Armunia, filmomhulde tabletten 0,02 mg/3 mg

ARMUNIA is a contraceptive pill and is used to prevent pregnancy.

Each tablet contains a small amount of two different female hormones, namely drospirenone and ethinylestradiol.

Contraceptive pills that contain two hormones are called “combination” pills.

• • When you should not use ARMUNIA
  • When to take special care with ARMUNIA
  • ARMUNIA and venous and arterial blood clots
  • ARMUNIA and cancer
  • Bleeding between periods
  • What to do if no bleeding occurs during the gap week
  • ARMUNIA and using other medicines
  • Taking ARMUNIA with food and drink
  • Laboratory tests
  • Pregnancy
  • Breast-feeding
  • Driving and using machines
  • Important information about some of the ingredients of ARMUNIA

General notes

Before you can begin taking ARMUNIA, your doctor will ask you some questions about your personal health history and that of your close relatives. The doctor will also measure your blood pressure, and, depending upon your personal situation, may also carry out some other tests.

In this leaflet, several situations are described where you should stop using ARMUNIA, or where the reliability of ARMUNIA may be decreased. In such situations you should either not have sex or you should take extra non-hormonal contraceptive precautions, e.g. use a condom or another barrier method. Do not use rhythm or temperature methods. These methods can be unreliable because ARMUNIA alters the monthly changes of body temperature and of the cervical mucus.

ARMUNIA, like other hormonal contraceptives, does not protect against HIV infection (AIDS) or any other sexually transmitted disease.

When you should not use ARMUNIA

Do not take ARMUNIA:

• if you have (or have ever had) a blood clot in a blood vessel of the leg (thrombosis), lung (pulmonary embolism) or other organs
• if you have (or have ever had) a heart attack or stroke
• if you have (or have ever had) a disease that can be an indicator of a heart attack in the future (for example, angina pectoris which causes severe pain in the chest) or of a stroke (for example, a passing slight stroke with no residual effects)
• if you have a disease that may increase the risk of a clot in the arteries. This applies to the following diseases:
  • diabetes with damaged blood vessels
  • very high blood pressure
  • a very high level of fat in the blood (cholesterol or triglycerides)
• if you have a disturbance of blood clotting (for example, protein C deficiency)
• if you have (or have ever had) a certain form of migraine (with so-called focal neurological symptoms)
• if you have (or have ever had) an inflammation of the pancreas (pancreatitis)
• if you have (or have ever had) a liver disease and your liver function is still not normal
• if your kidneys are not working well (renal failure)
• if you have (or have ever had) a tumour in the liver

• if you have (or have ever had) or if you are suspected of having breast cancer or cancer of the genital organs
• if you have any unexplained bleeding from the vagina
• if you are allergic to ethinylestradiol or drospirenone, or any of the other ingredients of ARMUNIA. This may cause itching, rash or swelling.

When to take special care with ARMUNIA

In some situations you need to take special care while using ARMUNIA or any other combination pill, and your doctor may need to examine you regularly. If any of the following conditions applies to you, tell your doctor before starting to use ARMUNIA. Also, if any of the following applies or if any of the conditions develops or worsens while you are using ARMUNIA consult your doctor:

• if a close relative has or has ever had breast cancer
• if you have a disease of the liver or the gallbladder
• if you have diabetes
• if you have depression
• if you have Crohn's disease or inflammatory bowel disease (ulcerative colitis)
• if you have a blood disease called HUS (haemolytic uraemic syndrome) which causes kidney damage
• if you have a blood disease called sickle cell anaemia
• if you have epilepsy (see "ARMUNIA and using other medicines")
• if you have a disease of the immune system called SLE (systemic lupus erythematosus)
• if you have a disease that first appeared during pregnancy or earlier use of sex hormones (for example, hearing loss, a blood disease called porphyria, skin rash with blisters during pregnancy (gestational herpes), a nerve disease causing sudden movements of the body (Sydenham's chorea))
• if you have or have ever had chloasma (a discoloration of the skin especially of the face or neck known as “pregnancy patches”). If so, avoid direct sunlight or ultraviolet light.
• if you have hereditary angioedema, products containing oestrogens may cause or worsen symptoms. You should see your doctor immediately if you experience symptoms of angioedema such as swollen face, tongue and/or throat and/or difficulty swallowing or hives together with difficulty breathing.

