What is a Patient Information Leaflet and why is it useful?

The Patient Information Leaflet (PIL) is the leaflet included in the pack with a medicine. It is written for patients and gives information about taking or using a medicine. It is possible that the leaflet in your medicine pack may differ from this version because it may have been updated since your medicine was packaged.

Below is a text only representation of the Patient Information Leaflet. The original can be viewed in PDF format using the link above.

The text only version may be available from RNIB in large print, Braille or audio CD. For further information call RNIB Medicine Leaflet Line on 0800 198 5000. The product code(s) for this leaflet is: PL14427/0026.

Levact 2.5 mg/ml powder for concentrate for solution for infusion

Package leaflet: Information for the user

Levact® 2.5 mg/ml powder for concentrate for solution for infusion

Bendamustine hydrochloride

Read all of this leaflet carefully before you start using this medicine, it contains important information for you.

  • 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. Do not pass it on to others. It may harm them, even if their symptoms are the same as yours.
  • If any of the side effects gets serious, or if you notice any side effects not listed in this leaflet, please tell your doctor or pharmacist.

What is in this leaflet:

1. What Levact is and what it is used for
2. What you need to know before you use Levact
3. How to use Levact
4. Possible side effects
5. How to store Levact
6. Contents of the pack and other information

1. WHAT LEVACT IS AND WHAT IT IS USED FOR

Levact is a medicine which is used for the treatment of certain types of cancer (cytotoxic medicine).

Levact is used alone (monotherapy) or in combination with other medicines for the treatment of the following forms of cancer:

  • chronic lymphocytic leukaemia in cases where fludarabine combination chemotherapy is not appropriate for you,
  • non-Hodgkin lymphomas, which had not, or only shortly, responded to prior rituximab treatment,
  • multiple myeloma in cases where thalidomide or bortezomib containing therapy is not appropriate for you.

2. WHAT YOU NEED TO KNOW BEFORE YOU USE LEVACT

Do not use Levact

  • if you are allergic to bendamustine hydrochloride or any of the other ingredients of this medicine (listed in section 6);
  • while breast-feeding, if treatment with Levact is necessary during lactation you must discontinue breast-feeding (see section warnings and precautions on breastfeeding);
  • if you have severe liver dysfunction (damage to the functional cells of the liver);
  • if you have yellowing of the skin or whites of the eyes caused by liver or blood problems (jaundice);
  • if you have severely disturbed bone marrow function (bone marrow depression) and serious changes in your number of white blood cells and platelets in the blood;
  • if you have had major surgical operations less than 30 days before starting treatment;
  • if you have an infection, especially one accompanied by a reduction in white blood cells (leucocytopenia);
  • in combination with yellow fever vaccines.

Warnings and precautions

Talk to your doctor, pharmacist or nurse before using Levact

  • in case of reduced capability of the bone marrow to replace blood cells. You should have your number of white blood cells and platelets in the blood checked before starting treatment with Levact, before each subsequent course of treatment and in the intervals between courses of treatment.
  • in case of infections. You should contact your doctor if you have signs of infection, including fever or lung symptoms.
  • in case of reactions on your skin during treatment with Levact. The skin reactions may increase in severity.
  • in case of painful red or purplish rash that spreads and blisters and/or other lesions begin to appear in the mucous membrane (e.g. mouth and lips), in particular if you had before light sensitivity, infections of the respiratory system (e.g. bronchitis) and/or fever.
  • in cases of existing heart disease (e.g. heart attack, chest pain, severely disturbed heart rhythms).
  • in case you notice any pain in your side, blood in your urine or reduced amount of urine. When your disease is very severe, your body may not be able to clear all the waste products from the dying cancer cells. This is called tumour lysis syndrome and can cause kidney failure and heart problems within 48 hours of the first dose of Levact. Your doctor may ensure you are adequately hydrated and give you other medicines to help prevent it.
  • in case of severe allergic or hypersensitivity reactions. You should pay attention to infusion reactions after your first cycle of therapy.

Other medicines and Levact

Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines.

