ETOXISCLEROL 5 mg/ml INJECTABLE SOLUTION

Contents of the Package Leaflet:

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

1. What is Etoxisclerol and what is it used for

Etoxisclerol is a sclerosing agent whose active substance is lauromacrogol 400.

Etoxisclerol is indicated for the sclerosing treatment or destruction of varicose veins and telangiectasias (spider veins).

2. What you need to know before you use Etoxisclerol

Do not use Etoxisclerol for sclerosing treatment of varices

• If you are allergic to lauromacrogol 400 or any of the other components of this medicine (listed in section 6),
• If you have a severe acute systemic disease (affecting the whole body), especially in untreated patients,
• If you must stay in bed or are unable to walk,
• If you have severe arterial circulation disorders (arterial occlusive disease, Fontaine stages III and IV),
• If you have a vascular occlusion due to a blood clot (thromboembolic diseases),
• If you are at high risk of vascular occlusions (thrombosis), for example, patients with a hereditary predisposition to produce blood clots or with multiple risk factors such as: use of hormonal contraceptives (e.g., the pill), hormone replacement therapy, overweight, smoking, prolonged periods of immobility, etc.

Warnings and Precautions

Etoxisclerol should be administered by a healthcare professional with experience in sclerotherapy techniques.

Consult your doctor, pharmacist, or nurse before starting treatment with Etoxisclerol:

• If you have a fever,
• If you have respiratory distress (bronchial asthma),
• If you have a strong predisposition to allergies,
• If your general state of health is poor,
• If you are going to undergo sclerosing treatment for spider veins: in patients with arterial circulation disorders (arterial occlusive diseases, Fontaine stage II),
• If you have swollen legs due to fluid accumulation (edema) that cannot be modified by compression,
• If you have an inflammatory skin disease in the area to be treated,
• If you have symptoms of occlusion of the smallest blood vessels, for example, due to diabetes (microangiopathy) and sensory impairment (neuropathy),
• If you have reduced mobility,
• If you frequently suffer from migraines.

Other Medicines and Etoxisclerol

Tell your doctor or pharmacist if you are using, have recently used, or might use any other medicines.

The use of Etoxisclerol with anesthetics may increase the anesthetic effect on the cardiovascular system.

Pregnancy, Breast-feeding, and Fertility

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 using this medicine.

If you are pregnant, your doctor should not administer Etoxisclerol to you unless it is strictly necessary, as there is not enough information on the use of Etoxisclerol in pregnant women. Animal studies did not show any evidence of malformation.

If treatment with Etoxisclerol is necessary during breast-feeding, it is recommended to suspend it for 2-3 days, as there is no data in humans on the passage of lauromacrogol 400 into breast milk.

Driving and Using Machines

No negative effects on the ability to drive and use machines due to the use of Etoxisclerol are known.

Etoxisclerol contains ethanol, potassium, and sodium

• This medicine contains 84 mg of alcohol (96% ethanol) in each 2 ml ampoule, which is equivalent to 5% (v/v). The amount in one ampoule of this medicine is equivalent to less than 3 ml of beer or 1 ml of wine.
• It is unlikely that the amount of alcohol in this medicine will have any noticeable effect on adults or adolescents.
• The amount of alcohol in this medicine may alter the effect of other medicines. Consult your doctor or pharmacist if you are taking other medicines. If you are pregnant or breast-feeding, consult your doctor or pharmacist before taking this medicine.
• If you have an alcohol addiction, consult your doctor or pharmacist before taking this medicine.
• This medicine contains less than 39 mg (1 mmol) of potassium per ampoule, so it is considered essentially "potassium-free".

This medicine contains less than 23 mg (1 mmol) of sodium per ampoule, which is essentially "sodium-free".

3. How to Use Etoxisclerol

Etoxisclerol is a medicine whose administration must be performed by a doctor, and it is up to the doctor to know and choose the most convenient dosage and technique in each case.

Depending on the size of the varix to be treated and the individual situation of each patient, your doctor will decide what treatment to apply. In case of doubt, the lowest possible dose should be chosen.

Generally, the dose of 2 mg/kg/day of lauromacrogol 400 should not be exceeded.

To avoid a possible allergic reaction, especially in a patient with a high predisposition to hypersensitivity reactions, it is recommended that for the first treatment, only a small test dose of Etoxisclerol be administered. Depending on the response, several injections can be administered in subsequent treatment sessions, as long as the maximum dose is not exceeded.

