DAPTOMYCIN TARBIS 500 mg POWDER FOR INJECTABLE SOLUTION AND FOR INFUSION

Introduction

Package Leaflet: Information for the Patient

Daptomicina Tarbis 500 mg powder for solution for injection and infusion EFG

Read all of this leaflet carefully before you start using 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 nurse.
• 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 get any side effects, talk to your doctor or nurse. This includes any possible side effects not listed in this leaflet. See section 4.

Contents of the pack

1. What is Daptomicina Tarbis and what is it used for
2. What you need to know before you are given Daptomicina Tarbis
3. How Daptomicina Tarbis is given
4. Possible side effects
5. Storing Daptomicina Tarbis
6. Contents of the pack and other information

1. What is Daptomicina Tarbis and what is it used for

The active substance is daptomycin. Daptomycin is an antibacterial agent capable of stopping the growth of certain bacteria. This medicine is used in adults and in children and adolescents (aged 1 to 17 years) to treat infections of the skin and soft tissues. It is also used to treat infections in the blood when associated with a skin infection.

This medicine is also used in adults to treat infections of the tissues that line the inside of the heart (including heart valves), caused by a type of bacteria called Staphylococcus aureus. It is also used to treat blood infections caused by the same type of bacteria when associated with a heart infection.

Depending on the type of infection(s) you are suffering from, your doctor may also prescribe other antibacterial agents while you are being treated with this medicine.

2. What you need to know before you are given Daptomicina Tarbis

You must not be given Daptomicina Tarbis

If you are allergic to daptomycin or sodium hydroxide or any of the other ingredients of this medicine (listed in section 6).

If this is the case, tell your doctor or nurse. If you think you may be allergic, consult your doctor or nurse.

Warnings and precautions

Tell your doctor or nurse before you are given Daptomicina Tarbis:

• If you have or have ever had kidney problems. Your doctor may need to change the dose of this medicine (see section 3 of this leaflet).
• Occasionally, patients who receive this medicine may develop increased sensitivity, pain, or muscle weakness (see section 4 of this leaflet for more information). Tell your doctor if this happens.

Your doctor will make sure you have a blood test and advise whether it is recommended to continue using this medicine. The symptoms usually disappear within a few days after stopping treatment with this medicine.

• If you have ever had, after taking daptomycin, a severe skin rash or skin peeling, blisters, and/or ulcers in the mouth, or severe kidney problems.
• If you are significantly overweight, there is a possibility that your blood levels of this medicine may be higher than those found in people of average weight, and you may need stricter monitoring in case of side effects.

If any of the above cases apply to you, tell your doctor or nurse before you are given this medicine.

Tell your doctor or nurse immediately if you develop any of the following symptoms:

• Severe and serious allergic reactions have been observed in patients treated with almost all antibacterial agents, including daptomycin. The symptoms may include shortness of breath, difficulty breathing, swelling of the face, neck, and throat, skin rash, and hives, or fever.
• Severe skin diseases have been reported with the use of daptomycin. The symptoms that occur with these skin diseases may include:

• onset of fever or worsening of it,
• red spots on the skin, raised or filled with fluid, which can start in the armpits or in areas of the chest or groin and can spread over a large area of the body,
• blisters or ulcers in the mouth or genitals.
• Severe kidney problems have been reported with the use of this medicine. The symptoms may include fever and rash. If you experience these symptoms, tell your doctor or nurse immediately. Your doctor will perform additional tests to establish a diagnosis.

Daptomycin may interfere with laboratory tests that measure the blood's ability to clot. The results may apparently suggest poor clotting, even if there is no actual problem. Therefore, it is essential that your doctor is aware that you are receiving daptomycin. Tell your doctor that you are being treated with daptomycin.

Your doctor will perform blood tests to monitor the health of your muscles before you start treatment and frequently during treatment with daptomycin.

Children and adolescents

Daptomycin should not be given to children under one year of age; animal studies have shown that this age group may experience severe side effects.

Use in elderly patients

Patients over 65 years of age may receive the same dose as other adults, provided their kidneys are functioning correctly.

Other medicines and Daptomicina Tarbis

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

It is particularly important that you mention the following:

• Medicines called statins or fibrates (to lower cholesterol) or cyclosporin (a medicine used in transplants to prevent organ rejection or for other conditions, e.g., rheumatoid arthritis or atopic dermatitis). It is possible that the risk of muscle side effects may increase if you take any of these medicines (and others that may affect the muscles) during treatment with daptomycin. Your doctor may decide not to administer daptomycin or temporarily interrupt treatment with the other medicine.
• Pain-relieving medicines called non-steroidal anti-inflammatory drugs (NSAIDs) or COX-2 inhibitors (e.g., celecoxib). These may interfere with the elimination of daptomycin by the kidneys.
• Oral anticoagulants (e.g., warfarin), which are medicines that prevent blood clotting. Your doctor may need to monitor your blood clotting times.