ARMUNIA and venous and arterial blood clots

The use of any combination pill, including ARMUNIA, increases a woman’s risk of developing a venous blood clot (venous thrombosis) compared with women who do not take any contraceptive pill.

The risk of venous blood clots in users of combination pills increases:

• with increasing age
• if you are overweight
• if one of your close relatives ever had a blood clot in the leg, lung (pulmonary embolism), or other organ at a young age
• if you have to have surgery, if you have had a serious accident or if you are immobilised for a long time. It is important to tell your doctor that you are using ARMUNIA as you may have to stop taking it. Your doctor will tell you when to start again. This is usually about two weeks after you are back on your feet.

Your chances of having a blood clot are increased by taking the Pill.

• - Of 100,000 women who are not on the Pill and not pregnant, about 5-10 may have a blood clot in a year.
• - Of 100,000 women taking a Pill like ARMUNIA, 30-40 may have a blood clot in a year, the exact number is unknown.
• - Of 100,000 women who are pregnant, around 60 may have a blood clot in a year.

A blood clot in the veins may travel to the lungs and may block blood vessels (called a lung embolus). Formation of blood clots in the veins may be fatal in 1-2% of cases.

The level of risk may vary according to the type of pill you take. Discuss with your doctor the available options.

The use of combination pills has been connected with an increase of the risk of an arterial blood clot (arterial thrombosis), for example, in the blood vessels of the heart (heart attack) or the brain (stroke).

The risk of an arterial blood clot in users of combination pills increases:

• if you smoke. You are strongly advised to stop smoking when you use ARMUNIA, especially if you are older than 35 years.
• if the fat content of your blood is increased (cholesterol or triglycerides)
• if you are overweight
• if one of your close relatives ever had a heart attack or stroke at a young age
• if you have high blood pressure
• if you suffer from migraine
• if you have a problem with your heart (valve disorder, a disturbance of the cardiac rhythm)

Stop taking ARMUNIA and contact your doctor immediately if you notice possible signs of a blood clot, such as:

• severe pain and/or swelling in one of your legs
• sudden severe pain in the chest which may reach the left arm
• sudden breathlessness
• sudden cough without an obvious cause
• any unusual, severe or long-lasting headache or worsening of migraine
• partial or complete blindness or double vision
• difficulty in speaking or inability to speak
• giddiness or fainting
• weakness, strange feeling, or numbness in any part of the body

ARMUNIA and cancer

Breast cancer has been observed slightly more often in women using combination pills, but it is not known whether this is caused by the treatment. For example, it may be that more tumours are detected in women on combination pills because they are examined by their doctor more often. The occurrence of breast tumours becomes gradually less after stopping the combination hormonal contraceptives. It is important to regularly check your breasts and you should contact your doctor if you feel any lump.

In rare cases, benign liver tumours, and in even fewer cases malignant liver tumours have been reported in pill users. Contact your doctor if you have unusually severe abdominal pain.

Bleeding between periods

During the first few months that you are taking ARMUNIA you may have unexpected bleeding (bleeding outside the gap week). If this bleeding occurs for more than a few months, or if it begins after some months, your doctor must find out what is wrong.

What to do if no bleeding occurs during the gap week

If you have taken all the tablets correctly, have not had vomiting or severe diarrhoea and you have not taken any other medicines, it is highly unlikely that you are pregnant.

If the expected bleeding does not happen twice in succession, you may be pregnant. Contact your doctor immediately. Do not start the next strip until you are sure that you are not pregnant.

ARMUNIA and using other medicines

Always tell your doctor which medicines or herbal products you are already using. Also tell any other doctor or dentist who prescribes another medicine (or the pharmacist) that you use ARMUNIA. They can tell you if you need to take additional contraceptive precautions (for example condoms) and if so, for how long.

Some medicines can make ARMUNIA less effective in preventing pregnancy, or can cause unexpected bleeding. These include:

• medicines used for the treatment of o epilepsy (e.g. primidone, phenytoin, barbiturates, carbamazepine, oxcarbazepine) o tuberculosis (e.g. rifampicin) o HIV infections (ritonavir, nevirapine) or other infections (antibiotics such as griseofulvin, penicillin, tetracycline) o high blood pressure in the blood vessels in the lungs (bosentan)
• the herbal remedy St John’s wort

ARMUNIA may influence the effect of other medicines, e.g.

