DIMETHYL FUMARATE NEURAXPHARM 240 mg HARD GASTRO-RESISTANT CAPSULES

Introduction

Package Leaflet: Information for the Patient

Dimethyl Fumarate Neuraxpharm 120 mg gastro-resistant hard capsules

Dimethyl Fumarate Neuraxpharm 240 mg gastro-resistant hard capsules

dimethyl fumarate

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

1. What is Dimethyl Fumarate Neuraxpharm and what is it used for

What is Dimethyl Fumarate Neuraxpharm

Dimethyl Fumarate Neuraxpharm is a medicine that contains dimethyl fumarateas the active substance.

What is Dimethyl Fumarate Neuraxpharm used for

Dimethyl Fumarate Neuraxpharm is used to treat multiple sclerosis (MS) in patients aged 13 years and over.

MS is a long-term disease that affects the central nervous system (CNS), which includes the brain and spinal cord. MS is characterized by repeated attacks (relapses) of neurological symptoms. The symptoms vary from person to person but often include: difficulty walking, balance problems, and vision problems (e.g., blurred or double vision). These symptoms can disappear completely when the relapse is over, but some problems may remain.

How Dimethyl Fumarate Neuraxpharm works

Dimethyl Fumarate Neuraxpharm is thought to work by preventing the body's defense system from damaging the brain and spinal cord. This may also help to delay future disability in MS.

2. What you need to know before you take Dimethyl Fumarate Neuraxpharm

Do not take Dimethyl Fumarate Neuraxpharm

• or any of the other ingredients of this medicine (listed in section 6).

Warnings and precautions

Dimethyl Fumarate Neuraxpharm may affect your white blood cell count, kidneys, and liver. Before starting Dimethyl Fumarate Neuraxpharm, your doctor will do a blood test to check your white blood cell count and make sure your kidneys and liver are working properly. Your doctor will do regular tests during treatment. If you have a low white blood cell count during treatment, your doctor may consider additional tests or stop your treatment.

Tell your doctorbefore starting Dimethyl Fumarate Neuraxpharm if you have:

• severe kidney disease
• severe liver disease
• a stomach or intestine disease
• a severe infection(e.g., pneumonia)

Herpes zoster (shingles) may occur during treatment with dimethyl fumarate. In some cases, serious complications have occurred. You must tell your doctor immediatelyif you suspect you have any symptoms of shingles.

If you think your MS is getting worse (e.g., weakness or changes in vision) or you notice any new symptoms, talk to your doctor directly, as they could be symptoms of a rare brain infection called PML. PML is a serious disease that can cause death or severe disability.

A rare but serious kidney disorder called Fanconi syndrome has been reported for a medicine that contains dimethyl fumarate in combination with other fumaric acid esters, used to treat psoriasis (a skin disease). If you notice that you are urinating more, feeling thirstier, and drinking more than usual, your muscles seem weaker, you break a bone, or you simply have aches and pains, tell your doctor as soon as possible so that this can be investigated further.

Children and adolescents

Do not give this medicine to children under 10 years old because there is no data available for this age group.

Other medicines and Dimethyl Fumarate Neuraxpharm

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

• medicines that contain fumaric acid esters(fumarates) used to treat psoriasis
• medicines that affect the immune system, including chemotherapy, immunosuppressants, or other medicines used to treat MS;
• medicines that affect the kidneys, including some antibiotics(used to treat infections), diuretics(pills that increase urine production), certain types of painkillers(such as ibuprofen or similar anti-inflammatory medicines, and over-the-counter medicines), and medicines that contain lithium;
• the use of Dimethyl Fumarate Neuraxpharm and the administration of certain types of vaccines(live vaccines) could cause you to get an infection, and therefore, should be avoided. Your doctor will tell you if you should get other types of vaccines (inactivated vaccines).

Taking Dimethyl Fumarate Neuraxpharm with alcohol

After taking Dimethyl Fumarate Neuraxpharm, you should avoid consuming more than a small amount (more than 50 ml) of strong alcoholic beverages (with an alcohol content of more than 30%, such as spirits) for the first hour because alcohol may interact with this medicine. This may cause stomach inflammation (gastritis), especially in people who are prone to this condition.

