Consumer medicine information

Tevaripiprazole

Aripiprazole

BRAND INFORMATION

Brand name

Tevaripiprazole

Active ingredient

Aripiprazole

Schedule

S4

 

Consumer medicine information (CMI) leaflet

Please read this leaflet carefully before you start using Tevaripiprazole.

What is in this leaflet

This leaflet answers some common questions about Tevaripiprazole. It does not contain all the available information. Some of the information contained in this leaflet may not apply to you.

It does not take the place of talking to your doctor or pharmacist.

All medicines have risks and benefits. Your doctor has weighed the risks of you taking Tevaripiprazole against the benefits it is expected to have for you.

If you have any concerns about taking this medicine, ask your doctor or pharmacist.

Keep this leaflet with the medicine. You may need to read it again.

What Tevaripiprazole is used for

Tevaripiprazole is a trade name (manufacturer's name) for the medicine aripiprazole (Ari-pip-rah-zol).

Aripiprazole belongs to a group of medicines called antipsychotic agents which improve the symptoms of certain types of mental illness.

Tevaripiprazole is used to treat symptoms of schizophrenia.

Schizophrenia is a mental illness with disturbances in thinking, feelings and behaviour.

Your doctor may have prescribed aripiprazole for another reason. Ask your doctor if you have any questions about why aripiprazole has been prescribed for you.

There is no evidence that aripiprazole is addictive.

This medicine is available only with a doctor's prescription.

Aripiprazole is not recommended for use in children under the age of 18, as safety and efficacy have not been established in this age group.

Before you take Tevaripiprazole

When you must not take it

Do not take Tevaripiprazole if you have an allergy to:

  • aripiprazole
  • any of the ingredients listed at the end of this leaflet

Symptoms of an allergic reaction include:

  • rash, itching or hives on the skin
  • shortness of breath, wheezing or difficulty breathing
  • swelling of the face, lips, tongue, throat or other parts of the body

Do not take Tevaripiprazole after the expiry or use by date printed on the pack. If you take this medicine after this date has passed, it may not work as well.

Do not take Tevaripiprazole if the packaging is torn or shows signs of tampering. If this is the case, return it to your pharmacist.

If you are not sure whether you should start taking Tevaripiprazole, talk to your doctor or pharmacist.

Before you start to take it

Tell your doctor or pharmacist if you have allergies to:

  • any other medicines
  • any other substances such as foods, preservatives or dyes

Tell your doctor if you are pregnant or intend to become pregnant. Tevaripiprazole is not recommended for use during pregnancy. If you need to take Tevaripiprazole during your pregnancy, your doctor will discuss with you the benefits and risks of taking it. Babies exposed to antipsychotics (including Tevaripiprazole) during the third trimester of pregnancy are at risk of experiencing shaking, muscle stiffness, difficulty in feeding and/or withdrawal symptoms. These symptoms may resolve spontaneously or require additional medical treatment.

Tell your doctor or pharmacist if you are breast-feeding or plan to breast-feed. It is recommended that you do not breast-feed while taking Tevaripiprazole, as it may pass into breast milk and therefore there is a possibility that the breast-fed baby may be affected.

Tell your doctor if you have, or have had any medical conditions, especially the following:

  • a reaction to some medicines with a sudden increase in body temperature, sweating, fast heart beat, muscle stiffness and fluctuating blood pressure, which may lead to coma. This reaction is called neuroleptic malignant syndrome.
  • a reaction to some medicines with abnormal movements of the tongue, or other uncontrolled movements of the mouth, tongue, cheeks or jaw which may progress to the arms and legs. This reaction is called tardive dyskinesia.
  • low blood pressure
  • problems with your heart or blood vessels
  • epilepsy, seizures or fits
  • problems with your oesophagus (food pipe) such as difficulty in swallowing
  • high blood sugar or diabetes mellitus
  • Alzheimer's disease or dementia
  • alcohol or drug abuse or dependence or a history of one of these
  • venous thromboembolism or are at risk of venous thromboembolism
  • lactose intolerance

Tell your doctor if you have past experience of excessive gambling.

