LENALIDOMIDE QILU 25 mg HARD CAPSULES

Introduction

Patient Information: Summary of Product Characteristics

Lenalidomida Qilu 25mg Hard Capsules EFG

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

1. What is Lenalidomida Qilu and what is it used for

What is Lenalidomida Qilu

Lenalidomida Qilu contains the active substance lenalidomide. This medicine belongs to a group of medicines that affect the way your immune system works.

What Lenalidomida Qilu is used for

Lenalidomida Qilu is used in adults for:

• Multiple Myeloma
• Myelodysplastic Syndromes
• Follicular Lymphoma

Multiple Myeloma

Multiple myeloma is a type of cancer that affects a specific type of white blood cell called plasma cells. These cells accumulate in the bone marrow and multiply out of control. This can damage bones and kidneys.

Multiple myeloma usually cannot be cured. However, the signs and symptoms can be greatly reduced or may disappear for a period of time. This is called a "remission".

Newly diagnosed multiple myeloma: in patients who have undergone a bone marrow transplant, lenalidomide is used as maintenance treatment after recovery from the bone marrow transplant.

Newly diagnosed multiple myeloma: in patients who cannot be treated with a bone marrow transplant

Lenalidomide is taken with other medicines, including:

• a chemotherapy medicine called "bortezomib"
• an anti-inflammatory called "dexamethasone"
• a chemotherapy medicine called "melphalan" and
• an immunosuppressant called "prednisone".

You will take these medicines at the start of treatment and then continue to take lenalidomide alone.

If you are 75 years or older or have moderate to severe kidney problems, your doctor will monitor you closely before starting treatment.

Multiple myeloma: in patients who have been previously treated

Lenalidomide is taken with an anti-inflammatory called "dexamethasone".

This medicine can delay the worsening of multiple myeloma symptoms. It has also been shown to delay the return of multiple myeloma after treatment.

Myelodysplastic Syndromes (MDS)

MDS are a group of many different blood and bone marrow disorders. The blood cells become abnormal and do not work properly. Patients may experience a variety of signs and symptoms including low red blood cell count (anemia), the need for blood transfusions, and an increased risk of infection.

Lenalidomida is used to treat adult patients with MDS when all of the following apply:

• need regular blood transfusions to treat low red blood cell counts ("transfusion-dependent anemia")
• have a bone marrow abnormality called "isolated deletion 5q cytogenetic anomaly". This means that your body does not produce enough healthy blood cells.
• other treatments you have used before are not suitable or do not work well enough.

Lenalidomida may increase the number of healthy red blood cells your body produces by reducing the number of abnormal cells:

• this may reduce the number of blood transfusions needed. You may not need transfusions at all.

Follicular Lymphoma (FL)

FL is a slow-growing cancer that affects B lymphocytes. These are a type of white blood cell that helps your body fight infections. When you have FL, you may have too many of these B lymphocytes in your blood, bone marrow, lymph nodes, and spleen.

Lenalidomida is used with another medicine called "rituximab" to treat adult patients who have received previous treatment for follicular lymphoma.

How Lenalidomida Qilu works

Lenalidomida works by affecting your immune system and directly attacking cancer cells. It works in several ways:

• stops the growth of cancer cells
• stops the growth of blood vessels in the cancer
• stimulates part of your immune system to attack cancer cells.

2. What you need to know before you take Lenalidomida Qilu

You must read the summary of product characteristics of all medicines you are going to take in combination with lenalidomide before starting treatment with lenalidomide.

Do not take Lenalidomida Qilu:

• if you are pregnant, think you may be pregnant or plan to become pregnant, as lenalidomide is expected to be harmful to the fetus(see section 2, "Pregnancy, breastfeeding and contraception: information for women and men").
• if you can become pregnant, unless you follow all the necessary measures to avoid it (see section 2, "Pregnancy, breastfeeding and contraception: information for women and men"). If you can become pregnant, your doctor will record with each prescription that all necessary measures have been taken and will provide you with this confirmation.
• if you are allergic to lenalidomide or any of the other ingredients of this medicine (listed in section 6). If you think you may be allergic, consult your doctor.

