What Vimovo is used for and how to use it
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Vimovo - Consumer Medicine Information

Manufacture: AstraZeneca
Country: Canada
Condition: Ankylosing Spondylitis, NSAID-Induced Ulcer Prophylaxis, Osteoarthritis, Rheumatoid Arthritis
Class: Nonsteroidal anti-inflammatory agents
Form: Tablets
Ingredients: naproxen, esomeprazole, carnauba wax, croscarmellose sodium, glycerol monostearate, hypromellose, iron oxide black, iron oxide yellow, macrogols, magnesium stearate, methacrylic acid-ethyl acrylate copolymer (1:1) dispersion, methyl parahydroxybenzoate, polydextrose, polysorbate, povidone, propylene glycol, propyl parahydroxybenzoate, silica colloidal anhydrous, titanium dioxide, triethyl citrate.

(naproxen/esomeprazole)

About this medication

What the medication is used for

Your health care provider has prescribed VIMOVO for you for one or more of the following medical conditions:

  • For the treatment of the signs and symptoms of osteoarthritis, rheumatoid arthritis or ankylosing spondylitis in patients at risk of developing stomach ulcers caused by medications for pain or inflammation.

What it does

VIMOVO contains two different drugs, naproxen and esomeprazole. Each of these works in a different way.

  • Naproxen as a nonsteroidal anti-inflammatory drug (NSAID) can reduce the substances produced by your body which cause pain and swelling.
  • Esomeprazole belongs to a group of medicines called “proton pump inhibitors”. It works by reducing the amount of acid your stomach produces.
    • Naproxen can cause damage to your stomach while esomeprazole can help to reduce this damage. Your health care provider has prescribed VIMOVO for you to reduce your inflammation or pain, and reduce the risk of damage by naproxen to your stomach.

      Naproxen, the NSAID component of VIMOVO, does NOT cure your illness or prevent it from getting worse.

      VIMOVO DOES help to reduce the pain and swelling caused by your condition, while protecting your stomach.

      VIMOVO can only relieve pain and reduce swelling as long as you continue to take it.

      When it should not be used

      DO NOT TAKE VIMOVO if you have any of the following medical conditions:

      • Heart bypass surgery (planning to have or recently had)
      • Severe, uncontrolled heart failure
      • Bleeding in the brain or other bleeding disorders
      • Current pregnancy (after 28 weeks of pregnancy)
      • Currently breastfeeding (or planning to breastfeed)
      • Allergy to ASA (Acetylsalicylic Acid), other NSAIDs (Nonsteroidal Anti-Inflammatory Drugs), naproxen, esomeprazole or other ingredients of VIMOVO (seeWhat the Nonmedicinal Ingredients Are)
      • Ulcer (active)
      • Bleeding from the stomach or gut (active)
      • Inflammatory bowel disease (Crohn’s Disease or Ulcerative Colitis)
      • Liver disease (active or severe)
      • Kidney disease (severe or worsening)
      • High potassium in the blood

      Patients who took a drug in the same class as VIMOVO after a type of heart surgery (coronary artery bypass grafting (CABG)) were more likely to have heart attacks, strokes, blood clots in the leg(s) or lung(s), and infections or other complications than those who did NOT take that drug.

      VIMOVO should NOT be used in patients under 18 years of age since safety and effectiveness have NOT been established.

      What the medicinal ingredients are

      Naproxen (enteric-coated, delayed release core) and esomeprazole (as esomeprazole magnesium trihydrate, immediate release coating)

      What the nonmedicinal ingredients are

      VIMOVO contains the following nonmedicinal ingredients (listed in alphabetical order): carnauba wax, croscarmellose sodium, glycerol monostearate, hypromellose, iron oxide black, iron oxide yellow, macrogols, magnesium stearate, methacrylic acid-ethyl acrylate copolymer (1:1) dispersion, methyl parahydroxybenzoate, polydextrose, polysorbate, povidone, propylene glycol, propyl parahydroxybenzoate, silica colloidal anhydrous, titanium dioxide and triethyl citrate.

      What dosage forms it comes in

      VIMOVO is available as modified release tablets of either 375 mg naproxen/20 mg esomeprazole or 500 mg naproxen/20 mg esomeprazole (as esomeprazole magnesium trihydrate).

