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MenoMood – SPC

Summary of Product Characteristics

1 Name of the medicinal product

Menomood Menoparuse Relief tablets
Holland & Barrett Menopause Mood Relief tablets

2 Qualitative and quantitative composition

Each coated tablet contains:

300 mg of extract (as dry extract) from St John’s wort aerial parts (Hypericum perforatum L.) (3.5-6:1) (equivalent to 1050 – 1800 mg of St John’s wort).

Extraction solvent: Ethanol 60% m/m, and 6.4 mg of extract (as dry extract) from Black Cohosh rhizome and root (Cimicifuga racemosa (L.) Nutt.) (4.5-8.5:1) (equivalent to 28.80-54.40 mg of Black Cohosh).

Extraction solvent: Ethanol 60% v/v.

Each coated tablet contains 234 mg of sucrose, 19 mg of lactose monohydrate and 6 mg glucose. (See Section 4.4.’Special warnings and precautions for use’).

For full list of excipients, see section 6.1

3 Pharmaceutical form

Coated tablet.

Light-yellow, round, biconvex, smooth glossy surface.

4 Clinical particulars

4.1 Therapeutic indications

A traditional herbal medicinal product used for the relief of symptoms of the menopause, including hot flushes, night sweats, slightly low mood and mild anxiety, based on traditional use only.

4.2 Posology and method of administration

For oral use only

For women experiencing menopausal symptoms, take 1 tablet daily. Tablets should be taken at the same time of day if possible (morning or evening) and swallowed whole with plenty of liquid. Do not chew the tablets.

If symptoms worsen or do not improve after 6 weeks a doctor or qualified healthcare practitioner should be consulted.

The use in children or adolescents under 18 years of age is not recommended (See Section 4.4 Special warnings and precautions for use).

4.3 Contraindications

Hypersensitivity to the active ingredients or to any of the excipients.

Patients with known dermal photosensitivity or patients undergoing phototherapy or any photodiagnostic procedures.

Concomitant use with the medicines included in Section 4.5. This is because St John’s wort (Hypericum perforatum) has been shown to induce the cytochrome P450 isoenzymes CYP1A2, CYP2C9, CYP2C19 and CYP3A4 as well as transport protein P-glycoprotein. This results in pharmacokinetic interactions with a large number of medicines including leading to a possible decrease in the effectiveness of those medicines.

In addition, pharmacodynamic interactions have also been identified with antidepressants, particularly the SSRI antidepressants and with the triptan group of medicine.

Patients who have hepatic and/or renal impairment since the safety of Black cohosh extract has not been studied in patients with hepatic andor renal impairment.

Patients who have active liver disease or a history of liver damage.

Patients who have been treated or who are undergoing treatment for breast cancer or other hormone dependent tumours.

As there is evidence that Black cohosh may have hormone-like actions, it should only be used by women of childbearing potential if contraception is used.

4.4 Special warnings and precautions for use

Do not exceed the stated dose.

If the condition worsens, or if symptoms persist for more than six weeks a doctor or qualified healthcare practitioner should be consulted.

The use of this product in children and adolescents under 18 years of age is not recommended since there is no relevant use.

This product is intended for relief of menopausal symptoms including slightly low mood and mild anxiety. Patients with signs and symptoms of depression should consult a doctor for appropriate treatment.

In very rare cases, particularly in light-skinned persons, sun burn type reactions on skin areas exposed to strong sunlight may occur due to photosensitisation by St John’s wort. Persons using this product should avoid excessive sunbathing or the use of sunbeds or solariums.

This product should be discontinued at least 10 days prior to elective surgery due to the potential for interactions with medicinal products used during general and regional anaesthesia (see Section 4.5)

There have been rare cases of hepatic reactions associated with the use of Black cohosh. Patients taking Menomood should be advised to immediately stop the use of the product and consult their doctor if they develop signs and symptoms suggestive of liver dysfunction. (Fatigue, anorexia, yellowing of the skin and eyes or severe upper stomach pain with nausea and vomiting or dark urine).

