VOPECIDEX 500mg Filmomhulde tabletten

Vopecidex belongs to the group of medicines called "cytostatic medicines", which stop the growth of cancer cells. Vopecidexcontains capecitabine, which itself is not a cytostatic medicine. Only after being absorbed by the body is it changed into an active anti-cancer medicine (more in tumour tissue than in normal tissue).

Vopecidex is prescribed by doctors for the treatment of colon, rectal, gastric, or breast cancers. Furthermore, Vopecidex is used to prevent new occurrence of colon cancer after complete removal of the tumour by surgery.

Vopecidex may be used either alone or in combination with other medicines.

Do not take Vopecidex

• if you are allergic to capecitabine or any of the other ingredients of this medicine (listed in section 6). You must inform your doctor if you know that you have an allergy or over-reaction to this medicine,
• if you previously have had severe reactions to fluoropyrimidine therapy (a group of anticancer medicines such as fluorouracil),
• if you are pregnant or breast-feeding,
• if you have severely low levels of white cells or platelets in the blood (leukopenia, neutropenia or thrombocytopenia),
• if you have severe liver or kidney problems,
• if you have a known deficiency for the enzyme dihydropyrimidine dehydrogenase (DPD) involved in the metabolism of uracil and thymine, or

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• if you are being treated now or have been treated in the last 4 weeks with brivudine, sorivudine or similar classes of substance as part of herpes zoster (chickenpox or shingles) therapy.

Warnings and precautions

Talk to your doctor or pharmacist before taking Vopecidex

• if you have liver or kidney diseases
• if you have or had heart problems for example an irregular heartbeat or pains to the chest jaw and back brought on by physical effort and due to problems with the blood flow to the heart)
• if you have brain diseases for example. cancer that has spread to the brain, or nerve damage (neuropathy)
• if you have calcium imbalances (seen in blood tests)
• if you have diabetes
• if you have diarrhoea
• if you are or become dehydrated
• if you have imbalances of ions in your blood (electrolyte imbalances, seen in tests)

DPD deficiency: DPD deficiency is a rare condition present at birth that is not usually associated with health problems unless you receive certain medicines. If you have an unrecognised DPD deficiency and take capecitabine, you may experience severe forms of the side effects listed under section 4 Possible side effects. Contact your doctor immediately if you are concerned about any of the side effects or if you notice any additional side effects not listed in the leaflet (see section 4 Possible side effects.

Children and adolescents

Capecitabine is not indicated in children and adolescent. Do not give Vopecidex to children and adolescent.

Other medicines and Vopecidex

Tell your doctor or pharmacist if you are taking or have recently taken or might take any other medicines. This is extremely important, as taking more than one medicine at the same time can strengthen or weaken the effect of the medicines. You need to be particularly careful if you are taking any of the following:

• gout medicines (allopurinol),
• blood-thinning medicines (coumarin, warfarin),
• certain anti-viral medicines (sorivudine and brivudine) or
• medicines for seizures or tremors (phenytoin).
• interferon alpha or
• radiotherapy and certain medicines used to treat cancer (folinic acid, oxaliplatin, bevacizumab)

Vopecidex with food, drink and alcohol

You should take Vopecidex no later than 30 minutes after meals.

Pregnancy and breast-feeding

Before starting treatment, you must tell your doctor if you are pregnant, if you think you are pregnant or if you intend to become pregnant. You must not take Vopecidex if you are pregnant or think you might be. You must not breast-feed if you are taking Vopecidex. Ask your doctor or pharmacist for advice before taking this medicine.

Driving and using machines

Vopecidex may make you feel dizzy, nauseous or tired. It is therefore possible that Vopecidex could affect your ability to drive a car or operate machinery.

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Vopecidex contains lactose

If you have been told by your doctor that you have an intolerance to some sugars, contact your doctor before taking this medicine.

Always take this medicine exactly as your doctor or pharmacist has told you. Check with your doctor or pharmacist if you are not sure.

Vopecidex should only be prescribed by a doctor experienced in the use of anticancer medicines.

Vopecidex tablets should be swallowed whole with water and within 30 minutes of a meal.

Your doctor will prescribe a dose and treatment regimen that is right for you. The dose of Vopecidex is based on your body surface area. This is calculated from your height and weight. The usual dose for adults is 1250 mg/m2 of body surface area taken two times daily (morning and evening). Two examples are provided here: A person whose body weight is 64 kg and height is 1.64 m has a body surface area of 1.7 m2 and should take 4 tablets of 500 mg and 1 tablet of 150 mg two times daily. A person whose body weight is 80 kg and height is 1.80 m has a body surface area of 2.00 m2 and should take 5 tablets of 500 mg two times daily.

Vopecidex tablets are usually taken for 14 days followed by a 7 day rest period (when no tablets are taken). This 21 day period is one treatment cycle.

