APO-Leflunomide general information

What is APO-Leflunomide used for?

APO-Leflunomide tablets 20mg are used to treat rheumatoid arthritis and active psoriatic arthritis, which are both autoimmune disorders (when the immune system attacks self), have an overactive immune system and have a genetic predisposition.  Rheumatoid arthritis is a chronic progressive disease of the joints in which inflammation causes joint destruction and deformity of the joints.  APO-Leflunomide 20 can help slow down the process of joint destruction and improve functional ability and quality of life and is particularly helpful in patients who do not respond to other treatments or if other treatments cannot be used.  Psoriatic arthritis is a form of arthritis that is often also associated with psoriasis of the skin, characterised by raised red patches covered in silvery scales, but can develop before skin symptoms appear.  Psoriatic arthritis differs from rheumatoid arthritis by being negative for rheumatoid factor, a blood test for an antibody that is usually positive in rheumatoid arthritis.  APO-Leflunomide tablets 20mg are used only for treating inflammation of the joints in psoriatic arthritis not for the skin condition alone.  Rheumatoid arthritis and active psoriatic arthritis are both characterised by periods of remission and periods of flare up when symptoms worsen and joints become painful and swollen.  APO-Leflunomide tablets 20mg will not cure arthritic disease but can be used to relieve symptoms of the disease including pain, inflammation, tenderness, stiffness and swelling in the affected joints, and improve the functional use of affected joints. 

How does APO-Leflunomide work?

APO-Leflunomide tablets 20mg contain leflunomide, a disease-modifying antirheumatic drug (DMARD) that is used to relieve inflammatory symptoms of the arthritic diseases rheumatoid arthritis and active psoriatic arthritis.  Leflunomide in APO-Leflunomide tablets 20mg acts as an immunomodulatory drug with immunosuppressive characteristics, which means that it can suppress the immune system by interacting directly with the lymphocytes (white blood cells) involved in the immune response.  Leflunomide in APO-Leflunomide tablets 20mg works by several possible mechanisms.  It is thought to inhibit the production by lymphocytes of inflammatory mediators called cytokines, such as interleukins and prostaglandins, particularly tumour necrosis factor (TNF), interleukin 1 (IL1) and interleukin 6 (IL6).  Leflunomide in APO-Leflunomide tablets also inhibits proliferation of rapidly dividing inflammatory lymphocytes by blocking the action of dihydroorotate dehydrogenase, an enzyme involved in pyrimidine synthesis, which inhibits lymphocyte proliferation, and helps reduce the inflammation that is responsible for the pain and swelling of rheumatic joints.  These actions of leflunomide in APO-Leflunomide tablets 20mg dampen down the immune response by interacting with immune cells that influence the immune response to autoantigens (directed against self) and help reduce progression of the disease and reduce symptoms. 

What does APO-Leflunomide contain?

APO-Leflunomide contains the active ingredient leflunomide 20mg, a disease-modifying antirheumatic drug (DMARD) used to treat rheumatoid arthritis and active psoriatic arthritis.  They also contain lactose, crospovidone, magnesium stearate, and colloidal silicon dioxide.

Treating rheumatic diseases with APO-Leflunomide

APO-Leflunomide tablets 20mg contain leflunomide, a disease-modifying antirheumatic drug (DMARD) that is used to treat rheumatoid arthritis and active psoriatic arthritis, to improve symptoms of the disease, which include pain, inflammation, tenderness, stiffness and swelling in the affected joints.  Rheumatoid arthritis and psoriatic arthritis (a form of arthritis that is often also associated with psoriasis of the skin, causing raised red patches covered in silvery scales) are both autoimmune disorders (when the immune system attacks self) and are characterised by an overactive immune system and a genetic predisposition.  Leflunomide in APO-Leflunomide tablets 20mg is an immunomodulatory drug and acts directly on the lymphocytes (white blood cells) involved in the immune response, by inhibiting the production of cytokines, which are inflammatory mediators.  Also, Leflunomide in APO-Leflunomide tablets 20mg blocks the proliferation of rapidly dividing inflammatory lymphocytes, which helps reduce the inflammation.  APO-Leflunomide 20 can help slow down the process of joint destruction and improve joint function and quality of life, by reducing pain and inflammation but will not cure arthritic disease.

What are the side effects of APO-Leflunomide?

The most commonly reported side effects when taking APO-Leflunomide tablets 20mg include diarrhoea, nausea, vomiting, abdominal pain, stomatitis (oral mucosal disorder) anorexia, weight loss, hair loss, eczema, rash, pruritus (itching), dry skin, mild increase in blood pressure, paraesthesia (tingling of the skin).

When should APO-Leflunomide not be used?

