H What you need to know before you take Everolimus Tablets

H How to take Everolimus Tablets

Q Possible side effects

Q How to store Everolimus Tablets

Q Contents of the pack and other information

H What you need to know before you take Everolimus Tablets

Do not take Everolimus Tablets:

• ifyou are allergic to everolimus, to related substances such as sirolimus or temsirolimus, or to any of the other ingredients ofthis medicine (listed in section 6).

Ifyouthinkyou maybeallergic,as­kyourdoctorfo­radvice.

Warnings and precautions

Talkto yourdoctor before taking Everolimus Tablets:

• ifyou have any problems with your liver or ifyou have ever had any disease which may have affected your liver. Ifthis isthe case, yourdoctor may need to prescribe a different dose of Everolimus Tablets.
• ifyou have diabetes (high level of sugar inyour blood). Everolimus Tablets may increase blood sugar levels and worsen diabetes mellitus. This may result inthe need for insulin and/or oral anti-diabetic agent therapy. Tell your doctor ifyou experience any excessivethirst or increased frequency of urination.
• ifyou need to receive a vaccine while taking Everolimus Tablets.
• ifyou have high cholesterol. Everolimus Tablets may elevate cholesterol and/or otherbloodfats.
• ifyou have had recent major surgery, or ifyou still have an unhealed wound following surgery. Everolimus Tablets may increase the risk of problems with wound healing.
• ifyou have an infection. It may be necessary to treat your infection before startingEvero­limusTablets.
• ifyou have previously had hepatitis B, because this may be reactivated during treatment with Everolimus Tablets (see section 4 ‚Possible side effects‘).

Everolimus Tabletsmayalso:

• weaken your immune system. Therefore, you may be at risk of getting an infection whileyouaretaking Everolimus Tablets.
• impact your kidney function. Therefore, yourdoctorwill monitor your kidney function whileyouareta­kingEverolimus­Tablets.
• cause shortness of breath, cough and fever.

Tell your doctor ifyou experience these symptoms.

You will have regular blood tests during treatment. These will check theamount of blood cells (white blood cells, red blood cells and platelets) in your body to see if Everolimus Tablets are having an unwanted effect on these cells. Blood tests will also be carried out to check your kidney function (level of creatinine) and liver function (level oftransaminases) and your blood sugar and cholesterol levels. This is because these can also be affected by EverolimusTablets.

Children and adolescents

Everolimus Tablets are not to be used in children or adolescents (aged below 18 years).

Other medicines and Everolimus Tablets

Everolimus Tablets may affect the way some other medicines work. Ifyou are taking other medicines at the same time as Everolimus Tablets, your doctor may need to changethe dose of Everolimus Tablets or the other medicines.

Tell your doctor or pharmacist ifyou are taking, have recently taken or might take anyothermedicines.

The following may increase the risk of side effects with Everolimus Tablets:

• ketoconazole, itraconazole, voriconazole, or fluconazole and other antifungals used to treat fungal infections.
• clarithromycin, telithromycin or erythromycin, antibiotics usedtotreat bacterial infections.
• ritonavir and other medicines used to treat HIV infection/AIDS.
• verapamil or diltiazem, used to treat heart conditions or high blood pressure.
• dronedarone, a medicine used to help regulate your heartbeat.
• ciclosporin, a medicine used to stop the bodyfrom rejecting organ transplants.
• imatinib, used to inhibit the growth ofabnormal cells.
• angiotensin-converting enzyme (ACE) inhibitors (such as ramipril) used to treat high blood pressure or other cardiovascular­problems.

Thefollowing mayreducetheef­fectivenessofE­verolimus Tablets:

• rifampicin, used to treat tuberculosis (TB).
• efavirenz or nevirapine, used to treat HIV infection/AIDS.
• St. John's wort (Hypericum perforatum), a herbal product used to treat depression andotherconditions.
• dexamethasone, a corticosteroid used totreat a wide variety of conditions including inflammatory or immune problems.
• phenytoin, carbamazepine or phenobarbital and other anti-epileptics used tostopseizure­sorfits.

These medicines should be avoided during yourtreatment with Everolimus Tablets. Ifyou are taking any ofthem, your doctor may switch you to a different medicine, or may change your dose of Everolimus Tablets.

Everolimus Tablets with food and drink

You should take Everolimus Tablets at the same time every day, consistently either with or without food. Avoid grapefruit and grapefruit juice while you are on Everolimus Tablets.

Pregnancy, breast-feeding and fertility

Pregnancy

Everolimus Tablets could harm an unborn baby and is not recommended during pregnancy. Tellyourdocto­rifyouarepreg­nantorthinktha­tyou maybe pregnant. Your doctor will discuss with you whether you should take this medicine during your pregnancy.

Women who could potentially become pregnant should use highly effective contraception during treatment. If, despite these measures, you thinkyou may have becomepregnan­t,askyourdoctor­foradvice before takingany moreEverolimus Tablets.

Breast-feeding

EverolimusTablets could harm a breast-fed baby. You should not breast-feed during treatment and for2weeks afterthe last dose ofeverolimus. Tell your doctor ifyou are breast-feeding.

