Package Leaflet: Information for the User
Fingolimod Accord 0.5 mg hard capsules EFG
fingolimod
Read all of this leaflet carefully before you start taking this medicine because it contains important information for you.
Contents of the Package Leaflet
What is Fingolimod Accord
The active substance of Fingolimod Accord is fingolimod.
What is Fingolimod Accord used for
Fingolimod Accord is used in adults and in children and adolescents (from 10 years of age and older) to treat relapsing-remitting multiple sclerosis (MS) (a disease that causes attacks or relapses), particularly in:
or
Fingolimod Accord does not cure MS, but it helps to reduce the number of relapses and slow down the progression of physical disabilities caused by MS.
What is multiple sclerosis
MS is a chronic disease that affects the central nervous system (CNS), which includes the brain and spinal cord. In MS, inflammation destroys the protective covering (called myelin) that surrounds the nerves in the CNS and prevents the nerves from functioning properly. This process is called demyelination.
Relapsing-remitting MS is characterized by repeated attacks (relapses) of neurological symptoms that reflect the inflammation occurring in the CNS. The symptoms vary from one patient to another, but usually include difficulties walking, loss of sensation in some parts of the body (numbness), vision problems, or balance disorders. The symptoms of a relapse may disappear completely when the relapse is over, but some problems may persist.
How Fingolimod Accord works
Fingolimod Accord helps to combat the attacks of the immune system on the CNS by reducing the ability of some white blood cells (lymphocytes) to move freely within the body and preventing them from reaching the brain and spinal cord. This limits the nerve damage attributed to multiple sclerosis. Fingolimod Accord also reduces some of the immune responses of your body.
Do not take Fingolimod Accord
If any of the above cases apply to you or if you are not sure, tell your doctor before taking Fingolimod Accord.
Warnings and precautions
Consult your doctor before starting to take Fingolimod Accord
If any of the above cases apply to you or if you are not sure, tell your doctor before taking Fingolimod Accord.
Slow heart rate (bradycardia) and irregular heartbeats
At the start of treatment or after taking the first dose of 0.5 mg, in the case that you have been changed from a previous dose of 0.25 mg once a day, Fingolimod Accord produces a decrease in heart rate. As a result, you may feel dizzy or tired, be aware of your heartbeat, or your blood pressure may drop. If these effects are severe, tell your doctor immediately, as you may need immediate treatment. Fingolimod Accord may also cause your heartbeats to become irregular, especially after the first dose. Irregular heartbeats usually normalize in less than a day. The slow heart rate usually normalizes within a month. During this period, no clinically significant effect on heart rate is usually expected.
Your doctor will ask you to stay in the office or hospital for at least 6 hours, with pulse and blood pressure checks every hour, after taking the first dose of Fingolimod Accord or after taking the first dose of 0.5 mg, in the case that you have been changed from a previous dose of 0.25 mg once a day, so that appropriate measures can be taken in case of adverse effects that appear at the start of treatment. You should have an electrocardiogram before the first dose of Fingolimod Accord and after the 6-hour monitoring period. Your doctor may continuously monitor your electrocardiogram during this time. If after the 6-hour period you have a very slow or decreasing heart rate, or if your electrocardiogram shows abnormalities, you will need to be monitored for a longer period (at least 2 hours more and possibly overnight, until this is resolved). The same may apply if you are resuming Fingolimod Accord after a pause in treatment, depending on both the duration of the pause and how long you were taking Fingolimod Accord before the pause.
If you have or are at risk of having irregular or abnormal heartbeats, if your electrocardiogram is abnormal, or if you have heart disease or heart failure, Fingolimod Accord may not be suitable for you.
If you have suffered from sudden fainting in the past or a decrease in heart rate, Fingolimod Accord may not be suitable for you. You will be evaluated by a cardiologist (heart specialist) who will advise you on how to start treatment with Fingolimod Accord, including monitoring during the night.
If you are taking other medications that can slow your heart rate, Fingolimod Accord may not be suitable for you. You need to be evaluated by a cardiologist, who will assess whether you can switch to alternative medications that do not slow the heart rate to allow treatment with Fingolimod Accord. If such a change is not possible, the cardiologist will advise you on how to start treatment with Fingolimod Accord, including monitoring during the night.
If you have never had chickenpox
If you have not had chickenpox, your doctor will check your immunity to the virus that causes it (varicella-zoster virus). If you are not protected against the virus, you will likely need to be vaccinated before starting treatment with Fingolimod Accord. If so, your doctor will delay the start of treatment with Fingolimod Accord for a month after completing the vaccination cycle.
