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SPRYCEL 20 mg film-coatedtabletsPatient’s LeafletSummary for
2014-01-15 20:54:07 来源: 作者: 【 】 浏览:400次 评论:0

For doctors

 

What is it and how is it used?

SPRYCEL is a leukaemia treatment for adults with chronic myeloid leukaemia (CML). Leukaemia is a cancer of white blood cells. These white cells usually help the body to fight infection. In people with CML, white cells called granulocytes start growing out of control. SPRYCEL inhibits the growth of these leukaemic cells.

SPRYCEL is also a treatment for adults with Philadelphia chromosome positive (Ph+) acute lymphoblastic leukaemia (ALL), and lymphoid blast CML who are not benefiting from prior therapies. In people with ALL, white cells called lymphocytes multiply too quickly and live too long. SPRYCEL inhibits the growth of these leukaemic cells.

If you have any questions about how SPRYCEL works or why this medicine has been prescribed for you, ask your doctor.

What do you have to consider before using it?

SPRYCEL will only be prescribed to you by a doctor with experience in medicines to treat leukaemia.

Do not take SPRYCEL
if you are allergic
( hypersensitive) to dasatinib or any of the other ingredients of SPRYCEL. If you could be allergic, ask your doctor for advice.

Take special care with SPRYCEL
if you are taking medicines to thin the blood
or prevent clots (see Using other medicines) if you have a liver or heart problem, or used to have one
if you start having difficulty breathing, chest pain, or a cough when taking SPRYCEL: this may be a sign of fluid retention in the lungs or chest (which can be more common in patients aged 65 years and older).

If any of these affects you, tell your doctor. Your doctor will regularly monitor your condition to check whether SPRYCEL is having the desired effect. You will also have blood tests regularly while you are taking SPRYCEL.

Children, adolescents and SPRYCEL
SPRYCEL is not recommended in patients below 18 years of age. There is limited experience with the use of SPRYCEL in this age group.

Older people and SPRYCEL
SPRYCEL can be used by people over 65 at the same doses as other adults.

Using other medicines
SPRYCEL is mainly handled by the liver. Certain medicines may interfere with the effect of SPRYCEL when taken together.

These medicines are not to be used with SPRYCEL:
ketoconazole, itraconazole - these are antifungal medicines erythromycin, clarithromycin, telithromycin - these are antibiotics ritonavir - this is an antiviral medicine dexamethasone - this is a corticosteroid phenytoin, carbamazepine, phenobarbital - these are treaments for epilepsy rifampicin - this is a treatment for tuberculosis
famotidine, omeprazole - these are medicines that block stomach acids
St. John’s wort - a herbal preparation obtained without a prescription used to treat depression and other conditions(also known as Hypericum perforatum)

Medicines that neutralise stomach acids (antacids such as aluminium hydroxide/magnesium hydroxide) may be taken up to 2 hours before or 2 hours after taking SPRYCEL.

You should tell your doctor if you are taking medicines to thin the blood or prevent clots.

Please tell your doctor if you are taking or have recently taken any other medicines, including medicines obtained without a prescription.

Pregnancy and breast-feeding
If you are pregnant
or think you may be, tell your doctor immediately. SPRYCEL is not to be used during pregnancy unless clearly necessary. Your doctor will discuss with you the potential risk of taking SPRYCEL during pregnancy. Both men and women taking SPRYCEL will be advised to use effective contraception during treatment.

If you are breast-feeding, tell your doctor. Breast-feeding should be stopped if you are taking SPRYCEL.

Driving and using machines
Take special care when driving or using machines in case you experience side effects such as dizziness and blurred vision. It is not known if SPRYCEL will affect your ability to drive or use machines.

Important information about some of the ingredients of SPRYCEL
SPRYCEL contains lactose. If you have been diagnosed with an intolerance to some sugars, talk to your doctor before taking this medicine.

How is it used?

Always take SPRYCEL exactly as your doctor has told you. You should check with your doctor or pharmacist if you are not sure. SPRYCEL is prescribed for adults.

The starting dose recommended for patients with chronic phase CML is 100 mg once a day.

The starting dose recommended for patients with accelerated or blast crisis CML or Ph+ ALL is 140 mg once a day.

Tablets should be taken at the same time every day.

Depending on how you respond to the treatment, your doctor may suggest a higher or lower dose, or even stopping treatment briefly. For higher or lower doses, use of combinations of the different tablet strengths may be necessary.

The tablets may come in calendar packs. These are blister packs showing the days of the week. There are arrows to show the next tablet to be taken according to your treatment schedule.

How to take SPRYCEL
The tablets must be swallowed whole, not crushed. They can be taken with or without a meal.

Special handling instructions for SPRYCEL
In the unlikely event of the tablets being broken, persons other than the patient are recommended to use gloves when handling SPRYCEL .