Female fertility

Absence of menstrual periods (amenorrhoea) has been observed in some female patients receiving Everolimus Tablets. Everolimus Tablets may have an impact on female fertility. Talkto your doctor ifyou wish to have children.

Male fertility

Everolimus Tablets may affectmalefer­tility. Talktoyourdoc­torifyouwishto­father achild.

Driving and using machines

Ifyou feel unusuallytired (fatigue is a very common side effect), take special care when driving or using machines.

Everolimus Tablets contain lactose

Ifyou have been told by yourdoctor that you have an intolerance to some sugars, contact yourdoctor before taking this medicinal product.

Q How to take Everolimus Tablets

Always take this medicine exactly as your doctor or pharmacist has told you. Check with yourdoctor or pharmacist ifyou are not sure.

The recommended dose is 10mg, taken once a day. Your doctor will tell you how many Everolimus Tablets to take.

Ifyou have liver problems, your doctor may start you on a lower dose of Everolimus Tablets (2.5,5 or 7.5mg per day).

Ifyou experience certain side effects while you are taking Everolimus Tablets (see section 4), your doctor may lower your dose or stop treatment, either for a short time or permanently.

Take Everolimus Tablets once a day, at about the same time every day, consistently eitherwith orwithoutfood.

Swallowthe tablet(s) whole with aglass ofwater. Do not chew or crush the tablets.

If you take more Everolimus Tablets than you should

• Ifyou have taken too many Everolimus Tablets, or if someone else accidentally takes your tablets, see a doctor or go to a hospital immediately. Urgent treatment may be necessary.
• Take the carton and this leaflet, so that the doctor knows what has been taken.

If you forget to take Everolimus Tablets

Ifyou miss a dose, take your next dose as scheduled. Do not take a double dose to make upfortheforgot­tentablets.

If you stop taking Everolimus Tablets

Do not stop taking Everolimus Tablets unless yourdoctor tells you to.

Ifyou have anyfurther questions on the use ofthis medicine, askyourdoctor or pharmacist.

□ Possible side effects

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

STOPtaking Everolimus Tablets and seek medical help immediately ifyou experience any ofthe following signs ofan allergic reaction:

• difficultybre­athingorswallo­wing
• swelling ofthe face, lips, tongue or throat
• severe itching ofthe skin,with a red rash or raised bumps.

Serious side effects of Everolimus Tablets include:

Very common (mayaffect morethan 1 in 10 people)

• increased temperature, chills (signs of infection) fever, coughing, difficulty breathing, wheezing (signs of inflammation ofthe lung, also known as pneumonitis).

Common (mayaffect upto 1 in 10 people)

• excessive thirst, high urine output, increased appetite with weight loss, tiredness (signs of diabetes) bleeding (haemorrhage), for example inthegutwall severely decreased urine output (sign of kidney failure).

Uncommon (may affect up to 1in100 people)

• fever,skin rash,joint pain and inflammation,aswell astiredness, lossofappetite, nauseajaundice (yellowing ofthe skin), pain in the upper right abdomen, pale stools, dark urine (may be signs of hepatitis B reactivation) breathlessness, difficulty breathing when lying down, swelling ofthe feet or legs (signs of heart failure) swelling and/or pain in one ofthe legs, usually in the calf, redness orwarm skin in the affected area (signs of blockade ofa blood vessel (vein) in the legs caused by blood clotting) sudden onset of shortness of breath, chest painor coughing up blood (potential signs of pulmonary embolism, a condition that occurs when one or more arteries in your lungs become blocked) severely decreased urine output, swelling inthe legs, feeling confused, paininthe back (signs of sudden kidney failure) rash, itching, hives difficulty breathing or swallowing, dizziness (signs of serious allergic reaction, also known as hypersensitivity).

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

• shortness of breath or rapid breath (signs of acute respiratory distress syndrome).

If you experience any of these side effects, tell your doctor immediately as this might have life-threatening consequences.

Other possible side effects of Everolimus Tablets include:

Very common (mayaffect morethan 1 in 10 people)

• tiredness, breathlessness, dizziness, pale skin, signs of low level of red blood cells (anaemia) high level ofsugar in the blood (hyperglycaemia) lossofappetite, high level of lipids (fats) in the blood (hypercholeste­rolaemia) disturbed taste (dysgeusia), headache nose bleeds (epistaxis) cough mouth ulcers upset stomach including feeling sick(nausea) ordiarrhoea skin rash itching (pruritus) feeling weakor tired, swelling ofarms, hands, feet, ankles or other part ofthe body (signs of oedema) weight loss.

