ARSENIC TRIOXIDE STADA 1 MG / ML CONCENTRATE FOR SOLUTION FOR INFUSION - patient leaflet, side effects, dosage

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 further questions, please ask your doctor or your pharmacist or nurse.

• – This medicine has been prescribed for you only. Do not pass it on to others. It may harm them, even if their signs of illness are the same as yours.

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

What is in this leaflet

• 1. What Arsenic Trioxide 1 mg/ml concentrate for solution for infusion is and what it is used for

• 2. What you need to know before you use Arsenic Trioxide 1 mg/ml concentrate for solution for infusion

• 3. How to use Arsenic Trioxide 1 mg/ml concentrate for solution for infusion

• 4. Possible side effects

• 5. How to store Arsenic Trioxide 1 mg/ml concentrate for solution for infusion

• 6. Contents of the pack and other information

1. what arsenic trioxide 1 mg/ml concentrate for solution for infusion is and what it is used for

Arsenic Trioxide 1 mg/ml concentrate for solution for infusion is used in adult patients with newly diagnosed low-to-intermediate risk acute promyelocytic leukaemia (APL), and in adult patients, whose disease has not responded to other therapies. APL is a unique type of myeloid leukaemia, a disease in which abnormal white blood cells and abnormal bleeding and bruising occur.

2. what you need to know before you use arsenic trioxide 1 mg/ml concentrate for solution for infusion

Please tell your doctor or pharmacist if you are taking or have recently taken any other medicines, including medicines obtained without a prescription.

Arsenic Trioxide 1 mg/ml concentrate for solution for infusion must be given under the supervision of a physician experienced in the treatment of acute leukaemias.

Do not use Arsenic Trioxide 1 mg/ml concentrate for solution for infusion

If you are allergic to arsenic trioxide or any of the other ingredients of this medicine (listed in section 6).

Warnings and precautions

You must talk to your doctor or nurse before using Arsenic Trioxide 1 mg/ml concentrate for solution for infusion, if

• you have impaired kidney function,
• you have any liver problems.

Your doctor will take the following precautions:

• Tests will be performed to check the amount of potassium, magnesium, calcium and creatinine in your blood before your first dose of Arsenic Trioxide 1 mg/ml concentrate for solution for infusion.
• You should have an electrical recording of the heart (electrocardiogram ECG) performed before your first dose.
• Blood tests (potassium, calcium, liver function) should be repeated during your treatment with Arsenic Trioxide 1 mg/ml concentrate for solution for infusion.
• In addition, you will receive electrocardiograms twice weekly.
• If you are at risk for a certain type of abnormal heart rhythm (e.g. torsade de pointes or QTc prolongation), your heart will be monitored continuously.
• Your doctor may monitor your health during and after treatment, since arsenic trioxide, the active substance in Arsenic Trioxide 1 mg/ml concentrate for solution for infusion, may cause other cancers. You should report any new and exceptional symptoms and circumstances whenever you see your doctor.
• Follow-up of your cognitive and mobility functions if you are at risk for vitamin B1 deficiency.

Children and adolescents

Arsenic Trioxide 1 mg/ml concentrate for solution for infusion is not recommended in children and adolescents below 18 years of age.

Other medicines and Arsenic Trioxide 1 mg/ml concentrate for solution for infusion

Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines, including medicines obtained without a prescription.

In particular tell your doctor

– if you are taking any of various types of medicines which could cause a change in the rhythm of your heartbeat.

These include:

• some types of antiarrhythmics (medicines used to correct irregular heartbeats, e.g. quinidine, amiodarone, sotalol, dofetilide),
• medicines to treat psychosis (loss of contact with reality, e.g. thioridazine),
• medicines for depression (e.g. amitriptyline),
• some types of medicines to treat bacterial infections (e.g. erythromycin and sparfloxacin),
• some medicines to treat allergies such as hayfever, called antihistamines (e.g. terfenadine and astemizole),
• any medicines that cause a decrease in magnesium or potassium in your blood (e.g. amphotericin B),
• cisapride (a medicine used to relieve certain stomach problems).

The effect of these medicines on your heartbeat can be made worse by Arsenic Trioxide 1 mg/ml concentrate for solution for infusion. You must be sure to tell your doctor about all medicines you are taking.

• – if you are taking or have recently taken any medicine which may affect your liver. If you are not sure, show the bottle or pack to your doctor.

Arsenic Trioxide 1 mg/ml concentrate for solution for infusion with food and drink

There are no restrictions on your food or drink while you are receiving this medicine.

