Package Leaflet: Information for the User
Fingolimod Normon0.5 mg hard capsules EFG
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 Normon
This medicine contains the active substance fingolimod.
What is Fingolimod Normon used for
This medicine 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 where symptoms periodically occur), particularly in:
or
This medicine 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 consists of 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. Symptoms vary from patient to patient but usually include difficulties walking, loss of sensation in some part 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 Normon works
This medicine 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. This medicine also reduces some of the immune responses of your body.
Do not take Fingolimod Normon
If any of the above cases apply to you or if you are unsure, tell your doctor before taking this medication.
Warnings and precautions
Consult your doctor before starting to take this medication:
If any of the above cases apply to you or if you are unsure, tell your doctor before taking this medication.
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 your previous dose was changed from 0.25 mg once a day, this medication can cause 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.This medication can also cause irregular heartbeats, especially after the first dose. Irregular heartbeats usually return to normal in less than a day. The slow heart rate usually returns to normal within a month. During this period, it is generally not expected to have any clinically significant effect on the heart rate.
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 this medication or after taking the first dose of 0.5 mg, in the case that your previous dose was changed from 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 will need to have an electrocardiogram before the first dose of this medication and after the 6-hour monitoring period. Your doctor may want to 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 this medication after a pause in treatment, depending on both the duration of the pause and how long you were taking this medication 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, this medication may not be suitable for you.
If you have suffered from sudden fainting or a decrease in heart rate in the past, this medication may not be appropriate for you. You will be evaluated by a cardiologist (heart specialist) who will advise you on how to start treatment with this medication, including overnight monitoring.
If you are taking other medications that can slow your heart rate, this medication may not be suitable for you. You will 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 this medication. If such a change is not possible, the cardiologist will advise you on how to start treatment with this medication, including overnight monitoring.
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 this medication. If so, your doctor will delay the start of treatment with this medication for one month after completing the vaccination cycle.
Infections
This medication reduces the number of white blood cells in your blood (especially the number of lymphocytes). White blood cells fight infections. During treatment with this medication (and up to two months after stopping treatment), you may be more likely to get infections. You may even have a worsening of an infection 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 or 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.
If you think your MS is getting worse (e.g., weakness or vision changes) or if you notice any new symptoms, tell your doctor immediately, as they may be symptoms of a rare brain disorder caused by an infection called progressive multifocal leukoencephalopathy (PML). PML is a serious disease that can cause severe disability or death. Your doctor will assess the need for an MRI scan to evaluate your condition and decide if you need to stop taking this medication.
It has been reported that patients with MS treated with this medication have developed human papillomavirus (HPV) infection, including papilloma, dysplasia, warts, and HPV-associated cancer. 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.
Macular edema
Before starting treatment with this medication, 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 inflammation or infection of the eye (uveitis), or diabetes.
After starting treatment with this medication, 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. This medication can cause inflammation of the macula, and this disorder is known as macular edema. The inflammation usually occurs within the first four months of treatment with this medication.
If you have diabetesor have had an eye inflammation known as uveitis, you will be 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 this medication.
Macular edema can cause the same visual symptoms as those produced by an MS attack (optic neuritis). At first, you may not have symptoms. It is essential that you inform your doctor of any changes you notice in your vision. Your doctor may want to perform an eye examination, especially if:
Liver function tests
If you have severe liver problems, you should not take this medication. This medication can affect liver function. You may not notice any symptoms, but if you notice a yellowish tone to your skin or the white part of your eyes, unusually dark urine (brown-colored), pain in your right side of the 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 this medication, tell your doctor immediately.
Before, during, and after treatment, your doctor will request blood tests to monitor your liver function. You may need to stop treatment with this medication if the results of your blood tests indicate a problem with your liver.
High blood pressure
Since this medication can cause a slight increase in blood pressure, your doctor will want you to have your blood pressure checked regularly.
Lung problems
This medication 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 this medication is to reduce the number of white blood cells in your blood. This effect usually returns to normal within two months after stopping treatment. If you need to have blood tests, inform your doctor that you are taking this medication, as they may not understand the results of the tests otherwise. For certain blood tests, your doctor may need more blood than usual.
Before starting treatment with this medication, 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 stop treatment with this medication.
Posterior reversible encephalopathy syndrome (PRES)
A rare condition called posterior reversible encephalopathy syndrome (PRES) has been reported in MS patients treated with this medication. 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 this medication, as it can be serious.
Cancer
In patients with MS who have been treated with this medication, cases of skin cancer have been reported. Tell your doctor immediately if you notice any nodules on the skin (e.g., shiny nodules with a pearl-like appearance), spots, or open sores that do not heal within weeks. The 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 this medication, a skin examination is required to check for any skin nodules. Your doctor will also perform regular skin checks during treatment with this medication. If any skin problems appear, your doctor may refer you to a dermatologist, who may decide if it is necessary to visit you regularly.
In patients with MS who have been treated with this medication, a type of cancer of the lymphatic system (lymphoma) has been reported.
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 this medication. In the case of severe relapses, your doctor will assess the need for an MRI scan to evaluate your condition and decide if you need to stop taking this medication.
Switching from other treatments to fingolimod
Your doctor may switch you directly from interferon beta, glatiramer acetate, or dimethyl fumarate to this medication if there are no signs of treatment-related abnormalities. Your doctor may want 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 this medication. 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 if this medication is suitable for you.
