• Keep this leaflet. You may need to read it again.
• If you have any further questions, ask your doctor or pharmacist.
• This medicine has been prescribed for you only. Do not pass it on to others. It may harm them, even if their signs of illness are the same as yours.
• If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. See section 4.

1. What Jinarc is and what it is used for
2. What you need to know before you take Jinarc
3. How to take Jinarc
4. Possible side effects
5. How to store Jinarc
6. Contents of the pack and other information

• if you are allergic to tolvaptan or any of the other ingredients of this medicine (listed in section 6) or if you are allergic to benzazepine or benzazepine derivatives (e.g. benazepril, conivaptan, fenoldopam mesylate or mirtazapine)
• if you have been told that you have raised levels of liver enzymes in your blood which do not allow treatment with tolvaptan
• if your kidneys do not work (no urine production)
• if you have a condition which is associated with a very low blood volume (e.g. severe dehydration or bleeding)
• if you have a condition which increases the sodium in your blood
• if you do not realise when you are thirsty
• if you are pregnant
• if you are breastfeeding.

Talk to your doctor before taking Jinarc

• if you suffer from liver disease.
• if you cannot drink enough water (see “drinking enough water” below) or if you have to restrict your fluid intake.
• if you have difficulties urinating (e.g. have an enlarged prostate).
• if you suffer from too high or too low blood sodium.
• if you had an allergic reaction in the past to benzazepine, tolvaptan or other benzazepine derivatives (e.g. benazepril, conivaptan, fenoldopam mesylate or mirtazapine), or to any of the other ingredients of this medicine (listed in section 6).
• if you have diabetes.
• if you have been told you have high levels of a chemical called uric acid in your blood (which may have caused attacks of gout).
• if you have advanced kidney disease.

• nausea
• vomiting
• fever
• tiredness
• loss of appetite
• pain in the abdomen
• dark urine
• jaundice (yellowing of skin or eyes)
• itching of your skin
• flu-like syndrome (joint and muscle pain with fever)

Drinking enough water

This medicine causes water loss because it increases your urine production. This water loss may result in side effects such as dry mouth and thirst or even more severe side effects like kidney problems (see section 4). It is therefore important that you have access to water and that you are able to drink sufficient amounts when you feel thirsty. Before bed-time you must drink 1 or 2 glasses of water even if you do not feel thirsty and you must also drink water after you urinate at night. Special care must be taken if you have a disease that reduces appropriate fluid intake or if you are at an increased risk of water loss e.g. in case of vomiting or diarrhoea. Due to the increased urine production, it is also important that you always have access to a toilet.

Do not give this medicine to children and adolescents (under age of 18 years) because it has not been studied in these age groups.

Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines, including medicines obtained without a prescription.

The following medicines may increase the effect of Jinarc:

• amprenavir, atazanavir, darunavir/ritonavir and fosamprenavir (used to treat HIV/AIDS),
• aprepitant (used to avoid nausea and vomiting in chemotherapy),
• crizotinib and imatinib (used to treat cancer),
• ketoconazole, fluconazole or itraconazole (used to treat fungal infections),
• macrolide antibiotics like erythromycin or clarithromycin,
• verapamil (used to treat heart diseases and high blood pressure),
• ciprofloxacin (an antibiotic),
• diltiazem (used to treat high blood pressure and chest pain).

The following medicines may lower the effect of Jinarc:

• phenytoin or carbamazepine (used to treat epilepsy),
• rifampicin, rifabutin or rifapentine (used to treat tuberculosis),
• St. John’s Wort (a traditional herbal medicinal product for the relief of slightly low mood and mild anxiety).

Jinarc may increase the effect of the following medicines:

• digoxin (used to treat irregular heart beat and heart failure),
• dabigatran (used to thin the blood),
• sulfasalazine (used to treat inflammatory bowel disease or rheumatoid arthritis),
• metformin (used to treat diabetes).

Jinarc may lower the effect of the following medicines:

• vasopressin analogues such as desmopressin (used to increase blood clotting factors or to control urine output or bedwetting).

These medicines can affect or be affected by Jinarc:

• diuretics (used to influence the production of urine). Taken with Jinarc these may increase the risk of side effects due to water loss or may cause kidney problems.
• diuretics or other medicines for the treatment of high blood pressure. Taken with Jinarc these may increase the risk of low blood pressure when you stand up from sitting or lying down.
• medicines which increase the level of sodium in your blood or which contain large amounts of salt (e.g. tablets that dissolve in water and indigestion remedies). These may increase the effect of Jinarc. There is a risk that this may lead to too much sodium in your blood.

It may still be alright for you to take these medicines and Jinarc together. Your doctor will be able to decide what is suitable for you.

Do not drink grapefruit juice when taking this medicine.

Do not take this medicine if you are pregnant or breast-feeding.

Women of childbearing age must use reliable contraceptive measures during use of this medicine.

If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, ask your doctor or pharmacist for advice before taking this medicine.

