BOSULIF 500 mg FILM-COATED TABLETS

2. What you need to know before you take Bosulif

Do not take Bosulif

• if you are allergic to bosutinib or any of the other ingredients of this medicine (listed in section 6).
• if your doctor has told you that you have liver problems and that your liver is not working normally.

Warnings and precautions

Tell your doctor, pharmacist, or nurse before you start taking Bosulif:

• if you have, or have had in the past, liver problems.Tell your doctor if you have a history of liver problems, including any type of hepatitis (infection or inflammation of the liver), or a history of any of the following signs and symptoms of liver problems: itching, yellowing of the eyes or skin, dark urine, and pain or discomfort in the upper right area of the stomach. Your doctor should perform blood tests to check your liver function before starting treatment with Bosulif and during the first 3 months of treatment with Bosulif, or as clinically indicated.

• if you have diarrheaand vomiting.Tell your doctor if you experience any of the following signs and symptoms: increased number of bowel movements per day, increased number of episodes of vomiting, blood in the vomit, in the stool, or in the urine, or black, tarry stools. Tell your doctor if treatment for vomiting may lead to a higher risk of heart rhythm problems. In particular, tell your doctor if you want to use any medicine that contains domperidone for the treatment of nausea and/or vomiting. Treatment of nausea or vomiting with medicines of this type, if used with Bosulif, may increase the risk of life-threatening heart rhythm problems.

• if you have bleeding problems.Tell your doctor if you experience any of the following signs and symptoms, such as abnormal bleeding or bruising without having had any injury.

• if you have an infection.Tell your doctor if you experience any of the following signs and symptoms, such as fever, problems with urination such as a burning sensation while urinating, new cough, or new sore throat.

• if you have fluid retention.Tell your doctor if you experience any of the following signs and symptoms of fluid retention during treatment with Bosulif, such as swelling of the ankles, feet, or legs; difficulty breathing, chest pain, or cough (all of which can be signs of fluid retention in the lungs or chest).

• if you have heart problems.Tell your doctor if you have any heart problems, such as heart failure and decreased blood flow to the heart that can cause a heart attack. Seek medical help immediately if you experience difficulty breathing, weight gain, chest pain, or swelling of the hands, ankles, or feet.

• if you have been told that you have an abnormal heart rhythm. Tell your doctor if you have arrhythmias or an abnormal electrical signal called "prolonged QT interval". These problems are always important, but even more so if you have frequent or prolonged diarrhea as mentioned earlier. If you faint (lose consciousness) or experience irregular heartbeats during treatment with Bosulif, tell your doctor immediately, as they can be signs of a serious heart condition.

• if you have been told that you have kidney problems.Tell your doctor if you urinate more frequently and produce larger amounts of pale urine, or if you urinate less frequently and produce smaller amounts of dark urine. Also, tell your doctor if you lose weight or experience swelling of the feet, ankles, legs, hands, or face.

• if you have ever had or may currently have a hepatitis B virus infection. This is because Bosulif could cause hepatitis B to become active again, which can be life-threatening in some cases. Your doctor will carefully check for signs of this infection before starting treatment.

• if you have or have had in the past pancreas problems.Tell your doctor if you experience abdominal pain or discomfort.

• if you haveany of these symptoms: severe skin rash.Tell your doctor if you experience any of the following signs and symptoms of a painful red or purple rash that spreads and if blisters and/or other lesions appear on the mucous membranes (e.g., the mouth and lips).

• if you notice any of these symptoms: side pain, blood in the urine, or decreased urine output.If your disease is very severe, your body may not be able to eliminate all the waste products from the dying cancer cells. This is known as tumor lysis syndrome and can cause kidney failure and heart problems within 48 hours of the first dose of Bosulif. Your doctor will make sure you are properly hydrated and will give you other medicines to help prevent it.

Sun/UV protection

During treatment with bosutinib, you may be more sensitive to the sun or UV rays. It is important that you cover exposed skin areas and use sunscreen with a high sun protection factor (SPF).

Children and adolescents

Bosulif is not recommended for children and adolescents under 18 years of age. This medicine has not been studied in children or adolescents.

Other medicines and Bosulif

Tell your doctor or pharmacist if you are taking, have recently taken, or might take any other medicines, including those obtained without a prescription, vitamins, and herbal medicines. Some medicines may affect the levels of Bosulif in your body. You should tell your doctor if you are using medicines that contain the following active substances:

The following active substances may increase the risk of side effects with Bosulif:

• ketoconazole, itraconazole, voriconazole, posaconazole, and fluconazole, used to treat fungal infections.
• clarithromycin, telithromycin, erythromycin, and ciprofloxacin, used to treat bacterial infections.
• nefazodone, used to treat depression.
• mibefradil, diltiazem, and verapamil, used to lower blood pressure in people with high blood pressure.
• ritonavir, lopinavir/ritonavir, indinavir, nelfinavir, saquinavir, atazanavir, amprenavir, fosamprenavir, and darunavir, used to treat HIV/AIDS.
• boceprevir and telaprevir, used to treat hepatitis C.
• aprepitant, used to prevent and control nausea and vomiting.
• imatinib, used to treat a type of leukemia.
• crizotinib, used to treat a type of lung cancer called non-small cell lung cancer.

The following active substances may reduce the effectiveness of Bosulif:

• rifampicin, used to treat tuberculosis.
• phenytoin and carbamazepine, used to treat epilepsy.
• bosentan, used to lower high blood pressure in the lungs (pulmonary hypertension).
• nafcillin, an antibiotic used to treat bacterial infections.
• St. John's Wort (a herbal medicine that can be obtained without a prescription), used to treat depression.
• efavirenz and etravirine, used to treat HIV/AIDS.
• modafinil, used to treat certain types of sleep disorders.

You should avoid using these medicines during treatment with Bosulif. If you are using any of them, tell your doctor. It may be possible for your doctor to change the dose of these medicines, change the dose of Bosulif, or have you use a different medicine.

The following active substances may affect heart rate:

• amiodarone, disopyramide, procainamide, quinidine, and sotalol, used to treat heart disorders.
• chloroquine and halofantrine, used to treat malaria.
• clarithromycin and moxifloxacin, which are antibiotics used to treat bacterial infections.
• haloperidol, used to treat psychotic disorders such as schizophrenia.
• domperidone, used to treat nausea and vomiting, or to stimulate milk production.
• methadone, used to treat pain.

These medicines should be used with caution during treatment with Bosulif. If you are taking any of them, tell your doctor.

It is possible that the medicines listed in this leaflet are not the only ones that may interact with Bosulif.

Taking Bosulif with food and drinks

Do not take Bosulif with grapefruit or grapefruit juice, as it may increase the risk of side effects.

Pregnancy, breastfeeding, and fertility

Bosulif should not be used during pregnancy unless clearly necessary, as Bosulif may harm the fetus. If you are pregnant or think you may be pregnant, ask your doctor before taking Bosulif.

Women taking Bosulif should be advised to use effective contraceptive methods during treatment and for at least 1 month after the last dose. Vomiting and diarrhea may reduce the effectiveness of oral contraceptives.

Ask for information about sperm preservation before starting treatment, if desired, due to the risk that treatment with Bosulif may reduce fertility.

If you are breastfeeding, tell your doctor. Do not breastfeed during treatment with Bosulif, as it may harm the baby.

Driving and using machines

If you experience dizziness, have blurred vision, or feel unusual fatigue, do not drive or use machines until these side effects have disappeared.

Bosulif containssodium

This medicine contains less than 1 mmol of sodium (23 mg) per 100 mg, 400 mg, or 500 mg tablet; this is essentially "sodium-free".

3. How to take Bosulif

Follow exactly the instructions of administration of this medicine given by your doctor. If you are unsure, ask your doctor or pharmacist again.

Bosulif will only be prescribed for you by a doctor who has experience with the medicines used to treat leukemia.

Dose and method of administration

The recommended dose is 400 mg once daily for patients with newly diagnosed CML. The recommended dose is 500 mg once daily for patients whose previous medicines for treating CML have not been effective or are not suitable. In case of moderate or severe kidney problems, your doctor will reduce the dose by 100 mg once daily for moderate kidney problems and by an additional 100 mg once daily for severe kidney problems. Your doctor may adjust the dose using the 100 mg tablets, depending on your health status, response to treatment, and/or side effects you may experience. Take the tablet(s) once daily, with food. Swallow the tablet(s) whole with a little water.

If you take more Bosulifthan you should

If you accidentally take too many Bosulif tablets or a higher dose than you need, go to a doctor immediately. If possible, show the doctor the pack or this leaflet. You may need medical attention.

If you forget to take Bosulif

If it has been less than 12 hours, take the recommended dose. If it has been more than 12 hours, take your next dose at the usual time the next day.

Do not take a double dose to make up for forgotten doses.

If you stop taking Bosulif

Do not stop taking Bosulif unless your doctor tells you to. If you are unable to take the medicine as directed by your doctor or think you no longer need it, consult your doctor immediately.

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

4. Possible Adverse Effects

Like all medicines, this medicine can cause adverse effects, although not all people suffer from them.

You should consult your doctor immediately if you suffer from any serious adverse effect (see also section 2 "What you need to know before starting to take Bosulif"):

Blood Disorders.Inform your doctor immediately if you have any of the following symptoms: bleeding, fever, or frequent bruising (you may have a blood or lymphatic system disorder).

Liver Disorders.Inform your doctor immediately if you have any of the following symptoms: itching, yellow eyes or skin, dark urine, and pain or discomfort in the upper right area of the stomach or fever.

Stomach/Intestinal Disorders.Inform your doctor if you experience stomach pain, heartburn, diarrhea, constipation, nausea, or vomiting.

Heart Problems.Inform your doctor if you have a heart condition, such as heart failure, decreased blood flow to the heart, an abnormal electrical signal called "prolongation of the QT interval", or if you faint (lose consciousness) or have an irregular heartbeat during treatment with Bosulif.

Reactivation of Hepatitis B Virus.Recurrence (reactivation) of hepatitis B virus infection if you have had hepatitis B in the past (a liver infection).

Severe Skin Reactions.Inform your doctor immediately if you have any of these symptoms: painful red or purple rash that spreads and if blisters and/or other lesions appear on the mucous membrane (e.g., mouth and lips).

The adverse effects that may appear with Bosulif are:

Very Common Adverse Effects (may affect more than 1 in 10 patients):

• reduction in the number of platelets, red blood cells, and/or neutrophils (a type of white blood cell).
• diarrhea, vomiting, stomach pain, nausea.
• fever, swelling of the hands, feet, or face, fatigue, weakness.
• respiratory tract infection.
• nasopharyngitis.
• alteration of blood test results to check if Bosulif is affecting the liver and/or pancreas, kidneys.
• decreased appetite.
• joint pain, back pain.
• headache.
• skin rash, with itching of the skin and/or generalized.
• cough.
• difficulty breathing.
• feeling of instability (dizziness).
• fluid in the lungs (pleural effusion).
• itching.

Common Adverse Effects (may affect up to 1 in 10 patients):

• decrease in white blood cell count (leucopenia).
• stomach irritation (gastritis), bleeding in the stomach or intestine.
• chest pain, pain.
• toxic liver lesions, abnormal liver function, including liver disorder.
• pulmonary infection (pneumonia), flu, bronchitis.
• the heart does not pump blood as it should (heart failure).
• decrease in heart rate that predisposes to fainting, dizziness, and palpitations.
• increase in blood pressure.
• increase in potassium in the blood, decrease in phosphorus in the blood, excessive loss of body fluids (dehydration).
• muscle pain.
• alteration of taste (dysgeusia).
• acute kidney failure, kidney failure, kidney deterioration.
• fluid around the heart (pericardial effusion).
• ringing in the ears (tinnitus).
• hives (urticaria), acne.
• photosensitivity reaction (sensitivity to UV rays from the sun and other light sources).
• allergic reaction.
• abnormally high blood pressure in the pulmonary arteries (pulmonary hypertension).
• acute pancreatitis.
• respiratory failure.

Uncommon Adverse Effects (may affect up to 1 in 100 patients):

• fever associated with a low white blood cell count (neutropenic fever).
• liver damage.
• life-threatening allergic reaction (anaphylactic shock).
• abnormal accumulation of fluid in the lungs (acute pulmonary edema).
• skin rash.
• inflammation of the heart or pericardium (pericarditis).
• significant decrease in the number of granulocytes (a type of white blood cell).
• severe skin disorder (erythema multiforme).
• nausea, difficulty breathing, irregular heartbeats, muscle cramps, convulsions, clouding of the urine, and fatigue related to abnormal test results (elevation of potassium, uric acid, and phosphorus in the blood and decrease in calcium in the blood) that can cause changes in kidney function and acute kidney failure (tumor lysis syndrome [TLS]).

Frequency Not Known (cannot be estimated from available data):

• severe skin disorder (Stevens-Johnson syndrome, toxic epidermal necrolysis) due to an allergic reaction, exfoliative rash (scaling)
• interstitial lung disease (disorders that cause scarring in the lungs): symptoms are cough, difficulty breathing, and painful breathing.

Reporting Adverse Effects

If you experience any type of adverse effect, consult your doctor, pharmacist, or nurse, even if it is a possible adverse effect that is not listed in this prospectus. You can also report them directly through the Spanish Medicines Monitoring System: www.notificaRAM.es. By reporting adverse effects, you can contribute to providing more information on the safety of this medicine.

5. Storage of Bosulif

• Keep this medicine out of the sight and reach of children.
• Do not use this medicine after the expiration date that appears on the aluminum foil of the blister pack and on the packaging after "EXP". The expiration date is the last day of the month indicated.
• This medicine does not require special storage conditions.
• Do not use this medicine if you notice that the packaging is damaged or shows signs of having been altered.
• Medicines should not be thrown away through wastewater or household waste. Ask your pharmacist how to dispose of packaging and medicines that are no longer needed. This will help protect the environment.

6. Package Contents and Additional Information

Bosulif Composition

• The active ingredient is bosutinib. Bosulif film-coated tablets are available in various doses.

Bosulif 100 mg: each film-coated tablet contains 100 mg of bosutinib (as monohydrate).

Bosulif 400 mg: each film-coated tablet contains 400 mg of bosutinib (as monohydrate).

Bosulif 500 mg: each film-coated tablet contains 500 mg of bosutinib (as monohydrate).

• The other ingredients are: microcrystalline cellulose (E460), sodium croscarmellose (E468), poloxamer 188, povidone (E1201), and magnesium stearate (E470b). The tablet coating contains polyvinyl alcohol, titanium dioxide (E171), macrogol 3350, talc (E553b), and yellow iron oxide (E172, in Bosulif 100 mg and 400 mg) or red iron oxide (E172, in Bosulif 400 mg and 500 mg).

Product Appearance and Package Contents

Bosulif 100 mg film-coated tablets are yellow and oval-shaped, biconvex, marked with "Pfizer" on one side and "100" on the other.

Bosulif 100 mg is marketed in blisters containing 14 or 15 tablets in packs of 28 or 30 tablets or 112 tablets.

Bosulif 400 mg film-coated tablets are orange and oval-shaped, biconvex, marked with "Pfizer" on one side and "400" on the other.

Bosulif 400 mg is marketed in blisters containing 14 or 15 tablets in packs of 28 or 30 tablets.

Bosulif 500 mg film-coated tablets are red and oval-shaped, biconvex, marked with "Pfizer" on one side and "500" on the other.

Bosulif 500 mg is marketed in blisters containing 14 or 15 tablets in packs of 28 or 30 tablets.

Only some pack sizes may be marketed.

Marketing Authorization Holder

Pfizer Europe MA EEIG

Boulevard de la Plaine 17

1050 Brussels

Belgium

Manufacturer

Pfizer Manufacturing Deutschland GmbH

Betriebsst?tte Freiburg

Mooswaldallee 1

79090 Freiburg

Germany

You can request more information about this medicine by contacting the local representative of the marketing authorization holder:

Date of Last Revision of this Prospectus:11/2024.

Detailed information about this medicine is available on the European Medicines Agency website: https://www.ema.europa.eu.