Tostran 2% Gel
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 or pharmacist.
* 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 or pharmacist. This includes any possible side effects not listed in this leaflet. See section 4
Your medicine is called Tostran 2% Gel but will be referred to as Tostran throughout the leaflet.
What is in this leaflet
,1^ What Tostran is and what it is used for
,2^ What you need to know before you use Tostran
.3^ How to use Tostran
.4^ Possible side effects
,5 How to store Tostran
,6^ Contents of the pack and other information
What Tostran is and what it is used for
The active substance, tesosterone, is a male hormone, which is a type of androgen. Tostran is used in adult men for testosterone replacement to treat various health problems caused by a lack of testosterone (male hypogonadism). This should be confirmed by two seperate blood testosterone measurements and also include clinical sympoms such as:
* Impotence
* infertility
* low sex drive.
* tirdness
* depressive moods
* bone loss caused by low hormone levels
[2) What you need to know before you use tostran
Tostran must only be used if hypogonadism has been confirmed by your doctor, based on your symptoms and laboratory tests. Other reasons for your symptoms must have been excluded by your doctor prior to the start of the treatment.
Only men can use Tostran. Tostran has not been tested in males less than 18 years of age, and there is limited experience of treating men older than 65 years of age.
Do not use Tostran:
If you:
* are allergic to testosterone or anyof the other ingredients of this medicine (listed in section 6.)
* have or are suspected of having cancer of the breast or prostrate If any of these applies to you tell your doctor or pharmacist.
Warnings and precautions:
A check-up is necessary before you begin treatment, and periodically during treatment (usually once or twice a year).
If you are suffering from severe heart, liver or kidney diseases, treatment with tostran may cause severe complications in the form of water retention in your body sometimes accompanied by (congestive) heart failure.
The following blood checks should be carried out by your doctor before and during the treatment: testosterone blood level, full blood count.
Tell your doctor if you have high blood pressure or if you are treated for high blood pressure, as testerone may cause a rise in blood pressure.
Testosterone treatment may increase the risk of development of an enlarged prostate gland (benign prostatic hyperplasia) or prostate cancer.
Testosterone treatment may also affect the number of red blood cells you have, your blood fat profile and your liver function.
Tell your doctor before treatment if you:
* have swollen hands and feet
* are overweight or suffer from a chronic lung disease, as testosterone treatment may worsen sleep apnoea (temporary cessation of breathing during sleep
* have diabetes and use insulin to control your blood sugar levels, as testosterone treatment may affect your response to insulin
* have or develop epilepsy or migraines, as these conditions may get worse during treatment
* suffer from skeletal cancer, as your doctor will have to monitor your blood calcium levels during treatment
Contact your doctor if you:
* have frequently-occurring or persistent erections
* feel irritable, nervous, or notice weight gain
* feel nauseous, vomit, notice changes in your skin colour or your ankle joints become swollen
* notice any changes in breathing patterns including during sleep
These symptoms may mean that your dose of Tostran is too high, and your doctor may need to adjust your dose.
Contact your doctor if you notice any skin reactions at the site of application such as burning or prickling sensation, dryness, rash, redness or itchiness. If the reaction is severe, treatment should be reviewed by your doctor and stopped if necessary.
If you are an athlete please note that Tostran contains testosterone, which may give positive results in a doping test.
Tostran should not be used to treat male sterility or sexual impotence.
Tostran should not be used by woman due to possible virilising effects (such as growth of facial or body hair deepening of the voice or changes in the menstrual cycle).
How to prevent transfer of Tostran osf someone else:
It is important not to transfer the product to others, especially woman and children. Transfer occurs through close skin to skin contact, resulting in increased testosterone levels in the other person. If the contact is repeated or prolonged, It may cause side-effects such as growth of facial or body hair, deepening of the voice or changes in the menstrual cylcle of woman.
This transfer can be avoided by covering the application site with loose clothing, or by showering or bathing prior to contact.
The following precautions are therefore recommended:
* wash your hands thoroughly with soap and water after applying the gel:
* cover the application site with loose clothing once the gel has dried;
* Shower or bathe before any situation involving close skin contact with somone else.
