INNOHEP 18,000 IU Anti-Xa / 0.9 mL Pre-filled Syringe Solution for Injection

Introduction

innohep 18,000 IU anti-Xa/0.9 ml injectable solution in pre-filled syringes

(20,000 IU anti-Xa/ml)

tinzaparin sodium

Read the entire leaflet carefully before starting to use this medication, as it contains important information for you.

• Keep this leaflet, as you may need to read it again. If you have any doubts, consult your doctor, pharmacist, or nurse.
• This medication has been prescribed to you only, and you should not give it to others, even if they have the same symptoms as you, as it may harm them.
• If you experience side effects, consult your doctor, pharmacist, or nurse, even if they are not listed in this leaflet.
• In the text of this leaflet, the term "innohep" will be used to refer to innohep 18,000 IU anti-Xa/0.9 ml injectable solution in pre-filled syringes

Contents of the leaflet

1. What is innohep and what is it used for
2. What you need to know before starting to use innohep
3. How to use innohep
4. Possible side effects
5. Storage of innohep
6. Package contents and additional information

1. What is innohep and what is it used for

innohep is a medication that inhibits the natural ability of blood to form clots (coagulate).

• innohep is used to treat blood clots and prevent the formation of new clots in adults.

You should consult a doctor if it worsens or does not improve.

2. What you need to know before starting to use innohep

Do not use innohep

• if you are allergic to tinzaparin sodium or any of the other components of this medication (listed in section 6).
• if you have or have had heparin-induced thrombocytopenia.
• if you have a severe bleeding disorder (e.g., in the brain, spinal cord, eyes, or stomach).
• if you have a severe infection in the heart (septic endocarditis).
• if you are scheduled for spinal or epidural anesthesia or a lumbar puncture.

Warnings and precautions

Consult your doctor or nurse before starting to use innohep

• if you know you have a tendency to bleed.
• if you are being treated with other medications by intramuscular route.
• if you have a low platelet count in your blood.
• if you have high potassium levels in your blood (hyperkalemia).
• if you have a prosthetic heart valve.
• if you have kidney problems.

Children and adolescents

innohep is not indicated for use in children and adolescents.

Use of innohep with other medications

Tell your doctor or pharmacist if you are using, have recently used, or may need to use any other medication. Some medications may interact with the effect of innohep.

Tell your doctor if you are using any of the following medications, as you may bleed more easily:

• Medications for the treatment of inflammation and pain, especially non-steroidal anti-inflammatory drugs (NSAIDs), such as acetylsalicylic acid
• Medications used to dissolve blood clots (thrombolytic agents)
• Medications that block the action of vitamin K (vitamin K antagonists)
• Activated protein C
• Direct inhibitors of factor Xa and IIa

Pregnancy and breastfeeding

If you are pregnant or breastfeeding, think you may be pregnant, or plan to become pregnant, consult your doctor or pharmacist before using this medication.

innohep in pre-filled syringes can be used during all trimesters of pregnancy.

If epidural anesthesia is necessary, you should inform your doctor that you are using innohep.

Tell your doctor or nurse if you have a prosthetic heart valve

Driving and using machines

innohep does not affect the ability to drive or use machines.

innohep contains sodium metabisulfite

• As it contains sodium metabisulfite as an excipient, innohep may rarely cause severe allergic reactions and bronchospasm.
• This medication contains 40 mg of sodium (main component of table salt/cooking salt) per ml. This is equivalent to 2% of the maximum recommended daily intake of sodium for an adult.

3. How to use innohep

Follow exactly the administration instructions for this medication indicated by your doctor or nurse. If in doubt, consult your doctor or nurse again.

During treatment, your doctor may request that you undergo routine blood tests to assess the effect of innohep.

innohep must be injected under the skin (subcutaneous injection). Administration by intramuscular injection of other medications should be avoided during treatment with innohep, due to the risk of hematoma formation.

The recommended dose is:

175 IU anti-Xa per kg of body weight administered once a day.

Your doctor will indicate the appropriate dose for you.

Treatment should be administered once a day, for 6 days, and may be extended up to 6 months. The need to extend treatment for more than 6 months should be evaluated by your doctor. Your doctor will indicate the duration of your treatment.

Instructions on how to inject innohep:

1. Wash your hands carefully before injecting this medication. Clean the skin around the injection site with an alcohol swab and let it dry, without rubbing.

1. Open the syringe container by lifting the colored cap all the way back, and remove the syringe.

Inspect the contents of the syringe before use. If you observe turbidity or a precipitate in the medication, do not use it and take another syringe. The medication may have a yellowish color during storage, but it can be used as long as the solution is clear and the expiration date has not been exceeded. Each syringe can be used only once.

1. Fold the safety device down, separating it from the needle protector cap.

1. Remove the cap that protects the needle without twisting it. Adjust the syringe contents to the prescribed dose by your doctor. Eliminate excess volume by pressing the plunger in a vertical position. Do not pull the plunger back, and do not remove the air bubble contained in the syringe. If the air bubble is not correctly positioned next to the plunger, gently tap the syringe until the air bubble is in place.