In combination with other medicines the usual dose for adults may be less than 1250 mg/m2 of body surface area, and you may need to take the tablets over a different time period (e.g. every day, with no rest period).

Your doctor will tell you what dose you need to take, when to take it and for how long you need to take it.

Your doctor may want you to take a combination of 150 mg and 500 mg tablets for each dose.

• Take the tablets morning and evening as prescribed by your doctor.
• Take the tablets within 30 minutes after the end of a meal (breakfast and dinner).
• It is important that you take all your medicine as prescribed by your doctor.

If you take more Vopecidex than you should

If you take more Vopecidex than you should, contact your doctor as soon as possible before taking the next dose.

You might get the following side effects if you take a lot more capecitabine than you should: feeling or being sick, diarrhoea, inflammation or ulceration of the gut or mouth, pain or bleeding from the intestine or stomach, or bone marrow depression (reduction in certain kinds of blood cells). Tell your doctor immediately if you experience any of these symptoms.

If you forget to take Vopecidex

Do not take the missed dose at all and do not double the next one. Instead, continue your regular dosing schedule and check with your doctor.

If you stop taking Vopecidex

There are no side-effects caused by stopping treatment with capecitabine. In case you are using coumarin anticoagulants (containing e.g. phenprocoumon), stopping capecitabine might require that your doctor adjusts your anticoagulant dose.

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

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

STOP taking Vopecidex immediately and contact your doctor if any of these symptoms occur:

• Diarrhoea: if you have an increase of 4 or more bowel movements compared to your normal bowel movements each day or any diarrhoea at night.
• Vomiting: if you vomit more than once in a 24-hour time period.
• Nausea: if you lose your appetite, and the amount of food you eat each day is much less than usual.
• Stomatitis: if you have pain, redness, swelling or sores in your mouth and/or throat.
• Hand-and-foot skin-reaction: if you have pain, swelling, and redness or tingling of hands and/or feet
• Fever: if you have a temperature of 38°C or greater.
• Infection: if you experience signs of infection caused by bacteria or virus, or other organisms.
• Chest pain: if you experience pain localised to the centre of the chest, especially if it occurs during exercise.

If caught early, these side effects usually improve within 2 to 3 days after treatment discontinuation. If these side effects continue, however, contact your doctor immediately. Your doctor may instruct you to restart treatment at a lower dose.

In addition to the above, when capecitabine is used alone, very common side effects, which may affect more than 1 person in 10 are:

• abdominal pain
• rash, dry or itchy skin
• tiredness
• loss of appetite (anorexia)

These side effects can become severe; therefore, it is important that you always contact your doctor immediately when you start to experience a side effect. Your doctor may instruct you to decrease the dose and/or temporarily discontinue treatment with Vopecidex. This will help reduce the likelihood that the side effect continues or becomes severe.

Other side effects are:

Common side effects (may affect up to 1 to 10 people) include:

• decreases in the number of white blood cells or red blood cells (seen in tests),
• dehydration, weight loss,
• sleeplessness (insomnia), depression,
• headache, sleepiness, dizziness, abnormal sensation in the skin (numbness or tingling sensation), taste changes,
• eye irritation, increased tears, eye redness (conjunctivitis),
• inflammation of the veins (thrombophlebitis),
• shortness of breath, nose bleeds, cough, runny nose,
• cold sores or other herpes infections,
• infections of the lungs or respiratory system (e.g. pneumonia or bronchitis),
• bleeding from the gut, constipation, pain in upper abdomen, indigestion, excess wind, dry mouth,

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• skin rash, hair loss (alopecia), skin reddening, dry skin, itching (pruritus),,skin discolouration, skin loss, skin inflammation, nail disorder
• pain in the joints, or in the limbs (extremities), chest or back,
• fever, swelling in the limbs, feeling ill
• problems with liver function (seen in blood tests) and increased blood bilirubin (excreted by the liver)

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

• blood infection, urinary tract infection, infection of the skin, infections in the nose and throat, fungal infections (including those of the mouth), influenza, gastroenteritis, tooth abscess,
• lumps under the skin (lipoma),
• decreases in blood cells including platelets, thinning of blood (seen in tests)
• allergy
• diabetes, decrease in blood potassium, malnutrition, increased blood triglycerides,
• confusional state, panic attacks, depressed mood, decreased libido,
• difficulty speaking, impaired memory, loss of movement coordination, balance disorder, fainting, nerve damage (neuropathy) and problems with sensation
• blurred or double vision,
• vertigo, ear pain.
• irregular heartbeat and palpitations (arrhythmias), chest pain and heart attack (infarction),
• blood clots in the deep veins, high or low blood pressure, hot flushes, cold limbs (extremities), purple spots on the skin
• blood clots in the veins in the lung (pulmonary embolism), collapsed lung, coughing up blood, asthma, shortness of breath on exertion,
• bowel obstruction, collection of fluid in the abdomen, inflammation of the small or large intestine, the stomach or the oesophagus, pain in the lower abdomen, abdominal discomfort, heartburn (reflux of food from the stomach), blood in the stool,
• jaundice (yellowing of skin and eyes)
• skin ulcer and blister, reaction of the skin with sunlight, reddening of palms, swelling or pain of the face
• joint swelling or stiffness, bone pain, muscle weakness or stiffness,
• fluid collection in the kidneys, increased frequency of urination during the night, incontinence, blood in the urine, increase in blood creatinine (sign of kidney dysfunction)
• unusual bleeding from the vagina
• swelling (oedema), chills and rigors

