Kirsty 100 units/ml solution for injection in pre-filled pen – patient leaflet, side effects, dosage

1. What Kirsty is and what it is used for

Kirsty is a modern insulin (insulin analogue) with a rapid-acting effect. Modern insulin products are improved versions of human insulin.

Kirsty is used to reduce the high blood sugar level in adults, adolescents and children aged 1 year and above with diabetes mellitus (diabetes). Diabetes is a disease where your body does not produce enough insulin to control the level of your blood sugar. Treatment with Kirsty helps to prevent complications from your diabetes.

Kirsty will start to lower your blood sugar 10-20 minutes after you inject it, a maximum effect occurs between 1 and 3 hours after the injection and the effect lasts for 3-5 hours. Due to this short action Kirsty should normally be used in combination with intermediate-acting or long-acting insulin preparations.

2. What you need to know before you use Kirsty

Do not use Kirsty

• If you are allergic to insulin aspart, or any of the other ingredients of this medicine listed in section 6.
• If you suspect hypoglycaemia (low blood sugar) is starting (see a) Summary of serious and very common side effects in section 4).
• If Kirsty is dropped, damaged or crushed.
• If it has not been stored correctly or been frozen (see section 5, How to store Kirsty). ➢ If the insulin does not appear clear and colourless.

If any of these applies, do not use Kirsty. Talk with your doctor, nurse or pharmacist for advice.

Before using Kirsty

• Check the label to make sure it is the right type of insulin.
• Always use a new needle for each injection to prevent contamination. ➢ Needles and Kirsty pre-filled pen must not be shared.
• Kirsty pre-filled pen is only suitable for injecting under the skin. Speak to your doctor if you need to inject your insulin by another method.

Warnings and precautions

• Some conditions and activities can affect your need for insulin. Consult your doctor: ➢ If you have trouble with your kidneys or liver, or with your adrenal, pituitary or thyroid glands. ➢ If you exercise more than usual or if you want to change your usual diet, as this may affect your blood sugar level.
• If you are ill, carry on using your insulin and consult your doctor.
• If you are going abroad, travelling over time zones may affect your insulin needs and the timing of your injections.

Skin changes at the injection site

The injection site should be rotated to help prevent changes to the fatty tissue under the skin, such as skin thickening, skin shrinking or lumps under the skin. The insulin may not work very well if you inject into a lumpy, shrunken or thickened area (see section 3, How to use Kirsty). Tell your doctor if you notice any skin changes at the injection site. Tell your doctor if you are currently injecting into these affected areas before you start injecting in a different area. Your doctor may tell you to check your blood sugar more closely, and to adjust your insulin or your other antidiabetic medications dose.

Children and adolescents

Do not give this medicine to children below 1 year of age since no clinical studies have been carried out in children below the age of 1 year.

Other medicines and Kirsty

Tell your doctor, nurse or pharmacist if you are taking, have recently used or might use any other medicines.

Some medicines affect your blood sugar level and this may mean that your insulin dose has to change. Listed below are the most common medicines which may affect your insulin treatment.

Your blood sugar level may fall (hypoglycaemia) if you use:

• Other medicines for the treatment of diabetes
• Monoamine oxidase inhibitors (MAOI) (used to treat depression)
• Beta-blockers (used to treat high blood pressure)
• Angiotensin converting enzyme (ACE) inhibitors (used to treat certain heart conditions or high blood pressure)
• Salicylates (used to relieve pain and lower fever)
• Anabolic steroids (such as testosterone)
• Sulphonamides (used to treat infections).

Your blood sugar level may rise (hyperglycaemia) if you use:

• Oral contraceptives (birth control pills)
• Thiazides (used to treat high blood pressure or excessive fluid retention) • Glucocorticoids (such as ‘cortisone’ used to treat inflammation)
• Thyroid hormones (used to treat thyroid gland disorders)
• Sympathomimetics (such as epinephrine [adrenaline], or salbutamol, terbutaline used to treat asthma)
• Growth hormone (medicine for stimulation of skeletal and somatic growth and pronounced influence on the body’s metabolic processes)
• Danazol (medicine acting on ovulation).