Common (mayaffect upto 1 in 10 people)

• spontaneous bleeding or bruising (signs of low level of platelets,also known as thrombocytopenia), fever, sore throat, mouth ulcers due to infections (signs of low level ofwhite blood cells, leukopenia, lymphopenia and/or neutropenia) breathlessness (dyspnoea) thirst, low urine output, dark urine, dry flushed skin, irritability (signsofdehydra­tion) trouble sleeping (insomnia) headache, dizziness (sign ofhigh blood pressure,also known as hypertension) fever
• inflammationof­theinnerlinin­gofthemouth,sto­mach,gut drymouth
• heartburn(dys­pepsia) beingsick(vomiting) difficultyinswa­llowing(dyspha­gia) abdominal pain acne^ rashandpainon­thepalmsofyou­rhandsorsoleso­fyour feet (hand-foot syndrome) reddening ofthe skin (erythema)
• jointpain paininthemouth menstruationdi­sorderssuchasi­rregularperiods
• high level of lipids (fats) in the blood (hyperlipidaemia, raised triglycerides)
• low level of potassium in the blood (hypokalaemia) low level of phosphate in the blood (hypophosphataemia) low level ofcalcium inthe blood (hypocalcaemia) dry skin, skin exfoliation, skin lesions nail disorders, breaking ofyour nails mild loss ofhair abnormal results of liver blood tests (increased alanineand aspartate aminotransferase) abnormal results of renal blood tests (increased creatinine) discharge from the eye with itching, rednessand swelling
• protein in the urine.

Uncommon (mayaffectupto 1 in 100 people)

• weakness, spontaneous bleeding or bruising and frequent infections with signs such as fever, chills, sore throat or mouth ulcers (signs of low level of blood cells, also known as pancytopenia) lossofsense oftaste (ageusia) coughing up blood (haemoptysis) menstruation disorders such asabsence of periods (amenorrhoea)
• passingurinemo­reoftenduringda­ytime chestpain abnormalwoundhe­aling^ hot flushes pink eye or red eye (conjunctivitis).

Rare (mayaffectupto! in 1,000people)

• tiredness, breathlessness, dizziness, pale skin (signs of low level of red blood cells, possibly dueto a type ofanaemia called pure red cell aplasia) swelling ofthe face, around the eyes, mouth, and inside the mouth and/or throat, as well as the tongue and difficulty breathing or swallowing (also known as angioedema), may be signs of anallergicreaction.

If these side effects get severe please tell your doctor and/or pharmacist. Most of the side effects are mild to moderate and will generally disappear if your treatment is interrupted for a few days.

Reporting of side effects

Ifyou get any side effects, talktoyour doctor, pharmacist or nurse. This includes any possible side effects not listed inthis leaflet. You can also report side effects directly via the Yellow Card Scheme Website: or search for MHRA Yellow Cardin the Google Play or Apple App Store.

By reporting side effects you can help provide more information on the safety ofthis medicine.

□ How to store Everolimus Tablets

Keep this medicine out ofthe sight and reach ofchildren.

Do not use this medicine after the expiry date which is stated on the carton and blister foil. The expiry date refers to the last day ofthat month.

Store inthe original package in order to protect from light.

This medicine does not require any special temperature storage conditions.

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

□Contents of the pack and other information

What Everolimus Tablets contain

• The active substance is everolimus. Each tablet contains 2.5mg, 5mg or 10mg everolimus.
• Theotheringre­dientsare: butylhydroxytoluene (E321), hypromellose (E464), lactose, lactose monohydrate, crospovidone (E1202) and magnesium stearate (E470b).

What Everolimus Tablets look like and contents of the pack

EverolimusTablets are available in three strengths:

Everolimus 2.5mg Tablets are white to offwhite oval biconvex tablets (approximately 10× 5mm), debossed with E9VS on one sideand 2.5 on the other side.

Everolimus 5mg Tablets are white to offwhite oval and biconvex tablets (approximately 13 × 6mm), debossed with E9VS 5 on one side.

Everolimus10mg Tablets arewhite tooffwhiteovaland biconvextablets (approximately 16× 8mm), debossed with E9VS10 on one side.

Packsize:30tablets

Marketing Authorisation Holder

Accord HealthcareLimited

SageHouse,319 Pin­ner Road,North Harrow, Middlesex, HA1 4HF, United Kingdom

Manufacturer

SynthonHispaniaS.L.

Castello, 1, Poligono Las Salinas, 08830 Sant Boi de Llobregat, Spain

This leaflet was last revised in October 2020

If you would like a leaflet with larger text, please contact 01271 385257.

accord

Everolimus 2.5mg, 5mg and 10mg Tablets

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.
• 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.

• The full name of this medicine is Everolimus 2.5mg, 5mg and 10mg Tablets but within this leaflet it will be referred to as Everolimus Tablets.

What is in this leaflet

jl What Everolimus Tablets are and what they are used for

2l What you need to know before you take Everolimus Tablets

3] How to take Everolimus Tablets

4l Possible side effects

si How to store Everolimus Tablets

6l Contents of the pack and other

information

jl What Everolimus Tablets are and what they are used for

Everolimus Tablets are an anticancer medicine containing the active substance everolimus. Everolimus reduces the blood supply to the tumour and slows down the growth and spread of cancer cells.

Everolimus Tablets are used to treat adult patients with:

• hormone receptor-positive advanced breast cancer in postmenopausal women, in whom other treatments (so called ‘non-steroidal aromatase inhibitors’) no longer keep the disease under control. It is given together with a medicine called exemestane, a steroidal aromatase inhibitor, which is used for hormonal anticancer therapy.
• advanced tumours called neuroendocrine tumours that originate from the stomach, bowels, lung or pancreas. It is given if the tumours are inoperable and do not overproduce specific hormones or other related natural substances.
• advanced kidney cancer (advanced renal cell carcinoma), where other treatments (so-called ‘VEGF-targeted therapy’) have not helped stop your disease.

