Xalkori
crizotinib
Keep this leaflet. You may need to read it again.
If you have any further questions, ask your doctor, pharmacist, or nurse.
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, pharmacist, or nurse. This includes any possible
side effects not listed in this leaflet. See section 4.
What XALKORI is and what it is used for
What you need to know before you take XALKORI
How to take XALKORI
Possible side effects
How to store XALKORI
Contents of the pack and other information
XALKORI is an anticancer medicine containing the active substance crizotinib used to treat adults with a type of lung cancer called non-small cell lung cancer, that presents with a specific rearrangement or defect in either a gene called anaplastic lymphoma kinase (ALK) or a gene called ROS1.
XALKORI can be prescribed to you for the initial treatment if your disease is at an advanced stage of lung cancer.
XALKORI can be prescribed to you if your disease is at an advanced stage and previous treatment has not helped to stop your disease.
XALKORI may slow or stop the growth of lung cancer. It may help shrink tumours.
If you have any questions about how XALKORI works or why this medicine has been prescribed for you, ask your doctor.
If you are allergic to crizotinib or any of the other ingredients of this medicine (listed in Section 6, “What XALKORI contains”).
Talk to your doctor before taking XALKORI:
If you have moderate or severe liver disease.
If you have ever had any other lung problems. Some lung problems may get worse during treatment with XALKORI, as XALKORI may cause inflammation of the lungs during
treatment. Symptoms may be similar to those from lung cancer. Tell your doctor right away if
you have any new or worsening symptoms including difficulty in breathing, shortness of breath, or cough with or without mucous, or fever.
If you have been told that you have an abnormality of your heart tracing after an electrocardiogram (ECG) known as prolonged QT interval.
If you have reduced heart rate.
If you have ever had stomach or intestine problems such as holes (perforation), or if you have conditions causing inflammation inside the abdomen (diverticulitis), or if you have spread of
cancer inside the abdomen (metastasis).
If you have vision disorders (seeing flashes of light, blurred vision, and double vision).
If you have severe kidney disease.
If you are currently treated with any of the medicines listed in section “Other medicines and XALKORI”.
Talk to your doctor right away after having taken XALKORI:
If you are experiencing severe stomach or abdominal pain, fever, chills, shortness of breath, fast heartbeat, partial or complete loss of vision (in one or both eyes) or changes in bowel habits.
Most of the available information is available in patients with some specific histology type of
ALK-positive NSCLC (adenocarcinoma) and limited information is available in the other histologies.
Treatment of children and adolescents with this medicine is not recommended. The indication does not cover children and adolescents.
Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines, including herbal medicines and medicine obtained over the counter.
In particular, the following medicines may increase the risk of side effects with XALKORI:
Clarithromycin, telithromycin, erythromycin, antibiotics used to treat bacterial infections.
Ketoconazole, itraconazole, posaconazole, voriconazole, used to treat fungal infections.
Atazanavir, ritonavir, cobicistat, used to treat HIV infections/AIDS.
The following medicines may reduce the effectiveness of XALKORI:
Phenytoin, carbamazepine or phenobarbital, anti-epileptics used to treat seizures or fits.
Rifabutin, rifampicin, used to treat tuberculosis.
St. John’s wort (Hypericum perforatum), a herbal product used to treat depression.
XALKORI may increase side effects associated with the following medicines:
Alfentanil and other short acting opiates such as fentanyl (painkillers used for surgical procedures).
Quinidine, digoxin, disopyramide, amiodarone, sotalol, dofetilide, ibutilide, verapamil, diltiazem used to treat heart problems.
Medicines for high blood pressure called beta-blockers such as atenolol, propranolol, labetolol.
Pimozide, used to treat mental illness.
Metformin, used to treat diabetes.
Procainamide, used to treat cardiac arrhythmia.
Cisapride, used to treat stomach problems.
Ciclosporin, sirolimus and tacrolimus used in transplant patients.
Ergot alkaloids (e.g., ergotamine, dihydroergotamine), used to treat migraine.
Dabigatran, anticoagulant used to slow down clotting of the blood.
Colchicine, used to treat gout.
Pravastatin, used to reduce cholesterol levels.
Clonidine, guanfacine, used to treat hypertension.
Mefloquine, used for the prevention of malaria.
Pilocarpine, used to treat glaucoma (a severe eye disease).
Anticholinesterases, used to restore muscle function.
Antipsychotics, used to treat mental illness.
Moxifloxacine, used to treat bacterial infections.
Methadone, used to treat pain and for the treatment of opioid dependence.
Bupropion, used to treat depression and smoking cessation.
Efavirenz, raltegravir, used to treat HIV infection.
Irinotecan, a chemotherapy medicine used to treat cancer of the colon and rectum.
Morphine, used to treat acute and cancer pain.
Naloxone, used to treat opiate medicine addiction and withdrawal.
These medicines should be avoided during your treatment with XALKORI.
If you take XALKORI whilst using oral contraceptives, the oral contraceptives may be ineffective.
