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Hyrimoz 40 mg solucion inyectable en jeringa precargada

About the medication

Introduction

Patient Information Leaflet

Hyrimoz 40 mg pre-filled syringe injectable solution

adalimumab

40 mg/0.4 ml

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

  • Keep this leaflet, as you may need to read it again.
  • Your doctor will give you aPatient Information Leaflet, which contains important safety information you need to know before and during treatment with Hyrimoz.
  • Keep thisPatient Information Leafletduring your treatment and for the 4 months following your last injection (or that of your child) of Hyrimoz.
  • 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.

1. What is Hyrimoz and what is it used for

Hyrimoz contains the active ingredient adalimumab, a medication that acts on the body's immune system.

Hyrimoz is indicated for the treatment of the inflammatory diseases described below:

  • Rheumatoid arthritis,
  • Polyarticular juvenile idiopathic arthritis,
  • Arthritis associated with enthesitis,
  • Ankylosing spondylitis
  • Undifferentiated axial spondyloarthritis without radiographic evidence of ankylosing spondylitis,
  • Psoriatic arthritis,
  • Plaque psoriasis,
  • Hidradenitis suppurativa,
  • Crohn's disease,
  • Ulcerative colitis,
  • Non-infectious uveitis.

The active ingredient of Hyrimoz, adalimumab, is a monoclonal antibody. Monoclonal antibodies are proteins that target a specific site in the body.

The target of adalimumab is another protein called tumor necrosis factor-alpha (TNFα), which is found in high concentrations in the aforementioned inflammatory diseases. By binding to TNFα, Hyrimoz blocks its action and reduces inflammation in these diseases.

Rheumatoid Arthritis

Rheumatoid arthritis is an inflammatory disease of the joints.

Hyrimoz is used to treat rheumatoid arthritis in adults. If you have active moderate to severe rheumatoid arthritis, you may be given Hyrimoz before other disease-modifying medications such as methotrexate. If these medications do not work well enough, you will be given Hyrimoz to treat your rheumatoid arthritis.

Hyrimoz can also be used in the treatment of severe, active, and progressive rheumatoid arthritis without prior treatment with methotrexate.

Hyrimoz can reduce the damage to the cartilage and bones of the joints caused by the disease and improve physical performance.

Hyrimoz is usually used in combination with methotrexate. If your doctor considers methotrexate not suitable, Hyrimoz can be administered alone.

Polyarticular Juvenile Idiopathic Arthritis

Polyarticular juvenile idiopathic arthritis is an inflammatory disease of the joints.

Hyrimoz is used to treat polyarticular juvenile idiopathic arthritis in children and adolescents aged 2 to 17 years. Patients may have received first other disease-modifying medications, such as methotrexate. If these medications do not work well enough, patients will receive Hyrimoz.

Arthritis associated with Enthesitis

Arthritis associated with enthesitis is an inflammatory disease of the joints and the sites of tendon attachment to bone. Hyrimoz is used to treat arthritis associated with enthesitis in patients aged 6 years and older.

Patients may have received first other disease-modifying medications, such as methotrexate. If they do not respond sufficiently to these medications, patients will be given Hyrimoz.

Ankylosing Spondylitis and Undifferentiated Axial Spondyloarthritis without Radiographic Evidence of Ankylosing Spondylitis

Ankylosing spondylitis and undifferentiated axial spondyloarthritis without radiographic evidence of ankylosing spondylitis are inflammatory diseases that affect the spine.

Hyrimoz is used in adults to treat these diseases. If you have ankylosing spondylitis or undifferentiated axial spondyloarthritis without radiographic evidence of ankylosing spondylitis, you will be treated first with other medications, and if these medications do not work well enough, you will receive Hyrimoz to reduce the signs and symptoms of your disease.

Plaque Psoriasis in Adults and Children

Plaque psoriasis is an inflammatory disease of the skin that causes red, scaly, crusty areas covered with silvery scales. Plaque psoriasis can also affect the nails, causing them to deteriorate, thicken, and lift from the nail bed, which can be painful. It is believed that plaque psoriasis is caused by a defect in the body's immune system that leads to an increase in skin cell production.

Hyrimoz is used to treat moderate to severe plaque psoriasis in adults. Hyrimoz is also used to treat severe plaque psoriasis in children and adolescents aged 4 to 17 years who have not responded or are not good candidates for topical medications or UV light treatment.

Psoriatic Arthritis

Psiatic arthritis is an inflammatory disease of the joints associated with psoriasis.

Hyrimoz is used to treat psoriatic arthritis in adults. Hyrimoz can reduce the joint damage caused by the disease in cartilage and bone and improve physical performance.

Hidradenitis Suppurativa in Adults and Adolescents

Hidradenitis suppurativa (also known as inverse acne) is a long-lasting and often painful inflammatory disease of the skin. Symptoms can include sensitive nodules (bumps) and abscesses (boils) that can secrete pus.

It usually affects specific areas of the skin, such as under the chest, armpits, inner thighs, groin, and buttocks. It can also cause scarring in affected areas.

Hyrimoz is used to treat

  • moderate to severe hidradenitis suppurativa in adults and
  • moderate to severe hidradenitis suppurativa in adolescents aged 12 to 17 years.

