500 mg film-coated tablets 
capecitabine

Read all of this leaflet carefully before you start taking this medicine. It contains information that is important to you.

  • Save this information, 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 give it to others. It can harm them, even if they show signs of illness similar to yours.
  • If you get any side effects, talk to your doctor or pharmacist. This also applies to any side effects not mentioned in this information. See section 4.

In this leaflet: 
1. What Capecitabine Sandoz is and what it is used for 
2. What you need to know before taking Capecitabine Sandoz 
3. How to take Capecitabine Sandoz 
4. Possible side effects 
5. How to store Capecitabine Sandoz 
6. Contents of the packaging and other information 

What Capecitabine Sandoz is and what it is used for

Capecitabine Sandoz belongs to a group of medicines called ‘cytostatics’, which prevent the growth of cancer cells. Capecitabine Sandoz contains capecitabine, which in itself is not a cytostatic drug. Only after the body has absorbed capecitabine is it converted into an active anti-cancer drug (preferably in tumor tissue).

Capecitabine Sandoz is used to treating colon, rectal, gastric, or breast cancer. Capecitabine Sandoz is also used to prevent colon cancer from coming back after a tumor has been removed.

Capecitabine Sandoz can be used either alone or in combination with other medicines.

Capecitabine contained in Capecitabine Sandoz may also be approved for the treatment of other conditions not mentioned in this product information. Ask your doctor, pharmacist, or another healthcare professional if you have any further questions, and always follow their instructions.

What you need to know before you take Capecitabine Sandoz

Do not take Capecitabine Sandoz:

  • if you are allergic to capecitabine or any of the other ingredients of this medicine (listed in section 6). You must tell your doctor if you know that you are allergic or hypersensitive to this medicine
  • if you have previously had severe reactions to fluoropyrimidine treatment (a group of anticancer medicines such as fluorouracil)
  • if you are pregnant or breastfeeding
  • if you have severely low levels of white blood cells or platelets ( leukopenia, neutropenia, or thrombocytopenia )
  • if you have severe liver or kidney problems
  • if you know that you are completely devoid of enzyme activity and dihydropyridine dehydrogenase (DPD)
  • if you are being treated with, or within the last 4 weeks have been treated with brivudine to treat herpes zoster (chickenpox or shingles ).

Warnings and cautions

Talk to your doctor or pharmacist before taking Capecitabine Sandoz.

  • if you know that the enzyme dihydropyridine dehydrogenase (DPD) is partially inactive in you
  • if the enzyme a dihydropyridine dehydrogenase (DPD) is partially or completely inactive in someone in your family
  • if you have liver or kidney disease
  • if you have or have had heart problems (for example, irregular heartbeat or pain in the chest, jaw, or back caused by physical exertion and due to problems with the blood flow to the heart)
  • if you have diseases of the brain (for example, cancer that has spread to the brain or nerve damage ( neuropathy ))
  • if you have disturbed calcium balance (seen in blood tests)
  • if you have diabetes
  • if you can not keep food or water in your body due to severe nausea and vomiting
  • if you have diarrhea
  • if you are or become dehydrated
  • if you have an imbalance of ions in the blood (imbalance of electrolyte is, seen in samples)
  • if you have previously had eye problems, as you may need extra eye checks
  • if you have a severe skin reaction.

DPD Deficiency: DPD deficiency is a congenital condition that is not usually associated with health problems unless you use certain medications. If you have DPD deficiency and are taking Capecitabine Sandoz, you have an increased risk of serious side effects (listed in section 4 Possible side effects). It is recommended that you be tested for DPD deficiency before starting treatment. If you have no enzyme activity, do not take Capecitabine Sandoz. If you have reduced enzyme activity ( partial deficiency), your doctor may prescribe a lower dose. Serious and life-threatening side effects may still occur even if your test result for DPD deficiency is negative.

Children and young people

Capecitabine Sandoz is not indicated for use in children and adolescents. Do not give Capecitabine Sandoz to children and adolescents.

