Package leaflet: Information for the user

Ibandronic Acid 3 mg solution for injection in pre-filled syringe

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.

-    If you get any side effects, talk to your doctor or nurse. This includes any possible side effects not listed in this leaflet. See section 4.

What is in this leaflet

1.    What Ibandronic Acid is and what it is used for

2.    What you need to know before you receive Ibandronic Acid

3.    How to receive Ibandronic Acid

4.    Possible side effects

5.    How to store Ibandronic Acid

6.    Contents of the pack and other information 1. What Ibandronic Acid is and what it is used for

Ibandronic Acid belongs to a group of medicines called bisphosphonates. It contains the active substance ibandronic acid.

Ibandronic Acid may reverse bone loss by stopping more loss of bone and increasing bone mass in most women who use it, even though they won't be able to see or feel a difference. Ibandronic Acid may help lower the chances of breaking bones (fractures). This reduction in fractures was shown for the spine but not for the hip.

Ibandronic Acid is prescribed to you to treat postmenopausal osteoporosis because you have an increased risk of fractures.

Osteoporosis is a thinning and weakening of the bones, which is common in women after the menopause. At the menopause, a woman's ovaries stop producing the female hormone, oestrogen, which helps to keep her skeleton healthy.

The earlier a woman reaches the menopause, the greater her risk of fractures in osteoporosis.

Other things that can increase the risk of fractures include:

-    not enough calcium and vitamin D in the diet;

-    smoking cigarettes, or drinking too much alcohol;

-    not enough walking or other weight-bearing exercise;

-    a family history of osteoporosis.

A healthy lifestyle will also help you to get the most benefit from your treatment. This includes:

-    eating a balanced diet rich in calcium and vitamin D,

-    walking or other weight-bearing exercise,

-    not smoking and not drinking too much alcohol.

2. What you need to know before you receive Ibandronic Acid

Do not receive Ibandronic Acid:

-    if you have, or had in the past, low blood calcium.

Please consult your doctor.

-    if you are allergic to ibandronic acid or any of the other ingredients of this medicine (listed in section 6).

Warning and precautions

Some patients need to be especially careful when using Ibandronic Acid.

Talk to your doctor, pharmacist or nurse before receiveing Ibandronic Acid:

-    If you have or have ever had kidney problems, kidney failure or have needed dialysis, or if you have any other disease that may affect your kidneys.

-    If you have any disturbance of mineral metabolism (such as vitamin D deficiency).

-    You should take calcium and vitamin-D supplements while receiving Ibandronic Acid. If you are unable to do so, inform your doctor.

-    If you are under dental treatment or will undergo dental surgery, tell your dentist that you are being treated with Ibandronic Acid. When you have cancer, tell your dentist as well.

-    If you have heart problems and the doctor recommended to limit your daily fluid intake.

Cases of serious, sometimes fatal allergic reaction have been reported in patients treated with intravenous ibandronic acid. If you experience one of the following symptoms, such as shortness of breath/ difficulty breathing, tight feeling in throat, swelling of tongue, dizziness, feeling of loss of consciousness, redness or swelling of face, body rash, nausea and vomiting, you should immediately alert your doctor or nurse (see section 4).

Children and adolescents

Ibandronic Acid must not be used in children or adolescents below 18 years.

Other medicines and Ibandronic Acid

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

Pregnancy, breast-feeding and fertility

Ibandronic Acid 3mg for solution for injection in prefilled syringes is for use only by postmenopausal women and must not be taken by women who could still have a baby.

Do not use Ibandronic Acid if you are pregnant or breast-feeding.

Ask your doctor or phrmacist for advice before taking this medicine.

Driving and using machines

You can drive and use machines as it's expected that Ibandronic Acid has no or negligible effect on your ability to drive and use machines

Ibandronic Acid contains sodium

This medicine contains less than 1 mmol sodium (23 mg) per dose (3 ml), that is, essentially “sodium-free”.

3. How to receive Ibandronic Acid

The recommended dose of Ibandronic Acid for the intravenous injection is 3 mg (1 pre-filled syringe) once every 3 months.

The injection should be given into the vein by a physician or qualified/trained healthcare worker. Do not administer the injection to yourself.

The solution for injection must be administered into a vein only, and not anywhere else in the body.

Continuing to receive Ibandronic Acid

To get the most benefit from the treatment it is important to continue receiving the injections every 3 months for as long as your doctor prescribes it for you. Ibandronic Acid can treat osteoporosis only for as long as you keep receiving the treatment, even though you will not be able to see or feel a difference.

After 5 years of using Ibandronic acid please consult with your doctor whether you should continue to receive Ibandronic acid.

You should also take calcium and vitamin-D supplements, as recommended by your doctor.

If too much Ibandronic Acid is given

You may develop low levels of calcium, phosphorus or magnesium in the blood. Your doctor may take steps to correct such changes and may give you an injection containing these minerals.

If a a dose of Ibandronic Acid is missed

You should arrange an appointment to get the next injection as soon as possible. After that, go back to getting the injections every 3 months from the date of the most recent injection.

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

4. Possible side effects

Like all medicines, this medicine can cause side

effects, although not everybody gets them.