Tell your doctor if you drink alcohol. Your doctor may advise you to avoid alcohol as it can magnify the side effects of this medicine.

If you have not told your doctor or pharmacist about any of the above, tell them before you start taking Tevaripiprazole.

Taking other medicines

Tell your doctor or pharmacist if you are taking any other medicines, including any that you buy without a prescription from your pharmacy, supermarket or health food shop.

Some medicines and Tevaripiprazole may interfere with each other. These include:

  • medicines used to treat brain disorders such as, anxiety, depression, mood swings, epilepsy or seizures, Parkinson's disease or insomnia.
  • medicines used to treat high blood pressure
  • medicines used to treat fungal infections
  • medicines used to treat heart rhythm disturbances
  • medicines used to treat bacterial or viral infections
  • a medicine called ciclosporin (Cysporin®; Neoral®; Sandimmun®)
  • a medicine called cimetidine (Tagamet®; Magicul®; Sigmetadine®)

These medicines may be affected by Tevaripiprazole, or may affect how well it works. Your doctor may need to adjust your dose of Tevaripiprazole or of the other medicine.

Eating grapefruit or drinking grapefruit juice may affect how Tevaripiprazole works.

Your doctor or pharmacist may have more information on medicines to be careful with or avoid while taking Tevaripiprazole.

How to take Tevaripiprazole

Follow all directions given to you by your doctor or pharmacist carefully. They may differ from the information contained in this leaflet.

Your doctor or pharmacist will tell you how much you need to take each day. This will depend on your condition and whether you are taking any other medicines.

The label put on the carton by the pharmacist will tell you how much you should take.

If you do not understand the instructions on the carton, ask your doctor or pharmacist for help.

How to take it

Tevaripiprazole tablets should be swallowed whole and washed down with a glass of water.

Take Tevaripiprazole at about the same time each day.

Unless your doctor gives you other directions, you should take Tevaripiprazole only once a day.

Taking the medicine at the same time each day will have the best effect. It will also help you remember when to take it.

It does not matter whether you take Tevaripiprazole with or without food.

If you forget to take it

If it is almost time for your next dose, skip the dose you missed and take your next dose when you are meant to.

Otherwise, take it as soon as you remember, and then go back to taking your medicine as you would normally.

Do not take a double dose to make up for the dose that you missed. This may increase the chance of you getting an unwanted side effect.

If you are not sure what to do, ask your doctor or pharmacist.

If you have trouble remembering to take your medicine, ask your pharmacist for some hints.

How long to take it

Continue taking Tevaripiprazole for as long as your doctor tells you.

Tevaripiprazole helps to control your condition but does not cure it. Therefore you must take Tevaripiprazole every day. Improvement in symptoms may take several days to some weeks to occur. Even if you feel better do not stop taking Tevaripiprazole unless your doctor tells you to.

If you take too much (overdose)

Immediately telephone your doctor or pharmacist or the Poisons Information Centre (telephone 13 1126) or go to the Accident and Emergency Centre at your nearest hospital, if you or anyone else may have taken too much Tevaripiprazole. Do this even if there are no signs of discomfort or poisoning. You may need urgent medical attention.

While you are taking Tevaripiprazole

Things you must do

Tell any doctors, dentists or pharmacists who are treating you that you are taking Tevaripiprazole.

If you are about to be started on any new medicine, tell your doctor, dentist and pharmacist that you are taking Tevaripiprazole.

If you plan to have any kind of surgery that needs a general anaesthetic, tell your doctor or dentist that you are taking Tevaripiprazole.

If you become pregnant while taking Tevaripiprazole, tell your doctor immediately.

Be sure to keep all of your doctor's appointments so that your progress can be checked.

Things you must not do

Do not give Tevaripiprazole to anyone else, even if their symptoms seem similar or they have the same condition as you.

Do not take Tevaripiprazole to treat any other complaints unless your doctor or pharmacist tells you to.

Do not stop taking Tevaripiprazole or lower the dosage, even if you are feeling better, without checking with your doctor. If you stop taking Tevaripiprazole suddenly your condition may worsen.

Do not take more of this medicine and do not take it more often than your doctor has ordered.