2l What you need to know before you take Everolimus Tablets

Everolimus Tablets will only be prescribed for you by a doctor with experience in cancer treatment. Follow all the doctor’s instruc­tions carefully.

They may differ from the general information contained in this leaflet. If you have any questions about Everolimus Tablets or why they have been prescribed for you, ask your doctor.

Do not take Everolimus Tablets:

• if you are allergic to everolimus, to related substances such as sirolimus or temsirolimus, or to any of the other ingredients of this medicine (listed in section 6).

If you think you may be allergic, ask your doctor for advice.

Warnings and precautions

Talk to your doctor before taking Everolimus Tablets:

• if you have any problems with your liver or if you have ever had any disease which may have affected your liver. If this is the case, your doctor may need to prescribe a different dose of Everolimus Tablets.
• if you have diabetes (high level of sugar in your blood). Everolimus Tablets may increase blood sugar levels and worsen diabetes mellitus. This may result in the need for insulin and/or oral anti-diabetic agent therapy. Tell your doctor if you experience any excessive thirst or increased frequency of urination.
• if you need to receive a vaccine while taking Everolimus Tablets.
• if you have high cholesterol. Everolimus Tablets may elevate cholesterol and/or other blood fats.
• if you have had recent major surgery, or if you still have an unhealed wound following surgery. Everolimus Tablets may increase the risk of problems with wound healing.
• if you have an infection. It may be necessary to treat your infection before starting Everolimus Tablets.
• if you have previously had hepatitis B, because this may be reactivated during treatment with Everolimus Tablets (see section 4 ‘Possible side effects’).

Everolimus Tablets may also:

• weaken your immune system. Therefore, you may be at risk of getting an infection while you are taking Everolimus Tablets.
• impact your kidney function. Therefore, your doctor will monitor your kidney function while you are taking Everolimus Tablets.
• cause shortness of breath, cough and fever.

Tell your doctor if you experience these symptoms.

You will have regular blood tests during treatment. These will check the amount of blood cells (white blood cells, red blood cells and platelets) in your body to see if Everolimus Tablets are having an unwanted effect on these cells. Blood tests will also be carried out to check your kidney function (level of creatinine) and liver function (level of transaminases) and your blood sugar and cholesterol levels. This is because these can also be affected by Everolimus Tablets.

Children and adolescents

Everolimus Tablets are not to be used in children or adolescents (aged below 18 years).

Other medicines and Everolimus Tablets Everolimus Tablets may affect the way some other medicines work. If you are taking other medicines at the same time as Everolimus Tablets, your doctor may need to change the dose of Everolimus Tablets or the other medicines.

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

The following may increase the risk of side effects with Everolimus Tablets:

• ketoconazole, itraconazole, voriconazole, or fluconazole and other antifungals used to treat fungal infections.
• clarithromycin, telithromycin or erythromycin, antibiotics used to treat bacterial infections.
• ritonavir and other medicines used to treat HIV infection/AIDS.
• verapamil or diltiazem, used to treat heart conditions or high blood pressure.
• dronedarone, a medicine used to help regulate your heartbeat.
• ciclosporin, a medicine used to stop the body from rejecting organ transplants.
• imatinib, used to inhibit the growth of abnormal cells.
• angiotensin-converting enzyme (ACE) inhibitors (such as ramipril) used to treat high blood pressure or other cardiovascular problems.

The following may reduce the effectiveness of Everolimus Tablets:

• rifampicin, used to treat tuberculosis (TB).
• efavirenz or nevirapine, used to treat HIV infection/AIDS.
• St. John’s wort (Hypericum perforatum), a herbal product used to treat depression and other conditions.
• dexamethasone, a corticosteroid used to treat a wide variety of conditions including inflammatory or immune problems.
• phenytoin, carbamazepine or phenobarbital and other anti-epileptics used to stop seizures or fits.

These medicines should be avoided during your treatment with Everolimus Tablets. If you are taking any of them, your doctor may switch you to a different medicine, or may change your dose of Everolimus Tablets.

Everolimus Tablets with food and drink You should take Everolimus Tablets at the same time every day, consistently either with or without food. Avoid grapefruit and grapefruit juice while you are on Everolimus Tablets.

Pregnancy, breast-feeding and fertility

Pregnancy

Everolimus Tablets could harm an unborn baby and is not recommended during pregnancy. Tell your doctor if you are pregnant or think that you may be pregnant. Your doctor will discuss with you whether you should take this medicine during your pregnancy.

Women who could potentially become pregnant should use highly effective contraception during treatment. If, despite these measures, you think you may have become pregnant, ask your doctor for advice before taking any more Everolimus Tablets.

Breast-feeding

Everolimus Tablets could harm a breast-fed baby. You should not breast-feed during treatment and for 2 weeks after the last dose of everolimus. Tell your doctor if you are breast-feeding.

Female fertility

Absence of menstrual periods (amenorrhoea) has been observed in some female patients receiving Everolimus Tablets. Everolimus Tablets may have an impact on female fertility. Talk to your doctor if you wish to have children.

Male fertility

Everolimus Tablets may affect male fertility. Talk to your doctor if you wish to father a child.

