ETOPOPHOS 100 MG POWDER FOR SOLUTION FOR INJECTION - patient leaflet, side effects, dosage

ETOPOPHOS

Etoposide phosphate

Read all of this leaflet carefully before you start taking this medicine because it contains important information for you.

• – Keep this leaflet. You may need to read it again.

• – If you have any further questions, ask your doctor or pharmacist.

______ – 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.

i – 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 ETOPOPHOS is and what it is used for

• 2. What you need to know before you are given ETOPOPHOS

• 3. How you will be given ETOPOPHOS

• 4. Possible Side Effects

• 5. How to store ETOPOPHOS

• 6. Contents of the pack and other information

1. what etopophos is and what it is used for

The name of your medicine is ETOPOPHOS.

Each vial contains etoposide phosphate equivalent to etoposide 100 mg as the active ingredient.

Etoposide phosphate belongs to a group of medicines called cytostatics which are used in the treatment of cancer.

ETOPOPHOS is used in the treatment of certain types of cancer in adults:

• – testicular cancer

• – small cell lung cancer

• – cancer of the blood (acute myeloid leukaemia)

• – tumour in the lymphatic system (Hodgkin’s lym­phoma, non-Hodgkin’s lymphoma)

• – reproductive system cancers (gestational trophoblastic neoplasia and ovarian cancer)

ETOPOPHOS is used in the treatment of certain types of cancers in children:

• – cancer of the blood (acute myeloid leukaemia)

• – tumour in the lymphatic system (Hodgkin’s lym­phoma, non-Hodgkin’s lymphoma)

The exact reason why you have been prescribed ETOPOPHOS is best discussed with your doctor.

2. what you need to know before you are given etopophos

Do not take ETOPOPHOS:

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

• – If you have recently been given a live vaccine, including Yellow fever vaccine.

• – If you are breast-feeding or planning to breast-feed.

If any of the above affects you, or if you are unsure if they do, tell your doctor who will be able to advise you.

Warnings and precautions

Talk to your doctor, pharmacist or nurse before receiving ETOPOPHOS:

• – if you have any infections.

• – if you have had radiotherapy or chemotherapy recently.

• – if you have low levels of a protein called albumin in your blood.

• – if you have liver or kidney problems.

Effective anti-cancer treatment can destroy cancer cells rapidly in large numbers. On very rare occasions this may cause harmful amounts of substances from these cancer cells to be released into the blood. If this happens it can cause problems with the liver, kidney, heart or blood, which may result in death if not treated.

In order to prevent this, your doctor will need to do regular blood tests to monitor the level of these substances during treatment with this medicine.

This medicine can cause a reduction in the level of some blood cells, which could cause you to suffer from infections, or may mean that your blood doesn’t clot as well as it should if you cut yourself. Blood tests will be taken at the start of your treatment, and before each dose you take, to make sure that this isn’t happening.

If you have reduced liver or kidney function, your doctor may also want you to take regular blood tests to monitor these levels.

Other medicines and ETOPOPHOS

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

This is especially important:

• If you are taking a medicine called ciclosporin (a drug used to reduce the activity of the immune system).
• If you are being treated with cisplatin (a medicine used to treat cancer)
• If you are taking phenytoin or any other medicines used to treat epilepsy
• If you are taking warfarin (a medicine used to prevent blood clots from forming)
• If you have recently been given any live vaccines
• If you are taking phenylbutazone, sodium salicylate, or aspirin
• If you are taking any anthracyclines (a group of medicines used to treat cancer)
• If you are taking any drugs with a similar mechanism of action as ETOPOPHOS

Pregnancy, breast-feeding and fertility

If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, ask your doctor or pharmacist for advice before taking this medicine.

ETOPOPHOS must not be used during pregnancy unless clearly indicated by your doctor.

You must not breastfeed while you are receiving ETOPOPHOS.

Both male patients and female patients of child-bearing age should use an effective contraceptive method (e.g. , the barrier method or condoms) during treatment and for at least 6 months after the end of treatment with ETOPOPHOS.

Male patients treated with ETOPOPHOS are advised not to father a child during treatment and for up to 6 months after treatment. In addition, men are advised to seek counselling on sperm preservation before starting treatment.

Both male and female patients who are considering having a child after having treatment with ETOPO-PHOS should discuss this with their doctor or nurse.

Driving and using machines

No studies on the effects on the ability to drive and use machines have been performed. However, if you feel tired, sick to your stomach, dizzy or light-headed you should not do so until you have discussed it with your doctor.

3. how you will be given etopophos

ETOPOPHOS will be given to you by a doctor or nurse. It will be given as a slow infusion into a vein. This may take between 30 to 60 minutes.

The dose you receive will be specific to you, which the doctor will calculate. The usual dose, based on etoposide, is 50 to100mg/m2 body surface area, daily for 5 days in a row or 100 to 120 mg/ m2 body surface area on days 1, 3 and 5. This course of treatment may then be repeated, depending on the results of

PLEASE DETACH BEFORE HANDING ABOVE SECTION TO THE PATIENT

INFORMATION FOR HEALTH PROFESSIONALS

The following information is intended for healthcare professionals only:

Preparation of Intravenous Solution

Procedures for proper handling and disposal of anti-cancer drugs should be followed.

ETOPOPHOS solutions must be prepared under aseptic conditions.

Before use the content of each vial must be reconstituted with 5 ml or 10 ml of:

• water for injections or,
• 5% glucose solution or,
• 0.9 % sodium chloride solution.

This will yield a reconstituted stock solution containing 20 mg/ml or 10 mg/ml etoposide.

