AMSPARITY 40 MG SOLUTION FOR INJECTION IN PRE FILLED PEN - patient leaflet, side effects, dosage

- 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.

What is in this leaflet

• 1. What Amsparity is and what it is used for

• 2. What you need to know before you use Amsparity

• 3. How to use Amsparity

• 4. Possible side effects

• 5. How to store Amsparity

• 6. Contents of the pack and other information

1. what amsparity is and what it is used for

Amsparity contains the active substance adalimumab, a medicine that acts on your body’s immune (defence) system.

Amsparity is intended for the treatment of the following inflammatory diseases:

• rheumatoid arthritis,
• polyarticular juvenile idiopathic arthritis,
• paediatric enthesitis-related arthritis,
• ankylosing spondylitis,
• axial spondyloarthritis without radiographic evidence of ankylosing spondylitis,
• psoriatic arthritis,
• psoriasis,
• hidradenitis suppurativa,
• Crohn’s disease,
• ulcerative colitis and
• non-infectious uveitis.

The active ingredient in Amsparity, adalimumab, is a monoclonal antibody. Monoclonal antibodies are proteins that attach to a specific target in the body.

The target of adalimumab is another protein called tumour necrosis factor (TNFa), which is involved in the immune (defence) system and is present at increased levels in the inflammatory diseases listed above. By attaching to TNFa, Amsparity blocks its action and reduces the inflammation in these diseases.

Rheumatoid arthritis

Rheumatoid arthritis is an inflammatory disease of the joints.

Amsparity is used to treat rheumatoid arthritis in adults. If you have moderate to severe active rheumatoid arthritis, you may first be given other disease-modifying medicines, such as methotrexate. If these medicines do not work well enough, you will be given Amsparity to treat your rheumatoid arthritis.

Amsparity can also be used to treat severe, active and progressive rheumatoid arthritis without previous methotrexate treatment.

Amsparity can slow down the damage to the cartilage and bone of the joints caused by the disease and improve physical function.

Usually, Amsparity is used with methotrexate. If your doctor considers that methotrexate is inappropriate, Amsparity can be given alone.

Polyarticular juvenile idiopathic arthritis

Polyarticular juvenile idiopathic arthritis is an inflammatory disease of the joints that usually first appears in childhood.

Amsparity is used to treat polyarticular juvenile idiopathic arthritis in children and adolescents aged 2 to 17 years. Patients may first be given other disease-modifying medicines, such as methotrexate. If these medicines do not work well enough, patients will be given Amsparity to treat their polyarticular juvenile idiopathic arthritis.

Paediatric enthesitis-related arthritis

Paediatric enthesitis-related arthritis is an inflammatory disease of the joints and the places where tendons join the bone.

Amsparity is used to treat enthesitis-related arthritis in children and adolescents aged 6 to 17 years. Patients may first be given other disease-modifying medicines, such as methotrexate. If these medicines do not work well enough, patients will be given Amsparity to treat their enthesitis-related arthritis.

Ankylosing spondylitis and axial spondyloarthritis without radiographic evidence of ankylosing spondylitis

Ankylosing spondylitis and axial spondyloarthritis without radiographic evidence of ankylosing spondylitis, are inflammatory diseases of the spine.

Amsparity is used in adults to treat these conditions. If you have ankylosing spondylitis or axial spondyloarthritis without radiographic evidence of ankylosing spondylitis, you will first be given other medicines. If these medicines do not work well enough, you will be given Amsparity to reduce the signs and symptoms of your disease.

Psoriatic arthritis

Psoriatic arthritis is an inflammation of the joints associated with psoriasis.

Amsparity is used to treat psoriatic arthritis in adults. Amsparity can slow down the damage to the cartilage and bone of the joints caused by the disease and to improve physical function.

Plaque psoriasis in adults and children

Plaque psoriasis is an inflammatory skin condition that causes red, flaky, crusty patches of skin covered with silvery scales. Plaque psoriasis can also affect the nails, causing them to crumble, become thickened and lift away from the nail bed which can be painful. Psoriasis is believed to be caused by a problem with the body’s immune system that leads to an increased production of skin cells.

Amsparity is used to treat moderate to severe plaque psoriasis in adults. Amsparity is also used to treat severe plaque psoriasis in children and adolescents aged 4 to 17 years for whom medicines applied to the skin and treatment with UV light have either not worked very well or are not suitable.

Hidradenitis suppurativa in adults and adolescents

Hidradenitis suppurativa (sometimes called acne inversa) is a long-term and often painful inflammatory skin disease. Symptoms may include tender nodules (lumps) and abscesses (boils) that may leak pus. It most commonly affects specific areas of the skin, such as under the breasts, the armpits, inner thighs, groin and buttocks. Scarring may also occur in affected areas.

