Aciclovir 25 Mg/Ml Concentrate For Solution For Infusion
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Hospira
PACKAGE LEAFLET: INFORMATION FOR THE USER
Aciclovir 25 mg/ml Concentrate for Solution for Infusion (Sterile Concentrate)
Read all of this leaflet carefully before you start using this medicine.
• Keep this leaflet. You may need to read it again.
• If you have any further questions, ask your doctor or pharmacist.
• If any of the side effects gets serious, or if you notice any side effects not listed in this leaflet, please tell your doctor.
In this leaflet:
1. What Aciclovir Sterile Concentrate is and what it is used for
2. Before you use Aciclovir Sterile Concentrate
3. How to use Aciclovir Sterile Concentrate
4. Possible side effects
5. How to store Aciclovir Sterile Concentrate
6. Further information
1. WHAT ACICLOVIR STERILE CONCENTRATE IS AND WHAT IT IS USED FOR
Aciclovir Sterile Concentrate is an anti-viral medicine. It is used:
• to treat severe genital herpes
• to prevent or treat Herpes simplex infections (may appear as cold sores around the lips or as blisters on any part of the skin including the genitals) in patients whose immune system is not working properly
• to treat Herpes simplex infections in very young babies or in infants up to 3 months of age
• to treat Varicella zoster viral infections (e.g. shingles)
• to treat herpes encephalitis (inflammation of the brain following infection with herpes)
2. BEFORE YOU USE ACICLOVIR STERILE CONCENTRATE
Do not use Aciclovir Sterile Concentrate
• if you have shown signs of hypersensitivity (severe allergy) to aciclovir or valaciclovir or to any of the other ingredients in the past
Tell your doctor if the above applies to you before this medicine is used.
Take special care with Aciclovir Sterile Concentrate
• if you have any nervous system problems such as convulsions or hallucinations
• if you had a nervous system side effect after treatment with an anti-cancer medicine in the past
• if you have serious problems with your liver
• if you have any problems with your kidneys
• if you are over 65 years old
• if your immune system is weakened
• if tests show that you are hypoxic (have a low amount of oxygen reaching your body tissues)
• if blood tests have shown that you have abnormal amounts of electrolytes in your blood
Tell your doctor if any of the above applies to you before this medicine is used.
It is important that while you are being treated with aciclovir you do not become dehydrated. Before you are given this medicine your doctor will check to make sure you are passing urine, are receiving enough fluid and are not dehydrated. The doctor will also check if you are taking any other medicine which could harm your kidneys. These checks are particularly important in patients whose kidneys may not be working properly.
Taking/using other medicines
Special care is needed if you are taking/using other medicines as some could interact with Aciclovir Sterile Concentrate, for example:
• probenecid (a medicine used in the treatment of gout)
• cimetidine (a medicine used to reduce stomach acid)
• theophylline (a medicine used to treat some breathing disorders)
• mycophenolate mofetil (a medicine used to prevent transplant rejection)
• lithium (a medicine used for manic-depressive disorder)
• drugs which may affect the kidneys e.g. ciclosporin, tacrolimus (medicines used to prevent transplant rejection)
• interferon (used for treating multiple sclerosis)
• intrathecal methotrexate (methotrexate injected into the spine) for cancer treatment
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
Tell your doctor if you are pregnant, trying to become pregnant or breast-feeding. Your doctor will decide if you should receive this medicine.
Ask your doctor or pharmacist for advice before taking any medicine.
Driving and using machines
This medicine may impair your ability to drive; if affected do not drive or operate machinery.
Important information about some of the ingredients of Aciclovir Sterile Concentrate
This medicinal product contains 2.67 mg/ml (0.166 mmol/ml) sodium. To be taken into consideration by patients on a controlled sodium diet.
3. HOW TO USE ACICLOVIR STERILE CONCENTRATE
This medicine will be diluted with a solution such as sodium chloride 0.9% before it is given to you. It will be given to you by a slow infusion (drip) into a vein over a period of 1 hour. You may be given fluids to ensure you do not become dehydrated.
If Aciclovir Sterile Concentrate accidentally gets into your eyes or onto your skin, tell your doctor or nurse immediately so that it may be washed away.