Octreotide and lanreotide (used for treatment of acromegaly, a rare hormonal disorder that usually occurs in middle-aged adults, caused by the pituitary gland producing excess growth hormone) may either increase or decrease your blood sugar level.

Beta-blockers (used to treat high blood pressure) may weaken or suppress entirely the first warning symptoms which help you to recognise low blood sugar.

Pioglitazone (tablets used for the treatment of type 2 diabetes)

Some patients with long-standing type 2 diabetes and heart disease or previous stroke who were treated with pioglitazone and insulin experienced the development of heart failure. Inform your doctor as soon as possible if you experience signs of heart failure such as unusual shortness of breath or rapid increase in weight or localised swelling (oedema).

If you have used any of the medicines listed here, tell your doctor, nurse or pharmacist.

Kirsty and alcohol

• If you drink alcohol, your need for insulin may change as your blood sugar level may either rise or fall. Careful monitoring is recommended.

Pregnancy and breast-feeding

• If you are pregnant, think you may be pregnant or are planning to have a baby, ask your doctor for advice before using this medicine. Kirsty can be used during pregnancy. Your insulin dose may need to be changed during pregnancy and after delivery. Careful control of your diabetes, particularly prevention of hypoglycaemia, is important for the health of your baby. ➢ There are no restrictions on treatment with Kirsty during breast-feeding.

Ask your doctor, nurse or pharmacist for advice before using this medicine while pregnant or breast-feeding.

Driving and using machines

Please ask your doctor whether you can drive a car or operate a machine:

• If you have frequent hypoglycaemia.
• If you find it hard to recognise hypoglycaemia.

If your blood sugar is low or high, your concentration and ability to react might be affected and therefore also your ability to drive or operate a machine. Bear in mind that you could endanger yourself or others.

Kirsty has a rapid onset of effect therefore if hypoglycaemia occurs, you may experience it earlier after an injection when compared to soluble human insulin.

Kirsty 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 Kirsty

Dose and when to use your insulin

Always use your insulin and adjust your dose exactly as your doctor has told you. Check with your doctor, pharmacist or nurse if you are not sure.

Kirsty is generally used immediately before a meal. Eat a meal or snack within 10 minutes of the injection to avoid low blood sugar. When necessary, Kirsty can be given soon after a meal. See How and where to inject below for information.

Do not change your insulin unless your doctor tells you to. If your doctor has switched you from one type or brand of insulin to another, your dose may have to be adjusted by your doctor.

Use in children and adolescents

Kirsty can be used in adolescents and children aged 1 year and above instead of soluble human insulin when a rapid onset of effect is preferred. For example, when it is difficult to dose the child in relation to meals.

Use in special patient groups

If you have reduced kidney or liver function, or if you are above 65 years of age, you need to check your blood sugar more regularly and discuss changes in your insulin dose with your doctor.

How and where to inject

Kirsty is for injection under the skin (subcutaneously). You must never inject yourself directly into a vein (intravenously) or muscle (intramuscularly). Kirsty pre-filled pen is only suitable for injecting under the skin. Speak to your doctor if you need to inject your insulin by another method.

With each injection, change the injection site within the particular area of skin that you use. This may reduce the risk of developing lumps or skin pitting (see section 4, Possible side effects). The best places to give yourself an injection are the front of your waist (abdomen), the upper arm or the front of your thighs. The insulin will work more quickly if injected into the front of your waist. You should always measure your blood sugar regularly.

How to handle Kirsty pre-filled pen

Kirsty pre-filled pen is a pre-filled, disposable pen containing insulin aspart.

Read carefully the instructions on how to use Kirsty pre-filled pen included in this package leaflet. You must use the pen as described in the instructions on how to use Kirsty pre-filled pen.

Always ensure you use the correct pen before you inject your insulin.

If you use more insulin than you should

If you use too much insulin your blood sugar gets too low (hypoglycaemia). See a) Summary of serious and very common side effects in section 4.

If you forget to use your insulin

If you forget to use your insulin your blood sugar may get too high (hyperglycaemia). See c) Effects from diabetes in section 4.

