EVEROLIMUS KRKA 5 MG TABLETS - patient leaflet, side effects, dosage

1. what everolimus krka is and what it is used for

Everolimus Krka is 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 Krka is used to treat adult patients with:

• advanced tumours called neuroendocrine tumours that originate from the pancreas. It is given if the tumours are inoperable and do not overproduce specific hormones or other related natural substances.

2. what you need to know before you take everolimus krka

Everolimus Krka 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 Krka or why it has been prescribed for you, ask your doctor.

Do not take Everolimus Krka:

• 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 Krka:

• 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 Krka.

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• if you have diabetes (high level of sugar in your blood). Everolimus Krka may increase blood sugar levels and worsen diabetes mellitus. This may result in the need for insulin and/or oral antidiabetic 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 Krka.
• if you have high cholesterol. Everolimus Krka 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 Krka 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 Krka.
• if you have previously had hepatitis B, because this may be reactivated during treatment with Everolimus Krka (see section 4 ‘Possible side effects’).

Everolimus Krka may also:

• weaken your immune system. Therefore, you may be at risk of getting an infection while you are taking Everolimus Krka.
• impact your kidney function. Therefore, your doctor will monitor your kidney function while you are taking Everolimus Krka.
• 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 Krka is 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 Krka.

Children and adolescents

Everolimus Krka is not to be used in children or adolescents (age below 18 years).

Other medicines and Everolimus Krka

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

• 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 heart beat.
• 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 Krka r:

• 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 Krka. If you are taking any of them, your doctor may switch you to a different medicine, or may change your dose of Everolimus Krka.

Everolimus Krka with food and drink

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

Pregnancy, breast-feeding and fertility

Pregnancy

Everolimus Krka 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 Krka.

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Breast-feeding

Everolimus Krka 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 Krka.

Everolimus Krka may have an impact on female fertility.

Talk to your doctor if you wish to have children.

Male fertility

Everolimus Krka 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 Krka contains 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.

3. how to take everolimus krka

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 10 mg, taken once a day. Your doctor will tell you how many tablets of Everolimus Krka to take.

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

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

Take Everolimus Krka 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 Krka than you should

• If you have taken too much Everolimus Krka, 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 Krka

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 Krka

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

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.

PL. EVEROLIUMS KRKA TBL GB second page

STOP taking Everolimus Krka 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 Krka 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 Krka 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 diarrhea 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 or pharmacist. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via 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.

5. how to store everolimus krka

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.

6. contents of the pack and other information

What Everolimus Krka contains

• The active substance is everolimus.

Everolimus Krka 2.5 mg

Each tablet contains 2.5 mg everolimus.

Everolimus Krka 5 mg

Each tablet contains 5 mg everolimus.

Everolimus Krka 10 mg

Each tablet contains 10 mg everolimus.

• The other ingredients are: butylhydroxytoluene (E321), hypromellose (E464), lactose, lactose monohydrate, crospovidone (E1202) and magnesium stearate (E470b).

What Everolimus Krka looks like and contents of the pack

Everolimus tablets are available in three strengths:

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

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

Everolimus Krka10 mg are white to off white oval and biconvex tablets (approximately 16 × 8 mm), debossed with E9VS 10 on one side.

Everolimus Krka 2.5 mg is available in packs containing 30 or 90 tablets.

Everolimus Krka 5 mg and Everolimus Krka 10 mg are available in packs containing 10, 30 or 90 tablets.

Not all pack sizes may be marketed.

Marketing Authorisation Holder

KRKA, d.d., Novo mesto, Smarjeska cesta 6, 8501 Novo mesto, Slovenia

Manufacturers

KRKA, d.d., Novo mesto, Smarjeska cesta 6,

8501 Novo mesto, Slovenia

Synthon Hispania, S.L., C/ Castello no1, Pol. Las Salinas, Sant Boi de Llobregat, 08830 Barcelo­na, Spain

This leaflet was last revised in 09/2018

CONFIDENTIAL