If Levact is used in combination with medicines which inhibit the formation of blood in the bone marrow, the effect on the bone marrow may be intensified.

If Levact is used in combination with medicines which alter you immune response, this effect may be intensified.

Cytostatic medicines may diminish the effectiveness of live-virus vaccination. Additionally cytostatic medicines increase the risk of an infection after vaccination with live vaccines (e.g. viral vaccination).

Pregnancy, breast-feeding and fertility

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 using this medicine.

Pregnancy

Levact can cause genetic damage and has caused malformations in animal studies. You should not use Levact during pregnancy unless certainly indicated by your doctor. In case of treatment you should use medical consultation about the risk of potential adverse effects of your therapy for the unborn child and genetic consultation is recommended.

If you are a woman of childbearing potential you must use an effective method of contraception both before and during treatment with Levact. If pregnancy occurs during your treatment with Levact you must immediately inform your doctor and should use genetic consultation.

Breast-feeding

Levact must not be administered during breast feeding. If treatment with Levact is necessary during lactation you must discontinue breast-feeding.

Ask your doctor or pharmacist for advice before taking any medicine.

Fertility

Men receiving treatment with Levact are advised not to father a child during treatment and for up to 6 months afterwards. Before starting treatment, you should seek advice on storing sperm because of the possibility of permanent infertility.

If you are a man, you should avoid fathering a child during treatment with Levact and for up to 6 months after treatment has stopped. There is a risk that treatment with Levact will lead to infertility and you may wish to seek advice on conservation of sperm before treatment starts.

Driving and using machines

Levact has major influence on the ability to drive and to use machines. Do not drive or operate machines if you experience side effects, such as dizziness or lack of coordination.

3. HOW TO USE LEVACT

Always use this medicine exactly as your doctor or pharmacist has told you. Check with your doctor or pharmacist if you are not sure.

Levact is administered into a vein over 30-60 minutes in various dosages, either alone (monotherapy) or in combination with other medicines.

Treatment should not be started if your white blood cells (leukocytes) and/or your blood platelets have fallen to counts below determined levels.

Your doctor will determine these values at regular intervals.

Chronic lymphocytic leukaemia

Levact 100 mg per square meter of your body surface area (based on your height and weight) on Days 1+2

Repeat the cycle after 4 weeks up to 6 times

Non-Hodgkin lymphomas

Levact 120 mg per square meter of your body surface area (based on your height and weight) on Days 1 + 2

Repeat the cycle after 3 weeks at least 6 times

Multiple myeloma

Levact 120 - 150 mg per square meter of your body surface area (based on your height and weight) on Days 1 + 2

Prednisone 60 mg per square meter of your body surface area (based on your height and weight) by injection or orally. on Days 1 - 4

Repeat the cycle after 4 weeks at least 3 times

Treatment should be terminated if white blood cell (leukocyte) and/or platelet values dropped to determined levels. Treatment can be continued after white blood cell and platelet values have increased.

Impaired liver or kidney function

Dependent on the degree of impairment of your liver function it may be necessary to adjust your dose (by 30% in case of moderate liver dysfunction). No dose adjustment is necessary in case of impairment of kidney function. Your attending doctor will decide whether a dosage adjustment is necessary.

How it is administered

Treatment with Levact should be undertaken only by doctors experienced in tumour therapy. Your doctor will give you the exact dose of Levact and use the necessary precautions.

Your attending doctor will administer the solution for infusion after preparation as prescribed. The solution is administered into a vein as a short-term infusion over 30 - 60 minutes.

Duration of use

There is no time limit laid down as a general rule for treatment with Levact. Duration of treatment depends on disease and response to treatment.

If you are at all worried or have any questions regarding treatment with Levact, please speak to your doctor or nurse.

If you forget to use Levact

If a dose of Levact has been forgotten, your doctor will usually retain the normal dosage schedule.

If you stop using Levact

The doctor treating you will decide whether to interrupt the treatment or to change over to a different preparation.

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

4. POSSIBLE SIDE EFFECTS

Like all medicines, Levact can cause side-effects, although not everybody will experience these effects. Some of the findings listed below may be found after tests are performed by your doctor.