Hyrimoz can reduce the number of nodules and abscesses and the pain associated with this disease. You may have received other medications previously. If these medications do not work well enough, you will receive Hyrimoz.

Crohn's Disease in Adults and Children

Crohn's disease is an inflammatory disease of the digestive tract.

Hyrimoz is used to treat

  • moderate to severe Crohn's disease in adults and
  • moderate to severe Crohn's disease in children and adolescents aged 6 to 17 years.

If you have Crohn's disease, you will be treated first with other medications. If you do not respond sufficiently to these medications, you will receive Hyrimoz to reduce the signs and symptoms of Crohn's disease.

Ulcerative Colitis in Adults and Children

Ulcerative colitis is an inflammatory disease of the large intestine.

Hyrimoz is used to treat

  • moderate to severe ulcerative colitis in adults and
  • moderate to severe ulcerative colitis in children and adolescents aged 6 to 17 years.

If you suffer from ulcerative colitis, you may be given other medications first. If these medications do not work well enough, you will be given Hyrimoz to reduce the signs and symptoms of ulcerative colitis.

Non-infectious Uveitis in Adults and Children

Non-infectious uveitis is an inflammatory disease that affects certain parts of the eye. The inflammation causes a decrease in vision and/or the presence of floaters in the eye (black dots or thin lines that move across the field of vision). Hyrimoz acts by reducing this inflammation.

Hyrimoz is used to treat

  • adults with non-infectious uveitis with inflammation affecting the back of the eye,
  • children aged 2 years and older with chronic non-infectious uveitis with inflammation affecting the front of the eye.

You may have received other medications previously. If you do not respond sufficiently to these medications, you will receive Hyrimoz.

2. What you need to know before your child starts using Hyrimoz

No use Hyrimoz

  • If you are allergic to adalimumab or any of the other components of this medication (listed in section 6).
  • If you have a severe infection, including tuberculosis, sepsis (blood poisoning), or other opportunistic infections (uncommon infections associated with a weakened immune system). If you have symptoms of any infection, such as fever, wounds, fatigue, or dental problems, inform your doctor (see "Warnings and precautions").
  • If you have moderate or severe heart failure. It is essential to inform your doctor if you have had or have any serious heart problems (see "Warnings and precautions").

Warnings and precautions

Consult your doctor or pharmacist before starting to use Hyrimoz.

Allergic reaction

  • If you have an allergic reaction with symptoms such as chest tightness, difficulty breathing, dizziness, swelling, or hives, discontinue Hyrimoz administration and contact your doctor immediately, as these reactions can be life-threatening in rare cases.

Infections

  • If you have any infection, including chronic or localized infections (e.g., a leg ulcer), consult your doctor before starting treatment with Hyrimoz. If unsure, contact your doctor.
  • With Hyrimoz treatment, you may be more susceptible to infections. This risk may be higher if you have reduced lung function. These infections can be severe and include tuberculosis, viral, fungal, parasitic, or bacterial infections, or other rare and unusual infectious organisms, and sepsis (blood poisoning).
  • In rare cases, these infections can be life-threatening. It is essential to inform your doctor if you have symptoms such as fever, wounds, fatigue, or dental problems. Your doctor may recommend temporarily stopping Hyrimoz treatment.

Tuberculosis (TB)

  • Since cases of tuberculosis have been reported in patients treated with adalimumab, your doctor will examine you for signs or symptoms of tuberculosis before starting your treatment with Hyrimoz. This will include a thorough medical evaluation, including your medical history and diagnostic tests (e.g., chest X-ray and tuberculin test). The results of these tests should be recorded on yourpatient information card. It is crucial to inform your doctor if you have had tuberculosis or have been in contact with a tuberculosis patient. You can develop tuberculosis during treatment, even if you have received preventive treatment for tuberculosis. If you experience symptoms of tuberculosis (persistent cough, weight loss, fatigue, or low-grade fever) or any other infection during or after treatment, contact your doctor immediately.

Travel/infection recurrence

  • Inform your doctor if you have resided or traveled to areas where fungal infections such as histoplasmosis, coccidioidomycosis, or blastomycosis are common.
  • Inform your doctor if you have a history of recurrent infections or other conditions or factors that increase the risk of infections.

Hepatitis B virus

  • Inform your doctor if you are a carrier of the hepatitis B virus (HBV), if you have active HBV infection, or if you think you may be at risk of contracting HBV. Your doctor should perform a test for HBV. Adalimumab can reactivate HBV in individuals who are carriers of this virus. In rare cases, especially if you are taking other medications that suppress the immune system, reactivation of HBV infection can be life-threatening.

Age 65 or older

  • If you are 65 or older, you may be more susceptible to infections while taking Hyrimoz. Both you and your doctor should pay special attention to the appearance of infection symptoms while you are being treated with Hyrimoz. It is essential to inform your doctor if you have symptoms of infections, such as fever, wounds, fatigue, or dental problems.

Dental procedures or surgery

  • If you are to undergo a surgical or dental procedure, inform your doctor that you are taking Hyrimoz. Your doctor may recommend temporarily stopping Hyrimoz treatment.

Demyelinating diseases

  • If you have or develop a demyelinating disease (a disease that affects the insulating layer around nerves, such as multiple sclerosis), your doctor will decide whether you should be treated or continue treatment with Hyrimoz. Inform your doctor immediately if you experience symptoms such as changes in vision, weakness in arms or legs, or numbness or tingling in any part of your body.