You can take XALKORI with or without food; however, you should avoid drinking grapefruit juice or eating grapefruit while on treatment with XALKORI as they may change the amount of XALKORI in your body.
Avoid spending prolonged time in sunlight. XALKORI can make your skin sensitive to the sun (photosensitivity), and you may burn more easily. You should wear protective clothing and/or use
sunscreen that covers your skin to help protect against sunburn if you have to be in the sunlight during treatment with XALKORI.
Talk to your doctor or pharmacist before taking this medicine if you are pregnant, may become pregnant or are breast-feeding.
It is recommended that women avoid becoming pregnant and that men do not father children during treatment with XALKORI because this medicine could harm the baby. If there is any possibility that the person taking this medicine may become pregnant or father a child, they must use adequate contraception during treatment, and for at least 90 days after completing therapy as oral contraceptives may be ineffective while taking XALKORI.
Do not breast-feed during treatment with XALKORI. XALKORI could harm a breast-fed baby.
If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, ask your doctor or pharmacist for advice before taking this medicine.
You should take special care when driving and using machines as patients taking XALKORI may experience visual disturbances, dizziness, and tiredness.
This medicine contains less than 1 mmol sodium (23 mg) per 200 mg or 250 mg capsule, that is to say essentially ‘sodium-free’.
Always take this medicine exactly as your doctor has told you. Check with your doctor or pharmacist if you are not sure.
The recommended dose is one capsule of 250 mg taken orally twice daily (total amount 500 mg).
Take the capsule once in the morning and once in the evening.
Take the capsules at about the same time each day.
You can take the capsules with or without food always avoiding grapefruit.
Swallow the capsules whole and do not crush, dissolve or open the capsules.
If necessary, your doctor may decide to reduce the dose to 200 mg to be taken orally twice daily (total amount 400 mg) and if further dose reduction is necessary, to reduce it to 250 mg to be taken orally once daily. Your doctor may decide to permanently discontinue your treatment if you are unable to tolerate XALKORI 250 mg taken orally once daily.
If you accidentally take too many capsules, tell your doctor or pharmacist right away. You may require medical attention.
What to do if you forget to take a capsule depends on how long it is until your next dose.
If your next dose is in 6 hours or more, take the missed capsule as soon as you remember.
Then take the next capsule at the usual time.
If your next dose is in less than 6 hours, skip the missed capsule. Then take the next capsule at the usual time.
Tell your doctor about the missed dose at your next visit.
Do not take a double dose (two capsules at the same time) to make up for a forgotten capsule.
If you vomit after taking a dose of XALKORI, do not take an extra dose; just take your next dose at your regular time.
It is important to take XALKORI every day, as long as your doctor prescribes it to you. If you are not able to take the medicine as your doctor prescribed, or you feel you do not need it anymore, contact
your doctor right away.
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.
If you experience any side effects, talk to your doctor, pharmacist, or nurse. This includes any possible side effects not listed in this leaflet.
Some side effects could be serious. You should immediately contact your doctor if you experience any of the following serious side effects (see also section 2 “What you need to know before you take XALKORI ”):
Tell your doctor right away if you feel more tired than usual, your skin and whites of your eyes turn yellow, your urine turns dark or brown (tea colour), you have nausea, vomiting, or decreased appetite, you have pain on the right side of your stomach, you have itching, or if
you bruise more easily than usual. Your doctor may do blood tests to check your liver
function, and if the results are abnormal, your doctor may decide to reduce the dose of XALKORI or stop your treatment.
Tell your doctor right away if you experience difficulty in breathing, especially if associated with cough or fever.
Tell your doctor right away if you experience fever or infection. Your doctor may do blood tests and if the results are abnormal, your doctor may decide to reduce the dose of XALKORI.
Tell your doctor right away if you experience these symptoms which could be signs of changes in the electrical activity (seen on electrocardiogram) or abnormal rhythm of the heart.
Your doctor may perform electrocardiograms to check there are no problems with your heart during treatment with XALKORI.
Tell your doctor right away if you experience any loss of vision or any change in vision such as difficulty seeing out of one or both eyes. Your doctor may stop XALKORI treatment and
refer you to an ophthalmologist.
Other side effects of XALKORI may include:
Very common side effects (may affect more than 1 in 10 people)
Visual effects (seeing flashes of light, blurred vision, or double vision, often beginning soon after starting treatment with XALKORI).
Stomach upset, including vomiting, diarrhoea, nausea.
Oedema (excess fluid in body tissue, causing swelling of the hands and feet).
Constipation.
Abnormalities in liver blood tests.
Decreased appetite.
Tiredness.
Dizziness.
Neuropathy (feeling of numbness or pins and needles in the joints or extremities).
Alteration in sense of taste.
Pain in the abdomen.
Reduction in the number of red blood cells (anaemia).
Skin rash.
Reduced heart rate.
Common side effects (may affect up to 1 in 10 people)
Indigestion.
Increased blood levels of creatinine (may indicate that kidneys are not functioning properly).
Increased levels of the enzyme alkaline phosphatase in the blood (an indicator of organ malfunction or injury, particularly liver, pancreas, bone, thyroid gland, or gall bladder).