In order to guarantee the safety of your partner you should wait for at least four hours after the application of tostran before having sexual intercourse and wear clothing which covers the application site at the time of contact or wash the site of application with soap and water before sexual intercourse. You should wear clothing which covers the application site when in contact with children in order to avoid risk of transfering the gel to the chld's skin.
If you transfer some of the testosterone gel to another person by skin-to-skin contact, or someone else is exposed by direct contact with the gel itself, wash the contact area of the other person with soap and water as soon as possible.
If Tostran is applied to a patient by a health care professional or carer, they should wear suitable disposable gloves. The gloves should be resistant to alcohol as gel contains ethanol and isopropyl alcohol. Contact your doctor if you notice changes in body hair, significantly incresed acne or other signs of devlopment of male characteristics in people not being treated with Tostran (i.e., female partner or children).
Other medicines and Tostran:
Tell your doctor or pharmacist if you are taking, have recently taken, or might take any other medicines, especially the following:
* anticoagulants
* corticosteroids
Also tell your doctor doctor or pharamacist about any medicines that you may have bought for yourself without prescription.
Tostran with food and drink:
Tostran is not affected by youir intake of food or drink.
Pregnancy or breast-feeding
* Tostran is only intended to be used by men.
* Tostran must not be used by pregnant or breastfeeding woman.
* Pregnant woman should avoid all contact with skin treated with Tostran. Tostran may cause harm or abnormalities in the unborn baby. If your partner becomes pregnant you must follow the advice regarding avoiding the transfer of the testoterone gel given in this section. In the event of contact with treated skin, the area should be washed immediately with soap and water.
Driving and using machines:
Tostran is unlikely to have an effect on your ability to drive and use machines.
Tostran contains butylhydroxytoluene and propylene glycol
Butylhydroxytoluene may cause local skin reactions (e.g. contact dermatitis) or irritation of the eyes and mucous membranes. Propylene glycol may cause skin irritation.
[m How to use Tostran
Always use this medicine exactly as your doctor has told you. You should check with your doctor or pharmacist if you are unsure about how and when to apply the gel.
The usual starting dose is 3g of gel (containing 60mg of testosterone) per day. The dose may be adjusted by your doctor, and the maximum dose is 4g of gel (80mg of testosterone) per day.
Tostran is supplied in a canister with a pumping mechanism which delivers one half gram of gel (10mg of testosterone) each time the piston is depressed (when the pump mechanism is pushed right down).
Using the canister for the first time:
Before you use the dosing pump for the first time it must be primed. To do so, with the canister in the upright position, slowly and fully depress the actuator eight times. The first few depressions may result in no discharge of gel. Discard the gel from the eight depressions. It is only necessary to prime the pump before the first dose.
Patient Information Leaflet (continued)
Administration of Tostran:
Your doctor will tell you how many depressions of the piston to make to get the correct dose of gel for you once the pump has been primed. The table below gives you more inormation on this.
|
Number of Depressions |
Amount of Gel (g) |
Quantity of Testoterone Applied to the skin (mg) |
|
1 |
0.5 |
10 |
|
2 |
1 |
20 |
|
4 |
2 |
40 |
|
6 |
3 |
60 |
|
8 |
4 |
80 |
Apply the gel onto clean, dry intact skin, once a day at the same time each day, for example in the morning after showering.
The gel should either be rubbed onto the abdomen (over an area of at least 10 by 30 cm) or divided in half and one half rubbed onto the inside of each thigh (over an area of at least 10 by 15 cm ). It is recommended that you rub Tostran onto your abdomen and both your inner thighs on alternate days. Application to other sites should be avoided. In particular do not apply Tostran to the genitals.
Rub the gel in gently with one finger untill dry, and then cover the area with loose clothing (e.g. T-shirts, shorts, pants). When finished, wash your hands thoroughly with soap and water.
If you are thinking of taking a shower or bath, do so either before application of Tostran or wait for at least two hours after application.
Two weeks after beginning to use your medicine your doctor will take blood samples to see if your dose needs to be changed. Whilst you are taking Tostran, you should expect to have regular medical follow-up.
If you arranging for testing of blood samples while using Tostran you must ensure that all your testerone measurements are preformend in the same laboratory, because of the variability in analytical values among diagnostic laboratories.
