Tyverb - patient leaflet, side effects, dosage

1. What Tyverb is and what it is used for

Tyverb is used to treat certain types of breast cancer (HER2-overexpressing) which have spread beyond the original tumour or to other organs (advanced or metastatic breast cancer). It may slow or stop cancer cells from growing, or may kill them.

Tyverb is prescribed to be taken in combination with another anti-cancer medicine.

Tyverb is prescribed in combination with capecitabine , for patients who have had treatment for advanced or metastatic breast cancer before. This previous treatment for metastatic breast cancer must have included trastuzumab.

Tyverb is prescribed in combination with trastuzumab , for patients who have hormone receptornegative metastatic breast cancer and have had other treatment for advanced or metastatic breast cancer before.

Tyverb is prescribed in combination with an aromatase inhibitor , for patients with hormone sensitive metastatic breast cancer (breast cancer that is more likely to grow in the presence of hormones), who are not currently intended for chemotherapy.

Information about these medicines is described in separate patient information leaflets. Ask your doctor to give you information about these other medicines.

2. What you need to know before you take Tyverb

Do not take Tyverb

• if you are allergic to lapatinib or any of the other ingredients of this medicine (listed in

Section 6).

Take special care with Tyverb

Your doctor will run tests to check that your heart is working properly before and during your treatment with Tyverb.

Tell your doctor if you have any heart problems before you take Tyverb.

Your doctor also needs to know before you take Tyverb:

• if you have lung disease
• if you have inflammation of the lung
• if you have any liver problems
• if you have any kidney problems
• if you have diarrhoea (see section 4).

Your doctor will run tests to check that your liver is working properly before and during your treatment with Tyverb.

Tell your doctor if any of these apply to you.

Serious skin reactions

Serious skin reactions have been seen with Tyverb. Symptoms may include skin rash, blisters and skin peeling.

Tell your doctor as soon as possible if you get any of these symptoms.

Other medicines and Tyverb

Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines. This includes herbal medicines and other medicines you bought without a prescription.

It is especially important to tell your doctor if you are taking, or have recently taken any of the following medicines. Some medicines may affect the way Tyverb works or Tyverb may affect how other medicines work. These medicines include some medicines in the following groups:

• St John’s Wort – a herb extract used to treat depression
• erythromycin, ketoconazole, itraconazole, posaconazole, voriconazole, rifabutin, rifampicin,

telithromycin - medicines used to treat infections

• cyclosporine – a medicine used to suppress the immune system for example after organ

transplantations

• ritonavir, saquinavir – medicines used to treat HIV
• phenytoin, carbamazepine – medicines used to treat seizures
• cisapride – a medicine used to treat certain digestive system problems
• pimozide – a medicine used to treat certain mental health problems
• quinidine, digoxin – medicines used to treat certain heart problems
• repaglinide – a medicine used to treat diabetes
• verapamil – a medicine used to treat high blood pressure or heart problems (angina)
• nefazodone – a medicine used to treat depression
• topotecan, paclitaxel, irinotecan, docetaxel – medicines used to treat certain types of cancer
• rosuvastatin – a medicine used to treat high cholesterol
• medicines that decrease stomach acidity – used to treat stomach ulcers or indigestion

Tell your doctor if you are taking, or have recently taken, any of these.

Your doctor will review the medicines you are currently taking to make sure you are not taking something that can’t be taken with the Tyverb. Your doctor will advise you whether an alternative is available.

Tyverb with food and drink

Don’t drink grapefruit juice while you are being treated with Tyverb. It can affect the way the medicine works.

Pregnancy and breast-feeding

The effect of Tyverb during pregnancy is not known. You should not use Tyverb if you are pregnant unless your doctor specifically recommends it.

• If you are pregnant or planning to become pregnant, tell your doctor.
• Use a reliable method of contraception to avoid becoming pregnant while you’re taking

Tyverb and for at least 5 days after the last dose.

• If you become pregnant during treatment with Tyverb, tell your doctor.

It is not known whether Tyverb passes into breast-milk. Do not breast-feed while taking Tyverb and for at least 5 days after the last dose.

• If you are breast-feeding or planning to breast-feed, tell your doctor.

Ask your doctor or pharmacist for advice before taking Tyverb if you are unsure.

Driving and using machines

You are responsible to decide if you are able to drive a motor vehicle or perform other tasks that require increased concentration. Because of the possible side effects of Tyverb, your ability to drive or operate machines could be affected. These effects are described in section 4, ‘Possible side effects’.