Dosage
The dose of medicine given to you and how often you are given it will be determined by your doctor and will depend on your medical condition, age, size and how well your kidneys are working.
Treatment with aciclovir usually lasts 5 days depending on how quickly you get better. However, treatment for herpes encephalitis usually lasts for at least 10 days. For very young babies treatment for herpes typically lasts 14 days for skin/eye/mouth infections and for 21 days for infections affecting the whole body.
If aciclovir is being given to prevent a viral infection, it will be given for the period your doctor thinks you are at risk of getting an infection.
If you are given too much or too little Aciclovir Sterile Concentrate
This medicine will be given to you in a hospital, under the supervision of a doctor. It is unlikely that you will be given too much or too little, however, tell your doctor or nurse if you have any concerns.
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Aciclovir 25 mg/ml Concentrate for Solution for Infusion (Sterile Concentrate)
The following information is intended for medical or healthcare professionals only
Further to the information included in section 3, practical information on the preparation/handling of the medicinal product is provided here.
Incompatibilities
Aciclovir sodium is reported to be incompatible with solutions of amifostine, amsacrine, aztreonam, diltiazem hydrochloride, dobutamine hydrochloride, dopamine hydrochloride, fludarabine phosphate, foscarnet sodium, idarubicin hydrochloride, meropenem, morphine sulphate, ondansetron hydrochloride, pethidine hydrochloride, piperacillin sodium - tazobactam sodium, sargramostim and vinorelbine tartrate.
Do not use bacteriostatic water for injection containing parabens or benzyl alcohol.
Biologic or colloidal fluids (e.g. blood products, protein containing solutions) are incompatible with aciclovir sodium.
Instructions for use and handling
Aciclovir 25 mg/ml Concentrate for Solution for Infusion contains no preservative. Dilution should therefore be carried out immediately before use under full aseptic conditions and any unused solution should be discarded.
Refrigeration is not recommended as precipitation may occur.
For adults, it is recommended that infusion bags containing 100 ml of infusion fluid are used, even when this would give an aciclovir concentration substantially below 0.5% w/v. Q79173
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If you have been given too much aciclovir you may:
• feel confused or agitated
• have hallucinations (seeing or hearing things that aren't there)
• have fits
• become unconscious (coma)
4. POSSIBLE SIDE EFFECTS
Like all medicines Aciclovir Sterile Concentrate can cause side effects, although not everybody gets them.
If any of the following happen, tell your doctor immediately:
• severe allergic reaction - you may experience a sudden itchy rash (hives), swelling of the hands, feet, ankles, face, lips, mouth or throat (which may cause difficulty in swallowing or breathing), and you may feel you are going to faint
• changes in your blood cells e.g. anaemia and/or reduced white blood cells and/or lowered platelet levels (leading to unexplained bruising). Your doctor may take blood samples to monitor for these
• yellowing of the skin and whites of the eyes (jaundice)
• pain or swelling at the injection site during or immediately after the injection
• convulsions or fits
• confusion or unusual and disordered thoughts (psychosis)
• hallucinations
• agitation
• trembling or shaking
• coma
• difficulty breathing, shortness of breath
• difficulty in controlling movements
• problems with your speech
• kidney problems or failure, including blood in urine
• a severe form of rash with itchy pink-red blotches (erythema multiforme), which may blister
• in patients who have a compromised immune system:
• a rare disorder of the blood clotting system called thrombotic thrombocytopenic purpura, which may give you bruising, headaches, hallucinations and also blood clots in the kidneys
• a severe form of anaemia called haemolytic uraemic syndrome, which may make you look pale and feel tired due to anaemia, and give you bruising and kidney problems
These side effects are very rare.
