ࡱ> twsW '.bjbjɺ 4Rأeأe$2jD D 8%|`l(M$M$M$kkkkkkk$ nplM$+$"M$M$M$l&l***M$T8(k*M$k***Ds%X*k0l0`l*q%q**q{/P<M$M$*M$M$M$M$M$ll(VM$M$M$`lM$M$M$M$qM$M$M$M$M$M$M$M$M$D O: Fencino (fentanyl) 12 micrograms/hour, 25 micrograms/hour, 50 micrograms/hour, 75 micrograms/hour and 100 micrograms/hour Transdermal Patches Prescribing Information See Summary of Product Characteristics (SPC) before prescribing. Presentation: Transdermal patches of varying sizes releasing 12.5, 25, 50, 75 or 100 micrograms (mcg) of fentanyl per hour. Indication: Adults: Severe chronic pain that requires continuous long-term opioid administration. Children over 2 years old: Long term management of severe chronic pain in children who are receiving opioid therapy. Dosage and Administration: Use the lowest effective dose and individualise the dose based upon the status of the patient and assess at regular intervals after application. Adults: See SPC for guidance on converting opioid-tolerant patients from oral or parenteral opioids to Fencino. Opioid-nave patients: Not recommended; consider alternative routes of administration (oral, parenteral). If Fencino is the only appropriate treatment option, only the lowest starting dose (12 mcg/h) should be considered and the patient must be closely monitored because of the potential for developing serious or life-threatening hypoventilation. Dose titration and maintenance therapy: Replace patch every 72 hours. Individually titrate the dose using increments of 12 or 25 mcg/hr until a balance between analgesic efficacy and tolerability is attained. It may take up to 6 days for the patient to reach equilibrium on the new dose level. Patients should wear the higher dose through two 72-hour applications before increasing the dose further. Use supplemental doses of a short acting analgesic to help with breakthrough pain. See SPC for guidance when the patch falls off or if the analgesia is insufficient during the first application only. Discontinuation: Replacement with other opioids should be gradual, starting at a low dose and increasing slowly. It may take 20 hours or more for the fentanyl serum concentrations to decrease by 50%. Some patients may experience opioid withdrawal syndrome after conversion or dose adjustment. Special populations: Elderly or patients with renal or hepatic impairment: Observe carefully and individualise dosing according to patient status. Children 16 years and above: Use adult dosage. Children 2 to 16 years old: Only use in children already receiving at least 30 mg oral morphine equivalents per day. See SPC for conversion guide and for dose titration and maintenance. Children below 2 years: Do not use due to lack of data. See SPC. Method