Other medicines and Capecitabine Sandoz

Tell your doctor or pharmacist if you are taking, have recently taken, or might take any other medicines. This is very important as the treatment effect can be affected if Capecitabine Sandoz is taken at the same time as other medicines.

You must not take brivudine (an antiviral medicine used to treat shingles or chickenpox) while you are being treated with capecitabine (including during the rest period when you are not taking any capecitabine tablets). If you have taken brivudine, you must wait at least 4 weeks after stopping brivudine before starting capecitabine treatment. See also section “Do not take Capecitabine Sandoz”.

You must also be especially careful if you take any of the following:

  • anti-gout medication (allopurinol)
  • blood thinners (coumarin, warfarin)
  • medicines for seizures or tremors ( phenytoin )
  • interferon-alpha 
  • radiation therapy and certain drugs used to treat cancer (folic acid, oxaliplatin, bevacizumab, cisplatin, irinotecan)
  • drugs used to treat folic acid deficiency.

Capecitabine Sandoz with food and drink

You should take the tablets within 30 minutes after the end of the meal.

Pregnancy and breastfeeding

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 not take Capecitabine Sandoz if you are or think you may be pregnant. You should not breast-feed while taking Capecitabine Sandoz and for 2 weeks after the last dose . If you are a pregnant woman, you should use effective contraception during treatment with Capecitabine Sandoz and for a further 6 months after the last dose . If you are a male patient and your female partner is fertile , you should use effective contraception during treatment with Capecitabine Sandoz and for a further 3 months after the last dose .

Driving and using machines

The treatment may make you feel dizzy, nauseous, or tired after ingestion. It is therefore possible that Capecitabine Sandoz may affect your ability to drive or use machines.

You are responsible for assessing whether you are fit to drive a motor vehicle or perform work that requires sharpened attention. One of the factors that can affect your ability in these respects is the use of drugs due to their effects and/or side effects. Descriptions of these effects and side effects can be found in other sections. Read all the information in this leaflet for guidance. If you are not sure, talk to your doctor or pharmacist.

Capecitabine Sandoz contains lactose and sodium

Capecitabine Sandoz contains lactose

If you have been told by your doctor that you have an intolerance to some sugars, contact your doctor

doctor before taking this medicine.

Capecitabine Sandoz contains sodium

This medicine contains less than 1 mmol (23 mg) sodium per tablet, ie it is essentially ‘sodium-free’.

How to take Capecitabine Sandoz

Always take this medicine exactly as your doctor or pharmacist has told you. Ask your doctor or pharmacist if you are unsure.

Capecitabine Sandoz should only be prescribed by a doctor who has experience in the use of anticancer medicines.

Your doctor will prescribe the right dose and dosage for you. Dose one of capecitabine is based on your body surface area. It is calculated using your height and weight. The usual dose for adults is 1250 mg / m 2 body surface area twice a day (morning and evening). Two examples are given here: A person whose body weight is 64 kg and length 1.64 m has a body surface area of ​​1.7 m 2 and should take 4 tablets of 500 mg and 1 tablet of 150 mg twice a day. A person whose body weight is 80 kg and length 1.80 m has a body surface area of ​​2.00 m 2 and should take 5 tablets of 500 mg twice a day.

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 at each dose.

  • Take the tablets morning and evening as prescribed by your doctor.
  • Take the tablets within 30 minutes after the end of the meal (breakfast and dinner) and swallow them whole with water. Do not crush or split the tablets. If you cannot swallow the Capecitabine Sandoz tablets whole, talk to your healthcare provider.
  • It is important that you take all the medicines prescribed by your doctor.

Capecitabine Sandoz tablets are normally taken for 14 days followed by a 7-day rest period (when no tablets are taken). This 21-day period is a treatment cycle.

In combination with other medicines, the normal dose for adults may be less than 1250 mg / m 2 body surface area, and you may need to take the tablets for a different period of time (eg every day without any rest period).

If you take more Capecitabine Sandoz than you should

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

If you forget to take Capecitabine Sandoz

Do not take the missed dose. Do not take a double dose to make up for a forgotten dose. Instead, continue with your prescribed dosage and talk to your doctor.