Things to be careful of

Make sure that you know how you react to Tevaripiprazole before you drive a car, operate machinery or do anything else that could be dangerous if you are dizzy or light headed or not alert.

Tevaripiprazole may cause some people to become drowsy or less alert than they are normally or cause light-headedness, dizziness or tiredness. If this occurs do not undertake the activity.

If Tevaripiprazole makes you feel light-headed, dizzy or faint, be careful when getting up from a sitting or lying position. Getting up slowly may help.

Be careful when drinking alcohol while taking Tevaripiprazole. Your doctor may suggest you avoid alcohol while you are being treated with Tevaripiprazole.

Make sure you keep cool in hot weather and keep warm in cool weather.

Tevaripiprazole may affect the way your body reacts to temperature changes. It may prevent sweating, even during heatwaves. You may feel dizzy or faint if you are too hot. To stay cool in hot weather, try to do the following:

  • wear light clothing
  • spend time in air-conditioned environments (or keep windows open and use electric fans)
  • drink plenty of water
  • take cool baths or showers and avoid hot baths and saunas
  • try to restrict exercise or heavy work to cool parts of the day

Side effects

Tell your doctor or pharmacist as soon as possible if you do not feel well while you are taking Tevaripiprazole.

Like other medicines Tevaripiprazole may cause some unwanted side effects. These are likely to vary from patient to patient. Tevaripiprazole is generally well-tolerated and the side effects are often hard to distinguish from disease symptoms. It is important that you tell your doctor as soon as possible about unwanted effects.

Ask your doctor or pharmacist to answer any questions you may have.

Tell your doctor if you notice any of the following side effects and they worry you:

  • headache
  • indigestion
  • nausea
  • vomiting
  • insomnia
  • constipation
  • light-headedness
  • drowsiness
  • agitation
  • anxiety
  • inability to sit or stand still; restless movement of the arms and legs such as tapping, marching in places, rocking, crossing and uncrossing the legs.

These are the more common side effects of Tevaripiprazole

Tell your doctor if you notice the following side effects:

  • feeling dizzy especially when getting up from a lying or sitting position
  • altered or increased sexual interest

These sided effects are uncommon.

  • high blood sugar (excessive thirst, hunger and weakness) or the onset or worsening of diabetes

This side effect is rare.

  • weight gain
  • weight loss
  • loss of appetite
  • excessive sweating
  • drowsiness
  • high blood pressure
  • chest pain
  • frequent infections such as fever, severe chills, sore throat or mouth ulcers
  • bleeding or bruising more easily than normal
  • speech disorder
  • urinary incontinence
  • difficulty swallowing
  • hiccups

These side effects are very rare.

Tell your doctor if you have obsessive (recurring) thoughts or behaviours or trouble controlling impulsive urges or while taking Tevaripiprazole. Obsessive compulsive behaviours (feeling the need to check things repeatedly or having certain thoughts repeatedly), gambling urges, sexual urges, compulsive spending, binge or compulsive eating and other urges have occurred in some patients.

Tell your doctor immediately or go to Accident and Emergency at your nearest hospital if you notice any of the following:

  • seizure, fits or convulsions.
  • fainting.
  • abnormal movements of the tongue or other uncontrolled movements of the tongue, mouth, cheeks, eye or jaw which may progress to the arms and legs.
  • sudden increase in body temperature, sweating, fast heartbeat, muscle stiffness, high blood pressure and convulsions.
  • rash.
  • allergic reaction (rash, itching or hives on the skin; shortness of breath, wheezing or difficulty breathing; swelling of the face, lips, tongue, throat or other parts of the body) with or without fever
  • muscle pain, muscle weakness or muscle stiffness
  • inflammation of the pancreas, severe upper stomach pain often with nausea and vomiting.
  • disorder of body temperature regulation resulting in low body temperature or high body temperature.
  • painful irreversible erection.
  • difficulty in passing urine.
  • yellowing of the skin and/or eyes, also called jaundice with or without nausea, vomiting, loss of appetite, feeling generally unwell, fever, itching and dark coloured urine.
  • serious lung infection with fever, chills, shortness of breath, cough, chest pain and blood streaked phlegm
  • thoughts or talk about death or suicide; thoughts or talk about self-harm or doing harm to others; any recent attempts at self-harm; an increase in aggressive behaviour, irritability or agitation. If you or someone you know is showing these signs contact your doctor or a mental health advisor right away or go to the nearest hospital for treatment.