Amsparity is used to treat hidradenitis suppurativa in adults and adolescents from 12 years of age. Amsparity can reduce the number of nodules and abscesses you have and the pain that is often associated with the disease. You may first be given other medicines. If these medicines do not work well enough, you will be given Amsparity.

Crohn’s disease in adults and children

Crohn’s disease is an inflammatory disease of the gut.

Amsparity is used to treat Crohn’s disease in adults and children aged 6 to 17 years.

If you have Crohn’s disease you will first be given other medicines. If you do not respond well enough to these medicines, you will be given Amsparity to reduce the signs and symptoms of your Crohn’s disease.

Ulcerative colitis in adults and children

Ulcerative colitis is an inflammatory disease of the large intestine.

Amsparity is used to treat moderate to severe ulcerative colitis in adults and children aged 6 to 17 years. If you have ulcerative colitis you may first be given other medicines. If these medicines do not work well enough, you will be given Amsparity to reduce the signs and symptoms of your disease.

Non-infectious uveitis in adults and children

Non-infectious uveitis is an inflammatory disease affecting certain parts of the eye. This inflammation may lead to a decrease of vision and/or the presence of floaters in the eye (black dots or wispy lines that move across the field of vision). Amsparity works by reducing this inflammation.

Amsparity is used to treat

• adults with non-infectious uveitis with inflammation affecting the back of the eye.
• children from 2 years of age with chronic non-infectious uveitis with inflammation affecting the

front of the eye.

You may first be given other medicines. If these medicines do not work well enough, you will be given Amsparity to reduce the signs and symptoms of your disease.

2. what you need to know before you use amsparity

Do not use Amsparity

• if you are allergic to adalimumab or any of the other ingredients of this medicine (listed in

section 6).

• if you have a severe infection, including active tuberculosis, sepsis (blood poisoning) or

opportunistic infections (unusual infections associated with a weakened immune system). It is important that you tell your doctor if you have symptoms of infections, for example, fever, wounds, feeling tired, dental problems (see “Warnings and precautions”).

• if you have moderate or severe heart failure. It is important to tell your doctor if you have had or

have a serious heart condition (see “Warnings and precautions”).

Warnings and precautions

Talk to your doctor or pharmacist before using Amsparity.

It is important that you and your doctor record the brand name and batch number of your medication.

Allergic reactions

• If you have allergic reactions with symptoms such as chest tightness, wheezing, dizziness,

swelling or rash, do not inject more Amsparity and contact your doctor immediately, since in rare cases, these reactions can be life-threatening.

Infections

• If you have an infection, including long-term infection or an infection in one part of the body

(for example, leg ulcer), consult your doctor before starting Amsparity. If you are unsure, contact your doctor.

• You might get infections more easily while you are receiving Amsparity treatment. This risk may increase if you have problems with your lungs. These infections may be serious and include tuberculosis, infections caused by viruses, fungi, parasites or bacteria, or other opportunistic infections (unusual infectious organisms) and sepsis (blood poisoning). In rare cases, these infections may be life-threatening. It is important to tell your doctor if you get symptoms such as fever, wounds, feeling tired or dental problems. Your doctor may recommend temporarily stopping Amsparity.

Tuberculosis (TB)

• As cases of tuberculosis have been reported in patients treated with adalimumab, your doctor will check you for signs and symptoms of tuberculosis before starting Amsparity. This will include a thorough medical evaluation including your medical history and screening tests (for example chest X-ray and a tuberculin test). The conduct and results of these tests should be recorded on your patient reminder card.
• It is very important that you tell your doctor if you have ever had tuberculosis, or if you have

been in close contact with someone who has had tuberculosis.

• Tuberculosis can develop during therapy even if you have had preventative treatment for

tuberculosis.

• If symptoms of tuberculosis (for example, cough that does not go away, weight loss, lack of

energy, mild fever), or any other infection appear during or after therapy tell your doctor immediately.

Travel / recurrent infection

• Tell your doctor if you have lived or travelled in regions where fungal infections such as

histoplasmosis, coccidioidomycosis or blastomycosis are endemic (found).

• Tell your doctor if you have infections which keep coming back or other conditions that increase

the risk of infections.

• You should pay special attention to signs of infection while you are being treated with Amsparity. It is important to tell your doctor if you get symptoms of infections, such as fever, wounds, feeling tired or dental problems.