• medicines containing ciclosporin
• the anti-epileptic lamotrigine (this could lead to an increased frequency of seizures)

Ask your doctor or pharmacist for advice before taking any medicine.

Taking ARMUNIA with food and drink

ARMUNIA may be taken with or without food, if necessary with a small amount of water.

Laboratory tests

If you need a blood test, tell your doctor or the laboratory staff that you are taking the pill, because hormone contraceptives can affect the results of some tests.

Pregnancy

If you are pregnant, do not take ARMUNIA. If you become pregnant while taking ARMUNIA stop immediately and contact your doctor. If you want to become pregnant, you can stop taking ARMUNIA at any time (see also “If you want to stop taking ARMUNIA”).

Ask your doctor or pharmacist for advice before taking any medicine.

Breast-feeding

Use of ARMUNIA is generally not advisable when a woman is breast-feeding. If you want to take the pill while you are breast-feeding you should contact your doctor.

Ask your doctor or pharmacist for advice before taking any medicine.

Driving and using machines

There is no information suggesting that use of ARMUNIA affects driving or use of machines.

Important information about some of the ingredients of ARMUNIA

ARMUNIA contains lactose.

If you have been told by your doctor that you have an intolerance to some sugars, contact your doctor before taking this medicinal product.

• • When can you start the with the first strip?
  • If you take more ARMUNIA than you should
  • If you forget to take ARMUNIA
  • What to do in the case of vomiting or severe diarrhoea
  • Delaying your period: what you need to know
  • Changing the first day of your period: what you need to know
  • If you want to stop taking ARMUNIA

Take one tablet of ARMUNIA every day, if necessary with a small amount of water. You may take the tablets with or without food, but you should take the tablets every day around the same time.

The strip contains 21 tablets. Next to each tablet is printed the day of the week that it should be taken. If, for example you start on a Wednesday, take a tablet with "WED" next to it. Follow the direction of the arrow on the strip until all 21 tablets have been taken.

Then take no tablets for 7 days. In the course of these 7 tablet-free days (otherwise called a stop or gap week) bleeding should begin. This so-called “withdrawal bleeding”, usually starts on the 2nd or 3rd day of the gap week.

On the 8th day after the last ARMUNIA tablet (that is, after the 7-day gap week), you should start with the following strip, whether your bleeding has stopped or not. This means that you should start every strip on the same day of the week and that the withdrawal bleed should occur on the same days each month.

If you use ARMUNIA in this manner, you are also protected against pregnancy also during the 7 days when you are not taking a tablet.

When can you start with the first strip?

• If you have not used a contraceptive with hormones in the previous month Begin with ARMUNIA on the first day of the cycle (that is the first day of your period). If you start ARMUNIA on the first day of your period you are immediately protected against

pregnancy. You may also begin on day 2-5 of the cycle, but then you must use extra protective measures (for example, a condom) for the first 7 days.

• Changing from a combination hormonal contraceptive, or combination contraceptive vaginal ring or patch You can start ARMUNIA preferably on the day after the last active tablet (the last tablet containing active substances) of your previous pill, but at the latest on the day after the tablet- free days of your previous pill (or after the last inactive tablet of your previous pill). When changing from a combination contraceptive vaginal ring or patch, follow the advice of your doctor.
• Changing from a progestogen-only-method (progestogen-only pill, injection, implant or a progestogen-releasing IUD) You may switch any day from the progestogen-only pill (from an implant or an IUD on the day of its removal, from an injectable when the next injection would be due) but in all of these cases use extra protective measures (for example, a condom) for the first 7 days of tablet-taking.
• After a miscarriage Follow the advice of your doctor.
• After having a baby You can start ARMUNIA between 21 and 28 days after having a baby. If you start later than day 28, use a so-called barrier method (for example, a condom) during the first seven days of ARMUNIA use. If, after having a baby, you have had sex before starting ARMUNIA (again), be sure that you are not pregnant or wait until your next period.
• If you are breast-feeding and want to start ARMUNIA (again) after having a baby Read the section on "Breast-feeding".

