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Noxap 800 Ppm Mol/Mol Medicinal Gas Compressed

PACKAGE LEAFLET: INFORMATION FOR THE USER

NOXAP 800 ppm mol/mol, medicinal gas, compressed

Active substance: Nitric Oxide

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, please ask your doctor or other healthcare professionals.

-    This medicine has been prescribed for you. Do not pass it on to others. It may harm them, even if their symptoms are the same as yours.

-    If any of the side effects gets serious, or if you notice any side effects not listed in this leaflet, please tell your doctor or other healthcare professionals.

In this leaflet :

1.    What NOXAP is and what is it used for

2.    Before you are given NOXAP

3.    How N OXAP is given

4.    Possible side effects

5.    Storing N OXAP

6.    Further information.

1. WHAT NOXAP IS AND WHAT IS IT IS USED FOR

NOXAP is a gas mixture for inhalation use.

NOXAP is a medicinal gas, compressed, consisting of a mixture of gases that contains 800 ppm mol/mol of nitric oxide.

What are its uses?

NOXAP must be administered exclusively by healthcare professionals and it is only for strict hospital use NOXAP is indicated in the following conditions:

1. In newborns with a shortage of oxygen in the blood (hypoxemic respiratory failure) related to different causes. NOXAP improves oxygenation and reduces the need for extracorporeal circulation.

2. In pediatric and adult cardiac surgery patients with acute high blood pressure within the lung

(pulmonary hypertension). NOXAP reduces the high blood pressure in the lung and reduces the risk of failure of the right heart.

2. BEFORE YOU ARE GIVEN NOXAP

Do not use NOXAP in the following situations :

- Newborns with known de pendency to right-left blood shunt or suffer from a significant left-right shunt.

-    Patients with congenital o r acquired deficiency of methemoglobin reductase (MetHb reductase) o r glucose 6 phosphate dehydrogenase (G6PD).

Take special care with NOXAP:

-    In patients with left ventricular dysfunction, NOXAP could lead to cardiac insufficiency and pulmonary oedema.

-    In patients with complex congenital heart defects.

Using other medicines

Please tell your doctor if you are taking or have recently taken any other medicines, including medicines obtained without a prescription.

-    Oxygen: In the presence of oxygen, nitric oxide oxidises rapidly producing substances that are toxic for the lungs. To avoid this situation, continuous monitoring will be undertaken during NOXAP treatment.

-    NO donors: Cardiologic medicines such as Sodium Nitroprusside and Nitroglycerine, can have an additive effect to NOXAP increasing the risk of developing methemoglobinemia.

-    Drugs that increase methemoglobin concentrations: When drugs such as alkyl nitrates, sulphonamides and prilocaine are administrated along with nitric oxide there is increased risk of methemoglobinemia.

-    Synergic effects have been reported with the administration of vasoconstrictors (almitrine, phenylephrine), prostacyclin and phosphodiesterase inhibitors, without increasing adverse effects.

-    Inhaled nitric oxide has been used concomitantly with tolazoline, dopamine, dobutamine, norepinephrine, steroids and surfactants, with no drug interactions observed.

The doctor will decide if NOXAP can be used with other medications and will closely monitor your treatment.

Pregnancy and breast-feeding

NOXAP should not be used during pregnancy unless the clinical condition of the woman requires treatment with NOXAP.

Harmful effects m ay be e xpected as methemoglobin is considered detrimental to the foetus and nitric oxide has shown genotoxic potential by inducing structural alterations on DNA.

Breastfeeding should be discontinued during treatment with NOXAP.

Driving and using machines

Adverse effects on the ability to drive and use machines have not been communicated.

3. HOW NOXAP IS GIVEN

NOXAP must be administered exclusively by healthcare professionals and it is only for strict hospital use. NOXAP is a dministered via inhalation which relies on a system that provides the lungs with the prescribed nitric oxide concentration by diluting NOXAP in a mixture of oxygen and air.

Your doctor will determine the dosage and duration of your NOXAP treatment.

If you receive more NOXAP than you should the delivery system will activate a warning signal. Your doctor will then reduce or stop the administration of NOXAP and subsequently will determine the most suitable treatment to be followed.

If you stop receiving NOXAP

Your doctor will gradually reduce your NOXAP dosage towards the end of the treatment.

NOXAP treatment should not be abruptly interrupted but slowly reduced and so allow the lungs to adapt to the normal oxygen concentration in the air.

If you have any further questions on the use of this product, ask your doctor or other health professionals.

