Temozolomide Fair-med

Leaflet accompanying the packaging: information for the user

Temozolomide FAIR-MED, 5 mg, hard capsules
Temozolomide FAIR-MED, 20 mg, hard capsules
Temozolomide FAIR-MED, 100 mg, hard capsules
Temozolomide FAIR-MED, 140 mg, hard capsules
Temozolomide FAIR-MED, 180 mg, hard capsules
Temozolomide FAIR-MED, 250 mg, hard capsules
Temozolomide

You should carefully read the contents of the leaflet before taking the medicine, as it contains important information for the patient.

• You should keep this leaflet, so that you can read it again if you need to.
• You should consult a doctor, pharmacist, or nurse if you have any doubts.
• This medicine has been prescribed specifically for you. Do not pass it on to others. The medicine may harm another person, even if their symptoms are the same as yours.
• If you experience any side effects, including any possible side effects not listed in this leaflet, you should tell your doctor, pharmacist, or nurse. See section 4.

Table of contents of the leaflet:

• 1. What is Temozolomide and what is it used for
• 2. Important information before taking Temozolomide
• 3. How to take Temozolomide
• 4. Possible side effects
• 5. How to store Temozolomide
• 6. Contents of the pack and other information

1. What is Temozolomide and what is it used for

Temozolomide contains the active substance temozolomide. This medicine is an anti-cancer medicine.
Temozolomide is used to treat the following type of brain tumor:

• in adults with newly diagnosed glioblastoma multiforme. Temozolomide is first given together with radiotherapy (concomitant phase), and then as the only medicine (monotherapy phase).
• in children aged 3 years and older and adult patients with malignant glioma, such as glioblastoma multiforme or anaplastic astrocytoma. Temozolomide is used to treat this type of tumor if it grows back or gets worse after standard treatment.

2. Important information before taking Temozolomide

When not to take Temozolomide

• if you are allergic to temozolomide or any of the other ingredients of this medicine (listed in section 6).
• if you have previously been found to be hypersensitive to dacarbazine (an anti-cancer medicine, sometimes called DTIC). Symptoms of an allergic reaction include itching, difficulty breathing, wheezing, swelling of the face, lips, tongue, or throat.
• if you have a severely reduced number of certain blood cells (myelosuppression), such as white blood cells and platelets. These cells play an important role in fighting infections and forming blood clots. Your doctor will examine your blood before starting treatment to make sure you have enough of these cells.

Warnings and precautions

Before taking Temozolomide, you should discuss with your doctor, pharmacist, or nurse:

• because you will need to be under close supervision due to the risk of developing severe pneumonia caused by the microorganism Pneumocystis jirovecii (formerly known as Pneumocystis carinii pneumonia - PCP). If you are newly diagnosed (glioblastoma multiforme), you may receive Temozolomide in a 42-day treatment schedule in combination with radiotherapy. In this case, your doctor will also prescribe a medicine to help prevent the development of this type of pneumonia (PCP).
• if you have ever had or may currently have a hepatitis B virus infection. This is necessary because Temozolomide may cause reactivation of hepatitis B virus infection, which in some cases can be fatal. Before starting treatment, patients will be carefully examined by a doctor to detect any signs of this infection.
• if you experience a reduced number of red blood cells (anemia), white blood cells, and platelets, or blood clotting disorders before or during treatment. In this case, your doctor may decide to reduce the dose of Temozolomide, interrupt, or change the treatment. Other treatments may be necessary. In some cases, it may be necessary to stop treatment with Temozolomide. During treatment, to monitor the unwanted effects of Temozolomide on blood cells, you will undergo frequent blood tests.
• because you may have a small risk of developing other blood cell changes, including leukemia.
• if you experience nausea (vomiting) and/or vomiting, which are very common side effects associated with taking Temozolomide (see section 4), your doctor may prescribe anti-vomiting medicines (anti-emetics). If you experience frequent vomiting before or during treatment, you should ask your doctor about the most convenient time to take Temozolomide, until vomiting is controlled. If vomiting occurs after taking the medicine, you should not take a second dose on the same day.
• if you have a fever or signs of infection, you should contact your doctor immediately.
• if you are over 70 years old, you may be more susceptible to infections, have an increased tendency to bruise or bleed.
• if you have kidney or liver disease, it may be necessary to adjust the dose of Temozolomide.

Children and adolescents

Temozolomide should not be given to children under 3 years of age, as there is limited experience in children.

Other medicines and Temozolomide

You should tell your doctor or pharmacist about all medicines you are taking or have recently taken, as well as any medicines you plan to take.