of administration: Apply the patch to non-irritated and non-irradiated skin on a flat surface of the torso or upper arms. In young children, apply the patch on the upper back. Change the patch application site and allow several days to elapse before applying to the same skin area. Contra-indications: Hypersensitivity to fentanyl, peanut, soya or to any of the excipients of the transdermal patch. Acute or post-operative pain. Severe respiratory depression. Precautions and Warnings: Patients who have experienced serious adverse events should be monitored for at least 24 hours after removal of the patch due to the long serum half-life of fentanyl (20 27 hours). Keep out of sight and reach of children both before and after use as fentanyl can be fatal to a child. In opioid-nave patients, very rare cases of significant respiratory depression and/or fatality have been observed, especially in non-cancer pain. Some patients may experience significant respiratory depression with Fencino which persists beyond the removal of the patch and has a higher incidence as the dose is increased. Central Nervous System (CNS) depressants may increase the respiratory depression. Concomitant use with sedative medicines (benzodiazepines or related drugs) may result in sedation, respiratory depression, coma or death. If concomitant use is necessary, advice patients and caregivers to be aware of these symptoms. Fentanyl and other opioids may decrease respiratory drive and increase airway resistance in patients with chronic obstructive or other pulmonary disease. Be aware of the potential to abuse fentanyl and that tolerance, physical and psychological dependence may develop with repeated use. Use with caution in patients with brain tumours or those susceptible to the intracranial effects of CO2 retention (raised intracranial pressure, impaired consciousness, or coma). Use with caution in patients with bradyarrhythmias. Correct any underlying symptomatic hypotension and/or hypovolaemia before starting fentanyl. Hepatic impairment increases the risk of toxicity, so consider a dose reduction. Use cautiously in renal impairment because of a lack of PK data in this patient population. A rise in skin temperature due to fever or other heat source (advise patients to avoid these) may result in overdose or death due to increased fentanyl concentration. Life-threatening serotonin syndrome may occur if used with Selective Serotonin Re-uptake Inhibitors (SSRIs), Serotonin Norepinephrine Re-uptake Inhibitors (SNRIs), Monoamine Oxidase Inhibitor (MAOIs) and if suspected, Fencino should be discontinued. Avoid concomitant use with CYP3A4 inhibitors because this may increase fentanyl concentrations