If any of these conditions apply to you, do not take lenalidomide. If in doubt, consult your doctor.

Warnings and precautions

Tell your doctor, pharmacist or nurse before you start taking lenalidomide if:

• you have ever had blood clots; during treatment, you have a higher risk of getting blood clots in your veins and arteries
• you have any signs of infection, such as cough or fever
• you have or have had a viral infection, especially hepatitis B, varicella-zoster or HIV. If in doubt, consult your doctor. Treatment with lenalidomide may cause the virus to become active again in patients who carry the virus. This can lead to the return of the infection. Your doctor should check if you have ever had a hepatitis B infection
• you have kidney problems; your doctor may adjust your dose of lenalidomide
• you have had a heart attack, have ever had a blood clot or if you smoke, have high blood pressure or high cholesterol levels
• you have had an allergic reaction while using thalidomide (another medicine used to treat multiple myeloma), such as skin rash, itching, swelling, dizziness or breathing problems
• you have experienced in the past a combination of any of the following symptoms: widespread rash, skin redness, high body temperature, flu-like symptoms, elevated liver enzymes, blood abnormalities (eosinophilia), swollen lymph nodes (these are signs of a severe skin reaction called Drug Reaction with Eosinophilia and Systemic Symptoms, also known as DRESS syndrome or hypersensitivity syndrome) (see also section 4 "Possible side effects").

If any of the above conditions apply to you, inform your doctor, pharmacist or nurse before starting treatment.

At any time, during or after treatment, tell your doctor or nurse immediately if you:

• have blurred vision, loss of vision or double vision, difficulty speaking, weakness in an arm or leg, a change in the way you walk or balance problems, persistent numbness, decreased or lost sensation, memory loss or confusion. These can be symptoms of a serious and potentially life-threatening brain disease called progressive multifocal leukoencephalopathy (PML). If you have any of these symptoms before starting treatment with lenalidomide, tell your doctor if you notice any change in these symptoms.
• have shortness of breath, tiredness, dizziness, chest pain, faster heartbeat or swelling in your legs or ankles. These can be symptoms of a serious condition called pulmonary hypertension (see section 4).

Tests and examinations

Before starting treatment with lenalidomide and during treatment, you will have regular blood tests. This is because lenalidomide can cause a decrease in the blood cells that help fight infections (white blood cells) and those that help your blood to clot (platelets).

Your doctor will ask you to have a blood test:

• before treatment
• every week during the first 8 weeks of treatment
• then at least every month.

You may be evaluated for signs of heart and lung problems before and during treatment with lenalidomide.

For patients with MDS taking Lenalidomida Qilu

If you have MDS, you may be more likely to develop a more advanced disease called acute myeloid leukemia (AML). Additionally, it is not known how lenalidomide affects your chances of developing AML. Your doctor may therefore ask you to have tests to detect signs that may predict your chances of developing AML during treatment with this medicine.

For patients with MCL taking Lenalidomida Qilu

Your doctor will ask you to have a blood test:

• before treatment
• every week during the first 8 weeks (2 cycles) of treatment
• then every 2 weeks in cycles 3 and 4 (see section 3 "Treatment cycle" for more information)
• after that, at the start of each cycle and
• at least once a month.

For patients with FL taking Lenalidomida Qilu

Your doctor will ask you to have a blood test:

• before treatment
• every week during the first 3 weeks (1 cycle) of treatment
• then every 2 weeks in cycles 2 to 4 (see section 3 "Treatment cycle" for more information)
• after that, at the start of each cycle and
• at least once a month.

Your doctor may check if you have a high tumor burden in your body, including your bone marrow. This could lead to a condition where the tumors break down and produce unusual levels of chemicals in your blood, which can lead to kidney failure (this condition is called "tumor lysis syndrome").

Your doctor may examine you to check for changes in your skin, such as red spots or skin rash.