Pregnancy, breastfeeding, and fertility

If you are pregnant, think you may be pregnant, or plan to become pregnant, you should consult your doctor or pharmacist before taking this medicine. You should not take Temozolomide during pregnancy unless your doctor has clearly indicated that you should.
During treatment with Temozolomide, both men and womenshould use effective contraceptive methods (see also the section below on "Male fertility").
You should stop breastfeeding while taking Temozolomide.

Male fertility

Temozolomide may cause permanent infertility. Men taking Temozolomide should use effective contraceptive methods and not father a child during treatment and for 6 months after treatment ends. It is recommended that the patient consult a doctor about sperm preservation before starting treatment.

Driving and using machines

Temozolomide may cause fatigue or drowsiness. In this case, you should not drive or operate machinery, or ride a bicycle, until you know how the medicine affects you (see section 4).

Temozolomide contains lactose

Temozolomide contains lactose (a type of sugar). If you have previously been diagnosed with intolerance to some sugars, you should contact your doctor before taking the medicine.

3. How to take Temozolomide

This medicine should always be taken exactly as prescribed by your doctor or pharmacist. If you are unsure, you should consult your doctor or pharmacist.
Dosage and duration of treatment
Your doctor will determine the appropriate dose of Temozolomide for you.
The dose is determined based on body size (height and weight), depending on whether the tumor has grown back and whether you have previously undergone chemotherapy.
To prevent nausea and vomiting or reduce them, other medicines may be prescribed to be taken before and/or after taking Temozolomide.
Patients with newly diagnosed glioblastoma multiforme:
Treatment will be given in two phases:

• first, treatment together with radiotherapy (concomitant phase)
• then, treatment with only Temozolomide (monotherapy phase).

During the concomitant phase, your doctor will start giving you Temozolomide at a dose of 75 mg/m2 (the usual dose). You will take this dose every day for 42 days (up to 49 days) with radiotherapy. Depending on the results of your blood tests and/or your tolerance to the medicine during the concomitant phase, the dose of Temozolomide may be delayed or not given. After completing radiotherapy, there will be a 4-week break in treatment to allow your body to recover. Then, the monotherapy phase will begin.
During the monotherapy phase, the dose and method of taking Temozolomide will be different (than during the concomitant phase). Your doctor will determine the exact dose for you. You may receive up to 6 cycles of treatment. Each cycle lasts 28 days. You will take Temozolomide only once a day for the first 5 days of each cycle ("days of taking the medicine"). The first dose is 150 mg/m2. Then, there will be a 23-day break from taking Temozolomide. This gives a total of 28 days per treatment cycle. After day 28, the next cycle will begin. You will take the medicine again once a day for 5 days, followed by a 23-day break from taking Temozolomide. Before starting each new cycle, you will undergo a blood test to assess whether the dose of Temozolomide needs to be adjusted. Depending on the results of the blood tests, your doctor may adjust the dose in the next cycles.
Patients with recurrent or progressive glioma (malignant glioma, such as glioblastoma multiforme or anaplastic astrocytoma), taking only Temozolomide:
The treatment cycle with Temozolomide lasts 28 days.
You will take Temozolomide only once a day for the first 5 days.
The daily dose depends on whether you have previously undergone chemotherapy.
If you have not previously undergone chemotherapy, the first dose of Temozolomide will be 200 mg/m2 once a day for the first 5 days. If you have previously undergone chemotherapy, the first dose of Temozolomide will be 150 mg/m2 once a day for the first 5 days.
Then, there will be a 23-day break from taking Temozolomide. This gives a total of 28 days per cycle.
After 28 days, the next cycle will begin. You will take Temozolomide again once a day for 5 days, followed by a 23-day break from taking Temozolomide. Before starting each new cycle, you will undergo a blood test to assess whether the dose of Temozolomide needs to be adjusted. Depending on the results of the blood tests, your doctor may adjust the dose in the next cycles.
How to take Temozolomide
You should take the prescribed dose of Temozolomide once a day, preferably at the same time every day.
The medicine should be taken on an empty stomach, for example, at least one hour before planned breakfast. You should swallow the capsule(s) whole, with a glass of water. Do not open, crush, or chew the capsules. If a capsule is damaged, you should avoid contact with its contents and your skin, eyes, or nose. If you accidentally come into contact with the medicine and your eyes or nose, you should rinse the affected area thoroughly with water.
Depending on the prescribed dose, you may take more than one capsule at a time, also of different strengths (active substance content, in mg). The color of the capsule cap is different for each strength (see the table below).

You must make sure you have fully understood and remembered the following:

• how many capsules of each strength you should take each day you take the medicine. You should ask your doctor or pharmacist to write down the number of capsules of each strength (also the color) you should take each day you take the medicine.
• which days are the days of taking the medicine. Before starting a new cycle, you should again receive instructions from your doctor about the dose, as it may be different from the dose taken in the last cycle.

