PHYSIONEAL 40 2.27% GLUCOSE SOLUTION FOR PERITONEAL DIALYSIS 22.7 mg/ml

Introduction

Package Leaflet: Information for the User

PHYSIONEAL 40 Glucose 1.36% w/v/ 13.6 mg/ml, Solution for Peritoneal Dialysis

PHYSIONEAL 40 Glucose 2.27% w/v/ 22.7 mg/ml, Solution for Peritoneal Dialysis

PHYSIONEAL 40 Glucose 3.86% w/v/ 38.6 mg/ml, Solution for Peritoneal Dialysis

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.
• If you get any side effects, talk to your doctor. This includes any possible side effects not listed in this leaflet. See section 4.

Contents of the pack:

1. What PHYSIONEAL 40 is and what it is used for
2. What you need to know before you use PHYSIONEAL 40
3. How to use PHYSIONEAL 40
4. Possible side effects
5. Storage of PHYSIONEAL 40
6. Contents of the pack and other information

1. What PHYSIONEAL 40 is and what it is used for

PHYSIONEAL 40 is a solution for peritoneal dialysis. It removes water and waste products from the blood. It also corrects abnormal levels of various blood components.

PHYSIONEAL 40 contains different concentrations of glucose (1.36%, 2.27%, or 3.86%). The higher the glucose concentration of the solution, the more water will be removed from the blood.

PHYSIONEAL 40 may be prescribed for you if you have:

• temporary or permanent kidney failure
• severe water retention
• severe acid-base disturbances (pH) and electrolyte imbalance in the blood
• certain types of drug poisoning for which there are no other available treatments.

The PHYSIONEAL 40 solution has an acidity (pH) similar to that of blood. For this reason, it may be particularly useful if you experience discomfort or pain during the administration of other more acidic peritoneal dialysis solutions.

2. What you need to know before you use PHYSIONEAL 40

Your doctor should supervise the administration of this product if it is the first time you are using it.

Do not use PHYSIONEAL 40

• if you are allergic to the active substances or to any of the other components of this medicine (listed in section 6).
• if you have any non-correctable surgical problem affecting your abdominal wall or cavity

or an uncorrectable condition that increases the risk of abdominal infections

• if you have a documented loss of peritoneal function due to severe peritoneal scarring.

Warnings and precautions

Consult your doctor before starting to use PHYSIONEAL 40.

Be particularly cautious:

• If you have severe problems affecting the integrity of the abdominal wall or cavity. For example, in the case of hernia or chronic infection or inflammatory disease affecting the intestines.
• If you have an aortic graft.
• If you have severe breathing difficulties.
• If you experience abdominal pain, elevated body temperature, or notice that the drainage fluid is cloudy or contains particles. This may be a sign of peritonitis (inflamed peritoneum) or infection. You should contact your medical team urgently. Note the batch number of the peritoneal dialysis solution bags you are using and take it with the drained fluid bag to the medical team. The medical team will decide whether to interrupt treatment or start corrective treatment. For example, if you have an infection, your doctor may perform several tests to determine which antibiotic is most suitable for you. Your doctor may give you a broad-spectrum antibiotic effective against a wide range of bacteria until they know what infection you have.

Interaction with other medicines

Tell your doctor if you are using or have recently used other medicines, including those obtained without a prescription.

If you use other medicines, your doctor may need to increase your dose since peritoneal dialysis treatment increases the elimination of certain medicines.

Be careful if you use heart medicines called cardiac glycosides (e.g., digoxin), you may:

• need potassium and calcium supplements
• develop cardiac arrhythmias.
• Your doctor will closely monitor you during treatment, especially your potassium levels.

Pregnancy and breastfeeding

If you are pregnant or breastfeeding, think you may be pregnant, or plan to become pregnant, consult your doctor before using this medicine. The use of Physioneal is not recommended during pregnancy or breastfeeding unless your doctor advises you to do so.

Driving and using machines

This treatment can cause weakness, blurred vision, or dizziness. Do not drive or use machines if you are affected.

3. How to use PHYSIONEAL 40

PHYSIONEAL 40 should be administered into your peritoneal cavity. This cavity is located in the abdomen (belly) between the skin and the peritoneum. The peritoneum is the membrane that surrounds the internal organs, such as the intestines or liver.

Do not use intravenously.

Follow exactly the administration instructions of this medicine indicated by the medical team specialized in peritoneal dialysis. If in doubt, consult them again.

If the bag is damaged, it should be discarded.

Dose and frequency

Your doctor will indicate the appropriate glucose concentration and the number of bags you should use each day.

Use in children and adolescents

If you are under 18 years of age, your doctor will carefully evaluate the prescription of this medicine.

If you interrupt treatment with PHYSIONEAL 40

Do not interrupt peritoneal dialysis without your doctor's consent. Interrupting treatment can have harmful consequences for your life.