The following definitions of frequency are used when assessing side-effects:

Very common affects more than 1 user in 10

Common affects 1 to 10 users in 100

Uncommon affects 1 to 10 users in 1,000

Rare affects 1 to 10 users in 10,000

Very rare affects less than 1 user in 10,000

not known frequency cannot be estimated from the available data

Tissue decay (necrosis) has been observed very rarely following leakage of Levact into the tissue outside the blood vessels (extravascular). A burning sensation where the infusion needle is inserted may be a sign of leakage outside the blood vessels. The consequence can be pain and poorly healing skin defects.

The dose-limiting side-effect of Levact is impaired bone-marrow function, which usually returns to normal after treatment. Suppressed bone marrow function may lead to low counts of blood cells, which in turn may lead to an increased risk of infection, anemia or a heightened risk of bleeding.

Very common:

  • Low counts of white blood cells (disease-fighting cells in your blood)
  • Decrease in the red pigment of the blood (haemoglobin: a protein in red blood cells that carries oxygen throughout the body)
  • Low counts of platelets (colorless blood cells that help blood clot)
  • Infections
  • Feeling sick (nausea)
  • Vomiting
  • Mucosal inflammation
  • Headache
  • Increased blood level of creatinine (a chemical waste product that is produced by your muscle)
  • Increased blood level of urea (a chemical waste product)
  • Fever
  • Fatigue

Common:

  • Bleeding (haemorrhage)
  • Disturbed metabolism caused by dying cancer cells releasing their contents into the blood stream
  • Reduction in red blood cells which can make the skin pale and cause weakness or breathlessness (anaemia)
  • Low counts of neutrophils (a common type of white blood cell important to fighting off infections)
  • Hypersensitivity reactions such as allergic inflammation of the skin (dermatitis), nettle rash (urticaria)
  • A rise in liver enzymes AST/ALT (which may indicate inflammation or damage to cells in the liver)
  • A rise in the enzyme alkaline phosphatase (an enzyme made mostly in the liver and bones)
  • A rise in bile pigment (a substance made during the normal breakdown of red blood cells)
  • Low potassium blood levels (a nutrient that is necessary for the function of nerve and muscle cells, including those in your heart)
  • Disturbed function (dysfunction) of the heart
  • Disturbed heart rhythms (arrhythmia)
  • Low or high blood pressure (hypotension or hypertension)
  • Disturbed lung function
  • Diarrhoea
  • Constipation
  • Sore mouth (Stomatitis)
  • Loss of appetite
  • Hair loss
  • Skin changes
  • Missed periods (amenorrhoea)
  • Pain
  • Insomnia
  • Chills
  • Dehydration
  • Dizziness
  • Itchy rash (urticaria)

Uncommon:

  • Accumulation of fluid in the heart sac (escape of fluid into the pericardial space)
  • Ineffective production of all blood cells in the bone marrow (the spongy material inside your bones where blood cells are made)
  • Acute leukemia
  • Heart attack, chest pain (myocardial infarct)
  • Heart failure

Rare:

  • Infection of the blood (sepsis)
  • Severe allergic hypersensitivity reactions (anaphylactic reactions)
  • Reduction in your bone marrow function, which may make you feel unwell or show up in your blood tests
  • Signs similar to anaphylactic reactions (anaphylactoid reactions)
  • Drowsiness
  • Loss of voice (aphonia)
  • Acute circulatory collapse (failure of blood circulation mainly from a cardiac origin with failure to maintain the supply of oxygen and other nutrients to the tissues and removing toxins)
  • Reddening of the skin (erythema)
  • Inflammation of the skin (dermatitis)
  • Itching (pruritus)
  • Skin rash (macular exanthema)
  • Excessive sweating (hyperhidrosis)

Very rare:

