This page is for general information. Consult a doctor for personal advice. Call emergency services if symptoms are severe.

How to use NORDITROPIN NORDIFLEX 10 mg/1.5 ml SOLUTION FOR INJECTION IN PRE-FILLED PEN

Introduction

Package Leaflet: Information for the User

Norditropin NordiFlex 10 mg/1.5 ml solution for injection in pre-filled pen

somatropin

Read all of this leaflet carefully before you start using 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

What Norditropin NordiFlex is and what it is used for
What you need to know before you use Norditropin NordiFlex
How to use Norditropin NordiFlex
Possible side effects
Storing Norditropin NordiFlex
Contents of the pack and other information

On the back:Instructions for using the Norditropin NordiFlex pen

1. What Norditropin NordiFlex is and what it is used for

Norditropin NordiFlex contains a biosynthetic human growth hormone, called somatropin, which is identical to the natural growth hormone produced by the body. Children need growth hormone to help them grow, but adults also need it for their general health.

Norditropin NordiFlex is used to treat growth failure in children:

If there is no or very low production of growth hormone (growth hormone deficiency).
If they have Turner syndrome (a genetic problem that can affect growth).
If they have kidney disease.
If they have low birth weight and were born small for gestational age (SGA).
If they have Noonan syndrome (a genetic problem that can affect growth).

Norditropin NordiFlex is used as a growth hormone substitute in adults:

In adults, Norditropin NordiFlex is used as a growth hormone substitute when the production of growth hormone has decreased since youth or has disappeared in adulthood as a result of a tumor, tumor treatment, or a disease that affects the gland that produces growth hormone. If you were treated for growth hormone deficiency during childhood, you will be re-evaluated once you have finished growing. If growth hormone deficiency is confirmed, you should continue treatment.

2. What you need to know before you use Norditropin NordiFlex

Do not use Norditropin NordiFlex

If you are allergic to somatropin, phenol, or any of the other ingredients of this medicine (listed in section 6).
If you have had a kidney transplant.
If you have an active tumor (cancer). Tumors must be inactive and you must have completed anti-tumor therapy before starting treatment with Norditropin NordiFlex.
If you have a severe acute illness, e.g., you have had open heart or abdominal surgery, have had multiple accidental injuries, or have acute respiratory failure.
If you have stopped growing (epiphyseal closure) and do not have a growth hormone deficiency.

Warnings and precautions

Consult your doctor or pharmacist before starting treatment with Norditropin NordiFlex

If you have diabetes.
If you have had cancer or any other type of tumor.
If you frequently have headaches, vision problems, nausea, or vomiting.
If your thyroid gland is not working properly.
A curvature of the spine (scoliosis) may develop in any child during rapid growth. During treatment with Norditropin NordiFlex, your doctor will examine you (or your child) for signs of scoliosis.
If you start limping during treatment with growth hormone, inform your doctor.
If you are over 60 years old or if, as an adult, you have been treated with somatropin for more than 5 years, as experience is limited in these cases.
If you have kidney disease, as your doctor will need to monitor your kidney function.
If you are receiving glucocorticoid replacement therapy, you should consult your doctor regularly, as it may be necessary to adjust your glucocorticoid dose.
Norditropin NordiFlex may cause pancreatitis, which causes severe abdominal and back pain. If you or your child develop stomach pain after administering Norditropin NordiFlex, consult your doctor.

Other medicines and Norditropin NordiFlex

Tell your doctor or pharmacist if you are using, have recently used, or might use any other medicines.

In particular, tell your doctor if you are taking or have recently taken any of the following medicines. Your doctor may need to adjust the dose of Norditropin NordiFlex or the other medicines:

Glucocorticoids – your adult height may be affected if you use Norditropin NordiFlex and glucocorticoids at the same time.
Ciclosporin (immunosuppressant) - may need a dose adjustment.
Insulin – may need a dose adjustment.
Thyroid hormones - may need a dose adjustment.
Gonadotropin (gonad-stimulating hormone) - may need a dose adjustment.
Anticonvulsants - may need a dose adjustment.
Oral estrogens or other sex hormones.

Pregnancy and breastfeeding

Products containing somatropin are not recommended in fertile women who do not use contraceptive methods.

Pregnancy. Stop treatment and inform your doctor if you become pregnant while being treated with Norditropin NordiFlex.
Breastfeeding. Do not use Norditropin NordiFlex during breastfeeding, as somatropin may pass into breast milk.

Driving and using machines

Norditropin NordiFlex does not affect the ability to drive or use machines.

Important information about some of the ingredients of Norditropin NordiFlex

This medicine contains somatropin, which may produce a positive result in doping tests.

