Stivarga
regorafenib
regorafenib
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.
What Stivarga is and what it is used for
What you need to know before you take Stivarga
How to take Stivarga
Possible side effects
How to store Stivarga
Contents of the pack and other information
Stivarga contains the active substance regorafenib. It is a medicine used to treat cancer by slowing down the growth and spread of cancer cells and cutting off the blood supply that keeps cancer cells growing.
Stivarga is used to treat:
colon or rectal cancer that has spread to other parts of the body in adult patients who have received other treatments or cannot be treated with other medicines (fluoropyrimidine-based chemotherapy, an anti-VEGF therapy and an anti-EGFR therapy)
gastrointestinal stromal tumours (GIST), a type of cancer of the stomach and bowel, that has spread to other parts of the body or is not amenable to surgery, in adult patients who have been previously treated with other anticancer medicines (imatinib and sunitinib)
liver cancer in adult patients who have been previously treated with another anticancer medicine (sorafenib).
If you have any questions about how Stivarga works or why this medicine has been prescribed for you, please ask your doctor.
if you are allergic to regorafenib or any of the other ingredients of this medicine (listed in section 6).
discolouration of the skin and the whites of the eyes, dark urine and confusion and/or disorientation. Treatment with Stivarga may lead to a higher risk of liver problems. Prior to and during treatment with Stivarga, your doctor will do blood tests to monitor your liver function. If your liver function is severely impaired, you should not be treated with Stivarga, as there are no data on the use of Stivarga in patients with a severely impaired liver function.
manage your symptoms, your doctor may recommend the use of creams and/or the use of shoe cushions and gloves. If you get this side effect, your doctor may change your dose or stop your treatment until your condition improves.
Before you take Stivarga tell your doctor if any of these conditions apply to you. You may need treatment for them and extra tests may be done (see also section 4 ‘Possible side effects’).
There is no relevant use of Stivarga in children and adolescents in the indication of colon or rectal cancer that has spread to other parts of the body.
The safety and efficacy of Stivarga in children and adolescents in the indication of gastrointestinal stromal tumours (GIST) have not been established. No data are available.
There is no relevant use of Stivarga in children and adolescents in the indication of liver cancer.
some medicines to treat fungal infections (e.g. ketoconazole, itraconazole, posaconazole and voriconazole)
some medicines to treat pain (e.g. mefenamic acid, diflunisal, and niflumic acid)
some medicines to treat bacterial infections (e.g. rifampicin, clarithromycin, telithromycin)
medicines typically used to treat epilepsy (seizures) (e.g. phenytoin, carbamazepine or phenobarbital)
methotrexate, a medicine typically used to treat cancer
rosuvastatin, fluvastatin, atorvastatin, medicines typically used to treat high cholesterol
warfarin or phenprocoumon, medicines typically used to thin your blood
St. John’s wort (medicine obtained also without a prescription), a herbal treatment for depression. Ask your doctor or pharmacist for advice before taking any medicine.
Avoid drinking grapefruit juice while taking Stivarga. This can affect the way Stivarga works.
Stivarga may reduce fertility in both men and women. Ask your doctor for advice before taking Stivarga.
It is not known whether Stivarga alters the ability to drive or use machines. Do not drive or use any tools or machines if you experience treatment-related symptoms that affect your ability to concentrate and react.
This medicine contains 56.06 mg sodium (main component of cooking/table salt) in each daily dose (4 tablets). This is equivalent to 3% of the recommended maximum daily dietary intake of sodium for an adult.
This medicine contains 1.68 mg of lecithin (derived from soya) per daily dose (4 tablets).
Always take this medicine exactly as your doctor has told you to. Check with your doctor or pharmacist if you are not sure.
Your doctor will usually ask you to take Stivarga for 3 weeks and then to stop for 1 week. This is 1 cycle of treatment.
Take Stivarga at the same time each day after a light (low-fat) meal. Swallow the tablet whole with water after a light meal that contains less than 30% fat. An example of a light (low-fat) meal would include 1 portion of cereal (about 30 g), 1 glass of skimmed milk, 1 slice of toast with jam, 1 glass of apple juice, and 1 cup of coffee or tea (520 calories, 2 g fat). You should not take Stivarga together with grapefruit juice (see also section ‘Taking Stivarga with food and drink’).
In case of vomiting after regorafenib administration, you should not take additional tablets and you should inform your doctor.
Your doctor may need to reduce your dose or may decide to interrupt or discontinue the treatment permanently if necessary. You will usually take Stivarga as long as you are benefiting and not suffering unacceptable side effects.