that could lead to serious respiratory depression. See SPC for more information. Sharing beds etc. may result in accidental patch transfer and overdose in a non-patch wearer (e.g. child). Observe elderly patients for signs of fentanyl toxicity as they may have reduced clearance. Fentanyl has a constipating effect and the use of a prophylactic laxative should be considered. Stop treatment if paralytic ileus is present or suspected. Use with caution in patients with myasthenia gravis as non-epileptic (myo)clonic reactions can occur. The concomitant use of buprenorphine, nalbuphine or pentazocine is not recommended. In children, guard against accidental ingestion and monitor the adhesion of the patch closely. Interactions: Refer to SPC for full details. Centrally-acting medicinal products (opioids, sedatives, hypnotics, general anaesthetics, phenothiazines, tranquilisers, sedating antihistamines, skeletal muscle relaxants) and alcohol: Concomitant use may produce additive depressant effects; hypoventilation, hypotension, profound sedation, coma or death may occur. MAOIs: Concomitant administration not recommended. Fencino should not be used within 14 days after discontinuation of treatment with MAOIs. Sedative medicines such as benzodiazepines or related drugs: Risk of additive CNS depressant effect that could lead to death. Limit the dose and duration of concomitant use. Serotonergic medicinal products: Concomitant use with SSRIs, SNRIs and MAOIs increases the risk of life-threatening serotonin syndrome. Concomitant use of mixed opioid agonists/antagonists: The concomitant use of buprenorphine, nalbuphine or pentazocine is not recommended. CYP3A4 Inhibitors: Concomitant use not recommended (risk of overdose/death), unless the patient is closely monitored. CYP3A4 Inducers: May reduce efficacy of fentanyl. Use with caution and careful monitoring. Paediatric population: Interaction studies have only been performed in adults. Fertility, Pregnancy and Lactation: Fertility: No clinical data. Pregnancy: Lack of data. Do not use unless necessary and be aware of the potential to cause respiratory depression in the newborn infant. Lactation: Fentanyl is excreted into human milk and may cause sedation/respiratory depression in a breastfed infant. Breastfeeding should be discontinued during treatment with Fencino and for at least 72 hours after removal of the patch. Effects on ability to drive and use machines: Fencino may impair the ability to drive or operate machinery. Undesirable effects: Based on data from 11 clinical studies with 1565 adult and 289 paediatric subjects and from post-marketing experience, the following adverse reactions were reported: Very Common (> 