GONAL-F 150 IU/0.25 ML SOLUTION FOR INJECTION IN PRE-FILLED PEN - 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 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.

What is in this leaflet

• 1. What GONAL-f is and what it is used for

• 2. What you need to know before you use GONAL-f

• 3. How to use GONAL-f

• 4. Possible side effects

• 5. How to store GONAL-f

• 6. Contents of the pack and other information

Instructions for use

1. what gonal-f is and what it is used forgonal-f contains a medicine called “follitropin alfa”. follitropin alfa is a type of “follicle stimulating hormone” (fsh) which belongs to the family of hormones called “gonadotropins”. gonadotropins are involved in reproduction and fertility.

What GONAL-f is used for

• to help release an egg from the ovary (ovulation) in women that cannot ovulate and that did not

respond to treatment with a medicine called “clomiphene citrate”.

• together with another medicine called “lutropin alfa” (“Luteinising Hormone” or LH) to help

release egg from the ovary (ovulation) in women that are not ovulating because their body is producing very little gonadotropins (FSH and LH).

• to help develop several follicles (each containing an egg) in women undergoing assisted

reproductive technology procedures (procedures that may help you to become pregnant) such as “in vitro fertilisation”, “gamete intra-fallopian transfer” or “zygote intra-fallopian transfer”.

In adult men, GONAL-f is used:

• together with another medicine called “human Chorionic Gonadotropin” (hCG) to help produce

sperm in men that are infertile due to a low level of certain hormones.

2. what you need to know before you use gonal-f

You and your partner’s fertility should be evaluated before the treatment is started by a doctor experienced in treating fertility disorders.

Do not use GONAL-f

• if you are allergic to Follicle Stimulating Hormone or any of the other ingredients of this

medicine listed in section 6.

• if you have a tumour in your hypothalamus or pituitary gland (both are parts of the brain).
• if you are a woman:

• – with large ovaries or sacs of fluids within the ovaries (ovarian cysts) of unknown origin.

• – with unexplained vaginal bleeding.

• – with cancer in your ovaries, womb or breasts.

• – with a condition that usually makes normal pregnancy impossible, such as ovarian failure

(early menopause), or malformed reproductive organs.

• if you are a man:

• – with damaged testicles that cannot be healed.

Do not use GONAL-f if any of the above applies to you. If you are not sure, talk to your doctor before using this medicine.

Warnings and precautions

Porphyria

Tell your doctor before you start treatment, if you or any member of your family have porphyria (an inability to break down porphyrins that may be passed on from parents to children).

Tell your doctor straight away if:

• your skin becomes fragile and easily blistered, especially skin that has been frequently in the

sun, and/or

• you have stomach, arm or leg pain.

In case of the above events your doctor may recommend that you stop treatment.

Ovarian Hyper-Stimulation Syndrome (OHSS)

If you are a woman, this medicine increases your risk of developing OHSS. This is when your follicles develop too much and become large cysts. If you get lower abdominal pain, gain any weight rapidly, feel sick or are vomiting or if you have difficulty in breathing, talk to your doctor straight away who might ask you to stop using this medicine (see section 4).

In case you are not ovulating, and if the recommended dose and schedule of administration are adhered to, the occurrence of OHSS is less likely. GONAL-f treatment seldom causes severe OHSS unless the medicine that is used for final follicular maturation (containing human Chorionic Gonadotropin, hCG) is administered. If you are developing OHSS your doctor may not give you any hCG in this treatment cycle and you may be told not to have sex or to use a barrier contraceptive method for at least four days.

Multiple pregnancy

When using GONAL-f, you have a higher risk of being pregnant with more than one child at the same time (“multiple pregnancy”, mostly twins), than if you conceived naturally. Multiple pregnancy may lead to medical complications for you and your babies. You can reduce the risk of multiple pregnancy by using the right dose of GONAL-f at the right times. When undergoing assisted reproductive technology, the risk of having a multiple pregnancy is related to your age, the quality and the number of fertilised eggs or embryos placed inside you.

Miscarriage

When undergoing assisted reproductive technology or stimulation of your ovaries to produce eggs, you are more likely to have a miscarriage than the average woman.

Blood clotting problems (thromboembolic events)

If you had in the past or recently blood clots in the leg or in the lung, or a heart attack or stroke, or if those happened in your family, then you might have a higher risk that these problems occur or become worse with GONAL-f treatment.