Norditropin contains sodium

Norditropin contains less than 1 mmol of sodium (23 mg) per 1.5 ml; i.e., it is essentially “sodium-free”.

3. How to use Norditropin NordiFlex

Follow the instructions for administration of this medicine exactly as prescribed by your doctor. If you are unsure, consult your doctor or pharmacist again.

Recommended dose

The dose for children depends on body weight and body surface area. The dose in later stages of life depends on height, weight, sex, and sensitivity to growth hormone and will be adjusted until the correct dose for you is found.

Children with growth hormone deficiency or deficiency:

The usual dose is 0.025 to 0.035 mg per kg body weight per day or 0.7 to 1.0 mg per m2 body surface area per day.

Girls with Turner syndrome:

The usual dose is 0.045 to 0.067 mg per kg body weight per day or 1.3 to 2.0 mg per m2 body surface area per day.

Children with kidney disease:

The usual dose is 0.050 mg per kg body weight per day or 1.4 mg per m2 body surface area per day.

Children born small for gestational age (SGA):

The usual dose is 0.035 mg per kg body weight per day or 1.0 mg per m2 body surface area per day until final height is reached. (In clinical trials in children with short stature born SGA, doses of 0.033 and 0.067 mg per kg body weight per day have been used).

Children with Noonan syndrome:

The usual dose is 0.066 mg per kg body weight per day; however, your doctor may decide that 0.033 mg/kg/day is sufficient.

Adults with insufficient or deficient growth hormone production:

If growth hormone deficiency persists after you have finished growing, you should continue treatment. The usual starting dose is 0.2 to 0.5 mg per day. Your dose will be adjusted until you reach the correct dose. If growth hormone deficiency begins in adulthood, the usual starting dose is 0.1 to 0.3 mg per day. Your doctor will increase this dose every month until you reach the correct dose for you. The usual maximum dose is 1.0 mg per day.

When to use Norditropin NordiFlex

Inject the daily dose under the skin every night before bedtime.

How to use Norditropin NordiFlex

The Norditropin NordiFlex growth hormone solution is available in a 1.5 ml pre-filled multidose pen.

On the back, you can find the complete instructions for using the Norditropin NordiFlex pen. The key points of the instructions are as follows:

Check the solution before use by turning the pen upside down one or two times. Do not use the pen if the solution is cloudy or discolored.

Norditropin NordiFlex is designed to be used with the NovoFine or NovoTwist disposable needles up to 8 mm in length.
Always use a new needle for each injection.
Vary the injection site to avoid damaging your skin.
Check the flow of growth hormone (called “priming” the pen) before the first injection with a new Norditropin NordiFlex pen to ensure you get the correct dose and do not inject air. Do not use the pen if a drop of growth hormone does not appear at the tip of the needle.
Do not share the Norditropin NordiFlex pen with anyone else.

How long will you need to continue treatment

Children with growth failure due to Turner syndrome, kidney disease, born small for gestational age (SGA), or Noonan syndrome: your doctor will recommend that you continue treatment until you have finished growing.
Children or adolescents who lack growth hormone: your doctor will recommend that you continue treatment in adulthood.

Do not stop treatment with Norditropin NordiFlex unless your doctor tells you to.

If you use more Norditropin NordiFlex than you should

Tell your doctorif you inject too much somatropin. Prolonged overdose may cause abnormal growth and deformation of facial features.

If you forget to use Norditropin NordiFlex

Use the next dose as usual, at the usual time. Do not take a double doseto make up for forgotten doses.

If you stop treatment with Norditropin NordiFlex

Do not stop treatment with Norditropin NordiFlex unless your doctor tells you to.

If you have any further questions on the use of this medicine, ask your doctor or pharmacist.

4. Possible side effects

Like all medicines, this medicine can cause side effects, although not everybody gets them.

Side effects seen in children and adults(frequency not known):

Skin rash, difficulty breathing, swollen eyelids, face, or lips, complete collapse. Any of these symptoms may indicate an allergic reaction.
Headache, vision problems, nausea, and vomiting. These may be symptoms of increased pressure in the brain.
Decreased serum thyroxine levels.
Hyperglycemia (high blood sugar levels).

If you experience any of these side effects, consult a doctor as soon as possible. Stop using Norditropin NordiFlex until your doctor tells you that you can continue treatment.

Rarely, the formation of antibodies against somatropin has been observed during treatment with Norditropin.

Increased liver enzyme levels have been observed in rare cases.

Cases of leukemia and recurrence of brain tumors have been observed in patients treated with somatropin (the active substance of Norditropin NordiFlex), although there is no evidence that somatropin is responsible for this.