Hepatitis B virus

• Tell your doctor if you are a carrier of the hepatitis B virus (HBV), if you have active HBV

infection or if you think you might be at risk of getting HBV. Your doctor should test you for HBV. Adalimumab can reactivate HBV infection in people who carry this virus. In some rare cases, especially if you are taking other medicines that suppress the immune system, reactivation of HBV infection can be life-threatening.

Age over 65 years

• If you are over 65 years you may be more susceptible to infections while taking Amsparity. You

and your doctor should pay special attention to signs of infection while you are being treated with Amsparity. It is important to tell your doctor if you get symptoms of infections, such as fever, wounds, feeling tired or dental problems.

Surgery or dental procedures

• If you are about to have surgery or dental procedures, tell your doctor that you are taking

Amsparity. Your doctor may recommend temporarily stopping Amsparity.

Demyelinating disease

• If you have or develop demyelinating disease (a disease that affects the insulating layer around

the nerves, such as multiple sclerosis), your doctor will decide if you should receive or continue to receive Amsparity. Tell your doctor immediately if you get symptoms like changes in your vision, weakness in your arms or legs or numbness or tingling in any part of your body.

Vaccination

• Certain vaccines contain living but weakened forms of disease-causing bacteria or viruses that

may cause infections and should not be given during treatment with Amsparity. Check with your doctor before you receive any vaccines. It is recommended that, if possible, children be given all the scheduled vaccinations for their age before they start treatment with Amsparity. If you receive Amsparity while you are pregnant, your baby may be at higher risk for getting an infection for up to about five months after the last dose you received during pregnancy. It is important that you tell your baby’s doctors and other health care professionals about your Amsparity use during your pregnancy so they can decide when your baby should receive any vaccine.

Heart failure

• It is important to tell your doctor if you have had or have a serious heart condition. If you have

mild heart failure and you are being treated with Amsparity, your heart failure status must be closely monitored by your doctor. If you develop new or worsening symptoms of heart failure (e.g. shortness of breath, or swelling of your feet), you must contact your doctor immediately.

Fever, bruising, bleeding or looking pale

• In some patients the body may fail to produce enough of the blood cells that fight off infections

or help you to stop bleeding. If you develop a fever that does not go away, or you bruise or bleed very easily or look very pale, call your doctor right away. Your doctor may decide to stop treatment.

Cancer

• There have been very rare cases of certain kinds of cancer in children and adults taking

adalimumab or other TNFa blockers. People with more serious rheumatoid arthritis who have had the disease for a long time may have a higher than average risk of getting lymphoma and leukaemia (cancers that affect blood cells and bone marrow). If you take Amsparity the risk of getting lymphoma, leukaemia, or other cancers may increase. On rare occasions, an uncommon and severe type of lymphoma has been seen in patients taking adalimumab. Some of those patients were also treated with the medicines azathioprine or mercaptopurine. Tell your doctor if you are taking azathioprine or mercaptopurine with Amsparity.

• In addition, cases of non-melanoma skin cancer have been observed in patients taking

adalimumab. If new areas of damaged skin appear during or after treatment or if existing marks or areas of damage change appearance, tell your doctor.

• There have been cases of cancers, other than lymphoma in patients with a specific type of lung

disease called chronic obstructive pulmonary disease (COPD) treated with another TNFa blocker. If you have COPD, or are a heavy smoker, you should discuss with your doctor whether treatment with a TNFa blocker is appropriate for you.

Autoimmune disease

• On rare occasions, treatment with Amsparity could result in lupus-like syndrome. Contact your

doctor if symptoms such as persistent unexplained rash, fever, joint pain or tiredness occur.

Other medicines and Amsparity

Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines.

Amsparity can be taken together with methotrexate or certain disease-modifying anti-rheumatic agents (for example, sulfasalazine, hydroxychloroquine, leflunomide and injectable gold preparations), corticosteroids or pain medications including non-steroidal anti-inflammatory drugs (NSAIDs).

You should not take Amsparity with medicines containing the active substances anakinra or abatacept due to increased risk of serious infection. The combination of adalimumab as well as other TNF-antagonists and anakinra or abatacept is not recommended based upon the possible increased risk for infections, including serious infections and other potential pharmacological interactions. If you have questions, please ask your doctor.

Pregnancy and breast-feeding

You should consider the use of adequate contraception to prevent pregnancy and continue its use for at least 5 months after the last Amsparity treatment.

If you are pregnant, think you may be pregnant or are planning to have a baby, ask your doctor for advice about taking this medicine.

Amsparity should only be used during a pregnancy if needed.