You should not use APO-Leflunomide tablets 20mg if you:

• are allergic to leflunomide or any ingredients in APO-Leflunomide
• are pregnant or are breastfeeding
• have kidney or liver disease
• have hypoproteinaemia (oedema – water retention, and loss of protein from the blood) such as nephrotic syndrome
• have reduced immunity or immunodeficiency (such as due to AIDS)
• have severe uncontrolled infection
• are taking medicines that interact with APO-Leflunomide, including other immunomodifiers like methotrexate, the anticoagulant warfarin, immunisation with a live vaccine, statins, cholestyramine or activated charcoal for high cholesterol, repaglinide for diabetes, rifampicin for tuberculosis, non-steroidal anti-inflammatories like diclofenac or corticosteroids for inflammation

What medications interact with APO-Leflunomide?

Several medications interact with APO-Leflunomide tablets 20mg and should either not be taken while you are taking APO-Leflunomide or only after discussion and instruction from your doctor:

• Drugs that cause a serious reaction with APO-Leflunomide: other immunomodifiers like methotrexate could cause liver toxicity, immunisation with a live vaccine, non-steroidal anti-inflammatories like diclofenac or corticosteroids for inflammation
• Drugs that affect APO-Leflunomide: cholestyramine or activated charcoal for high cholesterol
• Drugs that are affected by APO-Leflunomide: the anticoagulant warfarin, repaglinide for diabetes, statins for for high cholesterol, rifampicin for tuberculosis

How should APO-Leflunomide be taken?

You should take your APO-Leflunomide tablets 20mg swallowed whole once daily with or without food and at the same time each day.  The dose you take depends on what you are being treated for and you will probably be started on a loading dose (high dose) which will then be reduced after 3 days.  You should start to see a response after 4-6 weeks, with further improvement after 4-6 months.  You should continue to take your APO-Leflunomide tablets 20mg for as long as recommended by your doctor, which may be for several months or longer. 

How long should you take APO-Leflunomide?

You should continue to take your APO-Leflunomide tablets 20mg for as long as recommended by your doctor, which may be for several months or longer. 

Missed dose of APO-Leflunomide

If you miss a dose of APO-Leflunomide tablets 20mg take it as soon as you remember, unless it is time to take the next dose, then skip the missed dose.  Do not take a double dose.

How should APO-Leflunomide be stored?

You should store your APO-Leflunomide tablets 20mg below 25°C in a cool dry place. 

APO-Mirtazapine general information

What is APO-Mirtazapine used for?

APO-Mirtazapine tablets 30mg are used to treat episodes of major depression to relieve symptoms of depressive illness, including anxiety, loss of interest in usual activities, disturbed sleep, change in appetite, fatigue, feelings of worthlessness or guilt, difficulty thinking or concentrating, and recurrent thoughts of suicide.  APO-Mirtazapine tablets 30mg are also used to prevent relapse of depression.  APO-Mirtazapine tablets 30mg also have sedative properties. 

How does APO-Mirtazapine work?

APO-Mirtazapine tablets 30mg contain mirtazapine, which is an antidepressant belonging to the class of drugs known as tetracyclic antidepressant.  It is also classified as a Noradrenergic and Specific Seratonergic Antidepressant (NaSSA), because it acts as an antagonist of alpha adrenergic receptors in the central nervous system, which in turn increases the amount of noradrenaline and serotonin neurotransmitters (brain chemical that allows nerve cells to communicate).  Mirtazapine in APO-Mirtazapine tablets 30mg has several pharmacological properties, due to its interaction with several chemicals and numerous neurotransmitter systems that are thought to be involved in depression.  These include blocking the effect of histamine, which explains its sedative properties.  Also Mirtazapine in APO-Mirtazapine tablets 30mg blocks certain serotonin receptors, which prevents some of the side effects seen with antidepressants of the Selective Serotonin Reuptake Inhibitors (SSRI) and it does not have any effect as a reuptake inhibitor, which is how most SSRIs and SNRIs (Serotonin-Noradrenaline Reuptake Inhibitors) work.  The action of Mirtazapine in APO-Mirtazapine tablets 30mg helps correct the chemical imbalance caused by a lack of certain neurotransmitters that is thought to be one of the major causes of depression and other mood disorders, particularly a lack of serotonin, which controls many body activities, including regulating mood. 

What does APO-Mirtazapine contain?