If you think you may be suffering from any of these diseases, talk to your doctor.

Other side effects in children:

Uncommon(may affect up to 1 in 100 children):

Headache.
Redness, itching, and pain at the injection site.
Enlargement of the breast tissue (gynecomastia).

Rare(may affect up to 1 in 1,000 children):

Skin rash.
Muscle and joint pain.
Swollen hands and feet due to fluid retention.

In rare cases, children treated with Norditropin NordiFlex have experienced hip or knee pain or have started limping. These symptoms may be due to a disease that affects the upper end of the femur (Legg-Calve-Perthes disease) or because the end of the bone has slipped out of the cartilage (slipped capital femoral epiphysis) and may not be due to Norditropin NordiFlex.

In clinical trials, some cases of increased growth of hands and feetin relation to height have been observed in children with Turner syndrome.

In a clinical trial in children with Turner syndrome, it has been observed that high doses of Norditropin may possibly increase the risk of ear infections.

If you think any of the side effects are serious, or if you notice any side effects not listed in this leaflet, tell your doctor or pharmacist. It may be necessary to reduce the dose.

Other side effects in adults:

Very common(may affect more than 1 in 10 adults):

Swollen hands and feet due to fluid retention.

Common(may affect up to 1 in 10 adults):

Headache.
Feeling of pins and needles and numbness or pain, mainly in the fingers.
Pain and stiffness in the joints; muscle pain.

Uncommon(may affect up to 1 in 100 adults):

Type 2 diabetes.
Carpal tunnel syndrome; tingling and pain in the fingers and hands.
Itching (may be intense) and pain at the injection site.
Muscle stiffness.
Enlargement of the breast tissue (gynecomastia).

Reporting of side effects

If you experience any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via the Spanish Medicines Monitoring System for Human Use: www.notificaRAM.es. By reporting side effects, you can help provide more information on the safety of this medicine.

5. Storing Norditropin NordiFlex

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

Do not use this medicine after the expiry date which is stated on the carton after EXP. The expiry date is the last day of the month shown.

Storeunused Norditropin NordiFlex pens in the refrigerator(between 2°C and 8°C) in the outer packaging to protect them from light. Do not freeze or expose to heat. Do not store near the wall or the cooling element of the refrigerator.

While usingNorditropin NordiFlex 10 mg/1.5 ml you can:

Store it in the refrigerator (between 2°C and 8°C) for a maximum of 4 weeks, or
Store it at room temperature (below 25°C) for a maximum of 3 weeks.

Do not use the Norditropin NordiFlex pens if they have been frozen or exposed to excessive temperatures.

Do not use the Norditropin NordiFlex pens if the growth hormone solution is cloudy or discolored.

Always keep the Norditropin NordiFlex pen without the needle attached.

Always keep the pen cap completely closed on the Norditropin NordiFlex pen when not in use.

Always use a new needle for each injection.

Medicines should not be disposed of via wastewater or household waste. Ask your pharmacist how to dispose of medicines no longer required. This will help protect the environment.

6. Container Contents and Additional Information

Norditropin NordiFlex Composition

The active ingredient is somatropin
The other components are mannitol, histidine, poloxamer 188, phenol, water for injectable preparations, hydrochloric acid, and sodium hydroxide.

Product Appearance and Container Contents

Norditropin NordiFlex is a clear and colorless injectable solution in a 1.5 ml prefilled multidose pen.

1 ml of solution contains 6.7 mg of somatropin.

1 mg of somatropin corresponds to 3 IU of somatropin.

Norditropin NordiFlex is available in three concentrations:

5 mg/1.5 ml, 10 mg/1.5 ml, and 15 mg/1.5 ml (equivalent to 3.3 mg/ml, 6.7 mg/ml, and 10 mg/ml, respectively).

Marketing Authorization Holder and Manufacturer

Novo Nordisk A/S

Novo Allé

DK-2880 Bagsværd, Denmark

This medicinal product is authorized in the Member States of the European Economic Area and in the United Kingdom (Northern Ireland) under the following names:

Austria, Belgium, Cyprus, Croatia, Denmark, Slovakia, Spain, Finland, Greece, Hungary, Ireland, Iceland, Italy, Lithuania, Luxembourg, Norway, Poland, Portugal, United Kingdom (Northern Ireland), Czech Republic, Romania, Sweden: Norditropin NordiFlex 10 mg/1.5 ml

France: Norditropine NordiFlex 10 mg/1.5 ml

Date of Last Revision of this Leaflet: 11/2022

Other Sources of Information

Detailed and up-to-date information on this medicinal product is available on the website of the Spanish Agency for Medicines and Health Products (AEMPS) http://www.aemps.gob.es/