How long to take SPRYCEL
You should take SPRYCEL daily until your doctor tells you to stop. Make sure you take SPRYCEL for as long as it is prescribed.

If you take more SPRYCEL than you should
If you have accidentally taken too many tablets, talk to your doctor immediately. You may require medical attention.

If you forget to take SPRYCEL
Do not take a double dose to make up for a forgotten tablet. Take the next scheduled dose at the regular time.

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

What are possible side effects?

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

Tell your doctor immediately if you notice any of the following:
if you have chest pain, difficulty breathing, coughing and fainting if you experience unexpected bleeding or bruising without having an injury if you find blood in your vomit, stools or urine, or have black stools
if you get signs of infections such as fever, severe chills
These can all be signs of serious side effects.

Frequencies are defined as follows:

very common affects more than 1 user in 10 common affects 1 to 10 users in 100

uncommon affects 1 to 10 users in 1,000 rare affects 1 to 10 users in 10,000 very rare affects less than 1 user in 10,000 not known frequency cannot be estimated from the available data

Very common side effects
Infections
(including bacterial, viral and fungal)
Heart and lungs: shortness of breath
Digestive problems: diarrhoea, feeling or being sick (nausea, vomiting)
Skin, hair, eye, general: skin rash, fever, swelling around hands and feet, headache, feeling tired or weak, bleeding
Pain: pain in the muscles, abdominal (tummy) pain
Tests may show: low blood platelet count, low white blood cells count (neutropenia), anaemia, fluid around the lungs

Common side effects
Infections
: pneumonia, herpes viral infection, upper respiratory infection
Heart and lungs: cough, palpitations, flushing, dizziness, congestive heart failure, cardiac dysfunction, high blood pressure, increased blood pressure in the arteries that supply the lungs Digestive problems: appetite disturbances, taste disturbance, bloated or distended tummy (abdomen), inflammation of the colon, constipation, heartburn, mouth ulceration, weight increase, weight decrease, gastritis
Skin, hair, eye, general: skin tingling, itching, dry skin, acne, inflamation of the skin, persistant noise in ears, hair loss, excessive perspiration, visual disorder (including blurred vision and disturbed vision), dry eye, haematoma, depression, insomnia, contusion, anorexia, somnolence, generalised oedema
Pain: pain in joints, muscle inflammation, muscular weakness, chest pain, pain around hands and feet, chills
Tests may show: fluid around the heart, fluid in the lungs, arrhythmia, febrile neutropenia, deficiency in all blood cells, gastrointestinal bleeding

Other side effects that have been reported (frequency not known) include: inflammation of the lungs, blood clots in the blood vessels, and irregular heart rhythm.

Your doctor will check for some of these effects during your treatment.

If any of the side effects gets serious, or if you notice any side effects not listed in this leaflet, please tell your doctor or pharmacist.

How should it be stored?

Keep out of the reach and sight of children.

Do not use SPRYCEL after the expiry date which is stated on the label, blister or carton after EXP. The expiry date refers to the last day of that month.

This medicine does not require any special storage conditions.

Medicines should not be disposed of via wastewater or household waste. Ask your pharmacist how to dispose of medicines no longer required. These measures will help to protect the environment.

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For doctors

What is it?

Sprycel is a medicine that contains the active substance dasatinib. It is available as white tablets (round: 20, 70 and 140 mg; oval: 50 and 100 mg; triangular: 80 mg).

What is it used for?

Sprycel is an anticancer medicine. It is used to treat adults with the following types of leukaemia (cancer of the white blood cells):

chronic myeloid leukaemia CML in the chronic phase in newly diagnosed patients who are Philadelphia chromosome positive Ph. CML is a leukaemia where granulocytes a type of white blood cell start growing out of control. Ph means that some of the patients genes have rearranged themselves to form a special chromosome called the Philadelphia chromosome which produces an enzyme, Bcr-Abl kinase, that leads to the development of leukaemia.

CML in chronic, accelerated and blast phases. Sprycel is used when patients cannot tolerate, or when their disease is not responding to, other treatments including imatinib another anticancer medicine

Ph acute lymphoblastic leukaemia ALL, where lymphocytes another type of white blood cell multiply too quickly, or in lymphoid blast CML. Sprycel is used when patients cannot tolerate, or when their disease is not responding to, other treatments.

Because the number of patients with CML and ALL is low, the diseases are considered ‘rare’, and Sprycel was designated an ‘orphan medicine’ (a medicine used in rare diseases) on 23 December 2005.

The medicine can only be obtained with a prescription.

How is it used?

Treatment with Sprycel should be started by a doctor who has experience in the diagnosis and treatment of leukaemia.