No dosage adjustment is necessary if you have a mildly impaired liver function. If you have a mildly or moderately impaired liver function while you are being treated with Stivarga, your doctor should monitor you closely. If your liver function is severely impaired, you should not be treated with Stivarga, as there are no data on the use of Stivarga in patients with a severely impaired liver function.
No dosage adjustment is necessary if you have a mildly, moderately or severely impaired kidney function.
Tell your doctor immediately if you have taken more than your prescribed dose. You may require medical attention and your doctor may tell you to stop taking Stivarga.
Taking too much Stivarga may make some side effects more likely or more severe, especially:
skin reactions (rash, blisters, redness, pain, swelling, itching or peeling of your skin)
voice changes or hoarseness (dysphonia)
frequent or loose bowel movements (diarrhoea)
mouth sores (mucosal inflammation)
dry mouth
decreased appetite
high blood pressure (hypertension)
excessive tiredness (fatigue).
If you miss a dose, take it as soon as you remember on that day. Do not take two doses of Stivarga on the same day to make up for a missed dose from the previous day. Tell your doctor about any missed dose.
Like all medicines, this medicine can cause side effects, although not everybody gets them. This medicine may also affect the results of some blood tests.
Severe liver problems (including liver failure), bleeding, gastrointestinal perforation and infection.
Liver problems
Treatment with Stivarga may lead to a higher risk of severe liver problems. Get medical help immediately if you get the following symptoms:
yellowish discolouration of the skin and the whites of the eyes
dark urine
confusion and/or disorientation. These may be signs of severe liver injury.
Bleeding
Stivarga can cause severe bleeding in the digestive system such as stomach, throat, rectum or intestine, or in the lungs, kidneys, mouth, vagina and/or brain. Get medical help immediately, if you get the following symptoms:
passing blood in the stools or passing black stools
passing blood in the urine
stomach pain
coughing/vomiting up blood. These may be signs of bleeding.
Severe stomach and bowel problems (gastrointestinal perforation or fistula)
Get medical help immediately, if you get the following symptoms:
severe stomach (abdominal) pain or stomach pain that does not go away
vomiting blood
red or black stools.
These may be signs of severe stomach or bowel problems.
Infection
Treatment with Stivarga may lead to a higher risk of infections, especially of the urinary tract, nose, throat and lung. Treatment with Stivarga may also lead to a higher risk of fungal infections of the mucous membrane, skin or the body. Get medical help immediately if you get the following symptoms:
high fever
severe cough with or without an increase in mucus (sputum) production
severe sore throat
shortness of breath
burning/pain when urinating
unusual vaginal discharge or irritation
redness, swelling and/or pain in any part of the body. These may be signs of an infection.
Other side effects with Stivarga listed by frequency:
reduction in the number of blood platelets, characterised by easy bruising or bleeding (thrombocytopenia)
reduction in the number of red blood cells (anaemia)
- decreased appetite and food intake
high blood pressure (hypertension)
voice changes or hoarseness (dysphonia)
frequent or loose bowel movements (diarrhoea)
painful or dry mouth, painful tongue, mouth sores (stomatitis and/or mucosal inflammation)
feeling sick (nausea)
vomiting
high blood levels of bilirubin, a substance produced by the liver (hyperbilirubinaemia)
changes in enzymes produced by the liver, which may indicate that something is wrong with the liver (increase in transaminases)
redness, pain, blisters and swelling of the palms of the hands or soles of the feet (hand-foot skin reaction)
rash
weakness, lack of strength and energy, excessive tiredness and unusual sleepiness
(asthenia/fatigue)
pain (including abdominal pain and back pain)
constipation
fever
weight loss.
reduction in the number of white blood cells (leucopenia)
decreased activity of the thyroid gland (hypothyroidism)
low levels of potassium, phosphate, calcium, sodium or magnesium in your blood (hypokalaemia, hypophosphatemia, hypocalcaemia, hyponatraemia and hypomagnesaemia)
high level of uric acid in the blood (hyperuricaemia)
loss of body fluids (dehydration)
headache
shaking (tremor)
disorder of the nerves which can cause a change in sensation, such as numbness, tingling, weakness or pain (peripheral neuropathy)
taste disorders
dry mouth
heartburn (gastro-oesophageal reflux)
infection or irritation of the stomach and intestines (gastroenteritis)
hair loss (alopecia)
dry skin
rash with flaking or peeling of skin (exfoliative rash)
a sudden, involuntary contraction of a muscle (muscle spasms)
protein in the urine (proteinuria)
high levels of certain enzymes involved in digestion (increase in amylase and lipase)
abnormal blood clotting condition (abnormal International Normalized Ratio).
