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powder for solution for infusion

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, pharmacist or nurse.
- 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, pharmacist or nurse. This includes any possible
side effects not listed in this leaflet. See section 4.
What is in this leaflet
1.2What Gemcitabine is and what it is used for
2.2What you need to know before you use Gemcitabine
3.2How to use Gemcitabine
4.2Possible side effects
5.2How to store Gemcitabine
6.2Contents of the pack and other information
1.0What GEMCITABINE is and what it is used for
Gemcitabine belongs to a group of medicines called “cytotoxics”. These medicines kill dividing
cells, including cancer cells.
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.
2. What you need to know before you use GEMCITABINE
Do not use 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
Warnings and precautions
Talk to your doctor, pharmacist or nurse before using Gemcitabine.
Before the first infusion you will have samples of your blood taken to evaluate if you have sufficient
kidney and liver function. Before each infusion you will have samples of your blood taken to evaluate
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 evaluate your kidney and liver function.
If you have, or have previously had liver disease, heart disease, vascular disease or problems with your
kidneys talk to your doctor or hospital pharmacist as you may not be able to receive Gemcitabine.
If you have recently had, or are going to have radiotherapy, please tell your doctor as there may
be an early or late radiation reaction with Gemcitabine.
If you have been vaccinated recently please tell your doctor as this can possibly cause bad effects
with Gemcitabine.
If you develop breathing difficulties or feel very weak and are very pale, please tell your doctor as
this may be a sign of kidney failure or problem with your lungs.

The following information is intended for healthcare professionals only:
Handling of this cytotoxic agent by health professional requires a set of precautions to protect the
handler and his/her environment.
The preparation of cytotoxic solutions for injection must be carried out by trained specialist
personnel who know about the drugs involved, under conditions that ensure protection of the
environment and above all protection of the staff handling the solutions. It must be done in a
designated area. Smoking, eating and drinking are prohibited in this area.
The personnel preparing the solutions must be provided with all the equipment required for this
task, notably long-sleeved laboratory coats, protective masks, head-covering, safety goggles, sterile
single-use gloves, protective covering for the work surface, containers and sacks for waste.
Any excreta or vomit must be handled with adequate precautions.
Pregnant women should be informed and avoid handling cytotoxics.

If you develop generalised swelling, shortness of breath or weight gain, please tell your doctor as
this may be a sign of fluid leaking from your small blood vessels into the tissue.
Other medicines and GEMCITABINE
Tell your doctor or hospital pharmacist if you are taking, have recently taken or might take any
other medicines.
Pregnancy, breast-feeding and fertility
If you are pregnant, or thinking about becoming pregnant, tell your doctor. The use of Gemcitabine
should be avoided during pregnancy. Your doctor will discuss with you the potential risk of taking
Gemcitabine during pregnancy.
If you are breast-feeding, tell your doctor.
You must discontinue breast-feeding during Gemcitabine treatment.
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 or pharmacist. 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.
Important information about some of the ingredients of Gemcitabine
Gemcitabine (200 mg and 1000 mg vials) contains less than 1 mmol sodium per vial, i.e.
essentially ‘sodium-free’.
Gemcitabine (2000 mg vial) contains 1.5 mmol sodium per vial. To be taken into consideration by
patients on a controlled sodium diet.
3. How to use GEMCITABINE
The usual 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 dosage may be adjusted, or
treatment may be delayed depending on your blood cell counts and on your general condition.
How frequently you receive your Gemcitabine infusion depends on the type of cancer that you are
being treated for.
A hospital pharmacist or doctor will have dissolved the Gemcitabine powder before it is given to you.
You will always receive Gemcitabine by infusion into one of your veins. The infusion will last
approximately 30 minutes.
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.
You must contact your doctor immediately if you notice any of the following:
- Fever or infection (common): if you have a temperature of 38ºC or greater, sweating or other signs
of infection (since you might have less white blood cells than normal which is very common).
- Irregular heart rate (arrhythmia) (uncommon).
- Pain, redness, swelling or sores in your mouth (common).
- Allergic reactions: if you develop skin rash (very common) / itching (common), or fever (very
common). Contact your doctor if you get a severe rash or itching or blistering (Stevens – Johnson
syndrome, or Toxic epidermal necrolysis).
- Tiredness, feeling faint, becoming easily breathless or if you look pale (since you might have less
haemoglobin than normal which is very common).

Any broken container must be dealt with using the same precautions and considered to be
contaminated waste.
The disposal of contaminated waste is carried out by incineration in labelled rigid containers
provided for the purpose. See section “Disposal of waste” hereafter.
If gemcitabine comes in contact with the skin, it must be rinsed immediately with large amounts of
water. Precautions must be taken to avoid any accidental spraying of the medicinal product into
the eyes. If it is sprayed accidentally into the eyes, rinse the eyes immediately with large amounts
of water.
This medicinal product has only been shown to be compatible with an injectable solution of
9 mg/mL (0.9%) sodium chloride. Accordingly, only this diluent should be used to reconstitute the
solution. Compatibility with other drugs has not been studied, and therefore, it is not advisable to
mix gemcitabine with other drugs during reconstitution.