Pregnancy and breastfeeding

Daptomycin is not usually given to pregnant women. If you are pregnant or breastfeeding, think you may be pregnant, or plan to become pregnant, consult your doctor or pharmacist before using this medicine.

Do not breastfeed if you are receiving daptomycin, as it may pass into breast milk and affect the baby.

Driving and using machines

Daptomycin has no known effects on the ability to drive or use machines.

Daptomicina Tarbis contains sodium

This medicine contains less than 1 mmol of sodium (23 mg) per dose; this is essentially "sodium-free".

3. How Daptomicina Tarbis is given

Daptomicina Tarbis will be administered to you by your doctor or nurse.

Adults (18 years of age and older)

The dose will depend on your weight and the type of infection being treated. The usual dose for adults is 4 mg per kilogram of body weight once a day for skin infections or 6 mg per kilogram of body weight once a day for heart or blood infections associated with skin infections. In adult patients, this dose is administered directly into the bloodstream (into a vein), either as an infusion that lasts approximately 30 minutes or as an injection that lasts approximately 2 minutes. The same dose is recommended for people over 65 years of age, provided their kidneys are functioning correctly.

If your kidneys do not work well, you may receive this medicine less frequently, e.g., every other day. If you are undergoing dialysis and your next dose of this medicine is due on a dialysis day, you will usually receive this medicine after the dialysis session.

Children and adolescents (1 to 17 years of age)

The recommended doses in children and adolescents (1 to 17 years) will depend on the patient's age and the type of infection being treated. This dose is administered directly into the bloodstream (into a vein), as an infusion that lasts approximately 30-60 minutes.

A complete treatment for skin infections usually lasts between 1 and 2 weeks. Your doctor will decide the duration of your treatment for blood or heart infections and for skin infections.

Detailed instructions for use and handling are provided at the end of the leaflet.

4. Possible side effects

Like all medicines, daptomycin can cause side effects, although not everybody gets them. The following are the most serious side effects:

Serious side effects with frequency not known(cannot be estimated from the available data)

• Some cases of hypersensitivity reactions (severe allergic reactions, including anaphylaxis and angioedema) have been reported during the administration of daptomycin. These severe allergic reactions require immediate medical attention. Tell your doctor or nurse immediately if you have any of the following symptoms:

• Chest pain or pressure,
• Rash or hives,
• Swelling around the throat,
• Fast or weak pulse,
• Shortness of breath,
• Fever,
• Chills or shivering,
• Flushing,
• Dizziness,
• Fainting,
• Metallic taste.
• Tell your doctor immediately if you have pain, increased sensitivity, or muscle weakness of unknown origin. Muscle problems can be severe, including muscle breakdown (rhabdomyolysis), which can cause kidney damage.

Other side effects that have been reported with the use of daptomycin are:

• A rare but potentially serious lung condition called eosinophilic pneumonia, mostly after more than 2 weeks of treatment. The symptoms may include difficulty breathing, onset of cough or worsening of it, or onset of fever or worsening of it.
• Severe skin diseases. The symptoms may include:

• onset of fever or worsening of it,
• red spots on the skin, raised or filled with fluid, which can start in the armpits or in areas of the chest or groin and can spread over a large area of the body,
• blisters or ulcers in the mouth or genitals.
• A severe kidney problem. The symptoms may include fever and rash. If you experience these symptoms, tell your doctor or nurse immediately. Your doctor will perform additional tests to establish a diagnosis.

The following are the most frequently reported side effects:

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

• Fungal infections, such as thrush (mouth ulcers),
• Urinary tract infection,
• Decrease in the number of red blood cells (anemia),
• Dizziness, anxiety, difficulty sleeping,
• Headache,
• Fever, weakness (asthenia),
• High or low blood pressure,
• Constipation, abdominal pain,
• Diarrhea, nausea or vomiting,
• Flatulence,
• Abdominal swelling or abdominal distension,
• Skin rash or itching,
• Pain, itching, or redness at the infusion site,
• Pain in arms or legs,
• High levels of liver enzymes or creatine phosphokinase (CPK) in blood tests.

The following are other side effects that may occur with Daptomicina Tarbis:

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

• Blood disorders (e.g., increased platelet count, which may increase the tendency to develop blood clots, or increased count of certain types of white blood cells),
• Decreased appetite,
• Numbness or tingling in hands or feet, altered sense of taste,
• Tremors,
• Changes in heart rhythm, flushing,
• Indigestion (dyspepsia), tongue inflammation,
• Itchy rash,
• Pain, cramps, or muscle weakness, muscle inflammation (myositis), joint pain,
• Kidney problems,
• Vaginal inflammation and irritation,
• Generalized pain or weakness, fatigue,
• High blood sugar, serum creatinine, myoglobin, or lactate dehydrogenase (LDH), prolonged blood clotting time, or electrolyte imbalance in blood tests,
• Itchy eyes.