Women of childbearing age
If this medication is used during pregnancy, it may harm the fetus. Before starting treatment with this medication, your doctor will explain the risks and ask you to take a pregnancy test to ensure you are not pregnant. Your doctor will give you a card that explains why you should not become pregnant while taking this medication and what you should do to avoid becoming pregnant while taking this medication. During treatment and for two months after stopping treatment, you must use an effective contraceptive method (see section "Pregnancy and breastfeeding").
MS worsening after stopping treatment with fingolimod
Do not stop taking this medication or change the dose your doctor has prescribed without discussing it with your doctor first.
Tell your doctor immediately if you think your MS is getting worse after stopping treatment with this medication, as it can be serious (see section 3 "If you stop taking Fingolimod Normon" and also section 4 "Possible side effects").
Elderly
Experience with this medication in elderly patients (over 65 years) is limited. If you have any doubts, consult your doctor.
Children and adolescents
This medication 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 Normon
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 this medication will be supervised by a doctor with experience in treating multiple sclerosis.
Follow your doctor's instructions for taking this medication 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 first-dose observation period.
Do not exceed the recommended dose.
This medication is not available in 0.25 mg capsules. Therefore, another medication is needed for children and adolescents with a body weight of 40 kg or less.
This medication is taken orally.
Take this medication once a day with a glass of water. The capsules of this medication should always be swallowed whole, without opening them. You can take this medication with or without food.
Taking this medication at the same time every day will help you remember when to take it.
If you have doubts about the duration of treatment with this medication, consult your doctor or pharmacist.
If you take more Fingolimod Normon than you should
If you have taken more of this medication than you should, inform your doctor immediately.
If you forget to take Fingolimod Normon
If you have been taking this medication 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 this medication 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 Normon
Do not stop taking this medication or change the dose to be taken without discussing it with your doctor first.
This medication will remain in your body for up to 2 months after stopping treatment. The number of white blood cells in the blood (lymphocyte count) may remain low during this period, and it is possible that side effects described in this leaflet may still occur. After stopping treatment with this medication, you may need to wait for 6-8 weeks before starting new treatment with another medication.
If you need to restart treatment with this medication after a pause of more than 2 weeks, the effect on 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 this medication after interrupting it for more than 2 weeks without consulting your doctor.
Your doctor will decide if monitoring is necessary after stopping treatment with this medication and how it will be done. Inform your doctor immediately if you think your multiple sclerosis is getting worse after stopping treatment with this medication, as it could be serious.
If you have any other questions about the use of this medication, ask your doctor or pharmacist.
Like all medications, this medication can cause side effects, although not everyone will experience them.
Some side effects can be serious or potentially serious
Common(may affect up to 1 in 10 patients):
Uncommon(may affect up to 1 in 100 patients):
Rare(may affect up to 1 in 1,000 patients):
Very Rare(may affect up to 1 in 10,000 patients):
Frequency Not Known(cannot be estimated from 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 patients):
Common(may affect up to 1 in 10 patients):
Uncommon(may affect up to 1 in 100 patients):
Rare(may affect up to 1 in 1,000 patients):
Frequency Not Known(cannot be estimated from available data):
If you think any of the side effects you are experiencing is serious, inform your doctor.
Reporting Side Effects
If you experience any side effects, consult your doctor, pharmacist, or nurse, even if they are not listed in this leaflet. You can also report them directly through the Spanish Medicines Agency's online system: https://www.notificaram.es. By reporting side effects, you can help provide more information on the safety of this medication.
Keep this medication out of the sight and reach of children.
Do not use this medication after the expiration date stated on the packaging and on the aluminum blister after EXP. The expiration date is the last day of the month indicated.
This medication does not require special storage conditions.
Medications should not be disposed of via wastewater or household waste. Return the packaging and any unused medication to the pharmacy's SIGRE collection point. If you have any questions, ask your pharmacist how to dispose of the packaging and any unused medication. This will help protect the environment.
Composition of Fingolimod Normon
Capsule content: calcium phosphate, hydroxypropyl cellulose, magnesium stearate.
Capsule body: gelatin, titanium dioxide (E171).
Capsule coating: gelatin, titanium dioxide (E171), yellow iron oxide (E172)
Appearance of Fingolimod Normon and Package Contents
Fingolimod Normon 0.5 mg hard capsules EFG, have a white or almost white body and a yellow coating. The coating has a printed mark "C886 0.5 mg".
This medication is available in packages containing 7, 7x1, 10, 14, 28, 30, 84, 98, and 100 capsules.
Not all pack sizes may be marketed.
Marketing Authorization Holder
Laboratorios Normon, S.A.
Ronda de Valdecarrizo, 6 – 28760, Tres Cantos – Madrid (Spain)
Manufacturer
Coripharma ehf.
Reykjavikurvegur 78-80
220 Hafnarfjörður
Iceland
This medication is authorized in EEA Member States under the following names:
IS/H/0442/001/DC
Iceland Fingolimod Coripharma
Spain Fingolimod Normon 0.5 mg hard capsules EFG
Date of Last Revision of this Leaflet: September 2021
Detailed information on this medication is available on the website of the Spanish Agency for Medicines and Healthcare Products (AEMPS): http://www.aemps.gob.es