Patients who have been treated or who are undergoing treatment for breast cancer or other hormone-dependent tumours should not use Cimicifuga preparations without medical advice. Please see section 5.3 “Preclinical safety data”.

Oestrogens may only be taken simultaneously with Menomood under supervision of a doctor, as their effect may be intensified by Black cohosh.

If menstrual disorders occur or menstruation re-appears and if the symptoms are persistent, of unknown origin, or have recently occurred, a doctor should be consulted as this may indicate the presence of other conditions which need to be medically diagnosed.

This product contains sucrose, lactose and glucose.

Patients with rare hereditary problems of galactose intolerance and/or fructose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption or sucrose-isomaltase insufficiency should not take this medicine

4.5 Interaction with other medicinal products and other forms of interaction

There are no reported studies for Black Cohosh.

Substances in St John’s wort (Hypericum perforatum) have been shown to induce the cytochrome P450 isoenzymes CYP1A2, CYP2C19, CYP2C9 and CYP3A4 as well as the transport protein P-glycoprotein. This results in pharmacokinetic interactions with a large number of medicines leading to a potential decrease in the effectiveness of those medicines.

The concomitant use of ciclosporin, tacrolimus for systemic use, Amprenavir, indinavir and other protease inhibitors, irinotecan and warfarin is contraindicated. Special care should be taken in the case of the concomitant use of all drug substances the metabolism of which is influenced by CYP1A2, CYP3A4, CYP2C9, CYP2C19 or P-glycoprotein (e.g. amitriptyline, fexofanadine, benzodiazepines, methadone, simvastatin, digoxin, finasteride) because a reduction of plasma concentration is possible.

Users of oral contraceptives taking St John’s wort may experience intracyclic menstrual bleeding and risk of contraception failure is increased.

Clinically significant pharmacodynamic interactions have also been identified with the SSRI antidepressants, and the triptan group of medicines used to treat migraines. Due to the increased risk of undesirable effects associated with these interactions this product should not be used concomitantly with these types of medicines.

Therefore this product should not be taken concomitantly with the medicines included in table below.

Co-administered drug Interaction Recommendations concerning co­administration

Anaesthetics /pre-operative medicines

Fentanyl, propofol, sevoflurane, midazolam Reduced blood levels with risk of therapeutic failure. Based on the elimination half-lives of hypericin and hyperforin this product should be discontinued at least 10 days prior to elective surgery.

Analgesics

Tramadol Reduced blood levels with risk of therapeutic failure. Do not take with this product.

Antianginals

Ivabradine Reduced blood levels with risk of therapeutic failure. Do not take with this product.

Anti-arrhythmics

Amiodarone Reduced blood levels with risk of therapeutic failure. Do not take with this product.

Antibacterials

Erythromycin, clarithromycin, telithromycin Reduced blood levels with risk of therapeutic failure. Do not take with this product.

Anticoagulants

warfarin, acenocoumarol Reduced anticoagulant effect and need for increased dose Do not take with this product.

Antidepressants

Tricyclics eg.

amitriptyline, clomipramine

MAOIs eg.

moclobemide

SSRIs eg.

citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline

Others eg.

duloxetine, venlafaxine

Increased serotonergic effects with increased incidence of adverse reactions. Do not take with this product.

Antiepileptics

All drugs in this class including:

carbamazepine

phenobarbitone

phenytoin

primidone

sodium valproate

Reduced blood levels with increased risk of frequency and severity of seizures. Do not take with this product.

Antifungals

itraconazole, voriconazole Reduced blood levels with risk of therapeutic failure. Do not take with this product.

Antimalarials

artemether

lumefantrine

Reduced blood levels with risk of therapeutic failure. Do not take with this product.

Anti-parkinsons

rasagiline Reduced blood levels with risk of therapeutic failure. Do not take with this product.

Antipsychotics

aripiprazole Reduced blood levels with risk of therapeutic failure. Do not take with this product.

Antivirals

HIV protease inhibitors:

amprenavir, atazanavir, darunavir, fosamprenavir, indinavir, lopinavir, nelfinavir, ritonavir, saquinavir, tipranavir

Reduced blood levels with possible loss of HIV suppression. Do not take with this product.
HIV non-nucleoside reverse transcriptase inhibitors:

efavirenz, nevirapine, delavirdine

Reduced blood levels with possible loss of HIV suppression Do not take with this product.