Men with too much FSH in their blood

If you are a man, having too much FSH in your blood can be a sign of damaged testicles. GONAL-f usually does not work if you have this problem.

If your doctor decides to try GONAL-f treatment, to monitor the treatment, they may ask you to provide semen for analysis 4 to 6 months after starting treatment.

Children

GONAL-f is not indicated for use in children.

Other medicines and GONAL-f

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

• If you use GONAL-f with other medicines which help ovulation (such as hCG or clomiphene

citrate), this may increase the response of your follicles.

• If you use GONAL-f at the same time as a “gonadotropin-releasing hormone” (GnRH) agonist

or antagonist (these medicines reduce your sex hormone levels and stop you ovulating) you may need a higher dose of GONAL-f to produce follicles.

Pregnancy and breast-feeding

Do not use GONAL-f if you are pregnant or breast-feeding.

Driving and using machines

It is not expected that this medicine will affect your ability to drive and use machines.

GONAL-f 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 gonal-f

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

Using this medicine

GONAL-f is intended to be given by injection just under the skin (subcutaneously). The prefilled pen can be used for several injections.

The first injection of GONAL-f should be given under supervision of your doctor.

Your doctor or nurse will show you how to use the GONAL-f pre-filled pen to inject the medicine.

If you administer GONAL-f to yourself, please carefully read and follow the “Instructions for use”.

How much to use

Your doctor will decide how much medicine you will take and how often. The doses described below are stated in International Units (IU).

Women

• GONAL-f is usually given every day.
• If you have irregular periods, start using GONAL-f within the first 7 days of your menstrual

cycle. If you do not have periods you can start using the medicine on any convenient day.

• The usual starting dose of GONAL-f is 75 to 150 IU each day.
• Your dose of GONAL-f may be increased every 7 or every 14 days by 37.5 to 75 IU, until you

get the desired response.

• The maximum daily dose of GONAL-f is usually not higher than 225 IU.
• When you get the desired response, you will be given a single injection of 250 micrograms of

“recombinant hCG” (r-hCG, an hCG made in a laboratory by a special DNA technique), or 5,000 to 10,000 IU of hCG, 24 to 48 hours after your last GONAL-f injection. The best time to have sex is on the day of the hCG injection and the day after.

If your doctor cannot see a desired response after 4 weeks, that treatment cycle with GONAL-f should be stopped. For the following treatment cycle, your doctor will give you a higher starting dose of GONAL-f than before.

If your body responds too strongly, your treatment will be stopped and you will not be given any hCG (see section 2, OHSS). For the following cycle, your doctor will give you a lower dose of GONAL-f than before.

If you are not ovulating, having no periods and have been diagnosed with very low levels of FSH and LH hormones

• The usual starting dose of GONAL-f is 75 to 150 IU together with 75 IU of lutropin alfa.
• You will use these two medicines each day for up to five weeks.
• Your dose of GONAL-f may be increased every 7 or every 14 days by 37.5 to 75 IU, until you

get the desired response.

• When you get the desired response, you will be given a single injection of 250 micrograms of

“recombinant hCG” (r-hCG, an hCG made in a laboratory by a special DNA technique), or 5,000 to 10,000 IU of hCG, 24 to 48 hours after your last injections of GONAL-f and lutropin alfa. The best time to have sex is on the day of the hCG injection and the day after. Alternatively, intrauterine insemination may be performed by placing the sperm into the womb cavity.

If your doctor cannot see a response after 5 weeks, that treatment cycle with GONAL-f should be stopped. For the following cycle, your doctor will give you a higher starting dose of GONAL-f than before.

If your body responds too strongly, your treatment with GONAL-f will be stopped and you will not be given any hCG (see section 2, OHSS). For the following cycle, your doctor will give you a lower dose of GONAL-f than before.

If you need to develop several eggs for collection prior to any assisted reproductive technology

• The usual starting dose of GONAL-f is 150 to 225 IU each day, from day 2 or 3 of your

treatment cycle.

• GONAL-f dose may be increased, depending on your response. The maximum daily dose is

450 IU.

• Treatment is continued until your eggs have developed to a desired point. This usually takes

about 10 days but can take any time between 5 and 20 days. Your doctor will use blood tests and/or an ultrasound machine to check when this is.

• When your eggs are ready, you will be given a single injection of 250 micrograms “recombinant

hCG” (r-hCG, an hCG made in a laboratory by a special recombinant DNA technique), or 5,000 IU to 10,000 IU of hCG, 24 to 48 hours after the last GONAL-f injection. This gets your eggs ready for collection.