Ask your doctor what to do if you are not sure when to start.

If you take more ARMUNIA than you should

There are no reports of serious harmful results of taking too many ARMUNIA tablets.

If you take several tablets at once then you may have symptoms of nausea or vomiting. Young girls may have bleeding from the vagina.

If you have taken too many ARMUNIA tablets, or you discover that a child has taken some, ask your doctor or pharmacist for advice.

If you forget to take ARMUNIA

• If you are less than 12 hours late taking a tablet, the protection against pregnancy is not reduced. Take the tablet as soon as you remember and then take the following tablets again at the usual time.
• If you are more than 12 hours late taking a tablet, the protection against pregnancy may be reduced. The greater the number of tablets that you have forgotten, the greater is the risk of becoming pregnant.

The risk of incomplete protection against pregnancy is greatest if you forget a tablet at the beginning or at the end of the strip. Therefore, you should keep to the following rules (see the diagram below):

• More than one tablet forgotten in this strip Contact your doctor.
• One tablet forgotten in week 1

Take the forgotten tablet as soon as you remember, even if that means that you have to take two tablets at the same time. Continue taking the tablets at the usual time and use extra precautions for the next 7 days, for example, a condom. If you have had sex in the week before forgetting the tablet you may be pregnant. In that case, contact your doctor.

• One tablet forgotten in week 2

Take the forgotten tablet as soon as you remember, even if that means that you have to take two tablets at the same time. Continue taking the tablets at the usual time. The protection against pregnancy is not reduced, and you do not need to take extra precautions.

• One tablet forgotten in week 3

You can choose between two possibilities:

1. Take the forgotten tablet as soon as you remember, even if that means that you have to take two tablets at the same time. Continue taking the tablets at the usual time. Instead of taking the tablet-free period start the next strip. Most likely, you will have a period at the end of the second strip but you may have light or menstruation-like bleeding during the second strip.
2. You can also stop the strip and go directly to the tablet-free period of 7 days (record the day on which you forgot your tablet). If you want to start a new strip on the day you always start, make the tablet-free period less than 7 days.

If you follow one of these two recommendations, you will remain protected against pregnancy.

• If you have forgotten any of the tablets in a strip, and you do not have a bleeding during the first tablet-free period, you may be pregnant. Contact your doctor before you start the next strip.

More than 1 tablet forgotten in 1 strip

Only 1 tablet forgotten

(taken more than 12 hours late)

In week 1

In week 2

In week 3

Ask your doctor for advice

Yes

Had sex in the previous week before forgetting?

No

• Take the forgotten tablet
• Use a barrier method (condom) for the following 7 days and
• Finish the strip

- Take the forgotten tablet - Finish the strip

• Take the forgotten tablet and
• Finish the strip

- Instead of the gap week - Start the next strip

or

• Stop the strip immediately
• Begin the gap week (not longer than 7 days,

including the forgotten tablet) - Then, start the next strip

What to do in the case of vomiting or severe diarrhoea

If you vomit within 3-4 hours after taking a tablet or you have severe diarrhoea, there is a risk that the active substances in the pill will not be fully taken up by your body. The situation is almost the same as forgetting a tablet. After vomiting or diarrhoea, take another tablet from a reserve strip as soon as possible. If possible take it within 12 hours of when you normally take your pill. If that is not possible or 12 hours have passed, you should follow the advice given under "If you forget to take ARMUNIA".

Delaying your period: what you need to know

Even though it is not recommended, you can delay your period by going straight to a new strip of ARMUNIA instead of the tablet-free period and finishing it. You may experience light or menstruation-like bleeding while using this second strip. After the usual tablet-free period of 7 days, start the next strip.

You might ask your doctor for advice before deciding to delay your menstrual period.

Changing the first day of your period: what you need to know

If you take the tablets according to the instructions, then your period will begin during the tablet- free week. If you have to change this day, reduce the number of tablet-free days (but never increase them – 7 is the maximum!). For example, if your tablet-free days normally begin on a Friday, and you want to change this to a Tuesday (3 days earlier) start a new strip 3 days earlier than usual. If

you make the tablet-free interval very short (for example, 3 days or less) you may not have any bleeding during these days. You may then experience light or menstruation-like bleeding.

