FOSRENOL 1000 mg ORAL POWDER

2. What you need to know before you take Fosrenol

Do not take Fosrenol

? if you are allergic to lanthanum carbonate hydrate or any of the other ingredients of this medicine (listed in section 6)

? if you have low levels of phosphate in your blood (hypophosphataemia)

• if you have intestinal obstruction.

Warnings and precautions

Tell your doctor or pharmacist before you start taking Fosrenol if you know that you have or have had any of the following conditions:

• stomach or intestinal cancer
• inflammatory intestinal disease including ulcerative colitis or Crohn's disease
• abdominal surgery or infection or inflammation of the abdomen/intestine (peritonitis)
• stomach or intestinal ulcers
• intestinal obstruction or slow intestinal movement (e.g. constipation and stomach problems due to diabetes)

• reduced liver or kidney function.

If your kidney function is reduced, your doctor may decide to regularly check the level of calcium in your blood. If this level is too low, you may be given extra calcium.

If you are going to have an X-ray, tell your doctor that you are taking Fosrenol, as it may affect the results.

If you are going to have a gastrointestinal endoscopy, tell your doctor that you are taking Fosrenol (lanthanum) because the endoscopist may detect lanthanum accumulation in the gut.

Taking Fosrenol with other medicines

Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines.

Fosrenol may affect how certain medicines are absorbed in the gut. If you are taking chloroquine (for rheumatism and malaria), ketoconazole (for fungal infections) or antibiotics of the tetracycline or doxycycline group, you should not take these medicines within 2 hours before or after taking Fosrenol.

It is not recommended to take oral antibiotics of the fluoroquinolone group (including ciprofloxacin) within 2 hours before or 4 hours after taking Fosrenol.

If you are taking levothyroxine (for underactive thyroid), you should not take this medicine within 2 hours before or after taking Fosrenol. Your doctor may want to monitor your thyroid-stimulating hormone (TSH) blood levels more closely.

Taking Fosrenol with food and drink

Fosrenol should be taken with or immediately after food. See section 3 for instructions on how to take Fosrenol.

Pregnancy and breast-feeding

Fosrenol should not be used during pregnancy. 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.

As it is not known whether the medicine can pass to the baby through breast milk, you should not breast-feed while taking Fosrenol. If you are breast-feeding, ask your doctor or pharmacist for advice before taking any medicine.

Driving and using machines

Dizziness and vertigo (a feeling of dizziness or 'spinning') are uncommon side effects that have been reported by patients taking Fosrenol. If you experience these symptoms, they may affect your ability to drive or use machines.

Fosrenol contains glucose

If your doctor has told you that you have an intolerance to some sugars, consult them before taking this medicine.

3. How to take Fosrenol

Follow the instructions for administration of this medicine exactly as told by your doctor or pharmacist. If you are not sure, ask your doctor or pharmacist again.

You should take Fosrenol with or immediately after food. Side effects such as nausea and vomiting are more likely if you take Fosrenol before a meal.

Fosrenol oral powder should be mixed with a small amount of soft food (e.g. apple sauce or similar) and swallowed. You do not need to take extra liquid.

Do not open the sachet until you are ready to take it. Mix the whole contents of the sachet with 1-2 spoonfuls of soft food, making sure that all of the dose is mixed with the food. Make sure you swallow the mixture of oral powder and food immediately (within 15 minutes). Do not save any of the mixture of oral powder and food for later.

Your doctor will tell you how many sachets of oral powder to take with each meal (your daily dose will be divided between meals). The number of sachets you take will depend on:

? your diet (the amount of phosphate in the food you eat)

? your blood phosphate level.

Before starting treatment with Fosrenol oral powder, your doctor may have used Fosrenol chewable tablets to find the right dose for you. Fosrenol chewable tablets come in different strengths, which allows for smaller increases in dose. The starting dose of chewable tablets is usually 250 mg, three times a day with meals. Your dose of oral powder is likely to be 750 or 1000 mg, three times a day with meals. Every 2-3 weeks, your doctor will check the level of phosphate in your blood and may increase your dose until your blood phosphate level is acceptable, and regularly after that.

Fosrenol works by binding to phosphate in your gut. It is very important to take Fosrenol with every meal. If you change your diet, tell your doctor, as you may need to take extra Fosrenol. Your doctor will tell you what to do in this case.