Your doctor may adjust your dose of lenalidomide or stop your treatment, depending on the results of your blood tests and your overall condition. If you are a newly diagnosed patient, your doctor may also evaluate your treatment based on your age and other conditions you may have.

Blood donation

You must not donate blood during treatment or for at least 7 days after the end of treatment.

Children and adolescents

Lenalidomida is not recommended for use in children and adolescents under 18 years.

Elderly and patients with kidney problems

If you are 75 years or older or have moderate to severe kidney problems, your doctor will monitor you closely before starting treatment.

Other medicines and Lenalidomida Qilu

Tell your doctor or nurse if you are taking, have recently taken or might take any other medicines. This is because lenalidomide can affect the way other medicines work. Additionally, some medicines can affect the way lenalidomide works.

In particular, tell your doctor or nurse if you are taking any of the following medicines:

• some medicines used to prevent pregnancy, such as oral contraceptives, as they may stop working
• some medicines used for heart problems, such as digoxin
• some medicines used to thin the blood, such as warfarin.

Pregnancy, breastfeeding and contraception: information for women and men

Pregnancy

Women taking Lenalidomida Qilu

• Do not take lenalidomide if you are pregnant, as it is expected to be harmful to the fetus.
• Do not become pregnant while taking lenalidomide. You must use effective contraceptive methods if you can become pregnant (see "Contraception").
• If you become pregnant during treatment with lenalidomide, stop treatment and tell your doctor immediately.

Men taking Lenalidomida Qilu

• If your partner becomes pregnant while you are taking lenalidomide, tell your doctor immediately. It is recommended that your partner seeks medical advice.
• You must also use effective contraceptive methods (see "Contraception").

Breastfeeding

Do not breastfeed while taking Lenalidomida Qilu, as it is not known whether lenalidomide passes into breast milk.

Contraception

For women taking Lenalidomida Qilu

Before starting treatment, ask your doctor if you are able to become pregnant, even if you think this is unlikely.

If you can become pregnant:

• you will have pregnancy tests under medical supervision (before each treatment, at least every 4 weeks during treatment and for at least 4 weeks after the end of treatment) unless it has been confirmed that your fallopian tubes have been blocked (tubal ligation)

And

• you must use effective contraceptive methods from at least 4 weeks before starting treatment, during treatment and for at least 4 weeks after the end of treatment. Your doctor will advise you on the most suitable contraceptive methods.

For men taking Lenalidomida Qilu

Lenalidomide passes into human semen. If your partner is pregnant or can become pregnant and does not use any effective contraceptive method, you must use condoms during treatment and for at least 7 days after the end of treatment, even if you have had a vasectomy. Do not donate semen or sperm during treatment or for at least 7 days after the end of treatment.

Driving and using machines

Do not drive or use machines if you feel dizzy, tired, drowsy, have vertigo or blurred vision after taking lenalidomide.

Lenalidomida Qilu contains lactose and sodium

Lenalidomida Qilu contains lactose. If your doctor has told you that you have an intolerance to some sugars, consult your doctor before taking this medicine.

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

3. How to take Lenalidomida Qilu

Lenalidomida Qilu should be administered by a healthcare professional with experience in the treatment of multiple myeloma, MDS, or MF.

• When lenalidomida is used to treat multiple myeloma in patients who cannot be treated with a bone marrow transplant or have undergone other treatments before, it is taken with other medications (see section 1 "What Lenalidomida Qilu is used for").
• When lenalidomida is used to treat multiple myeloma in patients who have received a bone marrow transplant or to treat patients with MDS, it is taken alone.
• When lenalidomida is used to treat follicular lymphoma, it is taken with another medication called "rituximab".

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

If you are taking lenalidomida with other medications, you should consult the package insert of those other medications for additional information on their use and effects.

Treatment cycle

Lenalidomida is taken on certain days during a period of 3 weeks (21 days).

• A "treatment cycle" consists of 21 days.
• Depending on the day of the cycle, you will take one or more medications. However, some days you will not take any medication.
• After completing each 21-day cycle, you should start a new "cycle" during the following 21 days.