      VIMOVO is supplied in bottles of 60 tablets.

      Warning and precautions

      Serious Warnings and Precautions<

      If you have, or previously had, any of the following medical conditions, see your health care provider to discuss treatment options other than VIMOVO:

      • Heart Attack or Angina
      • Stroke or Mini-stroke
      • Loss of Vision
      • Current Pregnancy (less than 28 weeks)
      • Congestive Heart Failure

      Before taking this medication, tell your health care provider if you have any of the following:

      • High blood pressure
      • High cholesterol
      • Diabetes mellitus or on a low sugar diet
      • Atherosclerosis
      • Poor circulation to your extremities
      • Smoker or ex-smoker
      • Kidney disease or urine problems
      •  Previous ulcer or bleeding from the stomach or gut(small or large intestine)
      • Previous bleeding in the brain
      • Bleeding problems
      • Family history of allergy to NSAIDs, such as acetylsalicylic acid (ASA), celecoxib, diclofenac, diflunisal, etodolac, fenoprofen, flurbiprofen, ibuprofen, indomethacin, ketoprofen, ketorolac, mefenamic acid, meloxicam, nabumetone, naproxen, oxaprozin, piroxicam, rofecoxib, sulindac, tenoxicam, tiaprofenic acid, tolmetin, or valdecoxib (NOT a complete list)
      • Family history of asthma, nasal polyps, long-term swelling of the sinus (chronic sinusitis) or hives.
      • Also, before taking this medication, tell your health care provider if you are planning to get pregnant or if you are allergic to naproxen, esomeprazole or any other ingredients or components of the container.

        While taking this medication:

        • tell any other doctor, dentist, pharmacist or other health care professional that you see, that you are taking this medication, especially if you are planning to have heart surgery;
        • do NOT drink alcoholic beverages while taking this medication because you would be more likely to develop stomach problems;
        • fertility may be decreased. The use of VIMOVO is not recommended in women trying to get pregnant. In women who have difficulty conceiving, stoppingVIMOVO should be considered;
        • tell your doctor or pharmacist about symptoms that may be a sign of a more serious problem in your stomach or intestine such as: trouble swallowing, unplanned weight loss, vomiting blood or food, or black (blood-stained) stools.

        Talk to your health care provider about your risk of bone fracture if you are taking VIMOVO for a long time. People who take multiple daily doses of proton pump inhibitor medicines for a long period of time (a year or longer) may have an increased risk of fractures of the hip, wrist, or spine. You should take VIMOVO exactly as prescribed by your doctor.

        Long term use of proton pump inhibitors may prevent normal absorption of Vitamin B12 from the diet and could lead to Vitamin B12 deficiency. You should take VIMOVO exactly as prescribed by your doctor.

        Interactions whith medication

        Talk to your health care provider and pharmacist if you are taking any other medication (prescription or non-prescription) such as any of the following (NOT a complete list):

        • Acetylsalicylic Acid (ASA) or other NSAIDs (e.g. celecoxib, diclofenac, ibuprofen, indomethacin, ketorolac, meloxicam, naproxen)
        • Antacids
        • Antidepressants (Selective Serotonin Reuptake Inhibitors (SSRIs), e.g. citalopram, fluoxetine, paroxetine, sertraline)
        • Blood pressure medications (ACE (angiotensin converting enzyme) inhibitors, e.g. enalapril, lisinopril, perindopril, ramipril) or ARBs (angiotensin II receptor blockers, e.g. candesartan, irbesartan, losartan, valsartan)
        • Blood thinners (e.g. warfarin, ASA, clopidogrel)
        • Corticosteroids (including glucocorticoids e.g. prednisone)
        • Cyclosporin
        • Digoxin
        • Diuretics (e.g. furosemide, hydrochlorothiazide)
        • Erlotinib (or any other anticancer drug from the same class)
        • Lithium
        • Methotrexate
        • Oral contraceptives
        • Oral hypoglycemics (diabetes medications)
        • Tacrolimus

        Your health care provider may prescribe low-dose ASA (acetylsalicylic acid) as a blood thinner to reduce your risk of having a heart attack or stroke while you are taking VIMOVO.Take only the amount of ASA prescribed by your health care provider. The beneficial effects of VIMOVO apply whether you take ASA or not.