Norditropin NordiFlex 10 mg/1.5 ml Norditropin NordiFlex Pen Instructions for Use Read these instructions carefully before using Norditropin NordiFlex. Norditropin NordiFlex 10 mg/1.5 ml is a prefilled multidose pen that contains a solution of human growth hormone. You can use the dose selector to select any dose from 0.05 to 3.00 mg, in increments of 0.05 mg. Your doctor will determine the correct dose for you. Norditropin NordiFlex is designed to be used with disposable NovoFine or NovoTwist needles up to 8 mm in length. Start by checking the name, concentration, and color of the label on your Norditropin NordiFlex pen to ensure it contains the growth hormone concentration you need. Use the pen only if the solution it contains is clear and colorless. Always use a new needle for each injection. Always check the flow before performing the first injection with each new pen - see step 3. Checking the flow. Never share your pen or needles with anyone. It could cause cross-infection. Always keep your pen and needles out of the sight and reach of children. People caring for patients should be very careful when handling used needles to reduce the risk of needlestick injury and cross-infection.

Pen Check Check the name, concentration, and color of the label on your Norditropin NordiFlex pen to ensure it contains the growth hormone concentration you need. Remove the pen cap [A]. Check that the solution inside the cartridge is transparent and colorless by turning the pen upside down one or two times. Do not use the pen if the solution inside the cartridge is not clear or is cloudy.
Attach the Needle Always use a new needle for each injection. This reduces the risk of contamination, infection, loss of solution, needle blockage, and inaccurate dosing. Never use a bent or damaged needle. Remove the paper tab from the needle. Screw the straight needle onto the pen [B]. Make sure the needle is tightened. The needle has two caps. You need to remove both: Remove the outer needle cap and save it to properly remove the needle after injection. Remove the inner needle cap by pulling on the central tip and discard it.
Checking the Flow Before the first injection with each new pen, you need to check the flow to ensure you get the correct dose and do not inject air: Select 0.05 mg [C]. Click after 0.0 on the dose selector at the end of the pen.
Hold the pen with the needle pointing upwards and tap the top of the pen several times to make the air bubbles rise upwards [D].
Hold the pen with the needle pointing upwards, press the pen button all the way down [E]. A drop of solution should appear at the tip of the needle. If no drop appears, repeat steps C to E a maximum of 6 times until a drop appears. If still no drop appears, change the needle and repeat steps C to E once more. Do not use the pen if no drop appears. Use a new pen. Always check the flow before the first injection with each new pen. Check the flow again if your pen has been dropped or hit against a hard surface or if you suspect something is wrong.
Dose Selection Check that the dose selector is in the 0.0 position. Select the number of mg prescribed by your doctor [F]. You can increase or decrease the dose by turning the dose selector in both directions. When turning the selector backwards, be careful not to press the button as solution would come out. You cannot select a dose greater than the number of mg remaining in the pen.
Injecting the Dose Use the injection technique taught by your doctor or nurse. Change the injection site to avoid damaging the skin. Insert the needle into the skin. Press the button all the way down to inject the dose. Be careful to press the button only when injecting [G]. Keep the button fully pressed and leave the needle under the skin for at least 6 seconds. This ensures that the full dose is administered.
Removing the Needle Carefully replace the outer needle cap without touching the needle. Unscrew the needle and dispose of it carefully according to the instructions given by your doctor or nurse [H]. Never put the inner needle cap back on the needleonce you have removed it. You could accidentally prick yourself with the needle. Always replace the pen cap after each use. Always remove and dispose of the needle after each injection and keep the pen without the needle attached. This reduces the risk of contamination, infection, loss of solution, needle blockage, and inaccurate dosing. When the pen is empty, dispose of it without the needle as recommended by your doctor or nurse and according to local regulations. People caring for patients should be very careful when handling used needles to reduce the risk of needlestick injury and cross-infection.
Maintenance Handle the Norditropin NordiFlex pen with care. Do not drop the pen or hit it against a hard surface. If it is dropped or you suspect it is not working properly, always screw on a new needle and check the flow before injection. Do not attempt to refill the pen; it is prefilled. Do not attempt to repair the pen or disassemble it. Protect your pen from dust, dirt, freezing, and direct sunlight. Do not attempt to wash, soak, or lubricate the pen. If necessary, clean it with a mild detergent using a damp cloth. Do not freeze the pen or store it near the wall or the cooling element of the refrigerator. See section 5 "Storage of Norditropin NordiFlex" on the back of the page for information on how to store the pen.