Infections
Fingolimod Accord reduces the number of white blood cells in your blood (especially the number of lymphocytes). White blood cells fight infections. During treatment with Fingolimod Accord (and up to two months after you stop treatment), you may be more likely to get infections. You may even have a worsening of an infection that you already have. Infections can be serious and potentially life-threatening. If you think you have an infection, have a fever, have flu-like symptoms, have herpes (shingles), or have a headache accompanied by stiffness in the neck, sensitivity to light, nausea, rash, and/or confusion (seizures) (which can be symptoms of meningitis and/or encephalitis caused by a fungal or herpes virus infection), contact your doctor immediately, as it can be serious and life-threatening.
Human papillomavirus (HPV) infection, including papilloma, dysplasia, warts, and HPV-associated cancer, has been reported in patients treated with Fingolimod Accord. Your doctor will assess whether you need to be vaccinated against HPV before starting treatment. If you are a woman, your doctor will also recommend that you have regular HPV checks.
PML
PML is a rare brain disorder caused by an infection that can cause severe disability or death. Your doctor will perform magnetic resonance imaging (MRI) before starting treatment and during treatment to monitor the risk of PML.
If you think your MS is getting worse or if you notice any new symptoms, such as changes in your mood or behavior, worsening or appearance of weakness on one side of your body, changes in vision, confusion, memory problems, or difficulties with speech and communication, tell your doctor as soon as possible. These can be symptoms of PML. Also, talk to your family members or caregivers to inform them about your treatment. Symptoms can appear without you realizing it.
If you develop PML, it can be treated, and your treatment with Fingolimod Accord will be discontinued. Some people have an inflammatory reaction when Fingolimod Accord is removed from the body. This reaction (known as immune reconstitution inflammatory syndrome or IRIS) can cause a worsening of your disease, including a worsening of brain function.
Macular edema
Before starting treatment with Fingolimod Accord, your doctor may request an eye examination if you have or have had visual disorders or other signs of inflammation in the central vision area (the macula) of the eye, an eye infection (uveitis), or diabetes.
After starting treatment with Fingolimod Accord, your doctor may request an eye examination after 3 or 4 months of treatment.
The macula is a small area of the retina located at the back of the eye that allows you to see shapes, colors, and details clearly and sharply. Fingolimod Accord can cause inflammation of the macula, and this condition is known as macular edema. Inflammation usually occurs within the first four months of treatment with Fingolimod Accord.
If you have diabetesor have had an eye infection known as uveitis, you are more likely to develop macular edema. In these cases, your doctor will want you to have regular eye checks to detect macular edema.
If you have had macular edema, consult your doctor before continuing treatment with Fingolimod Accord.
Macular edema can cause the same visual symptoms as those produced in an MS attack (optic neuritis). At first, you may not have symptoms. It is necessary that you communicate any changes you notice in your vision to your doctor. Your doctor may want to perform an eye examination, especially if:
Liver function tests
If you have severe liver problems, you should not take Fingolimod Accord. Fingolimod Accord can affect liver function. You may not notice any symptoms, but if you notice a yellowish tone in your skin or the white part of your eye, unusually dark urine (brown color), pain in your right side of the stomach (abdomen), fatigue, loss of appetite, or nausea and vomiting without apparent cause, tell your doctor immediately.
If you have any of these symptoms after starting treatment with Fingolimod Accord, tell your doctor immediately.
Before, during, and after treatment, your doctor will request blood tests to check your liver function. You may need to interrupt treatment with Fingolimod Accord if the results of your blood tests indicate a problem with your liver.
High blood pressure
Since Fingolimod Accord causes a slight increase in blood pressure, your doctor will want you to have your blood pressure checked regularly.
Lung problems
Fingolimod Accord has a mild effect on lung function. Patients with severe lung problems or "smoker's cough" are more likely to develop adverse effects.
Blood count
The expected effect of treatment with Fingolimod Accord is to reduce the number of white blood cells in your blood. This effect usually normalizes during the 2 months after treatment is discontinued. If you need to have blood tests, tell your doctor that you are taking Fingolimod Accord, as your doctor may not understand the results of the tests if you do not. For certain blood tests, your doctor may need more blood than usual.
Before starting treatment with Fingolimod Accord, your doctor will confirm that you have enough white blood cells in your blood and may want to repeat checks regularly. If you do not have enough white blood cells, you may need to interrupt treatment with Fingolimod Accord.
Posterior reversible encephalopathy syndrome (PRES)
A rare condition known as posterior reversible encephalopathy syndrome (PRES) has been reported in MS patients treated with Fingolimod Accord. Symptoms can include sudden and severe headache, confusion, seizures, and changes in vision. Tell your doctor immediately if you experience any of these symptoms during treatment with Fingolimod Accord, as it can be serious.
