Evoxil 5mg/Ml Solution For Infusion
Package leaflet: Information for the user
Evoxil 5 mg/ml solution for infusion Levofloxacin
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, nurse or pharmacist.
- If you get any side effect, talk to your doctor, nurse or pharmacist. This includes any possible side effects not listed in this leaflet. See section 4.
What is in this leaflet:
1. What Evoxil is and what it is used for
2. What you need to know before you are given Evoxil
3. How Evoxil is given
4. Possible side effects
5. How to store Evoxil
6. Contents of the pack and other information
1. What Evoxil solution for infusion is and what it is used for
The name of your medicine is Evoxil solution for infusion. Evoxil solution for infusion contains a medicine called levofloxacin. This belongs to a group of medicines called antibiotics. Evoxil is a 'quinolone' antibiotic. It works by killing the bacteria that causes infections in your body.
Evoxil solution for infusion can be used to treat infections of the:
- Lungs, in people with pneumonia
- Urinary tract, including your kidneys or bladder
- Prostate gland, where you have a long lasting infection
- Skin and underneath the skin, including muscles. This is sometimes called 'soft
In some special situations Evoxil solution for infusion may be used to lessen the chances of getting a pulmonary disease named anthrax or worsening of the disease after you are exposed to the bacteria causing anthrax.
hydroquinidine, disopyramide, soltaol, dofetilide, ibutilide and amioriodarone), for depression (tricyclic antidepressants such as amitriptyline and imipiramine), for psychiatric disorders (antipsychotics), and for bacterial infections ('macrolide' antibiotics such as erythromycin, azithromycin and clarithromycin).
Urine test for opiates
Urine tests may show 'false-positive' results for strong painkillers called 'opiates; in people having Evoxil. If your doctor has prescribed a urine test, tell your doctor you are having Evoxil.
Tuberculosis tests
This medicine may cause 'false negative' results for some tests used in laboratory to search for the bacteria causing tuberculosis.
Pregnancy and Breast-feeding
Do not have this medicine if:
• You are pregnant, might become pregnant or think you may be pregnant.
• You are breast feeding or planning to breast-feed.
Driving and using machines
You may get side effects after being given this medicine, including feeling dizzy, sleepy, a spinning feeling (vertigo) or changes to your eyesight. Some of these side effects can affect you being able to concentrate and your reaction speed. If this happens, do not drive or carry out any work that requires a high level of attention.
Evoxil solution for infusion contains sodium
/.This medicine contains 0.15 mmol (or 3.54 mg) of sodium per ml of infusion (a total of 7.70 mmol or 177.10 mg sodium in 50 ml, a total of 15.40 mmol or 354.20 mg sodium in 100ml). This should be taken into consideration by patients on a controlled sodium diet.
2. WHAT YOU NEED TO KNOW BEFORE YOU ARE GIVEN EVOXIL
3. HOW EVOXIL SOLUTION FOR INFUSION IS GIVEN
Do not have this medicine and tell your doctor if:
• you are allergic to levofloxacin, any other quinolone antibiotic such as moxifloxacin, ciprofloxacin or ofloxacin or to any of the other ingredients of this medicine (listed in section 6)
• signs of an allergic reaction include: a rash, swallowing or breathing problems, swelling of your lips, face, throat or tongue
• you have ever had epilepsy
• you have ever had a problem with your tendons such as tendonitis that was related to treatment with a 'quinolone antibiotic'. A tendon is the cord that joins your muscle to your skeleton
• you are a child or a growing teenager
• you are pregnant, might become pregnant or think you may be pregnant
• you are breast-feeding.
Do not have this medicine if any of the above applies to you. If you are not sure, talk to your doctor, nurse or pharmacist before you are given Evoxil.
Warnings and precautions
Talk to your doctor, nurse or pharmacist before you have your medicine if:
• you are 60 years of age or older
• you are using corticosteroids, sometimes called steroids (see section "Other medicines and Evoxil”)
• you have had a fit (seizure)
• you have had damage to your brain due to a stroke or other brain injury
• you have kidney problems
• you have something known as 'glucose-6-phosphate dehydrogenase deficiency'. You are more likely to have serious problems with your blood when taking this medicine
• you have ever had mental health problems
• you are diabetic
• you have liver problems
• you have myasthenia gravis
• you have ever had heart problems: caution should be taken when using this kind of medicine, if you were born with or have family history of prolonged QT interval (seen on ECG, electrical recording of the heart), have salt imbalance (especially low levels of potassium or magnesium in the blood), have a very slow heart rhythm (called 'bradycardia'), have a weak heart (heart failure), have a history of heart attack (myocardial infarction), you are female or elderly or you are taking other medicines that result in abnormal ECG changes (see section Other medicines and Evoxil).