If you are not sure what to do, consult your doctor.

If you want to stop taking ARMUNIA

You can stop taking ARMUNIA whenever you want. If you do not want to become pregnant, ask your doctor for advice about other reliable methods of birth control. If you want to become pregnant, stop taking ARMUNIA and wait for a period before trying to become pregnant. You will be able to calculate the expected delivery date more easily.

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

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

The following is a list of the side effects that have been linked with the use of ARMUNIA.

Common side effects (between 1 and 10 in every 100 users may be affected):

• mood swings
• headache
• abdominal pain (stomach ache)
• acne
• breast pain, breast enlargement, painful or irregular periods
• weight gain

Uncommon side effects (between 1 and 10 in every 1,000 users may be affected):

• Candida (fungal infection)
• cold sores (herpes simplex)
• allergic reactions
• increased appetite
• depression, nervousness, sleep disorder, decreased interest in sex
• feeling of “pins and needles”, giddiness (vertigo)
• problems with vision
• irregular heart beat or unusually fast heart rate
• a blood clot (thrombosis) in a vessel of the leg or the lungs (pulmonary embolism), high blood pressure, low blood pressure, migraine, varicose veins
• sore throat
• nausea, vomiting, inflammation of stomach and/or intestine, diarrhoea, constipation
• sudden swelling of the skin and/or mucous membranes (e.g. tongue or throat), and/or difficulty swallowing or hives together with difficulty breathing (angioedema), hair loss (alopecia), eczema, itching, rashes, dry skin, oily skin disorders (seborrheic dermatitis)
• neck pain, limb pain, muscle cramps
• bladder infection
• breast lump (benign and cancer), milk production while not pregnant (galactorrhea), ovarian cysts, hot flushes, absence of periods, very heavy periods, vaginal discharge, vaginal dryness, lower abdominal (pelvic) pain, abnormal cervical smear (Papanicolaou or Pap smear)
• fluid retention, lack of energy, excessive thirst, increased sweating

- weight loss

Rare side effects (between 1 and 10 in every 10,000 users may be affected):

• asthma
• hearing impairment
• blockage of a blood vessel by a clot formed elsewhere in the body
• erythema nodosum (characterized by painful reddish skin nodules)
• erythema multiforme (rash with target-shaped reddening or sores)

If any of the side effects gets serious or if you notice any side effects not listed in this leaflet or if you think that this may be the case, please tell your doctor or pharmacist.

Keep ARMUNIA out of the reach and sight of children.

This medicinal product does not require any special storage conditions.

Expiry date

Do not take ARMUNIA after the date on the packaging after "Do not use after:" or "EXP:"

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.

What ARMUNIA contains

The active ingredients are ethinylestradiol 0.02 mg and drospirenone 3 mg. The other ingredients are:

Tablet core: lactose monohydrate, pregelatinised starch (maize), povidone, croscarmellose sodium, polysorbate 80, magnesium stearate.

Coating: Polyvinyl alcohol partial hydrolized, titanium dioxide (E171), macrogol 3350, talc, yellow iron oxide (E172), red iron oxide (E172), black iron oxide (E172).

What ARMUNIA looks like and contents of the pack

Tablets are pink, round film-coated tablets.

ARMUNIA is available in boxes of 1, 2, 3, 6 and 13 blisters, each one containing 21 tablets.

Not all package sizes may be marketed

This medicinal product is authorised in the Member States of the EEA under the following names:

Norway:	ARMUNIA
Belgium	Armunia 0,02 mg/3,0 mg, comprimé pelliculé
Germany:	ARMUNIA

France:	Armunia 0,02 mg/3,0 mg, comprimé pelliculé
The Netherlands:	ARMUNIA

This leaflet was last approved in: september 2011

Marketing Authorisation Holder and manufacturer

Marketing Authorisation Holder

Sandoz B.V., Veluwezoom 22, Almere, Nederland

Correspondentie: Postbus 10332, 1301 AH Almere

Manufacturer

Laboratorios León Farma, S.A. Pol. Ind. Navatejera.

C/ La Vallina s/n

24008 - Villaquilambre, León. Spain

RVG 107875