Prospecto: Information for the User
Lognif 0.25 mg Hard Capsules EFG
Lognif 0.50 mg Hard Capsules EFG
fingolimod
Read this prospectus carefully before starting to take this medicine, as it contains important information for you.
6. Contents of the pack and additional information
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 (10 years of age and older) to treat relapsing-remitting multiple sclerosis (MS), particularly in:
or
This medication does not cure MS, but helps to reduce the number of relapses and decrease the rate of physical disability progression due to MS.
What is multiple sclerosis
MS is a chronic disease that affects the central nervous system (CNS), consisting of the brain and spinal cord. In MS, inflammation destroys the protective covering (called myelin) that surrounds the nerves in the CNS, preventing nerves from functioning properly. This is called demyelination.
Relapsing-remitting MS is characterized by repeated attacks (relapses) of CNS symptoms reflecting inflammation in the CNS. Symptoms vary from patient to patient but generally include difficulties walking, numbness in some part of the body (tingling), vision problems, or balance disorders. Symptoms of a relapse may disappear completely when the relapse ends, but some problems may persist.
How Lognif works
This medication helps combat the immune system's attacks 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 nerve damage caused by MS. This medication also reduces some of the body's immune responses.
Do not takeLognif
If any of the above cases apply to you or if you are unsure, inform your doctor before taking this medication.
Warnings and precautions
Consult your doctor before starting to takeLognif:
If any of the above cases apply to you or if you are unsure, inform your doctor before taking this medication.
Slow heart rhythm (bradycardia) and irregular heart rhythm
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 causes a decrease in heart rhythm. As a result, you may feel dizzy or tired, or be aware of your heartbeats, or have a decrease in blood pressure.If these effects are severe, inform your doctor as you may need immediate treatment.This medication can also make heartbeats irregular, especially after the first dose. The irregular heartbeats usually normalize within a day. The slow heart rhythm usually normalizes within a month.During this period, you can generally not expect any clinically significant effects on heart rhythm.
Your doctor will ask you to stay in the consultation 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 the necessary measures if any adverse effects appear at the start of treatment. Before the first dose of this medication, you will have had to have an electrocardiogram, and after the 6-hour monitoring period. Your doctor will be able to continuously monitor your electrocardiogram during this time. If, after the 6-hour period, you have a very slow or decreasing heart rhythm, 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 restarting 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 heart rhythms, if your electrocardiogram is abnormal, or if you have a 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 decreased heart rhythm, 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 down your heart rhythm, 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 down your heart rhythm to allow treatment with this medication. If this 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 starting treatment with this medication for a month after completing the vaccination cycle.
Infections
Fingolimod reduces the number of white blood cells (especially lymphocytes). White blood cells fight infections. During treatment with this medication (and for up to 2 months after stopping treatment), you may be more susceptible to infections. You may even experience a worsening of an existing infection. Infections can be severe and potentially life-threatening. If you think you have contracted an infection, have a fever, have symptoms similar to the flu, have herpes (cold sore) or have a headache accompanied by neck stiffness, sensitivity to light, nausea, hives, and/or confusion or seizures (which may be due to a fungal infection and may be symptoms of meningitis and/or encephalitis caused by a fungal infection or the herpes virus), contact your doctor immediately, as it may be severe and life-threatening. If you think your MS is worsening (e.g., weakness or visual disturbances) or if you notice any new symptoms, inform your doctor immediately, as they may 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 a magnetic resonance imaging (MRI) scan to evaluate your condition and decide whether you need to stop taking this medication.
There have been reports of human papillomavirus (HPV) infection, including papilloma, dysplasia, warts, and cancer associated with HPV, 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 regular HPV screenings.
Macular edema
Before starting treatment with this medication, your doctor may request an eye examination if you have or have had visual disturbances or other signs of inflammation in the central vision area (macula) of the back of the eye, an inflammation or infection in the eye (uveitis), or diabetes.
After starting treatment with this medication, your doctor may request an eye examination 3 or 4 months after starting 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 clearly. This medication can cause inflammation of the macula, a condition known as macular edema. The inflammation usually occurs within the first 4 months of treatment with this medication.
If you have diabetes or have had uveitis, you are more likely to develop macular edema. In these cases, your doctor will want to perform regular eye checks to detect macular edema.
If you have had macular edema, consult your doctor before restarting treatment with this medication.