1/10): somnolence, dizziness, headache, nausea, vomiting and constipation. Common (> 1/100 to <1/10): hypersensitivity, anorexia, insomnia, depression, anxiety, confusional state, hallucination, tremor, paraesthesia, vertigo, palpitations, tachycardia, hypertension, dyspnoea, diarrhoea, dry mouth, abdominal pain, abdominal pain upper, dyspepsia, hyperhidrosis, pruritus, rash, erythema, muscle spasms, urinary retention, fatigue, peripheral oedema, asthenia, malaise, feeling cold. See SPC for other side effects. Overdose: Respiratory depression is the most serious effect of fentanyl overdose. See SPC for management guidance including the use of an opioid antagonist such as naloxone. Marketing Authorisation Number and Basic NHS Price: Fencino 12 micrograms/hour PL 01883/0313 (5 patches: 8.46); Fencino 25 micrograms/hour PL 01883/0314 (5 patches: 12.10); Fencino 50 micrograms/hour PL 01883/0315 (5 patches: 22.62); Fencino 75 micrograms/hour PL 01883/0316 (5 patches: 31.54); Fencino 100 micrograms/hour PL 01883/0317 (5 patches: 38.88). Marketing Authorisation Holder: Macarthys Laboratories Ltd T/A Martindale Pharma, Bampton Road, Harold Hill, Romford, Essex, RM3 8UG, United Kingdom. Legal Category: POM CD. Further information: Martindale Pharma, Bampton Road, Romford, RM3 8UG. Tel: 01277 266 600. Date of Preparation: March 2019.      Page  PAGE 3 of  NUMPAGES 3 Adverse events should be reported. Reporting forms and information can be found at  HYPERLINK "http://www.mhra.gov.uk/yellowcard" www.mhra.gov.uk/yellowcard. Adverse events should also be reported to Martindale Pharma, an Ethypharm Group Company. Tel: 01277 266 600 e-mail:  HYPERLINK "mailto:drugsafety.uk@ethypharm.com" drugsafety.uk@ethypharm.com  {& ' ) + - / 1 3 5 7 ; < I zslhshshshaZ hh" hP h"h? hP hM hP h?hP hP B*mH phsH h V hP hUhP hU5hP h15B*phhP h15hP h!Z5hP hM5hP hi+5 hi+5hhM5 hh15B*mH phsH hh15hhN$5hh"5",,,,,,,,,,,,,,,,$.%. $7$8$H$a$gd2W$a$gd;e $7$8$H$a$gd2W $a$gd*%3$a$gd4$a$gdI O d e f p q r y z { < = C V W Y ĸˌ}un_SIhh_56h VB*mH phsH hh!B*mH phsH hh?hh5hhB*mH phsH hP 56 hh1hhP B*mH phsH hhXGB*mH phsH hP B*mH phsH hhXGhh"56hh15hhU5hhM5h%Qh V hh"h&  . X Y Z o q s 6 ; ` q ~ ʶzzk_SSDhhB*mH phsH h&B*mH phsH h\B*mH phsH hh)B*mH phsH h VB*mH phsH hhu}B*mH phsH hhOB*mH phsH #hh6B*]mH phsH &hhu}6>*B*]mH phsH #h%Qh&6B*]mH phsH h%Qh&B*]mH phsH h?Dh&h V hh_    =  !"567JLTfƺ{ƟococR h\6>*B*]mH phsH h-B*mH phsH h?B*mH phsH h%QB*mH phsH hB*mH phsH h&B*mH phsH h\B*mH phsH hhz@B*mH phsH hM-B*mH phsH #hhz@6B*]mH phsH &hh6>*B*]mH phsH &hhz@6>*B*]mH phsH fkmǵm\K:) hJh?B*]mH phsH hJhz@B*]mH phsH hJhB*]mH phsH h6>*B*]mH phsH )h)hh\h\6B*]mH phsH h?B*mH phsH h5B*mH phsH hhz@B*mH phsH h\B*mH phsH #hhz@6B*]mH phsH &hh6>*B*]mH phsH h\6>*B*]mH phsH &hh\6>*B*]mH phsH En ͻᯣᑯvdSGvGvvGvh~G,B*mH phsH hh6B*mH phsH #hh6>*B*mH phsH hhB*mH phsH h%QB*mH phsH #hJh?6>*B*mH phsH h0vB*mH phsH h?B*mH phsH #hh6B*]mH phsH &hhz@6>*B*]mH phsH hhz@B*mH phsH hJhz@B*mH phsH (=EOj[H`cd! 