These are very serious side effects.

You may need urgent medical attention or hospitalisation.

All of these side effects are very rare.

Other side effects not listed above may occur in some patients.

Also, while taking aripiprazole, some elderly patients with dementia have suffered serious side effects such as a "mini" stroke, stroke, pneumonia or heart problems. These serious side effects can be life threatening.

Tell your doctor or pharmacist if you notice anything that is making you feel unwell.

Do not be alarmed by this list of possible side effects.

You may not experience any or only some of them.

After using Tevaripiprazole

Storage

Store Tevaripiprazole in a cool place where the temperature stays below 25°C.

Do not store it or any other medicine in the bathroom. Do not leave it in the car or on window sills. Heat and dampness can destroy some medicines.

Keep it where young children cannot reach it. A locked cupboard at least one-and-a-half metres above the ground is a good place to store medicines. Do not keep outdated medicine or medicine no longer needed.

Disposal

If your doctor tells you to stop taking Tevaripiprazole or the medicine has passed its expiry date, ask your pharmacist what to do with any leftover medicine.

Be sure that any discarded medicine is out of the reach of children.

Product Description

What it looks like

Tevaripiprazole 5 mg uncoated tablet

- Light yellow coloured round flat faced bevelled edge tablet debossed '5' on one side and plain on the other side.

Tevaripiprazole 10 mg uncoated tablet

- Pink to light pink coloured, oblong tablet with debossed '10' on one side and breakline on the other side.

Tevaripiprazole 15 mg uncoated tablet

- Light yellow coloured, round flat faced bevelled edged tablets with debossed '15' on one side and breakline on the other side.

Tevaripiprazole 20 mg uncoated tablet

- White to off white or pale cream coloured, capsule shaped biconvex table with debossed '20' on one side and breakline on the other side.

Tevaripiprazole 30 mg uncoated tablet

- Pink to light pink coloured, round biconvex tablets with debossed '30' on one side and breakline on the other side.

Aripiprazole tablets are packed in OPA/Al/PVC-Al blister in a carton. Each carton contains 30 tablets.

Ingredients

Active ingredient:

aripiprazole

Other Ingredients:

  • Lactose monohydrate
  • Maize starch
  • Microcrystalline cellulose
  • Hyprolose
  • Magnesium stearate
  • Croscarmellose sodium

The following colorants are also present in the tablets:

  • 5 mg - iron oxide yellow
  • 10 mg - iron oxide red
  • 15 mg - iron oxide yellow
  • 20 mg - no colourants
  • 30 mg - iron oxide red

Tevaripiprazole does not contain sucrose, gluten, tartrazine or any other azo dyes.

Tevaripiprazole contains sugars (as lactose).

Sponsored by

Teva Pharma Australia Pty Ltd
Level 1, 37 Epping Road
Macquarie Park NSW 2113
Australia

Australian Registration Numbers

5 mg tablets: AUST R 238013

10 mg tablets: AUST R 238014

15 mg tablets: AUST R 238032

20 mg tablets: AUST R 238033

30 mg tablets: AUST R 238034

Date of preparation: December 2020

Published by MIMS February 2021

BRAND INFORMATION

Brand name

Tevaripiprazole

Active ingredient

Aripiprazole

Schedule

S4

 

1 Name of Medicine

Aripiprazole.

2 Qualitative and Quantitative Composition

Tevaripiprazole tablets contain aripiprazole as the active ingredient. Tevaripiprazole tablets are available as 5 mg, 10 mg, 15 mg, 20 mg or 30 mg tablets.
Excipients with known effect. Sugars as lactose.
For the full list of excipients, see Section 6.1 List of Excipients.