1. Take a skin fold, without pressing, between the thumb and index finger of one hand, and with the other hand, insert the needle vertically and slowly into the skin fold, at a right angle to the skin.

1. Inject the necessary dose slowly into the fatty tissue, for example, the skin of the abdominal area, the front of the thighs, the lower back, or the back of the arms. Wait a few seconds to allow the solution to distribute before removing the needle and releasing the skin fold.

1. Clean the area with a gauze if bleeding occurs. Choose a different injection site for the next time (e.g., alternating between the left and right side of the abdomen).

1. Fold the safety device back to its original position, so that it is parallel to the needle. Then, with the safety device flat on a rigid surface, press down until the needle is locked in the device.

1. The used syringe, with the needle facing down, can be inserted into the same syringe container or a container for sharp waste. In this way, the syringe is safe, and the container with the syringe or the container for sharp waste can be returned to a hospital or pharmacist for destruction.

If you use more innohep than you should

If you are treated with more innohep than you need, bleeding may occur. Consult your doctor or nurse immediately if you do not feel well or think you have been given too high a dose of innohep.

If you forget to use innohep

You should not inject a double dose to make up for the forgotten dose. If you have forgotten to administer more than one dose, consult your doctor as soon as possible.

If you stop treatment with innohep

If you stop administering innohep, the effect of making the blood more fluid will cease. Do not stop treatment with innohep without consulting your doctor or nurse.

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

4. Possible side effects

Like all medications, innohep can cause side effects, although not everyone will experience them.

Severe side effects:

Rarely, severe side effects have been observed that require immediate medical attention during treatment with innohep. If you experience any of the following symptoms, consult your doctor or go to the nearest hospital for emergency treatment.

• Severe allergic reaction. Symptoms include sudden appearance of a severe skin rash, throat inflammation, face, lips, or mouth swelling, difficulty breathing.
• Severe bleeding. Symptoms include red or brown urine, black tarry stools, unusual bruising (very painful, extensive, or dark), and any bleeding that does not stop.

The following side effects have been observed with the administration of innohep:

Frequent: may affect up to 1 in 10 people

• Bleeding: May lead to complications, such as anemia (low red blood cell count) or bruising (hematomas)

• Injection site reactions (including bruising, bleeding, pain, itching, redness, inflammation, and hardening of the injection site)

Uncommon: may affect up to 1 in 100 people

• Thrombocytopenia (decrease in platelet count in blood)
• Hypersensitivity (allergic reaction)
• Bruising and skin discoloration
• Elevated liver enzyme levels
• Dermatitis (skin inflammation)
• Rash and itching

Rare: may affect up to 1 in 1,000 people

• Heparin-induced thrombocytopenia (decrease in platelet count in blood due to heparin treatment)
• Thrombocytosis (increase in platelet count in blood)
• Angioedema (swelling of the face, lips, and tongue)
• Anaphylactic reaction (see above "Severe allergic reaction")
• Hyperkalemia (elevated potassium levels in blood)
• Toxic skin rash
• Necrosis of the skin (death of skin tissue)
• Habones
• Osteoporosis, observed in long-term treatments
• Priapism (prolonged, often painful erection, without prior sexual stimulation)

Pediatric population

Limited information is available from a clinical trial and post-marketing data, indicating that the profile of adverse reactions in children and adolescents is comparable to that observed in adults.

Reporting of 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 and Healthcare Products Agency (AEMPS) https://www.notificaram.es. By reporting side effects, you can help provide more information on the safety of this medication.

5. Storage of innohep

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

Do not use this medication after the expiration date stated on the packaging. The expiration date is the last day of the month indicated.

• No special storage conditions are required.
• Do not use this medication if you observe turbidity or a precipitate in the syringe.
• The solution may have a yellowish color during storage, but this does not affect the quality of the product, which is still safe for use.
• Medications should not be disposed of via wastewater or household waste. Deposit the packaging and medications you no longer need in the SIGRE collection point at the pharmacy. If in doubt, ask your pharmacist how to dispose of the packaging and medications you no longer need. This will help protect the environment.

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6. Package contents and additional information

Composition of innohep

• The active ingredient is tinzaparin sodium. Each ml of injectable solution contains 20,000 IU anti-Xa of tinzaparin sodium.
• The other components are sodium metabisulfite (E 223), sodium hydroxide, and water for injections.

Appearance of the product and package contents

Injectable solution.

Transparent glass syringes containing a clear or pale yellow solution, free from turbidity and deposit when the syringe is left to stand.

Package sizes:

• 0.9 ml (18,000 IU anti-Xa), packages with 2, 6, 10, 30, 50, and 100 syringes.

Not all package sizes may be marketed.

Marketing authorization holder and manufacturer

Marketing authorization holder:

LEO Pharma A/S

Industriparken 55,

DK-2750 Ballerup

Denmark

Manufacturer:

Laboratoires LEO S.A.

39 Route de Chartres,

FR-28500 Vernouillet Cedex

France

Date of last revision of this leaflet:December 2019.

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