Vaccinations

  • Certain vaccines contain live but weakened forms of bacteria or viruses that cause diseases and should not be administered during Hyrimoz treatment, as they may cause infections. Consult your doctor before receiving any type of vaccine. It is recommended that children receive all scheduled vaccinations before starting Hyrimoz treatment. If you receive Hyrimoz while pregnant, your child may be at a higher risk of developing infections for approximately 5 months after the last dose you received during pregnancy. It is essential to inform your child's doctor and other healthcare professionals about your use of Hyrimoz during pregnancy, so they can decide whether your child should receive any vaccinations.

Heart failure

  • It is essential to inform your doctor if you have had or have any serious heart problems. If you have mild heart failure and are being treated with Hyrimoz, your doctor should closely monitor your heart failure. If you experience new symptoms of heart failure or worsening existing symptoms (e.g., difficulty breathing or swelling of the feet), contact your doctor immediately.

Fever, rashes, bleeding, or pale appearance

  • In some patients, the body may be unable to produce a sufficient number of white blood cells that fight infections or platelets that help stop bleeding. If you have persistent fever, rashes, or bleed easily or appear pale, consult your doctor immediately. Your doctor may decide tointerrupt treatment.

Cancer

  • In rare cases, certain types of cancer have been reported in children and adults treated with adalimumab or other TNFα blockers. Individuals with severe rheumatoid arthritis and those who have had the disease for a long time may be at a higher risk of developing lymphoma and leukemia (cancer affecting blood cells and bone marrow). While taking Hyrimoz, the risk of developing lymphoma, leukemia, and other types of cancer may increase. A rare and severe type of lymphoma has been observed in patients treated with adalimumab, especially those also taking azathioprine or mercaptopurine.
  • Cases of skin cancer (non-melanoma) have been reported in patients using adalimumab. Inform your doctor if you experience new skin damage or if existing marks or damaged areas change appearance during or after treatment.
  • Cases of cancers other than lymphoma have been reported in patients with a specific lung disease, known as chronic obstructive pulmonary disease (COPD), treated with another TNFα blocker. If you have COPD or smoke heavily, consult your doctor about the suitability of TNFα blockers for your condition.

Autoimmune diseases

  • In rare cases, Hyrimoz treatment may lead to a lupus-like syndrome. Contact your doctor if you experience symptoms such as persistent rash without explanation, fever, joint pain, or fatigue.

Children and adolescents

  • Do not administer Hyrimoz to children under 2 years old with juvenile idiopathic polyarticular arthritis.
  • Do not administer Hyrimoz to children under 4 years old with pediatric psoriasis or ulcerative colitis.
  • Do not administer Hyrimoz to children under 6 years old with pediatric Crohn's disease.
  • Do not use the 40 mg pre-filled syringe if recommended doses are less than 40 mg.

Other medications and Hyrimoz

Inform your doctor or pharmacist if you are taking, have taken recently, or may need to take any other medication.

Hyrimoz can be taken with methotrexate or certain disease-modifying antirheumatic drugs (DMARDs, such as sulfasalazine, hydroxychloroquine, leflunomide, and injectable gold preparations), corticosteroids, or pain medications, including nonsteroidal anti-inflammatory drugs (NSAIDs).

Do not use Hyrimoz with medications whose active ingredients are anakinra or abatacept due to an increased risk of severe infection. Do not recommend combining adalimumab and other TNF blockers with anakinra or abatacept, as this may increase the risk of infections, including severe infections, and other possible pharmacological interactions. If you have any doubts, consult your doctor.

Pregnancy and breastfeeding

  • Consider using effective contraceptive methods to avoid pregnancy and continue using them for at least 5 months after the last Hyrimoz treatment.
  • If you are pregnant, think you may be pregnant, or plan to become pregnant, consult your doctor about the use of this medication.
  • Hyrimoz should only be used during pregnancy if necessary.
  • A study on pregnancy found no increased risk of congenital defects when the mother received adalimumab during pregnancy compared to mothers with the same disease who did not receive adalimumab.
  • Hyrimoz can be used during breastfeeding.
  • If you use Hyrimoz while pregnant, your child may be at a higher risk of developing infections.
  • It is essential to inform your child's doctor and other healthcare professionals about your use of Hyrimoz during pregnancy before your child receives any vaccinations (for more information on vaccinations, see the "Warnings and precautions" section).

Driving and operating machinery

The influence of Hyrimoz on the ability to drive, ride a bike, or operate machinery is minimal. You may experience dizziness and visual disturbances after using Hyrimoz.

Hyrimoz contains sodium

This medication contains less than 1 mmol (23 mg) of sodium per 0.4 ml dose; it is essentially "sodium-free."

3. How to use Hyrimoz

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

The following table indicates the recommended doses of Hyrimoz for each of its approved uses. Your doctor may prescribe a different dose of Hyrimoz for you.

Rheumatoid Arthritis, Psoriatic Arthritis, Ankylosing Spondylitis, or Axial Spondyloarthritis without radiographic evidence of ankylosing spondylitis

Age or body weight

What amount and how often should be taken?

Notes

Adults

40 mg every other week as a single dose

In the case of rheumatoid arthritis, treatment with methotrexate is maintained during use of Hyrimoz. If your doctor determines that methotrexate is inappropriate, Hyrimoz may be administered alone.

