FOSAPREPITANT ACCORD 150 MG POWDER FOR SOLUTION FOR INFUSION

Read all of this leaflet carefully before you start using this medicine because it contains important information for you.

• Keep this leaflet, you may need to read it again.
• If you have any further questions, ask your doctor, pharmacist or nurse.
• If you experience any side effects, talk to your doctor, pharmacist or nurse, even if they are not listed in this leaflet. See section 4.

Contents of the pack

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

1. What is Fosaprepitant Accord and what is it used for

Fosaprepitant Accord contains the active substance fosaprepitant which is converted into aprepitant in your body. It belongs to a group of medicines called "neurokinin 1 (NK1) receptor antagonists". The brain has a specific area that controls nausea and vomiting. Fosaprepitant Accord works by blocking the signals to this area, thereby reducing nausea and vomiting.

Fosaprepitant Accord is used in adults, adolescents and children from 6 months of age, in combination with other medicines,to prevent nausea and vomiting caused by a type of chemotherapy (cancer treatment) that induces nausea and vomiting strongly or moderately.

2. What you need to know before you use Fosaprepitant Accord

Do not use Fosaprepitant Accord:

• if you are allergic to fosaprepitant, aprepitant, or polysorbate 80 or any of the other ingredients of this medicine (listed in section 6).
• with medicines that contain pimozide (used to treat psychiatric disorders), terfenadine and astemizole (used for allergic rhinitis and other allergic disorders), cisapride (used to treat digestive problems). Tell your doctor if you are taking these medicines as the treatment needs to be modified before starting Fosaprepitant Accord.

Warnings and precautions

Consult your doctor, pharmacist or nurse before starting treatment with Fosaprepitant Accord.

Before treatment with this medicine, tell your doctor if you have liver disease, as the liver is important for removing the medicine from the body. Therefore, your doctor may need to monitor your liver condition.

Children and adolescents

Do not give Fosaprepitant Accord to children under 6 months of age or weighing less than 6 kg, as the use of this medicine has not been studied in this population.

Other medicines and Fosaprepitant Accord

Fosaprepitant Accord may affect other medicines both during and after treatment with Fosaprepitant Accord. There are some medicines that should not be used with Fosaprepitant Accord (such as pimozide, terfenadine, astemizole and cisapride) or that require a dose adjustment (see also ‘Do not use Fosaprepitant Accord’).

The effects of Fosaprepitant Accord or other medicines may be influenced if you take Fosaprepitant Accord with other medicines, including those listed below. Consult your doctor or pharmacist if you are taking any of the following medicines:

• contraceptive medicines that may include birth control pills, skin patches, implants and certain intrauterine devices (IUDs) that release hormones, may not work properly when taken with Fosaprepitant Accord. During treatment with Fosaprepitant Accord and up to 2 months after using Fosaprepitant Accord, non-hormonal methods or additional methods of contraception should be used.
• cyclosporine, tacrolimus, sirolimus, everolimus (immunosuppressants),
• alfentanil, fentanyl (used to treat pain),
• quinidine (used to treat irregular heartbeats),
• irinotecan, etoposide, vinorelbine, ifosfamide (medicines used to treat cancer),
• medicines that contain ergotamine derivatives, such as ergotamine and dihydroergotamine (used to treat migraines),
• warfarin, acenocoumarol (blood thinners; blood tests may be needed),
• rifampicin, clarithromycin, telithromycin (antibiotics used to treat infections),
• phenytoin (a medicine used to treat seizures),
• carbamazepine (used to treat depression and epilepsy),
• midazolam, triazolam, phenobarbital (medicines used to calm or help sleep),
• St. John's Wort (a herbal preparation used to treat depression),
• protease inhibitors (used to treat HIV infections),
• ketoconazole, except shampoo (used to treat Cushing's syndrome - when the body produces too much cortisol),
• itraconazole, voriconazole, posaconazole (antifungals),
• nefazodone (used to treat depression),
• diltiazem (a medicine used to treat high blood pressure),
• corticosteroids (such as dexamethasone),
• anxiety medicines (such as alprazolam) and
• tolutamide (a medicine used to treat diabetes).

Tell your doctor if you are using, have recently used or might use any other medicine or herbal remedy.