  • Primary atypical inflammation of the lungs (pneumonia)
  • Break-down of red blood cell
  • Rapid decrease in blood pressure sometimes with skin reactions or rash (anaphylactic shock)
  • Disturbed sense of taste
  • Altered sensations (paraesthesia)
  • Malaise and pain in the limbs (peripheral neuropathy)
  • Serious condition resulting in the blockade of specific receptor in the nervous systems
  • Disorders of the nervous system
  • Lack of coordination (ataxia)
  • Inflammation of the brain (encephalitis)
  • Increased heart rate (tachycardia)
  • Inflammation of the veins (phlebitis)
  • Formation of tissue in the lungs (fibrosis of the lungs)
  • Bleeding inflammation of the gullet (haemorrhagic oesophagitis)
  • Bleeding of stomach or gut
  • Infertility
  • Multiple organ failure

Not known:

  • Liver failure
  • Renal failure
  • Irregular and often rapid heart rate (atrial fibrillation)
  • Painful red or purplish rash that spreads and blisters and/or other lesions begin to appear in the mucous membrane (e.g. mouth and lips), in particular if you had before light sensitivity, infections of the respiratory system (e.g. bronchitis) and/or fever.
  • Drug rash in combination therapy with rituximab
  • Pneumonitis
  • Bleeding from the lungs

There have been reports of tumours (myelodysplastic syndrome, AML, bronchial carcinoma) following treatment with Levact. No clear relationship with Levact could be determined.

Contact your doctor or seek medical attention immediately if you notice any of the following side effects (frequency not known):

Serious skin rashes including Stevens-Johnson syndrome and toxic epidermal necrolysis. These can appear as reddish target-like macules or circular patches often with central blisters on the trunk, skin peeling, ulcers of mouth, throat, nose, genitals and eyes and can be preceded by fever and flu-like symptoms.

Widespread rash, high body temperature, enlarged lymph nodes and other body organs involvement (Drug Reaction with Eosinophilia and Systemic Symptoms which is also known as DRESS or drug hypersensitivity syndrome).

If any of the side effects gets serious, or if you notice any side effects not listed in this leaflet, please tell your doctor.

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 via the Yellow Card scheme at: www.mhra.gov.uk/yellowcard. By reporting side effects you can help provide more information on the safety of this medicine.

5. HOW TO STORE LEVACT

Keep this medicine out of the sight and reach of children.

Do not use Levact after the expiry date which is stated on the label and the carton. The expiry date refers to the last day of that month.

Keep the container in the outer carton to protect the content from light.

Note on shelf-life after opening or preparing the solution

Solutions for infusions prepared according to the directions listed at the end of this leaflet are stable in polyethylene bags at room temperature / 60% relative humidity for 3.5 hours, and in a refrigerator they are stable for 2 days. Levact contains no preservatives. The solutions should not therefore be used after these lengths of time.

It is the responsibility of the user to maintain aseptic conditions.

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 PACK AND OTHER INFORMATION

What Levact contains

The active substance is bendamustine hydrochloride.

1 vial contains 25 mg of bendamustine hydrochloride

1 vial contains 100 mg of bendamustine hydrochloride

After reconstitution 1 ml of the concentrate contains 2.5 mg bendamustine hydrochloride.

The other ingredient is Mannitol.

What Levact looks like and contents of the pack

Brown glass vials with rubber stopper and an aluminium flip-off cap.

The powder appears white and crystalline.

Levact is available in packs containing

5, 10 and 20 vials with 25 mg of bendamustine hydrochloride and 5 vials with 100 mg of bendamustine hydrochloride.

Not all pack sizes may be available.

Marketing Authorisation Holder

Astellas Pharma GmbH
Ridlerstraße 57
80339 München

Local representative:

Napp Pharmaceuticals Ltd
Cambridge Science Park
Milton Road
Cambridge
CB4 0GW
Telephone: +44 (0) 1223 424444

Manufacturer

Haupt Pharma Wolfratshausen GmbH
Pfaffenrieder Strasse 5
82515 Wolfratshausen

This leaflet was last revised in October 2018

This leaflet is also available in large print, Braille or as an audio CD. To request a copy, please call the RNIB Medicine Information line (free of charge) on:

0800 198 5000

You will need to give details of the product name and reference number.

These are as follows:

Product name: Levact 2.5 mg/ml

Reference number: 14427/0026