If you stop taking Capecitabine Sandoz

There are no side effects caused by stopping capecitabine treatment. If you are taking coumarin anticoagulants (containing eg phenprocoumon), your doctor may require you to adjust your dose of anticoagulants when you stop taking capecitabine.

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

4. Possible side effects

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

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

  • Diarrhea: if you have an increase of more than 4 stools each day compared to your normal number of stools per day, or diarrhea at night.
  • Vomiting: if you vomit more than once in a day.
  • Nausea: if you lose your appetite and the amount of food you eat every day is much less than usual.
  • Stomatitis:  if you have pain, redness, swelling, or sores in your mouth and/or throat.
  • Hand-foot syndrome:  if you have pain, swelling, redness, or tingling in your hands and/or feet.
  • Fever:  if you have a body temperature of 38 ºC or more.
  • Infection:  if you have signs of infection caused by bacteria or viruses or other organisms.
  • Chest pain:  if you feel pain from the middle of the chest, especially if it comes when you exercise. 
  • Stevens-Johnson syndrome:  if you have painful red or violet skin rashes that spread and blisters and/or other sores that begin to appear in the mucous membranes (eg mouth and lips), especially if you have previously been photosensitive, had an infection in the respiratory tract (eg bronchitis ) and/or fever.
  • DPD deficiency:  if you have a known DPD deficiency, you are at increased risk of acute and early onset of poisoning and severe, life-threatening or fatal side effects caused by Capecitabine Sandoz (eg stomatitis , mucositis, diarrhea, neutropenia, and neurotoxicity) ).

If these side effects are detected early, they may subside within 2 to 3 days after stopping treatment. If these side effects persist, contact your doctor immediately. Your doctor may advise you to start treatment again with a lower dose.

If severe stomatitis (sores in your mouth and/or throat), mucositis, diarrhea, neutropenia (increased risk of infections ), or neurotoxicity occurs during the first treatment cycle, this may be due to DPD deficiency (see section 2 Warnings and precautions).

Skin reactions on hands and feet can lead to loss of fingerprints, which may affect your fingerprint identification.

In addition to the above, when Capecitabine Sandoz is used alone, very common side effects, which can affect more than 1 in 10 people:

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

These side effects can be serious. Therefore, always contact your doctor immediately when you start to feel a side effect. Your doctor may urge you to reduce your dose and/or temporarily stop taking Capecitabine Sandoz. In this way, the risk of the side effect continuing or worsening is reduced.

Other side effects are:

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

  • decreased number of white or red blood cells (seen in samples)
  • dehydration, weight loss
  • insomnia ( insomnia ), depression
  • headache, drowsiness, dizziness, abnormal sensation in the skin (numbness or tingling), taste changes
  • eye irritation, increased tear volume, red eyes ( conjunctivitis )
  • inflammation of the veins ( thrombophlebitis )
  • shortness of breath, nosebleeds, cough, runny nose
  • cold sores or other herpes infections
  • infection of the lungs or respiratory tract (eg pneumonia, bronchitis )
  • intestinal bleeding, constipation, upper abdominal pain, digestive problems, gas in the stomach, dry mouth
  • skin rash, hair loss ( alopecia ), redness of the skin, dry skin, itching, skin discoloration, skin detachment, skin inflammation, nail effects
  • pain in joints, extremities, chest or back
  • fever, swelling of the extremities, malaise
  • problems with liver function (seen in blood samples) and increased amount of bilirubin in the blood (excreted by the liver).