APO-Mirtazapine tablets 30mg contain the active ingredient mirtazapine, a tetracyclic antidepressant classified as a Noradrenergic and Specific Seratonergic Antidepressant (NaSSA), used to treat and relieve symptoms of major depression.  They also contain lactose monohydrate, microcrystalline cellulose, croscarmellose sodium, magnesium stearate, hypromellose, hydroxypropyl cellulose, macrogol 8000, titanium dioxide (E171), ferric oxide (red iron oxide) (E172), ferric oxide (yellow iron oxide) (E172)

Treating depression with APO-Mirtazapine

APO-Mirtazapine tablets 30mg contain mirtazapine, a tetracyclic antidepressant used to treat episodes of major depression to relieve symptoms of depressive illness, including anxiety, loss of interest in usual activities, disturbed sleep, change in appetite, fatigue, feelings of worthlessness or guilt, difficulty thinking or concentrating, and recurrent thoughts of suicide.  APO-Mirtazapine tablets 30mg are also used to prevent relapse of depression.  Mirtazapine in APO-Mirtazapine tablets 30mg interacts with several chemicals and numerous neurotransmitter systems that are thought to be involved in depression.  These include blocking alpha adrenergic receptors in the central nervous system, which in turn increases the amount of noradrenaline and serotonin neurotransmitters (brain chemical that allows nerve cells to communicate).  This action of Mirtazapine in APO-Mirtazapine tablets 30mg helps correct the chemical imbalance caused by a lack of these neurotransmitters, which is thought to be one of the major causes of depression and other mood disorders, particularly a lack of serotonin, which controls many body activities, including regulating mood.  Mirtazapine in APO-Mirtazapine tablets 30mg also blocks certain serotonin receptors, which prevents some of the side effects seen with antidepressants of the Selective Serotonin Reuptake Inhibitors (SSRI) and it does not have any effect as a reuptake inhibitor, which is how most SSRIs and SNRIs (Serotonin-Noradrenaline Reuptake Inhibitors) work. 

What are the side effects of APO-Mirtazapine?

The most commonly reported side effects when taking APO-Mirtazapine tablets 30mg include: increase in appetite and weight gain, lethargy, drowsiness or sleepiness, headache, tiredness, dry mouth, nausea diarrhoea, vomiting, orthostatic hypotension or dizzy spell (low blood pressure when standing up), abnormal dreams, tremor, dizziness, painful joints, back pain, muscle aches and pains, oedema (swelling due to fluid accumulation), skin rash.

When should APO-Mirtazapine not be used?

You should not use APO-Mirtazapine tablets 30mg if you:

• are allergic to mirtazapine or any ingredients in APO-Mirtazapine
• are pregnant or are breastfeeding
• have kidney or liver disease
• have had a recent heart attack or have other heart problems like angina
• have certain conditions without discussion with your doctor, including low blood pressure, diabetes, glaucoma, problems in urinating due to an enlarged prostate,
• are taking any monoamine oxidase inhibitor medications (such as phenelzine, tranylcypromine and moclobemide) as these can cause serious reactions if taken with APO-Mirtazapine
• are taking medicines that interact with APO-Mirtazapine, including other antidepressants like the SNRI venlafaxine, the SSRI fluoxetine, lithium for bipolar, St John’s wort, benzodiazepines for anxiety, anticoagulants like warfarin, the antifungal ketoconazole, cimetidine for stomach ulcers, the antibiotic erythromycin, anticonvulsant carbamazepine, the antiepileptic phenytoin, alcohol

What medications interact with APO-Mirtazapine?

Several medications interact with APO-Mirtazapine tablets 30mg and should either not be taken while you are taking APO-Mirtazapine or only after discussion and instruction from your doctor:

• Drugs that cause a serious reaction with APO-Mirtazapine: monoamine oxidase inhibitor medications, like phenelzine, other antidepressants like the SNRI venlafaxine, the SSRI fluoxetine, lithium for bipolar, St John’s wort, alcohol
• Drugs that affect APO-Mirtazapine: the antifungal ketoconazole, cimetidine for stomach ulcers, the antibiotic erythromycin, anticonvulsant carbamazepine, the antiepileptic phenytoin
• Drugs that are affected by APO-Mirtazapine: benzodiazepines for anxiety, anticoagulants like warfarin

How should APO-Mirtazapine be taken?

You should take your APO-Mirtazapine tablets 30mg swallowed whole with a glass of water with or without food once daily, at the same times each day preferably at bedtime.  The dose you take and for how long depends on your doctor’s recommendations how well you are responding to treatment.  You should begin to feel an improvement within one to two weeks, with maximum effect within four weeks and you should continue to take your APO-Mirtazapine tablets 30mg for at least a further four to six months after you feel well. 

How long should you take APO-Mirtazapine?

You should take your APO-Mirtazapine tablets 30mg regularly for as long as recommended by your doctor and you should begin to feel an improvement within one to two weeks, with maximum effect within four weeks.  You should continue to take your APO-Mirtazapine tablets 30mg for at least a further four to six months after you feel well. 

Missed dose of APO-Mirtazapine

If you miss a dose of APO-Mirtazapine take it as soon as you remember, unless it is time to take the next dose, then skip the missed dose.  Do not take a double dose.

How should APO-Mirtazapine be stored?

You should store your APO-Mirtazapine below 25°C in a cool dry place.  

