Gilenya
fingolimod
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 Gilenya is and what it is used for
What you need to know before you take Gilenya
How to take Gilenya
Possible side effects
How to store Gilenya
Contents of the pack and other information
Gilenya contains the active substance fingolimod.
Gilenya is used in adults and in children and adolescents (10 years of age and above) to treat
relapsing-remitting multiple sclerosis (MS), more specifically in:
Patients who have failed to respond despite treatment with an MS treatment. or
Patients who have rapidly evolving severe MS.
Gilenya does not cure MS, but it helps to reduce the number of relapses and to slow down the progression of physical disabilities due to MS.
MS is a long-term condition that affects the central nervous system (CNS), comprised of the brain and
spinal cord. In MS inflammation destroys the protective sheath (called myelin) around the nerves in the CNS and stops the nerves from working properly. This is called demyelination.
Relapsing-remitting MS is characterised by repeated attacks (relapses) of nervous system symptoms that reflect inflammation within the CNS. Symptoms vary from patient to patient but typically involve walking difficulties, numbness, vision problems or disturbed balance. Symptoms of a relapse may disappear completely when the relapse is over, but some problems may remain.
Gilenya helps to protect against attacks on the CNS by the immune system by reducing the ability of some white blood cells (lymphocytes) to move freely within the body and by stopping them from reaching the brain and spinal cord. This limits nerve damage caused by MS. Gilenya also reduces some of the immune reactions of your body.
if you have a lowered immune response (due to an immunodeficiency syndrome, a disease or to medicines that suppress the immune system).
if you have a severe active infection or active chronic infection such as hepatitis or tuberculosis.
if you have an active cancer.
if you have severe liver problems.
if you have certain types of irregular or abnormal heartbeat (arrhythmia), including patients in whom the electrocardiogram (ECG) shows prolonged QT interval before starting Gilenya.
if you are pregnant or a woman of childbearing potential not using effective contraception.
If this applies to you or you are unsure, talk to your doctor before taking Gilenya.
Talk to your doctor before taking Gilenya:
if you have high blood pressure that cannot be controlled by medicines.
if you have severe lung problems or smoker’s cough.
If any of these applies to you or you are unsure, talk to your doctor before taking Gilenya.
Slow heart rate (bradycardia) and irregular heartbeat
At the beginning of treatment or after taking the first dose of 0.5 mg when you switch from a 0.25 mg daily dose, Gilenya causes the heart rate to slow down. As a result, you may feel dizzy or tired, or be consciously aware of your heartbeat, or your blood pressure may drop. If these effects are severe, tell your doctor, because you may need treatment right away. Gilenya can also cause an irregular heartbeat, especially after the first dose. Irregular heartbeat usually returns to normal in less than one day. Slow heart rate usually returns to normal within one month. During this period, no clinically significant heart rate effects are usually expected.
Your doctor will ask you to stay at the surgery or clinic for at least 6 hours, with hourly pulse and blood pressure measurements, after taking the first dose of Gilenya or after taking the first dose of
0.5 mg when you switch from a 0.25 mg daily dose, so that appropriate measures can be taken in the
event of side effects that occur at the start of treatment. You should have an electrocardiogram performed prior to the first dose of Gilenya and after the 6-hour monitoring period. Your doctor may monitor your electrocardiogram continuously during that time. If after the 6-hour period you have a very slow or decreasing heart rate, or if your electrocardiogram shows abnormalities, you may need to be monitored for a longer period (at least 2 more hours and possibly overnight) until these have resolved. The same may apply if you are resuming Gilenya after a break in treatment, depending on both how long the break was and how long you had been taking Gilenya before the break.
If you have, or if you are at risk for, an irregular or abnormal heartbeat, if your electrocardiogram is abnormal, or if you have heart disease or heart failure, Gilenya may not be appropriate for you.
If you have a history of sudden loss of consciousness or decreased heart rate, Gilenya may not be appropriate for you. You will be evaluated by a cardiologist (heart specialist) to advise how you should start treatment with Gilenya, including overnight monitoring.
If you are taking medicines that can cause your heart rate to decrease, Gilenya may not be appropriate for you. You will need to be evaluated by a cardiologist, who will check whether you can be switched to alternative medicine that does not decrease your heart rate in order to allow treatment with Gilenya. If such a switch is impossible, the cardiologist will advise how you should start treatment with Gilenya, including overnight monitoring.