Temozolomide should always be taken as directed by your doctor. It is very important to contact your doctor or pharmacist if you have any doubts. Errors in taking the medicine can have serious consequences for your health.

Taking a higher dose of Temozolomide than recommended

If you accidentally take more Temozolomide capsules than prescribed, you should contact your doctor, pharmacist, or nurse immediately.

Missing a dose of Temozolomide

Missed doses should be taken as soon as possible, on the same day. If the medicine is not taken on the same day, you should consult your doctor. You should not take a double dose to make up for a missed dose, unless your doctor tells you to do so.
If you have any further doubts about taking this medicine, you should consult your doctor, pharmacist, or nurse.

4. Possible side effects

Like all medicines, Temozolomide can cause side effects, although not everybody gets them.
You should immediatelycontact your doctor if you experience any of the following symptoms:

• severe allergic reactions (hypersensitivity) (hives, wheezing, or other breathing difficulties),
• uncontrolled bleeding,
• seizures (convulsions),
• fever,
• chills,
• severe, persistent headaches.

Treatment with Temozolomide may cause a decrease in the number of certain blood cells. This can lead to increased bruising or bleeding, anemia (reduced number of red blood cells), fever, and reduced resistance to infections. The decrease in blood cells is usually temporary. In some cases, it may be long-lasting and may lead to a very severe form of anemia (aplastic anemia). Your doctor will recommend regular blood tests to detect any changes and decide whether specific treatment is needed.
In some cases, the dose of Temozolomide may be reduced or treatment may be interrupted.
Other reported side effects are listed below:

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

• loss of appetite, speech difficulties, headache
• vomiting, nausea, diarrhea, constipation
• rash, hair loss
• fatigue

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

• infections, oral infections, wound infections
• reduced number of blood cells (neutropenia, lymphopenia, thrombocytopenia)
• allergic reaction
• increased blood sugar levels
• memory disorders, depression, anxiety, confusion, insomnia, or sleep disturbances
• coordination and balance disorders
• difficulty concentrating, changes in mental state or alertness, forgetfulness
• dizziness, sensation disturbances, tingling, tremors, taste disorders
• partial loss of vision, abnormal vision, double vision, dryness, or eye pain
• hearing loss, ear infection, ear pain
• blood clots in the lungs or legs, high blood pressure
• pneumonia, shortness of breath, bronchitis, cough, sinusitis
• abdominal or stomach pain, stomach upset/heartburn, swallowing difficulties
• dry skin, itching
• muscle damage, muscle weakness, muscle pain
• joint pain, back pain
• frequent urination, difficulty controlling urination
• fever, flu-like symptoms, pain, malaise, cold, or flu
• fluid retention, swelling of the feet
• increased liver enzyme activity
• weight loss, weight gain
• radiation damage

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

• brain infections (herpes simplex encephalitis), including fatal cases
• new or reactivated cytomegalovirus infection
• reactivation of hepatitis B virus infection
• secondary tumors, including leukemia
• reduced number of blood cells (pancytopenia, anemia, leukopenia)
• red spots under the skin
• diabetes insipidus (symptoms include frequent urination and thirst), low potassium levels in the blood
• mood changes, hallucinations
• partial paralysis, changes in smell perception
• hearing disorders, ear infections
• heart palpitations (feeling your heartbeat), hot flashes
• stomach swelling, difficulty controlling bowel movements, hemorrhoids, dry mouth
• liver inflammation and liver damage (including fatal liver failure), cholestasis, increased bilirubin levels
• blisters on the body or in the mouth, skin peeling, skin rashes, painful redness of the skin, severe skin rash with skin peeling (including on the hands and feet)
• increased sensitivity to sunlight, hives, increased sweating, skin color changes
• difficulty urinating
• vaginal bleeding, vaginal irritation, absence or heavy menstrual periods, breast pain, sexual impotence
• chills, facial swelling, tongue discoloration, thirst, dental problems

Reporting side effects

If you experience any side effects, including any possible side effects not listed in this leaflet, you should tell your doctor or pharmacist. Side effects can be reported directly to:
Department for Monitoring of Adverse Reactions to Medicinal Products, Medical Devices, and Biocidal Products
Al. Jerozolimskie 181C
PL-02 222 Warsaw
Phone: +48 22 49 21 301
Fax: +48 22 49 21 309
Website: https://smz.ezdrowie.gov.pl
Side effects can also be reported to the marketing authorization holder. By reporting side effects, you can help provide more information on the safety of this medicine.

