Leaflet: information for the user

Anasma Accuhaler 50 micrograms/250 micrograms/inhalation, powder for inhalation

salmeterol/fluticasone propionate

Read this leaflet carefully before you start using this medicine, as it contains important information for you.

• Keep this leaflet, as you may need to read it again.
• If you have any questions, consult your doctor or pharmacist.
• This medicine has been prescribed for you only, and you must not give it to others even if they have the same symptoms as you, as it may harm them.
• If you experience any side effects, consult your doctor or pharmacist, even if they are not listed in this leaflet. See section 4.

6. Contents of the pack and additional information

Anasma contains two active principles, salmeterol and fluticasone propionate:

• Salmeterol is a long-acting bronchodilator. Bronchodilators help keep the airways in the lungs open, making it easier for air to enter and exit. The effects last for at least 12 hours.
• Fluticasone propionate is a corticosteroid that reduces inflammation and irritation in the lungs.

Your doctor has prescribed this medication to help prevent respiratory problems such as:

• Asthma.
• Chronic Obstructive Pulmonary Disease (COPD).Anasma Accuhaler, in a dose of 50/500 micrograms, reduces the number of exacerbations of COPD symptoms.

You must use Anasma every day, as recommended by your doctor. This will ensure that the medication acts correctly in controlling your asthma or COPD.

Anasma helps prevent shortness of breath and wheezing. However, Anasma should not be used to relieve a sudden attack of shortness of breath or wheezing. In such a case, you must use your rescue medication with rapid action, such as salbutamol. You should always carry your rescue medication with you.

No use Anasma

• If you are allergic to salmeterol, fluticasone propionate or to any of the other ingredients, lactose monohydrate.

Warnings and precautions

Consult your doctor before starting treatment if you have:

• Cardiac alterations including rapid or irregular heartbeat.
• Hyperthyroidism.
• High blood pressure.
• Diabetes mellitus (Anasma may increase blood sugar levels).
• Low levels of potassium in the blood.
• Tuberculosis (TB) today or in the past or other lung infections.

Contact your doctor if you experience blurred vision or other visual disturbances.

Use of Anasma with other medications

Inform your doctor or pharmacist if you are using, have used recently or may need to use any other medication, including those for asthma or those obtained without a prescription. The reason is that, in some cases, Anasma should not be administered with other medications.

Inform your doctor if you take any of the following medications before starting to use Anasma:

• β blockers (such as atenolol, propranolol and sotalol). β blockers are used mainly to treat hypertension or other cardiac conditions.
• Medications to treat infections (such as ketoconazole, itraconazole and erythromycin) including some HIV medications (such as ritonavir, cobicistat). Some of these medications may increase the amount of fluticasone propionate or salmeterol in your body. This may increase your risk of experiencing adverse effects with Anasma, including irregular heartbeats, or may worsen the adverse effects, so your doctor will perform meticulous controls if you are taking these medications.
• Corticosteroids (oral or injectable). If you have taken these medications recently, you may increase the risk that this medication will affect your adrenal gland.
• Diuretics, also known as medications to urinate, used to treat high blood pressure.
• Other bronchodilators (such as salbutamol).
• Medications containing xanthine. They are often used to treat asthma.

Pregnancy and breastfeeding

If you are pregnant or breastfeeding, or think you may be pregnant or intend to become pregnant, consult your doctor or pharmacist before using this medication.

Driving and operating machinery

Anasma is unlikely to affect your ability to drive or operate machinery.

Anasma Accuhaler contains lactose

Anasma Accuhaler contains up to 12.5 milligrams of lactose monohydrate in each dose.The amount of lactose in this medication usually does not cause problems in people with lactose intolerance.It may cause allergic reactions in patients with a milk protein allergy. If your doctor has indicated that you have an intolerance to certain sugars, consult with them before using this medication.

Follow exactly the administration instructions of this medication indicated by your doctor or pharmacist. In case of doubt, consult your doctor or pharmacist again.

• Use Anasma every day, until your doctor tells you to stop. Do not take more than the recommended dose. In case of doubt, consult your doctor or pharmacist.
• Do not stop taking Anasma or reduce your dose without talking to your doctor first.
• Anasma must be inhaled through the mouth into the lungs.
• You may not be able to taste or feel the powder on your tongue, even if you have used the Accuhaler correctly.

For asthma

Adults and adolescents 12 years and older

• Anasma 50/100 AccuhalerOne inhalation twice a day
• Anasma 50/250 AccuhalerOne inhalation twice a day
• Anasma 50/500 AccuhalerOne inhalation twice a day

Children 4 to 12 years old

• Anasma 50/100 AccuhalerOne inhalation twice a day
• Anasma is not recommended for use in children under 4 years old.

For adults with Chronic Obstructive Pulmonary Disease (COPD)

• Anasma 50/500 AccuhalerOne inhalation twice a day

Your symptoms may be well controlled using Anasma twice a day. If so, your doctor may decide to reduce your dose to once a day. The dose may change to:

• once at night if you have nocturnal symptomssymptoms,
• once in the morning if you have diurnal symptomssymptoms.