If you have rheumatoid arthritis and do not receive methotrexate during treatment with Hyrimoz, your doctor may decide to give you 40 mg of Hyrimoz weekly or 80 mg every other week.

Juvenile Idiopathic Arthritis Polyarticular

Age or body weight

What amount and how often should be taken?

Notes

Children, adolescents, and adults from 2 years of age with a body weight of 30 kg or more

40 mg every other week

Not applicable

Children, adolescents from 2 years of age with a body weight between 10 kg and less than 30 kg

20 mg every other week

Not applicable

Arthritis associated with enthesitis

Age or body weight

What amount and how often should be taken?

Notes

Children, adolescents, and adults from 6 years of age with a body weight of 30 kg or more

40 mg every other week

Not applicable

Children and adolescents from 6 years of age with a body weight between 15 kg and less than 30 kg

20 mg every other week

Not applicable

Plaque Psoriasis

Age or body weight

What amount and how often should be taken?

Notes

Adults

A first dose of 80 mg (as two injections of 40 mg on the same day), followed by 40 mg every other week starting one week after the first dose.

Continue injecting Hyrimoz for as long as your doctor has indicated. If that dose does not work well enough, your doctor may increase the dose to 40 mg weekly or 80 mg every other week.

Pediatric Plaque Psoriasis

Age or body weight

What amount and how often should be taken?

Notes

Children and adolescents from 4 to 17 years of age with a body weight of 30 kg or more

A first dose of 40 mg, followed by 40 mg one week later. From then on, the usual dose is 40 mg every other week.

Not applicable

Children and adolescents from 4 to 17 years of age with a body weight between 15 kg and less than 30 kg

A first dose of 20 mg, followed by 20 mg one week later. From then on, the usual dose is 20 mg every other week.

Not applicable

Hidradenitis Suppurativa

Age or body weight

What amount and how often should be taken?

Notes

Adults

A first dose of 160 mg (as four injections of 40 mg on the same day or two injections of 40 mg per day for two consecutive days), followed by a dose of 80 mg (as two injections of 40 mg on the same day) two weeks later.

After two more weeks, continue with a dose of 40 mg weekly or 80 mg every other week, as prescribed by your doctor.

It is recommended to use a daily antiseptic liquid on the affected areas.

Adolescents from 12 to 17 years of age with a body weight of 30 kg or more

A first dose of 80 mg (as two injections of 40 mg on the same day), followed by 40 mg every other week starting one week later.

If that dose does not work well enough, your doctor may increase the dose to 40 mg weekly or 80 mg every other week.

It is recommended to use a daily antiseptic liquid on the affected areas.

Crohn's Disease

Age or body weight

What amount and how often should be taken?

Notes

Adults

A first dose of 80 mg (as two injections of 40 mg on the same day), followed by 40 mg every other week starting two weeks later.

If a faster response is required, your doctor may prescribe a first dose of 160 mg (as four injections of 40 mg on the same day or two injections of 40 mg per day for two consecutive days), followed by 80 mg (as two injections of 40 mg on the same day) two weeks later.

From then on, the usual dose is 40 mg every other week.

If that dose does not work well enough, your doctor may increase the dose to 40 mg weekly or 80 mg every other week.

Pediatric Crohn's Disease

Age or body weight

What amount and how often should be taken?

Notes

Children and adolescents from 6 to 17 years of age with a body weight of 40 kg or more

A first dose of 80 mg (as two injections of 40 mg on the same day), followed by 40 mg every other week starting two weeks later.

If a faster response is required, your doctor may prescribe a first dose of 160 mg (as four injections of 40 mg on the same day or two injections of 40 mg per day for two consecutive days), followed by 80 mg (as two injections of 40 mg on the same day) two weeks later.

From then on, the usual dose is 40 mg every other week.

If that dose does not work well enough, your doctor may increase the dose to 40 mg weekly or 80 mg every other week.

Children and adolescents from 6 to 17 years of age with a body weight less than 40 kg

A first dose of 40 mg, followed by 20 mg every other week starting two weeks later.

If a faster response is required, your doctor may prescribe a first dose of 80 mg (as two injections of 40 mg on the same day), followed by 40 mg two weeks later.

From then on, the usual dose is 20 mg every other week.

If that dose does not work well enough, your doctor may increase the frequency of the dose to 20 mg weekly.

Ulcerative Colitis

Age or body weight

What amount and how often should be taken?

Notes

Adults

A first dose of 160 mg (as four injections of 40 mg on the same day or two injections of 40 mg per day for two consecutive days), followed by 80 mg (as two injections of 40 mg on the same day) two weeks later.

From then on, the usual dose is 40 mg every other week.

If that dose does not work well enough, your doctor may increase the dose to 40 mg weekly or 80 mg every other week.

Pediatric Ulcerative Colitis

Age or body weight

What amount and how often should be taken?

Notes

Children and adolescents from 6 years of age with a body weight of 40 kg or more

A first dose of 160 mg (as four injections of 40 mg on the same day or two injections of 40 mg per day for two consecutive days) initially, followed by 80 mg (as two injections of 40 mg on the same day) two weeks later.

From then on, the usual dose is 80 mg every other week.

Patients who reach 18 years of age while on treatment with 80 mg every other week should continue with the prescribed dose.