Macular edema can cause some of the same visual symptoms as an MS attack (optic neuritis). At first, you may not have any symptoms. You need to 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 tint to your skin or the white part of your eyes, abnormally dark urine (brown), right-sided abdominal pain, fatigue, decreased appetite, nausea, or vomiting without apparent cause, inform your doctor immediately.
If you experience any of these symptoms after starting treatment with this medication, inform your doctor immediately.
Before, during, and after treatment, your doctor will request blood tests to monitor your liver function. If the results indicate a problem with your liver, you may need to stop taking this medication.
High blood pressure
As this medication causes a slight increase in blood pressure, your doctor will want to regularly monitor your blood pressure.
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 to take 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 the checks regularly. If you do not have enough white blood cells, you may need to stop taking this medication.
Posterior reversible encephalopathy syndrome (PRES)
Rarely, a condition called posterior reversible encephalopathy syndrome (PRES) has been reported in patients with MS treated with fingolimod. Symptoms may include sudden onset of severe headache, confusion, seizures, and visual disturbances. Inform your doctor immediately if you experience any of these symptoms during treatment with this medication, as they may be severe.
Cancer
There have been reports of skin cancer in patients with MS treated with fingolimod. Inform your doctor immediately if you notice any new skin lesions (e.g., shiny nodules with a pearl-like appearance), skin discoloration, or open sores that do not heal within weeks. Symptoms of skin cancer may 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, your doctor will perform a skin examination to check for any skin lesions. 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 whether you need regular follow-up appointments.
There have been reports of lymphoma, a type of cancer of the lymphatic system, 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 unusual 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 whether you need to stop taking this medication.
Switching from another treatment to Lognif
Your doctor may switch you directly from 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 need to perform a blood test to rule out these abnormalities. After stopping natalizumab, you may need to wait 2-3 months before starting treatment with this medication. To switch from teriflunomide, your doctor may advise you to wait a certain period or undergo accelerated elimination. If you have been treated with alemtuzumab, you will need a thorough evaluation and discuss it with your doctor to decide whether this medication is suitable for you.
Women of childbearing age
If you are pregnant or intend to become pregnant, do not take this medication. If you are a woman who may become pregnant and are not using an effective contraceptive method, do not take this medication. If you take this medication during pregnancy, there is a risk of harming the fetus. The rate of congenital malformations observed in babies exposed to fingolimod during pregnancy is approximately 2 times higher than the rate observed in the general population (where the rate of congenital malformations is approximately 2-3%). The most frequently reported malformations included heart, kidney, and musculoskeletal malformations.
Therefore, if you are a woman of childbearing age:
and
Your doctor will provide you with a card explaining why you should not become pregnant while taking this medication.
If you become pregnant while taking this medication, inform your doctor immediately.Your doctor will decide whether to stop treatment (see "If you stop taking Lognif" in section 3 and also section 4, "Possible side effects"). You will receive specific prenatal follow-up.
Breastfeeding
You should not breastfeed while taking this medication.Fingolimod passes into breast milk, and there is a risk of severe adverse effects for the baby.
Driving and operating machinery
Your doctor will inform you if your disease allows you to drive vehicles, including bicycles, and use machinery safely. This medication is not expected to affect your ability to drive and use machinery.
However, after taking the first dose of this medication, you will need to stay in the doctor's consultation or hospital for at least 6 hours. During this period and possibly afterwards, your ability to drive and use machinery may be impaired.
Lognif contains sodium
This medication contains less than 23 mg of sodium (1 mmol) per capsule; this is essentially "sodium-free".
The treatment with this medication will be supervised by a doctor with experience in treating multiple sclerosis.
Follow exactly the administration instructions of this medication indicated by your doctor. In case of doubt, consult your doctor or pharmacist again.
The recommended dose is:
Adults:
The dose is one capsule of 0.5 mg per day.
Children and adolescents (10 years of age and older):
The dose depends on body weight:
Children and adolescents who start with one capsule of 0.25 mg per day and then reach a stable body weight greater than 40 kg, may have their doctor change them to one capsule of 0.5 mg per day. In these cases, it is recommended to repeat the observation period of the first dose.
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 must always be swallowed whole, without opening. This medication can be taken with or without food.
Taking this medication always at the same time each day may help you remember when 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 Toxicological Information Service, phone 91 562 04 20, indicating the medication and the amount ingested.
If you forgot to take Lognif
If you have been taking this medication for less than 1 month and forget to take a dose for an entire day, inform your doctor before taking the next dose. Your doctor may decide to keep you under observation at the time you take the next dose.