Anxiolytics

buspirone Increased serotonergic effects with increased incidence of adverse reactions. Do not take with this product.

Aprepitant

Reduced blood levels with risk of therapeutic failure. Do not take with this product.

Barbiturates

butobarbital, phenobarbital Reduced blood levels with risk of therapeutic failure. Do not take with this product.

Calcium channel blockers

amlodipine,nifedipine verapamil, felodipine Reduced blood levels with risk of therapeutic failure. Do not take with this product.

Cardiac glycosides

digoxin Reduced blood levels and loss of control of heart rhythm or heart failure. Do not take with this product.

CNS Stimulants

methyl phenidate Reduced blood levels with risk of therapeutic failure. Do not take with this product.

Cytotoxics

irinotecan, dasatinib, erlotinib, imatinib, sorafenib, sunitinib, etoposide, mitotane Reduced blood levels with risk of therapeutic failure. Do not take with this product.

Hormonal contraceptives

Oral contraceptives

Emergency Hormonal Contraception

Hormonal implants, injections

Transdermal patches, creams etc.

Intra-uterine devices with hormones

Reduced blood levels with risk of unintended pregnancy and breakthrough bleeding. Do not take with this product.

Hormone Replacement Therapy

Hormone Replacement

Therapy:

Oral

Trandermal patches, gels

Vaginal rings

Reduced blood levels with risk of therapeutic failure. Do not take with this product.

Hormone antagonists

exemestane Reduced blood levels with risk of therapeutic failure. Do not take with this product.

Diuretics

eplerenone Reduced blood levels with risk of therapeutic failure. Do not take with this product.

5HT agonists

almotriptan,eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan and zolmitriptan Increased serotonergic effects with increased incidence of adverse reactions. Do not take with this product.

Immunosuppressants

ciclosporin, tacrolimus Reduced blood levels with risk of transplant rejection. Do not take with this product.

Lipid regulating drugs

simvastatin, atorvastatin Reduced blood levels with risk of therapeutic failure. Do not take with this product.

Lithium

Reduced blood levels with risk of therapeutic failure. Do not take with this product.

Proton pump inhibitors

lansoprazole, omeprazole Reduced blood levels with risk of therapeutic failure. Do not take with this product.

Theophylline

Reduced blood levels and loss of control of asthma or chronic airflow limitation. Do not take with this product.

Thyroid hormones

thyroxine Reduced blood levels with risk of therapeutic failure. Do not take with this product.

Oral hypoglycaemic drugs

gliclazide Reduced blood levels with risk of therapeutic failure. Do not take with this product.

4.6 Fertility, pregnancy and lactation

The safety of this product during pregnancy and lactation has not been established. In the absence of sufficient data the use during pregnancy and lactation is not recommended.

Additionally because of the potential for Black cohosh to have hormone-like actions, the use by women who could become pregnant is not recommended unless contraception is used.

No studies on the effects on fertility have been performed.

4.7 Effects on ability to drive and use machines

No studies on the effect on the ability to drive and use machines have been performed.

4.8 Undesirable effects

Gastrointestinal disorders (e.g. dyspepsia, anorexia, nausea, diarrhea, constipation); allergic skin reactions (e.g. rash, urticaria, pruritis); fatigue and restlessness may occur. The frequency is not known.

Fair-skinned individuals may react with intensified sunburn-like symptoms under intense sunlight or strong ultra-violet (UV) irradiation.

Other adverse reactions that have been reported in the literature with products containing Black cohosh include facial oedema, and peripheral oedema, and weight gain.

Other adverse reactions that have been reported in the literature with products containing St John’s wort include headaches, neuropathy, anxiety, dizziness and mania.

In rare cases, Black cohosh containing products may cause liver reactions (including hepatitis, jaundice and disturbances in liver function tests).

If other adverse reactions not mentioned above occur, a doctor or qualified healthcare practitioner should be consulted.