According to a pregnancy study, there was no higher risk of birth defects when the mother had received adalimumab during pregnancy compared with mothers with the same disease who did not receive adalimumab.

Amsparity can be used during breast-feeding.

If you receive Amsparity during your pregnancy, your baby may have a higher risk for getting an infection. It is important that you tell your baby’s doctors and other health care professionals about your Amsparity use during your pregnancy before the baby receives any vaccine. For more information on vaccines see the “Warnings and precautions” section.

Driving and using machines

Amsparity may have a small effect on your ability to drive, cycle or use machines. Room spinning sensation (vertigo) and vision disturbances may occur after taking Amsparity.

Amsparity contains sodium

This medicine contains less than 1 mmol of sodium (23 mg) per 0.8 ml dose, that is to say essentially ‘sodium-free’.

3. how to use amsparity

Always use this medicine exactly as your doctor or pharmacist has told you. Check with your doctor or pharmacist if you are not sure. Your doctor may prescribe another strength of Amsparity if you need a different dose.

Amsparity is injected under the skin (subcutaneous use).

Adults with rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis or axial spondyloarthritis without radiographic evidence of ankylosing spondylitis

The usual dose for adults with rheumatoid arthritis, ankylosing spondylitis, axial spondyloarthritis without radiographic evidence of ankylosing spondylitis, and for patients with psoriatic arthritis is 40 mg adalimumab given every other week as a single dose.

In rheumatoid arthritis, methotrexate is continued while using Amsparity. If your doctor determines that methotrexate is inappropriate, Amsparity can be given alone.

If you have rheumatoid arthritis and you do not receive methotrexate with your Amsparity therapy, your doctor may decide to give 40 mg adalimumab every week or 80 mg every other week.

Children, adolescents and adults with polyarticular juvenile idiopathic arthritis

Children and adolescents from 2 years of age weighing 10 kg to less than 30 kg

The recommended dose of Amsparity is 20 mg every other week.

Children, adolescents and adults from 2 years of age weighing 30 kg or more

The recommended dose of Amsparity is 40 mg every other week.

Children, adolescents and adults with enthesitis-related arthritis

Children and adolescents from 6 years of age weighing 15 kg to less than 30 kg

The recommended dose of Amsparity is 20 mg every other week.

Children, adolescents and adults from 6 years of age weighing 30 kg or more

The recommended dose of Amsparity is 40 mg every other week.

Adults with psoriasis

The usual dose for adults with psoriasis is an initial dose of 80 mg (as two 40 mg injections in one day), followed by 40 mg given every other week starting one week after the initial dose. You should continue to inject Amsparity for as long as your doctor has told you. If this dose does not work well enough, your doctor may increase the dosage to 40 mg every week or 80 mg every other week.

Children and adolescents with plaque psoriasis

Children and adolescents from 4 to 17 years of age weighing 15 kg to less than 30 kg

The recommended dose of Amsparity is an initial dose of 20 mg, followed by 20 mg one week later. Thereafter, the usual dose is 20 mg every other week.

Children and adolescents from 4 to 17 years of age weighing 30 kg or more

The recommended dose of Amsparity is an initial dose of 40 mg, followed by 40 mg one week later. Thereafter, the usual dose is 40 mg every other week.

Adults with hidradenitis suppurativa

The usual dose regimen for hidradenitis suppurativa is an initial dose of 160 mg (as four 40 mg injections in one day or as two 40 mg injections per day for two consecutive days), followed by an 80 mg dose (as two 40 mg injections in one day) two weeks later. After two further weeks, continue with a dosage of 40 mg every week or 80 mg every other week, as prescribed by your doctor. It is recommended that you use an antiseptic wash daily on the affected areas.

Adolescents with hidradenitis suppurativa from 12 to 17 years of age weighing 30 kg or more

The recommended dose of Amsparity is an initial dose of 80 mg (as two 40 mg injections in one day), followed by 40 mg every other week starting one week later. If this dose does not work well enough, your doctor may increase the dosage to 40 mg every week or 80 mg every other week.

It is recommended that you use an antiseptic wash daily on the affected areas.

Adults with Crohn’s disease

The usual dose regimen for Crohn’s disease is 80 mg (as two 40 mg injections in one day) initially followed by 40 mg every other week starting two weeks later. If a faster response is required your doctor may prescribe an initial dose of 160 mg (as four 40 mg injections in one day or as two 40 mg injections per day for two consecutive days), followed by 80 mg (as two 40 mg injections in one day) two weeks later, and thereafter as 40 mg every other week. If this dose does not work well enough, your doctor may increase the dosage to 40 mg every week or 80 mg every other week.