Cancer
Cases of skin cancer have been reported in MS patients treated with Fingolimod Accord. Tell your doctor immediately if you notice any nodules on your skin (e.g., shiny nodules with a pearl-like appearance), spots, or open sores that do not heal within weeks. Symptoms of skin cancer can include abnormal growth or changes in skin tissue (e.g., unusual moles) that change color, shape, or size over time. Before starting treatment with Fingolimod Accord, a skin examination is required to check for any skin nodules. Your doctor will also perform regular skin checks during treatment with Fingolimod Accord. If any skin problems appear, your doctor may refer you to a dermatologist, who may decide whether it is important to visit you regularly.
A type of cancer of the lymphatic system (lymphoma) has been reported in MS patients treated with Fingolimod Accord.
Sun exposure and sun protection
Fingolimod weakens your immune system, which increases the risk of developing cancer, especially skin cancer. You should limit your exposure to the sun and UV rays by:
Unusual brain lesions associated with MS relapses
Rare cases of large and unusual brain lesions associated with MS relapses have been reported in patients treated with Fingolimod Accord. In the case of severe relapses, your doctor will assess the need to perform an MRI to evaluate your condition and decide whether you need to stop taking Fingolimod Accord.
Switching from other treatments to Fingolimod Accord
Your doctor may switch you directly from interferon beta, glatiramer acetate, or dimethyl fumarate to Fingolimod Accord if there are no signs of treatment-related abnormalities. Your doctor may need to perform a blood test to rule out such abnormalities. After stopping natalizumab, you may need to wait for 2-3 months before starting treatment with Fingolimod Accord. To switch from teriflunomide, your doctor may advise you to wait for a period or undergo an accelerated elimination procedure. If you have been treated with alemtuzumab, a thorough evaluation is necessary, and you should discuss it with your doctor to decide whether Fingolimod Accord is suitable for you.
Women of childbearing age
If Fingolimod Accord is used during pregnancy, it may harm the fetus. Before starting treatment with Fingolimod Accord, your doctor will explain the risks and ask you to have a pregnancy test to ensure that you are not pregnant. Your doctor will give you a card that explains why you should not become pregnant while taking Fingolimod Accord and what you should do to avoid becoming pregnant while taking Fingolimod Accord. During treatment and for 2 months after stopping treatment, you must use an effective contraceptive method (see section "Pregnancy and breastfeeding").
MS worsening after stopping treatment with Fingolimod Accord
Do not stop taking Fingolimod Accord or change the dose that you have been prescribed without discussing it with your doctor first.
Tell your doctor immediately if you think your MS is getting worse after stopping treatment with Fingolimod Accord, as it can be serious (see section 3 "If you stop treatment with Fingolimod Accord" and also section 4 "Possible side effects").
Elderly
Experience with Fingolimod Accord in elderly patients (over 65 years) is limited. If in doubt, consult your doctor.
Children and adolescents
Fingolimod Accord should not be administered to children under 10 years of age, as it has not been studied in patients with MS in this age group.
The warnings and precautions mentioned above also apply to children and adolescents. The following information is especially important for children and adolescents and their caregivers:
Other medications and Fingolimod Accord
Tell your doctor or pharmacist if you are taking, have recently taken, or may need to take any other medication. Tell your doctor if you are taking any of the following medications:
Treatment with Fingolimod Accord will be supervised by a doctor with experience in treating multiple sclerosis.
Follow your doctor's instructions for taking this medicine exactly. If you are unsure, consult your doctor again.
The recommended dose is:
Adults
The dose is one 0.5 mg capsule per day.
Children and adolescents (10 years of age and older)
The dose depends on body weight:
For children and adolescents who start with a 0.25 mg capsule per day and later reach a stable weight over 40 kg, the doctor will instruct them to switch to a 0.5 mg capsule per day. In this case, it is recommended to repeat the observation period of the first dose.
Fingolimod Accord is only available in 0.5 mg hard capsules, which are not suitable for children and adolescents with a body weight of 40 kg or less.
There are other medicines available with fingolimod 0.25 mg.
Consult your doctor or pharmacist.
Do not exceed the recommended dose.
Fingolimod Accord is taken orally.
Take Fingolimod Accord once a day with a glass of water. Fingolimod Accord capsules should always be swallowed whole, without opening them. You can take Fingolimod Accord with or without food.
Taking Fingolimod Accord every day at the same time will help you remember when to take the medicine.
If you have any doubts about the duration of treatment with Fingolimod Accord, consult your doctor or pharmacist.