轰xpxpxh`h`hXKXh%QhB*H*phhB*phhJB*phhSSB*phh?DB*phh0vB*phh`h0vB*phh`hD@B*phh`hD@5B*phh`hU5B*phh`hSN5B*phhhSN5 hhSN hh hh% hhk[ hhihhU5hhB*mH phsH C  rsĵvkW&hJhO6>*B*]mH phsH hJhEB*phhJhE5B*phhJh`JB*phhJhUB*phhJhU5B*phhJh%QB*mH phsH hJhpeB*mH phsH hJhpeB*phhJhJB*phhJhJB*mH phsH hJhB*phhJhB*phM Z [ k !j!!!!"ɺئteWK<0h_bCB*mH phsH h4h4B*mH phsH h4h46mH sH h}h46>*mH sH h`hOB*mH phsH hJhOB*mH phsH #hJhO6B*]mH phsH hJhOB*]mH phsH &hJhV6>*B*]mH phsH hJh_bCB*mH phsH hJhezB*mH phsH &hJhO6>*B*]mH phsH &hJh_bC6>*B*]mH phsH "8":"""""+#<#=#?#N#]#v#x########Ϳ۰잍ufUG;uhjB*mH phsH hVB*]mH phsH h`h`JB*]mH phsH h`hezB*mH phsH hVB*mH phsH hezB*mH phsH h`h#B*]mH phsH #h`h#6B*]mH phsH h`hOB*mH phsH h%QB*]mH phsH h_bCB*]mH phsH h`hOB*]mH phsH &h`hO6>*B*]mH phsH ##$$K$n$o$p$y${$|$$$$%%!%&3&4&s&&.';'<'C'D'c'd''yqdVdqOKOh E hh Eh%Qh E6>*B*phh%Qh E6B*phh EB*phhh/>55B*\phh%QB*mH phsH hVB*mH phsH hmB*mH phsH h`h`JB*phh`h%HB*phh`h%H5B*\phh`hOB*mH phsH #h`h`J6>*B*mH phsH h`h`JB*mH phsH '''''''''h(()!)@)A)J)L)))))) * *$*%*-*?*@*C*M*j*öung`Y h)hi+ h)h*%3 h,h*%3 h,hi+h,hi+B*mH phsH hahi+hah%Q5B*phhOB*phh%QhOB*phhO5B*phhahi+5B*phh EB*ph hh  hh5 hh7h%Qh E6h%Qh,*6h%Qh 6h%Qh Ej*|*}*******++++$+%+'+7+;+Q+R+S+T+V+Y+[+s+z+{++++++uhd]S]ShQdzh*%30J5 h*%30J5h*%3hh2W5B*phhi+hi+5B*phhh2WB*ph h<hi+hi+B*mH phsH hxphi+B*mH phsH hxphi+hi+ hhi+ hi+hi+ h\hi+h\hi+B*mH phsH h%Q htzkhi+ h)hi+h)hi+B*mH phsH +++, ,,[,\,_,`,e,y,z,,,,,,,,,,,,,,,,,,,,,,ƾֳ||||uh`hUhQ\mHnHuh;eh3\jh;eh3U\ h;eh3hjhU hh2Whh2WB*ph jhh2WUmHnHuh*%3h*%3\h%Qh2WB*phhi+B*phh%QB*phh*%3B*phhh2WB*phhh2W5B*ph h*%30J5h<h*%30J5!,,,,,,,,,,,--?-@-Z-[--------..!.".#.$.%.&.'.ʿʿʥʝʿ| hh2Wh2Whi+h2WB*phhi+h2WB*phh%Qhvn8hpjhi+h2W0JUhi+h2W0Jjhi+h2WU hi+h2Whh3hQ\mHnHuh;eh3\ h;eh3jh;eh3U\ %.&.'.$a$gd21h:pO. A!"#$o% "w002 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@6666_HmH nH sH tH @`@ NormalCJ_HaJmH sH tH DA D Default Paragraph FontRiR  Table Normal4 l4a (k (No List >> 6oTextdCJaJmHsHtHB/B 6o Text ZchnCJ_HaJmHsHtH:: kOption 8^8 B*phj#j !Z Table Grid7:V00U`10 !Z Hyperlink>*B*B' AB !ZComment ReferenceCJaJ<R< !Z Comment TextCJaJ:a: !ZComment Text CharLjQRL !ZComment Subject5\mHsHtHF/F !ZComment Subject Char5\PP !Z Balloon TextCJOJQJaJmHsHtHN/N !ZBalloon Text CharCJOJQJ^JaJ<o< _0 Standard Fett 5\^J@@ ;eHeader  B# mHsHtH6/6 ;e Header CharCJaJ@ @@ ;e0Footer  B# mHsHtH6/6 ;e0 Footer CharCJaJ8^@8 u}0 Normal (Web) V/V 4Default !7$8$H$!B*CJ_HaJmHphsHtHPK![Content_Types].xmlN0EH-J@%ǎǢ|ș$زULTB l,3;rØJB+$G]7O٭VGRU1a$N% ʣꂣKЛjVkUDRKQj/dR*SxMPsʧJ5$4vq^WCʽ D{>̳`3REB=꽻Ut Qy@֐\.X7<:+& 0h @>nƭBVqu ѡ{5kP?O&Cנ Aw0kPo۵(h[5($=CVs]mY2zw`nKDC]j%KXK 'P@$I=Y%C%gx'$!V(ekڤք'Qt!x7xbJ7 o߼W_y|nʒ;Fido/_1z/L?