Other medicines and Evoxil
Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines. This is because Evoxil can affect the way some other medicines work. Also some medicines can affect the way Evoxil work.
In particular, tell your doctor if you are taking any of the following medicines. This is because it can increase the chance of you getting side effects, when taken with Evoxil:
• Warfarin - used to thin the blood. You may be more likely to have a bleed. Your doctor may need to take regular blood tests to check how well your blood can clot.
• Theophylline used for breathing problems. You are more likely to have fits (seizure) if taken with Evoxil.
• Probenecid (used for gout) and cimetidine (used for ulcers and heartburn). Special care should be taken when either of these medicines with Evoxil. If you have kidney problems, your doctor may want to give you a lower dose.
• Ciclosporin - used after organ transplants. You may be more likely to get the side effects of ciclosporin.
• Corticosteroids, sometimes called steroids - used for inflammation. You may be more likely to have inflammation and/or rupture of your tendons.
• Non-steroidal anti-inflammatory drugs (NSAIDS) - used for pain and inflammation such as aspirin, ibuprofen, fenbufen, ketoprofen and indomethacin. You are more likely to have a fit (seizure) if taken with Evoxil.
• Medicines known to affect the way your heart beats. This includes medicines used for abnormal heart rhythm (antiarrhymics such as quinidine,
How Evoxil solution for infusion is given
• Evoxil solution for infusion is a medicine for use in hospitals.
• It will be given to you by a doctor or nurse as an injection. The injection will be into one of your veins and be given over a period of time (this is called intravenous infusion).
• For 250 mg Evoxil solution for infusion, the infusion time should be about 30 minutes or more.
• For 500 mg Evoxil solution for infusion, the infusion time should be about 60 minutes or more.
• Your heart rate and blood pressure should be closely monitored. This is because an unusual fast beating of the heart and a temporary lowering of blood pressure are possible side effects that have been seen during the infusion of a similar antibiotic. If your blood pressure drops noticeably while you are being given the infusion, it will be stopped straight away.
How much Evoxil solution for infusion is given
• If you are not why you are being given Evoxil or have any questions about how much Evoxil is being given to you, speak to your doctor, nurse or pharmacist'
• You doctor will decide on how much Evoxil you should have.
• The dose will depend on the type of infection you have and where the infection is in your body.
• The length of treatment will depend on how serious your infection is.
Adults and the elderly
• Pneumonia: 500 mg once or twice daily.
• Infection of urinary tract: 500 mg once daily.
• Prostate gland infection: 500 mg once daily.
• Infection of skin and underneath the skin, including muscles: 500 mg once or twice daily.
Adults and elderly with kidney problems
Your doctor may need to give you a lower dose.
Children and Teenagers
This medicine must not be given to children or teenagers.
Protect your skin from sunlight
Keep out of direct sunlight while having this medicine and for 2 days after you stop having it. This is because your skin will become much more sensitive to the sun and may burn, tingle or severely blister if you do not take the following precautions:
• Make sure you use high factor sun cream
• Always wear a hat and clothes which cover your arms and legs.
• Avoid sun beds.
If you have more Evoxil solution for infusion than you should
It is unlikely that your doctor will give you too much medicine. Your doctor and nurse will monitor your progress, and check the medicine you are given. Always ask if you are not sure why you are getting a dose of medicine.
Having too much Evoxil may cause the following effects to happen: convulsive fits (seizures), feeling confused, dizzy, less conscious, having tremor and heart problems - leading to uneven heart beats as well as feeling sick (nausea).
If you miss a dose of Evoxil solution for infusion
Your doctor or nurse will have instructions on when to give you this medicine. It is unlikely that you will not be given the medicine as it has been prescribed. However, if you do think you have missed a dose, tell your doctor or nurse.
If you stop having Evoxil solution for infusion
Your doctor or nurse will continue giving Evoxil, even if you feel better. If it is stopped too soon, your condition may get worse or the bacteria may become resistant to the medicine. After a few days treatment with the solution for infusion, your doctor may decide to switch you to the tablet form of this medicine to complete your course of treatment.
If you have any further questions on the use of this medicine, ask your doctor, nurse, or pharmacist.
The following information is intended for medical or healthcare professionals only:
This is an extract from the Summary of Product Characteristics to assist in the administration of Evoxil 5 mg/ml Solution for Infusion. When determining appropriateness of use in a particular patient, the prescriber should be familiar with the Summary of Product Characteristics of the product.
