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GEMCITABINE 10 MG/ML SOLUTION FOR INFUSION

Active substance(s): GEMCITABINE HYDROCHLORIDE / GEMCITABINE HYDROCHLORIDE / GEMCITABINE HYDROCHLORIDE

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Breast-feeding
Tell your doctor if you are breast-feeding. You must discontinue breast-feeding
during Gemcitabine treatment.

Gemcitabine 10 mg/ml, solution for infusion
gemcitabine
Read all of this leaflet carefully before you are given 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, pharmacist or nurse.
- If you get any side effects talk to your doctor, pharmacist or nurse. This includes
any possible side effects not listed in this leaflet. See section 4.

Fertility
Men are advised not to father a child during and up to 6 months following
treatment with Gemcitabine. If you would like to father a child during the treatment
or in the 6 months following treatment, seek advice from your doctor. You may
want to seek counselling on sperm storage before starting your therapy.
Driving and using machines
Gemcitabine may make you feel sleepy, particularly if you have consumed any
alcohol. Do not drive a car or use machinery until you are sure that Gemcitabine
treatment has not made you feel sleepy.

Other side effects
Tell your doctor as soon as possible about any of the following side effects:

Gemcitabine contains sodium
One ml of the solution for infusion contains 4.575 mg sodium.
To be taken into consideration by patients on a controlled sodium diet.

What is in this leaflet
1. What Gemcitabine is and what it is used for
2. What you need to know before you are given Gemcitabine
3. How Gemcitabine is given
4. Possible side effects
5. How to store Gemcitabine
6. Contents of the pack and other information

Gemcitabine SUN contains 549.00 mg (23.88 mmol) of sodium in each 120 ml
infusion bag, 640.50 mg (27.86 mmol) of sodium in each 140 ml infusion bag,
732.00 mg (31.84 mmol) of sodium in each 160 ml infusion bag, 777.75 mg
(33.83 mmol) of sodium in each 170 ml infusion bag, 823.50 mg (35.82 mmol) of
sodium in each 180 ml infusion bag, 915.00 mg (39.80 mmol) of sodium in each
200 ml infusion bag, 1006.50 mg (43.78 mmol) of sodium in each 220 ml
infusion bag.

1. What Gemcitabine is and what it is used for

3. How Gemcitabine is given

Gemcitabine belongs to a group of medicines called "cytotoxics". These medicines
kill dividing cells, including cancer cells.

The recommended dose of Gemcitabine is 1000-1250 mg for every square metre
of your body's surface area. Your height and weight are measured to work out the
surface area of your body. Your doctor will use this body surface area to work out
the right dose for you. This dose may be adjusted, or treatment may be delayed
depending on your blood cell counts and on your general condition.

Gemcitabine may be given alone or in combination with other anti-cancer
medicines, depending on the type of cancer.
Gemcitabine is used in the treatment of the following types of cancer:
- non-small cell lung cancer (NSCLC), alone or together with cisplatin
- pancreatic cancer
- breast cancer, together with paclitaxel
- ovarian cancer, together with carboplatin
- bladder cancer, together with cisplatin.

Very common (may affect more than 1 in 10 users)
- allergic reactions: if you develop mild to moderate skin rash or fever
- tiredness, feeling faint, becoming easily breathless or if you look pale (you might
have less haemoglobin than normal)
- bleeding from the gums, nose or mouth or any bleeding that would not stop,
reddish or pinkish urine, unexpected bruising (you might have less platelets than
normal).
Common (may affect up to 1 in 10 users)
- temperature of 38°C or greater, sweating or other signs of infection (you might
have less white blood cells than normal accompanied by fever also known as
febrile neutropenia)
- pain, redness, swelling or sores in your mouth (stomatitis)
- allergic reactions: if you develop itching
- mild breathing difficulty (it is common to have mild breathing difficulty soon
after the Gemcitabine infusion which soon passes).

Rare (may affect up to 1 in 1,000 users)
- low blood pressure
- skin scaling, ulceration or blister formation
- sloughing of skin and severe skin blistering
- injection site reactions
- a skin rash like severe sunburn which can occur on skin that has previously
been exposed to radiotherapy (radiation recall)
- fluid in the lungs
- scarring of the air sacs of the lung associated with radiation therapy (radiation
toxicity)
- gangrene of fingers or toes
- inflammation of the blood vessels (peripheral vasculitis).
Very rare (may affect up to 1 in 10,000 users)
- increased platelet count
- inflammation of the lining of the large bowel, caused by reduced blood supply
(ischaemic colitis).
Low haemoglobin level (anaemia), low white blood cells and low platelet count will
be detected by a blood test.