If you take more Fingolimod Accord than you should
If you have taken more Fingolimod Accord than you should, inform your doctor immediately.
If you forget to take Fingolimod Accord
If you have been taking Fingolimod Accord for less than 1 month and forget to take 1 dose for a whole day, talk to your doctor before taking the next dose. Your doctor may decide to keep you under observation when you take the next dose.
If you have been taking Fingolimod Accord for at least 1 month and have forgotten to take your treatment for more than 2 weeks, talk to your doctor before taking the next dose. Your doctor may decide to keep you under observation when you take the next dose. However, if you have forgotten to take your treatment for a period of up to 2 weeks, you can take the next dose as planned.
Never take a double dose to make up for forgotten doses.
If you stop treatment with Fingolimod Accord
Do not stop taking Fingolimod Accord or change the dose you are taking without discussing it with your doctor first.
Fingolimod Accord will remain in your body for up to 2 months after stopping treatment. The number of white blood cells in your blood (lymphocyte count) may remain low during this period, and it is possible that side effects may still occur. After stopping treatment with Fingolimod Accord, you may need to wait for 6-8 weeks before starting a new treatment with EM.
If you need to restart treatment with Fingolimod Accord after a pause of more than 2 weeks, the effect on the heart rate that may occur at the start of treatment may repeat, and you will need to be monitored in the doctor's office to restart treatment. Do not restart treatment with Fingolimod Accord after stopping it for more than 2 weeks without consulting your doctor first.
Your doctor will decide if it is necessary to monitor you after stopping treatment with Fingolimod Accord and how to do so. Inform your doctor immediately if you think your MS is getting worse after stopping treatment with Fingolimod Accord, as it could be serious.
If you have any other questions about using this medicine, ask your doctor or pharmacist.
Like all medicines, this medicine can cause side effects, although not everybody gets them.
Some side effects can be serious or potentially serious:
Common(may affect up to 1 in 10 people)
Uncommon(may affect up to 1 in 100 people)
Rare(may affect up to 1 in 1,000 people)
Very rare(may affect up to 1 in 10,000 people)
Frequency not known(cannot be estimated from the available data)
If you experience any of these symptoms, inform your doctor immediately.
Other side effects
Very common(may affect more than 1 in 10 people)
Common(may affect up to 1 in 10 people)
Uncommon(may affect up to 1 in 100 people)
Rare(may affect up to 1 in 1,000 patients)
Frequency not known(cannot be estimated from the available data)
If you consider any of the side effects you are experiencing to be serious, inform your doctor.
Reporting side effects
If you experience any side effects, consult your doctor or pharmacist, even if they are possible side effects not listed in this leaflet. You can also report them directly through the national reporting system included in Appendix V. By reporting side effects, you can help provide more information on the safety of this medicine.
Keep this medicine out of the sight and reach of children.
Composition of Fingolimod Accord
The other ingredients are:
Appearance of the product and package contents
Hard gelatin capsule (capsule) size "3", opaque yellow / opaque white, with "FO 0.5mg" printed on the cap with black ink, and containing white to off-white powder. Each capsule is approximately 15.8 mm long.
Fingolimod Accord is available in blister packs of 7, 28, or 98 hard capsules.
Single-dose blister packs of PVC/PVDC/aluminum containing 7 x 1, 28 x 1, and 98 x 1 hard capsules.
In your country, only some pack sizes may be marketed.
Marketing authorization holder
Accord Healthcare S.L.U.
World Trade Center, Moll de Barcelona, s/n,
Edifici Est, 6ª Planta,
08039 Barcelona,
Spain
Manufacturer
LABORATORI FUNDACIÓ DAU
C/ C, 12-14 Pol. Ind. Zona Franca, Barcelona,
08040 Barcelona, Spain
or
Accord Healthcare Polska Sp. z.o.o.
ul.Lutomierska 50,
95-200, Pabianice,
Poland
or
Accord Healthcare B.V.,
Winthontlaan 200,
3526 KV Utrecht,
Netherlands
For any information about this medicine, please contact the local representative of the marketing authorization holder:
AT / BE / BG / CY / CZ / DE / DK / EE / FI / FR / HR / HU / IE / IS / IT / LT / LV / LU / MT / NL / NO / PT / PL / RO / SE / SI / SK / ES
Accord Healthcare S.L.U.
Tel: +34 93 301 00 64
EL
Win Medica A.E.
Tel: +30 210 7488 821
Date of last revision of this leaflet: 05/2025
Other sources of information
Detailed information on this medicine is available on the European Medicines Agency website: https://www.ema.europa.eu.