APO-Sumatriptan general information

What is APO-Sumatriptan used for?

Apo-Sumatriptan tablets 50mg are used to relieve acute migraine attacks with or without aura, which is the perception of visual disturbances and/or smells and are usually the first sign that a migraine headache is on its way.  Apo-Sumatriptan tablets 50mg are specific for treatment of migraine attack to relieve headache and other symptoms, including nausea and sensitivity to light, but they are not used to prevent migraine headaches.  You can use Apo-Sumatriptan 50 at any stage of a migraine attack but it is more effective if taken as soon as possible after the first signs of headache and/or aura.  Apo-Sumatriptan 50 is not effective for treatment of other types of headache.

How does APO-Sumatriptan work?

Apo-Sumatriptan tablets 50mg contain sumatriptan, which is a member of the group of drugs called triptans and is a serotonin agonist that mimics the action of serotonin (also known as 5-hydroxytryptamine, or 5-HT).  Serotonin is a brain chemical that is involved in control of mood, pain sensation, sexual behaviour and sleep; as well as constriction (nApoing) of blood vessels.  Migraine is thought to be caused by dilatation or widening of blood vessels in the head due to one of many migraine triggers, which in turn stimulates nearby sensory nerves so that you feel pain.  Sumatriptan in Apo-Sumatriptan 50 stimulates the serotonin receptors in these expanded blood vessels making them contract again (vasoconstriction) and inhibits trigeminal nerve activity, relieving pain.  Both actions are thought to contribute to the anti-migraine action of sumatriptan and relieve headache and other symptoms of a migraine attack.

What does APO-Sumatriptan contain?

Apo-Sumatriptan tablets 50mg contain the active ingredient sumatriptan succinate, which is a serotonin agonist used to relieve symptoms of a migraine attack.  They also contain lactose monohydrate, microcrystalline Cellulose, pregelatinised starch, roscarmellose sodium, magnesium Stearate, purified Water, hypromellose, itanium dioxide, purified talc, macrogol 6000, ferric oxide red, ferric oxide yellow

Treating migraine headache with APO-Sumatriptan

Apo-Sumatriptan tablets 50mg contain sumatriptan, a serotonin agonist that mimics the action of serotonin, and are used to relieve acute migraine attacks with or without aura, which is the perception of visual disturbances and/or smells called and are usually the first sign that a migraine headache is on its way.  Sumatriptan in Apo-Sumatriptan 50 interacts with specific receptors on blood vessels in the head which have become vasodilated (widened), due to one of many possible migraine triggers, causing them to contract again back to normal.  This action along with interaction with the trigeminal nerve to block pain, relieves the headache and other symptoms of migraine, including nausea and sensitivity to light.  

What are the side effects of APO-Sumatriptan?

The most commonly reported side effects when taking APO-Sumatriptan include dizziness, drowsiness, sensory disturbance including, tingling, pricking, or numbness of the skin (paraesthesia), loss of sensitivity to pain or touch (hypoaesthesia), shortness of breath, sensations of heaviness, pain, sensations of heat or cold, pressure or tightness, weakness, fatigue.

When should APO-Sumatriptan not be used?

You should not use APO-Sumatriptan if you:

• are allergic to sumatriptan or any tryptan or any ingredients in APO-Sumatriptan
• have had myocardial infarction or have ischaemic heart disease, coronary vasospasm (Prinzmetal's angina), peripheral vascular disease, or a history of cerebovascular accident (CVA) or transient ischaemic attack (TIA)
• have liver disease or hypertension
• are using medicines that interact with Apo-Sumatriptan, including: ergotamine or derivatives of ergotamine (including methysergide), monoamine oxidase inhibitors (MAOIs)

What medications interact with APO-Sumatriptan?

Several medications interact with APO-Sumatriptan and should either not be taken while you are taking APO-Sumatriptan or only after discussion and instruction from your doctor:

• Ergot derivatives including methysergide (also for migraine headaches) should not be taken 24 hours before to 6 hours after dose of Apo-Sumatriptan
• MAOI antidepressants should not be taken within 14 days of Apo-Sumatriptan
• Other serotonin agonist antidepressants like SSRIs; SNRIs.

How should APO-Sumatriptan be taken?

You can take your Apo-Sumatriptan tablets 50mg at any stage of a migraine attack but it is more effective if taken as soon as possible after the first signs of headache and/or aura.  You should take one or two Apo-Sumatriptan tablets 50mg as recommended by your doctor, swallowed whole with a glass of water, with or without food.  You should not take another dose of Apo-Sumatriptan 50 for the same migraine, but you can take another dose if you have another migraine attack in the next 24 hours, provided you do not take more than 300mg in a 24 hour period.

How should APO-Sumatriptan be stored?

You should store your APO-Sumatriptan tablets 50mg below 30°C in a cool dry place.