Pregnancy

Ask your doctor or pharmacist for advice before taking any medicine.

Arsenic Trioxide 1 mg/ml concentrate for solution for infusion may cause harm to the foetus when used by pregnant women.

If you are able to become pregnant, you must use effective birth control during treatment with this medicine.

If you are pregnant or you become pregnant during the treatment with this medicine, you must ask your doctor for advice.

Men should also use effective contraception during treatment with this medicine.

Breast-feeding

Ask your doctor or pharmacist for advice before taking any medicine.

The arsenic in this medicine passes into breast milk.

Because this medicine can harm nursing infants, do not breast-feed while on Arsenic Trioxide 1 mg/ml concentrate for solution for infusion.

Driving and using machines

This medicine is expected to have no or negligible influence on your ability to drive and use machines.

If you experience discomfort or if you feel unwell after an injection, you should wait until the symptoms go away before driving or using machines.

Contains sodium

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

3. how to use arsenic trioxide 1 mg/ml concentrate for solution for infusionpatients with newly diagnosed acute promyelocytic leukaemia

Your doctor will give you this medicine once every day as an infusion. In your first treatment cycle, you may be treated every day up to 60 days at most or until your doctor determines that your disease is better. If your disease responds to this medicine, you will be given 4 additional treatment cycles of 20 doses given 5 days per week (followed by 2 days interruption) for 4 weeks followed by 4 weeks interruption. Your doctor will decide exactly how long you must continue on therapy with Arsenic Trioxide 1 mg/ml concentrate for solution for infusion.

Patients with acute promyelocytic leukaemia, whose disease has not responded to other therapies

Your doctor will give you this medicine once every day as an infusion. In your first treatment cycle, you may be treated every day up to 50 days at most or until your doctor determines that your disease is better. If your disease responds to this medicine, you will be given a second treatment cycle of 25 doses given 5 days per week (followed by 2 days interruption) for 5 weeks. Your doctor will decide exactly how long you must continue on therapy with Arsenic Trioxide 1 mg/ml concentrate for solution for infusion.

Method and route of administration

Arsenic Trioxide 1 mg/ml concentrate for solution for infusion must be diluted with a solution containing glucose or a solution containing sodium chloride.

Arsenic Trioxide 1 mg/ml concentrate for solution for infusion is normally given by a doctor or a nurse. It is given as a drip (infusion) into a vein over 1–2 hours, but the infusion may last longer if side effects like flushing and dizziness occur.

Arsenic Trioxide 1 mg/ml concentrate for solution for infusion must not be mixed with, or infused through the same tube with other medicines.

If your doctor gives you more Arsenic Trioxide 1 mg/ml concentrate for solution for infusion than he/she should

You may experience convulsions, muscle weakness and confusion. If this happens, treatment with Arsenic Trioxide 1 mg/ml concentrate for solution for infusion must be stopped immediately and your doctor will treat the arsenic overdose.

If you have any further question 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.

Tell your doctor or nurse straight away if you notice the following side effects, as these may be signs of a severe condition called “differentiation syndrome”, which might be fatal:

• – difficulty in breathing,

• – coughing,

• – chest pain, – fever.

Tell your doctor or nurse straight away if you notice one or more of the following side effects, as these may be signs of allergic reaction:

• – difficulty in breathing,

• – fever,

• – sudden weight gain,

• – water retention,

• – fainting,

• – palpitations (strong heartbeat you can feel in your chest).

While on treatment with this medicine, you may experience some of the following reactions:

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

• – fatigue (weariness), pain, fever, headache,

• – nausea, vomiting, diarrhea,

• – dizziness, muscle pain, numbness or tingling,

• – rash or itching, increased blood sugar, oedema (swelling due to excess fluid),

• – shortness of breath, fast heart beat, abnormal ECG heart tracing,

• – reduced potassium or magnesium in the blood, liver function tests abnormal including presence of excess bilirubin or gamma-glutamyltransferase in the blood.

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

• – reduction in blood cell counts (platelets, red and/or white blood cells), increased white blood cells,

• – chills, increased weight,

• – a fever due to an infection and low levels of white blood cells, herpes zoster infection,

• – chest pain, bleeding in the lung, hypoxia (low oxygen level), collection of fluid around the heart or the lung, low blood pressure, abnormal heart rhythm,

• – fit, joint or bone pain, inflammation of the blood vessels,

• – increased sodium or magnesium, ketones in the blood and urine (ketoacidosis), renal function tests abnormal, kidney failure,

• – stomach (abdominal) ache,

• – redness of the skin, swollen face, blurred vision.

