Package Leaflet: Information for the User
Lognif 0.25 mg hard capsules EFG
Lognif 0.50 mg hard capsules EFG
fingolimod
Read the entire package leaflet carefully before starting to take this medication, as it contains important information for you.
Contents of the Package Leaflet
What is Lognif
The active ingredient of Lognif is fingolimod.
What is Lognif used for
This medication is used in adults and in children and adolescents (aged 10 years and above) to treat relapsing-remitting multiple sclerosis (MS), particularly in:
or
This medication does not cure MS, but it helps reduce the number of relapses and slow down the progression of physical disabilities due to MS.
What is multiple sclerosis
MS is a chronic disease that affects the central nervous system (CNS), which consists of the brain and spinal cord. In MS, inflammation destroys the protective sheath (called myelin) that covers the nerves in the CNS, preventing the nerves from functioning properly. This is called demyelination.
Relapsing-remitting MS is characterized by repeated attacks (relapses) of neurological symptoms that reflect inflammation in the CNS. Symptoms vary from patient to patient but usually include difficulties with walking, loss of sensation in some part of the body (numbness), vision problems, or balance disorders. The symptoms of a relapse may disappear completely when the relapse ends, but some problems may persist.
How Lognif works
This medication helps combat the attacks of the immune system on the CNS by reducing the ability of some white blood cells (lymphocytes) to move freely within the body and preventing them from reaching the brain and spinal cord. This limits the nerve damage caused by MS. This medication also reduces some of the immune responses of your body.
Do not takeLognif
If any of the above cases apply to you or if you are unsure, tell your doctor before taking this medication.
Warnings and precautions
Consult your doctor before starting to take Lognif:
If any of the above cases apply to you or if you are unsure, tell your doctor before taking this medication.
Slow heart rate (bradycardia) and irregular heartbeat
At the start of treatment or after taking the first dose of 0.5 mg, when changing from a daily dose of 0.25 mg, this medication can cause a decrease in heart rate. As a result, you may feel dizzy or tired, or be aware of your heartbeats, or your blood pressure may drop. If these effects are severe, tell your doctor as you may need immediate treatment. This medication can also cause your heartbeats to become irregular, especially after the first dose. Irregular heartbeats usually normalize in less than a day. The slow heart rate usually normalizes in a month. During this period, it is generally not expected to have any clinically significant effect on the heart rate.
Your doctor will ask you to stay in the office or hospital for at least 6 hours, with pulse and blood pressure checks every hour after taking the first dose of this medication or after taking the first dose of 0.5 mg when changing from a daily dose of 0.25 mg, so that they can take appropriate measures in case of adverse effects that appear at the start of treatment. Before the first dose of this medication, you should have had an electrocardiogram and after the 6-hour monitoring period. Your doctor may want to continuously monitor your electrocardiogram during this time. If after the 6-hour period you have a very slow or decreasing heart rate, or if your electrocardiogram shows abnormalities, you may need to be monitored for a longer period (at least 2 hours more and possibly throughout the night) until this is resolved. The same may apply if you are resuming this medication after a pause in treatment, depending on both the duration of the pause and how long you have been taking this medication before the pause.
If you have or are at risk of having irregular or abnormal heartbeats, if your electrocardiogram is abnormal, or if you have heart disease or heart failure, this medication may not be suitable for you.
If you have a history of sudden loss of consciousness (fainting) or slow heart rate, this medication may not be suitable for you. You will be evaluated by a cardiologist (heart specialist) who will advise you on how to start treatment with this medication, including monitoring during the night.
If you are taking medications that can slow your heart rate, this medication may not be suitable for you. You will need to be evaluated by a cardiologist who will assess whether you can switch to an alternative medication that does not slow the heart rate to allow treatment with this medication. If this change is not possible, the cardiologist will advise you on how to start treatment with this medication, including monitoring during the night.
If you have never had chickenpox
If you have not had chickenpox, your doctor will check your immunity to the virus that causes it (varicella-zoster virus). If you are not protected against the virus, you may need a vaccine before starting treatment with this medication. If so, your doctor will delay the start of treatment with this medication for one month after completing the vaccination cycle.