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

  • infection of the blood, urinary tract infection, infection of the skin, infection of the nose and throat, fungal infection (including infections of the mouth), influenza, gastrointestinal catarrh, dental disease
  • lumps under the skin (lipoma)
  • decreased number of blood cells including platelets thinned blood (seen in samples)
  • allergy
  • diabetes decreased potassium in the blood, malnutrition, elevated blood fats
  • confusion, panic attacks, depression, decreased libido
  • difficulty speaking, impaired memory, loss of ability to coordinate movements, balance problems, fainting, nerve damage ( neuropathy ), and emotional problems
  • blurred vision or double vision
  • dizziness, earache
  • irregular heartbeat and palpitations ( arrhythmia ), chest pain and heart attack (infarction)
  • blood clots in the deep veins, high or low blood pressure, hot flashes, cold extremities, purple spots on the skin
  • blood clots in the veins of the lung ( pulmonary embolism), collapsing lung, coughing up blood, asthma, shortness of breath on exertion
  • intestinal obstruction, accumulation of fluid in the abdomen, inflammation of the small intestine, colon, stomach or esophagus, pain in the lower abdomen, abdominal discomfort, heartburn (regurgitation of food from the stomach), bloody stools
  • jaundice (yellowing of the skin and eyes)
  • sores and blisters on the skin, skin reaction to sunlight, redness of the palms, swelling or pain in the face
  • swollen or stiff joints, skeletal pain, weakness or stiffness in the muscles
  • accumulation of fluid in the kidneys, urinating more often at night, incontinence , blood in the urine, increased creatinine in the blood (signs of impaired kidney function)
  • unusual bleeding from the vagina
  • swelling ( edema ), chills, and stiffness.

Some of these side effects are more common when capecitabine is used with other medicines to treat cancer. Other side effects seen in these cases are as follows:

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

  • decreased amount of sodium, magnesium, or calcium in the blood, increased blood sugar
  • nerve pain
  • ringing or wheezing in the ears ( tinnitus ), hearing loss
  • inflammation of the veins
  • hiccups, altered voice
  • pain or altered / abnormal sensation in the mouth, pain in the jaw
  • sweating, night sweats
  • muscle cramps
  • difficulty urinating, blood or protein in the urine
  • bruising or reaction at the injection site (caused by medicines given as an injection at the same time ).

Rare (may affect up to 1 in 1,000 people):

  • narrowing or blockage of the lacrimal duct (lacrimal ductus stenosis)
  • liver failure
  • inflammation leading to dysfunction or blockage of bile secretion (cholestatic hepatitis )
  • specific changes in the electrocardiogram ( QT prolongation)
  • certain types of arrhythmias (including ventricular fibrillation, torsade de Pointes and bradycardia )
  • eye inflammation that causes pain in the eyes and possibly vision problems
  • inflammation of the skin that causes red scaly patches due to disease emanating from the immune system

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

  • severe skin reaction such as rash, sores and blisters that may include sores in the mouth, nose, genitals, hands, feet and eyes (red and swollen eyes).

Reporting of side effects

If you get any side effects, talk to your doctor, pharmacist, or nurse. This includes any possible side effects not listed in this leaflet. You can also report side effects directly to the Medical Products Agency, www.lakemedelsverket.se. By reporting side effects, you can help increase drug safety information. 

5. How to store Capecitabine Sandoz

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 after EXP. The expiration date is the last day of the specified month.

Do not store above 30 ° C.

Medicines should not be disposed of via wastewater or household waste. Ask your pharmacist how to dispose of medicines no longer required. These measures will help to protect the environment.

6. Contents of the packaging and other information

Content declaration

  • The active substance is capecitabine. One film-coated tablet contains 500 mg of capecitabine.
  • Other ingredients are:Tablet core : lactose monohydrate , hypromellose, microcrystalline cellulose, croscarmellose sodium, magnesium stearate Tablet coating : hypromellose, talc, titanium dioxide (E171), red iron oxide (E172).

What the medicine looks like and contents of the pack

Pink film-coated tablet with oval shape (8.4 x 16.0 mm) and marked with “500” on one side.

Capecitabine Sandoz is packaged in blisters of PVC / PVDC-Al or Al-Al foil, in cartons containing 28, 30, 50, 56, 60, 80, 84, 90, 100, 110, 112, 120 or 180 film-coated tablets.

Not all pack sizes may be marketed.

Marketing Authorization Holder and Manufacturer

Marketing Authorisation Holder

Sandoz A / S, Edvard Thomsens Vej 14, 2300 Copenhagen S, Denmark

Manufacturer

Salutas Pharma GmbH, Otto-von-Guericke-Allee 1, 39179 Barleben, Germany

Muhammad Nadeem

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