Introduction

Lenalidomida Stada 5 mg Hard Capsules EFG

Lenalidomida Stada 10 mg Hard Capsules EFG

Lenalidomida Stada 15 mg Hard Capsules EFG

Lenalidomida Stada 20 mg Hard Capsules EFG

Lenalidomida Stada 25 mg Hard Capsules EFG

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

-Keep this leaflet, as you may need to read it again.

-If you have any questions, ask your doctor or pharmacist.

-This medicine has been prescribed for you only. Do 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 Lenalidomida Stada is and what it is used for

2.What you need to know before you start taking Lenalidomida Stada

3.How to take Lenalidomida Stada

4.Possible side effects

5.Storage of Lenalidomida Stada

6.Contents of the pack and additional information

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

What is Lenalidomida Stada

Lenalidomida Stada contains the active ingredient “lenalidomida”. This medicine belongs to a group of medicines that affect how the immune system works.

What Lenalidomida Stada is used for

Lenalidomida Stada is used in adults for:

Multiple myeloma
Myelodysplastic syndromes (MDS)
Castleman's disease (LCD)
Follicular lymphoma

Multiple myeloma

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

Multiple myeloma is generally incurable. However, the symptoms and signs can be significantly reduced or disappear for a period of time. This is called “remission”.

Newly diagnosed multiple myeloma:in patients who have undergone a bone marrow transplant

Lenalidomida is used as maintenance treatment after recovering adequately from a bone marrow transplant.

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

Lenalidomida is taken with other medicines, including:

A chemotherapy medicine called “bortezomib”;
An anti-inflammatory called “dexametasona”;
A chemotherapy medicine called “melfalán”; and
An immunosuppressant called “prednisona”.

You will take these medicines when starting treatment and then continue taking lenalidomida only.

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

Multiple myeloma: in previously treated patients

Lenalidomida is taken with an anti-inflammatory called “dexametasona”.

Lenalidomida can slow the progression of multiple myeloma symptoms. It has also been shown to delay the recurrence of multiple myeloma after treatment.

Myelodysplastic syndromes (MDS)

MDS are a group of many different blood and bone marrow diseases. Blood cells become abnormal and do not function correctly. Patients may experience a variety of symptoms, including low red blood cell count (anemia), the need for blood transfusions, and the risk of infection.

Lenalidomida is used to treat adult patients diagnosed with MDS, when the following points are applicable:

you need periodic blood transfusions to treat low red blood cell levels (“transfusion-dependent anemia”);
you have a bone marrow cell anomaly called “isolated 5q deletion cytogenetic anomaly”. This means your body does not produce enough healthy blood cells;
previous treatments you have used are not suitable or do not work well enough.

Lenalidomida can increase the number of healthy red blood cells produced by the body by reducing the number of abnormal cells:

this can reduce the number of blood transfusions needed. It may be possible to avoid transfusions.

Castleman's disease (LCD)

Castleman's disease is a cancer of a part of the immune system (lymphatic tissue). It affects a type of white blood cell in the blood called “B lymphocytes” or B cells. Castleman's disease is a disease in which B cells grow uncontrollably and accumulate in lymphatic tissue, bone marrow, or blood.

Lenalidomida is used as monotherapy to treat adult patients who have received previous treatment with other medicines.

Follicular lymphoma (FL)

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

Lenalidomida is used with another medicine called “rituximab” for the treatment of adult patients who have received previous treatment for follicular lymphoma.

How Lenalidomida Stada works

Lenalidomida works by affecting the body's immune system and directly attacking cancer. It acts in several ways:

it stops the development of cancer cells;
it stops the growth of blood vessels in cancer;
it stimulates part of the immune system to attack cancer cells.

2. What you need to know before starting Lenalidomida Stada

You must read the leaflet for all the medicines you are going to take in combination with lenalidomide before starting treatment with Lenalidomida Stada

Do not take Lenalidomida Stada:

if you are pregnant, think you may be pregnant or intend 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”);since 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 note on each prescription that all necessary measures have been taken and will provide you with this confirmation;
if you are allergic to lenalidomide or to any of the other components of this medicine (including 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. In case of doubt, consult your doctor.

Warnings and precautions

Consult your doctor, pharmacist or nurse before starting to take Lenalidomida Stada if:

you have ever had blood clots; during treatment, you have a higher risk of presenting blood clots in veins and arteries;
you have any sign of infection, such as cough or fever;
you have or have had previously a viral infection, especially hepatitis B infection, varicella zoster, HIV. In case of doubt, consult your doctor. Treatment with lenalidomide may make the virus become active again in patients who are virus carriers. This leads to the reappearance of the infection. Your doctor must check if you have ever had a hepatitis B infection;
you have kidney problems; your doctor may adjust your lenalidomide dose;
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 for example skin rash, itching, swelling, dizziness or respiratory problems;
you have experienced in the past a combination of any of the following symptoms:generalised rash, skin redness, high body temperature, flu-like symptoms,increased 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 for its English acronymor drug hypersensitivity syndrome)(see also section 4 “Possible side effects”).