Method of administration

Before use,

• Warm the bag to 37 °C. Use the specially designed heating plate for this purpose. Never submerge the bag in water to warm it. Never use a microwave oven to warm the bag.
• You must use an aseptic technique during the entire administration of the solution, as you have been taught.
• Before performing an exchange, make sure to wash your hands and the area where you will perform the exchange.
• Before opening the overbag, check that it is the correct solution, the expiration date, and the quantity (volume). Lift the bag to check for leaks (excess liquid in the overbag). Do not use the bag if you find any leaks.
• After removing the overbag, check for signs of leaks in the container by pressing firmly on the bag. Check that the breakable seal that separates the two chambers is not broken. If the seal is broken, discard the bag. Do not use the bag if you detect any leaks.

• Check that the solution is clear. Do not use the bag if the solution is cloudy or contains particles
• Before starting the exchange, check that all connections are secure.

• Mix the two chambers carefully by breaking the breakable seal between the two chambers. Wait until the upper chamber has completely emptied into the lower chamber. Mix the solution carefully, pressing with both hands on the walls of the lower chamber.
• • Consult your doctor if you have any questions or doubts about this product or its use.
  • Use each bag only once. Discard any unused solution.
  • The solution must be administered within 24 hours after mixing.

After use, check that the drained fluid is not cloudy.

Compatibility with other medicines

Your doctor may prescribe other injectable medicines to be added directly to the PHYSIONEAL 40 bag. In this case, add the medicine through the medication addition site located in the small chamber, before breaking the breakable seal between the two chambers. Use the product immediately after adding the medicine. Consult your doctor if you are unsure.

If you use more PHYSIONEAL 40 bags than you should in 24 hours

If you are administered an excessive dose of PHYSIONEAL 40, you may experience:

• abdominal distension
• heaviness of the stomach and/or
• difficulty breathing.

Contact your doctor immediately. They will inform you of what to do.

If you have any further questions about the use of this product, ask your doctor.

4. Possible side effects

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

If you experience any of the following situations, contact your doctor or peritoneal dialysis unit immediately:

• Hypertension (blood pressure above normal levels),
• Swelling of the ankles or legs, puffy eyes, difficulty breathing, or chest pain (hypervolemia),

• Abdominal pain,
• Chills (flu-like symptoms), fever.
• Inflamed peritoneum (peritonitis)

All these are serious side effects. You may need urgent medical attention.

If you experience any side effect, inform your doctor or peritoneal dialysis unit. This includes any possible side effect not listed in this leaflet.

Frequent (may affect up to 1 in 10 people):

• Changes in your blood parameters:

• increased calcium level (hypercalcemia)
• decreased potassium level (hypokalemia) that can cause muscle weakness, muscle contractions, or cardiac arrhythmias
• increased bicarbonate level (alkalosis).

• Weakness, fatigue
• Fluid retention (edema)
• Weight gain

• Uncommon (may affect up to 1 in 100 people): Decreased fluid removal during dialysis.
• Fainting, dizziness, or headache.
• Cloudy solution drained from the peritoneum, stomach pain.
• Peritoneal hemorrhage, pus, swelling, or pain around the catheter exit site and catheter blockage.

• Nausea, loss of appetite, indigestion, flatulence (gas), thirst, and dry mouth.
• Abdominal distension or inflammation, shoulder pain, abdominal cavity hernia (lump in the groin).

• Changes in your blood parameters:
• • lactic acidosis
  • increased carbon dioxide level
  • increased sugar level (hyperglycemia)
  • increased white blood cell count (eosinophilia)
  • Sleep disorders
  • Low blood pressure (hypotension)
  • Cough
  • Muscle or bone pain
  • Facial or throat swelling
  • Rash

Other side effects related to the peritoneal dialysis procedure:

• Infection around the catheter exit site, catheter blockage

Reporting of side effects

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

5. Storage of PHYSIONEAL 40

• Keep this medicine out of the sight and reach of children.
• Store in the original packaging.
• Do not store at a temperature below 4 °C.
• Do not use this medicine after the expiration date stated on the outer packaging label and on the bag after the abbreviation EXP and the symbol.

Discard PHYSIONEAL 40 as indicated.

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

6. Package Contents and Additional Information

This leaflet does not contain all the information about this medicine. If you have any doubts or are unsure about something, ask your doctor.

Composition of PHYSIONEAL 40

The mixed peritoneal dialysis solution contains the following active principles:

The other components are: water for injectable preparations and carbon dioxide.

The composition in mmol/l of the mixed solution is:

Appearance of the Product and Package Contents

PHYSIONEAL 40 is a colorless, transparent, and sterile solution for peritoneal dialysis.

• PHYSIONEAL 40 is packaged in a double-chamber PVC bag. The two chambers are separated by a permanent seal. You should only administer PHYSIONEAL 40 when the solutions from the two chambers are fully mixed.
• Each bag is wrapped in an overbag and supplied in a cardboard box.

Only some package sizes may be marketed.

Marketing Authorization Holder

Vantive Health, S.L.

Polígono Industrial Sector 14

C/Pouet de Camilo 2

46394 Ribarroja del Turia (Valencia) Spain

Manufacturer

Vantive Manufacturing Limited

Moneen Road

Castlebar

County Mayo – Ireland

or

Bieffe Medital SpA

Via Nuova Provinciale

23034 Grosotto

Italy

Date of the Last Revision of this Leaflet: November 2018

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

Vantive and Physioneal are registered trademarks of Vantive Health Inc. or its subsidiaries