Or

Lenalidomida is taken on certain days during a period of 4 weeks (28 days).

• A "treatment cycle" consists of 28 days.
• Depending on the day of the cycle, you will take one or more medications. However, some days you will not take any medication.
• After completing each 28-day cycle, you should start a new "cycle" during the following 28 days.

How much Lenalidomida Qilu to take

Before starting treatment, your doctor will indicate:

• what amount of lenalidomida you should take
• what amount of other medications you should take with lenalidomida, if applicable
• which days of the treatment cycle you should take each medication.

How and when to take Lenalidomida Qilu

• Swallow the capsules whole, preferably with water.
• Do not break, open, or chew the capsules. In the event that the powder from a broken lenalidomida capsule comes into contact with the skin, wash the skin immediately and carefully with water and soap.
• Healthcare professionals, caregivers, and family members should wear disposable gloves when handling the blister or capsule. Afterwards, they should carefully remove the gloves to avoid skin exposure, place them in a sealable polyethylene plastic bag, and dispose of them according to local requirements. Then, they should wash their hands well with water and soap. Pregnant women or those who suspect they may be pregnant should not handle the blister or capsule.
• The capsules can be taken with or without food.
• You should take lenalidomida approximately at the same time on scheduled days.

Taking this medication

To remove the capsule from the blister:

• Press only one end of the capsule so that it comes out through the foil.
• Do not press in the center of the capsule as it may break.

Duration of treatment with Lenalidomida Qilu

Lenalidomida is taken in treatment cycles, each cycle lasting 21 or 28 days (see "Treatment cycle" above). You should continue the treatment cycles until your doctor tells you to stop the treatment.

If you take more Lenalidomida Qilu than you should

If you take more lenalidomida than prescribed, inform your doctor immediately.

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

If you forget to take Lenalidomida Qilu

If you forget to take lenalidomida at your usual time and:

• less than 12 hours have passed: take the capsule immediately.
• more than 12 hours have passed: do not take the capsule. Take the next capsule the next day at the usual time.

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

4. Possible side effects

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

If you experience any of the following serious side effects, stop treatment with lenalidomida and see a doctor immediately, as you may need urgent medical treatment:

• Hives, rash, swelling of the eyes, mouth, or face, difficulty breathing or itching, which can be symptoms of severe allergic reactions called angioedema and anaphylactic reaction.
• Severe allergic reaction that can start as a rash in one area but spreads, causing significant skin loss throughout the body (Stevens-Johnson syndrome and/or toxic epidermal necrolysis).
• Widespread rash, high body temperature, increased liver enzymes, blood abnormalities (eosinophilia), swollen lymph nodes, and effects on other organs of the body (drug reaction with eosinophilia and systemic symptoms, also known as DRESS or drug hypersensitivity syndrome). See also section 2.

Consult your doctor immediately if you notice any of the following serious side effects:

• Fever, chills, sore throat, cough, mouth ulcers, or any other symptom of infection, including in the bloodstream (sepsis)
• Bleeding (bleeding) or bruising (bruising) not due to an injury
• Chest pain (thoracic) or leg pain
• Difficulty breathing
• Bone pain, muscle pain, confusion, or fatigue that may be due to high levels of calcium in the blood.

Lenalidomida may reduce the number of white blood cells that fight infections and also the blood cells that help blood to clot (platelets), which can cause bleeding disorders such as nosebleeds and bruising.

Lenalidomida can also cause blood clots in the veins (thrombosis).

Other side effects

It is essential to note that a small number of patients may develop other types of cancer, and this risk may increase with lenalidomida treatment. Therefore, your doctor should carefully evaluate the benefits and risks when prescribing lenalidomida.