Pregnancy and breastfeeding

This medicine should not be used during pregnancy unless clearly necessary. If you are pregnant or breastfeeding, think you may be pregnant or are planning to have a baby, ask your doctor for advice before taking this medicine.

For information on birth control, see ‘Using Fosaprepitant Accord with other medicines’.

It is not known if Fosaprepitant Accord passes into breast milk; therefore, breastfeeding should not be done during treatment with this medicine. It is important to tell your doctor before receiving this medicine if you are breastfeeding or plan to breastfeed.

Driving and using machines

It should be taken into account that some people experience dizziness and drowsiness after using Fosaprepitant Accord. If you feel dizzy or drowsy, avoid driving or using machines after using this medicine (see ‘Possible side effects’).

Fosaprepitant Accord contains sodium

This medicine contains less than 23 mg (1 mmol) of sodium per dose, i.e., it is essentially “sodium-free”.

3. How to use Fosaprepitant Accord

In adults (from 18 years of age), the recommended dose of Fosaprepitant Accord is 150 mg of fosaprepitant on day 1 (day of chemotherapy).

In children and adolescents (from 6 months to 17 years of age), the recommended dose of Fosaprepitant Accord is based on the patient's age and weight. Depending on the chemotherapy received, Fosaprepitant Accord can be administered in two ways:

Fosaprepitant Accord is administered only on day 1 (single-day chemotherapy)

Fosaprepitant Accord is administered on days 1, 2, and 3 (one or several days of chemotherapy)

• On days 2 and 3, oral formulations of aprepitant may be prescribed instead of Fosaprepitant Accord.

The powder is reconstituted and diluted before use. The infusion solution is administered by a healthcare professional, such as a doctor or nurse, by intravenous infusion (a drip) approximately 30 minutes before chemotherapy starts in adults or 60-90 minutes before chemotherapy starts in children and adolescents. Your doctor may ask you to take other medicines to prevent nausea and vomiting, including corticosteroids (such as dexamethasone) and a 5-HT3 antagonist (such as ondansetron). In case of doubt, consult your doctor or pharmacist.

4. Possible side effects

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

Stop taking Fosaprepitant Accord and contact your doctor immediately if you notice any of the following side effects, which can be serious and may require urgent medical treatment:

• Hives, rash, itching, difficulty breathing or swallowing, or a severe drop in blood pressure (frequency not known, cannot be estimated from the available data): these are signs of an allergic reaction.
• Reactions at the infusion site or near it. The most serious infusion site reactions have occurred with a certain type of chemotherapy that can burn or blister the skin (vesicant) with side effects including pain, swelling, and redness. In some people receiving this type of chemotherapy, death of skin tissue (necrosis) has occurred.

Other side effects that have been reported are listed below.

Common side effects (may affect up to 1 in 10 people) are:

• constipation, indigestion,
• headache,
• fatigue,
• loss of appetite,
• hypo,
• increase in liver enzymes in the blood.

Uncommon side effects (may affect up to 1 in 100 people) are:

• dizziness, drowsiness,
• acne, rash,
• anxiety,
• belching, nausea, vomiting, heartburn, stomach pain, dry mouth, flatulence,
• increased urge to urinate with pain or discomfort,
• weakness, general malaise,
• flushing of the face/skin, hot flushes,
• rapid or irregular heartbeat, increased blood pressure,
• fever with increased risk of infection, decrease in red blood cells,
• pain at the injection site, redness at the injection site, itching at the injection site, inflammation of the veins at the injection site.

Rare side effects (may affect up to 1 in 1,000 people) are:

• difficulty thinking, lack of energy, altered taste,
• sensitivity of the skin to the sun, excessive sweating, oily skin, skin ulcers, itching, Stevens-Johnson syndrome/toxic epidermal necrolysis (a rare, severe skin reaction),
• euphoria (extreme feeling of happiness), disorientation,
• bacterial infection, fungal infection,
• severe constipation, stomach ulcer, inflammation of the small intestine and colon, mouth ulcers, abdominal swelling,
• frequent urge to urinate, urinating more than usual, presence of sugar or blood in the urine,
• chest discomfort, swelling, changes in gait,
• cough, mucus in the back of the throat, throat irritation, sneezing, sore throat,
• eye discharge and itching,
• ringing in the ears,
• muscle spasms, muscle weakness,
• excessive thirst,
• slow heartbeat, disease of the blood vessels and blood,
• decrease in white blood cells, low sodium levels in the blood, weight loss,
• hardening of the injection site.