In other cases, your doctor may first stop you from ovulating by using a gonadotropin-releasing hormone (GnRH) agonist or antagonist. Then GONAL-f is started approximately two weeks after start of agonist treatment. The GONAL-f and GnRH agonist are then both given until your follicles develop as desired. For example, after two weeks of GnRH agonist treatment, 150 to 225 IU GONAL-f is administered for 7 days. The dose is then adjusted according to your ovarian response.

Men

• The usual dose of GONAL-f is 150 IU together with hCG.
• You will use these two medicines three times a week for at least 4 months.
• If you have not responded to treatment after 4 months, your doctor may suggest that you

continue using these two medicines for at least 18 months.

If you use more GONAL-f than you should

The effects of taking too much GONAL-f are unknown. Nevertheless, one could expect Ovarian Hyper-Stimulation Syndrome (OHSS) to occur, which is described in section 4. However, the OHSS will only occur if hCG is also administered (see section 2, OHSS).

If you forget to use GONAL-f

If you forget to use GONAL-f, do not take a double dose to make up for a forgotten dose. Please talk to your doctor as soon as you notice that you forgot a dose.

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.

Serious side effects in women

• Lower abdominal pain together with nausea or vomiting may be the symptoms of Ovarian

Hyper-Stimulation Syndrome (OHSS). This may indicate that the ovaries over-reacted to the treatment and that large ovarian cysts developed (see also in section 2. under “Ovarian HyperStimulation Syndrome”). This side effect is common (may affect up to 1 in 10 people).

• The OHSS may become severe with clearly enlarged ovaries, decreased urine production,

weight gain, difficulty in breathing and/or possible fluid accumulation in your stomach or chest. This side effect is uncommon (may affect up to 1 in 100 people).

• Complications of OHSS such as twisting of ovaries or blood clotting may occur rarely (may

affect up to 1 in 1,000 people).

• Serious blood clotting complications (thromboembolic events) sometimes independent of OHSS

may be found very rarely (may affect up to 1 in 10,000 people). This could cause chest pain, breathlessness, stroke or heart attack (see also in section 2. under “Blood clotting problems”).

Serious side effects in men and women

• Allergic reactions such as rash, red skin, hives, swelling of your face with difficulty breathing

can sometimes be serious. This side effect is very rare (may affect up to 1 in 10,000 people).

If you notice any of the above-listed side effects, you should immediately contact your doctor who might ask you to stop using GONAL-f.

Other side effects in women

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

• Sacs of fluid within the ovaries (ovarian cysts)
• Headache
• Local reactions at the injection site, such as pain, redness, bruising, swelling and/or irritation

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

• Abdominal pain
• Feeling sick, vomiting, diarrhoea, abdominal cramps and bloating

Very rare (may affect up to 1 in 10,000 people):

• Allergic reactions such as rash, red skin, hives, swelling of your face with difficulty breathing

may occur. These reactions can sometimes be serious.

• Your asthma may get worse.

Other side effects in men

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

• Local reactions at the injection site, such as pain, redness, bruising, swelling and/or irritation

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

• Swelling of the veins above and behind the testicles (varicocele)
• Breast development, acne or weight gain

Very rare (may affect up to 1 in 10,000 people):

• Allergic reactions such as rash, red skin, hives, swelling of your face with difficulty in breathing

may occur. These reactions can sometimes be serious.

• Your asthma may get worse.

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

United Kingdom

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 ofthis medicine.

5. how to store gonal-f

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 cartridge label or carton after EXP. The expiry date refers to the last day of that month.

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

Within its shelf life, the product may be stored at or below 25°C for up to 3 months without being refrigerated again and must be discarded if it has not been used after 3 months.

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

Do not use GONAL-f if you notice any visible signs of deterioration, if the liquid contains particles or is not clear.

Please write on the GONAL-f pre-filled pen the day you first use it. For this purpose, a sticker is provided with the “Instructions for use”.

• Once opened, the pen may be stored for a maximum of 28 days outside of the fridge (at or

below 25°C).

• Do not use any medicine left in your pre-filled pen after 28 days.

At the end of the treatment any unused solution must be discarded.

Do not throw away any medicines via wastewater. 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 follitropin alfa.

• There are 600 IU (44 micrograms) of follitropin alfa in each millilitre of liquid. Each pre-filled

pen with multidose cartridge delivers 150 IU (11 micrograms) in 0.25 mL.