Common side effects (may affect up to 1 in 10 people)
• inflammation (soreness, redness and swelling) along the vein used for the infusion
• feeling or being sick
• rash, hives or sensitivity of the skin to light
• changes in your liver and kidney function (Your doctor may take blood samples to monitor for these)
Uncommon side effects (may affect up to 1 in 100 people)
• reduced numbers of red blood cells (anaemia)
• reduced numbers of white blood cells (leukopenia)
• reduced numbers of blood platelets (thrombocytopenia)
Very rare side effects (may affect up to 1 in 10,000 people)
• sweating or fever
• headache
• abdominal pain
• diarrhoea
• dizziness
• tiredness
• feeling unusually sleepy
• problem of the brain (encephalopathy)
• pain in your lower back, the kidney area of your back or pain when passing urine (renal pain)
Frequency unknown (frequency cannot be estimated from the available data)
• thirst
• low blood pressure (you may feel dizzy when you stand up)
• rupture of red blood cells (haemolysis)
• problems with small blood vessels (leukocytoclastic vasculitis)
• tingling or numbness
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 Yellow Card Scheme,
Website www.mhra.gov.uk/yellowcard. By reporting side effects you can help provide more information on the safety of this medicine.
5. HOW TO STORE ACICLOVIR STERILE CONCENTRATE
Keep out of the reach and sight of children Expiry
This medicine must not be used after the expiry date which is stated on the vial label and carton after ‘EXP'. Where only a month and year is stated, the expiry date refers to the last day of that month.
Storage
Do not store above 25°C. Do not refrigerate.
Visible signs of deterioration
This medicine should not be used if it has visible particles in it.
6. FURTHER INFORMATION
What Aciclovir Sterile Concentrate contains
The active substance is aciclovir. Each millilitre (ml) of sterile concentrate contains 25 milligrams (mg) of aciclovir (as aciclovir sodium).
The other ingredients are sodium hydroxide and Water for Injections.
Sodium hydroxide and/or hydrochloric acid are used to adjust the pH of the solution.
What Aciclovir Sterile Concentrate looks like and contents of the pack
Aciclovir Sterile Concentrate is a concentrate for solution for infusion (sterile concentrate). This means it is a concentrated solution, which is diluted then given as an infusion (drip). It comes in glass containers called vials.
It may be supplied in packs containing:
• 5 x 250 mg/10 ml vials
• 5 x 500 mg/20 ml vials
• 1 x 1 g/40 ml vial
Not all pack sizes may be marketed.
Marketing authorisation holder and manufacturer responsible for batch release in Europe
Hospira UK Limited, Queensway, Royal Leamington Spa, Warwickshire, CV31 3RW, UK
Manufacturer
Hospira Australia Pty Ltd, Lexia Place, Mulgrave, Victoria 3170, Australia
This leaflet was last approved in 05/2015
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Thus one 100 ml infusion bag may be used for any dose between 250 mg and 500 mg aciclovir but a second bag must be used for doses between 500 and 1000 mg. Aciclovir 25 mg/ml Concentrate for Solution for Infusion should not be diluted to a concentration greater than 5 mg/ml (0.5%w/v) for administration by infusion. After addition of Aciclovir 25 mg/ml Concentrate for Solution for Infusion to an infusion solution the mixture should be shaken to ensure thorough mixing.
For children and neonates, where it is advisable to keep the volume of infusion fluid to a minimum, it is recommended that dilution is on the basis of 4 ml of solution (100 mg aciclovir) added to 20 ml of infusion fluid.
When diluted in accordance with the recommended schedules, Aciclovir 25 mg/ml Concentrate for Solution for Infusion is known to be compatible with the infusion fluids listed below:
• Sodium Chloride Intravenous Infusion 0.9% w/v
• Sodium Chloride (0.18% w/v) and Glucose (4% w/v) Intravenous Infusion
• Sodium Chloride (0.9% w/v) and Glucose (5% w/v) Intravenous Infusion
• Sodium Chloride (0.45% w/v) and Glucose (2.5% w/v) Intravenous Infusion
• Compound Sodium Lactate Intravenous Infusion (Hartmann's Solution)
Aciclovir 25 mg/ml Concentrate for Solution for Infusion when diluted in accordance with the above schedule will give an aciclovir concentration not greater than 0.5% w/v.
Aciclovir 25 mg/ml Concentrate for Solution for Infusion contains no preservative.
Should any visible turbidity or crystallisation appear in the solution before or during infusion, the preparation should be discarded.
Hospira