Infections
Fingolimod reduces the number of white blood cells (especially the number of lymphocytes). White blood cells fight infections. During treatment with this medication (and up to two months after stopping treatment), you may be more likely to get infections. You may even get worse if you already have an infection. Infections can be serious and potentially life-threatening. If you think you have an infection, have a fever, have flu-like symptoms, have herpes (shingles), or have a headache accompanied by stiffness in the neck, sensitivity to light, nausea, vomiting, and/or confusion or seizures (which can be symptoms of meningitis and/or encephalitis caused by a fungal infection or the herpes virus), contact your doctor immediately because it can be serious and life-threatening. If you think your MS is getting worse (e.g., weakness or vision problems) or if you notice any new symptoms, tell your doctor immediately, as they can be symptoms of a rare brain disorder caused by an infection called progressive multifocal leukoencephalopathy (PML). PML is a serious disease that can cause severe disability or death. Your doctor will assess the need for an MRI scan to evaluate your condition and decide if you need to stop taking this medication.
Human papillomavirus (HPV) infection, including papilloma, dysplasia, warts, and HPV-associated cancer, has been reported in patients treated with fingolimod. Your doctor will assess whether you need to be vaccinated against HPV before starting treatment. If you are a woman, your doctor will also recommend that you have regular HPV checks.
Macular edema
Before starting treatment with this medication, your doctor may request an eye examination if you have or have had visual disorders or other signs of inflammation in the central vision area (macula) of the eye, inflammation or infection in the eye (uveitis), or diabetes.
After starting treatment with this medication, your doctor may request an eye examination after 3 or 4 months of treatment.
The macula is a small area of the retina located at the back of the eye that allows you to see shapes, colors, and details clearly and sharply. This medication can cause inflammation of the macula, a disease known as macular edema. Inflammation usually occurs within the first 4 months of treatment with this medication.
If you have diabetesor have had inflammation in the eye called uveitis, you are more likely to develop macular edema. In these cases, your doctor will want you to have regular eye checks to detect macular edema.
If you have had macular edema, consult your doctor before resuming treatment with this medication.
Macular edema can cause some of the same visual symptoms as those produced by an MS attack (optic neuritis). At first, you may not have symptoms. It is essential that you inform your doctor of any changes you notice in your vision.
Your doctor may want to perform an eye examination, especially if:
Liver function tests
If you have severe liver problems, you should not take this medication. This medication can affect liver function. You may not notice any symptoms, but if you notice a yellowish tone to your skin or the white part of your eyes, unusually dark urine (brown color), pain in your right side of the stomach (abdomen), fatigue, loss of appetite, or nausea and vomiting without apparent cause, tell your doctor immediately.
If you have any of these symptoms after starting treatment with this medication, tell your doctor immediately.
Before, during, and after treatment, your doctor will request blood tests to check your liver function. If the results indicate a problem with your liver, you may need to stop treatment with this medication.
High blood pressure
Since this medication can cause a slight increase in blood pressure, your doctor will want you to have your blood pressure checked regularly.
Lung problems
This medication has a mild effect on lung function. Patients with severe lung problems or smoker's cough are more likely to develop adverse effects.
Blood count
The expected effect of treatment with this medication is to reduce the number of white blood cells in your blood. This effect usually normalizes within 2 months after stopping treatment. If you need to have blood tests, inform your doctor that you are taking this medication. If you do not, it may not be possible for your doctor to understand the test results, and for certain types of blood tests, your doctor may need more blood than usual.
Before starting treatment with this medication, your doctor will confirm that you have a sufficient number of white blood cells in your blood and may want to repeat checks regularly. If you do not have enough white blood cells, you may need to stop treatment with this medication.
Posterior reversible encephalopathy syndrome (PRES)
A rare disease called posterior reversible encephalopathy syndrome (PRES) has been reported in patients with MS treated with fingolimod. Symptoms can include sudden severe headache, confusion, seizures, and changes in vision. Tell your doctor immediately if you experience any of these symptoms during treatment with this medication because they can be serious.
Cancer
Skin cancer has been reported in patients with MS treated with fingolimod. Tell your doctor immediately if you notice any nodules on the skin (e.g., shiny nodules), spots, or open sores that do not heal within weeks. Symptoms of skin cancer can include abnormal growth or changes in skin tissue (e.g., unusual moles) that change color, shape, or size over time. Before starting treatment with this medication, a skin examination is required to check for any skin nodules. Your doctor will also perform regular skin checks during treatment with this medication. If any skin problems appear, your doctor may refer you to a dermatologist, who may decide if it is essential to see you regularly.
