Actikerall 5 mg / g + 100 mg / g cutaneous solution – patient leaflet, side effects, dosage

1. What Actikerall is and what it is used for

Actikerall contains two active substances, fluorouracil and salicylic acid. Fluorouracil belongs to a group of medicines known as antimetabolites, which inhibit the growth of cells (cytostatic agent). Salicylic acid is a substance to soften hard skin. Actikerall is a solution to treat actinic keratosis (grade I/II) in adult patients with a healthy immune system.

Actinic keratoses are small crusty, scaly or crumbly patches of skin. They may be red or light brown or have the same colour as your skin. They may be dry or rough to touch and they are sometimes easier to feel than see.

These skin changes commonly occur in people that have had a lot of sun exposure.

2. What you need to know before you use Actikerall

Do not use Actikerall

• if you are allergic to fluorouracil, salicylic acid or any of the other ingredients of this medicine (listed in section 6).
• while breast-feeding.
• during pregnancy, and if there is a possibility that you might be pregnant.
• if you have kidney problems.
• if it could come into contact with the eyes, the inside of the mouth or nose or the genitals (mucous membranes).

Certain other medicines can intensify the side effects of Actikerall or lead to other side effects. See ‘Other medicines and Actikerall’ below.

Warnings and precautions

Talk to your doctor or pharmacist before using Actikerall

• if you know that you do not have any activity of the enzyme dihydropyrimidine dehydrogenase (DPD) (complete DPD deficiency). It is important that you do not apply more Actikerall than indicated in section 3 of this package leaflet.
• if you suffer from a reduced ability to sense touch, pain and temperature (if you have diabetes, for example). In this case, your treatment areas must be closely monitored by your doctor.
• Actikerall should not be used on bleeding lesions.
• The area treated should be protected against direct sunlight as much as possible while using Actikerall and the patient must not use a sunlamp or sun bed.
• There is no experience with Actikerall for the treatment of skin cancers such as rodent ulcer (BCC) and Bowen's disease, which should therefore not be treated with the product.
• In treating an area with actinic keratosis that is also affected by another skin disease it should be taken into account that the outcome of treatment may differ.
• There is no experience with Actikerall for repeated treatment cycles in patients with actinic keratosis or for retreatment, if a lesion comes back.

Children and adolescents

Actikerall should not be used in children or adolescents under 18 years of age. Children usually do not get actinic keratosis.

Other medicines and Actikerall

Tell your doctor or pharmacist, if you are using, have recently taken or might take any other medicines. If several medicines are taken at the same time, the effect of individual medicines can be intensified or weakened.

In particular tell your doctor, if you take any of the following:

• medicines used to treat viruses such as chicken pox or shingles (brivudine, sorivudine or similar medicines). You must not use Actikerall, if you are using or have used any of these medicines in the past 4 weeks as it may result in increased side effects.
• epilepsy medicine (phenytoin). Using Actikerall may lead to elevated blood levels of phenytoin.
• medicine used to treat cancer and auto-immune diseases (methotrexate). This medicine may interact with Actikerall causing undesirable effects.
• medicine used to treat diabetes (sulfonylureas). This medicine may interact with Actikerall causing undesirable effects.

Pregnancy, breast-feeding and fertility

You must not use Actikerall while breast-feeding, during pregnancy and if there is a possibility that you might be pregnant.

Driving and using machines

No special precautions are required.

Actikerall contains dimethyl sulfoxide and ethanol. Dimethyl sulfoxide may be irritant to the skin. This medicine contains 160 mg of alcohol (ethanol) in each gram. It may cause burning sensation on damaged skin.

3. How to use Actikerall

Always use this medicine exactly as your doctor has told you. Check with your doctor or pharmacist, if you are not sure.

Dosage

Actikerall should be applied once daily unless your doctor has told you otherwise. If you have an actinic keratosis in an area of thin skin e.g. around the eyes and temple, your doctor may tell you to apply Actikerall less frequently. If severe side effects occur, reduce the frequency of drug application to three times per week until the side effects improve. It may also be necessary for your doctor to monitor your treatment more often. Method of administration

For application to the skin (cutaneous use).

• Remove the white film on your skin from the previous day’s application by gently peeling it off (unless this is the first time you have used this medicine). Warm water may help to remove the film.
• To open the bottle, press the lid down and turn (Fig. 1).
• Remove excess solution from the brush by wiping it in the inner side of the neck of the bottle. Although allowing enough product for film formation upon drying.
• Dab the solution on the actinic keratosis once daily.
• Multiple actinic keratoses (up to 10 lesions) can be treated simultaneously, but do not use on large areas of skin.
• The total area of skin being treated with Actikerall at any one time should not exceed 25 cm² (5 cm x 5 cm).
• Let the solution dry and form a film.
• Do not cover with a dressing.

• Close the bottle tightly to prevent it drying out (Fig. 2). If Actikerall dries out, it must not be used any longer. Do not use Actikerall if you notice any crystals.