Pregnancy and breastfeeding

If you are pregnant or breastfeeding, think you may be pregnant, or are planning to have a baby, ask your doctor or pharmacist for advice before taking this medicine.

Pregnancy

There is limited information on the effects of this medicine when used during pregnancy. Do not take Dimethyl Fumarate Neuraxpharm during pregnancy unless you have discussed this with your doctor and the medicine is clearly necessary for you.

Breastfeeding

It is not known if the active ingredient of Dimethyl Fumarate Neuraxpharm passes into breast milk. Your doctor will inform you whether you should stop breastfeeding, or stop taking Dimethyl Fumarate Neuraxpharm. This decision will involve weighing the benefits of breastfeeding for your child and the benefits of treatment for you.

Driving and using machines

Dimethyl Fumarate Neuraxpharm is not expected to affect your ability to drive or use machines.

Dimethyl Fumarate Neuraxpharm contains sodium

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

3. How to take Dimethyl Fumarate Neuraxpharm

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

Starting dose: 120 mg twice a day.

Take this starting dose for the first 7 days, then take the usual dose.

Usual dose: 240 mg twice a day.

Dimethyl Fumarate Neuraxpharm is taken by mouth.

The capsules should be swallowed whole, with some water. Do not break, crush, dissolve, suck, or chew the capsules because this may increase some side effects.

Take Dimethyl Fumarate Neuraxpharm with food– this helps to reduce some of the very common side effects (listed in section 4).

If you take more Dimethyl Fumarate Neuraxpharm than you should

If you take too many capsules, tell your doctor immediately. You may experience side effects similar to those described below in section 4.

In case of overdose or accidental ingestion, consult your doctor or pharmacist immediately or call the Toxicology Information Service, telephone 91 562 04 20, indicating the medicine and the amount ingested.

If you forget to take Dimethyl Fumarate Neuraxpharm

Do not take a double doseto make up for forgotten doses.

You can take the forgotten dose if it is at least 4 hours until the next dose. Otherwise, wait until the next dose.

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.

Serious side effects

Dimethyl Fumarate Neuraxpharm may lower your white blood cell count. A low white blood cell count can increase the risk of infection, including a rare brain infection called progressive multifocal leukoencephalopathy (PML). PML can cause death or severe disability. PML has occurred after 1 to 5 years of treatment, so your doctor will continue to monitor your white blood cell count during treatment, and you should be aware of any possible symptoms of PML, as described below. The risk of PML may be higher if you have previously taken a medicine that has weakened your immune system.

The symptoms of PML can be similar to those of an MS relapse. The symptoms can include new or worsening weakness on one side of the body; clumsiness; changes in vision, thinking, or memory; or confusion or personality changes, or difficulty speaking and communicating that may last for more than several days. Therefore, it is very important that you talk to your doctor as soon as possible if you think your MS is getting worse or if you notice any new symptoms while being treated with dimethyl fumarate. Also, inform your partner or caregivers about your treatment. It is possible that symptoms may arise that you are not aware of on your own.

→ Call your doctor immediately if you experience any of these symptoms

Severe allergic reactions

The frequency of severe allergic reactions cannot be estimated from the available data (frequency not known).

Facial or body redness (flushing) is a very common side effect. However, if the redness is accompanied by a red rash or hives and you have any of the following symptoms:

• swelling of the face, lips, mouth, or tongue (angioedema)
• wheezing, difficulty breathing, or shortness of breath (dyspnea, hypoxia)
• dizziness or loss of consciousness (hypotension)

this could be a severe allergic reaction (anaphylaxis).

→ Stop taking Dimethyl Fumarate Neuraxpharm and call your doctor immediately

Other side effects

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

• facial or body redness, feeling of heat, heat, burning sensation, or itching (flushing)
• loose stools (diarrhea)
• nausea or vomiting
• stomach pain or cramps

→ Taking the medicine with foodmay help reduce the above side effects

While taking Dimethyl Fumarate Neuraxpharm, it is common for urine tests to show the presence of ketones, substances that are naturally produced by the body.

Tell your doctorabout these side effects. Your doctor may reduce your dose. Do not reduce the dose unless your doctor tells you to.