Sprycel is taken once a day, consistently either in the morning or in the evening. For chronic phase CML, the starting dose is 100 mg. For advanced (accelerated or blast) phase CML and for Ph+ ALL, it is 140 mg. The dose can be increased or decreased on the basis of the patient’s response to the medicine. Treatment is continued until either the disease gets worse or until the patient cannot tolerate the medicine any longer. Patients must be monitored during treatment to check their blood levels of platelets (components that help the blood to clot) and neutrophils (the white blood cells that fight infection). Doctors may recommend a lower dose or a break from treatment if these values change or if patients have certain side effects. Sprycel tablets must be swallowed whole. See the summary of product characteristics (also part of the EPAR) for full details.

How does it work?

The active substance in Sprycel, dasatinib, belongs to a group of medicines called ‘protein kinase inhibitors’. These compounds act by blocking types of enzymes known as protein kinases. Dasatinib acts mainly by blocking the Bcr-Abl protein kinase. This enzyme is produced by leukaemia cells, and causes them to multiply uncontrollably. By blocking Bcr-Abl kinase, as well as other kinases, Sprycel helps to control the spread of leukaemia cells.

How has it been studied?

The five main studies of Sprycel, taken twice a day, involved 515 patients, all of whom had received prior treatment with imatinib and had either failed or become resistant to it. None of these studies included a head-to-head comparison of Sprycel with any other medicine. Two studies were carried out in chronic CML (198 and 36 patients), one was in accelerated CML (120 patients), one was in myeloid blast CML (80 patients), and one was in Ph+ ALL and lymphoid blast CML (81 patients).

Two further studies compared the effects of Sprycel taken once or twice a day, one in 670 patients with chronic phase CML and the other in 611 patients with advanced phase CML or Ph+ ALL.

All of the studies assessed the patients’ responses by measuring the levels of white cells and platelets in the blood, to see if they were returning to normal, and by measuring the number of white blood cells that contained the Philadelphia chromosome, to see if it was decreasing.

A further study involving 519 patients compared Sprycel with imatinib in treating newly diagnosed Ph+ patients with chronic phase CML who had not received any previous treatment. The main measure of effectiveness was the number of patients whose blood cells no longer contained the Philadelphia chromosome within one year of treatment.

What benefits has it shown during the studies?

In the larger main study of patients with chronic phase CML, 90% of the patients responded to treatment, with blood levels of platelets and white blood cells returning to within predefined, normal values. In patients with CML in other phases (accelerated, myeloid blast and lymphoid blast) and in ALL, between a quarter and a third of the patients showed a complete response. In addition, between one and two thirds of the patients in the five main trials showed a reduction in the number of white blood cells containing the Philadelphia chromosome. In the additional studies, once- and twice-daily Sprycel had similar rates of effectiveness, but the once-daily dose caused fewer side effects.

In the study on newly diagnosed Ph+ patients with chronic phase CML, Sprycel was more effective than imatinib: within one year, 77% of patients receiving Sprycel no longer had the Philadelphia chromosome in their blood cells, compared with 66% of patients receiving imatinib.

What is the risk associated?

In studies, the most common side effects with Sprycel (seen in more than 1 patient in 10) were infection, headache, haemorrhage (bleeding), pleural effusion (fluid around the lungs), dyspnoea (difficulty breathing), diarrhoea, vomiting, nausea (feeling sick), abdominal pain (stomach ache), skin rash, musculoskeletal pain (pain in the muscles and bones), fluid retention, fatigue (tiredness), superficial oedema (swelling), pyrexia (fever), neutropenia (low levels of neutrophils), thrombocytopenia (low blood platelet counts) and anaemia (low red blood cell counts). For the full list of all side effects reported with Sprycel, see the package leaflet.

Sprycel should not be used in people who may be hypersensitive (allergic) to dasatinib or any of the other ingredients.

Why has it been approved?

The CHMP decided that Sprycel’s benefits are greater than its risks and recommended that it be given marketing authorisation.

Further information

The European Commission granted a marketing authorisation valid throughout the European Union for Sprycel to Bristol-Myers Squibb Pharma EEIG on 20 November 2006. The marketing authorisation is valid for five years, after which it can be renewed.

The summaries of opinion of the Committee for Orphan Medicinal Products for Sprycel can be found on the Agency’s website ema.europa.eu/Find medicine/Human medicines/Rare disease designation:

CML

ALL. europa.eu/Find medicine/Human medicines/European Public Assessment Reports.. For more information about treatment with Sprycel, read the package leaflet (also part of the EPAR) or contact your doctor or pharmacist.

This summary was last updated in 10-2010.

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Name

 

SPRYCEL 20 mg film-coatedtablets

 

Composition

 

Each film-coated tablet contains 20 mg dasatinib (as monohydrate).

Excipients
Each tablet contains 27 mg of lactose monohydrate.
For a full list of excipients, see section 6.1.

 

Pharmaceutical Form

 

Film-coatedtablet (tablet)

White to off-white, biconvex, round tablet with "BMS" debossed on one side and "527" on the other side.

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