- Bleeding from the gums, nose or mouth or any bleeding that would not stop, reddish or pinkish
urine, unexpected bruising (since you might have less platelets than normal which is very common).
- Difficulty breathing (it is very common to have mild breathing difficulty soon after the Gemcitabine
infusion which soon passes, however uncommonly or rarely there can be more severe lung problems)
- Generalised swelling, shortness of breath or weight gain, as you might have fluid leakage from
small blood vessels into the tissues (very rare).
Side effects with Gemcitabine may include:
Very common: may affect more than 1 in 10 people
Low haemoglobin level (anaemia)
Low white blood cells
Low platelet count
Difficulty breathing
Skin rash- allergic skin rash, frequently itchy
Hair loss
Liver problems: found through abnormal blood test results
Blood in urine
Abnormal urine tests: protein in urine
Flu like symptoms including fever
Oedema (swelling of ankles, fingers, feet, face)

Adult respiratory distress syndrome (severe lung inflammation causing respiratory failure)
Severe skin reactions, including desquamation and bullous skin eruptions
Radiation recall (a skin rash like severe sunburn) which can occur on skin that has previously been
exposed to radiotherapy
Very rare: may affect up to 1 in 10,000 people
Increased platelet count
Anaphylactic reaction (severe hypersensitivity/ allergic reaction)
Sloughing of skin and severe skin blistering
Ischaemic colitis (inflammation of the lining of the large bowel, caused by reduced blood supply)
Capillary leak syndrome (fluids from your small blood vessels leak out into the tissue)
You might have any of these symptoms and/or conditions. You must tell your doctor as soon as
possible when you start experiencing any of these side effects.
If you are concerned about any side effects, talk to your doctor.
Reporting of side effects
If you get any side effects, talk to your doctor. This includes any possible side effects not listed in this
leaflet. You can also report side effects directly via the internet at By
reporting side effects you can help provide more information on the safety of this medicine.
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 vial and box. The expiry date
refers to the last day of that month.

Common: may affect up to 1 in 10 people
Fever accompanied by low white blood cell count (febrile neutropaenia)
Anorexia (poor appetite)
Runny nose
Pain, redness, swelling or sores in the mouth
Muscle pain
Back pain

Before reconstitution: this medicinal product does not require any special storage conditions.
Reconstituted solution: The product should be used immediately. When prepared as directed,
chemical and physical in-use stability of reconstituted solutions of gemcitabine were demonstrated
for 24 hours at 25°C. Further dilution by a healthcare provider may be done. Solutions of
reconstituted gemcitabine should not be refrigerated, as crystallisation may occur.
This medicine is for single use only; any unused solution should be discarded under the local
6. Contents of the pack and other information
What Gemcitabine contains
The active substance is gemcitabine. Each vial contains 200 or 1000 mg or 2000 mg of
gemcitabine (as gemcitabine hydrochloride).
1 mL of solution for infusion contains 38 mg of gemcitabine.
The other ingredients are mannitol (E421), sodium acetate, hydrochloric acid and sodium hydroxide.
What Gemcitabine looks like and contents of the pack
This medicine is a powder for solution for infusion.
Vial of 200 mg of powder. Box of 1, 5, 10 or 20 vials.
Vial of 1000 mg of powder. Box of 1, 5, 10 or 20 vials.
Vial of 2000 mg of powder. Box of 1, 5, 10 or 20 vials.
Not all of the presentations may be marketed.

Uncommon: may affect up to 1 in 100 people
Interstitial pneumonitis (scarring of the air sacs of the lung)
Spasm of the airways (wheeze)
Abnormal chest X ray/scan (scarring of the lungs)
Irregular heart beat (arrhythmia)
Heart failure
Serious liver damage, including liver failure
Kidney failure

Marketing Authorisation Holder and Manufacturer
Marketing Authorisation Holder
Generics [UK] Limited, Station Close, Potters Bar, Hertfordshire, EN6 1TL.

Rare: may affect up to 1 in 1,000 people
Heart attack (myocardial infarction)
Low blood pressure
Skin scaling, ulceration or blister formation
Injection site reactions
Gangrene of fingers or toes
Fluid in the lungs

MYLAN S.A.S, 117 allée des Parcs, 69800 Saint Priest Cedex, France
CEMELOG BRS Kft, 2040 Budaörs, Vasut u.13., Hungary.

Reconstitution at concentrations greater than 38 mg/mL may result in incomplete dissolution, and
should be avoided.
For the reconstitution, slower add the appropriate volume of 9 mg/mL (0.9%) Sodium Chloride
Solution for Injection (as shown in the table below) and shake till completely dissolved.

The appropriate amount of the medicinal product can again be diluted in a 9 mg/mL (0.9%)
sodium chloride solution.
Medicinal products administered by the parenteral route should be inspected visually for
particulate matter and discolouration, prior to administration, whenever the solution and container

This leaflet was last revised in September 2013.


Volume of 9 mg/mL
(0.9%) sodium chloride
solution to add



200 mg

5 mL

0.26 mL

38 mg/mL

1 g

25 mL

1.3 mL

38 mg/mL

2000 mg

50 ml

2.6 mL

38 mg/mL


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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.