Driving and using machines

If you feel unusually tired (fatigue is a very common side effect), take special care when driving or using machines.

Everolimus Tablets contain lactose

If you have been told by your doctor that you have an intolerance to some sugars, contact your doctor before taking this medicinal product.

31 how to take everolimus tablets

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

The recommended dose is 10mg, taken once a day. Your doctor will tell you how many Everolimus Tablets to take.

If you have liver problems, your doctor may start you on a lower dose of Everolimus Tablets (2.5, 5 or 7.5mg per day).

If you experience certain side effects while you are taking Everolimus Tablets (see section 4), your doctor may lower your dose or stop treatment, either for a short time or permanently.

Take Everolimus Tablets once a day, at about the same time every day, consistently either with or without food.

Swallow the tablet(s) whole with a glass of water. Do not chew or crush the tablets.

If you take more Everolimus Tablets than you should

• If you have taken too many Everolimus Tablets, or if someone else accidentally takes your tablets, see a doctor or go to a hospital immediately. Urgent treatment may be necessary.
• Take the carton and this leaflet, so that the doctor knows what has been taken.

If you forget to take Everolimus Tablets

If you miss a dose, take your next dose as scheduled. Do not take a double dose to make up for the forgotten tablets.

If you stop taking Everolimus Tablets

Do not stop taking Everolimus Tablets unless your doctor tells you to.

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

4l

Possible side effects

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

• STOP taking Everolimus Tablets and seek medical help immediately if you experience any of the following signs of an allergic reaction: difficulty breathing or swallowing swelling of the face, lips, tongue or throat
• severe itching of the skin, with a red rash or raised bumps.

Serious side effects of Everolimus Tablets include:

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

• increased temperature, chills (signs of infection)
• fever, coughing, difficulty breathing, wheezing

(signs of inflammation of the lung, also known as pneumonitis).

Common (may affect up to 1 in 10 people)

• excessive thirst, high urine output, increased appetite with weight loss, tiredness (signs of diabetes) bleeding (haemorrhage), for example in the gut wall severely decreased urine output (sign of kidney failure).
• Uncommon (may affect up to 1 in 100 people) fever, skin rash, joint pain and inflammation, as well as tiredness, loss of appetite, nausea, jaundice (yellowing of the skin), pain in the upper right abdomen, pale stools, dark urine (may be signs of hepatitis B reactivation) breathlessness, difficulty breathing when lying down, swelling of the feet or legs (signs of heart failure) swelling and/or pain in one of the legs, usually in the calf, redness or warm skin in the affected area (signs of blockade of a blood vessel (vein) in the legs caused by blood clotting) sudden onset of shortness of breath, chest pain or coughing up blood (potential signs of pulmonary embolism, a condition that occurs when one or more arteries in your lungs become blocked) severely decreased urine output, swelling in the legs, feeling confused, pain in the back (signs of sudden kidney failure) rash, itching, hives difficulty breathing or swallowing, dizziness (signs of serious allergic reaction, also known as hypersensitivity).

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

• shortness of breath or rapid breath (signs of acute respiratory distress syndrome).

If you experience any of these side effects, tell your doctor immediately as this might have life-threatening consequences.

Other possible side effects of Everolimus Tablets include:

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

• tiredness, breathlessness, dizziness, pale skin, signs of low level of red blood cells (anaemia) high level of sugar in the blood (hyperglycaemia) loss of appetite, high level of lipids (fats) in the blood (hypercholeste­rolaemia) disturbed taste (dysgeusia), headache nose bleeds (epistaxis) cough mouth ulcers upset stomach including feeling sick (nausea) or diarrhoea skin rash itching (pruritus) feeling weak or tired, swelling of arms, hands, feet, ankles or other part of the body (signs of oedema) weight loss.
• Common (may affect up to 1 in 10 people) spontaneous bleeding or bruising (signs of low level of platelets, also known as thrombocytopenia), fever, sore throat, mouth ulcers due to infections (signs of low level of white blood cells, leukopenia, lymphopenia and/or neutropenia) breathlessness (dyspnoea) thirst, low urine output, dark urine, dry flushed skin, irritability (signs of dehydration) trouble sleeping (insomnia)
• headache, dizziness (sign of high blood pressure, also known as hypertension) fever inflammation of the inner lining of the mouth, stomach, gut dry mouth heartburn (dyspepsia) being sick (vomiting) difficulty in swallowing (dysphagia) abdominal pain acne rash and pain on the palms of your hands or soles of your feet (hand-foot syndrome) reddening of the skin (erythema) joint pain pain in the mouth menstruation disorders such as irregular periods high level of lipids (fats) in the blood (hyperlipidaemia, raised triglycerides) low level of potassium in the blood (hypokalaemia) low level of phosphate in the blood (hypophosphataemia) low level of calcium in the blood (hypocalcaemia) dry skin, skin exfoliation, skin lesions nail disorders, breaking of your nails mild loss of hair abnormal results of liver blood tests (increased alanine and aspartate aminotransferase)
• abnormal results of renal blood tests (increased creatinine) discharge from the eye with itching, redness and swelling protein in the urine.