>o_;9:33`=—S,FĔ觑@)R8elmEv|!ո/,Ә%qh|'1:`ij.̳u'k CZ^WcK0'E8S߱sˮdΙ`K}A"NșM1I/AeހQתGF@A~eh-QR9C 5 ~d"9 0exp<^!͸~J7䒜t L䈝c\)Ic8E&]Sf~@Aw?'r3Ȱ&2@7k}̬naWJ}N1XGVh`L%Z`=`VKb*X=z%"sI<&n| .qc:?7/N<Z*`]u-]e|aѸ¾|mH{m3CԚ .ÕnAr)[;-ݑ$$`:Ʊ>NVl%kv:Ns _OuCX=mO4m's߸d|0n;pt2e}:zOrgI( 'B='8\L`"Ǚ 4F+8JI$rՑVLvVxNN";fVYx-,JfV<+k>hP!aLfh:HHX WQXt,:JU{,Z BpB)sֻڙӇiE4(=U\.O. +x"aMB[F7x"ytѫиK-zz>F>75eo5C9Z%c7ܼ%6M2ˊ 9B" N "1(IzZ~>Yr]H+9pd\4n(Kg\V$=]B,lוDA=eX)Ly5ot e㈮bW3gp : j$/g*QjZTa!e9#i5*j5ö fE`514g{7vnO(^ ,j~V9;kvv"adV݊oTAn7jah+y^@ARhW.GMuO "/e5[s󿬅`Z'WfPt~f}kA'0z|>ܙ|Uw{@՘tAm'`4T֠2j ۣhvWwA9 ZNU+Awvhv36V`^PK! ѐ'theme/theme/_rels/themeManager.xml.relsM 0wooӺ&݈Э5 6?$Q ,.aic21h:qm@RN;d`o7gK(M&$R(.1r'JЊT8V"AȻHu}|$b{P8g/]QAsم(#L[PK-![Content_Types].xmlPK-!֧6 0_rels/.relsPK-!kytheme/theme/themeManager.xmlPK-!g theme/theme/theme1.xmlPK-! ѐ' theme/theme/_rels/themeManager.xml.relsPK] i'&il'&R 1114I f"#'j*+,'. !"#$%&'%.'.(+-4!SIelXX48@{(  C  F?"Text Box 2s"Ï?PK!8[Content_Types].xmlAN0EH%N@%邴K@`dOdlyLhoDX3'AL:*/@X*eRp208J妾)G,R}Q)=HiҺ0BL):T뢸WQDY;d]6O&8* VCLj"󃒝 yJ.;[wIC_ :{IOA !>Ø4 p;fɑ3׶Vc.ӵn(&poPK!8! _rels/.relsj0 }qN/k؊c[F232zQLZ%R6zPT]( LJ[ۑ̱j,Z˫fLV:*f"N.]m@= 7LuP[i?T;GI4Ew=}3b9`5YCƵkρؖ9#ۄo~e?zrPK!.3$Gdrs/e2oDoc.xmlSn0 }I41]  hY6I}(Ͳ0=H琛^Ir K:pL-Vi4/fŦȚ; -i-̳+cFgc;dѕfy:j ۄ4My [HK{li?d@h uщߠ`xӄ 3*3M#O5`5jZ<Ղx{?XQ*DBykӓY䧳k9a_[Lr1i|]<p|oL"yHAtMLb\Vbju>Fx(C<}@Fz/L;T; Qi?IM_!DBtu"Fש91eG"#wQOH3Cg$5%vuI#8N|Qt>czT J(F'foQHFL\[dqSԏ~PK!Nt6drs/downrev.xmlLn0DHzAI*MSOnm5^@n{HYͼ)֣})H ڙ D+XIs.s!rqȥ uVvȧoᶗY,qCܴXT'`yg_fFva6R+c=>CLw"Deo񌃂,KSe!_PK-!8[Content_Types].xmlPK-!8! /_rels/.relsPK-!.3$G.drs/e2oDoc.xmlPK-!Nt6~drs/downrev.xmlPK B S  ?$'&7%tQX;= }& 4;%","b"i"""""###{##$$$$$$$$$$$%&(&$$$$$$$$$$$$%&(&++efrryy.XXZZE E ) ) H`cd  rsvv;;A!A!!!!! " """""##z$$$$$$$$$$$%%%%%%%%%%(&++efrryy.XXZZE E ) ) H`cd  rsvv;;A!A!!!!! " """""##z$$$%%%%%%%%(&Lt:8}Xi _:<ea { x*OcWxN%CYLQ%0Tj<eayqRlC{vHY@?[ %zmS-"`&YZ" YLQ%0qh'ea*("Pj ~(!VgVX,/lT-8JV.v)`z1Te;f2kX>:2p=^ E4ld58JV.hR9x* _:&""wASe;lTe;kOTj<& Mj=z(ip=mR>|QkX>N%CY@?*(7?ea.CvHOofU;HW3+5IKSJ$iWxHrL& MHrLkOVX,,alQ|Q.CyqRT-^RkGBxKSld5OofUJWz1tX`&YZ"v)`:2wcf2!Vgz(it:"PjtX/l ~(Rk8leam %zmASe;#r3+5I&""w[ kGBxe {OcWxuLx$iWxR>uLxj=e {3|3|S-"8},alQ(~eaC^ E4 .=jG6S[\_efDm#l7"75EuI5c;dgs $2?PVX]ddM g"|&v'))/g4:C;oAPHJqPP&em_f:'N'*/H/29ELgSZ_dozC 3t:=>R?9EiIWK[cd[jr]t uj!#-6@8W< $&&o'4t?EL?Z~^dSdYffh-vw#3e?I]ko s {u|  s C  ), 60 ]0 3 3 7 18 U T_ c k +m n w w z V|  ! 1 3 ^ e j hr u z F  @   P> I 'K K P T W V^ b >c "g u i{ }  W 4 I d Tg Qs Gu ]v y  k  " W+ ; > )H VH S h lk  Q8RB[`hkrK ZT&1ALWl~ :%f%)*4>MzUW]nyw)% 3$"`',<E3M(`LqqSb V6AB!MQMQTVoYO]idsd p,,.141ENOiUbcth.]