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

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

blurred vision, loss of vision or double vision, difficulty speaking, weakness in one arm or leg, a change in the way you walk or balance problems, persistent numbness, decreased sensitivity or loss of sensitivity, memory loss or confusion. All of them can be symptoms of a severe and potentially fatal brain disease called multifocal progressive leukoencephalopathy (LMP). If you have any of these symptoms before starting treatment with lenalidomide, inform your doctor if you notice any change in these symptoms.
shortness of breath, fatigue, dizziness, chest pain, faster heart rate or swelling in the legs or ankles. These can be symptoms of a severe condition known as pulmonary hypertension (see section 4).

Analysis and tests

Before starting treatment with lenalidomide and during the same, blood tests will be done regularly. This is because lenalidomide can cause a decrease in the blood cells that help fight infections (white blood cells) and those that participate in coagulation (platelets).

Your doctor will ask you to have a blood test:

before treatment;
every week for the first 8 weeks of treatment;
subsequently, at least once a month.

You may be evaluated to detect signs of cardiopulmonary problems before and during treatment with lenalidomide.

For patients with SMD who take Lenalidomida Stada

If you have SMD, you may be more prone to developing a more advanced disease called acute myeloid leukemia (AML). In addition, it is unknown how lenalidomide affects the likelihood of developing AML. Your doctor may perform tests to detect signs that may predict better the likelihood of developing AML during treatment with lenalidomide.

For patients with LCM who take Lenalidomida Stada

Your doctor will ask you to have a blood test:

?before treatment;

?every week for the first 8 weeks (2 cycles) of treatment;

subsequently, every 2 weeks in cycles 3 and 4 (see section 3 “Treatment cycle” for more information);

?after that, at the beginningof each cycle;

?at least once a month.

For patients with LF who take Lenalidomida Stada

Your doctor will ask you to have a blood test:

before treatment;
every week for the first 3 weeks (1 cycle) of treatment;
subsequently, every 2 weeks in cycles 2 to 4 (see section 3 “Treatment cycle” for more information).
after that, at the beginning of each cycle and
at least once a month.

Your doctor may check if you have a high total tumor burden in the body, including the bone marrow. This could lead to a disease in which the tumors break down and produce unusual levels of chemical substances in the blood that, in turn, can cause kidney failure (this disease is called “tumor lysis syndrome”).

Your doctor may examine you to check if any changes have occurred in your skin, such as red spots or skin rashes.

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

Blood donation

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

Children and adolescents

The use of lenalidomide is not recommended in children and adolescents under 18 years old.

Older people and people with kidney problems

If you are 75 years old or more or have moderate to severe kidney problems, your doctor will examine you carefully before starting treatment.

Other medicines and Lenalidomida Stada

Inform your doctor or nurse if you are taking, have taken recently or may have to take any other medicine. This is because lenalidomide can affect how other medicines work. In addition, some medicines can affect how lenalidomide works.

Specifically, inform 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 to treat 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 Stada

You should not take lenalidomide if you are pregnant, as it is expected to be harmful to the fetus.
You should not become pregnant while taking lenalidomide. Therefore, you must use effective contraceptive methods if there is a possibility that you may become pregnant (see “Contraception”).
If you become pregnant during treatment with lenalidomide, you must stop treatment and inform your doctor immediately.

Men taking Lenalidomida Stada

If your partner becomes pregnant while you are taking lenalidomide, you must inform your doctor immediately. It is recommended that your partner seek medical advice.
You should also use effective contraceptive methods (see “Contraception”).

Breastfeeding

You should not breastfeed while taking lenalidomide, as it is unknown whether lenalidomide passes into breast milk.

Contraception

For women taking Lenalidomida Stada

Before starting treatment, ask your doctor if you are capable of becoming pregnant, although you may 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 finishing treatment) except that tubal ligation has been confirmed so that the eggs do not reach the uterus;

And

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

For men taking Lenalidomida Stada

Lenalidomide passes into human semen. If your partner is pregnant or may become pregnant and does not use any effective contraceptive method, you must use condoms during treatment and for at least 7 days after finishing treatment, even if you have undergone a vasectomy. You should not donate semen or sperm during treatment or for at least 7 days after finishing treatment.