        Studies with esomeprazole have shown that blood levels of some drugs may be influenced if taken at the same time as drugs used to prevent fungal infections (itraconazole, ketoconazole, voriconazole), anxiety (diazepam), epilepsy (phenytoin), drugs to speed up stomach emptying (cisapride*), poor circulation in the legs (cilostazol*), heart problems (digoxin), treatment for tuberculosis (rifampin), St John’s Wort (Hypericum perforatum) or a certain type of anticancer drug (erlotinib or any other anticancer drug from the same class). However, none of these interactions have been shown to change the effectiveness of esomeprazole or the other drug.

        *not available in Canada

        Drugs used for blood clotting (warfarin or coumarin derivatives, clopidogrel) have been reported to interact with esomeprazole. Speak to your doctor or pharmacist if you are taking any of these drugs as monitoring may be required when you start or stop taking VIMOVO. Use of VIMOVO with clopidogrel should be avoided.

        Esomeprazole may decrease the effectiveness of some drugs used for HIV treatment; atazanavir and nelfinavir should not be used with VIMOVO.

        Proper use of this medication

        USUAL DOSE (18 years and older):

        Medical ConditionRecommended (and
        Maximum) Dose per day
        Osteoarthritis
        or
        Rheumatoid Arthritis
        or
        Ankylosing Spondylitis
        375/20 mg twice a day
        or
        500/20 mg twice a day

        Take VIMOVO only as directed by your health care provider. Do NOT take more of it, do NOT take it more often and do NOT take it for a longer period of time than your health care provider recommended. If possible, you should take the lowest dose of thismedication for the shortest time period. Taking too much VIMOVO may increase your chances of unwanted and sometimes dangerous side effects, especially if you are elderly, have other diseases or take other medications.

        This medication has been prescribed specifically for you. Do NOT give it to anyone else. It may harm them, even if their symptoms seem to be similar to yours.

        VIMOVO is NOT recommended for use in patients under 18 years of age since safety and effectiveness have NOT been established.

        Administration

        VIMOVO should be taken at least 30 minutes before a meal. The tablets should be swallowed whole with water. Do not chew, split or crush them.

        Missed dose:

        If you miss a dose of VIMOVO, take the dose as soon as possible. Then go back to your regular schedule. If you remember your missed dose close to the time of your next dose, do not take the missed dose. Do not double dose. Just take the next dose on time.

        Overdose:

        In case of drug overdose, contact a health care practitioner, hospital emergency department or regional Poison Control Centre immediately, even if there are no symptoms.

        Side effects and what to do about them

        VIMOVO may cause some side effects, especially when used for a long time or in large doses. When these side effects occur, you may require medical attention. Report all symptoms or side effects to your health care provider.

        VIMOVO may cause you to become drowsy or tired. Be careful about driving or participating in activities that require you to be alert. If you become drowsy, dizzy or light-headed after taking VIMOVO, do NOT drive or operate machinery.

        VIMOVO may cause you to become more sensitive to sunlight. Any exposure to sunlight or sunlamps may cause sunburn, skin blisters, skin rash, redness, itching or discolouration, or vision changes. If you have a reaction from the sun, check with your health care provider.

        Check with your health care provider IMMEDIATELY if you develop chills, fever, muscle aches or pains, or other flu-like symptoms, especially if they occur before or together with a skin rash. These symptoms may be the first signs of a SERIOUS ALLERGIC REACTION to this medication.

        Sertous side effects of Nsaids, and what to do about them

        SymptomSTOP taking
        VIMOVO and
        get emergency
        medical attention
        IMMEDIATELY
        STOP taking
        VIMOVO
        and talk
        to your
        physician or
        pharmacist
        Blurred vision, or any visual disturbance
        Any change in the amount or colour of your urine (red or brown)
        Any pain or difficulty experienced while urinating
        Swelling of the feet, lower legs; weight gain
        Vomiting or persistent indigestion, nausea, stomach pain or diarrhea
        Yellow discolouration of the skin or eyes, with or without itchy skin
        Malaise, fatigue, loss of appetite
        Headaches, stiff neck
        Mental confusion, depression
        Dizziness, lightheadedness
        Hearing problems

        Stomach upset is one of the common problems with NSAIDs, such as naproxen. The esomeprazole in VIMOVO helps to reduce this side effect from happening. However,side effects, usually mild, have been reported with esomeprazole use. These side effects may not be caused by esomeprazole in your case, but only a doctor can assess this. If these become bothersome (or exceed 1-2 days), discuss with your doctor.