If you have never had chickenpox
If you have never had chickenpox, your doctor will check your immunity against the virus that causes it (varicella zoster virus). If you are not protected against the virus, you may need a vaccination before you start treatment with Gilenya. If this is the case, your doctor will delay the start of treatment with Gilenya until one month after the full course of vaccination is completed.
Infections
Gilenya lowers the white blood cell count (particularly the lymphocyte count). White blood cells fight infection. While you are taking Gilenya (and for up to 2 months after you stop taking it), you may get
infections more easily. Any infection that you already have may get worse. Infections could be serious
and life-threatening. If you think you have an infection, have fever, feel like you have the flu, have shingles or have a headache accompanied by stiff neck, sensitivity to light, nausea, rash, and/or
confusion or seizures (fits) (these may be symptoms of meningitis and/or encephalitis caused by a
fungal or herpes viral infection), contact your doctor straight away, because it could be serious and life-threatening.
If you believe your MS is getting worse (e.g. weakness or visual changes) or if you notice any new symptoms, talk to your doctor straight away, because these may be the symptoms of a rare brain disorder caused by infection and called progressive multifocal leukoencephalopathy (PML). PML is a serious condition that may lead to severe disability or death. Your doctor will consider performing an MRI scan to evaluate this condition and will decide whether you need to stop taking Gilenya.
Human papilloma virus (HPV) infection, including papilloma, dysplasia, warts and HPV-related cancer, has been reported in patients treated with Gilenya. Your doctor will consider whether you need to have a vaccination against HPV before starting treatment. If you are a woman, your doctor will also recommend HPV screening.
Macular oedema
Before you start Gilenya, if you have or have had visual disturbances or other signs of swelling in the central vision area (macula) at the back of the eye, inflammation or infection of the eye (uveitis) or diabetes, your doctor may want you to undergo an eye examination.
Your doctor may want you to undergo an eye examination 3 to 4 months after starting Gilenya treatment.
The macula is a small area of the retina at the back of the eye which enables you to see shapes, colours, and details clearly and sharply. Gilenya may cause swelling in the macula, a condition that is known as macular oedema. The swelling usually happens in the first 4 months of Gilenya treatment.
Your chance of developing macular oedema is higher if you have diabetes or have had an inflammation of the eye called uveitis. In these cases your doctor will want you to undergo regular eye examinations in order to detect macular oedema.
If you have had macular oedema, talk to your doctor before you resume treatment with Gilenya. Macular oedema can cause some of the same vision symptoms as an MS attack (optic neuritis). Early
on, there may not be any symptoms. Be sure to tell your doctor about any changes in your vision. Your
doctor may want you to undergo an eye examination, especially if:
the centre of your vision gets blurry or has shadows;
you develop a blind spot in the centre of your vision;
you have problems seeing colours or fine detail.
Liver function tests
If you have severe liver problems, you should not take Gilenya. Gilenya may affect your liver function. You will probably not notice any symptoms but if you notice yellowing of your skin or the
whites of your eyes, abnormally dark urine (brown coloured), pain on the right side of your stomach
area (abdomen), tiredness, feeling less hungry than usual or unexplained nausea and vomiting, tell your doctor straight away.
If you get any of these symptoms after starting Gilenya, tell your doctor straight away.
Before, during and after the treatment, your doctor will request blood tests to monitor your liver function. If your test results indicate a problem with your liver you may have to interrupt treatment with Gilenya.
High blood pressure
As Gilenya causes a slight elevation of blood pressure, your doctor may want to check your blood pressure regularly.
Lung problems
Gilenya has a slight effect on the lung function. Patients with severe lung problems or with smoker’s cough may have a higher chance of developing side effects.
Blood count
The desired effect of Gilenya treatment is to reduce the amount of white blood cells in your blood. This will usually go back to normal within 2 months of stopping treatment. If you need to have any
blood tests, tell the doctor that you are taking Gilenya. Otherwise, it may not be possible for the doctor
to understand the results of the test, and for certain types of blood test your doctor may need to take more blood than usual.