Since the volume to be injected per session is limited, repeated sessions are usually necessary (on average 2 to 4).

After being treated with Etoxisclerol, you should follow your doctor's advice. You may be advised to wear a bandage or compression stockings to help reduce inflammation and skin pigmentation.

Use in Children and Adolescents

There is no relevant use of Etoxisclerol in the pediatric population.

If You Use More Etoxisclerol Than You Should

In case of overdose or accidental ingestion, consult your doctor, pharmacist, or call the Toxicology Information Service, phone 91 562 04 20, indicating the medicine and the amount ingested.

Overdose can cause local tissue death (necrosis), especially after injection into tissue near the varix.

4. Possible Side Effects

Like all medicines, this medicine can cause side effects, although not everybody gets them.

In this section, we inform you about the adverse reactions that have been reported in association with the widespread use of the active substance. In some cases, these reactions were annoying but, in most cases, only temporary. As they were often spontaneous reports without any reference to a defined group of patients and without any reference group, it is not possible to calculate the exact frequencies or establish a clear causal relationship with the drug in each case. However, a reasonable estimate can be made from long-term experience.

Local adverse effects (e.g., necrosis) have been observed, especially in the skin and tissue near the varix (and in rare cases, in the nerves) when treating leg varices after accidental injections into tissue near the varices.

The risk increases when the concentration and volume of Etoxisclerol increase.

The following side effects have been observed with the frequencies described below:

• Frequent (may affect up to 1 in 10 people):appearance of blood vessels in the treated area not visible before treatment (neovascularization), bruising (hematoma), skin spots (hyperpigmentation), skin bleeding (ecchymosis), pain at the injection site (short-term), thrombosis at the injection site (local intravascular blood clots).

• Uncommon (may affect up to 1 in 100 people):venous inflammation (superficial thrombophlebitis, phlebitis), allergic skin inflammation (dermatitis), contact urticaria, skin reaction, skin redness (erythema), local tissue death (necrosis), tissue hardening, swelling, nerve damage.

• Rare (may affect up to 1 in 1,000 people):deep vein thrombosis (possibly due to another disease you have at the same time), pain in the limbs.

• Very Rare (may affect up to 1 in 10,000 people):anaphylactic shock (severe and sudden allergic reaction, whose symptoms are difficulty breathing, dizziness, drop in blood pressure), angioedema (whose symptoms include sudden swelling, especially in the face, e.g., eyelids, lips, or larynx), generalized urticaria, asthma (asthmatic crisis), stroke (cerebrovascular accident), weakness causing loss of mobility in a part of the body (hemiparesis), headache, migraine, local sensory disturbances (paresthesia), decreased sensation or sensations in the mouth (oral hypoesthesia), loss of consciousness, confusion, central speech disorders (aphasia), difficulty controlling movements (ataxia), dizziness, visual disturbances, heart attack (cardiac arrest), broken heart syndrome (stress cardiomyopathy), rapid or irregular heartbeats (palpitations), abnormal heart rate, pulmonary artery obstruction (pulmonary embolism), fainting (vasovagal syncope), circulatory collapse, inflammation of the blood vessel wall (vasculitis), difficulty breathing (dyspnea), feeling of pressure in the chest, cough, taste disorders, nausea, vomiting, excessive hair growth (hypertrichosis) in the treated area, fever, hot flashes, unusual weakness (asthenia), general malaise, abnormal blood pressure.

Reporting of Side Effects

If you experience any side effects, talk to your doctor or pharmacist, even if it is possible side effects not listed in this leaflet. You can also report side effects directly through the Spanish Medicines Surveillance System for Human Use: https://www.notificaram.es. By reporting side effects, you can help provide more information on the safety of this medicine.

5. Storage of Etoxisclerol

This medicine does not require any special storage temperature.

Keep this medicineout of the sight and reach of children.

Do not use this medicine after the expiry date which is stated on the carton, after EXP. The expiry date is the last day of the month shown.

Medicines should not be disposed of via wastewater or household waste. Ask your pharmacist how to dispose of medicines no longer required. These measures will help protect the environment.

6. Contents of the Pack and Other Information

Composition of Etoxisclerol 5 mg/ml

• The active substance is lauromacrogol 400.

Each ml of solution for injection contains 5 mg of lauromacrogol 400.

Each 2 ml ampoule of solution for injection contains 10 mg of lauromacrogol 400.

• The other components (excipients) are: 96% ethanol, potassium dihydrogen phosphate, disodium hydrogen phosphate dihydrate, water for injections.