• The other ingredients are poloxamer 188, sucrose, methionine, sodium dihydrogen phosphate

monohydrate, disodium phosphate dihydrate, m-cresol, concentrated phosphoric acid, sodium hydroxide and water for injections.

What GONAL-f looks like and contents of the pack

• GONAL-f is presented as a clear, colourless liquid for injection in a pre-filled pen.
• It is supplied in packs with 1 pre-filled pen and 4 disposable needles.

Marketing Authorisation Holder

Merck Serono Ltd, 5 New Square, Bedfont Lakes Business Park, Feltham, Middlesex, TW14 8HA, UK

Manufacturer

Merck Serono S.p.A., Via delle Magnolie 15, 70026 Modugno (Bari), Italy

This leaflet was last revised in 01/2021.

Instructions for use

GONAL-f PRE-FILLED PEN 150 IU/0.25 mL

Solution for injection in pre-filled pen Follitropin alfa

Contents

1. How to use the GONAL-f pre-filled pen

2. How to use your GONAL-f pre-filled pen Treatment Diary

• 3. Before you start using your GONAL-f pre-filled pen

• 4. Getting your GONAL-f pre-filled pen ready for injection

• 5. Setting the dose prescribed by your doctor

• 6. Injecting the dose

• 7. After the injection

• 8. GONAL-f pre-filled pen Treatment Diary (see table at the end)

Warning: Please read these instructions for use before using your GONAL-f pre-filled pen. Follow

the procedure exactly, as it may differ from your past experience.

1. how to use the gonal-f pre-filled pen

Do not share the pen. The pen is for subcutaneous injection only.

The numbers on the Dose Feedback Window are measured in International Units or IUs. Your doctor will have told you how many IUs to inject each day.

The numbers displayed in the Dose Feedback Window help you to:

• a. Dial your prescribed dose.

• b. Verify a complete injection.

• c. Read the dose remaining to be injected with a second

pen.

Give yourself the injection at the same time each day. Example:

Your doctor/pharmacist will tell you how many pens you need to complete your treatment.

2. how to use your gonal-f pre-filled pen treatment diary

A treatment diary is included on the last page.

Use the treatment diary to record the amount of injected IUs you use each time.

• Record the treatment day number (1), date (2) and time (3) of your injection.
• In the first line of the table the volume of your pen is already recorded for you (4).
• Record your prescribed dose in the “Prescribed Dose” section (5).
• Verify you dialed the right dose before injecting (6).
• After injection, read the number shown in the Dose Feedback Window.

Confirm you received a complete injection (7) or record the number shown in the Dose

Feedback Window if other than “0” (8).

When needed, inject yourself using a second pen, dialing your remaining dose written in the “Amount Displayed After Injection” section (8).

Record this remaining dose in the “Amount Set to Inject” section in the next row (6).

CAUTION:

Using your treatment diary to record your daily injection(s) allows you to verify every day that you received the full prescribed dose.

An example of a treatment diary:

Note: The 150 IU pen maximum single-dose setting is 150 IU; the 300 IU pen maximum single-dose setting is 300 IU; the 450 IU pen maximum single-dose setting is 450 IU; the 900 IU pen maximum single-dose setting is 450 IU.

3. Before you start using your GONAL-f pre-filled pen

Wash your hands with soap and water.

Find a clean area and a flat surface.

Verify the expiration date on the pen label.

2.

3. Plunger piston

• 4. Reservoir holder

• 4. Getting your GONAL-f pre-filled pen ready for injection 4.1.

4.2.

4.3. Prepare your needle for injection

• Get a new needle – only use the

“single-use” needles supplied.

• Hold the outer needle cap firmly.
• Check that the peel-off seal on

the outer needle cap is not damaged or loose.

• Remove the peel-off seal.

CAUTION:

If the peel-off seal is damaged or loose, do not use the needle. Throw it away in a sharps disposal container. Get a new needle.

4.4. Attach the needle

• Screw the threaded tip of the GONAL-f pre-filled pen into the outer needle cap until you

feel a light resistance.

Warning: Do not attach the needle too tightly; the needle could be difficult to remove after

the injection.

4.5. Look closely at the tip of the needle for tiny drop(s) of fluid

Warning:  ONLY

you use a new GONAL-f pre-filled pen to remove air in the system.

If you do not see a tiny drop(s) of fluid at or near the tip the first time you use a new pen:

Hold the pen with the needle pointing upward.

Tap the reservoir holder gently.