Uncommon (may affect up to 1 in 100 people)

• weakness, spontaneous bleeding or bruising and frequent infections with signs such as fever, chills, sore throat or mouth ulcers (signs of low level of blood cells, also known as pancytopenia) loss of sense of taste (ageusia) coughing up blood (haemoptysis) menstruation disorders such as absence of periods (amenorrhoea) passing urine more often during daytime chest pain
• abnormal wound healing hot flushes pink eye or red eye (conjunctivitis).
• Rare (may affect up to 1 in 1,000 people) tiredness, breathlessness, dizziness, pale skin (signs of low level of red blood cells, possibly due to a type of anaemia called pure red cell aplasia) swelling of the face, around the eyes, mouth, and inside the mouth and/or throat, as well as the tongue and difficulty breathing or swallowing (also known as angioedema), may be signs of an allergic reaction.

If these side effects get severe please tell your doctor and/or pharmacist. Most of the side effects are mild to moderate and will generally disappear if your treatment is interrupted for a few days.

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 Website: 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.

31

How to store Everolimus Tablets

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 blister foil. The expiry date refers to the last day of that month.

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

This medicine does not require any special temperature storage conditions.

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.

31

Contents of the pack and other information

What Everolimus Tablets contain

• The active substance is everolimus. Each tablet contains 2.5mg, 5mg or 10mg everolimus.
• The other ingredients are: butylhydroxytoluene (E321), hypromellose (E464), lactose, lactose monohydrate, crospovidone (E1202) and magnesium stearate (E470b).

What Everolimus Tablets look like and contents of the pack

EverolimusTablets are available in three strengths:

Everolimus 2.5mg Tablets are white to offwhite oval biconvex tablets (approximately 10× 5mm), debossed with E9VS on one sideand 2.5 on the other side.

Everolimus 5mg Tablets are white to offwhite oval and biconvex tablets (approximately 13 × 6mm), debossed with E9VS 5 on one side.

Everolimus10mg Tablets arewhite tooffwhiteovaland biconvextablets (approximately 16× 8mm), debossed with E9VS10 on one side.

Packsize:30tablets

Marketing Authorisation Holder

Accord HealthcareLimited

SageHouse,319 Pin­ner Road,North Harrow, Middlesex, HA1 4HF, United Kingdom

Manufacturer

SynthonHispaniaS.L.

Castello, 1, Poligono Las Salinas, 08830 Sant Boi de Llobregat, Spain

This leaflet was last revised in October 2020

If you would like a leaflet with larger text, please contact 01271 385257.

Everolimus 2.5mg, 5mg and 10mg Tablets

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.
• 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.

• The full name of this medicine is Everolimus 2.5mg, 5mg and 10mg Tablets but within this leaflet it will be referred to as Everolimus Tablets.

What is in this leaflet

jl What Everolimus Tablets are and what they are used for

2l What you need to know before you take Everolimus Tablets

3] How to take Everolimus Tablets

4l Possible side effects

si How to store Everolimus Tablets

6l Contents of the pack and other

information

jl What Everolimus Tablets are and what they are used for

Everolimus Tablets are an anticancer medicine containing the active substance everolimus. Everolimus reduces the blood supply to the tumour and slows down the growth and spread of cancer cells.

Everolimus Tablets are used to treat adult patients with:

• hormone receptor-positive advanced breast cancer in postmenopausal women, in whom other treatments (so called ‘non-steroidal aromatase inhibitors’) no longer keep the disease under control. It is given together with a medicine called exemestane, a steroidal aromatase inhibitor, which is used for hormonal anticancer therapy.
• advanced tumours called neuroendocrine tumours that originate from the stomach, bowels, lung or pancreas. It is given if the tumours are inoperable and do not overproduce specific hormones or other related natural substances.
• advanced kidney cancer (advanced renal cell carcinoma), where other treatments (so-called ‘VEGF-targeted therapy’) have not helped stop your disease.

2l What you need to know before you take Everolimus Tablets

Everolimus Tablets will only be prescribed for you by a doctor with experience in cancer treatment. Follow all the doctor’s instruc­tions carefully.

They may differ from the general information contained in this leaflet. If you have any questions about Everolimus Tablets or why they have been prescribed for you, ask your doctor.

Do not take Everolimus Tablets:

• if you are allergic to everolimus, to related substances such as sirolimus or temsirolimus, or to any of the other ingredients of this medicine (listed in section 6).

If you think you may be allergic, ask your doctor for advice.

Warnings and precautions

Talk to your doctor before taking Everolimus Tablets:

• if you have any problems with your liver or if you have ever had any disease which may have affected your liver. If this is the case, your doctor may need to prescribe a different dose of Everolimus Tablets.
• if you have diabetes (high level of sugar in your blood). Everolimus Tablets may increase blood sugar levels and worsen diabetes mellitus. This may result in the need for insulin and/or oral anti-diabetic agent therapy. Tell your doctor if you experience any excessive thirst or increased frequency of urination.
• if you need to receive a vaccine while taking Everolimus Tablets.
• if you have high cholesterol. Everolimus Tablets may elevate cholesterol and/or other blood fats.
• if you have had recent major surgery, or if you still have an unhealed wound following surgery. Everolimus Tablets may increase the risk of problems with wound healing.
• if you have an infection. It may be necessary to treat your infection before starting Everolimus Tablets.
• if you have previously had hepatitis B, because this may be reactivated during treatment with Everolimus Tablets (see section 4 ‘Possible side effects’).