Children and adolescents from 6 years of age with a body weight less than 40 kg

A first dose of 80 mg (as two injections of 40 mg on the same day) initially, followed by 40 mg (as one injection of 40 mg) two weeks later.

From then on, the usual dose is 40 mg every other week.

Patients who reach 18 years of age while on treatment with 40 mg every other week should continue with the prescribed dose.

Non-infectious Uveitis

Age or body weight

What amount and how often should be taken?

Notes

Adults

A first dose of 80 mg (as two injections of 40 mg), followed by 40 mg every other week starting one week after the first dose.

In non-infectious uveitis, treatment with corticosteroids or other medications that affect the immune system may be continued during use of Hyrimoz. Hyrimoz may also be administered alone.

Continue injecting Hyrimoz for as long as your doctor has indicated.

Children and adolescents from 2 years of age with a body weight of 30 kg or more

40 mg every other week

Your doctor may also prescribe a first dose of 80 mg, which may be administered one week before starting with the usual dose of 40 mg every other week. It is recommended to use Hyrimoz in combination with methotrexate.

Children and adolescents from 2 years of age with a body weight less than 30 kg

20 mg every other week

Your doctor may also prescribe a first dose of 40 mg, which may be administered one week before starting with the usual dose of 20 mg every other week. It is recommended to use Hyrimoz in combination with methotrexate.

Form and route of administration

Hyrimoz is injected under the skin (subcutaneously).

Detailed instructions on how to inject Hyrimoz are found in section 7, “Instructions for use”.

If you use more Hyrimoz than you should

If you accidentally inject Hyrimoz more frequently than you should, call your doctor or pharmacist and explain that you have taken more than necessary. Always carry the medication box with you, even if it is empty.

If you forget to use Hyrimoz

If you forget to administer an injection, you should inject the next dose of Hyrimoz as soon as you remember. Then, administer the next dose as usual, as if you had not forgotten a dose.

If you interrupt treatment with Hyrimoz

The decision to stop using Hyrimoz should be discussed with your doctor. Your symptoms may return after stopping treatment.

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

4. Possible Adverse Effects

Like all medicines, this medicine can cause side effects, although not everyone will experience them. Most side effects are mild to moderate. However, some can be severe and require treatment. Side effects can appear up to 4 months or more after the last injection of Hyrimoz.

Seek urgent medical attentionif you notice any of the following signs of allergic reaction or heart failure:

  • severe rash, urticaria;
  • swelling of the face, hands, feet;
  • difficulty breathing, swallowing;
  • difficult breathing with physical activity or lying down, or swelling of the feet.

Contact your doctor as soon as possibleif you notice any of the following effects:

  • signs and symptoms of infection such as fever, nausea, wounds, dental problems, burning sensation while urinating, weakness, fatigue, or cough;
  • symptoms of nervous system problems, such as tingling, numbness, double vision, weakness in arms or legs;
  • signs of skin cancer, such as a lump or an open wound that does not heal;
  • signs and symptoms of blood disorders such as persistent fever, petechiae, bleeding, and pallor.

The following side effects have been observed with adalimumab:

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

  • reactions at the injection site (including pain, swelling, redness, or itching);
  • lower respiratory tract infections (including colds, coughing, sinusitis, pneumonia);
  • headache;
  • abdominal pain;
  • nausea and vomiting;
  • hives;
  • muscle pain.

Common(may affect up to 1 in 10 people)

  • serious infections (including sepsis and flu);
  • gastrointestinal infections (including gastroenteritis);
  • skin infections (including cellulitis and herpes);
  • ear infection;
  • oral infections (including dental infection and cold sore);
  • reproductive system infections;
  • urinary tract infections;
  • fungus infections;
  • joint infections;
  • benign tumors;
  • skin cancer;
  • allergic reactions (including seasonal allergy);
  • dehydration;
  • mood changes (including depression);
  • anxiety;
  • difficulty sleeping;
  • sensory alterations such as tingling, itching, or numbness;
  • migraine;
  • symptoms of nerve root compression (including lower back and leg pain);
  • visual disturbances;
  • eye inflammation;
  • eyelid inflammation and swelling of the eye;
  • dizziness (feeling the room spinning);
  • rapid pulse;
  • high blood pressure;
  • flushing;
  • hematomas (solid swelling with coagulated blood);
  • cough;
  • asthma;
  • difficulty breathing;
  • gastrointestinal bleeding;
  • indigestion, bloating, and heartburn;
  • acid reflux;
  • dry eye syndrome (including dry eyes and mouth);
  • itching;
  • hives with itching;
  • bruises;
  • skin inflammation (such as eczema);
  • breaking of fingernails and toenails;
  • excessive sweating;
  • hair loss;
  • new-onset or worsening psoriasis;
  • muscle spasms;
  • blood in urine;
  • kidney problems;
  • chest pain;
  • edema (accumulation of fluid in the body that can cause swelling of the affected tissue);
  • fever;
  • decreased platelet count in blood, increasing the risk of bleeding or bruising;
  • wound healing problems.