If you stop using your insulin

Do not stop using your insulin without speaking with a doctor, who will tell you what needs to be done. This could lead to very high blood sugar (severe hyperglycaemia) and ketoacidosis. See c) Effects from diabetes in section 4.

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

4. Possible side effects

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

1. a) Summary of serious and very common side effects

Low blood sugar (hypoglycaemia) is a very common side effect. It may affect more than 1 in 10 people.

Low blood sugar may occur if you:

• Inject too much insulin.
• Eat too little or miss a meal.
• Exercise more than usual.
• Drink alcohol (see Drinking alcohol and using Kirsty in section 2).

Signs of low blood sugar: Cold sweat; cool pale skin; headache; rapid heartbeat; feeling sick; feeling very hungry; temporary changes in vision; drowsiness; unusual tiredness and weakness; nervousness or tremor; feeling anxious; feeling confused; difficulty in concentrating.

Severe low blood sugar can lead to unconsciousness. If prolonged severe low blood sugar is not treated, it can cause brain damage (temporary or permanent) and even death. You may recover more quickly from unconsciousness with an injection of the hormone glucagon by someone who knows how to use it. If you are given glucagon, you will need glucose or a sugar snack as soon as you are conscious. If you do not respond to glucagon treatment, you will have to be treated in a hospital.

What to do if you experience low blood sugar:

• If you experience low blood sugar, eat glucose tablets or another high sugar snack (e.g. sweets, biscuits, fruit juice). Measure your blood sugar if possible and rest. Always carry glucose tablets or high sugar snacks with you, just in case.
• When symptoms of low blood sugar have disappeared or when blood sugar level is stabilised, continue insulin treatment as usual.
• If you have such a low blood sugar that it makes you pass out, if you have had need for injection of glucagon, or if you have experienced many incidents of low blood sugar, talk with a doctor. The amount or timing of insulin, food or exercise may need to be adjusted.

Tell relevant people that you have diabetes and what the consequences may be, including the risk of passing out (become unconscious) due to low blood sugar. Let them know that if you pass out, they must turn you on your side and get medical help straight away. They must not give you any food or drink due to risk of suffocation.

Serious allergic reactions to Kirsty or one of its ingredients (called a systemic allergic reaction) is a very rare side effect but can potentially be life threatening. It may affect up to 1 in 10,000 people.

Seek medical advice immediately:

• If signs of allergy spread to other parts of your body.
• If you suddenly feel unwell, and you: start sweating; start being sick (vomiting); have difficulty in breathing; have a rapid heartbeat; feel dizzy.

If you notice any of these signs, seek medical advice immediately.

Skin changes at the injection site: If you inject insulin at the same place, the fatty tissue may shrink (lipoatrophy) or thicken (lipohypertrophy) (may affect up to 1 in 100 people). Lumps under the skin may also be caused by build-up of a protein called amyloid (cutaneous amyloidosis; how often this occurs is not known). The insulin may not work very well if you inject into a lumpy, shrunken or thickened area. Change the injection site with each injection to help prevent these skin changes.

1. b) List of other side effects

Uncommon side effects (may affect up to 1 in 100 people)

Signs of allergy: Local allergic reactions (pain, redness, hives, inflammation, bruising, swelling and itching) at the injection site may occur. These usually disappear after a few weeks of using your insulin. If they do not disappear, or if they spread throughout your body, talk to your doctor immediately. See also Serious allergic reactions above.

Vision problems: When you first start your insulin treatment, it may disturb your vision, but the disturbance is usually temporary.

Swollen joints: When you start using insulin, water retention may cause swelling around your ankles and other joints. Normally this soon disappears. If not, talk to your doctor.

Diabetic retinopathy (an eye disease related to diabetes which can lead to loss of vision): If you have diabetic retinopathy and your blood sugar level improves very fast, the retinopathy may get worse. Ask your doctor about this.

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

Painful neuropathy (pain due to nerve damage): If your blood sugar level improves very fast, you may get nerve related pain. This is called acute painful neuropathy and is usually transient.

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 at www.mhra.gov.uk/yellowcard 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.