Driving and using machines

You should not drive or use machines if you feel dizzy, tired, drowsy, have vertigo or blurred vision after taking lenalidomida.

Lenalidomida Stada contains lactose and sodium

LenalidomidaStada contains lactose. If your doctor has told you that you have an intolerance to certain sugars, consult with him before taking this medicine.

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

3. How to Take Lenalidomida Stada

Lenalidomide should be administered by a healthcare professional with experience in the treatment of multiple myeloma, SMD, LCM or LF.

When lenalidomide is used for the treatment of 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 Lenalidomide Stada is used for”).
When lenalidomide is used for the treatment of multiple myeloma in patients who have received a bone marrow transplant or to treat patients with SMD or LCM, it is taken alone.
When lenalidomide is used for the treatment of follicular lymphoma, it is taken with another medication called “rituximab”.

Follow exactly the administration instructions of lenalidomide indicated by your doctor. In case of doubt, consult your doctor or pharmacist.

If you are taking lenalidomide with other medications, you must consult the leaflet of those other medications to obtain additional information on their use and effects.

Treatment cycle

Lenalidomide is taken on certain days during the 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 cycle of 21 days, you must start a new “cycle” during the following 21 days.

Lenalidomide is taken on certain days during the 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 cycle of 28 days, you must start a new “cycle” during the following 28 days.

How much Lenalidomide Stada to take

Before starting treatment, your doctor will indicate:

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

How and when to take Lenalidomide Stada

Swallow the capsules whole, preferably with water.

Do not break, open or chew the capsules. In the event that the powder from a broken lenalidomide 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 pack or capsule. Subsequently, they should carefully remove the gloves to avoid skin exposure, place them in a plastic polyethylene bag and dispose of them in accordance with local requirements. They should then wash their hands thoroughly with water and soap. Pregnant women or those who suspect they may be pregnant should not handle the blister pack or capsule.

The capsules can be taken with or without food.
You should take lenalidomide approximately at the same time on the scheduled days.

Medication intake

To remove the capsule from the blister pack:

Press only one end of the capsule to allow it to come out through the foil.
Do not press in the center of the capsule as it may break.

Duration of treatment with Lenalidomide Stada

Lenalidomide 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 informs you to stop treatment.

If you take more Lenalidomide Stada than you should

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

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

If you forget to take Lenalidomide Stada

If you forget to take lenalidomide 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 doubts about the use of this medication, ask your doctor or pharmacist.

4. Possible Adverse Effects

Like all medicines, lenalidomide can cause side effects, although not everyone will experience them.

If you experience any of the following serious side effects, stop taking lenalidomide and seek medical attention immediately, as they may require urgent medical treatment:

Urticaria, rashes, swelling of the eyes, mouth, or face, difficulty breathing, or itching, which can be symptoms of severe allergic reactions called angioedema and anaphylaxis.
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).
Generalized rash, high body temperature, elevated 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).

Seek medical attention 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 sepsis.
Bleeding (hemorrhage) or hematoma (bruise) not caused by 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.

Lenalidomide can reduce the number of white blood cells that fight infections and also the cells in the blood that help to clot (platelets), which can cause bleeding disorders such as nosebleeds and bruises. Lenalidomide can also cause blood clots in the veins (thrombosis).

Other side effects

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

Side effectsvery common(can affect more than 1 in 10 people):

Decreased red blood cell count, which can cause anemia leading to fatigue and weakness.
Rash, itching.
Muscle cramps, muscle weakness, muscle pain, muscle discomfort, bone pain, joint pain, back pain, limb pain.
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 prickling sensation in the skin, hand or foot pain, dizziness, tremors.
Loss of appetite, changes in the taste of things.
Increased pain, tumor size, or redness around the tumor.
Weight loss.
Constipation, diarrhea, nausea, vomiting, stomach pain, acid reflux.
Low levels of potassium, calcium, or sodium in the blood.
Underactive thyroid function.
Chest pain (that could be a symptom of pulmonary embolism), leg pain (that could be a symptom of deep vein thrombosis), or difficulty breathing (that could be a symptom of pulmonary embolism).
Infections of all types, including sinusitis, pneumonia, and upper respiratory tract infections.
Difficulty breathing.
Blurred vision.
Cataracts.
Renal problems, including kidneys that do not function correctly or are unable to maintain normal function.
Abnormal liver test results.
High levels of liver test results.
Changes in a blood protein that can cause swelling of the arteries (vasculitis).
Increased blood sugar levels (diabetes).
Decreased blood sugar levels.
Headache.
Nosebleeds.
Dry skin.
Depression, changes in mood, difficulty sleeping.
Cough.
Low blood pressure.
A vague feeling of discomfort in the body, feeling unwell.
Inflammation of the mouth, dry mouth.
Dehydration.