Uncommon(may affect up to 1 in 100 people)

  • unusual infections (including tuberculosis and other infections that occur when resistance to disease decreases);
  • neurological infections (including viral meningitis);
  • eye infections;
  • bacterial infections;
  • diverticulitis (inflammation and infection of the large intestine);
  • cancer, including lymphoma (a type of cancer that affects the lymphatic system) and melanoma (a type of skin cancer);
  • immunological disorders that can affect the lungs, skin, and lymph nodes (the most common presentation is in the form of a disease called sarcoidosis);
  • vasculitis (inflammation of blood vessels);
  • tremor (feeling shaky);
  • neuropathy (nerve damage);
  • stroke;
  • hearing loss, ringing;
  • sensation of irregular pulse like skipping;
  • heart problems that can cause difficulty breathing or swelling of the ankles;
  • heart attack;
  • sac in the wall of a major artery, inflammation and coagulation in a vein, blockage of a blood vessel;
  • lung diseases that can cause difficulty breathing (including inflammation);
  • pulmonary embolism (blockage of a pulmonary artery);
  • pleural effusion (abnormal fluid accumulation in the pleural space);
  • pancreatitis (inflammation of the pancreas that causes severe abdominal and back pain);
  • difficulty swallowing;
  • facial edema;
  • inflammation of the gallbladder; gallstones;
  • fat accumulation in the liver (accumulation of fat in liver cells);
  • nocturnal sweating;
  • scars;
  • abnormal muscle crisis;
  • systemic lupus erythematosus (a disorder in which the immune system attacks the skin, heart, lungs, joints, and other organs);
  • sleep interruptions;
  • impotence;
  • inflammations.

Rare(may affect up to 1 in 1,000 people)

  • leukemia (cancer that affects the blood and bone marrow);
  • severe allergic reaction with shock;
  • multiple sclerosis;
  • neurological disorders (such as optic nerve inflammation and Guillain-Barré syndrome, a disease that can cause muscle weakness, abnormal sensations, tingling in the arms and upper body);
  • cardiac arrest;
  • lung fibrosis (scar tissue in the lungs);
  • intestinal perforation (hole in the intestinal wall);
  • hepatitis (inflammation of the liver);
  • reactivation of the hepatitis B virus;
  • autoimmune hepatitis (inflammation of the liver caused by the body's own immune system);
  • cutaneous vasculitis (inflammation of blood vessels in the skin);
  • Stevens-Johnson syndrome (a potentially life-threatening disease with flu-like symptoms and rash with blisters);
  • facial edema associated with allergic reactions;
  • erythema multiforme (inflammatory rash on the skin);
  • syndrome similar to lupus;
  • angioedema (localized swelling of the skin);
  • lichenoid reaction in the skin (red-purple hives with itching).

Frequency not known(cannot be estimated from available data)

  • hepatosplenic T-cell lymphoma (rare blood cancer that is often fatal);
  • Merkel cell carcinoma (a type of skin cancer);
  • Kaposi's sarcoma, a rare cancer related to infection with human herpesvirus 8. Kaposi's sarcoma usually manifests as purple skin lesions;
  • hepatic failure;
  • worsening of a disease called dermatomyositis (seen as skin rash accompanied by muscle weakness);
  • weight gain (for most patients, weight gain was reduced).

Some side effects observed in clinical trials with adalimumab can only be identified by blood tests and do not have symptoms. These include:

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

  • low white blood cell count;
  • low red blood cell count;
  • high lipid levels in blood;
  • high liver enzymes.

Common(may affect up to 1 in 10 people)

  • high white blood cell count;
  • low platelet count;
  • high uric acid levels in blood;
  • abnormal sodium levels in blood;
  • low calcium levels in blood;
  • low phosphate levels in blood;
  • high blood sugar;
  • high lactate dehydrogenase levels in blood;
  • presence of autoantibodies in blood;
  • low potassium levels in blood.

Uncommon(may affect up to 1 in 100 people)

  • high bilirubin levels (blood test of liver function).

Rare(may affect up to 1 in 1,000 people)

  • low counts in blood for white cells, red cells, and platelets.

Reporting of 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 leaflet. You can also report them directly through thenational reporting system included in theAppendix V. By reporting side effects, you can contribute to providing more information on the safety of this medicine.

5. Hyrimoz Storage

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

Do not use this medication after the expiration date that appears on the label/blister/package after “CAD” or “EXP”. The expiration date is the last day of the month indicated.

Store in refrigerator (between 2 °C and 8 °C). Do not freeze.

Store the pre-filled syringe in the outer packaging to protect it from light.

Alternative Storage:

When necessary (for example, when traveling), you can store Hyrimoz at room temperature (up to 25 °C) for a maximum period of 42 days (ensure it is protected from light). Once removed from the refrigerator for storage at room temperature, the pre-filled syringemust be used within the next 42 days or discarded, even if it is returned to the refrigerator later. You must note the date when you removed the pre-filled syringe from the refrigerator, and the date after which it must be discarded.

Medicines should not be disposed of through the drains or in the trash. Ask your pharmacist how to dispose of the containers and the medication that you no longer need. This will help protect the environment.

6. Contents of the packaging and additional information

Composition of Hyrimoz

  • The active ingredient is adalimumab. Each pre-filled syringe contains 40 mg of adalimumab in 0.4 ml of solution.
  • The other components are: adipic acid, mannitol (E 421), polisorbate 80 (E 433), hydrochloric acid (E 507), sodium hydroxide (E 524), and water for injection.