1. c) Effects from diabetes

High blood sugar (hyperglycaemia)

High blood sugar may occur if you:

• Have not injected enough insulin.
• Forget to inject your insulin or stop using insulin.
• Repeatedly inject less insulin than you need.
• Get an infection and/or a fever.
• Eat more than usual.
• Exercise less than usual.

Warning signs of high blood sugar: The warning signs appear gradually. They include: increased urination; feeling thirsty; losing your appetite; feeling sick (nausea or vomiting); feeling drowsy or tired; flushed; dry skin; dry mouth and a fruity (acetone) smell of the breath.

What to do if you experience high blood sugar:

• If you get any of the above signs: test your blood sugar level, test your urine for ketones if you can, then seek medical advice immediately.
• These may be signs of a very serious condition called diabetic ketoacidosis (build-up of acid in the blood because the body is breaking down fat instead of sugar). If you do not treat it, this could lead to diabetic coma and eventually death.

5. How to store Kirsty

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 pre-filled pen label and carton after ‘EXP’. The expiry date refers to the last day of that month.

Keep the medicine in the outer carton in order to protect from light.

Before opening: Kirsty pre-filled pen that is not being used is to be stored in the refrigerator at 2°C to 8°C, away from the cooling element. Do not freeze.

After first use: You can carry your Kirsty pre-filled pen with you and keep it at a temperature below 30°C or in a refrigerator (2 ˚C to 8 ˚C) for up to 28 days. If refrigerated, keep away from the cooling element. Do not freeze.

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 protect the environment.

6. Contents of the pack and other information

What Kirsty pre-filled pen contains

• The active substance is insulin aspart. Each ml contains 100 units of insulin aspart. Each pre-filled pen contains 300 units in insulin aspart in 3 ml solution for injection. • The other ingredients are glycerol, phenol, metacresol, zinc chloride, disodium phosphate dihydrate, sodium chloride, hydrochloric acid, sodium hydroxide (see section 2 “Kirsty contains sodium”), and water for injections.

What Kirsty looks like and contents of the pack

Pre-filled plastic pen with cap containing 3 ml of clear colourless solution.

Pack sizes of 1, 5, 10 pre-filled pens, or a multipack containing 10 (2 packs of 5) pre-filled pens. Not all pack sizes may be marketed.

The solution is clear and colourless.

Marketing Authorisation Holder

Biosimilar Collaborations Ireland Limited

Unit 35/36

Grange Parade

Baldoyle Industrial Estate

Dublin 13

Dublin

D13 R20R

Ireland

Manufacturer

McDermott Laboratories T/A Mylan Dublin Biologics

Newenham Court Northern Cross Malahide Road

Dublin 17, Ireland

This leaflet was last revised in July 2023

Kirsty pre-filled pen

INSTRUCTIONS FOR USE

Read the following instructions, as well as the package leaflet carefully before using your Kirsty pre-filled pen.

If you do not follow the instructions carefully, you may get too little or too much insulin, which can lead to too high or too low blood sugar level.

Kirsty pre-Filled pen is a prefilled dial-a-dose insulin pen. You can select doses from 1 to 80 units in increments of 1 unit.

Needle sizes compatible with this pen:

• 31G, 5 mm
• 32G, 4 mm
• 34G, 4 mm

As a precautionary measure, always carry a spare insulin delivery device in case your Kirsty pre-filled pen is lost or damaged.

Kirsty pre-filled pen

Each time you use the pen

• Wash your hands before using the pen
• Check the name and coloured label of your pen to make sure that it contains the correct type of insulin. This is especially important if you use more than one type of insulin. If you use the wrong type of insulin, your blood sugar level may get too high or too low. • Check the insulin in the cartridge. Kirsty should be clear, colourless and free of particles. If not, do not use.

Step 1. Prepare your pen

1a- Pull of the pen cap (see figure A)

1b- Wipe the rubber stopper with an alcohol swab

Step 2. Attach the needle

2a- Remove the paper tab from a new disposable needle.

2b- Screw the needle straight and tightly onto your Kirsty pre-filled pen (see figure B).

2c- Pull off the big outer needle cap and keep it for later (see figure C)

2d- Pull off the inner needle cap and dispose of it (see figure D).