Before you start Gilenya, your doctor will confirm whether you have enough white blood cells in your blood and may want to repeat a check regularly. In case you do not have enough white blood cells, you may have to interrupt treatment with Gilenya.
Posterior reversible encephalopathy syndrome (PRES)
A condition called posterior reversible encephalopathy syndrome (PRES) has been rarely reported in MS patients treated with Gilenya. Symptoms may include sudden onset of severe headache, confusion, seizures and vision changes. Tell your doctor straight away if you experience any of these symptoms during your treatment with Gilenya, because it could be serious.
Cancer
Skin cancers have been reported in MS patients treated with Gilenya. Talk to your doctor straight away if you notice any skin nodules (e.g. shiny pearly nodules), patches or open sores that do not heal
within weeks. Symptoms of skin cancer may include abnormal growth or changes of skin tissue (e.g.
unusual moles) with a change in colour, shape or size over time. Before you start Gilenya, a skin examination is required to check whether you have any skin nodules. Your doctor will also carry out regular skin examinations during your treatment with Gilenya. If you develop problems with your skin, your doctor may refer you to a dermatologist, who after consultation may decide that it is important for you to be seen on a regular basis.
A type of cancer of the lymphatic system (lymphoma) has been reported in MS patients treated with Gilenya.
Exposure to the sun and protection against the sun
Fingolimod weakens your immune system. This increases your risk of developing cancers, in particular skin cancers. You should limit your exposure to the sun and UV rays by:
wearing appropriate protective clothing.
regularly applying sunscreen with a high degree of UV protection.
Unusual brain lesions associated with MS relapse
Rare cases of unusually large brain lesions associated with MS relapse have been reported in patients treated with Gilenya. In case of severe relapse, your doctor will consider performing MRI to evaluate
this condition and will decide whether you need to stop taking Gilenya.
Switch from other treatments to Gilenya
Your doctor may switch you directly from beta interferon, glatiramer acetate or dimethyl fumarate to Gilenya if there are no signs of abnormalities caused by your previous treatment. Your doctor may
have to do a blood test in order to exclude such abnormalities. After stopping natalizumab you may
have to wait for 2-3 months before starting treatment with Gilenya. To switch from teriflunomide, your doctor may advise you to wait for a certain time or to go through an accelerated elimination procedure. If you have been treated with alemtuzumab, a thorough evaluation and discussion with your doctor is required to decide if Gilenya is appropriate for you.
Women of childbearing potential
If used during pregnancy, Gilenya can harm the unborn baby. Before you start treatment with Gilenya your doctor will explain the risk to you and ask you to do a pregnancy test in order to ensure that you
are not pregnant. Your doctor will give you a card which explains why you should not become pregnant while taking Gilenya. It also explains what you should do to avoid becoming pregnant while
you are taking Gilenya. You must use effective contraception during treatment and for 2 months after stopping treatment (see section “Pregnancy and breastfeeding”).
Worsening of MS after stopping Gilenya treatment
Do not stop taking Gilenya or change your dose without talking to your doctor first.
Tell your doctor straight away if you think your MS is getting worse after you have stopped treatment with Gilenya. This could be serious (see “If you stop taking Gilenya” in section 3, and also section 4, “Possible side effects”).
Experience with Gilenya in elderly patients (over 65 years) is limited. Talk to your doctor if you have any concerns.
Gilenya is not intended for use in children below 10 years old as it has not been studied in MS patients in this age group.
The warnings and precautions listed above also apply to children and adolescents. The following information is particularly important for children and adolescents and their caregivers:
Before you start Gilenya, your doctor will check your vaccination status. If you have not had certain vaccinations, it may be necessary for you to be given them before Gilenya can be started.
The first time you take Gilenya, or when you switch from a 0.25 mg daily dose to a 0.5 mg daily
dose, your doctor will monitor your heart rate and heartbeat (see “Slow heart rate (bradycardia) and irregular heartbeat” above).
If you experience convulsions or fits before or whilst taking Gilenya, let your doctor know.
If you suffer from depression or anxiety or if you become depressed or anxious while you are taking Gilenya, let your doctor know. You may need to be monitored more closely.
Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines. Tell your doctor if you are taking any of the following medicines:
teriflunomide, dimethyl fumarate or alemtuzumab. You must not use Gilenya together with such medicines as this could intensify the effect on the immune system (see also “Do not take
Gilenya”).