Uncommon (may affect up to 1 in 100 users)
- difficulty breathing due to more severe lung problems (interstitial pneumonitis,
bronchospasm)
- irregular heart rate (arrhythmia).
Rare (may affect up to 1 in 1,000 users)
- difficulty breathing due to more severe lung problems (pulmonary oedema, adult
respiratory distress syndrome)
- extreme tiredness and weakness, red or purple skin discolouration or small
areas of bleeding in the skin (bruises), acute renal failure (low urine output /or
no urine output), and signs of infection (haemolytic uraemic syndrome). This
may be fatal.
- severe chest pain (myocardial infarction).

Removal of infusion bag from overwrap and infusion bag inspection
- Tear overwrap at notch. Do not use if overwrap has been
previously opened or damaged.
- Remove infusion bag from overwrap.
- Use only if infusion bag and seal are intact. Prior to administration
check for minute leaks by squeezing bag firmly. If leaks are
found, discard the bag and solution as sterility may be impaired.
- Parenteral medicinal products should be inspected visually for
particulate matter and discolouration prior to administration. If
particulate matter is observed, do not administer.

Handling
- Calculate the dose, and decide which size of the Gemcitabine
infusion bags is needed. If the required dose cannot be achieved
with the available presentations, use of an alternative gemcitabine
product, including gemcitabine as a concentrate or gemcitabine
as powder for solution for infusion, is recommended.
- Inspect the product pack for any damage. Do not use if there are
signs of tampering.
- Apply patient-specific label on the overwrap.

Instructions for use, handling and disposal

Pregnancy, breast-feeding and fertility
Pregnancy
If you are pregnant, think you may be pregnant or are planning to have a baby, ask
your doctor for advice before this medicine is given to you. The use of
Gemcitabine should be avoided during pregnancy. Your doctor will discuss with
you the potential risk of treatment with Gemcitabine during pregnancy.

Serious side effects
You must tell your doctor immediately about any of the following serious side
effects:

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

If the product comes into contact with the eyes, severe irritation
may result. In such an event, the eyes should be washed thoroughly
and immediately. Consult a doctor if irritation persists. If the solution
should come into contact with skin, rinse the affected area
thoroughly with water. Excreta and vomit must be handled with care.

Other medicines and Gemcitabine
Tell your doctor, pharmacist or nurse if you are taking, have recently taken or might
take any other medicines.

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

Cytotoxic preparations should not be handled by pregnant staff.

Children and adolescents
This medicine is not recommended for use in children under 18 years of age due
to insufficient data on safety and efficacy.

Uncommon (may affect up to 1 in 100 users)
- scarring of the air sacs of the lung (interstitial pneumonitis)
- wheeze (spasm of the airways)
- scarring of the lungs (abnormal chest X ray/scan)
- heart failure
- kidney failure
- serious liver damage, including liver failure
- stroke.

4. Possible side effects

Personnel must be provided with appropriate handling materials,
notably long sleeved gowns, protection masks, caps, protective
goggles, sterile single-use gloves, protective covers for the work
area and collection bags for waste.

Please tell your doctor before you are given Gemcitabine if:
- you have, or have previously had liver disease, heart disease, vascular disease
or problems with your kidneys as you may not be able to receive Gemcitabine
- you have recently had, or are going to have radiotherapy, as there may be an
early or late radiation reaction
- you have been vaccinated recently.

The following information is intended for healthcare
professionals only

You will always receive Gemcitabine by infusion (a drip) into one of your veins.
The infusion will last approximately 30 minutes.

Precautions
- Do not use in series connection.
- Do not introduce additives into the infusion bag.
- The solution for infusion is ready to use and and must not be
mixed with other medicinal products.
- After opening the infusion bag:
From a microbiological point of view, the solution should be used
immediately. If not used immediately, in-use storage times and
conditions prior to use are the responsibility of the user.
- Gemcitabine solution for infusion is for single use only.

Warnings and precautions
Before the first infusion you will have samples of your blood taken to check if you
have sufficient kidney and liver function. Before each infusion you will have
samples of your blood taken to check if you have enough blood cells to receive
Gemcitabine. Your doctor may decide to change the dose or delay treating you
depending on your general condition and if your blood cell counts are too low.
Periodically you will have samples of your blood taken to check your kidney and
liver function.

gemcitabine

How frequently you receive your Gemcitabine infusion depends on the type of
cancer that you are being treated for.