A type of cancer of the lymphatic system (lymphoma) has been reported in patients with MS treated with fingolimod.
Sun exposure and sun protection
Fingolimod weakens your immune system. This increases the risk of developing cancer, particularly skin cancer. You should limit your exposure to the sun and UV rays by:
Unusual brain lesions associated with MS relapses
Rare cases of unusually large brain lesions associated with MS relapses have been reported in patients treated with fingolimod. In the case of severe relapses, your doctor will assess the need for an MRI scan to evaluate your condition and decide if you need to stop treatment with this medication.
Switching from another treatment to Lognif
Your doctor may switch your treatment directly from an interferon beta, glatiramer acetate, or dimethyl fumarate to this medication if there are no signs of abnormalities caused by your previous treatment. Your doctor may want to perform a blood test to rule out such abnormalities. After stopping natalizumab, you may need to wait for 2-3 months before starting treatment with this medication. To switch from teriflunomide, your doctor may advise you to wait for a certain period or undergo an accelerated elimination procedure. If you have been treated with alemtuzumab, a thorough evaluation is necessary, and you should discuss it with your doctor to decide if this medication is suitable for you.
Women of childbearing age
If this medication is used during pregnancy, it may harm the fetus. Before starting treatment with this medication, your doctor will explain the risks and ask you to have a pregnancy test to ensure you are not pregnant. Your doctor will give you a card that explains why you should not become pregnant while taking this medication. It also explains what you should do to avoid becoming pregnant while taking this medication. During treatment and for 2 months after stopping treatment, you must use an effective contraceptive method (see "Pregnancy and breastfeeding" section).
MS worsening after stopping treatment with Lognif
Do not stop taking this medication or change your dose without talking to your doctor first.
Tell your doctor immediately if you think your MS is getting worse after stopping treatment with this medication. This can be serious (see "If you stop taking Lognif" in section 3 and also section 4 "Possible side effects").
Elderly patients
Experience with fingolimod in elderly patients (over 65 years) is limited. If in doubt, consult your doctor.
Children and adolescents
Fingolimod should not be administered to children under 10 years of age, as it has not been studied in patients with MS in this age group.
The warnings and precautions mentioned above also apply to children and adolescents.
The following information is especially important for children and adolescents and their caregivers:
Other medications and Lognif
Tell your doctor or pharmacist if you are taking, have recently taken, or may need to take any other medication.
Tell your doctor if you are taking any of the following medications:
Treatment with this medication will be supervised by a doctor with experience in treating multiple sclerosis.
Follow the administration instructions for this medication exactly as indicated by your doctor. If in doubt, consult your doctor or pharmacist again.
The recommended dose is:
Adults:
The dose is one 0.5 mg capsule per day.
Children and adolescents (10 years of age and older):
The dose depends on body weight:
Children and adolescents who start with a 0.25 mg capsule per day and later reach a stable body weight over 40 kg may have their doctor switch them to a 0.5 mg capsule per day. In these cases, it is recommended to repeat the first-dose observation period.
Do not exceed the recommended dose.
Lognif is for oral use.
Take this medication once a day with a glass of water. The capsules of this medication should always be swallowed whole, without opening them. This medication can be taken with or without food.
Taking this medication at the same time every day can help you remember to take your medication.
If you have doubts about the duration of treatment with this medication, consult your doctor or pharmacist.
If you take more Lognif than you should
If you have taken too much medication, consult 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 Lognif
If you have been taking this medication for less than 1 month and forget to take a dose for a whole day, inform your doctor before taking the next dose. Your doctor may decide to keep you under observation when you take the next dose.
If you have been taking this medication for at least 1 month and have forgotten to take your treatment for more than 2 weeks, inform your doctor before taking the next dose. Your doctor may decide to keep you under observation when you take the next dose. However, if you have forgotten to take the treatment for a period of up to two weeks, you can take the next dose as planned.
Never take a double dose to make up for missed doses.
If you stop treatment with Lognif
Do not stop taking this medication or change your dose without talking to your doctor first.
Fingolimod will remain in your body for up to 2 months after stopping treatment. The number of white blood cells (lymphocyte count) may also remain low during this time, and it is possible that side effects may still occur. After stopping treatment with this medication, you may need to wait for 6-8 weeks before starting a new treatment for MS.
