Mepact
mifamurtide
mifamurtide
Keep this leaflet. You may need to read it again.
If you have any further questions, ask your doctor.
If you get any side effects, talk to your doctor. This includes any possible side effects not listed in this leaflet. See section 4.
What MEPACT is and what it is used for
What you need to know before you use MEPACT
How to use MEPACT
Possible side effects
How to store MEPACT
Contents of the pack and other information
MEPACT contains the active substance mifamurtide, similar to a component of the cell wall of certain bacteria. It stimulates your immune system to help your body kill tumour cells.
MEPACT is used to treat osteosarcoma (bone cancer) in children, adolescents and young adults (between 2 and 30 years). It is used after you have had surgery to remove the tumour and together with chemotherapy to kill remaining cancer cells to reduce the risk of cancer coming back.
if you are allergic to mifamurtide or any of the other ingredients of this medicine (listed in
section 6).
if you are taking medicines containing ciclosporin or other calcineurin inhibitors or high doses of non-steroidal-anti-inflammatory drugs (NSAIDs) (see “Using other medicines” below).
Talk to your doctor before using MEPACT:
if you have or have had problems with your heart or blood vessels, like blood clots (thrombosis), bleeding (haemorrhage) or inflammation of the veins (vasculitis). You should be more closely monitored while receiving MEPACT treatment. If you have long-lasting or worsening symptoms, you should contact your doctor, as MEPACT treatment may need to be delayed or discontinued.
if you have a history of asthma or other breathing disorders. Before using MEPACT, you
should discuss with your doctor whether you should take medicine for your asthma when using MEPACT.
if you have a history of inflammatory or autoimmune disease or have been treated with
corticosteroids or other medicines that may affect your immune system.
if you have any allergic reactions to any medicines such as rash, breathlessness and high blood pressure. If you have worsening symptoms, you should contact your doctor, as these may have been caused by MEPACT.
if you have stomach problems such as nausea, vomiting and lack of appetite. If your problems increase, you should contact your doctor, as these may have been caused by MEPACT when used with chemotherapy.
if you develop chills or shivering, or feel warm. You should take your temperature as you
may have a fever. A fever with a low white blood cell count (neutropenia) may be a sign of serious infection.
Detailed information on warnings and precautions relating to side effects that could occur while you are taking the medicine is presented in section 4.
It is not recommended to give this medicine to children below the age of 2 years because
information on how safe and how well this medicine works is not available for this age group.
Tell your doctor if you are taking, have recently taken or might take any other medicines. This
includes medicines that may be obtained without a prescription. It is especially important to tell your doctor if you are taking medicines containing any of the following active substances:
ciclosporin, tacrolimus, used after a transplant to prevent rejection of transplanted organs, or other immunosuppressants used e.g. to treat psoriasis (a skin disease).
Non-steroidal-anti-inflammatory drugs (NSAIDs), such as acetylsalicylic acid, ibuprofen, or diclofenac, used for treatment of headaches, fever or pain. You must not use MEPACT with high doses of NSAIDs.
corticosteroids, used to treat inflammations, allergies or asthma. Regular use of corticosteroids should be avoided when using MEPACT as this may affect the way the medicine works.
It is recommended to separate the times of administration of MEPACT and doxorubicin or other medicines if used in the same chemotherapy treatment regimen.
If you are pregnant or breast-feeding, think you may be pregnant or planning to have a baby, ask your doctor for advice before taking this medicine.
MEPACT has not been tested in pregnant women. Therefore, MEPACT should not be used during pregnancy and in women of childbearing potential not using effective contraception.
You should use effective contraception if you are being treated with MEPACT.
It is not known whether MEPACT passes to human milk. If you are breast-feeding, you should discuss with your doctor.
Some very common and common side effects of MEPACT treatment (such as dizziness, vertigo,
fatigue and blurred vision) may affect your ability to drive and use machines.
This medicine contains less than 1 mmol sodium (23 mg) per dosage unit, that is to say essentially ‘sodium-free’.
MEPACT will be administered only under the supervision of a specialist physician.
Always use this medicine exactly as your doctor has told you. Check with your doctor if you are
not sure.