Children and adolescents with Crohn’s disease

Children and adolescents from 6 to17 years of age weighing less than 40 kg

The usual dose regimen is 40 mg initially followed by 20 mg two weeks later. If a faster response is required, your doctor may prescribe an initial dose of 80 mg (as two 40 mg injections in one day) followed by 40 mg starting two weeks later.

Thereafter, the usual dose is 20 mg every other week. If this dose does not work well enough, your doctor may increase the dose frequency to 20 mg every week.

Children and adolescents from 6 to 17 years of age weighing 40 kg or more

The usual dose regimen is 80 mg (as two 40 mg injections in one day) initially followed by 40 mg two weeks later. If a faster response is required, your doctor may prescribe an initial dose of 160 mg (as four 40 mg injections in one day or as two 40 mg injections per day for two consecutive days) followed by 80 mg (as two 40 mg injections in one day) two weeks later.

Thereafter, the usual dose is 40 mg every other week. If this dose does not work well enough, your doctor may increase the dosage to 40 mg every week or 80 mg every other week.

Adults with ulcerative colitis

The usual Amsparity dose for adults with ulcerative colitis is 160 mg initially (as four 40 mg injections in one day or as two 40 mg injections per day for two consecutive days), then 80 mg (as two 40 mg injections in one day) two weeks later, and then 40 mg every other week. If this dose does not work well enough, your doctor may increase the dosage to 40 mg every week or 80 mg every other week.

Children and adolescents with ulcerative colitis

Children and adolescents from 6 years of age weighing less than 40 kg

The usual Amsparity dose is 80 mg (as two 40 mg injections in one day) initially followed by 40 mg (as one 40 mg injection) two weeks later. Thereafter, the usual dose is 40 mg every other week.

Patients who turn 18 years of age while on 40 mg every other week, should continue their prescribed dose.

Children and adolescents from 6 years of age weighing 40 kg or more

The usual Amsparity dose is 160 mg (as four 40 mg injections in one day or two 40 mg injections per day for two consecutive days) initially, followed by 80 mg (as two 40 mg injections in one day) two weeks later. Thereafter the usual dose is 80 mg every other week.

Patients who turn 18 years of age while on 80 mg every other week, should continue their prescribed dose.

Adults with non-infectious uveitis

The usual dose for adults with non-infectious uveitis is an initial dose of 80 mg (as two 40 mg injections in one day), followed by 40 mg given every other week starting one week after the initial dose. You should continue to inject Amsparity for as long as your doctor has told you.

In non-infectious uveitis, corticosteroids or other medicines that influence the immune system may be continued while using Amsparity. Amsparity can also be given alone.

Children and adolescents with chronic non-infectious uveitis from 2 years of age

Children and adolescents from 2 years of age weighing less than 30 kg

The usual dose of Amsparity is 20 mg every other week with methotrexate.

Your doctor may also prescribe an initial dose of 40 mg which may be administered one week prior to the start of the usual dose.

Children and adolescents from 2 years of age weighing 30 kg or more

The usual dose of Amsparity is 40 mg every other week with methotrexate.

Your doctor may also prescribe an initial dose of 80 mg which may be administered one week prior to the start of the usual dose.

Method and route of administration

Amsparity is administered by injection under the skin (by subcutaneous injection).

Detailed instructions on how to inject Amsparity, the Instructions for Use, are provided at the end of this leaflet.

If you use more Amsparity than you should

If you accidentally inject Amsparity more frequently than you should, call your doctor or pharmacist and explain that you have taken more than required. Always take the outer carton of the medicine with you, even if it is empty.

If you forget to use Amsparity

If you forget to give yourself an injection, you should inject the next dose of Amsparity as soon as you remember. Then take your next dose as you would have on your originally scheduled day, had you not forgotten a dose.

If you stop using Amsparity

The decision to stop using Amsparity should be discussed with your doctor. Your symptoms may return upon stopping 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. Most side effects are mild to moderate. However, some may be serious and require treatment. Side effects may occur at least up to 4 months after the last Amsparity injection.

Seek medical attention urgently, if you notice any of the following signs:

• severe rash, hives or other signs of allergic reaction;
• swollen face, hands, feet;
• trouble breathing, swallowing;
• shortness of breath with exertion or upon lying down or swelling of the feet.