Appearance of the product and contents of the pack

Hyrimoz 40 mg solution for injection (injection) in pre-filled syringe is supplied as 0.4 ml of transparent to slightly opalescent, colourless or slightly yellowish solution.

Hyrimoz is supplied in a type I transparent glass syringe of single use with a stainless steel needle of calibre 29 with a needle guard with wings for secure attachment, rubber (thermoplastic elastomer) needle cap, and plastic plunger, with 0.4 ml of solution.

Boxes with 1 and 2 pre-filled syringes of Hyrimoz.

Boxes of multiple packs with 6 (3 packs of 2) pre-filled syringes of Hyrimoz.

Only some pack sizes may be marketed.

Hyrimoz is available in pre-filled syringe and in pre-filled pen.

Marketing authorisation holder

Sandoz GmbH

Biochemiestr. 10

6250 Kundl

Austria

Responsible for manufacturing

Sandoz GmbH Schaftenau

Biochemiestr. 10

6336 Langkampfen

Austria

Novartis Pharmaceutical Manufacturing GmbH

Biochemiestrasse 10

6336 Langkampfen

Austria

For more information about this medicinal product, please contact the local representative of the marketing authorisation holder:

België/Belgique/Belgien

Sandoz nv/sa

Tél/Tel: +32 2 722 97 97

Lietuva

Sandoz Pharmaceuticals d.d filialas

Tel: +370 5 2636 037

Luxembourg/Luxemburg

Sandoz nv/sa

Tél/Tel.: +32 2 722 97 97

Ceská republika

Sandoz s.r.o.

Tel: +420 225 775 111

Magyarország

Sandoz Hungária Kft.

Tel.: +36 1 430 2890

Danmark/Norge/Ísland/Sverige

Sandoz A/S

Tlf: +45 63 95 10 00

Malta

Sandoz Pharmaceuticals d.d.

Tel: +356 21222872

Deutschland

Hexal AG

Tel: +49 8024 908 0

Nederland

Sandoz B.V.

Tel: +31 36 52 41 600

Eesti

Sandoz d.d. Eesti filiaal

Tel: +372 665 2400

Österreich

Sandoz GmbH

Tel: +43 5338 2000

Ελλáδα

Novartis (Hellas) A.E.B.E.

Τηλ: +30 210 281 17 12

Polska

Sandoz Polska Sp. z o.o.

Tel.: +48 22 209 70 00

España

Sandoz Farmacéutica, S.A.

Tel: +34 900 456 856

Portugal

Sandoz Farmacêutica Lda.

Tel: +351 21 196 40 00

France

Sandoz SAS

Tél: +331 49 64 48 00

România

Sandoz SRL

Tel: +40 21 407 51 60

Hrvatska

Sandoz d.o.o.

Tel: +385 1 23 53 111

Slovenija

Lek farmacevtska družba d.d.

Tel: +386 1 580 21 11

Ireland

Rowex Ltd.

Tel: + 353 27 50077

Slovenská republika

Sandoz d.d. - organizacná zložka

Tel: +421 2 48 200 600

Italia

Sandoz S.p.A.

Tel: +39 02 96541

Suomi/Finland

Sandoz A/S

Puh/Tel: +358 10 6133 400

Κúpρος

Sandoz Pharmaceuticals d.d.

Τηλ: +357 22 69 0690

United Kingdom (Northern Ireland)

Sandoz GmbH

Tel: +43 5338 2000

Latvija

Sandoz d.d. Latvia filiale

Tel: +371 67 892 006

Last update of the leaflet

Other sources of information

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

  1. Instructions for use

To help prevent possible infections and ensure correct use of the medicinal product, it is important to follow these instructions.

Make sure to read, understand, and follow these instructions for use before injecting Hyrimoz. Your healthcare professional should teach you how to prepare and inject Hyrimoz correctly with the pre-filled syringe before you use it for the first time. If you have any questions, consult your healthcare professional.

Your single-use pre-filled syringe of Hyrimoz, with needle guard and additional wings for secure attachment

Figure A:pre-filled syringe of Hyrimoz with needle guard and wings for secure attachment

It is important that:

  • Do not usethe pre-filled syringe if the blister packaging is broken, as its use may not be safe.
  • Do not openthe outer box until you are ready to use the pre-filled syringe.
  • Do not leavethe pre-filled syringe unattended in places where others may handle it.
  • If the pre-filled syringe is dropped,do not useit if it is damaged or if it has fallen without the needle cap being in place.
  • Do not removethe needle cap until just before administering the injection.
  • Be careful not totouchthe wings of the needle guard before using the pre-filled syringe. Touching them may cause the needle guard to activate too soon.
  • Do not removethe wings for secure attachment before the injection.
  • To make the injection more comfortable, inject Hyrimoz 15-30 minutes after taking it out of the refrigerator.
  • Dispose of the used pre-filled syringe immediately after use.Do not re-use pre-filled syringes. See“4. Disposal of used pre-filled syringes”at the end of these instructions for use.