signs/symptoms of an allergic reaction which may include widespread severe rash, feeling sick, fever, breathlessness, jaundice, changes in chemicals produced by the liver (hypersensitivity reaction)
heart attack, chest pain (myocardial infarction and ischaemia)
severely elevated blood pressure causing headache, confusion, blurry vision, nausea, vomiting, and fits (hypertensive crisis)
inflammation of the pancreas characterized by pain in the area of the stomach, nausea, vomiting, and fever (pancreatitis)
nail disorder (changes to the nail such as ridges and/or splitting)
multiple skin eruptions (erythema multiforme).
certain skin cancers (keratoacanthoma/squamous cell carcinoma of the skin)
headache, confusion, seizures and visual loss associated with or without high blood pressure (posterior reversible encephalopathy syndrome/PRES)
serious reactions of the skin and/or mucous membranes which may include painful blisters and fever, including extensive detachment of the skin (Stevens-Johnson syndrome and toxic epidermal necrolysis).
an enlargement and weakening of a blood vessel wall or a tear in a blood vessel wall (aneurysms and artery dissections).
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 the national reporting system listed in Appendix V. By reporting side effects, you can help provide more information on the safety of this medicine.
Keep this medicine out of the sight and reach of children.
Do not use this medicine after the expiry date which is stated on the carton and the bottle label after EXP. The expiry date refers to the last day of that month.
Store in the original package in order to protect from moisture. Keep the bottle tightly closed.
Once the bottle is opened the medicine is to be discarded after 7 weeks.
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.
The active substance is regorafenib. Each film-coated tablet contains 40 mg regorafenib.
The other ingredients are: cellulose microcrystalline, croscarmellose sodium, magnesium stearate, povidone (K-25) and silica colloidal anhydrous, iron oxide red (E172), iron oxide yellow (E172), lecithin (derived from soya), macrogol 3350, polyvinyl alcohol (partially hydrolysed), talc and titanium dioxide (E171) (see also section ‘Important information about some of the ingredients of Stivarga’).
Stivarga 40 mg tablets are light pink and oval, marked with “BAYER” on one side and “40” on the other side.
Each bottle contains 28 film-coated tablets.
Stivarga 40 mg tablets are available in packs containing one bottle or three bottles. Not all pack sizes may be marketed.
Keep the desiccant in the bottle. The desiccant is a moisture absorbing material filled in a small container to protect the tablets from moisture.
Bayer AG
51368 Leverkusen Germany
Bayer AG
Kaiser-Wilhelm-Allee 51368 Leverkusen Germany
For any information about this medicine, please contact the local representative of the Marketing Authorisation Holder:
Bayer SA-NV
Tél/Tel: +32-(0)2-535 63 11
Байер България ЕООД Тел. +359-(0)2-424 72 80
Bayer s.r.o.
Tel: +420 266 101 111
Bayer A/S
Tlf: +45-45 23 50 00
Bayer Vital GmbH
Tel: +49-(0)214-30 513 48
Bayer OÜ
Tel: +372 655 85 65
Bayer Ελλάς ΑΒΕΕ Τηλ:+30 210 618 75 00
Bayer Hispania S.L. Tel: +34-93-495 65 00
Bayer HealthCare
Tél: +33-(0)800 87 54 54
Bayer d.o.o.
Tel: + 385-(0)1-6599 900
Bayer Limited
Tel: +353 1 216 3300
Icepharma hf.
Sími: +354 540 80 00
Bayer S.p.A.
Tel: +39-02-397 81
NOVAGEM Limited
Τηλ: +357 22 48 38 58
SIA Bayer
Tel: +371 67 84 55 63
UAB Bayer
Tel. +370 5 23 36 868
Bayer SA-NV
Tél/Tel: +32-(0)2-535 63 11
Bayer Hungária Kft. Tel.: +36-14 87-41 00
Alfred Gera and Sons Ltd. Tel: +356-21 44 62 05
Bayer B.V.
Tel: +31-(0)23 799 1000
Bayer AS
Tlf. +47 23 13 05 00
Bayer Austria Ges. m. b. H. Tel: +43-(0)1-711 46-0
Bayer Sp. z o.o.
Tel.: +48-22-572 35 00
Bayer Portugal, Lda. Tel: +351-21-416 42 00
SC Bayer SRL
Tel: +40 21 529 59 00
Bayer d. o. o.
Tel.: +386-(0)1-58 14 400
Bayer, spol. s r.o.
Tel: +421 2 59 21 31 11
Bayer Oy
Puh/Tel: +358-20 785 21
Bayer AB
Tel: +46-(0)8-580 223 00
Bayer AG
Tel: +44-(0) 118 206 3000