Press the dose setting knob as far as it will go. A tiny drop of liquid will appear at the tip of the needle.

Verify that the Dose Feedback Window reads “0”.

Proceed to Section 5: Setting the dose prescribed by your doctor.

• 5. Setting the dose prescribed by your doctor

  5.1.

  5.2.

  
  

The pen contains 150 IU follitropin alfa.

The 150 IU pen maximum single-dose setting is 150 IU. The smallest single-dose

setting is 12.5 IU and the dose can be increased in increments of 12.5 IU.

Turn the dose setting knob until your intended dose shows in the Dose Feedback Window

Warning: Check that the Dose Feedback Window displays your complete prescribed dose

before you move on to the next step.

• 6. Injecting the dose

  6.1.

  
  

Choose an injection site in the area your doctor or nurse has told you to give the injection.

To minimize skin irritation, select a different injection site each day.

Clean the skin by wiping with an alcohol swab.

Verify once more that the Dose Feedback Window displays the correct dose.

Inject the dose as you were trained to do by your doctor or nurse.

Slowly push the needle into the skin entirely (1).

Press the dose knob down as far as it will go

• Hold the dose knob down for a minimum of

5 seconds to ensure you inject the full dose (2). The larger the dose, the longer it will take to inject.

• The dose number shown in the Dose Feedback

Window will turn back to “0”.

• After a minimum of 5 seconds, pull the needle

out of the skin while keeping the dose setting knob pressed down (3).

• Release the dose setting knob.

Warning: Always make sure to use a new needle

for each injection.

7. After the injection

Warning: If the Dose Feedback Window shows a number higher than “0”, the GONAL-f

pre-filled pen is empty and you have not received your full prescribed dose.

Complete a partial injection (only when needed)

• The Dose Feedback Window will indicate the missing amount you need to inject using a

new pen.

Repeat Section 3

Set the dose to the missing amount you recorded in the treatment diary or the number still displayed in the Dose Feedback Window on your previous pen and inject.

7.3. Removing the needle after each injection

• Place the outer needle cap on a flat surface.
• Hold the GONAL-f pre-filled pen firmly with one hand,

and slip the needle into the outer needle cap.

Continue by pushing the capped needle against a firm surface until you hear a “click”.

Grip the outer needle cap and unscrew the needle by turning anti-clockwise. Dispose of the used needle safely.

Never reuse any used needle. Never share needles. Recap the pen.

7.4. Storing the GONAL-f pre-filled pen

CAUTION:

Never store the pen with the needle attached.

Always remove the needle from the GONAL-fpre-filled pen before replacing the pen cap.

• Store the pen in its original packaging in a safe place.
• When the pen is empty, ask your pharmacist how to dispose of it.

Warning: Do not throw away any medicines via wastewater or household waste.

• 8. GONAL-f pre-filled pen Treatment Diary

  1 Treatment Day Number	2 Date	3 Time	4 Pen Volume	5 Prescribed Dose	6 7 8 Dose Feedback Window
  					Amount Set to Inject	Amount Displayed After Injection a ’ '
  	/		150 IU			Yif „0“, injection complete	Yif not „0“, need second injection Inject this amount........using new pen
  	/		150 IU			Yif „0“, injection complete	Yif not „0“, need second injection Inject this amount........using new pen
  	/		150 IU			Yif „0“, injection complete	Yif not „0“, need second injection Inject this amount........using new pen
  	/		150 IU			Yif „0“, injection complete	Yif not „0“, need second injection Inject this amount........using new pen
  	/		150 IU			Yif „0“, injection complete	Yif not „0“, need second injection Inject this amount........using new pen –
  	/		150 IU			Yif „0“, injection complete	Yif not „0“, need second injection Inject this amount........using new pen
  	/		150 IU			Yif „0“, injection complete	Yif not „0“, need second injection Inject this amount........using new pen
  	/		150 IU			Yif „0“, injection complete	Yif not „0“, need second injection Inject this amount........using new pen
  	/		150 IU			Yif „0“, injection complete	Yif not „0“, need second injection Inject this amount........using new pen
  	/		150 IU			Yif „0“, injection complete	Yif not „0“, need second injection Inject this amount........using new pen
  	/		150 IU			Yif „0“, injection complete	Yif not „0“, need second injection Inject this amount........using new pen
  	/		150 IU			Yif „0“, injection complete	Yif not „0“, need second injection Inject this amount........using new pen

These instructions for use were last revised in 01/2021.

166