Reporting of suspected adverse reactions
Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continual monitoring of the benefit/risk of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via the Yellow card Scheme at www.mhra.gov.uk/yellowcard

4.9 Overdose

There are no data on human overdose with St John’s wort.

After the intake of up to 4.5 g dry extract per day for 2 weeks and additionally 15 g dry extract just before hospitalization, seizures and confusion have been reported. Where a large overdose has occurred, phototoxic reactions may occur. The skin of the patient should be protected for one to two weeks from UV irradiation and sunlight. Outdoor activities should be restricted and clothes and/or sun block preparations used to protect the skin from sunlight. Symptomatic and supportive measures should be taken as appropriate.

Older herbal texts state that doses of over 5 g of unprocessed Black Cohosh daily may produce symptoms of nausea, vomiting, dizziness, visual and nervous disturbances, reduced pulse rate and increased perspiration.

5 Pharmacological properties

5.1 Pharmacodynamic properties

Not required as per Article 16c(1)(a)(iii) of Directive 2001/83/EC as amended.

5.2 Pharmacokinetic properties

Not required as per Article 16c(1)(a)(iii) of Directive 2001/83/EC as amended.

5.3 Preclinical safety data

Reverse mutation assays (Ames test) on bacteria indicated that the product was not mutagenic in Salmonella typhimurium (strains TA 98, TA 100, TA 102, TA 1535 and TA 1537) mutation assays with or without metabolic activation. Adequate tests on reproductive toxicity have not been performed. Tests on carcinogenicity have not been performed.

Evidence from in-vitro and in-vivo pharmacological studies suggests that Cimicifuga extracts do not influence the latency or development of breast cancer. However, contradictory results have been obtained in other in-vitro experiments.

In Cimicifuga-treated (isopropanolic black cohosh extract equivalent to 40 mg of root and rhizome), tumour-bearing, female transgenic mice, the percentage of mice with detectable metastatic lung tumours at necropsy was increased compared to those on the control diet. However, in the same experimental model, no increase in primary breast tumour was seen. Influence on breast cancer or other hormone-depending tumours cannot be completely excluded.

A genotoxicity study (AMES-test) of the ethanolic extract (4.5-8.5:1, ethanol 60% (V/V)) was performed to a concentration of 1 mg/plate. The test does not fulfil the recent criteria of such testing and therefore the relevance of these results for safety assessment is doubtful.

There are no conclusive studies on carcinogenicity and reproductive toxicity.

6 Pharmaceutical particulars

6.1 List of excipients

Extract excipients

Maltodextrin

Silica colloidal anhydrous

Lactose monohydrate

Cellulose, powdered

Tablet core

Silica, colloidal anhydrous

Cellulose, microcrystalline

Croscarmellose sodium

Sodium starch glycolate (type A)

Magnesium stearate

Tablet coating

Hypromellose

Sucrose

Talc

Calcium carbonate E170

Tragacanth

Acacia

Liquid glucose (dry substance)

Titanium dioxide E171

Iron oxide hydrate E172 (= yellow iron oxide)

Vanillin

Capol 600 solids

consist of Beeswax, white

Carnauba wax

Shellac

6.2 Incompatibilities

Not applicable

6.3 Shelf life

3 years

6.4 Special precautions for storage

Do not store above 25°C. Store in the original packaging

6.5 Nature and contents of container

Original packages contain 28, 30, 56 and 60 Menomood Menopause Mood Relief coated tablets. Not all pack sizes may be marketed. Also original packages containing 30 Holland & Barrett Menopause Mood Relief coated tablets.

The coated tablets are packed in PVC/ PVDC aluminium blisters and inserted into a carton together with the package leaflet.

6.6 Special precautions for disposal

No special requirements

7 Registration holder

Schwabe Pharma (UK) Limited

Alexander House

Mere Park

Dedmere Road

Marlow

Buckinghamshire

SL7 1PD

8 Marketing authorisation number

THR 23056/0013

9 Date of first authorisation/renewal of the authorisation

05/06/2017

10 Date of Revision of the text

05/06/2017

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