3 Pharmaceutical Form

Tevaripiprazole 5 mg uncoated tablet. Light yellow coloured round flat faced bevelled edge tablet with debossed '5' on one side and plain on the other side.
Tevaripiprazole 10 mg uncoated tablet. Pink to light pink coloured, oblong tablet with debossed '10' on one side and breakline on the other side.
Tevaripiprazole 15 mg uncoated tablet. Light yellow coloured, round flat faced bevelled edge tablet with debossed '15' on one side and breakline on the other side.
Tevaripiprazole 20 mg uncoated tablet. White to off white or pale cream coloured, capsule shaped biconvex tablet with debossed '20' on one side and breakline on the other side.
Tevaripiprazole 30 mg uncoated tablet. Pink to light pink coloured, round biconvex tablet with debossed '30' on one side and breakline on the other side.

4 Clinical Particulars

4.9 Overdose

Human experience. In clinical studies, and postmarketing experience accidental or intentional acute overdosage of aripiprazole alone was identified in adult patients with estimated doses up to 1260 mg with no fatalities. The potentially medically important signs and symptoms observed in adult patients who overdosed with aripiprazole alone at doses up to 1260 mg included lethargy, blood pressure increased, somnolence, tachycardia and vomiting. In addition, reports of accidental overdose with aripiprazole alone (up to 195 mg) in children have been received. The potentially medically serious signs and symptoms reported include somnolence, and transient loss of consciousness. In the patients who were evaluated in hospital settings, there were no reported observations indicating a clinically significant adverse change in vital signs, laboratory assessments, or ECG.
Management of overdosage. No specific information is available on the treatment of overdose with aripiprazole. The possibility of multiple drug involvement should be considered. Therefore cardiovascular monitoring should commence immediately and should include continuous electrocardiographic monitoring to detect possible arrhythmias. Otherwise, management of overdose should concentrate on supportive therapy, maintaining an adequate airway, oxygenation and ventilation, and management of symptoms. Close medical supervision and monitoring should continue until the patient recovers.
Charcoal. In the event of an overdose of aripiprazole, an early charcoal administration may be useful in partially preventing the absorption of aripiprazole. In a single-dose study in which 15 mg of aripiprazole was administered to fully compliant, fully conscious, healthy, male volunteers and followed by activated charcoal (50 g), administered one hour after aripiprazole, aripiprazole AUC and Cmax was decreased by 51 and 41%, respectively, compared to historic controls, suggesting that charcoal may be effective for overdose management.
Haemodialysis. Although there is no information on the effect of haemodialysis in treating an overdose with aripiprazole, haemodialysis is unlikely to be useful in overdose management, since aripiprazole is not eliminated unchanged by the kidneys and is highly bound to plasma proteins.
For information on the management of overdose, contact the Poisons Information Centre on 13 11 26 (Australia).