Method of administration
The solution for infusion is ready for use, and should only be administered by slow infusion into a vein. The infusion time should not be less than 30 minutes for 250 mg (50 ml) or not be less than 60 minutes for 500 mg (100 ml) Evoxil solution for infusion (See 'Take special care with Evoxil'). Protection from light is not necessary during infusion time.
From a microbiological point of view, unless the method of opening precludes the risk of microbial contamination, the product should be used immediately. If not used immediately, in-use storage times and conditions are the responsibility of the user. (see also 'How to store Evoxil solution for infusion').
The product should be inspected visually for particles and discoloration prior to administration. Only clear, greenish-yellow solution free from particles should be used.
For single use only. Discard any unused solution.
4. Possible side effects
Like all medicines, this medicine can cause side effects although not everybody gets them. These effects are normally mild or moderate and often disappear after a short time.
Stop having Evoxil and tell your doctor or nurse straight away if you notice the following side effect:
Very rare (may affect up to 1 in 10,000 people)
• You may have an allergic reaction. The signs may include: a rash, swallowing or breathing problems, swelling of your lips, face, throat, or tongue.
Stop having Evoxil and tell your doctor or nurse straight away if you notice any of the following serious side effects - you may need urgent medical treatment:
Rare (may affect up to 1 in 1,000 people)
• Watery diarrhoea which may have blood in it, possibly with stomach cramps and a high temperature. These could be signs of a severe bowel problem.
• Pain and inflammation in your tendons or ligaments which could lead to rupture. The Achilles tendon is affected most often.
• Fits (convulsions).
Very rare (may affect up to 1 in 10,000 people)
• Burning, tingling, pain, or numbness. These may be signs of something called 'neuropathy'.
other:
• Severe skin rashes which may include blistering or peeling of the skin around your lips, eyes, mouthy, nose and genitals.
• Loss of appetite, skin and eyes becoming yellow in colour, dark-coloured urine, itching or tender stomach (abdomen). These may be signs of liver problems which may include a fatal failure of the liver.
If your eyesight becomes impaired or if you have other eye disturbances whilst taking Evoxil, consult an eye specialist immediately.
Tell your doctor if any of the following side effects gets serious or lasts longer than a few days:
Common (may affect up to 1 in 10 people)
• Sleeping problems.
• Headache, feeling dizzy.
• Feeling sick (nausea, vomiting) and diarrhoea.
• Increase in the level of some liver enzymes in your blood.
• Reactions at the site of infusion.
• Inflammation of a vein.
Uncommon (may affect up to 1 in 100 people)
• Changes in the number of other bacteria or fungi, infection by fungi named Candida, which may need to be treated.
• Changes in the number of white blood cells shown up in the results of some blood tests (leukopenia, eosinophilia).
• Feeling stressed (anxiety), feeling confused, feeling nervous, feeling sleepy, trembling, a spinning feeling (vertigo).
• Shortness of breath (dyspnoea).
• Changes in the way things taste, loss of appetite, stomach upset or indigestion (dyspepsia), pain in your stomach area, feeling bloated (flatulence) or constipation.
• Itching and skin rash, severe itching or hives (urticaria), sweating too much (hyperhidrosis).
• Joint pain or muscle pain.
• Blood tests may show unusual results due to liver (bilirubin increased) or kidney (creatinine increased) problems.
• General weakness.
Rare (may affect up to 1 in 1,000 people)
• Bruising and bleeding easily due to a lowering in the number of blood platelets (thrombocytopenia).
• Low number of white blood cells (neutropenia).
• Exaggerated immune response (hypersensitivity).
• Lowering of your blood sugar levels (hypoglycaemia). This is important for people that have diabetes.
• Seeing or hearing things that are not there (hallucinations, paranoia), change in your opinion and thoughts (psychotic reactions) with a risk of having suicidal thoughts or actions.
• Feeling depressed, mental problems, feeling restless (agitation), abnormal dreams or nightmares.
• Tingly feeling in your hands and feet (parasthesia)
• Problems with your hearing (tinnitus) or eyesight (blurred vision).
• Unusual fast beating of your heart (tachycardia) or low blood pressure (hypotension).
• Muscle weakness. This is important in people with myasthenia gravis (a rare disease of the nervous system).
• Changes in the way your kidney works and occasional kidney failure which may be due to an allergic kidney reaction called interstitial nephritis.
• Fever.
Other side effects include:
• Lowering in red blood cells (anaemia): this can make the skin pale or yellow due to damage of the red blood cells; lowering in the number of all types of blood cells (panocytopenia).
• Fever, sore throat and a general feeling of being unwell that does not go away. This may be due to lowering in the number of white blood cells (agranulocytosis).