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

• inflammation of the intestinal mucosa (gastroenteritis)
• vomiting
• indigestion (dyspepsia)
• inflammation of the stomach mucosa (gastritis)
• gastrointestinal disorders
• burning sensation
• hot flashes, feeling of heat
• skin itching (pruritus)
• rash
• red patches or redness accompanied by itching on the skin (erythema)
• hair loss (alopecia)

Side effects that may appear in blood or urine tests

• low white blood cell count (lymphopenia, leucopenia) in blood. A decrease in white blood cells can make the body less able to fight infections. If you have a severe infection (such as pneumonia), tell your doctor immediately
• proteins (albumin) in urine
• increased liver enzymes (ALT, AST) in blood

Uncommon(may affect up to 1 in 100 people):

• allergic reactions (hypersensitivity)
• reduction of blood platelets

Not known(cannot be estimated from the available data)

• inflammation of the liver and increased liver enzymes (ALT or AST simultaneously with bilirubin)
• herpes zoster (shingles) with symptoms such as blisters, burning, itching, or pain on the skin, usually on one side of the upper body or face, and other symptoms, such as fever and weakness in the early stages of infection, followed by numbness, itching, or red spots with severe pain
• nasal discharge (rhinorrhea).

Children (13 years of age and older) and adolescents

The side effects described above also apply to children and adolescents.

Some side effects were reported more frequently in children and adolescents than in adults, e.g., headache, stomach pain or cramps, vomiting, sore throat, cough, and painful menstruation.

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 via 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 Dimethyl Fumarate Neuraxpharm

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

Do not store above 30°C.

Do not use this medicine after the expiry date which is stated on the carton after EXP.

The expiry date is the last day of the month stated.

Medicines should not be disposed of via wastewater or household waste. Ask your pharmacist how to dispose of medicines no longer required. These measures will help protect the environment.

6. Package Contents and Additional Information

Composition of Dimethyl Fumarate Neuraxpharm

The active ingredientis dimethyl fumarate.

Dimethyl Fumarate Neuraxpharm 120 mg: each capsule contains 120 mg of dimethyl fumarate.

Dimethyl Fumarate Neuraxpharm 240 mg: each capsule contains 240 mg of dimethyl fumarate.

The other components are:

capsule content: sodium croscarmellose, anhydrous colloidal silica, sodium stearyl fumarate, methyl methacrylate copolymer (1:1), methacrylic acid copolymer and ethyl acrylate (1:1), 30% dispersion, talc, triethyl citrate, polysorbate 80, glycerol monooleate 40-55;

capsule: gelatin, titanium dioxide (E171), yellow iron oxide (E172), brilliant blue FCF (E133); capsule ink: shellac, black iron oxide (E172), propylene glycol (E1520), 28% ammonia hydroxide.

Appearance of the Product and Package Contents

Dimethyl Fumarate Neuraxpharm 120 mg hard gastro-resistant capsules are hard gelatin capsules, length: 19 mm, with a white body and light green cap, with the imprint on the body '120 mg' and are marketed in blister packs containing 14 or 56 capsules and 14 x 1 capsules in perforated unit-dose blister packs.

Dimethyl Fumarate Neuraxpharm 240 mg hard gastro-resistant capsules are hard gelatin capsules, length: 23 mm, light green, with the imprint on the body '240 mg' and are marketed in blister packs containing 14, 56, 168 or 196 capsules and 56 x 1 capsules in perforated unit-dose blister packs.

Only some package sizes may be marketed.

Marketing Authorization Holder and Manufacturer

Marketing Authorization Holder

Neuraxpharm Pharmaceuticals, S.L.

Avda. Barcelona 69

08970 Sant Joan Despí - Barcelona

Spain

Tel: +34 93 475 96 00

E-mail: medinfo@neuraxpharm.com

Manufacturer

Zaklady Farmaceutyczne POLPHARMA S.A.

ul. Pelplinska 19, 83-200 Starogard Gdanski

Poland

Zaklady Farmaceutyczne POLPHARMA S.A.

Oddzial Produkcyjny w Nowej Debie

ul. Metalowca 2, 39-460 Nowa Deba

Poland

Neuraxpharm Pharmaceuticals, S.L.

Avda. Barcelona 69

08970 Sant Joan Despí

Barcelona - Spain

neuraxpharm Arzneimittel GmbH

Elisabeth-Selbert-Straße 23

40764 Langenfeld - Germany

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

Date of the Last Revision of this Leaflet:{MM/AAAA}

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