Tyverb contains sodium

This medicine contains less than 1 mmol sodium (23 mg) per tablet, that is to say essentially ‘sodium-free’.

3. How to take Tyverb

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

Your doctor will decide on the correct dose of Tyverb depending on the type of breast cancer being treated.

If you are prescribed Tyverb in combination with capecitabine , the usual dose is 5 Tyverb tablets a day , as a single dose.

If you are prescribed Tyverb in combination with trastuzumab , the usual dose is 4 Tyverb tablets a day , as a single dose.

If you are prescribed Tyverb in combination with an aromatase inhibitor , the usual dose is

6 Tyverb tablets a day , as a single dose.

Take the prescribed dose every day for as long as your doctor tells you to.

Your doctor will advise you about the dose of your other anti-cancer medicine, and how to take it.

Taking your tablets

• Swallow the tablets whole with water, one after the other, at the same time each day.
• Take Tyverb either at least one hour before or at least one hour after food. Take Tyverb at

the same time in relation to food each day – for example, you could always take your tablet one hour before breakfast.

While you are taking Tyverb

• Depending on the side effects you experience, your doctor may recommend lowering your dose

or temporarily stopping your treatment.

• Your doctor will also carry out tests to check your heart and liver function before and during

treatment with Tyverb.

If you take too much Tyverb

Contact a doctor or pharmacist immediately. If possible, show them the pack.

If you forget to take Tyverb

Don’t take a double dose to make up for a forgotten dose. Just take the next dose at the scheduled time.

4. Possible side effects

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

A severe allergic reaction is a rare side effect (may affect up to 1 in 1,000 people) and may develop rapidly.

Symptoms may include:

• skin rash (including itchy, bumpy rash)
• unusual wheezing, or difficulty in breathing
• swollen eyelids, lips or tongue
• pains in muscles or joints
• collapse or blackout.

Tell your doctor immediately if you get any of these symptoms. Don’t take any more tablets.

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

• diarrhoea (which may make you dehydrated and lead to more severe complications)

Tell your doctor immediately at the first sign of diarrhoea (loose stool), as it is important that this is treated right away. Also tell your doctor immediately if your diarrhoea worsens . There is more advice on reducing the risk of diarrhoea at the end of section 4.

• rash, dry skin, itching

Tell your doctor if you get a skin rash . There is more advice on reducing the risk of skin rash at the end of section 4.

Other very common side effects

• loss of appetite
• feeling sick (nausea)
• being sick (vomiting)
• tiredness, feeling weak
• indigestion
• constipation
• sore mouth/mouth ulcers
• stomach pain
• trouble sleeping
• back pain
• pain in hands and feet
• joint or back pain
• a skin reaction on the palms of the hands or soles of the feet (including tingling, numbness,

pain, swelling or reddening)

• cough, shortness of breath
• headache
• nose bleed
• hot flush
• unusual hair loss or thinning

Tell your doctor if any of these side effects get severe or troublesome.

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

• an effect on how your heart works

In most cases, the effect on your heart will not have any symptoms. If you do experience symptoms associated with this side effect, these are likely to include an irregular heartbeat and shortness of breath.

• liver problems, which may cause itching, yellow eyes or skin (jaundice), or dark urine or pain

or discomfort in the right upper area of the stomach

• nail disorders – such as a tender infection and swelling of the cuticles
• skin fissures (deep cracks on the skin or chapped skin)

Tell your doctor if you get any of these symptoms.

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

• treatment-induced lung inflammation, which may cause shortness of breath or cough Tell your doctor immediately if you get either of these symptoms.

Other uncommon side effects include:

• blood tests results that show changes in liver function (usually mild and temporary)

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

• severe allergic reactions (see the beginning of section 4)

The frequency of some side effects is not known (it cannot be estimated from the available data):

• irregular heart-beat (change in the electrical activity of the heart)
• severe skin reaction that might include: rash, red skin, blistering of the lips, eyes or mouth, skin

peeling, fever or any combination of these

• pulmonary arterial hypertension (increased blood pressure in the arteries (blood vessels) of the

lungs)

If you get other side effects

Tell your doctor or pharmacist if you notice any side effects not listed in this leaflet.

Reducing the risk of diarrhoea and skin rash

Tyverb can cause severe diarrhoea

If you suffer from diarrhoea while taking Tyverb:

• drink plenty of fluids (8 to 10 glasses a day), such as water, sports drinks or other clear liquids
• eat low-fat, high protein foods instead of fatty or spicy foods
• eat cooked vegetables instead of raw vegetables and remove the skin from fruits before eating
• avoid milk and milk products (including ice cream)
• avoid herbal supplements (some may cause diarrhoea).