Tell your doctor as soon as possible, if you notice any of the following:

• signs and symptoms of infection such as fever, feeling sick, wounds, dental problems, burning

on urination, feeling weak or tired or coughing;

• symptoms of nerve problems such as tingling, numbness, double vision, or arm or leg weakness;
• signs of skin cancer such as a bump or open sore that does not heal;
• signs and symptoms suggestive of blood disorders such as persistent fever, bruising, bleeding,

paleness

The signs and symptoms described above can represent the side effects listed below, which have been observed with adalimumab:

Very common (may affect more than 1 in 10 people)

• injection site reactions (including pain, swelling, redness or itching);
• respiratory tract infections (including cold, runny nose, sinus infection, pneumonia);
• headache;
• abdominal (belly) pain;
• nausea and vomiting;
• rash;
• pain in the muscles or joints.

Common (may affect up to 1 in 10 people)

• serious infections (including blood poisoning and influenza);
• intestinal infections (including gastroenteritis);
• skin infections (including cellulitis and shingles);
• ear infections;
• mouth infections (including tooth infections and cold sores);
• reproductive tract infections;
• urinary tract infection;
• fungal infections;
• joint infections;
• benign tumours;
• skin cancer;
• allergic reactions (including seasonal allergy);
• dehydration;
• mood swings (including depression);
• anxiety;
• difficulty sleeping;
• sensation disorders such as tingling, prickling or numbness;
• migraine;
• symptoms of nerve root compression (including low back pain and leg pain);
• vision disturbances;
• eye inflammation;
• inflammation of the eye lid and eye swelling;
• vertigo (sensation of room spinning);
• sensation of heart beating rapidly;
• high blood pressure;
• flushing;
• haematoma (a solid swelling with clotted blood);
• cough;
• asthma;
• shortness of breath;
• gastrointestinal bleeding;
• dyspepsia (indigestion, bloating, heart burn);
• acid reflux disease;
• sicca syndrome (including dry eyes and dry mouth);
• itching;
• itchy rash;
• bruising;
• inflammation of the skin (such as eczema);
• breaking of finger nails and toe nails;
• increased sweating;
• hair loss;
• new onset or worsening of psoriasis;
• muscle spasms;
• blood in urine;
• kidney problems;
• chest pain;
• oedema (a build-up of fluid in the body which causes the affected tissue to swell);
• fever;
• reduction in blood platelets which increases risk of bleeding or bruising;
• impaired healing.

Uncommon (may affect up to 1 in 100 people)

• opportunistic (unusual) infections (which include tuberculosis and other infections) that occur

when resistance to disease is lowered;

• neurological infections (including viral meningitis);
• eye infections;
• bacterial infections;
• diverticulitis (inflammation and infection of the large intestine);
• cancer, including cancer that affects the lymph system (lymphoma) and melanoma (a type of

skin cancer);

• immune disorders that could affect the lungs, skin and lymph nodes (most commonly as a

condition called sarcoidosis);

• vasculitis (inflammation of blood vessels);
• tremor (shaking);
• neuropathy (nerve damage);
• stroke;
• double vision;
• hearing loss, buzzing;
• sensation of heart beating irregularly such as skipped beats;
• heart problems that can cause shortness of breath or ankle swelling;
• heart attack;
• a sac in the wall of a major artery, inflammation and clot of a vein; blockage of a blood vessel;
• lung diseases causing shortness of breath (including inflammation);
• pulmonary embolism (blockage in an artery of the lung);
• pleural effusion (abnormal collection of fluid in the pleural space);
• inflammation of the pancreas which causes severe pain in the abdomen and back;
• difficulty in swallowing;
• facial oedema (swelling of the face);
• gallbladder inflammation, gallbladder stones;
• fatty liver (build up of fat in liver cells);
• night sweats;
• scar;
• abnormal muscle breakdown;
• systemic lupus erythematosus (an immune disorder including inflammation of skin, heart, lung,

joints and other organ systems);

• sleep interruptions;
• impotence;
• inflammations.

Rare (may affect up to 1 in 1,000 people)

• leukaemia (cancer affecting the blood and bone marrow);
• severe allergic reaction with shock;
• multiple sclerosis;
• nerve disorders (such as inflammation of the optic nerve to the eye, and Guillain-Barre syndrome, a condition that may cause muscle weakness, abnormal sensations, tingling in the arms and upper body);
• heart stops pumping;
• pulmonary fibrosis (scarring of the lung);
• intestinal perforation (hole in the wall of the gut);
• hepatitis (liver inflammation);
• reactivation of hepatitis B infection;
• autoimmune hepatitis (inflammation of the liver caused by the body’s own immune system);
• cutaneous vasculitis (inflammation of blood vessels in the skin);
• Stevens-Johnson syndrome (life-threatening reaction with flu-like symptoms and blistering

rash);

• facial oedema (swelling of the face) associated with allergic reactions;
• erythema multiforme (inflammatory skin rash);
• lupus-like syndrome;
• angioedema (localised swelling of the skin);
• lichenoid skin reaction (itchy reddish-purple skin rash).