Never try to put the inner needle cap back on the needle. You may stick yourself with the needle.

Important information:

• Always use a new needle for each injection. This reduces the risk of contamination, infection, leakage of insulin, blocked needles and inaccurate dosing.
• Be careful not to bend or damage the needle before use.

Step 3. Checking the insulin flow

Prior to each injection small amounts of air may collect in the cartridge during normal use. To avoid injection of air and ensure proper dosing

3a- Turn the dose selector to select 2 units (see figure E)

3b- Hold your Kirsty Pre-Filled Pen with the needle pointing upwards and tap the cartridge gently with your finger a few times to make any air bubbles collect at the top of the cartridge (see figure F)

3c- Keeping the needle upwards, press the push-button all the way in. The dose selector returns to 0. A drop of insulin should appear at the needle tip (see figure G). If not, change the needle and repeat procedure from step 3a to 3c no more than 6 times. If a drop of insulin still does not appear, the pen is defective, and you must use a new one.

.

Important information:

• Always make sure that a drop appears at the needle tip before you inject. This makes sure that the insulin flows. If no drop appears, you will not inject any insulin, even though the dose selector may move. This may indicate a blocked or damaged needle.
• Always check the flow before you inject. If you do not check the flow, you may get too little insulin or no insulin at all. This may lead to too high blood sugar level.

Step 4: Selecting your dose

4a- Check that the dose selector is set at 0.

4b- Turn the dose selector to the number of units you need to inject (see figure H). The dose can be corrected either up or down by turning the dose selector in either direction until the correct dose lines up with the pointer. When turning the dose selector, be careful not to push the push button as insulin will come out. You cannot select a dose larger than the number of units left in the cartridge

Important information:

• Always use the dose selector and the pointer to see how many units you have selected before injecting the insulin.
• Do not count the pen clicks. If you select and inject the wrong dose, your blood sugar level may get too high or too low. Do not use the residual scale, it only shows approximately how much insulin is left in your pen.

Step 5. Giving the injection

5a- Use the injection technique shown by your doctor or nurse.

Kirsty pre-filled pen can be injected under the skin (subcutaneously) of your stomach area, buttocks, upper legs (thighs) or upper arms (see figure I).

5b- For each injection change (rotate) your injection site within the area of skin that you use. Do not use the same injection site for each injection.

5c- Insert the needle into your skin. Inject the dose by pressing the push button all the way in until 0 lines up with the pointer (see figure J). Be careful only to push the push button when injecting. 5d- Keep the push-button fully depressed and let the needle remain under the skin for at least 6 seconds (see figure K). This will make sure you get the full dose.

5e- After holding and slowly counting to 6, withdraw the needle from the skin, then release the pressure on the push-button.

Important information:

• Always make sure that the dose selector returns to 0 after the injection. If the dose selector stops before it returns to 0, the full dose has not been delivered, which may result in too high blood sugar level.

Step 6: After the injection

6a- Carefully put the outer needle cap over the needle (see figure L).

Unscrew the needle. Safely remove the needle from your Kirsty pre-filled pen after each use.

Dispose of needle in a suitable sharps container.

6b. Put the pen cap on the Kirsty pre-filled pen (see figure M) and store the pen without the needle attached.

Caring for your pen

Your Kirsty Pre-Filled Pen must be handled with care. If it is dropped, damaged, or crushed, there is a risk of insulin leakage. This may cause inaccurate dosing, which can lead to too high or too low blood sugar level.

You can clean the exterior of your Kirsty Pre-Filled Pen by wiping it with a medicinal swab. Do not soak it, wash or lubricate it as it may damage the pen.

Do not refill your Kirsty Pre-Filled Pen. Once empty, it must be disposed of.

Further important information

• Caregivers must be very careful when handling used needles to reduce the risk of needle sticks and cross-infection.
• Dispose of your used Kirsty Pre-Filled Pen carefully without the needle attached.
• Never share your pen or your needles with other people. It might lead to cross-infection.
• Never share your pen with other people. Your medicine might be harmful to their health.
• Always keep your pen and needles out of sight and reach of others, especially children.