Some of these side effects are more common when capecitabine is used with other medicines for the treatment of cancer. Other side-effects seen in this setting are the following:

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

• decrease in blood sodium, magnesium or calcium, increase in blood sugar,
• nerve pain,
• ringing or buzzing in the ears (tinnitus), loss of hearing,
• vein inflammation,
• hiccups, change in voice,
• pain or altered/abnormal sensation in the mouth, pain in the jaw,
• sweating, night sweats,
• muscle spasm,
• difficulty in urination, blood or protein in the urine,
• bruising or reaction at the injection site (caused by medicines given by injection at the same time)

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

• narrowing or blockage of tear duct (lacrimal duct stenosis),
• liver failure,

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• inflammation leading to dysfunction or obstruction in bile secretion (cholestatic hepatitis),
• specific changes in the electrocardiogram (QT prolongation),
• certain types of arrhythmia (including ventricular fibrillation, torsade de pointes, and bradycardia).

If you are concerned about these or any other unexpected effect(s), talk to your doctor. 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 pharmacist.

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

Aluminium/aluminium blisters

This medicinal product does not require any special storage conditions.

PVC/PVdC/Aluminium blisters

Do not store above 30°C

Do not use this medicine after the expiry date which is stated on the carton and blister after EXP.

Do not throw away any medicines via wastewater or household waste. Ask your pharmacist how to throw away medicines you no longer use. These measures will help protect the environment.

What Vopecidex contains

The active substance is capecitabine

Each film-coated tablet contains 150 mg of capecitabine

Each film-coated tablet contains 500 mg of capecitabine

• The other ingredients are:
  • Tablet core: anhydrous lactose, croscarmellose sodium, hypromellose, microcrystalline cellulose, magnesium stearate.
  • Tablet coating: hypromellose, titanium dioxide (E171), yellow iron oxide and red iron oxide (E172), talc.

What VOPECIDEX looks like and contents of the pack

Vopecidex 150 mg tablet is a light peach coloured, oblong shaped, biconvex, film-coated tablet of approximately 11.4 mm in length and 5.3 mm in width, debossed with “150” on one side and plain on other side.

Vopecidex 500 mg tablet is a peach coloured, oblong shaped, biconvex, film-coated tablet of approximately 15.9 mm in length and 8.4 mm in width, debossed with “500” on one side and plain on other side.

Capecitabine is available in blister packs (Aluminium- Aluminium or PVC/PVdC-Aluminium) containing 30, 60 or 120 film-coated tablets.

Not all pack sizes may be marketed.

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Marketing authorization holder

PharmaSwiss Čzech Republic Jankovcova 1569/2c

17000 Prague 7

Czech Republic

Manufacturer

Accord Healthcare Limited,

Sage house, 319 Pinner road, Harrow, Middlesex, HA1 4HF, United Kingdom or

Pharmacare Premium Limited,

HHF 003, Hal Far Industrial Estate Birzebbugia, BBG 3000, Malta or

PharmaSwiss d.o.o,

Wolfova 1, 1000 Ljubljana, Slovenia

The medicinal product is authorized in the Member States of the EEA under the following names:

Name of member state	: Name of medicinal product
BG	: VOPECIDEX 150 mg/500mg film-coated tablets
CZ	:	VOPECIDEX 150mg/500mg
EE	:	VOPECIDEX
HU	:	VOPECIDEX 150mg/500mg Film tabletta
LT	:	VOPECIDEX 150mg/500mg	plėvele dengtos tabletės
LV	:	VOPECIDEX 150mg/500mg	apvalkotās tabletes
PL	:	VOPECIDEX
RO	: VOPECIDEX 150mg/500mg, comprimate filmate
NL	:	VOPECIDEX 150mg/500mg filmomhulde tabletten
SI	:	VOPECIDEX 150mg/500mg	filmsko obložene tableta
SK	:	VOPECIDEX 150mg/500mg Filmom obalené tablety

This leaflet was last revised in June 2013

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