FOSAPREPITANT ZENTIVA 150 MG POWDER FOR SOLUTION FOR INFUSION

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

Do not use Fosaprepitant Zentiva:

• 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). Inform your doctor if you are taking these medicines as the treatment should be modified before starting Fosaprepitant

Warnings and precautions

Talk to your doctor, pharmacist, or nurse before starting Fosaprepitant

Before treatment with this medicine, tell your doctor if you have liver disease, because 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 to children under 6 months of age or weighing less than 6 kg, because the use of this medicine has not been studied in this population.

Using Fosaprepitant Zentiva withother medicines

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

The effects of Fosaprepitant or other medicines may be influenced if you take Fosaprepitant with other medicines, including those listed below. Talk to 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. During treatment with Fosaprepitant and up to 2 months after using Fosaprepitant, 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),
• medicines for anxiety (such as alprazolam),
• 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 andbreastfeeding

This medicine should not be used during pregnancy unless clearly necessary. If you are pregnant or breastfeeding, think you may be pregnant, or plan to become pregnant, consult your doctor before using this medicine.

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

It is not known if Fosaprepitant passes into breast milk; therefore, breastfeeding is not recommended during treatment with this medicine. It is important to inform 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. If you feel dizzy or drowsy, avoid driving or using machines after using this medicine (see ‘Possible side effects’).

Fosaprepitant Zentiva contains sodium

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

3. How to use Fosaprepitant Zentiva

Follow the instructions for administration of this medicine exactly as indicated by your doctor. In case of doubt, consult your doctor again.

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

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

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

Fosaprepitant 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.

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.

If you use more Fosaprepitant Zentiva than you should:

In case of overdoseconsult your doctor or pharmacist or call the Toxicology Information Service, phone: 91 562 04 20, indicating the medicine and the amount taken.

4. Possible side effects

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

Stop taking Fosaprepitant and contact your doctor immediately if you notice any of the following side effects, which can be serious and 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 a severe allergic reaction.
• Reactions at the infusion site or near it. The most severe reactions at the infusion site 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,
• increased 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 burning,
• weakness, general malaise,
• flushing of the face/skin, hot flushes,
• rapid or irregular heartbeat, increased blood pressure,
• fever with increased risk of infection, decreased 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 sunlight, excessive sweating, oily skin, skin ulcers, itching, Stevens-Johnson syndrome/toxic epidermal necrolysis (a rare severe skin reaction),
• euphoria (feeling of extreme happiness), disorientation,
• bacterial infection, fungal infection,
• severe constipation, stomach ulcers, inflammation of the small intestine and colon, mouth ulcers, abdominal swelling,
• increased urination, 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 or itching,
• ringing in the ears,
• muscle spasms, muscle weakness,
• excessive thirst,
• slow heartbeat, disease of the blood vessels and blood,
• decreased 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 through the Spanish Pharmacovigilance System for Human Use Medicines: https://www.notificaram.es. By reporting side effects, you can help provide more information on the safety of this medicine.

5. Storage of Fosaprepitant Zentiva

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 24 hours at 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 Zentiva

• 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/or hydrochloric acid diluted (E-507) (for pH adjustment).

Appearance and packaging

Fosaprepitant Zentiva is a white to off-white powder for solution for infusion.

The powder is contained in a transparent glass vial with a rubber stopper and an aluminum seal with a green plastic cap.

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

Marketing authorization holder

Zentiva, k.s.,

U kabelovny 130,

Dolní Mecholupy,

102 37 Prague 10

Czech Republic

Manufacturer

Tillomed Malta Limited,

Malta Life Sciences Park,

LS2.01.06 Industrial Estate,

San Gwann, SGN 3000, Malta

Pharmadox Healthcare Limited

KW20A Kordin Industrial Park,

Paola PLA 3000, Malta

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

Zentiva Spain S.L.U.,

Avenida de Europa, 19, Edificio 3, Planta 1.

28224 Pozuelo de Alarcón, Madrid

Spain

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

Date of last revision of this leaflet:March 2023

Other sources of information

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

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This information is intended only for healthcare professionals:

Instructions for reconstitution and dilution of Fosaprepitant Zentiva 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.
2. 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).
3. 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 Tillomed’).
4. Determine the volume to be administered from this prepared infusion bag, according to the recommended dose (see the Summary of Product Characteristics or Package Leaflet, section 4.2).

Adults

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

Pediatric population

In patients from 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 between 6 months and 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 the Summary of Product Characteristics or Package Leaflet, section 4.2).

1. For volumes less than 150 ml, if necessary, the calculated volume can be transferred to a smaller bag or a syringe before administration by infusion.

The final reconstituted and diluted solution is stable for 24 hours at 25°C.

When the solution and packaging allow, 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.

Discard any remaining solution and residual material. The disposal of unused medicine and all materials that have come into contact with it should be carried out in accordance with local regulations.

The medicine should not be reconstituted or mixed with solutions for which physical and chemical compatibility has not been established (see the Summary of Product Characteristics or Package Leaflet, section 6.2).