After reconstitution, the solution can be administered without further dilution or it can be further diluted with 5% glucose solution or 0.9% sodium chloride solution to obtain concentrations as low as 0.1 mg/ ml etoposide.

Only use clear solutions. Cloudy or discolored solutions must be discarded.

ETOPOPHOS is for single use only. Any unused medicinal product or waste material should be disposed of in accordance with local requirements.

ETOPOPHOS should not be physically mixed with any other drug.

Any unused medicinal product or waste material should be disposed of in accordance with local requirements.

Administration and Dosage

ETOPOPHOS is administered by slow intravenous infusion (usually over a 30 to 60 minute period) since hypotension has been reported as a possible side effect of rapid intravenous injection. ETOPOPHOS SHOULD NOT BE GIVEN BY RAPID INTRAVENOUS INJECTION.

blood tests, but this will not be for at least 21 days after the first course of treatment.

For children being treated for cancer of the blood or lymphatic system the dose used is 75 to 150 mg/m2 body surface area daily for 2 to 5 days.

The doctor may sometimes prescribe a different dose particularly if you are receiving, or have received, other treatments for your cancer or if you have kidney problems.

If you are given more ETOPOPHOS

As ETOPOPHOS is given to you by a doctor or nurse, overdose is unlikely. However, if this does occur your doctor will treat any symptoms that follow.

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

4. possible side effects

Like all medicines, this medicine can cause side effects, although not everybody gets them.

Tell your doctor or nurse immediately if you get any of the following symptoms: swelling of your tongue or throat, breathing difficulties, fast heartbeat, flushing of the skin or a rash. These may be signs of a severe allergic reaction.

Severe liver, kidney or heart damage from a condition called tumour lysis syndrome, caused by harmful amounts of substances from the cancer cells getting into the blood stream, has been seen sometimes when ETOPOPHOS is taken along with other drugs used to treat cancer.

Possible side effects

experienced with ETOPOPHOS that are;

Very common side effects (affecting more than 1 in 10 people)

Uncommon side effects (affecting between 1 in 100 and 1 in 1000 people)

• tingling or numbness in hands and feet bleeding

Rare side effects (affecting between 1 in 1,000 and 1 in 10,000 people)

temporary blindness

serious reactions of the skin and/or mucous membranes which may include painful blisters and fever, including extensive detachment of the skin (Stevens-Johnson syndrome and toxic epidermal necrolysis)

a sunburn-like rash that may occur on skin that has previously been exposed to radiotherapy and can be severe (radiation recall dermatitis)

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

• tumour lysis syndrome (complications of face and tongue swelling
• substances released from treated cancer cells infertility
• entering the blood) difficulty breathing

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 (see details below). By reporting side effects you can help provide more information on the safety of this medicine.

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5. how to store etopophos

Store in a refrigerator (2 to 8°C).

Store in the original package in order to protect from light.

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 carton and vial after EXP. The expiry date refers to the last day of that month.

6. contents of the pack and other information

What ETOPOPHOS contains

• – The active substance is etoposide phophate. Each vial contains etoposide phosphate equivalent to etoposide 100 mg.

• – The other ingredients are Sodium citrate and Dextran 40.

What ETOPOPHOS looks like and contents of the pack

ETOPOPHOS is a white to off-white dry powder.

It is supplied in a glass vial with a butyl rubber stopper and flip-off aluminium seal.

100 mg powder for solution for infusion is supplied in packs of 1, 5, 10, 20 or 25 vials

Not all pack sizes may be marketed.

Marketing Authorisation Holder and Manufacturer

Marketing Authorisation Holder

Bristol-Myers Squibb Pharmaceuticals Limited Uxbridge Business Park, Sanderson Road, Uxbridge, Middlesex UB8 1DH, England

Tel: 0800 731136

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

France	Etopophos
Germany	Etopophos
Sweden	Etopofos
United Kingdom	Etopophos

This leaflet was last revised in August 2018

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The recommended dose of ETOPOPHOS is 50 to 100 mg/m2/day (etoposide equivalent) on days 1 to 5 or 100 to 120 mg/m2 on days 1, 3, and 5 every 3 to 4 weeks in combination with other drugs indicated in the disease to be treated. Dosage should be modified to take into account the myelosuppressive effects of other drugs in the combination or the effects of prior radiation therapy or chemotherapy which may have compromised bone marrow reserve.

Administration Precautions: As with other potentially toxic compounds, caution should be exercised in handling and preparing the solution of ETOPOPHOS. Skin reactions associated with accidental exposure to ETOPOPHOS may occur. The use of gloves is recommended. If ETOPOPHOS solution contacts the skin or mucosa, immediately wash the skin with soap and water and flush the mucosa with water.

Care should be taken to avoid extravasation.

Elderly

No dosage adjustment is necessary in elderly patients (age > 65 years old), other than based on renal function.

Paediatric use

ETOPOPHOS in paediatric patients has been used in the range of 75 to 150 mg/m2/day (etoposide equivalent) for 2 to 5 days in combination with other antineoplastic agents. The treatment regimen should be chosen according to the local standard of care.

Renal Impairment

In patients with impaired renal function, the following initial dose modification should be considered based on measured creatinine clearance.

Measured Creatinine Clearance	Dose of Etoposide Phosphate
>50 mL/min	100% of dose
15–50 mL/min	75% of dose

Subsequent dosing should be based on patient tolerance and clinical effect. In patients with creatinine clearance less than 15 mL/min and on dialysis further dose reduction should be considered.

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1244137A3

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