If you use more Tostran than you should:
If you have applied too much Tostran, contact a doctor, hospital or pharmacist.
If you forget to use Tostran:
Do not take a double dose to make up for forgotten individual doses. Apply the next dose at the usual time.
If you stop using Tostran:
Always talk to your doctor or pharmacist before stopping using Tostran.
If you have any furthur questions on the use of this medicine, ask your doctor or pharmacist.
[4) Possible side effects
Like all medicines, this medicine can cause side, although not everybody gets them.
Very common side effects (affects more than 1 user in 10) are skin reactions at the site of application such as burning or prickling sensation, dryness, rash, redness or itchiness. These are useually mild transient side effects of Tostran but if they are troublesome or last for more than a few days, talk to your doctor or pharmacist as soon as possible.
Common side effects (affects 1 to 10 users in 100) are: swelling of hands and feet, high blood pressure, prostrate changes (including: increased blood levels of protein called prostrate specific antigen that is produced by the prostrate), increased body hair growth, increase in breast size, increased number of red blood cells (measured in blood samples). Increase in red blood cell count, haematocrit (percentage of red blood cells in blood) and haemoglobin (the component of red blood cells that carries oxygen, identified by pereodixc blood tests.
Other known undesirable effects associated with tesosterone treatments include: baldness, seborrhoea, acne, jaundice (liver problems which sometimes may be associated with yellowing of the skin and the whites of eyes), abnormal liver function tests, nausea, changes in libido, increased frequency of erections, difficulty in passing urine, depression, nervousness, hostility, weight gain, muscle cramps or pain, fluid retention, swelling of ankles, sleep apnoea, and rare cases of painful and persistent erections. A reduction in sperm production and the sizes of the testicals may occur at high doses. Prolonged testosterone administration may cause changes in the levels of salts (electrolytes) in the body.
There is no convincing evidence that testosterone replacement in hypogonadal men induces prostrate cancer. However, testosterone therapy is to be avoided in men already known or thought to have prostrate cancer. Hyperglycaemia (to much sugar in the bloodstream) has been reported in the case of 2 people with a history of diabetes millitus.
Reporting of side effects:
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 (Tel: Freephone 0808 100 3352 or Website: www.mhra.gov.uk/yellowcard). By reporting side effects you can help provide more information on the safety of this medicine.
[a How to store Tostran
Keep out of the sight and reach of children.
Do not store above 25°C.
Do not refrigerate or freeze.
Store canister upright
Do not use Tostran after the expiry date which is stated on the canister label or carton. The expiry date refers to the last day of the month.
If your doctor tells you to stop taking this medicine, return any unused gel to your pharmacist (chemist) for safe disposal. Only keep this gel if your doctor tells you to.
If the becomes discoloured or shows any other signs of
deterioration, you should seek the advice of your pharmacist who will tell you
what to do.
Medicines should not be disposed of via wastewater or household waste.
Ask your pharmacist how to dispose of medicines that are no longer required. These measures will help to protect the environment.
[6) Contents of the pack and other information
What Tostran contains:
Each gram of gel contains 20mg of testosterone.
One press of the canister piston delivers 0.5 g of gel containing 10 mg testosterone.
Other ingredients are propylene glycol, ethanol, anhydrous isopropyl alcohol, oleic acid, carbomer 1382, trolamine, butylhydroxytoluene (E321), water purified and hydrochloric acid (for pH adjustment).
What Tostran look like and contents of the pack Tostran is a clear, colourless gel.
Each pack contains a 60g Tube.
Manufacturer and Licence Holder
Manufactured by Pharbil Waltrop GmbH, Im Wirrigen 25, 45731 Waltrop Germany and is procured from within the EU and repackaged by the Product Licence Holder: Lexon (UK) Limited, Unit 18, Oxleasow Road, East Moons Moat, Redditch, Worcestershire, B98 0RE.
If you have any questions or are not sure about anything, ask your doctor or pharmacist. They will have additional information about this medicine and will be able to advise you.
POM PL 15184/1610 Tostran 2% Gel
Tostran is a registered trademark of Straken International Limited.
Revision date: 03/05/15