Appearance of the Product and Contents of the Pack

Etoxisclerol is a clear solution with a slight greenish-yellow color. It is presented as a solution for injection in a pack containing 5 ampoules of 2 ml each.

Other Presentations

• Etoxisclerol 10 mg/ml solution for injection. Pack containing 5 ampoules of 2 ml each.
• Etoxisclerol 20 mg/ml solution for injection. Pack containing 5 ampoules of 2 ml each.
• Etoxisclerol 30 mg/ml solution for injection. Pack containing 5 ampoules of 2 ml each.

Marketing Authorization Holder and Manufacturer

Chemische Fabrik Kreussler & Co. GmbH

Rheingaustrasse 87-93

65203 Wiesbaden, Germany

tel.: +49 611 9271-0

fax: +49 611 9271-111

e-mail: [email protected]

You can ask for more information about this medicine by contacting the local representative of the marketing authorization holder:

FERRER FARMA, S.A.

Av. Diagonal 549 5ª Planta,

08029 Barcelona (Spain)

Date of the Last Revision of this Leaflet:June 2021

Detailed and updated information on this medicine is available on the website of the Spanish Agency for Medicines and Health Products (AEMPS) http://www.aemps.gob.es/

This information is intended only for healthcare professionals

For more information, see the Summary of Product Characteristics.

Important Precautions for Use

• Etoxisclerol should only be administered by a healthcare professional experienced in venous anatomy and in the diagnosis and treatment of diseases affecting the venous system and who is familiar with a correct injection technique.
• Before treatment, the healthcare professional should investigate the patient's risk factors and inform them about the risks of this technique. Sclerotherapy is particularly not recommended in patients with a history of thromboembolic events. However, if sclerotherapy is deemed necessary, preventive anticoagulation may be initiated.
• Severe local adverse effects, such as tissue necrosis, can occur after extravasation, so great care should be taken in the placement of the intravenous needle, and it is important to use the minimum effective volume at each injection site.
• Sclerosing agents should never be injected intra-arterially because severe necrosis can occur, which may require amputation. In case of an accident, immediate vascular surgical treatment should be sought.
• The use of any type of sclerosing agent in the facial area should be strictly evaluated, as intravascular injections can lead to negative pressure in the arteries and cause irreversible vision loss.
• In some parts of the body, such as the feet or the maleolar region, the risk of inadvertently infiltrating the interior of the artery may be increased. Therefore, only small amounts should be used and in low concentrations with special care during this type of treatment.

Dosage and Daily Dose

Adults and Elderly

Generally, the dose of 2 mg/kg/day of lauromacrogol 400 should not be exceeded.

To avoid a possible allergic reaction, especially in a patient with a high predisposition to hypersensitivity reactions, it is recommended that for the first treatment, only a small test dose of Etoxisclerol be administered. Depending on the response, several injections can be administered in subsequent treatment sessions, as long as the maximum dose is not exceeded.

Since the volume to be injected per session is limited, repeated sessions are usually necessary (on average 2 to 4).

Pediatric Population

There is no relevant use of Etoxisclerol in the pediatric population.

Method of Administration

All injections must be administered intravenously; the position of the needle must be checked (e.g., by aspirating blood).

Regardless of the mode of venous puncture (in a standing patient with only a cannula or in a seated patient with a ready-to-inject syringe), the injections will be performed normally in a leg in a horizontal position. Smooth-movement disposable syringes are recommended for sclerotherapy, as well as needles of different diameters, depending on the indication.

For telangiectasias, very fine needles (e.g., insulin needles) are used. The puncture is performed tangentially, and the injection is administered slowly.

The sclerosing agent should be administered intravenously in small aliquots at multiple points in the vein to be treated. In the treatment of perforating veins, it is recommended not to inject directly into the target vein. The goal is to achieve optimal destruction of the vessel wall with the minimum concentration of sclerosing agent necessary for a clinical result. If the concentration is too high, necrosis or other adverse sequelae may occur.

Depending on the degree and extent of varicose veins, several treatment sessions may be required.

A strictly aseptic technique should be maintained during the handling of Etoxisclerol.

Compression Treatment After Etoxisclerol Injection

Once the injection site has been covered, a compression bandage or elastic stocking should be applied. After this, the patient should walk for 30 minutes, preferably within the clinic or office where the injection was performed.

Compression should be applied from several days to several weeks, depending on the extent and severity of the varicose veins.

Trombi may occasionally appear, which are eliminated by incision and evacuation of the thrombus.