It is very important that you follow your doctor's instructions on how many applications and how often you should take your medication.

If you are using Anasma to treat asthma, your doctor will want to monitor your symptoms regularly.

If your asthma worsens or you have greater difficulty breathing, see your doctor immediately. You may notice more wheezing or a feeling of choking more often or that you need to use your rescue medication more frequently. If any of these things happen, you should continue using Anasma, but do not increase the number of applications. Your respiratory disease may worsen and you may become seriously ill. See your doctor, as you may need additional treatment.

Instructions for use

• Your doctor, nurse, or pharmacist should teach you how to use your inhaler. Periodically, they should check how you use it. Not using Anasma Accuhaler properly or as prescribed may result in your asthma or COPD not improving as it should.
• This Accuhaler contains alveoli that contain Anasma powder.
• There is a dose counter on the top of the Accuhaler that indicates how many doses are left. Counts back, to 0. The numbersfrom 5 to 0 will appear in red to warn you that there are few doses left. Once the counter marks 0, your inhaler is empty.

Using your inhaler

1.To open the Accuhaler, hold the outer casing with one hand and place your thumb in the reserved hole with the other hand. Push with your thumb, moving it away from you, until it reaches. You will hear a "click". This will open a small hole in the mouthpiece.

2.Hold the device with the mouthpiece towards you. You can hold it with your right or left hand. Slide the lever back. You will hear a "click". This will place the medication dose in the mouthpiece.

Each time the lever is pushed back, an alveolus opens and the powder is prepared to be inhaled. Do not play with the lever, as the alveoli will open and the medication will be wasted.

3.Hold theAccuhaleraway from your mouth. Breathe out as much as possible. Do not breathe into theAccuhaler.

4.Place the mouthpiece in your lips; take a progressive and intense breath through theAccuhaler, not through your nose.

Remove theAccuhalerfrom your mouth.

Hold your breath for 10 seconds or as long as possible.

Breathe out slowly.

5.After rinsing your mouth with water and spitting it out and/or brushing your teeth. This may help prevent mouth ulcers and hoarseness.

6.To close theAccuhaler, slide the lever towards you with your thumb as far as possible. You will hear a "click".

The lever will automatically return to its original position.

TheAccuhaleris now ready to be used again.

Just like with all inhalers, caregivers should ensure that children using Anasma Accuhaler use the correct inhalation technique described above.

Cleaning your inhaler

To clean it, pass a dry cloth over the mouthpiece of theAccuhaler.

If you use more Anasma than you should

It is very important to use the inhaler as instructed. If you accidentally take a higher dose than recommended, consult your doctor or pharmacist. You may notice that your heart beats faster than normal and feel tremors. You may also have dizziness, headache, muscle weakness, and joint pain.

If you have used large doses for a long time, you should ask your doctor or pharmacist for advice. This is because high concentrations of Anasma can reduce the amount of steroid hormones produced by the adrenal gland.

In case of overdose, consult your doctor or pharmacist immediately or call the Toxicology Information Service, phone: 91 562 04 20, indicating the medication and the amount administered.

If you forgot to use Anasma

Do not take a double dose to compensate for the missed doses. Take the next dose at the usual time.

If you interrupt treatment with Anasma

It is very important to use Anasma every day as instructed.Continue taking it until your doctor tells you to stop. Do not stop using Anasma abruptly.This may worsen your breathing.

Additionally, if you stop taking Anasma suddenly or reduce your dose, you may (rarely) cause problems with your adrenal gland (adrenal insufficiency), which may cause adverse effects.

These adverse effects may include any of the following:

• Stomach pain.

• Fatigue and loss of appetite, feeling unwell.

• Discomfort and diarrhea.

• Weight loss.

• Headache or drowsiness.

• Low blood sugar levels.

• Hypotension and convulsions (seizures).

When your body is under stress, such as fever, trauma (e.g., car accident), infection, or surgery, adrenal insufficiency may worsen and you may experience any of the adverse effects listed above.

If you have any adverse effect, consult your doctor or pharmacist. To prevent these symptoms, your doctor may prescribe an additional dose of corticosteroids in tablets during that time (such as prednisolone).

If you have any other questions about the use of this medication, ask your doctor, nurse, or pharmacist.

Like all medications, this medication may produce side effects, although not everyone will experience them. To reduce the occurrence of side effects, your doctor will prescribe the lowest dose of Anasma that controls your asthma or Chronic Obstructive Pulmonary Disease (COPD).

Allergic reactions: you may notice that your breathing suddenly worsens immediately after using Anasma.You may experience wheezing and coughing or shortness of breath. You may also notice itching, hives (urticaria), and swelling (usually of the face, lips, tongue, or throat). You may also feel, suddenly, that your heart is beating very fast, feel like you are losing consciousness, and dizziness (which can lead to collapse or loss of consciousness).If you experience any of these side effects or if they appear suddenly after using Anasma, stop taking Anasma and inform your doctor immediately.Allergic reactions to Anasma are rare (affect less than 1 in 100 people).