Very common: may affect more than 1 in 10 people

• A decrease in the number of red blood cells, which can cause anemia, leading to fatigue and weakness
• Skin rash, itching
• Muscle cramps, muscle weakness, muscle pain, muscle discomfort, bone pain, joint pain, back pain, pain in the limbs
• Generalized swelling, including swelling of the arms and legs
• Weakness, fatigue
• Fever and flu-like symptoms, including fever, muscle pain, headache, ear pain, cough, and chills
• Numbness, tingling, or a prickling sensation in the skin, pain in the hands or feet, dizziness, tremors
• Decreased appetite, changes in taste
• Increased pain, tumor size, or redness around the tumor
• Weight loss
• Constipation, diarrhea, nausea, vomiting, stomach pain, heartburn
• Low levels of potassium, calcium, or sodium in the blood
• Underactive thyroid function
• Leg pain (which could be a symptom of thrombosis), chest pain, or difficulty breathing (which could be a symptom of blood clots in the lungs, called pulmonary embolism)
• Infections of all kinds, including sinusitis, pneumonia, and upper respiratory tract infections
• Difficulty breathing
• Blurred vision
• Eye opacity (cataracts)
• Kidney problems, including kidney failure or inability to maintain normal kidney function
• Abnormal liver function test results
• High liver function test results
• Changes in a blood protein that can cause artery swelling (vasculitis)
• Increased blood sugar levels (diabetes)
• Decreased blood sugar levels
• Headache
• Nosebleeds
• Dry skin
• Depression, mood changes, difficulty sleeping
• Cough
• Low blood pressure
• A vague feeling of discomfort in the body, feeling unwell
• Painful inflammation of the mouth, dry mouth
• Dehydration

Common: may affect up to 1 in 10 people

• Destruction of red blood cells (hemolytic anemia)
• Certain types of skin tumors
• Bleeding from the gums, stomach, or intestines
• Increased blood pressure, slow, fast, or irregular heartbeat
• Increased levels of a substance released after normal or abnormal red blood cell destruction
• Increased levels of a protein that indicates inflammation in the body
• Darkening of skin color; skin color changes due to internal bleeding, usually caused by bruising; skin inflammation caused by blood accumulation; bruising
• Increased uric acid levels in the blood
• Skin rashes, redness, cracked skin, skin peeling or flaking, hives
• Increased sweating, night sweats
• Difficulty swallowing, sore throat, difficulty maintaining voice quality or changes in voice
• Runny nose
• Significant increase or decrease in urine output compared to usual or inability to control urination
• Blood in the urine
• Difficulty breathing, especially when lying down (which could be a symptom of heart failure)
• Difficulty having an erection
• Stroke, fainting, vertigo (inner ear disorder that causes a sensation of spinning), temporary loss of consciousness
• Chest pain that spreads to arms, neck, jaw, back, or stomach, sensation of sweating and shortness of breath, nausea or vomiting, which can be symptoms of a heart attack (myocardial infarction)
• Muscle weakness, lack of energy
• Neck pain, chest pain
• Chills
• Joint swelling
• Slower or blocked bile flow from the liver
• Low levels of phosphate or magnesium in the blood
• Difficulty speaking
• Liver damage
• Balance disturbance, difficulty moving
• Hearing loss, ringing in the ears (tinnitus)
• Nerve pain, abnormal and unpleasant sensation, especially when touched
• Excess iron in the body
• Thirst
• Confusion
• Toothache
• Fall that can cause injury

Uncommon: may affect up to 1 in 100 people

• Bleeding inside the skull
• Circulatory problems
• Vision loss
• Loss of sexual desire (libido)
• Excretion of large amounts of urine with bone pain and weakness, which can be symptoms of a kidney disorder (Fanconi syndrome)
• Yellowing of the skin, mucous membranes, or eyes (jaundice), pale stools, dark urine, itching, skin rash, pain or swelling of the stomach; these can be symptoms of liver damage (liver failure)
• Stomach pain, abdominal swelling, or diarrhea, which can be symptoms of inflammation of the large intestine (called colitis or typhlitis)
• Damage to kidney cells (called tubular necrosis)
• Changes in skin color, sensitivity to sunlight
• Tumor lysis syndrome - metabolic complications can occur during cancer treatment and sometimes even without treatment. These complications occur as a result of the breakdown products of dying cancer cells and can include: changes in blood biochemistry, high levels of potassium, phosphorus, uric acid, and low levels of calcium, which can cause changes in kidney function and heart rhythm, seizures, and sometimes death.
• Increased blood pressure in the blood vessels that supply the lungs (pulmonary hypertension).