Administration
- Break the Minitulipe stopper seal by applying pressure on one
side with hand.
- Using aseptic technique, attach sterile administration set.
- Refer to directions for use accompanying the administration set.

You should NOT be given Gemcitabine
- if you are allergic to gemcitabine or any of the other ingredients of this medicine
(listed in section 6)
- if you are breast-feeding.

Gemcitabine 10 mg/ml, solution for infusion

Common (may affect up to 1 in 10 users)
- poor appetite (anorexia)
- headache
- insomnia
- sleepiness
- cough
- runny nose
- constipation
- diarrhoea
- itching
- sweating
- muscle pain
- back pain
- fever
- weakness
- chills.

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

2. What you need to know before you are given Gemcitabine

Very common (may affect more than 1 in 10 users)
- low white blood cells
- difficulty breathing
- vomiting
- nausea
- hair loss
- liver problems: found through abnormal blood test results
- blood in urine
- abnormal urine tests: protein in urine
- flu like symptoms including fever
- swelling of ankles, fingers, feet, face (oedema).

Disposal
Any unused medicinal product or waste material should be disposed
of in accordance with local requirements for cytotoxic agents.

Package leaflet: Information for the patient

Very rare (may affect up to 1 in 10,000 users)
- severe hypersensitivity/allergic reaction with severe skin rash including red itchy
skin, swelling of the hands, feet, ankles, face, lips, mouth or throat (which may
cause difficulty in swallowing or breathing), wheezing, fast beating heart and
you may feel you are going to faint (anaphylactic reaction)
- generalised swelling, shortness of breath or weight gain, as you might have fluid
leakage from small blood vessels into the tissues (capillary leak syndrome)
- headache with changes in vision, confusion, seizures or fits (posterior reversible
encephalopathy syndrome)
- severe rash with itching, blistering or peeling of the skin (Stevens-Johnson
syndrome, toxic epidermal necrolysis).

350 mm
Size: 350x430 mm

5. How to store Gemcitabine
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 infusion bag
and the outer packaging after EXP. The expiry date refers to the last day of that
month.
This medicine does not require any special storage conditions. Do not refrigerate
or freeze.
After opening the infusion bag:
From a microbiological point of view, the solution should be used immediately. If
not used immediately, in-use storage times and conditions prior to use are the
responsibility of the user.
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 Gemcitabine solution for infusion contains
- The active substance is: gemcitabine (as hydrochloride)
- The other ingredients are: sodium chloride, water for injection, sodium hydroxide
and/or hydrochloric acid (for pH adjustment).
One 120 ml infusion bag contains 1200 mg gemcitabine (as hydrochloride).
One 140 ml infusion bag contains 1400 mg gemcitabine (as hydrochloride).
One 160 ml infusion bag contains 1600 mg gemcitabine (as hydrochloride).
One 170 ml infusion bag contains 1700 mg gemcitabine (as hydrochloride).
One 180 ml infusion bag contains 1800 mg gemcitabine (as hydrochloride).
One 200 ml infusion bag contains 2000 mg gemcitabine (as hydrochloride).
One 220 ml infusion bag contains 2200 mg gemcitabine (as hydrochloride).
One ml of the solution for infusion contains 10 mg gemcitabine.
One ml of the solution for infusion contains 4.575 mg sodium.
What Gemcitabine solution for infusion looks like and contents of the pack
Gemcitabine solution for infusion is a clear, colourless, sterile solution free from
visible particulate matter.
Gemcitabine SUN solution for infusion is supplied in carton boxes each containing
1, 5 or 10 single-dose infusion bags of 120 ml, 140 ml, 160 ml, 170 ml, 180 ml,
200 ml or 220 ml.
Not all pack sizes may be marketed.
Marketing Authorisation Holder and Manufacturer
Sun Pharmaceutical Industries Europe BV
Polarisavenue 87
2132 JH Hoofddorp
The Netherlands
This leaflet was last revised in February 2017

350 mm
Size: 350x430 mm

5

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Source: Medicines and Healthcare Products Regulatory Agency

Disclaimer: Every effort has been made to ensure that the information provided here is accurate, up-to-date and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. This information has been compiled for use by healthcare practitioners and consumers in the United States. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate that the drug or combination is safe, effective or appropriate for any given patient. If you have questions about the substances you are taking, check with your doctor, nurse or pharmacist.

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