma concentration of levodopa.

Levodopa relieves the symptoms of Parkinson’s disease by being decarboxylated to dopamine in the brain. Carbidopa, which does not pass the blood/brain barrier, inhibits only the extra-cerebral decarboxylation of levodopa, making more levodopa available for transport to the brain and subsequent conversion to dopamine. Therefore it is normally not necessary to administer high doses of levodopa at frequent intervals. Gastro-intestinal and cardiovascular side-effects, in particular those which can be attributed to the dopamine formed in the extra-cerebral tissues, are avoided totally or partially by the reduced dose.

During clinical trials patients with motor fluctuations experienced a shorter “off” period with levodopa and carbidopa in retard form in comparison with an immediate-release tablet of a combination of levodopa and carbidopa. The reduction of the “off’ time is rather small (about 10%) and the incidence of dyskinesia was slightly increased after administration of levodopa+carbidopa retard compared to treatment with an immediate-release tablet of a combination of levodopa and carbidopa. In patients without motor fluctuations levodopa+carbidopa retard provided, under controlled circumstances, the same therapeutic advantage in less frequent doses than the immediate-release tablet with a combination of levodopa and carbidopa. Improvement of other symptoms of Parkinson’s Disease did not generally take place.

5.2. Pharmacokinetic properties

Absorption

The pharmacokinetics of levodopa after administration of Levodopa+Carbidopa 200+50 mg in retard form compared to an immediate release Levodopa+Carbidopa 200+50 mg tablet has been studied in young healthy volunteers. After administration of Levodopa+Carbidopa 200+50 mg retard it took approximately two hours before maximal levodopa plasma levels were reached in comparison to 0.75 hours for the immediate-release tablet. The mean maximal levodopa plasma levels were reduced 60% in Levodopa+Carbidopa 200+50 mg retard compared in immediate-release tablets. The absorption of levodopa after the administration of Levodopa+Carbidopa 200+50 mg retard occurred continuously for four to six hours. In these studies the levodopa plasma concentrations fluctuated within closer margins than with the immediate-release tablet of levodopa and carbidopa. As the bio-availability of levodopa from Levodopa+Carbidopa 200+50 mg retard in comparison to an immediate-release tablet with a combination of levodopa and carbidopa is approximately 70%, the daily dose of levodopa in the modified release formulation should as a rule be higher than that of the immediate-release product.

The mean maximal plasma concentration of levodopa after the administration of a single dose Levodopa+Carbidopa 100+25 mg retard was approximately 70% of Levodopa+Carbidopa 200+50 mg retard.

The mean time to reach the maximal plasma concentrations was reduced a little with Levodopa+Carbidopa 100+25 mg retard over Levodopa+Carbidopa 200+50 mg retard.

The pharmacokinetics of levodopa after administration of Levodopa+Carbidopa retard was also studied in patients with Parkinson’s Disease. Regular twice daily administering of Levodopa+Carbidopa 100+25 mg retard (varying from 50 mg carbidopa and 200 mg levodopa to 150 mg carbidopa and 600 mg levodopa) for three months showed no accumulation of levodopa in the plasma.

Intake of food had no influence on the absorption of levodopa. With regard to carbidopa the simultaneous intake of food resulted in a 50% AUC reduction and a 40% C_max reduction. The reduced plasma levels of carbidopa have no clinical relevance.

Distribution

Levodopa is widely distributed to most body tissues, but not to the central nervous because of extensive metabolism in the periphery. Levodopa is not bound to proteins.

Levodopa crosses the blood-brain barrier by an active but saturable transport system for large neutral amino acids.

Carbidopa does not cross the blood brain barrier. Both Levodopa and carbidopa cross the placenta and are excreted in breast milk.

Metabolism and elimination

In the presence of carbidopa, levodopa is mainly metabolised to aminoacids and, to a less extent, to catecholamine derivates. All metabolites are excreted renally.

Following an oral dose approximately 50% is recorded in the urine.

5.3 Preclinical safety data

Animal studies with regard to the pharmacological safety and toxicity after repeated administration, mutagenicity studies and carcinogenicity investigations showed no particular risk for humans. In reproductive toxicity studies both levodopa and the combination of carbidopa/levodopa have caused visceral and skeletal malformations in rabbits.

6 PHARMACEUTICAL PARTICULARS

6.1 List of excipients

Hypromellose Colloidal anhydrous silica Fumaric acid Sodium stearyl fumarate Macrogol 6000

Quinoline yellow (E104) Iron oxide yellow (E172) Iron oxide red (E172) Titaniumdioxide (E171)

6.2 Incompatibilities

Not applicable

6.3. Shelf life

4 years.

6.4    Special precautions for storage

This medicinal product does not require any special storage conditions.

6.5    Nature and contents of container

Blister packs (aluminium/aluminium)

Package sizes

30, 50, 60, 100 and 200 prolonged-release tablets Not all pack sizes may be marketed

6.6    Special precautions for disposal

No special requirements

7    MARKETING AUTHORISATION HOLDER

Tillomed Laboratories Ltd 3 Howard Road Eaton Socon St Neots

CambsPE193ET United Kingdom

8    MARKETING AUTHORISATION NUMBER(S)

PL 11311/0194

9    DATE OF FIRST AUTHORISATION/RENEWAL OF THE AUTHORISATION 30/05/2012

DATE OF REVISION OF THE TEXT

30/05/2012

1

Addition of other anti-Parkinson medications