        Common: nausea, stomach upset, diarrhea, headache

        Uncommon: dry mouth, dizziness, insomnia, feeling of burning/prickliness/numbing, swelling of extremities, feeling sleepy, vertigo

        Rare: taste disorders, nervousness, hair loss, increased sweating

        Treatment in combination with antibiotics: If you experience symptoms such as severe (bloody or repeated watery) diarrhea, with or without fever, abdominal pain or tenderness, you may have bowel inflammation caused by a bacterial infection (Clostridium difficile). If this happens call your doctor or pharmacist immediately and stop taking the drug combination.

        Long-term use of proton pump inhibitors may lead to low blood magnesium in some people; and when blood magnesium is lower than normal it has been reported in the literature that this may also lead to low blood calcium and low blood potassium.

        As with other proton pump inhibitors, stopping VIMOVO therapy after taking it for a long time, may cause an increase insecretion of stomach acid and associated acid-related symptoms. Carefully follow your doctor’s instructions when discontinuingyour VIMOVO therapy.

        Serios side effects of esomeprazole, how often they happen and what to do about

        Symptom / effectSTOP taking
        VIMOVO and
        call your
        physician or
        pharmacist
        Talk with
        your
        physician or
        pharmacist
        in all cases
        Rare (frequency of greater than or equal to 1 in 10 000 patients
         but less than 1 in 1000 patients)
        inflammation in the mouth
        severe allergic reaction (such as swelling or anaphylactic reaction/shock)
        muscle pain
        blood disorders (reduced number of cells in the blood, low blood sodium
        gastrointestinal fungal infection
        photosensitivity
        Very Rare (frequency of less than 1 in 10 000 patients)
        severe skin disorders (blisters,
         ulcers and/or lesions)
        aggression
        hallucinations
        severely impaired liver function
        decreased consciousness
        inflammation of the kidney
        muscular weakness
        development of breasts in males
        low blood magnesium (which may result in low blood calcium and/or low blood potassium)
        Inflammation in the gut
         (leading to diarrhea)

        These would only be seen if a blood test was taken

        This is NOT a complete list of side effects. If you develop any other symptoms while taking VIMOVO, see your health care provider.

        How to store it

        VIMOVO tablets should be kept in their original container. Keep bottles tightly closed to protect from moisture.

        Store at room temperature (15-30°C). Do not keep VIMOVO in the bathroom medicine cabinet or other warm, moist places.

        Do NOT keep outdated medicine or medicine no longer needed. Any outdated or unused medicine should be returned to your pharmacist.

        Keep out of reach and sight of children.

        Reporting suspected side effects

        You can report any suspected adverse reactions associated with the use of health products to the Canada Vigilance Program by one of the following 3 ways:

        • Report online at www.healthcanada.gc.ca/medeffect
        • Call toll-free at 1-866-234-2345
        • Complete a Canada Vigilance Reporting Form and:
          • Fax toll-free to 1-866-678-6789, or
          • Mail to: Canada Vigilance Program
                            Health Canada
                            Postal Locator 0701Е
                            Ottawa, ON K1A 0K9

          Postage paid labels, Canada Vigilance Reporting Form and the adverse reaction reporting guidelines are available on the MedEffectTM Canada Web site at
          www.healthcanada.gc.ca/medeffect.


        NOTE: Should you require information related to the management of side effects, contact your health professional. The Canada Vigilance Program does not provide medical advice.

        More information

        NOTE: This CONSUMER INFORMATION leaflet provides you with the most current information at the time of printing.

        The Consumer Information Leaflet plus the full Product Monograph, prepared for health professionals can be found at:
        www.astrazeneca.ca
        or by contacting the sponsor, AstraZeneca Canada Inc. at:
        Customer Inquiries – 1 (800) 668-6000,
        Renseignements – 1 (800) 461-3787.