  • Do not apply to hairy skin due to sticking together of the hair in the skin area where Actikerall is applied, making it difficult to remove the film. When applied to hairy skin, a shave or other suitable methods of hair removal should be considered prior to any application.

Further instructions

Actikerall must not be allowed to come into contact with the eyes, the inside of the mouth or nose or the genitals (mucous membranes).

Actikerall solution may permanently stain clothing, fabric or acrylics (such as acrylic bathtubs), so avoid contact with them.

Caution flammable: keep away from fire and do not use near an open flame, lit cigarette or some devices (e.g. hairdryers).

Consult your doctor regularly during treatment.

Duration of treatment

Actikerall is applied to actinic keratoses once daily until the lesions have completely cleared or for up to a maximum of 12 weeks. Improvement of actinic keratoses can be seen as early as 4 weeks after starting treatment and the improvement increases over time up to 12 weeks. The clearance of actinic keratoses may continue for up to 8 weeks after stopping treatment. Treatment should be continued even in the absence of any effect after the first 4 weeks.

If you have the impression that the effect of Actikerall is too strong or too weak, talk to your doctor or pharmacist.

If you use more Actikerall than you should

If you apply Actikerall more often than once daily, you will be more likely to experience skin reactions and they may be more severe. In this case, please contact your doctor.

If you forget to use Actikerall

Do not use a double dose to make up for a forgotten dose. Continue your treatment as the doctor has told you or as described in this leaflet.

If you stop using Actikerall

Please contact your doctor, if you want to stop treatment.

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.

Mild to moderate irritation and inflammation at the site of application occur in the majority of patients treated with Actikerall. If these reactions get severe, please contact your treating doctor.

As this medicine has a very strong softening effect on the skin, whitish discolorations and scaling of the skin may occur.

The salicylic acid in Actikerall may cause slight irritation, such as skin inflammation (dermatitis) and contact allergic reactions, in patients with sensitive skin or allergy to salicylic acid. Symptoms of contact allergic reactions may include itching, reddening and small blisters even outside the area of application.

Side effects can occur with the following frequencies:

Very common, may affect more than 1 in 10 people

• reactions at the application site

  • skin redness (erythema), inflammation, irritation (including burning), pain, itch Common, may affect up to 1 in 10 people
• headache
• skin scaling (exfoliation)

• reactions at the application site

  • mild bleeding, loss of the top layer of skin (erosion), scab

Uncommon, may affect up to 1 in 100 people

• dry eye, itching eye, increased watery eyes (lacrimation)

• reactions at the application site

  • skin inflammation (dermatitis), swelling (oedema), ulcer

Mild bleeding, loss of the top layer of skin (erosion), scab, swelling (oedema), ulcer and skin inflammation (dermatitis) frequencies were one category higher in one study when applying Actikerall on an affected area of 25 cm²

Reporting of side effects

If you get 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 Yellow Card Scheme Website: mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store. By reporting side effects you can help provide more information on the safety of this medicine.

5. How to store Actikerall

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 label and on the carton after EXP. The expiry date refers to the last day of that month. Do not store above 25 ºC. Do not refrigerate or freeze. Keep the bottle tightly closed to prevent drying up.

Caution flammable: keep away from fire and do not use near an open flame, lit cigarette or some devices (e.g. hairdryers).

Do not use Actikerall 3 months after first opening of the bottle.

Do not use Actikerall if you notice crystals.

Do not throw away any medicines via wastewater <or household waste>. Ask your pharmacist how to throw away medicines you no longer use. These measures will help to protect the environment.

6. Contents of the pack and other information

What Actikerall contains

The active substances are fluorouracil and salicylic acid.

1 g (= 1.05 ml) of cutaneous solution contains 5 mg of fluorouracil and 100 mg of salicylic acid.

The other ingredients are: dimethyl sulfoxide; ethanol, anhydrous; ethyl acetate; pyroxyline; poly(butyl methacrylate, methyl methacrylate).

What Actikerall looks like and contents of the pack

Actikerall is a clear, colourless to slightly orange-white cutaneous solution. This medicinal product is packed in a brown glass bottle with a child resistant closure of white polypropylene in a cardboard carton. The closure of the bottle is connected to a brush with which to apply the solution. The brush applicator consists of plastic (polyethylene) with brush hairs of nylon secured in shaft with stainless steel (V2A). Pack size: bottle containing 25 ml cutaneous solution.

Marketing Authorisation Holder and Manufacturer

Almirall Hermal GmbH

Scholtzstrasse 3, 21465 Reinbek - Germany

This medicinal product is authorised in the Member States of the EEA under the following names:

This leaflet was last revised in 01/2023

00000000 / GB / 0123 Package leaflet: Information for the patient

Actikerall 5 mg/g + 100 mg/g Cutaneous Solution

fluorouracil + salicylic acid

Section 3 continued overleaf