Storage of the pre-filled syringe of Hyrimoz

  • Store the outer box of the pre-filled syringes in a refrigerator, between 2°C and 8°C.
  • When necessary (e.g. when travelling), you may store Hyrimoz at room temperature (up to 25°C) for a maximum of 42 days (ensure it is protected from light). Once it has been taken out of the refrigerator to store it at room temperature, the pre-filled syringemust be used within the next 42 days or discarded, even if it is put back in the refrigerator later. You should note the date when you removed the pre-filled syringe from the refrigerator and the date after which it should be discarded.
  • Keep the pre-filled syringes in the original packaging until you are ready to use them to protect them from light.
  • Do not expose the pre-filled syringes to extreme heat or cold.
  • Do not freeze the pre-filled syringes.

Keep Hyrimoz and all medicines out of the reach of children.

What is needed for the injection?

Place the following items on a clean and flat surface.

The box of the pre-filled syringe includes:

  • Pre-filled syringe/s of Hyrimoz (seeFigure A). Each pre-filled syringe contains

40 mg/0.4 ml of adalimumab.

The box of the pre-filled syringe of Hyrimoz does not include (seeFigure B):

  • Moist towelette with alcohol
  • Cotton or gauze
  • Sharps container. See section“4. Disposal of used pre-filled syringes”at the end of these instructions for use.
  • Adhesive bandage

Figure B:items not included in the box

Before the injection

Figure C:the needle guard is not activated; the pre-filled syringe is ready to use

  • In this configuration, the needle guardIS NOT ACTIVATED.
  • The pre-filled syringe is ready to use (seeFigure C).

Figure D:the needle guard is activated; do not use

  • In this configuration, the needle guardIS ACTIVATED.
  • DO NOT USEthe pre-filled syringe (seeFigure D).

Preparing the pre-filled syringe

  • To make the injection more comfortable, take the box containing the pre-filled syringe out of the refrigerator and leave it unopened on the work surface for 15-30 minutes to allow it to reach room temperature.
  • Take the pre-filled syringe out of the blister packaging.
  • Look through the viewfinder. The solution should be colourless or slightly yellowish, and transparent to slightly opalescent. Do not use it if you see particles or changes in colour. If you are concerned about the appearance of the solution, consult your pharmacist.
  • Do not use the pre-filled syringe if it is broken or if the needle guard is activated. Return the pre-filled syringe and the packaging it came in to the pharmacy.
  • Look at the expiry date (CAD) on the pre-filled syringe. Do not use the pre-filled syringe after the expiry date has passed.

If the pre-filled syringe does not pass any of the above checks,contact your pharmacist.

1. Choosing the injection site:

  • The recommended injection site is the front of the thigh. It can also be administered in the lower abdomen, except in an area of 5 cm around the navel (seeFigure E).
  • Choose a different site each time you self-administer an injection.
  • Do notinject in areas where the skin is painful, bruised, red, flaky, or hardened. Avoid areas with scars or extensive marks. If you have psoriasis, DO NOT inject directly into areas with psoriasis plaques.

Figure E:choose the injection site

2. Cleaning the injection site:

  • Wash your hands thoroughly with soap and water.
  • Clean the injection site with an alcohol wipe, making circular motions. Wait for it to dry before administering the injection (seeFigure F).
  • Do nottouch the cleaned area before the injection.

Figure F:clean the injection site

3. Administering the injection:

  • Carefully pull the needle cap straight off in the upright position to remove it from the pre-filled syringe (seeFigure G).
  • Dispose of the needle cap.
  • You may see a drop of liquid at the end of the needle. This is normal.

Figure G:remove the needle cap

  • Gently pinch the skin at the injection site (seeFigure H).
  • Insert the needle into the skin as shown.
  • Push the needle all the way in to ensure that all the medicine is administered.
  • Use the pre-filled syringe within 5 minutes of removing the needle cap.

Figure H:insert the needle

  • Hold the pre-filled syringe as shown (seeFigure I).
  • Slowly push the plunger until it reaches the top, so that the push button of the plunger is completely between the wings of the needle guard.
  • Hold the plunger completely pressed while holding the pre-filled syringe without moving it for 5 seconds.

Figure I: hold the pre-filled syringe

  • Hold the plunger completely pressed while carefully pulling the needle straight out of the injection site and allowing it to come out of the skin (seeFigure J).

Figure J:pull the needle straight out

  • Slowly release the plunger and let the safety needle cover automatically the exposed needle (seeFigure K).
  • You may see a small amount of blood at the injection site. You can press a cotton ball or gauze against it for 10 seconds. Do not rub the injection site. If necessary, you can cover it with a small adhesive bandage.

Figure K:slowly release the plunger

4. Disposal of used pre-filled syringes:

  • Dispose of the used pre-filled syringe in a sharps container (seeFigure L). For your health and safety and that of others, used needles and pre-filled syringes should never be re-used.
  • Medicines should not be thrown away in the trash or down the drain. Ask your pharmacist how to dispose of the packaging and the medicines that are no longer needed. This will help protect the environment. The disposal of unused medicines and all materials that have come into contact with them will be carried out in accordance with local regulations.

Figure L:disposal of the used pre-filled syringe

If you have any questions, consult a doctor, pharmacist, or nurse who is familiar with Hyrimoz.

Country of registration
Active substance
Prescription required
Yes
Manufacturer
Composition
Manitol (e-421) (42 mg mg), Hidroxido de sodio (e 524) (c.s.p. 1 ml mg)
This information is for reference only and does not constitute medical advice. Always consult a licensed doctor before taking any medication. Oladoctor is not responsible for medical decisions based on this content.

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