4. POSSIBLE SIDE EFFECTS

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

Your doctor will notice and closely monitor any side effects. It is not likely that you will experience these side effects yourself.

Blood system disorders

-    elevated concentration of nitric oxide in the blood may run the risk of developing methemogobinemia. In this case, blood oxygen transport capacity may be reduced. If this occurs, your doctor will immediately reduce the nitric oxide dosage to allow the blood to achieve its normal oxygen transport capacity. In pediatric patients and others with reduced levels of the enzyme, methemoglobin reductase, this risk may increase. The formation of methemoglobin at a serum level of >5% with inhaled nitric oxide at a concentrations of <20ppm is very rare (<1/10,000)

-    Bleeding time: In a preclinical study has been found that inhaled nitric oxide increases the bleeding time. However, in controlled clinical trials no significant differences have been found between the control group and the treatment group regarding hemorrhagic complications.

General disorders and administration site conditions

-    No response to the treatment can be observed in 30 to 45% of the cases.

-    Significant elevations of NO2 levels at low therapeutic doses (<20 ppm) of inhaled NO, as well as evidence of clinical toxicity by NO2 is a very rare (<1/10,000) complication.

-    Abrupt interruption of the inhaled nitric oxide therapy, leads very frequently (>1/10) to rapid rebound reactions presenting with intensified pulmonary vasoconstriction and hypoxemia. .

If any of the side effects become serious, or if you notice any side effects not listed in this leaflet, please tell your doctor or other healthcare professionals.

5. STORING NOXAP

Keep out of the reach and sight of children.

Do not use NOXAP after the expiry date which is stated on the gas cylinder label after “EXP”.

All regulations concerning handling of pressurised gas cylinders must be followed.

Storage is supervised by the local specialists at the hospital. Gas cylinders are to be stored in well-ventilated rooms or in ventilated sheds where they are protected from rain and direct sunlight.

Protect the gas cylinders from shocks, falls, oxidising and flammable materials, moisture, sources of heat or ignition.

Storage in the pharmacy department

The gas cylinders should be kept in a place designated exclusively for medicinal gas storage that is well ventilated, clean and under lock and key. This place should house a separate, special facility for the storage of nitric oxide cylinders.

Storage in the medical department

The gas cylinders should be stored in a place with the appropriate equipment to ensure that it stays in a vertical position.

6. FURTHER INFORMATION What NOXAPcontains

NOXAP is a combination of gases.

•    The active substance is: nitric oxide 800 ppm (mol/mol)

•    The other ingredient is: nitrogen.

What NOXAP looks like and contents of the pack

NOXAP is a medicinal gas, compressed.

NOXAPis stored in high pressure gas cylinders made out of aluminium or aluminium with an external elastomers layer. The valves which close the gas cylinders are made out of stainless steel. The pack sizes of the gas cylinders are 2 L, 5L, 10L, 20L and 40L

NOXAP is filled as a gas in these gas cylinders to a pressure of 200 bar. Not all pack si zes may be marketed.

Pack sizes litres)

Filling Pressure (bar)

Litres Quantity of the mixture 800ppm NO/N2

m3 Quantity of the mixture 800 ppm NO/N2

2

200

400

0.400

5

200

945

0.945

10

200

1890

1.890

20

200

3780

3.780

40

200

7560

7.560

The colour coding of the cylinder is a turquoise blue shoulder on a white cylinder body.

Marketing Authorisation Holder and Manufacturer

Air Products Plc 2 Millenium Gate

Westmere Drive Crewe Cheshire CW 1 6AP United Kingdom

Manufacturer:

S.E. de CARBUROS METALICOS S.A.

C/ Aragon 300, 08009-Barcelona Spain

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

Belgium: NOXAP 800 ppm mol/mol, medicinaal gas, samengeperst

The Netherlands : NOXAP 800 ppm mol/mol, medicinaal gas, samengeperst

France : NOXAP 800 ppm mol/mol, gaz medicinal comprime

Portugal: NOXAP 800 ppm mol/mol, gas medicinal comprimido

Czech Republic : NOXAP 800 ppm mol/mol, medicinalm plyn, stlaceny

Germany : NOXAP 800 ppm Mol/Mol Gas zur medizinischen Anwendung, druckverdichtet

United Kingdom: NOXAP 800 ppm mol/mol, medicinal gas, compressed

Spain : NOXAP 800 ppm moles/mole, gas medicinal comprimido

This leaflet was last approved in March 2013

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