You must not use Gilenya if you are taking such a medicine because it could intensify the effect on irregular heartbeat (see also “Do not take Gilenya”).
protease inhibitors, anti-infectives such as ketoconazole, azole antifungals, clarithromycin or telithromycin.
carbamazepine, rifampicine, phenobarbital, phenytoin, efavirenz or St. John’s Wort (potential risk of reduced efficacy of Gilenya).
If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, ask your doctor for advice before taking this medicine.
Pregnancy
Do not use Gilenya during pregnancy, if you are trying to become pregnant or if you are a woman who could become pregnant and you are not using effective contraception. If Gilenya is used during pregnancy, there is a risk of harm to the unborn baby. The rate of congenital malformations observed in babies exposed to Gilenya during pregnancy is about 2 times the rate observed in the general population (in whom the rate of congenital malformations is about 2-3%). The most frequently reported malformations included cardiac, renal and musculoskeletal malformations.
Therefore, if you are a woman of childbearing potential:
before you start treatment with Gilenya your doctor will inform you about the risk to an unborn baby and ask you to do a pregnancy test in order to ensure that you are not pregnant,
and,
you must use effective contraception while taking Gilenya and for two months after you stop taking it to avoid becoming pregnant. Talk to your doctor about reliable methods of
contraception.
Your doctor will give you a card which explains why you should not become pregnant while taking Gilenya.
Breast-feeding
Your doctor will tell you whether your illness allows you to drive vehicles, including a bicycle, and
use machines safely. Gilenya is not expected to have an influence on your ability to drive and use machines.
However, at initiation of treatment you will have to stay at the doctor’s surgery or clinic for 6 hours after taking the first dose of Gilenya. Your ability to drive and use machines may be impaired during and potentially after this time period.
Treatment with Gilenya will be overseen by a doctor who is experienced in the treatment of multiple sclerosis.
Always take this medicine exactly as your doctor has told you. Check with your doctor if you are not sure.
The recommended dose is:
Children and adolescents with body weight equal to or below 40 kg: one 0.25 mg capsule per day.
Children and adolescents with body weight above 40 kg: one 0.5 mg capsule per day. Children and adolescents who start on one 0.25 mg capsule per day and later reach a stable body weight above 40 kg will be instructed by their doctor to switch to one 0.5 mg capsule per day. In this
case, it is recommended to repeat the first-dose observation period.
Do not exceed the recommended dose. Gilenya is for oral use.
Take Gilenya once a day with a glass of water. Gilenya capsules should always be swallowed intact, without opening them. Gilenya can be taken with or without food.
Taking Gilenya at the same time each day will help you remember when to take your medicine.
If you have questions about how long to take Gilenya, talk to your doctor or your pharmacist.
If you have taken too much Gilenya, call your doctor straight away.
If you have been taking Gilenya for less than 1 month and you forget to take 1 dose for a whole day,
call your doctor before you take the next dose. Your doctor may decide to keep you under observation at the time you take the next dose.
If you have been taking Gilenya for at least 1 month and have forgotten to take your treatment for more than 2 weeks, call your doctor before you take the next dose. Your doctor may decide to keep you under observation at the time you take the next dose. However, if you have forgotten to take your treatment for up to 2 weeks, you can take the next dose as planned.
Never take a double dose to make up for a forgotten dose.
Do not stop taking Gilenya or change your dose without talking to your doctor first.
Gilenya will stay in your body for up to 2 months after you stop taking it. Your white blood cell count (lymphocyte count) may also remain low during this time and the side effects described in this leaflet may still occur. After stopping Gilenya you may have to wait for 6-8 weeks before starting a new MS treatment.
If you have to restart Gilenya more than 2 weeks after you stop taking it, the effect on heart rate normally seen when treatment is first started may re-occur and you will need to be monitored at the doctor’s surgery or clinic for re-initiation of treatment. Do not restart Gilenya after stopping it for more than two weeks without seeking advice from your doctor.
Your doctor will decide whether and how you need to be monitored after stopping Gilenya. Tell your doctor straight away if you think your MS is getting worse after you have stopped treatment with Gilenya. This could be serious.