Frequency not known: cannot be estimated from available data

• Sudden, mild, or worsening pain in the upper stomach and/or back, lasting several days, possibly accompanied by nausea, vomiting, fever, and rapid pulse. These symptoms can be due to pancreatitis.
• Wheezing or whistling when breathing, difficulty breathing, or dry cough, which can be symptoms caused by inflammation of lung tissue.
• Rare cases of muscle breakdown (pain, weakness, or swelling of the muscles) have been observed, which can lead to kidney problems (rhabdomyolysis), some of which occur when lenalidomida is administered with a statin (a type of cholesterol-lowering medication).
• A disease that affects the skin, caused by inflammation of small blood vessels, accompanied by joint pain and fever (leukocytoclastic vasculitis).
• Rupture of the stomach or intestine wall. This can lead to a severe infection. Inform your doctor if you have severe stomach pain, fever, nausea, vomiting, blood in the stool, or changes in bowel habits.
• Viral infections, including herpes zoster (also known as shingles, a viral disease that causes a painful rash with blisters) and the recurrence of hepatitis B infection (which can cause yellowing of the skin and eyes, dark urine, stomach pain on the right side, fever, and nausea or feeling sick).
• Rejection of solid organ transplants (such as kidney, heart).

Reporting side effects

If you experience any side effects, consult your doctor, pharmacist, or nurse, even if they are possible side effects not listed in this package insert. You can also report them directly through the Spanish Medication Surveillance System for Human Use www.notificaRAM.es. By reporting side effects, you can contribute to providing more information on the safety of this medication.

5. Storage of Lenalidomida Qilu

Keep this medication out of sight and reach of children.

Do not use this medication after the expiration date shown on the blister and carton after "EXP". The expiration date is the last day of the month indicated.

Store below 30°C.

Do not use this medication if you observe visible signs of deterioration or signs of tampering.

Medications should not be thrown down the drain or into the trash. Return any unused medication to your pharmacist. This will help protect the environment.

6. Package contents and additional information

Composition of Lenalidomida Qilu 25 mg hard capsules

• The active ingredient is lenalidomida. Each capsule contains 25 mg of lenalidomida.
• The other ingredients are:

• Capsule contents: lactose (see section 2), microcrystalline cellulose, sodium croscarmellose, and magnesium stearate.
• Capsule shell: gelatin and titanium dioxide (E171).
• Printing ink: shellac, iron oxide black (E172), and potassium hydroxide.

Appearance of the product and package contents

Lenalidomida Qilu 25 mg hard capsules are white, opaque capsules, size 0, 21.7±1.0 mm, printed with "82 25 mg" on the body in black ink.

Each carton contains one or three perforated blisters, each blister with seven capsules. Each carton contains 7 or 21 capsules in single-dose blisters.

Only some pack sizes may be marketed.

Marketing authorization holder and manufacturer

Marketing authorization holder

QILU PHARMA SPAIN S.L.

Paseo de la Castellana 40,

8th floor, 28046 - Madrid,

Spain

Manufacturer

KYMOS S.L.

Ronda de Can Fatjó, 7B (Parque Tecnológico del Vallès),

Cerdanyola del Vallès,

08290 Barcelona,

Spain

or

Eurofins Analytical Services Hungary Kft.

Anonymus utca 6.

Budapest, H-1045,

Hungary

This medication is authorized in the member states of the European Economic Area under the following names:

Germany: Lenalidomid Qilu 25 mg Hartkapseln

Spain: Lenalidomida Qilu 25 mg cápsulas duras EFG

Italy: Lenalidomide Qilu

Date of the last revision of this package insert: August 2024

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