Rare side effects(may affect up to 1 in 1,000 patients)

• Yellowing of the skin and eyes (jaundice),
• Prolonged prothrombin time.

Frequency not known(cannot be estimated from the available data)

Antibiotic-associated colitis, including pseudomembranous colitis (severe or persistent diarrhea containing blood and/or mucus, associated with abdominal pain or fever), bruising more easily, bleeding gums, or nosebleeds.

Reporting of side effects

If you experience any side effects, talk to your doctor, pharmacist, or nurse, even if it is possible side effects not listed in this leaflet. You can also report side effects directly through the Spanish Pharmacovigilance System for Human Use Medicines: https://www.notificaram.es.

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

5. Storing Daptomicina Tarbis

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 carton and label after EXP. The expiry date refers to the last day of the month stated.

Store in a refrigerator (between 2°C and 8°C).

6. Contents of the pack and other information

Composition of Daptomicina Tarbis

The active ingredient is daptomycin.

A vial of powder contains 500 mg of daptomycin.

The other component (excipient) is sodium hydroxide.

Appearance of the product and package contents

Daptomicina Tarbis powder for solution for injection and infusion EFG is presented in a glass vial as a pale yellow to light brown powder. It is mixed with a solvent to form a solution before administration.

Daptomicina Tarbis is presented in packs containing 1 vial or 5 vials.

Only some pack sizes may be marketed.

Marketing authorization holder

Tarbis Farma S.L.

Gran Vía Carlos III, 94

08028 Barcelona

Spain

Manufacturer

Amarox Pharma B.V.

Rouboslaan 32

Voorschoten, 2252TR

Netherlands

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

Netherlands: Daptomycine Amarox 500 mg powder for solution for injection or infusion

Spain: Daptomicina Tarbis 500 mg powder for solution for injection and infusion EFG

Germany: Daptomycin Amarox 500 mg powder for solution for injection/infusion

Date of last revision of this leaflet: May 2023

Detailed information on this medicinal product is available on the website of the Spanish Agency for Medicines and Health Products (AEMPS) http://www.aemps.gob.es/

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This information is intended only for healthcare professionals:

Important: Please consult the Summary of Product Characteristics or Package Leaflet before prescribing.

Instructions for use and handling

In adults, daptomycin can be administered intravenously as an infusion over 30 minutes or as an injection over 2 minutes. Unlike adults, daptomycin should not be administered to pediatric patients as an injection over 2 minutes. Pediatric patients from 7 to 17 years of age should receive daptomycin by infusion over 30 minutes. Pediatric patients under 7 years of age who receive doses of 9-12 mg/kg should be administered daptomycin by infusion over 60 minutes. The preparation of the solution for infusion requires an additional dilution phase, as described below.

Daptomicina Tarbis administered as an intravenous infusion over 30 or 60 minutes

Reconstituting the lyophilized product with 10 ml of an injectable solution containing 9 mg/ml of sodium chloride (0.9%) can obtain a concentration of 50 mg/ml of Daptomicina Tarbis 500 mg powder for infusion.

The lyophilized product takes approximately 15 minutes to dissolve. The fully reconstituted product has a transparent appearance and may present some small bubbles or foam around the edge of the vial.

To prepare Daptomicina Tarbis for intravenous infusion, follow these instructions: To reconstitute or dilute Daptomicina Tarbis lyophilized product, an aseptic technique should be used throughout the process.

For reconstitution:

1. The polypropylene "flip-off" closure cap should be removed to expose the central part of the rubber stopper. Clean the top of the rubber stopper with a cotton swab with alcohol or another antiseptic solution and let it dry. After cleaning, do not touch the rubber stopper or allow it to touch any other surface. Withdraw 10 ml of an injectable solution containing 9 mg/ml of sodium chloride (0.9%) into a syringe using a sterile transfer needle with a diameter of 21 gauge or less, or a needleless device, and slowly inject it through the center of the rubber stopper into the vial, aiming the needle at the wall of the vial.
2. The vial should be gently rotated to ensure that the product is completely wetted, and then left to stand for 10 minutes.
3. Finally, the vial should be gently rotated/shaken for a few minutes until a transparent reconstituted solution is obtained. Avoid vigorous agitation to prevent foam formation.
4. The reconstituted solution should be carefully inspected before use to ensure that the substance is dissolved and to verify the absence of particles in suspension. The color of the reconstituted solution of Daptomicina Tarbis may vary from pale yellow to light brown.
5. The reconstituted solution should then be diluted with 9 mg/ml of sodium chloride (0.9%) (typical volume of 50 ml).