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. Some side effects could be or could become serious
Coughing with phlegm, chest discomfort, fever (signs of lung disorders)
Herpes virus infection (shingles or herpes zoster) with symptoms such as blisters, burning, itching or pain of the skin, typically on the upper body or the face. Other symptoms may be
fever and weakness in the early stages of infection, followed by numbness, itching or red
patches with severe pain
Slow heartbeat (bradycardia), irregular heart rhythm
A type of skin cancer called basal cell carcinoma (BCC) which often appears as a pearly nodule, although it can also take other forms
Depression and anxiety are known to occur with increased frequency in the MS population and
have also been reported in paediatric patients treated with Gilenya.
Weight loss.
Pneumonia with symptoms such as fever, cough, difficulty breathing
Macular oedema (swelling in the central vision area of the retina at the back of the eye) with symptoms such as shadows or blind spot in the centre of the vision, blurred vision, problems seeing colours or details
Reduction in blood platelets which increases risk of bleeding or bruising
Malignant melanoma (a type of skin cancer which usually develops from an unusual mole).
Possible signs of melanoma include moles which may change size, shape, elevation or colour over time, or new moles. The moles may itch, bleed or ulcerate
Convulsion, fits (more frequent in children and adolescents than in adults)
A condition called posterior reversible encephalopathy syndrome (PRES). Symptoms may include sudden onset of severe headache, confusion, seizures and/or vision disturbances
Lymphoma (a type of cancer that affects the lymph system)
Squamous cell carcinoma: a type of skin cancer which may present as a firm red nodule, a sore with crust, or a new sore on an existing scar
Electrocardiogram anomaly (T-wave inversion)
Tumour related to infection with human herpes virus 8 (Kaposi’s sarcoma)
Allergic reactions, including symptoms of rash or itchy hives, swelling of lips, tongue or face, which are more likely to occur on the day you start Gilenya treatment
Signs of liver disease (including liver failure), such as yellowing of your skin or the whites of your eyes (jaundice), nausea or vomiting, pain on the right side of your stomach area (abdomen),
dark urine (brown coloured), feeling less hungry than usual, tiredness and abnormal liver function tests. In a very small number of cases, liver failure could lead to liver transplantation
Risk of a rare brain infection called progressive multifocal leukoencephalopathy (PML). The
symptoms of PML may be similar to an MS relapse. Symptoms might also arise that you might not become aware of by yourself, such as changes in mood or behaviour, memory lapses, speech and communication difficulties, which your doctor may need to investigate further to rule out PML. Therefore, if you believe your MS is getting worse or if you or those close to you notice any new or unusual symptoms, it is very important that you speak to your doctor as soon as possible
Cryptococcal infections (a type of fungal infection), including cryptococcal meningitis with symptoms such as headache accompanied by stiff neck, sensitivity to light, nausea, and/or
confusion
Merkel cell carcinoma (a type of skin cancer). Possible signs of Merkel cell carcinoma include
flesh-coloured or bluish-red, painless nodule, often on the face, head or neck. Merkel cell carcinoma can also present as a firm painless nodule or mass. Long-term exposure to the sun and a weak immune system can affect the risk of developing Merkel cell carcinoma.
After Gilenya treatment is stopped, symptoms of MS can return and may become worse than they were before or during treatment.
Autoimmune form of anaemia (decreased amount of red blood cells) where red blood cells are destroyed (autoimmune haemolytic anaemia).
If you experience any of these, tell your doctor straight away. Other side effects
Infection from flu virus with symptoms such as tiredness, chills, sore throat, aching in the joints or muscles, fever
Feeling of pressure or pain in the cheeks and forehead (sinusitis)
Headache
Diarrhoea
Back pain
Blood testing showing higher levels of liver enzymes
Cough
Ringworm, a fungal infection of the skin (tinea versicolor)
Dizziness
Severe headache often accompanied by nausea, vomiting and sensitivity to light (migraine)
Low level of white blood cells (lymphocytes, leucocytes)
Weakness
Itchy, red, burning rash (eczema)
Itching
Blood fat (triglycerides) level increased
Hair loss
Breathlessness
Depression
Blurred vision (see also the section on macular oedema under “Some side effects could be or could become serious”)
Hypertension (Gilenya may cause a mild increase in blood pressure)
Muscle pain
Joint pain
Low level of certain white blood cells (neutrophils)
Depressed mood
Nausea
Cancer of the lymphatic system (lymphoma)
Peripheral swelling
If any of these affects you severely, tell your doctor 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 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 blister foil after “EXP”. The expiry date refers to the last day of that month.