Hypophosphataemia (low blood phosphate levels that can cause confusion or muscle weakness).
Closed pouches of fluid within the kidneys (kidney cysts).
Fainting.
Inflammation of the oesophagus (swallowing tube).
Decreased levels of testosterone, a male sex hormone.
Heart failure.
Uncommon side effects (may affect up to 1 in 100 people)
Hole (perforation) in stomach or intestine.
Sensitivity to sunlight (photosensitivity).
Increased blood levels of tests that check for muscle damage (high creatine phosphokinase levels).
If you get any side effects, talk to your doctor or pharmacist or nurse. 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 bottle or blister foil and carton after “EXP”. The expiry date refers to the last day of that month.
This medicine does not require any special storage conditions.
Do not use any pack that is damaged or shows signs of tampering.
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 in XALKORI is crizotinib.
XALKORI 200 mg: each capsule contains 200 mg crizotinib XALKORI 250 mg: each capsule contains 250 mg crizotinib
The other ingredients are (see also section 2 “XALKORI contains sodium”):
Capsule content: colloidal anhydrous silica, microcrystalline cellulose, anhydrous calcium hydrogen phosphate, sodium starch glycolate (Type A), magnesium stearate.
Capsule shell: gelatin, titanium dioxide (E171), and red iron oxide (E172).
Printing ink: shellac, propylene glycol, potassium hydroxide, and black iron oxide (E172).
XALKORI 200 mg is supplied as hard gelatin capsules with pink cap and white body, printed with black ink “Pfizer” on the cap, “CRZ 200” on the body.
XALKORI 250 mg is supplied as hard gelatin capsules with pink cap and body, printed with black ink “Pfizer” on the cap, “CRZ 250” on the body.
It is available in blister packs of 60 hard capsules and in plastic bottles of 60 hard capsules. Not all pack sizes may be marketed.
Pfizer Europe MA EEIG Boulevard de la Plaine 17 1050 Bruxelles
Belgium
Pfizer Manufacturing Deutschland GmbH Betriebsstӓtte Freiburg
Mooswaldallee 1
79090 Freiburg Germany
For any information about this medicine, please contact the local representative of the Marketing Authorisation Holder:
Tél/Tel: +32 (0)2 554 62 11
Пфайзер Люксембург САРЛ, Клон България Тел.: +359 2 970 4333
Pfizer Luxembourg SARL filialas Lietuvoje Tel: +370 5 251 4000
Pfizer Kft.
Tel.: +36 1488 37 00
Pfizer, spol. s r.o.
Tel: +420 283 004 111
Vivian Corporation Ltd. Tel: +356 21344610
Pfizer ApS
Tlf: +45 44 20 11 00
Pfizer bv
Tel: +31 (0)800 63 34 636
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Pfizer AS
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Pfizer Luxembourg SARL Eesti filiaal Tel: +372 666 7500
Pfizer Corporation Austria Ges.m.b.H. Tel: +43 (0)1 521 15-0
Pfizer Ελλάς A.E.
Τηλ: +30 210 6785800
Pfizer Polska Sp. z o.o. Tel.: +48 22 335 61 00
Pfizer, S.L.
Tel: +34 91 490 99 00
Laboratórios Pfizer, Lda. Tel: +351 21 423 5500
Pfizer
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Pfizer Luxembourg SARL
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Tel: +386 (0)1 52 11 400
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Tel: +1800 633 363 (toll free)
Tel: +44 (0)1304 616161
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Sími: +354 540 8000
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Pfizer AB
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Pfizer Luxembourg SARL filiāle Latvijā Tel: +371 670 35 775
Pfizer Limited
Tel: +44 (0)1304 616161
Taking into account the PRAC Assessment Report on the PSUR(s) for crizotinib, the scientific conclusions of the CHMP are as follows:
In view of available data on photosensitivity from an in vitro phototoxicity study (which demonstrated that crizotinib may have phototoxic potential), clinical trials, literature, spontaneous reports, including three cases with a close temporal relationship, positive dechallenge and rechallenge, two cases with positive dechallenge either at full dose or reduced dose and two cases highlighting that with appropriate prophylactic sun protective measures, crizotinib may be continued without dose modification in some patients, the PRAC considers a causal relationship between crizotinib and photosensitivity is at least a reasonable possibility. The PRAC concluded that the product information of products containing crizotinib should be amended accordingly.
In view of available data on blood creatine phosphokinase increased from spontaneous reports including five cases with a close temporal relationship and a positive rechallenge, and in view of a possible class effect, the PRAC considers a causal relationship between crizotinib and blood creatine phosphokinase increased is at least a reasonable possibility. The PRAC concluded that the product information of products containing crizotinib should be amended accordingly.
The CHMP agrees with the scientific conclusions made by the PRAC.
On the basis of the scientific conclusions for crizotinib the CHMP is of the opinion that the benefit-risk balance of the medicinal product(s) containing crizotinib is unchanged subject to the proposed changes to the product information.
The CHMP recommends that the terms of the marketing authorisation(s) should be varied.