The recommended dose of MEPACT is 2 mg mifamurtide/m2 body surface area. It will be given to you twice a week (at least three days apart) for the first 12 weeks, then once a week for 24 more weeks.
The schedule of your MEPACT treatments can be adjusted to fit with your chemotherapy schedule. It is not necessary to interrupt your schedule of MEPACT if your chemotherapy is delayed; you should complete 36 weeks (9 months) of treatment with MEPACT without an interruption.
The freeze-dried powder has to be reconstituted into a liquid suspension, filtered using the filter
provided and further diluted before use. MEPACT is then infused directly into your vein (intravenous) over about 1 hour. This is done by your doctor or a nurse, who will also monitor you during that time. You do not need to be hospitalised to receive MEPACT. It can also be administered as an outpatient.
You may experience more severe side effects, including fever, chills, fatigue, nausea, vomiting,
headache and high blood pressure or low blood pressure. In the event of such an overdose, contact your doctor or nearest hospital.
You should not stop treatment with MEPACT before finishing the course of treatment without discussing with your doctor first. If you have any further questions on the use of this medicine, ask
your doctor.
Like all medicines, MEPACT can cause side effects, although not everybody gets them.
The majority of patients experience chills, fever and fatigue especially during the first administration of MEPACT. These are typically mild to moderate and transient and can usually be treated by your doctor, e.g. with paracetamol for fever.
Treatment with MEPACT can often cause stomach problems such as nausea, vomiting and loss of appetite when used with chemotherapy.
Contact your doctor immediately:
if you have continuing fever or chills more than 8 hours after your dose of MEPACT, because this may be a sign of an infection, or
if you experience rash or have any problems breathing (wheezing), or
if you experience any stomach problems.
fever, shaking/shivering, weakness, tiredness or general discomfort
nausea and/or vomiting, diarrhoea or constipation
headache or dizziness
rapid beating of the heart
high blood pressure or low blood pressure
no appetite for food
sweating
pain, including general pain, pain in your muscles and/or joints and pain in back, chest, abdomen, arm or leg
cough, trouble breathing or rapid breathing
low body temperature
low number of red blood cells
blue colour of tissues such as the skin or gums caused by too little oxygen
perceptible increase in frequency or force of heartbeat
swelling in arms or legs or other swelling
chest discomfort
upset stomach, decreased appetite or weight loss
injection site or catheter site redness, swelling, infection or other local reaction
rash or redness, inflammation of the skin, itching, dry skin, pale or transient red appearance
inflammation of skin, tendons, muscles or similar tissues that support body structure
inflammation of a vein
upper abdominal or chest wall pain; abdominal bloating or pain; indigestion or pain in your
liver
other pain, including neck, shoulder, groin, bone or throat pain; pain after an operation
muscle spasms or stiffness
feeling cold
tired feeling, drowsiness or sleepiness
burning, pricking/tingling sensation, diminished sensitivity to sensation or feeling a sensation without stimulus
involuntary shaking movement
dehydration
low concentration of potassium in blood
mucosal inflammation
nose, throat, or sinus congestion or inflammation
infections of the upper respiratory tract (such as a cold) or the urinary tract (such as a
bladder infection)
generalised infection
Herpes simplex (virus) infection
productive cough, wheezing or exertional or exacerbated shortness of breath
spitting of blood or nosebleed
fluid in the lung cavity
blood in urine, difficulty or pain in urination or frequent urination
difficulty sleeping, depression, anxiety or confusion
dizziness
ears ringing
blurred vision
hair loss
difficult, painful menstruation
hearing loss
low number of white blood cells with or without fever, low number of platelets
abnormal accumulation of fluid around the heart (pericardial effusion)
If you get any side effects, talk to your doctor. This includes any possible side effects not listed in this
leaflet. You can also report side effects directly via 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 vial label and the carton after “EXP”. The expiry date refers to the last day of that month.
Unopened vial
Store in a refrigerator (2 C-8 °C). Do not freeze.
Keep the vial in outer carton in order to protect from light.
Reconstituted suspension
Once reconstituted in sodium chloride 9 mg/mL (0.9%) solution, store at room temperature
(approximately 20ºC - 25ºC) and use within 6 hours.
Do not use this medicine if you notice any visible signs of deterioration.
Do not throw away any medicines via wastewater. These measures will help protect the environment.
The active substance is mifamurtide. Each vial contains 4 mg of mifamurtide. After reconstitution, each mL of suspension contains 0.08 mg of mifamurtide.
The other ingredients are 1-Palmitoyl-2-oleoyl-sn-glycero-3-phosphocholine (POPC) and 1,2-Dioleoyl-sn-glycero-3-phospho-L-serine monosodium salt (OOPS). See section 2 “MEPACT contains sodium”
MEPACT is a white to off-white homogeneous cake or powder for concentrate for dispersion for
infusion.
MEPACT is supplied in a carton that contains
One 50 mL vial with a grey butyl stopper, aluminium seal and plastic flip-off cap.
One sterile filter for MEPACT supplied in a blister.
Takeda France SAS
112 avenue Kléber
75116 Paris France
Takeda Austria GmbH
St. Peter-Straβe 25 A-4020 Linz Austria
Delpharm Novara S.r.l. Via Crosa, 86
28065 Cerano (NO)
Italy
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The following information is intended for healthcare professionals only: Instructions for preparation of MEPACT for intravenous infusion
Materials provided in each package -
1 vial of MEPACT (mifamurtide)
1 Filter for MEPACT
Materials required but not provided -
Sodium chloride 9 mg/mL (0.9%) solution for injection, 100 mL bag
1 single use 60 or 100 mL sterile syringe with luer lock
2 medium (18) gauge sterile injection needles
It is recommended that the reconstitution of the liposomal suspension should be performed in a laminar flow cabinet utilising sterile gloves using aseptic technique.
The lyophilised powder should be allowed to reach a temperature between approximately
20 C-25 °C prior to reconstitution, filtering using the filter provided and dilution. This should take approximately 30 minutes.
The cap of the vial should be removed and the stopper cleaned using an alcohol pad.
The filter should be removed from the blister pack, and the cap removed from the filter spike.
The spike should then be inserted into the vial septum firmly until seated. The filter luer connector cap should not be removed at this time.
The 100 mL sodium chloride 9 mg/mL (0.9%) solution for injection bag, needle and syringe
should be unpacked (not provided in the pack).
The site of the sodium chloride 9 mg/mL (0.9%) solution for injection bag where the needle is going to be inserted should be swabbed with an alcohol pad.
Using the needle and syringe, 50 mL of sodium chloride 9 mg/mL (0.9%) solution for
injection should be withdrawn from the bag.
After removing the needle from the syringe, the syringe should be attached to the filter by opening the filter luer connector cap (figure 1).
Figure 1
The sodium chloride 9 mg/mL (0.9%) solution for injection is added to the vial by slow, firm depression of the syringe plunger. The filter and syringe must not be removed from the vial.
The vial should be allowed to stand undisturbed for 1 minute to ensure thorough hydration of the dry substance.
Figure 2
The desired dose may be withdrawn from the vial by inverting the vial and slowly pulling back on the syringe plunger (figure 3). Each mL reconstituted suspension contains 0.08 mg mifamurtide. The volume of suspension to be withdrawn for dose quantities is calculated as follows:
Volume to withdraw = [12.5 x calculated dose (mg)] mL
For convenience, the following table of concordance is provided:
Dose | Volume |
1.0 mg | 12.5 mL |
2.0 mg | 25 mL |
3.0 mg | 37.5 mL |
4.0 mg | 50 mL |
Figure 3
The syringe should then be removed from the filter and a new needle placed on the suspension-filled syringe. The bag injection site should be wiped with an alcohol pad and the suspension in the syringe should be injected into the original bag containing the remaining 50 mL of sodium chloride 9 mg/mL (0.9%) solution for injection (figure 4).
Figure 4
The bag should be gently swirled to mix the solution.
Patient identification, time and date should be added to the label on the bag containing the reconstituted, filtered and diluted liposomal suspension.
Chemical and physical in-use stability has been demonstrated for 6 hours at room
temperature (between approximately 20 C-25 °C).
From a microbiological point of view, the product should be used immediately. If not used
immediately, in-use storage times and conditions prior to use are the responsibility of the user and would normally not be longer than 6 hours at room temperature.
No special requirements for disposal.