Talk to a nurse or a doctor 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):

•    itching, swelling of your face, lips, tongue and throat, with difficulty breathing.

•    persistent eye pain and inflammation (if prolonged)

•    new pain, weakness or discomfort in your thigh, hip or groin. You may have early signs of a possible unusual fracture of the thigh bone

Very rare (may affect up to 1 in 10,000 people):

•    pain or sore in your mouth or jaw .You may have early signs of severe jaw problems (necrosis (dead bone tissue) in the jaw bone).

•    ear pain, discharge from the ear, and/or an ear infection. These could be signs of bone damage in the ear.

•    serious, potentially life-threatening allergic reaction (see section 2).

•    severe adverse skin reactions Other possible side effects

Common (may affect up to 1 in 10 people):

•    headache

•    stomach pain (such as gastritis) or tummy pain, indigestion, nausea, having diarrhoea (loose bowels) or constipation

•    pain in your muscles, joints, or back

•    feeling tired and exhausted

•    flu-like symptoms including fever, shaking and shivering, feeling of discomfort, bone pain and aching muscles and joints. Talk to a nurse or doctor if any effects become troublesome or last more than a couple of days;

•    rash.

Uncommon (may affect up to 1 in 100 people):

•    inflammation of a vein

•    pain or injury at the injection site

•    bone pain

•    feeling weak

•    asthma attacks

Rare (may affect up to 1 in 1000 people):

•    hives

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 national reporting system via the Yellow Card Scheme at: www.mhra.gov.uk/vellowcard. By reporting side effects you can help provide more information on the safety of this medicine.

5. How to store Ibandronic Acid

Keep this medicine out of the sight and reach of children.

This medicinal product does not require any special storage conditions.

Do not use this medicine after the expiry date which is stated on the carton and on the syringe after “EXP”. The expiry date refers to the last day of that month.

The person giving the injection should throw away any unused solution and put the used syringe and injection needle into an appropriate disposal container.

6. Contents of the pack and other information

What Ibandronic Acid contains

-    The active substance is ibandronic acid. One prefilled syringe contains 3 mg of ibandronic acid (as sodium anhydrous) in 3 ml of solution.

-    The other ingredients are: sodium chloride, acetic acid glacial, sodium acetate trihydrate, sodium hydroxide for pH adjustment, hydrochloric acid for pH adjustment and water for injections.

What Ibandronic Acid looks like and contents of the pack

Ibandronic Acid is a clear colourless solution. Each pre-filled syringe contains 3 ml of solution. Ibandronic Acid is available in packs of 1 pre-filled syringe and 1 injection needle.

Marketing Authorisation Holder and Manufacturer

Marketing Authorisation Holder

Fresenius Kabi Ltd.

Cestrian Court Eastgate Way, Manor Park Runcorn, Cheshire WA71NT United Kingdom

Manufacturer

Fresenius Kabi Austria GmbH Hafnerstrasse 36 8055 Graz Austria

This medicinal product is authorised in the Member States of the EEA under the following names:

The following information is intended for healthcare professionals only:

INFORMATION FOR THE HEALTHCARE PROFESSIONALS

Please see the Summary of Product Characteristics for more information.

Administration of Ibandronic Acid 3mg solution for injection in pre-filled syringe:

Ibandronic Acid 3mg should be injected intravenously over a period of 15 - 30 seconds.

The solution is irritant, therefore strict adherence to the intravenous route of administration is important. If you inadvertently inject into the tissues around the vein, patients may experience local irritation, pain and inflammation at the injection site.

Ibandronic Acid 3mg solution for injection in pre-filled syringes must not be mixed with calcium-containing solutions (such as Ringer-Lactate solution, calcium heparin) or other intravenously administered medicinal products. Where Ibandronic Acid is administered via an existing intravenous infusion line, the intravenous infusate should be restricted to either isotonic saline or 50 mg/ml (5 %) glucose solution.

Missed dose:

If a dose is missed, the injection should be administered as soon as convenient. Thereafter, injections should be scheduled every 3 months from the date of the last injection.

Overdose:

No specific information is available on the treatment of overdosage with Ibandronic Acid.

Based on knowledge of this class of compounds, intravenous overdosage may result in hypocalcaemia, hypophosphataemia, and hypomagnesaemia, which can cause paraesthesia. In severe cases intravenous infusion of appropriate doses of calcium gluconate, potassium or sodium phosphate, and magnesium sulfate, may be needed.

General advice:

Ibandronic Acid 3 mg in pre-filled syringe like other bisphosphonates administered intravenously may cause a transient decrease in serum calcium values.

Hypocalcaemia and other disturbances of bone and mineral metabolism should be assessed and effectively treated before starting Ibandronic Acid injection therapy. Adequate intake of calcium and vitamin D is important in all patients. All patients must receive supplemental calcium and vitamin D.

Patients with concomitant diseases, or who use medicinal products which have a potential for undesirable effects on the kidney, should be reviewed regularly in line with good medical practice during treatment.

Any unused solution for injection, syringe and injection needle should be disposed of in accordance with local requirements.

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