PROTOPIC 0.03% OINTMENT

2. What you need to know before you start using Protopic

Do not use Protopic

• If you are allergic to tacrolimus or any of the other ingredients of this medicine (listed in section 6), or to macrolide antibiotics (e.g. azithromycin, clarithromycin, erythromycin).

Warnings and precautions

Talk to your doctor before you start using Protopic:

• If you have liver problems.
• If you have any skin malignancies(tumours) or if you have a weakened immune system(immunocompromised) for any reason.
• If you have a hereditary skin barrier diseasesuch as Netherton's syndrome, lamellar ichthyosis (widespread scaling of the skin due to thickening of the outer layer of the skin), or if you suffer from generalized erythroderma(inflammatory redness and scaling of the whole skin).
• If you have a skin graft-versus-host disease (an immune reaction of the skin that is a common complication in patients who have undergone a bone marrow transplant).
• If your lymph nodes are swollenat the start of treatment. If your lymph nodes become swollen during treatment with Protopic, talk to your doctor.
• If you have infected lesions. Do not apply the ointment to infected lesions.
• If you notice any change in the appearance of your skin, please inform your doctor.
• After long-term studies and experience, no relationship has been confirmed between treatment with Protopic ointment and the occurrence of malignant tumours. However, no definitive conclusions can be drawn.
• Avoid exposing your skin to long periods of sunlight or artificial light such as sunlamps. If you stay outdoors after applying Protopic, use a sun protection factor and wear loose clothing that protects your skin from the sun. Also, talk to your doctor for other suitable methods to protect yourself from the sun. If you are prescribed light therapy, inform your doctor that you are using Protopic, as it is not recommended to use Protopic and light therapy at the same time.
• If your doctor tells you to use Protopic twice a week to maintain the disappearance of your atopic dermatitis, your condition should be reviewed by your doctor at least every 12 months, even if it remains under control. In children, the maintenance treatment should be stopped after 12 months to assess whether there is still a need for continued treatment.
• It is recommended to use Protopic ointment with the lowest concentration and frequency necessary for the shortest possible time. This decision should be based on your doctor's assessment of how your eczema responds to Protopic ointment.

Children

• Protopic ointment is not authorised for children under 2 years. Therefore, it must not be used in this age group. Please consult your doctor.

• The effect of treatment with Protopic on the development of the child's immune system has not been established, especially in younger children.

Other medicines, cosmetics and Protopic

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

You can use moisturising creams and lotions during treatment with Protopic, but not in the 2 hours before and after applying Protopic.

The use of Protopic at the same time as other skin preparations or simultaneously with oral corticosteroids or immunosuppressants has not been studied.

Using Protopic with alcohol

While using Protopic, drinking alcohol may cause flushing or redness of the skin or face and a feeling of warmth.

Pregnancy and breast-feeding

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.

Protopic contains butylhydroxytoluene (E321)

Protopic contains butylhydroxytoluene (E321), which may cause local skin reactions (such as contact dermatitis) or irritation of the eyes and mucous membranes.

3. How to use Protopic

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

• Apply Protopic as a thin layer to the affected areas of your skin.
• Protopic can be used on most parts of the body, including the face and neck and in the folds of the elbows and knees.
• Avoid using the ointment inside your nose or mouth, or in your eyes. If ointment gets in any of these areas, it should be removed by carefully wiping and/or rinsing with water.
• Do not cover the treated skin with bandages or dressings.
• Wash your hands after applying Protopic if these areas are not being treated.
• Before using Protopic after a bath or shower, make sure your skin is completely dry.

Children (2 years of age and older)

Apply Protopic 0.03% ointment twice a day for up to three weeks, once in the morning and once in the evening. Then use the ointment once a day on each affected area of skin until the eczema has disappeared.

Adults (16 years of age and older)

Two concentrations of Protopic (Protopic 0.03% and Protopic 0.1% ointment) are available for adult patients (16 years of age and older). Your doctor will decide which concentration is most suitable for you.

Treatment is usually started with Protopic 0.1% ointment, twice a day, once in the morning and once in the evening, until the eczema has cleared. Your doctor will decide whether the frequency of application can be reduced depending on the response of your eczema or whether the lower concentration Protopic 0.03% ointment can be used.

Treat each affected area of your skin until the eczema has disappeared. Improvement is usually seen within one week. If you do not see any improvement after two weeks, talk to your doctor about other possible treatments.

Your doctor may tell you to use Protopic ointment twice a week once your atopic dermatitis has disappeared or almost disappeared (Protopic 0.03% for children and Protopic 0.1% for adults). Protopic ointment should be applied once a day, twice a week (e.g. Monday and Thursday), to the areas of your body that are usually affected by atopic dermatitis. There should be 2-3 days without treatment with Protopic between applications.

If the symptoms come back, you should use Protopic twice a day as described above and go to see your doctor to have your treatment reviewed.

If you accidentally swallow some ointment

If someone accidentally swallows the ointment, talk to your doctor or pharmacist as soon as possible. Do not try to vomit.

If you forget to use Protopic

If you forget to apply the ointment at the right time, do so as soon as you remember and then continue as before.

If you have any further questions on the use of this medicine, ask your doctor or pharmacist.

4. Possible side effects

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

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

• burning sensation and itching

These symptoms are usually mild or moderate and generally disappear within one week of using Protopic.

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

• redness
• feeling of warmth
• pain
• increased sensitivity of the skin (especially to heat and cold)
• tingling
• rash
• local skin infections, regardless of their specific cause, including but not limited to: inflamed or infected hair follicles, cold sores, generalised herpes simplex infections
• facial redness or skin irritation after drinking alcohol is also common

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

• acne

After twice-weekly treatment, infections at the site of application have been reported in children and adults. Impetigo, a superficial bacterial infection of the skin that usually produces blisters or sores, has been reported in children.

Rosacea (facial redness), rosacea-like dermatitis, lentigo (flat brown spots on the skin), swelling at the site of application and herpes infections of the eyes have also been reported during post-marketing use.

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 national reporting system listed in Appendix V. By reporting side effects, you can help provide more information on the safety of this medicine.

5. Storing Protopic

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 packaging and carton after EXP. The expiry date is the last day of the month shown.

Do not store above 25°C.

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. Package contents and further information

What is in Protopic

• The active substance is tacrolimus monohydrate.

One gram of Protopic 0.03% ointment contains 0.3 mg of tacrolimus (as tacrolimus monohydrate).

• The other ingredients are white soft paraffin, liquid paraffin, propylene carbonate, white beeswax, hard paraffin, butylhydroxytoluene (E321) and all-rac-α-tocopherol.

Appearance and packaging

Protopic is a white or slightly yellowish ointment. It is available in tubes containing 10, 30 or 60 grams of ointment. Not all pack sizes may be marketed.

Protopic is available in two concentrations (Protopic 0.03% and Protopic 0.1% ointment).

Marketing authorisation holder

LEO Pharma A/S

Industriparken 55

2750 Ballerup

Denmark

Manufacturer

Astellas Ireland Co. Ltd.

Killorglin

County Kerry

Ireland

LEO Laboratories Ltd.

285 Cashel Road

Crumlin, Dublin 12

Ireland

For further information about this medicine, contact the local representative of the marketing authorisation holder:

Date of last revision of this leaflet

Detailed information on this medicine is available on the European Medicines Agency web site: http://www.ema.europa.eu.