5. How to store Temozolomide

The medicine should be stored out of sight and reach of children, preferably in a locked cabinet. Accidental ingestion of the medicine can be fatal in children.
Do not take this medicine after the expiry date stated on the label and carton after the abbreviation "EXP". The expiry date refers to the last day of the month stated.
HDPE bottle
Store at a temperature below 30°C.
Store in the original packaging to protect from moisture.
Store the bottle tightly closed.
Blisters
Capsules of 5 mg and 20 mg: store at a temperature below 25°C.
Capsules of 100 mg, 140 mg, 180 mg, and 250 mg: store at a temperature below 30°C.
You should inform your pharmacist if you notice any changes in the appearance of the capsules.
Medicines should not be disposed of via wastewater or household waste. You should ask your pharmacist how to dispose of medicines that are no longer needed. This will help protect the environment.

6. Contents of the pack and other information

What Temozolomide contains

• The active substance of Temozolomide is temozolomide. Each capsule contains 5 mg of temozolomide.
• The active substance of Temozolomide is temozolomide. Each capsule contains 20 mg of temozolomide.
• The active substance of Temozolomide is temozolomide. Each capsule contains 100 mg of temozolomide.
• The active substance of Temozolomide is temozolomide. Each capsule contains 140 mg of temozolomide.
• The active substance of Temozolomide is temozolomide. Each capsule contains 180 mg of temozolomide.
• The active substance of Temozolomide is temozolomide. Each capsule contains 250 mg of temozolomide.
• Other ingredients are:

Capsule contents:
Anhydrous lactose
Anhydrous colloidal silica
Sodium carboxymethylcellulose Type A
Tartaric acid
Stearic acid
(see section 2 "Temozolomide FAIR-MED contains lactose").
Capsule shell, size 0:
Capsules of 5 mg:
Gelatin
Titanium dioxide (E 171)
Yellow iron oxide (E 172)
Indigo carmine (E 132)
Capsules of 20 mg:
Gelatin
Titanium dioxide (E 171)
Red iron oxide (E 172)
Yellow iron oxide (E 172)
Capsules of 100 mg:
Gelatin
Titanium dioxide (E 171)
Red iron oxide (E 172)
Indigo carmine (E 132)
Capsules of 140 mg:
Gelatin
Titanium dioxide (E 171)
Indigo carmine (E 132)
Capsules of 180 mg:
Gelatin
Titanium dioxide (E 171)
Red iron oxide (E 172)
Black iron oxide (E 172)
Yellow iron oxide (E 172)
Capsules of 250 mg:
Gelatin
Titanium dioxide (E 171)
Black printing ink:
Shellac
Propylene glycol
Purified water
Concentrated ammonia solution
Potassium hydroxide
Black iron oxide (E 172).

What Temozolomide looks like and contents of the pack

Capsules of 5 mg: Hard gelatin capsules, size 0, with a green opaque cap and a white opaque body. The body is printed with black ink with the number "5".
Capsules of 20 mg: Hard gelatin capsules, size 0, with an orange opaque cap and a white opaque body. The body is printed with black ink with the number "20".
Capsules of 100 mg: Hard gelatin capsules, size 0, with a purple opaque cap and a white opaque body. The body is printed with black ink with the number "100".
Capsules of 140 mg: Hard gelatin capsules, size 0, with a blue opaque cap and a white opaque body. The body is printed with black ink with the number "140".
Capsules of 180 mg: Hard gelatin capsules, size 0, with a chocolate-brown opaque cap and a white opaque body. The body is printed with black ink with the number "180".
Capsules of 250 mg: Hard gelatin capsules, size 0, with a white opaque cap and a white opaque body. The body is printed with black ink with the number "250".
HDPE bottle
5 capsules in an HDPE bottle with a PP child-resistant closure, containing a polyester coil and a desiccant, in a cardboard box.
Blisters
5 or 20 capsules in separate blisters (Paper/LDPE/Aluminum/Ethylene-acrylic acid copolymer), in a cardboard box.
Not all pack sizes may be marketed.

Marketing authorization holder and manufacturer

Marketing authorization holder
Fairmed Healthcare GmbH
Dorotheenstraße 48
22301 Hamburg
Germany
pv@fair-med.com
Manufacturer
Fairmed Healthcare GmbH
Maria-Göppert-Straße 3
23562 Lübeck
Germany
EirGen Pharma Ltd.
64/65 Westside Business Park
Old Kilmeaden Road, Waterford
Ireland

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

Netherlands:
Temozolomide FAIR-MED 5mg/20mg/100mg/140mg/180mg/250mg, hard capsules
Germany:
Temozolomide Fair-Med Healthcare 5mg/20mg/100mg/140mg/180mg/250mg Hartkapseln
Denmark:
Temozolomide FAIR-MED
Ireland:
Temozolomide FAIR-MED 5mg/20mg/100mg/140mg/180mg/250mg hard capsules

Date of last revision of the leaflet: October 2021