Everolimus Tablets may also:

• weaken your immune system. Therefore, you may be at risk of getting an infection while you are taking Everolimus Tablets.
• impact your kidney function. Therefore, your doctor will monitor your kidney function while you are taking Everolimus Tablets.
• cause shortness of breath, cough and fever.

Tell your doctor if you experience these symptoms.

You will have regular blood tests during treatment. These will check the amount of blood cells (white blood cells, red blood cells and platelets) in your body to see if Everolimus Tablets are having an unwanted effect on these cells. Blood tests will also be carried out to check your kidney function (level of creatinine) and liver function (level of transaminases) and your blood sugar and cholesterol levels. This is because these can also be affected by Everolimus Tablets.

Children and adolescents

Everolimus Tablets are not to be used in children or adolescents (aged below 18 years).

Other medicines and Everolimus Tablets Everolimus Tablets may affect the way some other medicines work. If you are taking other medicines at the same time as Everolimus Tablets, your doctor may need to change the dose of Everolimus Tablets or the other medicines.

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

The following may increase the risk of side effects with Everolimus Tablets:

• ketoconazole, itraconazole, voriconazole, or fluconazole and other antifungals used to treat fungal infections.
• clarithromycin, telithromycin or erythromycin, antibiotics used to treat bacterial infections.
• ritonavir and other medicines used to treat HIV infection/AIDS.
• verapamil or diltiazem, used to treat heart conditions or high blood pressure.
• dronedarone, a medicine used to help regulate your heartbeat.
• ciclosporin, a medicine used to stop the body from rejecting organ transplants.
• imatinib, used to inhibit the growth of abnormal cells.
• angiotensin-converting enzyme (ACE) inhibitors (such as ramipril) used to treat high blood pressure or other cardiovascular problems.

The following may reduce the effectiveness of Everolimus Tablets:

• rifampicin, used to treat tuberculosis (TB).
• efavirenz or nevirapine, used to treat HIV infection/AIDS.
• St. John’s wort (Hypericum perforatum), a herbal product used to treat depression and other conditions.
• dexamethasone, a corticosteroid used to treat a wide variety of conditions including inflammatory or immune problems.
• phenytoin, carbamazepine or phenobarbital and other anti-epileptics used to stop seizures or fits.

These medicines should be avoided during your treatment with Everolimus Tablets. If you are taking any of them, your doctor may switch you to a different medicine, or may change your dose of Everolimus Tablets.

Everolimus Tablets with food and drink You should take Everolimus Tablets at the same time every day, consistently either with or without food. Avoid grapefruit and grapefruit juice while you are on Everolimus Tablets.

Pregnancy, breast-feeding and fertility

Pregnancy

Everolimus Tablets could harm an unborn baby and is not recommended during pregnancy. Tell your doctor if you are pregnant or think that you may be pregnant. Your doctor will discuss with you whether you should take this medicine during your pregnancy.

Women who could potentially become pregnant should use highly effective contraception during treatment. If, despite these measures, you think you may have become pregnant, ask your doctor for advice before taking any more Everolimus Tablets.

Breast-feeding

Everolimus Tablets could harm a breast-fed baby. You should not breast-feed during treatment and for 2 weeks after the last dose of everolimus. Tell your doctor if you are breast-feeding.

Female fertility

Absence of menstrual periods (amenorrhoea) has been observed in some female patients receiving Everolimus Tablets. Everolimus Tablets may have an impact on female fertility. Talk to your doctor if you wish to have children.

Male fertility

Everolimus Tablets may affect male fertility. Talk to your doctor if you wish to father a child.

Driving and using machines

If you feel unusually tired (fatigue is a very common side effect), take special care when driving or using machines.

Everolimus Tablets contain lactose

If you have been told by your doctor that you have an intolerance to some sugars, contact your doctor before taking this medicinal product.

31 how to take everolimus tablets

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

The recommended dose is 10mg, taken once a day. Your doctor will tell you how many Everolimus Tablets to take.

If you have liver problems, your doctor may start you on a lower dose of Everolimus Tablets (2.5, 5 or 7.5mg per day).

If you experience certain side effects while you are taking Everolimus Tablets (see section 4), your doctor may lower your dose or stop treatment, either for a short time or permanently.

Take Everolimus Tablets once a day, at about the same time every day, consistently either with or without food.

Swallow the tablet(s) whole with a glass of water. Do not chew or crush the tablets.

If you take more Everolimus Tablets than you should

• If you have taken too many Everolimus Tablets, or if someone else accidentally takes your tablets, see a doctor or go to a hospital immediately. Urgent treatment may be necessary.
• Take the carton and this leaflet, so that the doctor knows what has been taken.

If you forget to take Everolimus Tablets

If you miss a dose, take your next dose as scheduled. Do not take a double dose to make up for the forgotten tablets.

If you stop taking Everolimus Tablets

Do not stop taking Everolimus Tablets unless your doctor tells you to.

