4.1. Therapeutic indications

ALMERG 180 mg tablet is indicated in adults and children 12 years and older for the relief of symptoms associated with chronic idiopathic urticaria.

4.2. Posology and method of administration

Posology

Adults

The recommended dose of fexofenadine hydrochloride for adults is 180 mg once daily taken before a meal.

Fexofenadine is a pharmacologically active metabolite of terfenadine.

Paediatric population

Adolescents aged 12 years and over

The recommended dose of fexofenadine hydrochloride for adolescents aged 12 years and over is 180 mg once daily taken before a meal.

Children under 12 years of age

The efficacy and safety of fexofenadine hydrochloride 180 mg has not been studied in children under 12.

Special populations

Studies in special risk groups (elderly, renally or hepatically impaired patients) indicate that it is not necessary to adjust the dose of fexofenadine hydrochloride in these patients.

Method of administration

ALMERG tablet is for oral use.

4.3. Contraindications

Hypersensitivity to the active substance or to any of the excipients listed in section 6.1.

4.4. Special warnings and precautions for use

As with most new medicinal products there is only limited data in the elderly and renally or hepatically impaired patients.

Fexofenadine hydrochloride should only be administered in these special groups on the advice of a doctor.

Patients with a history of or ongoing cardiovascular disease should be warned that, antihistamines as a medicine class, have been associated with the adverse reactions, tachycardia and palpitations (see section 4.8) and should use fexofenadine hydrochloride only on the advice of their doctor.

Excipient

This medicine contains less than 1 mmol sodium (23 mg) per tablet, that is to say essentially 'sodium-free.'

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

Fexofenadine does not undergo hepatic biotransformation and therefore will not interact with other medicinal products through hepatic mechanisms. Fexofenadine is a P-glycoprotein (P-gp) and organic-anion-transporting polypeptide (OATP) substrate. Concomitant use of fexofenadine with P-gp inhibitors or inducers can affect the exposure to fexofenadine. Co-administration of fexofenadine hydrochloride with P-gp inhibitors erythromycin or ketoconazole has been found to result in a 2-3 times increase in the level of fexofenadine in plasma. The changes were not accompanied by any effects on the QT interval and were not associated with any increase in adverse reactions compared to the medicinal products given singly.

A clinical drug-drug interaction study showed that co-administration of apalutamide (a weak inducer of P-gp) and a single oral dose of 30 mg fexofenadine resulted in a 30 % decrease in AUC of fexofenadine.

No interaction between fexofenadine and omeprazole was observed. However, the administration of an antacid containing aluminium and magnesium hydroxide gels 15 minutes prior to fexofenadine hydrochloride caused a reduction in bioavailability, most likely due to binding in the gastrointestinal tract. It is advisable to leave 2 hours between administration of fexofenadine hydrochloride and aluminium and magnesium hydroxide containing antacids.

4.6. Fertility, pregnancy and lactation

Pregnancy

There are no adequate data from the use of fexofenadine hydrochloride in pregnant women.

Limited animal studies do not indicate direct or indirect harmful effects with respect to effects on pregnancy, embryonal/foetal development, parturition or postnatal development (see section 5.3). Fexofenadine hydrochloride should not be used during pregnancy unless on the advice of a doctor.

Breast-feeding

There are no data on the content of human milk after administering fexofenadine hydrochloride. However, when terfenadine was administered to nursing mothers fexofenadine was found to cross into human breast milk. Therefore fexofenadine hydrochloride is not recommended for mothers breast-feeding their babies. Breast-feeding women should only use fexofenadine hydrochloride if advised to do so by a doctor.

Fertility

No human data on the effect of fexofenadine hydrochloride on fertility are available. In mice, there was no effect on fertility with fexofenadine hydrochloride treatment (see section 5.3).

4.7. Effects on ability to drive and use machines

On the basis of the pharmacodynamic profile and reported adverse reactions it is unlikely that fexofenadine hydrochloride tablets will produce an effect on the ability to drive or use machines. In objective tests, fexofenadine has been shown to have no significant effects on central nervous system function. This means that patients may drive or perform tasks that require concentration. However, in order to identify sensitive people who have an unusual reaction to medicinal products, it is advisable to check the individual response before driving or performing complicated tasks.

4.8. Undesirable effects

The following frequency rating has been used, when applicable

Very common ≥1/10;

Common ≥1/100 to <1/10;

Uncommon ≥1/1,000 to <1/100;

Rare ≥1/10,000 to <1/1,000;

Very rare <1/10,000;

Not known (frequency cannot be estimated from the available data).

Within each frequency grouping, undesirable effects are presented in order of decreasing seriousness.

In adults, the following undesirable effects have been reported in clinical trials, with an incidence similar to that observed with placebo

Nervous system disorders

Common: headache, drowsiness, dizziness

Eye disorders

Not known: vision blurred

Gastrointestinal disorders

Common: nausea

General disorders and administration site conditions

Uncommon: fatigue

In adults, the following undesirable effects have been reported in post-marketing surveillance. The frequency with which they occur is not known (can not be estimated from available data)

Immune system disorders

Hypersensitivity reactions with manifestations such as angioedema, chest tightness, dyspnoea, flushing and systemic anaphylaxis

Psychiatric disorders

Insomnia, nervousness, sleep disorders or nightmares/excessive dreaming (paroniria)

Cardiac disorders

Tachycardia, palpitations

Gastrointestinal disorders

Diarrhoea

Skin and subcutaneous tissue disorders

Rash, urticaria, pruritus

Reporting of suspected adverse reactions

Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via the Yellow Card Scheme at: https://yellowcard.mhra.gov.uk/ or search for MHRA Yellow Card in the Google Play or Apple App Store

4.9. Overdose

Dizziness, drowsiness, fatigue and dry mouth have been reported with overdose of fexofenadine hydrochloride. Single doses up to 800 mg, and doses up to 690 mg twice daily for 1 month, or 240 mg once daily for 1 year have been administered to healthy subjects without the development of clinically significant adverse reactions as compared with placebo. The maximum tolerated dose of fexofenadine hydrochloride has not been established.

Standard measures should be considered to remove any unabsorbed medicinal product. Symptomatic and supportive treatment is recommended. Haemodialysis does not effectively remove fexofenadine hydrochloride from blood.