Some people may feel dizzy, weak or tired after being given Jinarc. If this happens to you, do not drive or use any tools or machines.

If you have been told by your doctor that you have an intolerance to some sugars, contact your doctor before taking this medicine.

If you have taken more tablets than your prescribed dose, drink plenty of water and contact your doctor or your local hospital immediately. Remember to take the medicine pack with you so that it is clear what you have taken. If you take the higher dose very late in the day you may have to go to the toilet at night more frequently.

If you forget to take your medicine, you should take the dose as soon as you remember on the same day. If you do not take your tablets on one day, take your normal dose on the next day. DO NOT take a double dose to make up for forgotten individual doses.

If you stop taking this medicine your kidney cysts may grow as fast as they did before you started treatment with Jinarc. Therefore, you should only stop taking this medicine if you notice side effects requiring urgent medical attention (see section 4) or if your doctor tells you to.

If you notice any of the following side effects, you may need urgent medical attention. Stop taking Jinarc and immediately contact a doctor or go to the nearest hospital if you:

• find it difficult to urinate.
• experience swelling of the face, lips or tongue, itching, generalised rash, or severe wheezing or breathlessness (symptoms of an allergic reaction).

Consult your doctor if symptoms of nausea, vomiting, fever, tiredness, loss of appetite, pain in the abdomen, dark urine, jaundice (yellowing of skin or eyes), itching of your skin or joint and muscle pain with fever occur.

Very common (may affect more than 1 in 10 people)

• thirst (requiring excessive drinking of water)
• headache
• dizziness
• diarrhoea
• dry mouth
• increased need to urinate, to urinate at night, or to urinate more frequently
• fatigue

Common (may affect up to 1 in 10 people)

• dehydration
• high levels of sodium, uric acid and blood sugar
• decreased appetite
• taste changes
• gout
• difficulty sleeping
• fainting
• heart pounding
• shortness of breath
• belly pain
• full or bloated or uncomfortable feeling in the stomach
• constipation
• heartburn
• liver function abnormal
• dry skin
• rash
• itching
• hives
• joint pain
• muscle spasms
• muscle pain
• general weakness
• raised levels of liver enzymes in the blood
• weight loss
• weight gain

Uncommon (may affect up to 1 in 100 people)

• increase of bilirubin (a substance that can cause yellowing of skin or eyes) in the blood

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

• allergic reactions (see above)
• generalised rash
• acute liver failure (ALF)

If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via the Yellow Card Scheme at: www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store.

By reporting side effects you can help provide more information on the safety of this medicine.

• The active substance is tolvaptan.
  Each Jinarc 15 mg tablet contains 15 mg tolvaptan.
  Each Jinarc 30 mg tablet contains 30 mg tolvaptan.
  Each Jinarc 45 mg tablet contains 45 mg tolvaptan.
  Each Jinarc 60 mg tablet contains 60 mg tolvaptan.
  Each Jinarc 90 mg tablet contains 90 mg tolvaptan.
• The other ingredients are lactose monohydrate (see section 2), maize starch, microcrystalline cellulose, hydroxypropylcellulose, magnesium stearate, indigo carmine aluminium lake.

The different strengths of Jinarc tablets have different shapes and embossing:

15 mg tablet: blue, triangular, debossed with “OTSUKA” and “15” on one side.

30 mg tablet: blue, round, debossed with “OTSUKA” and “30” on one side.

45 mg tablet: blue, square, debossed with “OTSUKA” and “45” on one side

60 mg tablet: blue, modified rectangular, debossed with “OTSUKA” and “60” on one side

90 mg tablet: blue, pentagonal, debossed with “OTSUKA” and “90” on one side

Your medicine is supplied in the following pack sizes:

Jinarc 15 mg tablets: packs containing 7 tablets or 28 tablets

Jinarc 30 mg tablets: packs containing 7 tablets or 28 tablets

Jinarc 45 mg tablets + Jinarc 15 mg tablets: packs (blisters with or without wallet card) containing

14 tablets (7 tablets of the higher strength + 7 tablets of the lower strength),

28 tablets (14 tablets of the higher strength + 14 tablets of the lower strength) or

56 tablets (28 tablets of the higher strength + 28 tablets of the lower strength).

Jinarc 60 mg tablets + Jinarc 30 mg tablets: packs (blisters with or without wallet card) containing

14 tablets (7 tablets of the higher strength + 7 tablets of the lower strength),

28 tablets (14 tablets of the higher strength + 14 tablets of the lower strength) or

56 tablets (28 tablets of the higher strength + 28 tablets of the lower strength).

Jinarc 90 mg tablets + Jinarc 30 mg tablets: packs (blisters with or without wallet card) containing

14 tablets (7 tablets of the higher strength + 7 tablets of the lower strength),

28 tablets (14 tablets of the higher strength + 14 tablets of the lower strength) or

56 tablets (28 tablets of the higher strength + 28 tablets of the lower strength).

Not all pack sizes may be marketed.

For any information about this medicine, please contact: