ALUNBRIG 90 mg FILM-COATED TABLETS

Introduction

Package Leaflet: Information for the Patient

Alunbrig 30mg film-coated tablets

Alunbrig 90mg film-coated tablets

Alunbrig 180mg film-coated tablets

brigatinib

Read all of this leaflet carefully before you start taking 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 or pharmacist.
• This medicine has been prescribed for you only. Do not pass it on to others. It may harm them, even if their signs of illness are the same as yours.
• If you experience any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. See section 4.

Contents of the pack

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

1. What is Alunbrig and what is it used for

Alunbrig contains the active substance brigatinib, a type of cancer medicine called a kinase inhibitor. Alunbrig is used to treat a type of lung cancer in adults in advanced stages called non-small cell lung cancer. It is given to patients whose cancer is related to an abnormal form of the anaplastic lymphoma kinase (ALK) gene.

How Alunbrig works

The abnormal gene produces a protein known as kinase that stimulates the growth of cancer cells. Alunbrig blocks the action of this protein and thus slows down the growth and spread of the cancer.

2. What you need to know before you take Alunbrig

Do not take Alunbrig

• if you are allergicto brigatinib or any of the other ingredients of this medicine (listed in section 6).

Warnings and precautions

Talk to your doctor before starting treatment with Alunbrig or during treatment if you have:

• lung or breathing problems

Lung problems, some of which are serious, are more common in the first seven days of treatment. The symptoms can be similar to those of lung cancer. Tell your doctor if you experience new symptoms or if they get worse, including breathing difficulties, shortness of breath, chest pain, cough, and fever.

• high blood pressure
• slow heart rate (bradycardia)
• visual disturbances

Tell your doctor about any visual disturbances you notice during treatment, such as seeing flashing lights, blurred vision, or if light hurts your eyes.

• muscle problems

Tell your doctor if you experience any weakness, discomfort, or muscle pain without apparent cause.

• pancreas problems

Talk to your doctor if you experience stomach pain in the upper abdomen, including stomach pain that gets worse when eating and can spread to the back, weight loss, or nausea.

• liver problems

Talk to your doctor if you experience pain in the right side of the stomach area, if you have yellowing of the skin or whites of the eyes, or dark urine.

• high blood sugar
• sensitivity to sunlight

Limit your exposure to sunlight during treatment and for at least 5 days after the last dose. When exposed to sunlight, wear a hat, protective clothing, broad-spectrum ultraviolet A (UVA)/ultraviolet B (UVB) sunscreen, and lip balm with a sun protection factor (SPF) of 30 or higher. This will help protect you from possible sunburn.

Tell your doctor if you have kidney problems or are on dialysis. Symptoms related to kidney problems include nausea, changes in urine volume or frequency, or abnormalities in blood tests (see section 4).

Your doctor may need to adjust your treatment or interrupt the use of Alunbrig temporarily or permanently. See also the beginning of section 4.

Children and adolescents

Alunbrig has not been studied in children or adolescents. Treatment with Alunbrig is not recommended in people under 18 years of age.

Other medicines and Alunbrig

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

The following medicines may affect Alunbrig or be affected by it:

• ketoconazole, itraconazole, voriconazole:medicines for the treatment of fungi
• indinavir, nelfinavir, ritonavir, saquinavir:medicines for the treatment of HIV
• clarithromycin, telithromycin, troleandomycin:medicines for the treatment of bacterial infections
• nefazodone:a medicine for the treatment of depression
• St. John's Wort:a herbal medicine used in the treatment of depression
• carbamazepine:a medicine for the treatment of epilepsy, manic/depressive episodes, and certain types of pain
• phenobarbital, phenytoin:medicines for the treatment of epilepsy
• rifabutin, rifampicin:medicines for the treatment of tuberculosis or certain infections
• digoxin:a medicine for the treatment of heart problems
• dabigatran:a medicine to prevent blood clotting
• colchicine:a medicine for the treatment of gout attacks
• pravastatin, rosuvastatin:medicines to lower high cholesterol levels
• methotrexate:a medicine for the treatment of severe joint inflammation, cancer, and skin disease psoriasis
• sulfasalazine:a medicine for the treatment of severe intestinal inflammation and rheumatic joint inflammation
• efavirenz, etravirine:medicines for the treatment of HIV
• modafinil:a medicine for the treatment of narcolepsy
• bosentan:a medicine for the treatment of pulmonary hypertension
• nafcillin:a medicine for the treatment of bacterial infections
• alfentanil, fentanyl:medicines for the treatment of pain
• quinidine:a medicine for the treatment of people with an irregular heart rhythm
• cyclosporin, sirolimus, tacrolimus:medicines to suppress the immune system

Taking Alunbrig with food and drinks

Avoid consuming grapefruit products during treatment, as they may change the amount of brigatinib in your body.

Pregnancy

Alunbrig is not recommendedduring pregnancy unless the benefit outweighs the risk to the baby. If you are pregnant, think you may be pregnant, or plan to become pregnant, consult your doctor about the risks of using Alunbrig during pregnancy.

Women of childbearing age who are taking Alunbrig should avoid becoming pregnant. Effective non-hormonal contraception must be used during treatment and for 4 months after stopping Alunbrig. Ask your doctor about suitable contraceptive methods for you.

Breast-feeding

Do not breast-feedduring treatment with Alunbrig. It is not known whether brigatinib passes into breast milk, and there is a possibility of harming the baby.

Fertility

Men receiving treatment with Alunbrig are advised not to father a child during treatment and to use effective contraception during treatment and for 3 months after stopping treatment.

Driving and using machines

Alunbrig may cause visual disturbances, dizziness, and fatigue. Do not drive or use machines during treatment if you experience these symptoms.

Alunbrig contains lactose

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

Alunbrig contains sodium

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

3. How to take Alunbrig

Always take this medicine exactly as your doctor or pharmacist has told you. If you are not sure, check with your doctor or pharmacist.

The recommended dose is

One 90 mg tablet once a day for the first seven days of treatment; after that, one 180 mg tablet once a day.

Do not change the dose without consulting your doctor. Your doctor may adjust the dose based on your needs, which may require using a 30 mg tablet to achieve the recommended dose.

Initial treatment pack

At the start of your treatment with Alunbrig, your doctor may prescribe an initial treatment pack. To facilitate the start of treatment, each initial treatment pack consists of an outer carton containing two inner packs that contain:

• 7 film-coated tablets of Alunbrig 90 mg
• 21 film-coated tablets of Alunbrig 180 mg

The required dose is printed on the initial treatment pack.

Method of administration

• Take Alunbrig once a day and always at the same time.
• Swallow the tablets whole with a glass of water. Do not break or dissolve the tablets.
• The tablets can be taken with or without food.
• If you vomit after taking Alunbrig, do not take another tablet until your next scheduled dose.

Do not take the desiccant container in the bottle.

If you take more Alunbrig than you should

Tell your doctor or pharmacist immediately if you have taken more tablets than recommended.

If you forget to take Alunbrig

Do not take a double dose to make up for a forgotten dose. Take your next dose when it is scheduled.

If you stop taking Alunbrig

Do not stop your treatment with Alunbrig without consulting your doctor.

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.

Tell your doctor or pharmacist immediatelyif you experience any of the following serious side effects:

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

• high blood pressure

Talk to your doctor if you experience headaches, dizziness, blurred vision, chest pain, or shortness of breath.

• vision problems

Talk to your doctor if you experience any visual disturbances, such as seeing flashing lights, blurred vision, or if light hurts your eyes. Your doctor may interrupt your treatment with Alunbrig and refer you to an ophthalmologist.

• increased creatine phosphokinase levels in blood tests: may indicate muscle damage, for example, to the heart. Talk to your doctor if you experience weakness, discomfort, or muscle pain without apparent cause.

• increased amylase or lipase levels in blood tests: may indicate pancreas inflammation.

Talk to your doctor if you experience stomach pain in the upper abdomen, including stomach pain that gets worse when eating and can spread to the back, weight loss, or nausea.

• increased liver enzyme levels in blood tests (aspartate aminotransferase and alanine aminotransferase): may indicate liver cell damage. Talk to your doctor if you experience pain in the right side of the stomach area, if you have yellowing of the skin or whites of the eyes, or dark urine.
• high blood sugar

Talk to your doctor if you feel very thirsty, need to urinate more often than usual, are very hungry, feel nauseous, or feel weak, tired, or disoriented.

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

• lung inflammation

Talk to your doctor if you experience new or worsening respiratory or lung problems, including chest pain, cough, and fever, especially during the first week of treatment with Alunbrig, as they may be a symptom of serious lung problems.

• slow heart rate

Talk to your doctor if you experience chest discomfort or pain, changes in heart rhythm, dizziness, lightheadedness, or fainting.

• sensitivity to sunlight

Talk to your doctor if you experience any skin reaction.

See also section 2, "Warnings and precautions".

Uncommon(may affect up to 1 in 100 people)

• pancreas inflammation, which can cause severe and persistent stomach pain, with or without nausea and vomiting (pancreatitis)

Other possible side effects:

Talk to your doctor or pharmacist if you notice any of the following side effects

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

• lung infection (pneumonia)
• cold symptoms (infection of the upper respiratory tract)
• reduced red blood cell count (anemia) in blood tests
• reduced white blood cell count, including neutrophils and lymphocytes in blood tests
• increased blood clotting time measured by the activated partial thromboplastin time test
• in blood tests, an increase in:

‑ insulin

‑ calcium

• in blood tests, a decrease in:

• phosphorus
• magnesium
• sodium
• potassium
• decreased appetite
• headache
• symptoms such as numbness, tingling, prickling, weakness, or pain in the hands or feet (peripheral neuropathy)
• dizziness
• cough
• shortness of breath
• diarrhea
• nausea
• vomiting
• abdominal pain (stomach)
• constipation
• inflammation of the mouth or lips (stomatitis)
• increased levels of the enzyme alkaline phosphatase in blood tests (may indicate organ damage or failure)
• rash
• itching of the skin
• muscle or joint pain (including muscle spasms)
• increased creatinine levels in blood tests (may indicate decreased kidney function)
• fatigue
• inflammation of tissues caused by excess fluid
• fever

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

• low platelet count in blood tests that can increase the risk of bleeding and bruising
• difficulty sleeping (insomnia)

• memory disorders
• change in taste
• abnormal heart rhythm (prolonged QT interval on the electrocardiogram)
• fast heart rate (tachycardia)
• palpitations
• dry mouth
• indigestion
• flatulence
• increased lactate dehydrogenase levels in blood tests (may indicate tissue breakdown)
• increased bilirubin levels in blood tests
• dry skin
• musculoskeletal chest pain
• pain in arms and legs
• muscle and joint stiffness
• chest discomfort or pain
• pain
• increased cholesterol levels in blood tests
• weight loss

Reporting of side effects

If you experience 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 through 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. Storage of Alunbrig

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 label of the bottle or blister and carton after EXP. The expiry date refers to the last day of the month shown.

This medicine does not require any special storage conditions.

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. Package Contents and Additional Information

Alunbrig Composition

• The active ingredient is brigatinib.

Each 30 mg film-coated tablet contains 30 mg of brigatinib.

Each 90 mg film-coated tablet contains 90 mg of brigatinib.

Each 180 mg film-coated tablet contains 180 mg of brigatinib.

• The other excipients are lactose monohydrate, microcrystalline cellulose, sodium carboxymethyl starch type A, hydrophobic colloidal silica, magnesium stearate, talc, macrogol, polyvinyl alcohol, and titanium dioxide (see also sections 2 'Alunbrig contains lactose' and 'Alunbrig contains sodium').

Appearance of Alunbrig and Package Contents

Alunbrig film-coated tablets are oval (90 mg and 180 mg) or round (30 mg) and white to off-white. They are convex in shape on the top and bottom.

Alunbrig 30 mg:

• Each 30 mg tablet contains 30 mg of brigatinib.
• Film-coated tablets approximately 7 mm in diameter with "U3" engraved on one side and smooth on the other side.

Alunbrig 90 mg:

• Each 90 mg tablet contains 90 mg of brigatinib.
• Film-coated tablets approximately 15 mm long with "U7" engraved on one side and smooth on the other side.

Alunbrig 180 mg:

• Each 180 mg tablet contains 180 mg of brigatinib.
• Film-coated tablets approximately 19 mm long with "U13" engraved on one side and smooth on the other side.

Alunbrig is available in plastic strips (blister packs) packaged in a box with:

• Alunbrig 30 mg: 28, 56, or 112 film-coated tablets
• Alunbrig 90 mg: 7 or 28 film-coated tablets
• Alunbrig 180 mg: 28 film-coated tablets

Alunbrig is available in plastic bottles with a child-resistant screw cap. Each bottle contains a desiccant and is packaged in a box with:

• Alunbrig 30 mg: 60 or 120 film-coated tablets
• Alunbrig 90 mg: 7 or 30 film-coated tablets
• Alunbrig 180 mg: 30 film-coated tablets

Keep the desiccant container inside the bottle.

Alunbrig is available in a starter pack. Each pack contains an outer box with two inner boxes containing:

• Alunbrig 90 mg film-coated tablets

1 plastic strip (blister pack) with 7 film-coated tablets

• Alunbrig 180 mg film-coated tablets

3 plastic strips (blister packs) with 21 film-coated tablets

Not all pack sizes may be marketed.

Marketing Authorisation Holder

Takeda Pharma A/S

Delta Park 45

2665 Vallensbaek Strand

Denmark

Manufacturer

Takeda Austria GmbH

St. Peter-Strasse 25

4020 Linz

Austria

Takeda Ireland Limited

Bray Business Park

Kilruddery

Co. Wicklow

A98 CD36

Ireland

You can request more information about this medicinal product by contacting the local representative of the marketing authorisation holder:

Date of Last Revision of this Leaflet:

Other Sources of Information

Detailed information on this medicinal product is available on the European Medicines Agency website: http://www.ema.europa.eu.