If you have been taking this medication for at least a 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 at the time 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 compensate for the missed doses.
If you interrupt 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 treatment interruption. The number of white blood cells (lymphocyte count) may also remain low during this time and it is possible that the adverse effects described in this prospectus will still occur. After interrupting treatment with this medication, you may need to wait 6-8 weeks before starting a new treatment for MS.
If you need to resume treatment with this medication after a pause of more than 2 weeks, the effect on heart rhythm 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 interrupting it for more than two weeks without consulting your doctor.
Your doctor will decide if and how you need to be followed up after interrupting treatment with this medication. Inform your doctor immediately if you think your MS is getting worse after interrupting treatment with fingolimod. This could be serious.
If you have any other doubts about the use of this medication, ask your doctor or pharmacist.
Like all medicines, this medicine can cause side effects, although not everyone will experience them.
Some side effects can be serious or potentially serious.
Frequent(may affect up to 1 in 10 people)
Frequent (may affect up to 1 in 10 people)
Rare(may affect up to 1 in 1,000 people)
Very rare (may affect up to 1 in 10,000 people)
Frequency unknown(the frequency cannot be estimated from available data)
If you have any of these symptoms,inform your doctor immediately.
Other side effects
Very frequent(may affect more than 1 in 10 people).
Frequent(may affect up to 1 in 10 people)
Poorly frequent(may affect up to 1 in 100 people):
Rare(may affect up to 1 in 1,000 people):
Frequency unknown(the frequencycannot be estimated from available data):
If you consider that any of the side effects you are experiencing are serious,inform your doctor.
Reporting 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 the Spanish System for the Vigilance 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 medicine.
Keep this medication out of the sight and reach of children.
Do not use this medication after the expiration date that appears on the packaging and 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 disposed of through drains or trash. Dispose of packaging and medications you no longer need at the SIGRE collection point at the pharmacy. If in doubt, ask your pharmacist how to dispose of unused packaging and medications. By doing so, you 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).
Capule content: maize pregelatinized starch, sodium lauryl sulfate
Lognif 0.25 mg hard capsules EFG
Capsule coating: titanium dioxide (E171), gelatin.
Lognif 0.50 mg hard capsules EFG
Capsule coating: iron oxide yellow (E172), titanium dioxide (E171), gelatin
Printing ink: shellac, propylene glycol, strong ammonia solution, iron oxide black (E172), potassium hydroxide.
Appearance of the product and contents of the pack
Lognif 0.25 mg hard capsules EFG: gelatin capsule of approximately 14 mm, printed in black with “TV 3654” on the opaque white cap of the capsule and “TV 3654” on the opaque white body of the capsule.
Lognif 0.50 mg hard capsules EFG: gelatin capsule of approximately 14 mm, printed in black with “TV 7820” on the yellow cap of the capsule and “TV 7820” on the opaque white body of the capsule.
Lognif is available in packs containing 7, 10, 28, 30 and 98 hard capsules in blister or in packs containing 7 x 1.10 x 1, 28 x 1, 30 x 1, 98 x 1 and 100 x 1 hard capsules in perforated unit dose blisters.
Only some pack sizes may be marketed.
Marketing authorization holder and responsible person for manufacturing
Marketing authorization holder
Teva Pharma, S.L.U
C/ Anabel Segura, 11, Edificio Albatros B, 1st floor,
Alcobendas 28108
Madrid (Spain)
Responsible person for manufacturing
Balkanpharma-Dupnitsa AD
3 Samokovsko Shosse Str.
Dupnitsa 2600
Bulgaria
This medicinal product is authorized in the member states of the European Economic Area with the following names:
Germany:LOGNIF
Bulgaria:Lognif 0.5 mg hard capsules
Cyprus:Lognif 0,5mg σκληρ? καψ?κια
Czech Republic:Lognif
Slovakia:LOGNIF 0,5 mg tvrdé kapsuly
Spain:Lognif 0,25 mg hard capsules EFG; Lognif 0,50 mg hard capsules EFG
Hungary:Lognif 0,25 mg kemény kapszula;
Italy:LOGNIF
Greece:Lognif 0,5 mg σκληρ? καψ?κια
Revision date of this leaflet:August 2021
The detailed information on this medicinal product is available on the website of theSpanish Agency of Medicines and Medical Devices (AEMPS)http://www.aemps.gob.es
Have questions about this medication or your symptoms? Connect with a licensed doctor for guidance and personalized care.