If you need to restart treatment with this medication after a pause of more than 2 weeks, the effect on heart rate that may occur at the start of treatment may recur, and you will need to be monitored in the doctor's office or hospital to restart treatment. Do not restart treatment with this medication after stopping it for more than two weeks without consulting your doctor.
Your doctor will decide if and how you need to be monitored after stopping treatment with this medication. Inform your doctor immediately if you think your MS is getting worse after stopping treatment with fingolimod. This could be serious.
If you have any other questions about using this medication, ask your doctor or pharmacist.
Like all medications, this medication can cause side effects, although not everyone will experience them.
Some side effects may be serious or potentially serious.
Common(may affect up to 1 in 10 people)
Uncommon(may affect up to 1 in 100 people)
Rare(may affect up to 1 in 1,000 people)
Very rare(may affect up to 1 in 10,000 people)
Frequency not known(frequency cannot be estimated from available data)
If you experience any of these symptoms, inform your doctor immediately.
Other side effects
Very common(may affect more than 1 in 10 people).
Common(may affect up to 1 in 10 people)
Uncommon(may affect up to 1 in 100 people):
Rare(may affect up to 1 in 1,000 people):
Frequency not known(frequency cannot be estimated from available data):
If you consider that any of the side effects you are experiencing is serious, inform your doctor.
Reporting side effects
If you experience any 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 the Spanish Medicines and Healthcare Products Agency's website: https://www.notificaram.es. By reporting side effects, you can help provide more information on the safety of this medication.
Keep this medication out of sight and reach of children.
Do not use this medication after the expiration date shown on the packaging and on the blister after CAD/EXP. The expiration date refers to the last day of the month indicated.
This medication does not require special storage conditions.
Medications should not be thrown down the drain or into the trash. 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.
Composition ofLognif
Lognif 0.25 mg hard capsules EFG
Each capsule contains 0.25 mg of fingolimod (as hydrochloride).
Lognif 0.50 mg hard capsules EFG
Each capsule contains 0.50 mg of fingolimod (as hydrochloride).
Capsule content: pregelatinized corn starch, sodium lauryl sulfate
Lognif 0.25 mg hard capsules EFG
Capsule shell: titanium dioxide (E171), gelatin.
Lognif 0.50 mg hard capsules EFG
Capsule shell: yellow iron oxide (E172), titanium dioxide (E171), gelatin
Printing ink: Shellac, propylene glycol, strong ammonia solution, black iron oxide (E172), potassium hydroxide.
Appearance of the product and package contents
Lognif 0.25 mg hard capsules EFG: gelatin capsule approximately 14 mm in size, printed in black with "TV 3654" on the opaque white capsule cap and "TV 3654" on the opaque white capsule body.
Lognif 0.50 mg hard capsules EFG: gelatin capsule approximately 14 mm in size, printed in black with "TV 7820" on the yellow capsule cap and "TV 7820" on the opaque white capsule body.
Lognif is available in packages containing 7, 10, 28, 30, and 98 hard capsules in blisters or in packages containing 7 x 1, 10 x 1, 28 x 1, 30 x 1, 98 x 1, and 100 x 1 hard capsules in single-dose perforated blisters.
Not all pack sizes may be marketed.
Marketing authorization holder and manufacturer
Marketing authorization holder
Teva Pharma, S.L.U
C/ Anabel Segura, 11, Edificio Albatros B, 1ª planta,
Alcobendas 28108
Madrid (Spain)
Manufacturer
Balkanpharma-Dupnitsa AD
3 Samokovsko Shosse Str.
Dupnitsa 2600
Bulgaria
This medication is authorized in the Member States of the European Economic Area under the following names:
Germany: LOGNIF
Bulgaria: Lognif 0.5 mg hard capsules
Cyprus: Lognif 0.5 mg σκληρ? καψ?κια
Czech Republic: Lognif
Slovakia: LOGNIF 0.5 mg tvrdé kapsuly
Spain: Lognif 0.25 mg cápsulas duras EFG; Lognif 0.50 mg cápsulas duras EFG
Hungary: Lognif 0.25 mg kemény kapszula;
Italy: LOGNIF
Greece: Lognif 0.5 mg σκληρ? καψ?κια
Date of last revision of this leaflet:August 2021
Detailed information about this medication is available on the website of the Spanish Agency for Medicines and Healthcare Products (AEMPS)http://www.aemps.gob.es