Not known (frequency cannot be estimated from available data)

• hepatosplenic T-cell lymphoma (a rare blood cancer that is often fatal);
• Merkel cell carcinoma (a type of skin cancer);
• Kaposi’s sarcoma, a rare cancer related to infection with human herpes virus 8. Kaposi’s

sarcoma most commonly appears as purple lesions on the skin;

• liver failure;
• worsening of a condition called dermatomyositis (seen as a skin rash accompanying muscle weakness);
• weight gain (for most patients, the weight gain was small).

Some side effects observed with adalimumab may not have symptoms and may only be discovered through blood tests. These include:

Very common (may affect more than 1 in 10 people)

• low blood measurements for white blood cells;
• low blood measurements for red blood cells;
• increased lipids in the blood;
• raised liver enzymes.

Common (may affect up to 1 in 10 people)

• high blood measurements for white blood cells;
• low blood measurements for platelets;
• increased uric acid in the blood;
• abnormal blood measurements for sodium;
• low blood measurements for calcium;
• low blood measurements for phosphate;
• high blood sugar;
• high blood measurements for lactate dehydrogenase;
• autoantibodies present in the blood;
• low blood potassium.

Uncommon (may affect up to 1 in 100 people)

• raised bilirubin measurement (liver blood test).

Rare (may affect up to 1 in 1,000 people)

• low blood measurements for white blood cells, red blood cells and platelet count.

Reporting of side effects

If you get 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 via the Yellow Card Scheme at: 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 amsparity

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 / carton after EXP.

Store in a refrigerator (2°C –8°C). Do not freeze.

Keep the pre-filled pen in the outer carton in order to protect from light.

Alternative Storage:

When needed (for example, when you are travelling), a single Amsparity pre-filled pen may be stored at room temperature (up to 30°C) for a maximum period of 30 days – be sure to protect it from light.

Once removed from the refrigerator for room temperature storage, the pen must be used within

• 30 days or discarded , even if it is returned to the refrigerator.

You should record the date when the pen is first removed from refrigerator and the date after which it should be discarded.

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

6. contents of the pack and other information

What Amsparity contains

The active substance is adalimumab.

The other ingredients are L-histidine, L-histidine hydrochloride monohydrate, sucrose, edetate disodium dihydrate, L-methionine, polysorbate 80, and water for injections.

What the Amsparity pre-filled pen looks like and contents of the pack

Amsparity 40 mg solution for injection in pre-filled pen is supplied as a sterile solution of 40 mg adalimumab dissolved in 0.8 ml solution.

The Amsparity pre-filled pen contains a clear, colourless to very light brown solution of adalimumab.

Each pack contains 1, 2, 4 or 6 pre-filled pens for patient use with 2 (1 spare), 2, 4 or 6 alcohol pads, respectively.

Not all pack sizes may be marketed.

Amsparity may be available as a vial, a pre-filled syringe and/or a pre-filled pen.

Marketing Authorisation Holder

Pfizer Limited

Ramsgate Road

Sandwich

Kent

CT13 9NJ

United Kingdom

Manufacturer

Pfizer Service Company BVBA

Hoge Wei 10

Zaventem 1930

Belgium

United Kingdom

For any information about this medicine, please contact:

Medical Information, Pfizer Ltd, Walton Oaks, Dorking Road, Tadworth, Surrey, KT20 7NS.

Telephone 01304 616161.

This leaflet was last revised in 07/2021.

Ref: bAY 3_0

INSTRUCTIONS FOR USE

Amsparity (adalimumab) Single-dose Pre-filled Pen 40 mg for subcutaneous injection

Keep this leaflet. These instructions show step-by-step how to prepare and give an injection. Store your Amsparity pen in the refrigerator between 2°C to 8°C.

Store Amsparity pen in the original carton until use to protect from direct sunlight. If needed, for example when you are traveling, you may store Amsparity pen at room temperature up to 30°C for up to 30 days.

Keep Amsparity, injection supplies, and all other medicines out of the reach of children.

Amsparity for injection comes in a disposable single use pen that contains a single dose of medicine. Do not try to inject Amsparity yourself until you have read and understood the Instructions for Use. If your doctor, nurse or pharmacist decides that you or a caregiver may be able to give your injections of Amsparity at home, you should receive training on the correct way to prepare and inject Amsparity. It is also important to talk to your doctor, nurse or pharmacist to be sure you understand your Amsparity dosing instructions. To help you remember when to inject Amsparity, you can mark your calendar ahead of time. Talk to your doctor, nurse or pharmacist if you or your caregiver have any questions about the correct way to inject Amsparity.