Do not store above 25ºC.
Store in the original package in order to protect from moisture.
Do not use this medicine if you notice that the pack 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 to protect the environment.
The active substance is fingolimod.
Gilenya 0.25 mg hard capsules
Each capsule contains 0.25 mg fingolimod (as hydrochloride).
The other ingredients are:
Capsule fill: mannitol, hydroxypropylcellulose, hydroxypropylbetadex, magnesium stearate.
Capsule shell: gelatin, titanium dioxide (E171), yellow iron oxide (E172).
Printing ink: shellac (E904), black iron oxide (E172), propylene glycol (E1520), ammonia solution, concentrated (E527).
Gilenya 0.5 mg hard capsules
Each capsule contains 0.5 mg fingolimod (as hydrochloride).
The other ingredients are:
Capsule fill: mannitol, magnesium stearate.
Capsule shell: gelatin, titanium dioxide (E171), yellow iron oxide (E172).
Printing ink: shellac (E904), ethanol anhydrous, isopropyl alcohol, butyl alcohol, propylene glycol (E1520), purified water, ammonia solution, concentrated (E527), potassium hydroxide,
black iron oxide (E172), yellow iron oxide (E172), titanium dioxide (E171), dimethicone.
Gilenya 0.25 mg hard capsules have an ivory opaque body and cap. “FTY 0.25mg” is imprinted on the cap with black ink and a black radial band on the body.
Gilenya 0.5 mg hard capsules have a white opaque body and bright yellow opaque cap. “FTY0.5mg” is imprinted on the cap with black ink and two bands are imprinted on the body with yellow ink.
Gilenya 0.25 mg capsules are available in packs containing 7 or 28 capsules. Not all pack sizes may be marketed in your country.
Gilenya 0.5 mg capsules are available in packs containing 7, 28 or 98 capsules or in multipacks containing 84 capsules (3 packs of 28 capsules). Not all pack sizes may be marketed in your country.
Novartis Europharm Limited
Vista Building
Elm Park, Merrion Road Dublin 4
Ireland
90429 Nuremberg Germany
For any information about this medicine, please contact the local representative of the Marketing Authorisation Holder:
SIA Novartis Baltics Lietuvos filialas Tel: +370 5 269 16 50
Novartis Bulgaria EOOD
Тел.: +359 2 489 98 28
Novartis s.r.o.
Tel: +420 225 775 111
Novartis Healthcare A/S Tlf: +45 39 16 84 00
Novartis Pharma Services Inc. Tel: +356 2122 2872
Novartis Pharma GmbH
Tel: +49 911 273 0
Novartis Pharma B.V.
Tel: +31 88 04 52 111
SIA Novartis Baltics Eesti filiaal Tel: +372 66 30 810
Novartis Norge AS Tlf: +47 23 05 20 00
Novartis (Hellas) A.E.B.E. Τηλ: +30 210 281 17 12
Novartis Pharma GmbH Tel: +43 1 86 6570
Novartis Farmacéutica, S.A. Tel: +34 93 306 42 00
Novartis Poland Sp. z o.o. Tel.: +48 22 375 4888
Novartis Pharma S.A.S. Tél: +33 1 55 47 66 00
Novartis Farma - Produtos Farmacêuticos, S.A. Tel: +351 21 000 8600
Novartis Hrvatska d.o.o. Tel. +385 1 6274 220
Novartis Pharma Services Romania SRL
Tel: +40 21 31299 01
Novartis Ireland Limited Tel: +353 1 260 12 55
Novartis Pharma Services Inc. Tel: +386 1 300 75 50
Vistor hf.
Sími: +354 535 7000
Novartis Farma S.p.A. Tel: +39 02 96 54 1
Novartis Finland Oy
Puh/Tel: +358 (0)10 6133 200
Novartis Pharma Services Inc.
Τηλ: +357 22 690 690
Novartis Sverige AB
Tel: +46 8 732 32 00
SIA Novartis Baltics
Tel: +371 67 887 070
Novartis Ireland Limited
Tel: +44 1276 698370