Side effectscommon(can affect up to 1 in 10 people):

Red blood cell destruction (hemolytic anemia).
Certain types of skin cancer.
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 destruction of red blood cells.
Increased levels of a type of protein that indicates inflammation in the body.
Darkening of the skin; change in skin color due to internal bleeding, usually caused by hematomas; inflammation of the skin caused by the accumulation of blood; hematoma.
Increased uric acid levels in the blood.
Rashes, redness of the skin, dry skin, peeling or exfoliation of the skin, urticaria.
Increased sweating, nocturnal sweating.
Difficulty swallowing, sore throat, difficulty maintaining voice quality or changes in voice.
Nasal discharge.
Significant increase or decrease in urine output compared to normal or inability to control urination.
Blood in the urine.
Difficulty breathing, especially when lying down (which could be a symptom of heart failure).
Difficulty achieving an erection.
Stroke, fainting, vertigo (inner ear disorder that causes the sensation of everything spinning), temporary loss of consciousness.
Chest pain that radiates to arms, neck, jaw, spine, 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 problems, difficulty moving.
Deafness, tinnitus (ringing in the ears).
Nerve pain, abnormal and unpleasant sensation, especially when touched.
Excess iron in the body.
Thirst.
Confusion.
Toothache.
Fall that can cause injuries.

Side effectsuncommon(can affect up to 1 in 100 people):

Subarachnoid hemorrhage.
Circulatory problems.
Loss of vision.
Loss of libido (sex drive).
Expulsion of large amounts of urine with bone pain and weakness, which can be symptoms of kidney disease (Fanconi syndrome).
Yellow pigmentation in the skin, mucous membranes, or eyes (jaundice), pale stools, dark urine, skin itching, rash, stomach pain or swelling; these can be symptoms of liver damage (hepatic insufficiency).
Abdominal pain, swelling, or diarrhea, which can be symptoms of inflammation of the large intestine (colitis or typhlitis).
Kidney cell damage (necrotizing tubular renal damage).
Changes in skin color, sensitivity to sunlight.
Tumor lysis syndrome – complications can occur during cancer treatment and sometimes even without treatment. These complications occur as a result of the breakdown products of tumor cells that die and can include: changes in blood biochemistry, high potassium levels, high phosphorus levels, high uric acid levels, and low calcium levels, which can cause changes in kidney function and heart rhythm, seizures, and sometimes death.
Increased blood pressure within the blood vessels that supply the lungs (pulmonary hypertension).

Side effects of unknown frequency(cannot be estimated from available data):

Sudden, severe, or worsening pain in the upper stomach and/or back, possibly accompanied by nausea, vomiting, fever, and rapid pulse. These symptoms may be due to pancreatitis.
Wheezing or ringing in the lungs, difficulty breathing, or dry cough, which can be symptoms caused by inflammation of the lung tissue.
Rare cases of muscle degradation (pain, weakness, or swelling) that can lead to kidney problems (rhabdomyolysis), some of which occur when lenalidomide is administered with a statin (a type of medication to reduce cholesterol).
A disease that affects the skin caused by inflammation of small blood vessels, accompanied by joint pain and fever (leukocytoclastic vasculitis).
Perforation 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.
Viruses, including herpes zoster (also known as shingles, a viral disease that causes a painful skin rash with blisters) and the reactivation of hepatitis B infection (which can cause yellowing of the skin and eyes, dark urine, right-sided stomach pain, fever, and nausea or feeling sick).
Rejection of solid organ transplants (such as kidney, heart).

Reporting side effects

If you experience any type of side effect, consult your doctor, pharmacist, or nurse, even if it is a possible side effect that does not appear in this leaflet. You can also report them directly through the Spanish System for Pharmacovigilance of Medicines for Human Use: https://www.notificaram.es. By reporting side effects, you can contribute to providing more information on the safety of this medication.

5. Conservation of Lenalidomida Stada

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

Do not use this medication after the expiration date that appears on the blister pack and the box after “CAD”. The expiration date is the last day of the month indicated.

This medication does not require special conditions for conservation.

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

Medications should not be disposed of through drains or in the trash. Return unused medication to your pharmacist. This will help protect the environment.

6. Contents of the packaging and additional information

Composition of Lenalidomida Stada

Lenalidomida Stada 5 mg hard capsules EFG:

The active ingredient is lenalidomida. Each capsule contains 5 mg of lenalidomida.
The other components are: