OMNITROPE 10 mg/1.5 ml INJECTABLE SOLUTION IN CARTRIDGE

2. What you need to know before you use Omnitrope

Do not use Omnitrope

• if you are allergic (hypersensitive) to somatropin or any of the other ingredients of Omnitrope.
• and tell your doctor if you have an active tumor (cancer). Tumors must be inactive and you must have finished your anti-tumor treatment before starting treatment with Omnitrope.
• and tell your doctor if you have been prescribed Omnitrope to stimulate growth but you have already stopped growing (epiphyses closed).
• if you are seriously ill (for example, post-surgical complications to open heart, abdominal surgery, accidental trauma, acute respiratory failure, or similar conditions). If you are going to have or have had a major operation, or if you are going to the hospital for any reason, tell your doctor and remind the other doctors you see that you are using growth hormone.

Warnings and precautions

Consult your doctor before starting Omnitrope.

• If you are receiving glucocorticoid replacement therapy, you should consult your doctor regularly as it may be necessary to adjust your glucocorticoid dose.
• If you are at risk of developing diabetes, your doctor should regularly check your blood glucose levels during treatment with somatropin.
• If you have diabetes mellitus, you should closely monitor your blood glucose levels during treatment with somatropin and discuss the results with your doctor to decide if you need to change the dose of your diabetes medications.
• After starting treatment with somatropin, some patients may need to start thyroid hormone replacement.
• If you are receiving thyroid hormone treatment, it may be necessary to adjust your thyroid hormone dose.
• If you have increased intracranial pressure (which causes symptoms such as severe headache, visual disturbances, or vomiting), you should inform your doctor.
• If you start limping or develop a limp during treatment with growth hormone, you should inform your doctor.
• If you are receiving somatropin for a growth hormone deficiency after a previous tumor (cancer), you should be regularly examined to detect any recurrence of the tumor or any other cancer.
• If you experience worsening abdominal pain, you should inform your doctor.
• Experience in patients over 80 years is limited. Elderly people may be more sensitive to the effects of somatropin and may be more prone to adverse reactions.
• Omnitrope may cause pancreatitis, which causes severe abdominal and back pain. Contact your doctor if you or your child experience stomach pain after administration of Omnitrope.
• Lateral curvature of the spine (scoliosis) may increase in any child during rapid growth. Your doctor will examine you (or your child) for signs of scoliosis during treatment with somatropin.

Children with chronic renal failure

• Your doctor should examine your kidney function and growth rate before starting treatment with somatropin. Medical treatment for your kidneys should continue. Treatment with somatropin should be interrupted in case of kidney transplant.

Children with Prader-Willi syndrome

• Your doctor will give you dietary restrictions to follow to control your weight.
• Your doctor will assess signs of upper airway obstruction, sleep apnea (where breathing stops during sleep), or respiratory infection before starting treatment with somatropin.
• During treatment with somatropin, inform your doctor if you experience signs of upper airway obstruction (including starting to snore or worsening of snoring). Your doctor may need to examine you and may interrupt treatment with somatropin.
• During treatment, your doctor will examine you for signs of scoliosis, a type of spinal deformity.
• During treatment, if you experience a lung infection, inform your doctor so that they can treat the infection.

Children born too small or underweight

• If you were too small or underweight at birth and are between 9 and 12 years old, consult your doctor specifically about puberty and treatment with this medicine.
• Treatment should continue until you have stopped growing.
• Your doctor will examine your glucose and insulin levels before starting treatment and every year during treatment.

Using Omnitrope with other medicines

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 Omnitrope or the other medicines:

• medicines for diabetes;
• thyroid hormones;
• medicines to control epilepsy (anticonvulsants);
• cyclosporin (a medicine that weakens the immune system after transplants);
• oral estrogens or other sex hormones;
• synthetic adrenal hormones (corticosteroids).

Your doctor may need to adjust the dose of these medicines or the dose of somatropin.

Pregnancy and breastfeeding

Do not use Omnitrope if you are pregnant or trying to become pregnant.

Consult your doctor or pharmacist if you are pregnant or breastfeeding. The reason is that benzyl alcohol may be formed in your body and cause side effects (called "metabolic acidosis").

Important information about some of the ingredients of Omnitrope

This medicine contains less than 1 mmol of sodium (23 mg) per ml; it is essentially "sodium-free".

Omnitrope 5 mg/1.5 ml solution for injection:

This medicine contains 9 mg of benzyl alcohol in each ml. Benzyl alcohol may cause allergic reactions.

Benzyl alcohol has been linked to the risk of serious side effects, including respiratory problems (called "gasping syndrome") in small children.

Do not give it to your newborn baby (up to 4 weeks old), unless your doctor recommends it.

If you have liver or kidney disease, consult your doctor or pharmacist. The reason is that large amounts of benzyl alcohol may be formed in your body and cause side effects (called "metabolic acidosis").

Due to the presence of benzyl alcohol, the medicine should not be given to premature or newborn babies. It may cause toxic and allergic reactions in children up to 3 years old.

Do not use it for more than one week in small children (under 3 years old), unless your doctor or pharmacist advises you to.

3. How to use Omnitrope

Follow the administration instructions of this medication exactly as indicated by your doctor, pharmacist, or nurse. In case of doubt, consult your doctor, pharmacist, or nurse again.

The dose depends on your size, the condition being treated, and how well the growth hormone works in you. All people are different. Your doctor will advise you on your individualized dose of Omnitrope in milligrams (mg) based on your body weight in kilograms (kg) or body surface area, calculated from your height and weight in square meters (m2), as well as your treatment regimen. Do not change the dosage and treatment regimen without consulting your doctor.

The recommended dose is for:

Children with growth hormone deficiency:

0.025 to 0.035 mg/kg body weight per day or 0.7 to 1.0 mg/m2 body surface area per day. Higher doses may be used. When growth hormone deficiency continues during adolescence, Omnitrope should be continued until physical development is complete.

Girls with Turner syndrome:

0.045 to 0.050 mg/kg body weight per day or 1.4 mg/m2 body surface area per day.

Children with chronic renal failure:

0.045 to 0.050 mg/kg body weight per day or 1.4 mg/m2 body surface area per day. Higher doses may be necessary if the growth rate is too low. A dose adjustment may be necessary after six months of treatment.

Children with Prader-Willi syndrome:

0.035 mg/kg body weight per day or 1.0 mg/m2 body surface area per day. The daily dose should not exceed 2.7 mg. Treatment should not be used in children who have almost stopped growing after puberty.

Children born smaller or with lower weight than expected and with a growth disorder:

0.035 mg/kg body weight per day or 1.0 mg/m2 body surface area per day. It is essential to continue treatment until final height is reached. Treatment should be discontinued after the first year if there is no response, or if final height has been reached and growth has stopped.

Adults with growth hormone deficiency:

If you continue using Omnitrope after childhood treatment, you should start with 0.2 to 0.5 mg per day.

This dosage should be gradually increased or decreased based on blood test results, as well as clinical response and side effects.

If growth hormone deficiency begins during adulthood, you should start with 0.15 to 0.3 mg per day. This dosage should be gradually increased based on blood test results, as well as clinical response and side effects. The daily maintenance dose is rarely more than 1.0 mg per day. Women may need higher doses than men. The dosage should be monitored every six months. People over 60 years old should start with a dose of 0.1 to 0.2 mg per day, which should be gradually increased according to individual needs. The minimum effective dose should be used. The maintenance dose rarely exceeds 0.5 mg per day. Follow the instructions given by your doctor.

Omnitrope injection

Inject the growth hormone at about the same time every day. Bedtime is a good time because it is easy to remember. Additionally, it is natural to have a higher concentration of growth hormone at night.

Omnitrope 5 mg/1.5 ml in a cartridge for SurePal 5 is intended for multiple uses. It should only be administered with SurePal 5, an injection device specifically developed for use with Omnitrope 5 mg/1.5 ml injectable solution.

Omnitrope 10 mg/1.5 ml in a cartridge for SurePal 10 is intended for multiple uses. It should only be administered with SurePal 10, an injection device specifically developed for use with Omnitrope 10 mg/1.5 ml injectable solution.

Omnitrope 15 mg/1.5 ml in a cartridge for SurePal 15 is intended for multiple uses. It should only be administered with SurePal 15, an injection device specifically developed for use with Omnitrope 15 mg/1.5 ml injectable solution.

Omnitrope is indicated for subcutaneous use. This means it is injected through a small needle into the fatty tissue under the skin. Most people inject themselves in the thigh or buttocks. Put the injection in the site that your doctor has taught you. The fatty tissue of the skin may be reduced at the injection site. To avoid this, use a slightly different site each time you inject yourself. This gives the skin and the area underneath it time to recover from an injection before receiving another one in the same spot.

Your doctor should have already taught you how to use Omnitrope. Always inject Omnitrope as your doctor has told you. If you are unsure, check with your doctor or pharmacist.

How to inject Omnitrope

The following instructions explain how to inject Omnitrope yourself. Read the instructions carefully and follow them step by step. Your doctor or nurse will teach you how to inject Omnitrope. Do not attempt to inject yourself unless you are sure you understand the procedure and what the injection involves.

• Omnitrope is administered as an injection under the skin.
• Inspect the solution carefully before injecting it and use it only if it is clear and colorless.
• Change the injection site to minimize the risk of local lipoatrophy (reduction of fatty tissue under the skin).

If you use more Omnitrope than you should

If you inject much more than you should, consult your doctor or pharmacist as soon as possible. Your blood sugar levels may drop too low and then rise too high. You may feel tremors, sweating, drowsiness, or "not like yourself," and you may faint.

If you forget to use Omnitrope

Do not use a double dose to make up for forgotten doses. It is best to use the growth hormone regularly. If you forget to use a dose, put the next injection at the usual time, the next day. Take note of the forgotten injections and inform your doctor at the next check-up.

If you stop treatment with Omnitrope

Consult your doctor before stopping the use of Omnitrope.

If you have any other questions about the use of this medication, ask your doctor, pharmacist, or nurse.

4. Possible side effects

Like all medicines, this medicine can cause side effects, although not everybody gets them. Very common and common side effects in adults may start in the first few months of treatment and may stop spontaneously or if the dose is reduced.

Very common side effects (which may affect more than 1 in 10 patients) include:

• Joint pain
• Water retention (which appears as swelling of the fingers or ankles, during a brief period at the start of treatment)
• Redness, itching, or pain at the injection site

Common side effects (which may affect less than 1 in 10 patients) include:

• Itchy rashes on the skin
• Skin rash
• Numbness, tingling
• Stiffness of the arms and legs, muscle pain

In adults

• Pain or tingling sensation in the hands or forearms (known as carpal tunnel syndrome)

Uncommon side effects (which may affect less than 1 in 100 patients) include:

• Enlargement of the breasts (gynecomastia)
• Itching

Rare side effects (which may affect less than 1 in 1,000 patients) include:

In children

• Leukemia (has been observed in a small number of patients with growth hormone deficiency, some of whom had been treated with somatropin. However, there is no indication that the incidence of leukemia is higher in growth hormone recipients without predisposing factors)
• Increased intracranial pressure (which causes symptoms such as severe headache, visual disturbances, or vomiting)

Frequency not known (cannot be estimated from the available data)

• Type 2 diabetes
• Decreased cortisol hormone levels in the blood
• Facial swelling
• Headache
• Hypothyroidism

In adults

• Increased intracranial pressure (which causes symptoms such as severe headache, visual disturbances, or vomiting)

Formation of antibodies against the injected growth hormone, but these do not seem to make the growth hormone stop working.

The skin around the injection site may become irregular or lumpy, but this should not happen if you inject in a different place each time.