• Loss of circulation (anaphylactic like shock).
• Increase of your blood sugar levels (hyperglycaemia) or lowering of your blood sugar levels leading to coma (hypoglycaemic coma). This is important for people that have diabetes.
• Changes in the way things smell, loss of smell or taste (parosmia, anosmia, ageusia).
• Problems moving and walking (dyskinesia, extrapyramidal disorders).
• Temporary loss of consciousness or posture (syncope)
• Temporary loss of vision.
• Impairment or loss of hearing.
• Abnormal fast heart rhythm, life-threatening irregular heart rhythm including cardiac arrest, alteration of the heart rhythm (called 'prolongation of QT interval', as seen on ECG, electrical activity of the heart).
• Difficulty breathing or wheezing (bronchospasm).
• Allergic lung reactions
• Pancreatitis.
• Inflammation of the liver (hepatitis).
• Increased sensitivity of your skin to sun and ultraviolet light (photosensitivity).
• Inflammation of the vessels that carry blood around your body due to an allergic reaction (vasculitis).
• Inflammation of the tissue inside the mouth (stomatitis).
• Muscle rupture and muscle destruction (rhabdomyolysis).
• Joint redness and swelling (arthritis)
• Pain, including pain in the back, chest and extremities.
• Attacks of porphyria in people who already have porphyria (a very rare metabolic disease).
• Persistent headache with or without blurred vision (benign intracranial hypertension).
Reporting of side effects
If you get any side effects, talk to your doctor or pharmacist or nurse. This includes any possible side effects not listed in this leaflet. Also you can help to make sure that medicines remain as safe as possible by reporting any unwanted side effects via the internet at www.mhra.gov.uk/yellowcard. Alternatively you can call Freephone 0808 100 3352 (available from 10 a.m. to 2 p.m. Mondays to Fridays) or fill in a paper form available from your local pharmacy.
5. How to store Evoxil
Keep this medicine out of the sight and reach of children.
Your doctor or nurse will ensure that Evoxil is properly stored. As with all medicines it must be kept out of the reach of children.
This medicine should be kept in its cardboard box for protection from light until use. No protection from light is required during infusion, or within three days after removal from the outer packaging if stored under indoor light conditions. Once the infusion bottle has been opened (rubber stopper perforated) the solution should be used immediately (within 3 hours) in order to prevent any bacterial contamination. Do not use this medicine after the expiry date shown on the packaging. The expiry date refers to the last day of the month.
Do not throw away any medicines via wastewater or household waste. Ask your nurse or 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 Evoxil contains
The active substance is levofloxacin (as hemihydrate).
One ml solution for infusion contains 5 mg of levofloxacin. Each 50 ml vial of solution for infusion contains 250 mg of levofloxacin and each 100 ml vial of solution for infusion contains 500 mg of levofloxacin.
The other ingredients are: Sodium Chloride, Hydrochloric Acid (for pH adjustment) and Water for Injection
What Evoxil looks like and contents of the pack
Evoxil solution for infusion is supplied in type I transparent glass vial sealed with bromobutyl rubber stopper and an aluminium cap. It is clear greenish-yellow solution ready for use. Each vial contains 50 ml or 100 ml solution.
Pack sizes:
50 ml vials are available in packs of 1, 5 or 20.
100 ml vials are available in packs of 1, 5 or 20.
Not all pack sizes may be marketed.
Marketing Authorisation Holder: Beacon Pharmaceuticals Ltd, 85 High Street, Tunbridge Wells, Kent TN1 1YG, U.K.
Manufacturer: Pharmathen S.A.,Dervenakion 6,Pallini 15351,Attikis, Greece tel.: +30 210 666 4300 fax: +30 210 666 6749 e-mail: info@pharmathen.com and
Anfarm Hellas S.A., Sximatari Viotias, Sximatari Viotias 32009, Greece.
This leaflet was last approved in...September 2013
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PHARMACEUTICALS
Any unused product or waste material should be disposed of in accordance with local requirements.
Incompatibilities
Evoxil 5 mg/ml solution for infusion should not be mixed with heparin or alkaline solutions (e.g. sodium hydrogen carbonate).
This medicinal product must not be mixed with other medicinal products except those mentioned in the section below.
Mixture with other solutions for infusion
This medicine may be given alone or with one of the following solutions: 0.9 % sodium chloride solution
5 % dextrose injection
2.5 % dextrose in Ringer's solution
Combination solutions for parenteral nutrition (amino acids, carbohydrates, electrolytes).
Chemical and physical compatibility of Evoxil Solution for Infusion with the above solutions have been demonstrated for 4 hours at room conditions.
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PHARMACEUTICALS