Not known (frequency cannot be estimated from the available data):

• – lung infection, infection in the blood,

• – inflammation of the lungs which causes chest pain and breathlessness, cardiac failure,

• – dehydration, confusion

• – cerebral disease (Encephalopathy, Wernicke encephalopathy) with various manifestations

including difficulties to use arms and legs, speech disorders and confusion

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 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 arsenic trioxide 1 mg/ml concentrate for solution for infusion

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 ampoule label and the carton.

This medicinal product does not require any special storage condition.

After dilution with 0,9 % sodium chloride solution or 5% glucose solution, this medicine is chemically and physically stable for 24 hours at 25°C and 48 hours at refrigerated (2°C-8°C) temperatures. From a microbiological point of view, the product must be used immediately. If not used immediately, in-use storage times and conditions prior to use are the responsibility of the user and would normally not be longer than 24 hours at 2–8°C, unless dilution has taken place in controlled and validated aseptic conditions.

This medicine must not be used if you notice foreign particulate matter or if the solution is discoloured.

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- the active substance is arsenic trioxide 1 mg/ml

• – The other ingredients are sodium hydroxide, hydrochloric acid (as pH adjuster) and water for injections

What Arsenic Trioxide 1 mg/ml concentrate for solution for infusion looks like and contents of the pack

Arsenic Trioxide 1 mg/ml concentrate for solution for infusion is a concentrate for solution for infusion. This medicine is supplied in glass ampoules as a concentrated, sterile, clear, colourless, aqueous solution that is prepared and diluted at the hospital and given as an infusion into a blood vessel. Each carton contains 10 single-use glass ampoules. Each ampoule contains 10 mg of arsenic trioxide.

Marketing Authorisation Holder

STADA, Linthwaite, Huddersfield, HD7 5QH, UK

Manufacturer

STADAPHARM GmbH, Feodor-Lynen-Strasse 35, 30625, Hannover, Germany

This leaflet was last revised in May 2019

The following information is intended for medical or healthcare professionals only:

ASEPTIC TECHNIQUE MUST BE STRICTLY OBSERVED THROUGHOUT HANDLING OF ARSENIC TRIOXIDE 1 MG/ML CONCENTRATE FOR SOLUTION FOR INFUSION SINCE NO PRESERVATIVE IS PRESENT.

Dilution of Arsenic Trioxide 1 mg/ml concentrate for solution for infusion

Arsenic Trioxide 1 mg/ml concentrate for solution for infusion must be diluted before administration.

Personnel should be trained to handle and dilute arsenic trioxide and should wear appropriate protective clothing.

Opening the ampoule : Hold the ampoule of Arsenic Trioxide 1 mg/ml concentrate for solution for infusion with the coloured point upwards and in front of you. Shake or tap the ampoule to get any fluid in the stem into the body of the ampoule. Now press your thumb on the coloured point and break the ampoule by holding firmly the body of the ampoule with the other hand.

Dilution : Carefully insert the needle of a syringe into the ampoule and draw up all of the content. Arsenic Trioxide 1 mg/ml concentrate for solution for infusion must then be diluted immediately with 100 to 250 ml of glucose 50 mg/ml (5%) solution for injection or sodium chloride 9 mg/ml (0.9%) solution for injection.

Unused portions of each ampoule must be discarded properly. Do not save any unused portions for later administration.

Use of Arsenic Trioxide 1 mg/ml concentrate for solution for infusion

For single use only. Arsenic Trioxide 1 mg/ml concentrate for solution for infusion must not be mixed with or concomitantly administered in the same intravenous line with other medicinal products.

Arsenic Trioxide 1 mg/ml concentrate for solution for infusion must be administered intravenously over 1–2 hours. The infusion duration may be extended up to 4 hours if vasomotor reactions are observed. A central venous catheter is not required.

The diluted solution must be clear and colourless. All parenteral solutions must be inspected visually for particulate matter and discoloration prior to administration. Do not use the preparation if foreign particulate matter is present.

After dilution in intravenous solutions, Arsenic Trioxide 1 mg/ml concentrate for solution for infusion is chemically and physically stable for 24 hours at 25°C and 48 hours at refrigerated (2–8°C) temperatures. From a microbiological point of view, the product must be used immediately. If not used immediately, in-use storage times and conditions prior to use are the responsibility of the user and would normally not be longer than 24 hours at 2–8°C, unless dilution has taken place in controlled and validated aseptic conditions.

Procedure for proper disposal

Any unused product, any items that come into contact with the product, and waste material must be disposed of in accordance with local requirements.