Pneumonia (lung infection) in patients with COPD (frequent side effect)

Inform your doctorif you have any of the following symptoms while inhaling Anasma, they may be symptoms of a lung infection:

• Fever or chills
• Increased mucus production, change in mucus color
• Increased coughing or difficulty breathing

The following are other side effects:

Very frequent (may affect more than 1 in 10 people)

• Headache, which usually improves as treatment continues.
• An increase in the number of colds in patients with Chronic Obstructive Pulmonary Disease (COPD) has been reported.

Frequent (may affect less than 1 in 10 people)

• Candidiasis (itching, appearance of yellowish cream-colored ulcers) in the mouth and throat. Also, tongue pain, hoarse voice, and throat irritation. Rinsing the mouth with water and spitting it out and/or brushing your teeth immediately after each dose of medication may help. Your doctor may prescribe antifungal medication (for the treatment of fungal infections) for the treatment of candidiasis.
• Pain, inflammation in the joints and muscle pain.
• Muscle cramps.

The following side effects have been reported in patients with Chronic Obstructive Pulmonary Disease (COPD):

• Cardiac arrhythmias and fractures.
• Salivary gland inflammation (sensation of tension or congestion in the nose, cheeks, and behind the eyes, sometimes with a pulsating pain).
• Reduction of potassium levels in the blood (may feel irregular heartbeats, muscle weakness, cramps).

Rare (may affect less than 1 in 100 people)

• Increased blood sugar levels (hyperglycemia). If you have diabetes, you will need to monitor your blood sugar levels more frequently and adjust your usual diabetic treatment as needed.

The following side effects have been reported:

• Cataracts (opacity of the lens of the eye).
• Very fast heart rate (tachycardia).
• Feeling tremors and a fast or irregular heart rate (palpitations). These side effects are usually harmless and decrease as treatment continues.
• Chest pain.
• Sensation of concern (mainly occurs in children).
• Sleep disturbances.
• Skin rash.
• Allergic rash on the skin.

Rare (may affect less than 1 in 1,000 people)

• Difficulty breathing (or wheezing) that worsens immediately after using Anasma. If this happens, stop using Anasma. Use your rescue inhaler for quick action to improve your breathing andinform your doctor immediately..
• Anasma may increase normal hormone steroid production, particularly if you have been taking high doses for long periods of time. The effects include:

-Delayed growth in children and adolescents.

-Bone mineral density reduction.

-Glaucoma.

-Weight gain.

-Rounded face (moon-shaped) (Cushing's syndrome).

Your doctor will regularly monitor any of these side effects and ensure that you are taking the lowest dose of Anasma to control your asthma.

• Changes in behavior, such as hyperactivity and irritability (these effects occur mainly in children).
• Irregular heartbeats or extra heartbeats (arrhythmias). Consult your doctor, but do not stop taking Anasma unless your doctor tells you to.
• Fungal infection of the esophagus (throat), which can cause difficulty swallowing.

Frequency unknown, but may also occur:

• Depression or aggression. It is more likely that these effects will occur in children.
• Blurred vision

Reporting side effects:

If you experience any type of side effect, consult your doctor or pharmacist, even if it is a possible side effect that does not appear in this prospectus. You can also report them directly through theSpanish System for Pharmacovigilance of Medicines for Human Use:www.notificaRAM.es. By reporting side effects, you can contribute to providing more information on the safety of this medication.

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

Do not use Anasma after the expiration date that appears on the label and on the packaging after CAD. The expiration date is the last day of the month indicated.

Do not store at a temperature above 86°F (30°C).

Do not dispose of medications through drains or in the trash. Dispose of packaging and medications you no longer need at the SIGRE collection point at your pharmacy. If in doubt, ask your pharmacist how to dispose of packaging and medications you no longer need. By doing so, you will help protect the environment.

Composition of Anasma

• Each pre-dispensed dose contains 50 micrograms of salmeterol (as xinafoate of salmeterol) and 250 micrograms of fluticasone propionate.
• The other component is lactose monohydrate (contains milk proteins).

Appearance of the product and content of the container

Anasma Accuhaler contains an alveoli strip. The alveoli protect the inhalation powder from atmospheric effects.

Each dose is pre-dispensed.

The devices are found in containers of 1 accuhaler x 60 inhalations.

Holder of the marketing authorization and responsible manufacturer

Holder of the marketing authorization:

GlaxoSmithKline, S.A.

P.T.M. C/ Severo Ochoa, 2

28760 Tres Cantos (Madrid)

Tel: +34 900 202 700

[email protected]

Responsible manufacturer:

Glaxo Wellcome Production

Zone Industrielle nº 2, 23 Rue Lavoisier, La Madeleine, 27000 Evreux, France

Tel: + 33 2 3223 5500

Fax: +33 2 3223 5558

or

Aspen Bad Oldesloe GmbH

Industriestrasse 32-36, 23843 Bad Oldesloe, Germany

This leaflet has been reviewed in July 2020.

The detailed and updated information of this medicine is available on the webpage of the Spanish Agency of Medicines and Medical Devices (AEMPS)http://www.aemps.gob.es/