If you take more Fosrenol than you should

If you take too much Fosrenol, contact your doctor for an assessment of the risk and advice. Symptoms of overdose may be nausea and headache.

If you have taken more Fosrenol than you should, contact your doctor, pharmacist or call the Toxicology Information Service, telephone: 91-562-04-20, stating the name and amount of the medicine taken.

It is recommended that you take the medicine packaging and leaflet with you to the healthcare professional.

If you forget to take Fosrenol

It is important to take Fosrenol with every meal.

If you forget to take Fosrenol, take the next dose with your next meal. Do not take a double dose to make up for a forgotten dose.

4. Possible side effects

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

Some side effects could be serious. If you experience any of the following side effects, contact your doctor immediately:

• Intestinal wall rupture (signs include: severe stomach pain, chills, fever, nausea, vomiting or abdominal pain on palpation). This side effect occurs rarely (may affect up to 1 in 1000 people).
• Intestinal obstruction (signs include: severe swelling, pain, oedema or abdominal cramps, severe constipation). This side effect occurs uncommonly (may affect up to 1 in 100 people).
• Contact your doctor if you experience a new or severe episode of constipation, it may be an early sign of intestinal obstruction. Constipation is a common side effect (may affect up to 1 in 10 people).

Other less serious side effects include the following:

.

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

? Nausea, vomiting, diarrhoea, stomach pain, headache, itching, rash.

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

? Heartburn and flatulence.

? Hypocalcaemia (a low level of calcium in the blood) is also a common side effect; symptoms may include tingling in hands and feet, muscle cramps and abdominal or facial muscle spasms.

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

? Fatigue; feeling unwell; chest pain; weakness; swelling of hands and feet; body pain; dizziness; vertigo; belching; inflammation of the stomach and intestines (gastroenteritis); indigestion; irritable bowel syndrome; dry mouth; dental problems; inflammation of the oesophagus or mouth; soft stools; increases in certain liver enzymes, parathyroid hormone; aluminium, calcium and glucose in the blood; increase or decrease in phosphate level in the blood; thirst; weight loss; joint pain; muscle pain; weakness and loss of bone mass (osteoporosis); loss and increased appetite; inflammation of the larynx; hair loss; increased sweating; changes in taste and increased white blood cell count.

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

• Presence of product residues in the gut.

Reporting of side effects

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 Spanish Medicines Monitoring System for Human Use: www.notificaRAM.es.

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

5. Storing Fosrenol

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

This medicine does not require any special storage conditions.

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

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.

Return unused medicine to the pharmacy. Ask your pharmacist about the SIGRE collection point in the pharmacy. Ask your pharmacist how to dispose of the packaging and any unused medicine. This will help to protect the environment.

6. Contents of the pack and other information

What Fosrenol contains

• The active substance is lanthanum (as lanthanum carbonate hydrate). Each sachet contains lanthanum carbonate hydrate equivalent to 750 mg or 1000 mg of lanthanum.
• The other ingredients are dextrates (hydrated), colloidal anhydrous silica and magnesium stearate.

Appearance and packaging

Fosrenol is a white to off-white oral powder in a sachet.

The sachets are supplied in a carton of 90 units. (the outer carton contains 9 cartons of 10 sachets).

Marketing authorisation holder and manufacturer

The marketing authorisation holder is:

Takeda Pharmaceuticals International AG Ireland Branch

Block 2 Miesian Plaza, 50-58 Baggot Street Lower,

Dublin 2, D02 HW68, Ireland

Email: [email protected]

The manufacturer is:

Catalent Germany Schorndorf GmbH

Steinbeisstr. 1 and 2

Schorndorf, Baden-Wuerttemberg, 73614

Germany.

You can obtain further information on this medicine from the local representative of the marketing authorisation holder:

Local representative:

Takeda Farmacéutica España S.A.

Calle Albacete, 5, 9th floor,

Edificio Los Cubos

28027 Madrid

Spain

Tel: +34 91 790 42 22

This medicine is authorised in the Member States of the European Economic Area and in the United Kingdom (Northern Ireland) under the following names:

Date of last revision of this leaflet: 04/2025

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/)