Reporting of side effects

If you experience any side effects, talk to your doctor, pharmacist or nurse, even if they are not listed in this leaflet. You can also report side effects directly via the Spanish Medicines and Healthcare Products Agency (AEMPS) website: https://www.notificaram.es. By reporting side effects, you can help provide more information on the safety of this medicine.

5. Storage of Fosaprepitant Accord

Keep this medicine out of the sight and reach of children.

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

Store in a refrigerator (2°C - 8°C).

The reconstituted and diluted solution is stable for 48 hours at 20-25°C.

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

6. Contents of the pack and other information

Composition of Fosaprepitant Accord

• The active substance is fosaprepitant. Each vial contains fosaprepitant dimeglumine equivalent to 150 mg of fosaprepitant. After reconstitution and dilution, 1 ml of solution contains 1 mg of fosaprepitant (1 mg/ml).
• The other ingredients are disodium edetate (E-386), polysorbate 80 (E-433), anhydrous lactose, sodium hydroxide (E-524) (for pH adjustment) and concentrated hydrochloric acid (E-507) (for pH adjustment).

Appearance of the product and pack contents

Fosaprepitant Accord is a white to off-white solid lyophilisate for solution for infusion.

The powder is contained in a transparent glass vial with a rubber stopper and an orange, smooth aluminum seal.

Each vial contains 150 mg of fosaprepitant. Pack sizes: 1 vial.

Not all pack sizes may be marketed.

Marketing authorisation holder and manufacturer

Marketing authorisation holder

Accord Healthcare S.L.U.

World Trade Center

Moll de Barcelona, s/n

Edifici Est, 6ª planta

08039 Barcelona

Spain

Manufacturer

LABORATORI FUNDACIÓ DAU

Pol. Ind. Consorci Zona Franca,

c/ C, 12-14,

08040, Barcelona

Spain

Or

Accord Healthcare Polska Sp.z o.o.,

ul. Lutomierska 50,

95-200 Pabianice,

Poland

This medicine isauthorised in the Member States of the European Economic Area under the following names:

Date of last revision of this leaflet: February 2022

Detailed and up-to-date information on this medicine is available on the website of the Spanish Agency for Medicines and Healthcare Products (AEMPS) http://www.aemps.gob.es/

This information is intended only for healthcare professionals: Instructions for reconstitution and dilution of Fosaprepitant Accord 150 mg:

1. Inject 5 ml of sodium chloride 9 mg/ml (0.9%) injection solution into the vial. Ensure that the injection solution is added to the vial along the wall of the vial to avoid foaming. Gently rotate the vial. Avoid shaking and agitating the injection solution in the vial.

1. Prepare an infusion bag containing 145 mlof sodium chloride 9 mg/ml (0.9%) injection solution (e.g., by removing 105 ml of sodium chloride 9 mg/ml (0.9%) injection solution from a 250 ml infusion bag of sodium chloride 9 mg/ml (0.9%) injection solution).

1. Withdraw the entire volume from the vial and transfer it into the infusion bag containing 145 ml of sodium chloride 9 mg/ml (0.9%) injection solution to obtain a total volume of 150 ml and a final concentration of 1 mg/ml. Gently invert the bag 2-3 times (see ‘How to use Fosaprepitant Accord’).

1. Determine the volume to be administered from this prepared infusion bag, based on the recommended dose (see Summary of Product Characteristics, section 4.2).

Adults

The entire volume of the prepared infusion bag should be administered (150 ml).

Paediatric patients

In patients over 12 years of age, the volume to be administered is calculated as follows:

• The volume to be administered (ml) is equal to the recommended dose (mg)

In patients from 6 months to less than 12 years of age, the volume to be administered is calculated as follows:

• Volume to be administered (ml) = recommended dose (mg/kg) x weight (kg)

• Note: Do not exceed the maximum doses (see Summary of Product Characteristics, section 4.2).

1. If necessary, for volumes less than 150 ml, the calculated volume can be transferred to a smaller bag or syringe before infusion.

The final reconstituted and diluted solution is stable for 48 hours at 20-25°C.

When the solution and container permit, a visual inspection of parenteral medicines should be performed before administration to check for particles or discoloration.

The appearance of the reconstituted solution is the same as the appearance of the diluent used.