For dilution:

1. Slowly withdraw the appropriate reconstituted liquid (50 mg daptomycin/ml) from the vial using a new sterile needle with a diameter of 21 gauge or less, inverting the vial so that the solution falls towards the stopper. Using a syringe, insert the needle into the inverted vial. Keeping the vial inverted, place the tip of the needle at the lowest point of the liquid while withdrawing the solution into the syringe. Before removing the needle from the vial, pull the plunger back to the end of the syringe cylinder to withdraw the required solution from the inverted vial.
2. Expel air, large bubbles, and any excess solution to obtain the required dose.
3. Transfer the required reconstituted dose to 50 ml of 9 mg/ml sodium chloride (0.9%).
4. The reconstituted and diluted solution should be infused intravenously over 30 or 60 minutes.

Daptomicina Tarbis is not physically or chemically compatible with solutions containing glucose. The following drugs have been shown to be compatible when added to infusion solutions containing Daptomicina Tarbis: aztreonam, ceftazidime, ceftriaxone, gentamicin, fluconazole, levofloxacin, dopamine, heparin, and lidocaine.

The combined storage time (reconstituted solution in the vial and diluted solution in infusion bags) at 25 °C should not exceed 12 hours (24 hours if refrigerated).

The stability of the diluted solution in infusion bags has been established for 12 hours at 25°C or 24 hours if refrigerated at 2 °C – 8 °C.

Daptomicina Tarbis administered as an intravenous injection over 2 minutes (only for adult patients)

Water should not be used for the reconstitution of Daptomicina Tarbis for intravenous injection. Daptomicina Tarbis should be reconstituted only with 9 mg/ml of sodium chloride (0.9%).

Reconstituting the lyophilized product with 10 ml of an injectable solution containing 9 mg/ml of sodium chloride (0.9%) yields a concentration of 50 mg/ml of Daptomicina Tarbis for injection.

The lyophilized product takes approximately 15 minutes to dissolve. The fully reconstituted product has a transparent appearance and may present some small bubbles or foam around the edge of the vial.

To prepare Daptomicina Tarbis for intravenous injection, follow these instructions: To reconstitute Daptomicina Tarbis lyophilized product, an aseptic technique should be used throughout the process.

1. The polypropylene "flip-off" closure cap should be removed to expose the central part of the rubber stopper. Clean the top of the rubber stopper with a cotton swab with alcohol or another antiseptic solution and let it dry. After cleaning, do not touch the rubber stopper or allow it to touch any other surface. Withdraw 10 ml of an injectable solution containing 9 mg/ml of sodium chloride (0.9%) into a syringe using a sterile transfer needle with a diameter of 21 gauge or less, or a needleless device, and slowly inject it through the center of the rubber stopper into the vial, aiming the needle at the wall of the vial.
2. The vial should be gently rotated to ensure that the product is completely wetted, and then left to stand for 10 minutes.
3. Finally, the vial should be gently rotated/shaken for a few minutes until a transparent reconstituted solution is obtained. Avoid vigorous agitation to prevent foam formation.
4. The reconstituted solution should be carefully inspected before use to ensure that the substance is dissolved and to verify the absence of particles in suspension. The color of the reconstituted solution of Daptomicina Tarbis may vary from pale yellow to light brown.
5. Slowly withdraw the reconstituted liquid (50 mg daptomycin/ml) from the vial using a sterile needle with a diameter of 21 gauge or less.
6. Invert the vial so that the solution falls towards the stopper. Using a new syringe, insert the needle into the inverted vial. Keeping the vial inverted, place the tip of the needle at the lowest point of the liquid while withdrawing the solution into the syringe. Before removing the needle from the vial, pull the plunger back to the end of the syringe cylinder to withdraw all the solution from the inverted vial.
7. Replace the needle with a new one for intravenous injection.
8. Expel air, large bubbles, and any excess solution to obtain the required dose.
9. The reconstituted solution should be slowly injected intravenously over 2 minutes.

The physical and chemical stability during use of the reconstituted solution in the vial has been demonstrated for 12 hours at 25 °C and up to a maximum of 48 hours if refrigerated (2 °C – 8 °C).

However, from a microbiological point of view, the product should be used immediately. If not used immediately, the storage time during use is the responsibility of the user and should not normally exceed 24 hours at 2 °C – 8 °C, unless the reconstitution/dissolution has taken place in controlled and validated aseptic conditions.

This medicinal product should not be mixed with other medicinal products except those mentioned above.

The vials of Daptomicina Tarbis are for single use only. Any unused remainder of the vial should be discarded.