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

4l Possible side effects

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

• STOP taking Everolimus Tablets and seek medical help immediately if you experience any of the following signs of an allergic reaction: difficulty breathing or swallowing swelling of the face, lips, tongue or throat
• severe itching of the skin, with a red rash or raised bumps.

Serious side effects of Everolimus Tablets include:

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

• increased temperature, chills (signs of infection)
• fever, coughing, difficulty breathing, wheezing

(signs of inflammation of the lung, also known as pneumonitis).

Common (may affect up to 1 in 10 people)

• excessive thirst, high urine output, increased appetite with weight loss, tiredness (signs of diabetes) bleeding (haemorrhage), for example in the gut wall severely decreased urine output (sign of kidney failure).
• Uncommon (may affect up to 1 in 100 people) fever, skin rash, joint pain and inflammation, as well as tiredness, loss of appetite, nausea, jaundice (yellowing of the skin), pain in the upper right abdomen, pale stools, dark urine (may be signs of hepatitis B reactivation) breathlessness, difficulty breathing when lying down, swelling of the feet or legs (signs of heart failure) swelling and/or pain in one of the legs, usually in the calf, redness or warm skin in the affected area (signs of blockade of a blood vessel (vein) in the legs caused by blood clotting) sudden onset of shortness of breath, chest pain or coughing up blood (potential signs of pulmonary embolism, a condition that occurs when one or more arteries in your lungs become blocked) severely decreased urine output, swelling in the legs, feeling confused, pain in the back (signs of sudden kidney failure) rash, itching, hives difficulty breathing or swallowing, dizziness (signs of serious allergic reaction, also known as hypersensitivity).

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

• shortness of breath or rapid breath (signs of acute respiratory distress syndrome).

If you experience any of these side effects, tell your doctor immediately as this might have life-threatening consequences.

Other possible side effects of Everolimus Tablets include:

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

• tiredness, breathlessness, dizziness, pale skin, signs of low level of red blood cells (anaemia) high level of sugar in the blood (hyperglycaemia) loss of appetite, high level of lipids (fats) in the blood (hypercholeste­rolaemia) disturbed taste (dysgeusia), headache nose bleeds (epistaxis) cough mouth ulcers upset stomach including feeling sick (nausea) or diarrhoea skin rash itching (pruritus) feeling weak or tired, swelling of arms, hands, feet, ankles or other part of the body (signs of oedema) weight loss.
• Common (may affect up to 1 in 10 people) spontaneous bleeding or bruising (signs of low level of platelets, also known as thrombocytopenia), fever, sore throat, mouth ulcers due to infections (signs of low level of white blood cells, leukopenia, lymphopenia and/or neutropenia) breathlessness (dyspnoea) thirst, low urine output, dark urine, dry flushed skin, irritability (signs of dehydration) trouble sleeping (insomnia)
• headache, dizziness (sign of high blood pressure, also known as hypertension) fever inflammation of the inner lining of the mouth, stomach, gut dry mouth heartburn (dyspepsia) being sick (vomiting) difficulty in swallowing (dysphagia) abdominal pain acne rash and pain on the palms of your hands or soles of your feet (hand-foot syndrome) reddening of the skin (erythema) joint pain pain in the mouth menstruation disorders such as irregular periods high level of lipids (fats) in the blood (hyperlipidaemia, raised triglycerides) low level of potassium in the blood (hypokalaemia) low level of phosphate in the blood (hypophosphataemia) low level of calcium in the blood (hypocalcaemia) dry skin, skin exfoliation, skin lesions nail disorders, breaking of your nails mild loss of hair abnormal results of liver blood tests (increased alanine and aspartate aminotransferase)
• abnormal results of renal blood tests (increased creatinine) discharge from the eye with itching, redness and swelling protein in the urine.

Uncommon (may affect up to 1 in 100 people)

• weakness, spontaneous bleeding or bruising and frequent infections with signs such as fever, chills, sore throat or mouth ulcers (signs of low level of blood cells, also known as pancytopenia) loss of sense of taste (ageusia) coughing up blood (haemoptysis) menstruation disorders such as absence of periods (amenorrhoea) passing urine more often during daytime chest pain
• abnormal wound healing hot flushes pink eye or red eye (conjunctivitis).
• Rare (may affect up to 1 in 1,000 people) tiredness, breathlessness, dizziness, pale skin (signs of low level of red blood cells, possibly due to a type of anaemia called pure red cell aplasia) swelling of the face, around the eyes, mouth, and inside the mouth and/or throat, as well as the tongue and difficulty breathing or swallowing (also known as angioedema), may be signs of an allergic reaction.

If these side effects get severe please tell your doctor and/or pharmacist. Most of the side effects are mild to moderate and will generally disappear if your treatment is interrupted for a few days.

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 Website: 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.

31 How to store Everolimus Tablets

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 blister foil. The expiry date refers to the last day of that month.

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

This medicine does not require any special temperature storage conditions.

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.

31 Contents of the pack and other information

What Everolimus Tablets contain

• The active substance is everolimus. Each tablet contains 2.5mg, 5mg or 10mg everolimus.
• The other ingredients are: butylhydroxytoluene (E321), hypromellose (E464), lactose, lactose monohydrate, crospovidone (E1202) and magnesium stearate (E470b).