After proper training, Amsparity for injection can be self-administered or given by a caregiver.

• 1. Supplies you need

• You will need the following supplies for each injection of Amsparity. Find a clean, flat surface to place the supplies on.

o 1 Amsparity pen, inside the carton

o 1 alcohol swab, inside the carton

o 1 cotton ball or gauze pad (not included in your Amsparity carton)

o A suitable sharps container (not included in your Amsparity carton). Important: If you have any questions about your Amsparity pen or medicine, talk to your doctor, nurse or pharmacist.

• 2. Getting ready

• Remove the Amsparity carton from the refrigerator.
• Take out 1 Amsparity pen and the alcohol swab. Keep your pen out of direct sunlight. Put the

original carton with any unused pens back in the refrigerator.

• Do not use your pen if:

o your pen or the carton containing the pen has been dropped, even if it looks undamaged o it has been frozen or thawed

o it appears to be damaged

o the seals on a new carton are broken

o it has been out of the refrigerator for more than 30 days o the expiration date has passed.

• If any of the above apply, dispose of your pen in the same way as a used pen. You will need a

new pen to give your injection.

• Your pen may be used straight from the refrigerator.
• You may find that using your pen at room temperature reduces stinging or discomfort. Leave

your pen at room temperature away from direct sunlight for 15 to 30 minutes before your injection.

• Wash your hands with soap and water, and dry completely.
• Do not remove the cap until you are ready to inject.
• Look carefully at your medicine in the window.
• Gently tilt your pen back and forth to check the medicine.
• Do not shake your pen. Shaking can damage your medicine.
• Make sure the medicine in the pen is clear and colourless to very light brown and free from

flakes or particles. It is normal to see one or more air bubbles in the window. Do not attempt to remove air bubbles.

If you have any questions about your medicine, please talk to your doctor, nurse or pharmacist.

• Choose a different site each time you give yourself an injection.
• Do not inject into bony areas or areas on your skin that are bruised, red, sore (tender) or hard.

Avoid injecting into areas with scars or stretch marks.

o If you have psoriasis, do not inject directly into any raised, thick, red, or scaly skin patches or lesions on your skin.

• Do not inject through your clothes.
• Wipe the injection site with the alcohol swab.
• Allow the injection site to dry.
• Twist and pull off the cap.
• Throw the cap away into a sharps disposal container; it is not needed again.
• It is normal to see a few drops of medicine at the needle tip when you remove the cap.

Caution: Handle your pen with care to avoid an accidental needle stick injury.

Note: The needle cover stays inside the cap after removal.

• Push your pen firmly against the skin at 90 degrees, as shown.

Note: The needle goes into the skin as you push your pen down. The injection button will unlock when you are pushing the pen down firmly enough.

• Keep your pen pushed against the skin until Step 8.

Note: Do not re-insert the needle into your skin if you change your mind about where to inject. You will need a replacement pen if the needle has already been inserted into the skin.

• Press the injection button all the way down and you will hear a click. You may take your finger

off the injection button when the injection has started.

• Keep holding your pen firmly against the skin while the orange bar moves across the window.

This usually takes 3 to 10 seconds to deliver the dose.

• Wait for at least 5 more seconds after the 2nd click to allow the medicine to be absorbed.

Note: If you cannot press down the injection button, it is because you are not pushing the pen down firmly enough. Take your finger off the injection button and push your pen down more firmly against the skin. Then try pushing the button again. If this does not work, stretching or pinching the skin may make the injection site firmer, making pressing the injection button easier.

• Do not remove your pen until you have waited at least 5 seconds after the 2nd click.
• Remove your pen from the skin.

Note: After you remove your pen from the skin, the needle will be automatically covered.

• If you see more than a small drop of medicine on the skin after your injection, next time you

inject wait a little longer to remove the pen from the skin.

You should see an orange bar in the window.

If the window has not turned orange, or if it looks like the medicine is still injecting, this means you have not received a full dose. Talk to your doctor, nurse or pharmacist right away.

Do not inject another dose.

Dispose of the pen straight away as instructed by your doctor, nurse or pharmacist and in accordance with local health and safety laws.

• Look closely at your injection site. If there is blood, use a clean cotton ball or gauze pad to press

lightly on the injection area for a few seconds.

• Do not rub the injection site.