>DNPOSaUh~a5(U26= ?Q@Da2qmq0v v#$%/4<V= CIyKOTR]caejM  "&(.1EDpGI4LMHTWfginjo Wh(:QfTZXfddj z6A#D$)@akrU   v!"+.02::CDKMraa~.m -5IJXU+Vd 3j7C:MSN~VWwh`jqruw4 0]24=@DxEUub{ %**9{HMV]pt} M[& ):/024_5eTVX ^bgevhirk   j2 m s } !!!v*!W5!B!ID!G!J!4W!a!a!p!q!" "F"""'"]7"]:"K"R"qS"sT"Z"g"xr""#(#07#K#X#Y#\#g]#~]#]#^#g#u#x#j|#v|#%$N$$O$$$($/$o9$<$M$N$O$b$n$u$x % %%0%8%b%%% %W.%/%T>%D%cF%zk%k%o%t%w%sx%x%z%G& & &G&&*&9&|D&N&O&W&d&e&g&gk&k&fw&F~& '7'' '5'8'/H'H'r'((($(,(-(/2(4(6(:(B(>F(J(P(^(b(e(>g(m(o(q(w(3>3JB3C3D3I3#\3xc3l3q3q44n"4r"4X)4e,404<4D>4.E4J4M4N4PR4T4_]4 ^4b4o4rx4a~45 5(535d95:5/>5^P5m5Xo56 6666 6%6 )6+6?,616z36=6B6Z6Z6X^6a6Wk6 7?7777H#7%7>376787_>7D7gQ7U7W7n7t7w7}7%828>8?8Z8[8vn8x8|8999Z9'9+9<9F9I9 T9]V9p9u9!: :: :%:%: *: 3:!;:Y:5[:ch:h:!j:l:m:o:`u:jy: ;);5;7;N;u];k;q;x;};;@< <<'<*<-<i.<10<3<8<?<A<D<F<HJ<0\<\<bg<n<"v<=(=g.=6=7>=#S=y=y= >P>P > > >>X)>,>N>N>Y>h>i>\n>mn>A?$?z-?.?+o?v}?}?p@:@X@@!@m"@)@,@-@#.@D@F@MQM=\McM3MNNNN%N*N/N 6NFNHNSNeNvNyNjO OOO#O^5O5O?OEOPOXOaO mOmOpOqOvO]"Pp)P-P{1PC3P5PFPIPQPWPUXPYP]PgPfiPnPnPeoP{PqQ"Q%Qm(Q;Q;Q=Q>Q?Q?Q~DQXHQWKQMQ iQR7 R0 RC RR RgR5)R7.R0R CRFRIR(KR NRWR]eR_jRSKSS0S6SCHSOSSSXS+_SgSskSIpSqSnxS|S- T, TT)!T*T!4T9TOCTDTOTUTC]TXaTU+#U-Ut5U=UEU*FUylUsUuUVdV" VV=V*V:2V>VSZV}hVmVpV|VVrWWWW2WRGWNWWWKhWlWpWPXxXXLFXCKXNX#PXQXZRXWX \XWpX{X|X^8YR9YoFY2GYFJYNPY ZjZ!Z=ZCZxDZFZ IZLZ,SZhYZecZhZZmZoZjzZ}Z3Z [<[[![Y3[4[7[<[,>[>?[L[Mf[k[\( \b\\#\)\4\Q4\N\yR\pS\T\IU\^U\W\\\\\;^\g\3o\q\:s\9w\{\J]]R]\]]!]$]Z+]4]WB]%H]I]!P]^]e`]g]r]>^ ^y^!^-^4^J^J^]^Sc^w^&_ ;_!=_S_AT_T_^Y_q__,f_f_g_i_i_i_Dw_,x_`k`y*`6K`wK`Q`S`Y`db`{`|`ata aaa@aCaGaHaHaeMa`aba7maY}a~a~abba bbb "b<;b>bHbObRbWbdbArbub)zbc cc c 5cCcXcZc[c*]cxic~xc d~ddCd)d;d=dOVdKddrdydeee#e;e8MeMeTe XeaeAse ffzff15fO7f;fUfsfStfMyfcgg5g gV$g-gEDgSg[gbgcg8jgkgflgqg~ghhGhRhhhhXh:h!h)h.h2hr6h9hll l_lgl/l:lD=l?l~@lBlDlGlLl`lalelilkulmmmmmmmmYmymm4(m>*m4m6m6m6m~8mBmTm0mmRsmtm;wm#n n|nnnn,n^LnYnqnnznn$oa"o-BoJoYofgorgokowo%yow~opqp5#p'p3p;p?p]p^pgpkprp qqq:qKq\q~qrr+rv@r_IrJrTr^r`crdr hr)trurss)s.s0s1s=s tDt"tH#t&t4,t /t6tK9t_9t=t0[tPct)dtlgtgtjtututul)uK^u{ausuvvvvv!v 1v>vDvJv#_vuvwwwwhwwVw w&ws+wz,w>w%?wuDwDwLwfwuw}~wx x3xxxx? x"x/x3xA4xA8xKHxcIxMxQxFSxbxexnxyVyy y*yyyayy y yS#y&y'y1y3yk4y7y7y<8yPyqyvy]zzz zzEzVzz z*'zT,z6z:z|C| O|R|j|y|~|`}}#}//}1}2}]7};O}ba}e}u} ~~~&~5~$:~I~WO~T~aa~o~Wt~t~|~  `d*9HW>dgd k!!!"%C-.18@@ BsCNWYmoz|M~`(90<IBzMQTRkTmqoraw9 8 S!"00q8C_FNN4RWe>m %uHTX^cf`ffhort S&;>NMQRgTU[]fq2 ()+/9nDGV]c`fpeuvVw|)G#)m/p29e;B(dh@wwyzz|>[ _"$,3O&SWjdp^!<&?BOT`kt3] [+,45= >z>I=Lm\n`^hkay-t  `"-5_btx3 i'`*,138)=?nuu^~E .. 0 V.\%^j}#/3`LQCW^ai^$.(I-:7<DmL"]abtlln p~.b +f$%D&(g668N9TWg !,=45.DELR4_! )+M-28KiLOPVL`bc]gvx{o :/o5=@JL3Wbojnopox~ F2NV [k]l|xxOy]bc oqr Gm"n#4DEX\epuqkrwe >f/4^BO@EaNgamq2 "11ElzC -d0J(KMNyUUV9fmo~rv(}~ F.667>$A;E?NNafiGkezzw Wh!&t;NZ\:]flovz /"/5GHILh 6<FBKMhUa>mmzrvbw1 O \ 35iTY[byQI25?@_MbGu.{<|: ,*8>K@Pg]7gKuVxn[ +.88 BBO3_axxq(#/T:=A|D[GNU!^j ",#&7S8QQ^qg!iktvy'*OECKXRSU\Kelp~>bi+[8;%PUUNV]Y\or`z{=| )m+k0V9=#CD\=m{w~l %12377@;RMjsu} J a2O$:BFXGT9UkY\(e~h"sCy}"S9EIOUVbv 2?d05=>>?IPSXw^ctnRos)w~G eW-]^o8s[F"K#S-0117pAJW ^?c fThhovux4}W}~F1Z0FKZ`l9py@zj0%K|OY]^sdeCsttx9't3{AxQQSNTeXjYpeex"#'??pA2DBE0H NRRZjue [ZE!:EMBPXkv~ VS"7#(}48:>Z9iv \79?:@6HkJ`g(rHuv{  #)-.F35<OKS7W,ZW[fOlpsrtz|h=2"85/<RXfivS  (d-29;=}>?CmI^c_`jor`s"2W9;LQUZ[w^aVj^tv&y|2L),CFG%P+P1Q~RS-Ue}{{{A}n##%-8Mgi j-z)~uG&nd!"#a)-:>?W^r~xza{JK$8jOyOtQVpWEZjo*3\=@KRSTN]V_}ahmcu{{/KOzPPkSFYmtwJTU")*-?.73EX,knuBu #&h,648(@JDKMNUOPTYZrRuvx~U H 8 N!)*37>JK'OPPShdjflWz|~r :{%02*==>0@JAOVbfq~uOwy|}~ |Ag$-3>CiV4Zfgl=oFR)48<CeffmDmn~~. 689AH_JJV`mZvm =)+,Y6KZdfojpu)n 6'(1;hhm"qLOO[^h)hioqs3{ U;;=HHJNPiUj !4$:<X _c dd8dweops|N F!v$'.1,1?CLHLMPWV[__d@ily? & {8=?DR%_8bf"rrt]yyy|w +8AKKR\pt-e/D7:;c<3HmHenU%_'[126$V`d#iq tn(p++23L8BMUUY\5{~v$8s:CHjmty 5,656X[ntWM%y+7r9IJUbcdttU +D"#/2BINPQdhk.z~) " U' ,C35VZqr} l.`3Z@@RCHHS%TSY{^eepqjs l*.3U<TIOfS#[]5fixVM )"h&+<=iCgD= 5qJ [Z^T_:c6o!sdye~!&s>uBW[\b*c;d{| !)|/>OfUooqu .TTbSr*w_ s6x>fRkSWUY^i^m{{}q~p/[3<3^^_cefhNnsscxz 57=:;B7G``*a0ab&chjp 05 :I<AE)GZGHMXYo %,.Y4n:f;>KOS]jjoXtyh}F7##$28=CKdZpF}C#$*05c79 @&F%HJ]KMip8us\ !:;@Gdno j-$4567N&PYa\icoeglp[.$S+M-47(G9TUXh s5~ B$238H,^=ajmmpq5{Z P5129FaM_QjlXo.m%/<&A"G!HU^WM^jl}6 %@FH NPYghv.3`;bJ Kx} . ~c&-2<S7U%V9ccAkr;|%~ *134i8U?LM\1]&bnnysDm ;A/2G;9BCC$RYggio9 "K]"*4:KLPWf`a/g q~"'n4LS[_jnvy [b)24DD"NVgDht?v("?(6:_V\din}~} r0z8<=D:PRZ>`cmp9 - = 5>AEUKLLkq}D +9>DFSehCi$(6,1x?AIOS[``enzst "25;6>IKM\Zamfj  j .%)l59u@sT] h$$@'&@UnknownG.[x Times New Roman5Symbol3. .Cx Arial5. .[`)TahomaC.,*{$ Calibri Light7.*{$ CalibriA$BCambria Math"qh2sg2sg"s'tBtB!r4x$x$3qHX ?U2!xx YPresentation: Tablets containing 75 mg, 150 mg or 225 mg venlafaxine (as hydrochloride)Victoria Marsh Fania Bennett Oh+'0 ,< T`    \Presentation: Tablets containing 75 mg, 150 mg or 225 mg venlafaxine (as hydrochloride)Victoria MarshNormalFania Bennett2Microsoft Office Word@@ș|@4(@4(t ՜.+,D՜.+,@ hp|  "GFABx$ ZPresentation: Tablets containing 75 mg, 150 mg or 225 mg venlafaxine (as hydrochloride) Title@ 8@ _PID_HLINKSA A(#mailto:drugsafety.uk@ethypharm.com ["http://www.mhra.gov.uk/yellowcard  !"#$%&'()+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abdefghijlmnopqruvyRoot Entry FDsx@1Table*qWordDocument 4RSummaryInformation(cDocumentSummaryInformation8kMsoDataStoreppDYA2SG3IGG3==2ppItem 2PropertiesUCompObj r   F Microsoft Word 97-2003 Document MSWordDocWord.Document.89q