5 Pharmacological Properties

5.3 Preclinical Safety Data

Choleliths (gallsand and/or gallstones) were observed in the bile of monkeys given aripiprazole orally for 4 - 52 weeks at doses of 25 -125 mg/kg/day (1 - 3 times the MRHD based on plasma AUC and 15 -76 times the MRHD based on mg/m2) and were attributed to precipitation of sulfate conjugates of hydroxy metabolites, which exceeded their solubility limits in bile. Human biliary concentrations of these sulfate conjugates after repeated daily administration of the MRHD are substantially lower (0.2 - 14% of their in vitro solubility limits).
Bilateral retinal degeneration was observed in albino rats given oral aripiprazole for 6 months or two years at exposures of 6-13 times the clinical exposure at the MRHD (based on plasma AUC). The exposure at the NOEL dose was 3 times that at the MRHD. A subsequent 18-month study reported this finding in albino but not pigmented rats, possibly due to lack of photoprotective ocular melanin in the albino rats, although it is unknown whether pigmentation prevented or merely delayed retinal degeneration in the pigmented rats. The clinical relevance of this finding is uncertain.
Genotoxicity. Aripiprazole was tested in a standard range of assays for gene mutation, chromosomal damage, and DNA damage and repair. Aripiprazole was non-genotoxic in the in vitro bacterial reverse-mutation assay, the in vitro forward gene mutation assay in mouse lymphoma cells, in vitro bacterial DNA repair assay, and the unscheduled DNA synthesis assay in rat hepatocytes. However, aripiprazole and its minor metabolite 2,3-DCPP were clastogenic in the in vitro chromosomal aberration assay in Chinese hamster lung (CHL) cells in both the presence and absence of metabolic activation. A positive response for aripiprazole in 1 of 6 in vivo mouse micronucleus tests was attributed to drug-induced hypothermia.
Carcinogenicity. Lifetime carcinogenicity studies were conducted in ICR mice and in Sprague-Dawley (SD) and Fischer (F344) rats. Aripiprazole was administered for 2 years in the diet at doses of 1, 3, 10, and 30 mg/kg/day to ICR mice and 1, 3, and 10 mg/kg/day to F344 rats (0.2 to 5 and 0.3 to 3 times the maximum recommended human dose [MRHD] based on mg/m2, respectively). SD rats were dosed orally by gavage for 2 years at 10, 20, 40, and 60 mg/kg/day (3 to 18 times the MRHD based on mg/m2). There was no evidence of tumorigenesis in male mice or rats. In female mice, the incidences of pituitary gland adenomas and mammary gland adenocarcinomas and adenoacanthomas were increased at dietary doses of 3 to 30 mg/kg/day (0.1 to 0.9 times MRHD based on AUC and 0.5 to 5 times the MRHD based on mg/m2). In female rats, the incidence of mammary gland fibroadenomas was increased at a dietary dose of 10 mg/kg/day (< 0.1 times MRHD based on AUC and 3 times the MRHD based on mg/m2); and the incidences of adrenocortical carcinomas and combined adrenocortical adenomas/carcinomas were increased at an oral gavage dose of 60 mg/kg/day (10 times the MRHD based on AUC and 18 times MRHD based on mg/m2). In male rats, the incidence of benign and combined benign/malignant phaeochromocytomas were also increased at an oral gavage dose of 60 mg/kg/day (10 times the MRHD based on AUC and 18 times the MRHD based on mg/m2).
Proliferative changes in the pituitary and mammary gland of rodents have been observed following chronic administration of other antipsychotic agents and are considered prolactin-mediated. Serum prolactin was not measured in the aripiprazole carcinogenicity studies. Hyperprolactinaemia was observed in female mice in a 13-week dietary study at doses associated with mammary gland and pituitary tumours, but not in female rats in 4- and 13-week dietary studies at doses associated with mammary gland tumours. Hyperprolactinaemia was observed in female rats after 5 and 13 weeks of oral administration at doses up to that associated with adrenocortical tumours, but serum prolactin was decreased at this dose in male rats. The relationship between tumourigenic findings with aripiprazole and prolactin is unclear and the relevance for human risk of prolactin-mediated endocrine tumours is unknown. The adrenocortical response in female rats is considered a consequence of increased adrenocortical cell proliferation secondary to chronic drug-related adrenocortical cytotoxicity; the no-effect exposure (plasma AUC) was about fold 7 clinical exposure at the MRHD.

6 Pharmaceutical Particulars

6.7 Physicochemical Properties

Aripiprazole is a novel antipsychotic agent with unique pharmacologic properties and a chemical structure that differs from current antipsychotic agents.
Since aripiprazole is insoluble in water with its equilibrium solubility being about 0.00001% w/v, its pKa was established in 20% aqueous ethanol pKa = 7.6 (20% ethanol, at 25°C). The partition coefficients (Po/w) of aripiprazole range from 3.4 at pH 2.0 to > 1000 at pH 6.0.
Chemical structure. The structural formula of aripiprazole is shown below:
https://stagingapi.mims.com/au/public/v2/images/fullchemgif/CSARIPIP.gif Active ingredient: aripiprazole.
Chemical name: 7-[4-[4- (2, 3-dichlorophenyl)-1-piperazinyl] butoxy]-3, 4- dihydrocarbostyril.
Molecular formula: C23H27Cl2N3O2.
Molecular weight: 448.39.
CAS number. 129722-12-9.

7 Medicine Schedule (Poisons Standard)

Prescription Only Medicine (Schedule 4).

Summary Table of Changes

https://stagingapi.mims.com/au/public/v2/images/fulltablegif/TEVARIST.gif