Tell your doctor if your diarrhoea continues.

Tyverb can cause skin rash

Your doctor will check your skin before and during treatment.

To care for sensitive skin:

• wash with a soap-free cleanser
• use fragrance free, hypoallergenic beauty products
• use sunscreen (Sun Protection Factor [SPF] 30 or higher).

Tell your doctor if you get a skin rash.

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 the national reporting system listed in By reporting side effects you can help provide more information on the safety of this medicine.

5. How to store Tyverb

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 blister or bottle and the carton.

Do not store above 30°C.

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 Tyverb contains

• – The active substance in Tyverb is lapatinib. Each film-coated tablet contains lapatinib ditosylate

monohydrate, equivalent to 250 mg lapatinib.

• – The other ingredients are: microcrystalline cellulose, povidone (K30), sodium starch glycolate

What Tyverb looks like and contents of the pack

Tyverb film-coated tablets are oval, biconvex, yellow film-coated, with ‘GS XJG’ marked on one side.

Tyverb is supplied in either blisters packs or bottles:

Blister packs

Each pack of Tyverb contains 70 or 84 tablets in aluminium foil blisters of 10 or 12 tablets each. Each foil has a perforation down the middle and can be divided into two blisters with 5 or 6 tablets in each, depending on the pack size.

Tyverb is also available in multipacks containing 140 tablets that comprise 2 packs, each containing 70 tablets.

Bottles

Tyverb is also available in plastic bottles containing 70, 84, 105 or 140 tablets.

Not all pack sizes may be marketed.

Marketing Authorisation Holder

Novartis Europharm Limited

Vista Building

Elm Park, Merrion Road

Dublin 4

Ireland

Manufacturer

Glaxo Wellcome S.A.

Avenida de Extremadura 3

09400 Aranda de Duero

Burgos

Spain

Novartis Pharma GmbH

RoonstraBe 25

D-90429 Nuremberg

Germany

For any information about this medicine, please contact the local representative of the Marketing Authorisation Holder:

België/Belgiqu­e/Belgien Novartis Pharma N.V. Tél/Tel: +32 2 246 16 11	Lietuva SIA Novartis Baltics Lietuvos filialas Tel: +370 5 269 16 50
Efc^rapufl Novartis Bulgaria EOOD Ten: +359 2 489 98 28	Luxembourg/Lu­xemburg Novartis Pharma N.V. Tél/Tel: +32 2 246 16 11
Česká republika Novartis s.r.o. Tel: +420 225 775 111	Magyarország Novartis Hungária Kft. Tel.: +36 1 457 65 00
Danmark Novartis Healthcare A/S Tlf: +45 39 16 84 00	Malta Novartis Pharma Services Inc. Tel: +356 2122 2872
Deutschland Novartis Pharma GmbH Tel: +49 911 273 0	Nederland Novartis Pharma B.V. Tel: +31 88 04 52 555
Eesti SIA Novartis Baltics Eesti filiaal Tel: +372 66 30 810	Norge Novartis Norge AS Tlf: +47 23 05 20 00
EÀÀàôa Novartis (Hellas) A.E.B.E. Tql: +30 210 281 17 12	Österreich Novartis Pharma GmbH Tel: +43 1 86 6570
España Novartis Farmacéutica, S.A. Tel: +34 93 306 42 00	Polska Novartis Poland Sp. z o.o. Tel.: +48 22 375 4888
France Novartis Pharma S.A.S. Tél: +33 1 55 47 66 00	Portugal Novartis Farma – Produtos Farmacêuticos, S.A. Tel: +351 21 000 8600
Hrvatska Novartis Hrvatska d.o.o. Tel. +385 1 6274 220	România Novartis Pharma Services Romania SRL Tel: +40 21 31299 01
Ireland Novartis Ireland Limited Tel: +353 1 260 12 55	Slovenija Novartis Pharma Services Inc. Tel: +386 1 300 75 50
Ísland Vistor hf. Sími: +354 535 7000	Slovenská republika Novartis Slovakia s.r.o. Tel: +421 2 5542 5439
Italia Novartis Farma S.p.A. Tel: +39 02 96 54 1	Suomi/Finland Novartis Finland Oy Puh/Tel: +358 (0)10 6133 200

United Kingdom (Northern Ireland)

Novartis Ireland Limited

Tel: +44 1276 698370

This leaflet was last revised in

Detailed information on this medicine is available on the European Medicines Agency web site:

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