There have been rare cases of sudden death in patients with Prader-Willi syndrome. However, these cases have not been related to treatment with Omnitrope.

Your doctor may consider a slipped capital femoral epiphysis or Legg-Calvé-Perthes disease if you experience discomfort or pain in the hip or knee while being treated with Omnitrope.

Other possible side effects related to your treatment with growth hormone may include:

You (or your child) may have high blood sugar levels or low thyroid hormone levels. Your doctor can check this and, if necessary, prescribe the appropriate treatment. In rare cases, pancreatitis has been observed in patients treated with growth hormone.

Reporting side effects

If you experience any side effects, consult your doctor, pharmacist, or nurse, even if it is a possible side effect not listed in this leaflet. You can also report them directly through the national reporting system included in Appendix V. By reporting side effects, you can help provide more information on the safety of this medicine.

5. Storage of Omnitrope

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

Do not use this medicine after the expiration date that appears on the label and carton after EXP. The expiration date is the last day of the month indicated.

• Store and transport refrigerated (between 2°C and 8°C).
• Do not freeze.
• Store in the original packaging to protect it from light.
• After the first injection, the cartridge should remain in the pen and should be stored in a refrigerator, at a temperature of 2 to 8 °C, and should only be used for a maximum of 28 days.

Do not use Omnitrope if you notice that the solution is cloudy.

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. Container contents and additional information

Composition of Omnitrope 5 mg/1.5 ml

• The active substance of Omnitrope is somatropin.

Each ml of solution contains 3.3 mg of somatropin (which corresponds to 10 IU).

A cartridge contains 5.0 mg (which corresponds to 15 IU) of somatropin in 1.5 ml.

• The other ingredients are:

Disodium hydrogen phosphate heptahydrate

Sodium dihydrogen phosphate dihydrate

Mannitol

Poloxamer 188

Benzyl alcohol

Water for injections

Composition of Omnitrope 10 mg/1.5 ml

• The active substance of Omnitrope is somatropin.

Each ml of solution contains 6.7 mg of somatropin (which corresponds to 20 IU).

A cartridge contains 10.0 mg (which corresponds to 30 IU) of somatropin in 1.5 ml.

• The other ingredients are:

Disodium hydrogen phosphate heptahydrate

Sodium dihydrogen phosphate dihydrate

Glycine

Poloxamer 188

Phenol

Water for injections

Composition of Omnitrope 15 mg/1.5 ml

• The active substance of Omnitrope is somatropin.

Each ml of solution contains 10 mg of somatropin (which corresponds to 30 IU).

A cartridge contains 15.0 mg (which corresponds to 45 IU) of somatropin in 1.5 ml.

• The other ingredients are:

Disodium hydrogen phosphate heptahydrate

Sodium dihydrogen phosphate dihydrate

Sodium chloride

Poloxamer 188

Phenol

Water for injections

Appearance and container contents

Omnitrope is a clear and colorless injectable solution.

Omnitrope 5 mg/1.5 ml solution for injection is for use only with SurePal 5.

Omnitrope 10 mg/1.5 ml solution for injection is for use only with SurePal 10.

Omnitrope 15 mg/1.5 ml solution for injection is for use only with SurePal 15.

Packs containing 1, 5 or 10 cartridges.

Only certain pack sizes may be marketed.

Marketing authorisation holder

Sandoz GmbH

Biochemiestr. 10

A-6250 Kundl

Austria

Manufacturer

Sandoz GmbH

Biochemiestr. 10

A-6336 Langkampfen

Austria

Novartis Pharmaceutical Manufacturing GmbH

Biochemiestr. 10

A-6336 Langkampfen

Austria

Date of last revision of this leaflet: {MM/YYYY}.

Detailed information on this medicinal product is available on the European Medicines Agency website: http://www.ema.europa.eu.

Further information about this medicinal product is available on the website of the European Medicines Agency: http://www.ema.europa.eu.

You can request more information about this medicinal product from the local representative of the marketing authorisation holder: