Norditropin NordiFlex 15 mg/1.5 ml

Read all of this leaflet carefully before you start using this medicine because 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 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 is in this leaflet

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

Overleaf: Using your Norditropin NordiFlex pen

Norditropin NordiFlex is used to treat growth failure in children:

• If they have no or very low production of growth hormone (growth hormone deficiency)
• If they have Turner syndrome (a genetic problem which may affect growth)
• If they have reduced kidney function
• If they are short and were born small for gestational age (SGA)
• If they have Noonan syndrome (a genetic problem which may affect growth).

Norditropin NordiFlex is used as a growth hormone replacement in adults:

In adults Norditropin NordiFlex is used to replace growth hormone if their growth hormone production has been decreased since childhood or has been lost in adulthood because of a tumour, treatment of a tumour, or a disease that affects the gland which produces growth hormone. If you have been treated for growth hormone deficiency during childhood, you will be retested after completion of growth. If growth hormone deficiency is confirmed, you should continue treatment.

Do not use Norditropin NordiFlex

• If you are allergic to somatropin, to phenol, or to any of the other ingredients of this medicine (listed in section 6)
• If you have had a kidney transplant
• If you have an active tumour (cancer). Tumours must be inactive and you must have finished your antitumour treatment before you start your treatment with Norditropin NordiFlex
• If you have an acute critical illness e.g. open heart surgery, abdominal surgery, multiple accidental trauma or acute respiratory failure
• If you have stopped growing (closed epiphyses) and you do not have growth hormone deficiency.

Warnings and precautions

Talk to your doctor or pharmacist before using Norditropin NordiFlex

• If you have diabetes
• If you have ever had a cancer or another kind of tumour
• If you have recurrent headaches, eyesight problems, nausea or if vomiting occurs
• If you have abnormal thyroid function
• An increase in sideways curvature of the spine (scoliosis) may progress in any child during rapid growth. During treatment with Norditropin NordiFlex, your doctor will check you (or your child) for signs of scoliosis
• If you walk with a limp or if you start to limp during your growth hormone treatment, you should inform your doctor
• If you are over 60 years of age, or have received somatropin treatment as an adult for more than 5 years, as experience is limited
• If you suffer from kidney disease, as your kidney function should be monitored by your physician
• If you have a replacement therapy with glucocorticoids, you should consult your doctor regularly, as you may need adjustment of your glucocorticoid dose.
• Norditropin NordiFlex may cause an inflammation of the pancreas, which causes severe pain in the abdomen and back. Contact your doctor if you or your child develops stomach ache after taking Norditropin NordiFlex.

Other medicines and Norditropin NordiFlex

Tell your doctor or pharmacist if you are using, have recently used or might use any other medicines.

In particular, inform your doctor if you are taking or have recently taken any of the following medicines. Your doctor may need to adjust the dose of Norditropin NordiFlex or of the other medicines:

• Glucocorticoids – your adult height may be affected if you use Norditropin NordiFlex and glucocorticoids at the same time
• Cyclosporine (immunosuppressive) – as your dose may need to be adjusted
• Insulin – as your dose may need to be adjusted
• Thyroid hormone – as your dose may need to be adjusted
• Gonadotropin (gonad stimulating hormone) – as your dose may need to be adjusted
• Anticonvulsants – as your dose may need to be adjusted
• Oestrogen taken orally or other sex hormones.

Pregnancy and breast-feeding

Somatropin containing products are not recommended in women of childbearing potential not using contraception.

• Pregnancy – Stop the treatment and tell your doctor if you become pregnant while you are using Norditropin NordiFlex
• Breast-feeding – Do not use Norditropin NordiFlex while you are breast-feeding because somatropin might pass into your milk.

Driving and using machines

Norditropin NordiFlex does not affect the use of any machines or the ability to drive safely.

Norditropin contains sodium

Norditropin contains less than 1 mmol sodium (23 mg) per 1.5 ml, that is to say essentially ‘sodium-free’.

Recommended dose

The dose for children depends on their body weight and body surface area. Later in life, the dose depends on your height, weight, gender and growth hormone sensitivity and will be adjusted until you are on the right dose.

• Children with low production or lack of growth hormone:
  The usual dose is 0.025 to 0.035 mg per kg body weight per day or 0.7 to 1.0 mg per m² body surface area per day
• Children with Turner syndrome:
  The usual dose is 0.045 to 0.067 mg per kg body weight per day or 1.3 to 2.0 mg per m² body surface area per day
• Children with kidney disease:
  The usual dose is 0.050 mg per kg body weight per day or 1.4 mg per m² body surface area per day
• Children born small for gestational age (SGA):
  The usual dose is 0.035 mg per kg body weight per day or 1.0 mg per m² body surface area per day until final height is reached. (In clinical trials of short children born SGA doses of 0.033 and 0.067 mg per kg body weight per day have typically been used)
• Children with Noonan syndrome:
  The usual dose is 0.066 mg per kg body weight per day, however your doctor may decide that 0.033 mg per kg body weight per day is sufficient
• Adults with low production or lack of growth hormone:
  If your growth hormone deficiency continues after completion of growth, treatment should be continued. The usual starting dose is 0.2 to 0.5 mg per day. The dose will be adjusted until you are on the right dose. If your growth hormone deficiency starts during adult life, the usual starting dose is 0.1 to 0.3 mg per day. Your doctor will increase this dose each month until you are getting the dose you need. The usual maximum dose is 1.0 mg per day.

When to use Norditropin NordiFlex

Inject your daily dose into the skin every evening just before bedtime.

How to use Norditropin NordiFlex

Norditropin NordiFlex growth hormone solution comes in a multidose disposable 1.5 ml pre-filled pen.

Full instructions on how to use the Norditropin NordiFlex pen are given overleaf. The instructional key points are as follows:

• Check the solution before use by turning the pen upside down once or twice. Do not use the pen if the solution is cloudy or discoloured
• Norditropin NordiFlex is designed to be used with NovoFine or NovoTwist disposable needles up to a length of 8 mm
• Always use a new needle for each injection
• Vary the area you inject so you do not harm your skin
• To make sure you get the proper dose and do not inject air, check the growth hormone flow (called ‘priming’ the pen) before the first injection from a new Norditropin NordiFlex pen. Do not use the pen if a drop of growth hormone solution does not appear at the needle tip
• Do not share your Norditropin NordiFlex pen with anyone else.

How long you will need treatment for

• Children with growth failure because of Turner syndrome, kidney disease, SGA or Noonan syndrome: Your doctor will recommend you continue treatment until you stop growing
• Children or adolescents who lack growth hormone: Your doctor will recommend you continue treatment into adulthood

Do not stop using Norditropin NordiFlex without discussing it with your doctor first.

If you use more Norditropin NordiFlex than you should

Tell your doctor if you inject too much somatropin. Long-term overdosing can cause abnormal growth and coarsening of facial features.

If you forget to use Norditropin NordiFlex

Take the next dose as usual, at the normal time. Do not take a double dose to make up for a forgotten dose.

If you stop using Norditropin NordiFlex

Do not stop using Norditropin NordiFlex without discussing it with your doctor first.

Additional side effects in children:

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

• Headache
• Redness, itching and pain in the area of injection
• Breast enlargement (gynaecomastia).

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

• Rash
• Muscle and joint pain
• Swollen hands and feet due to fluid retention.

In rare cases, children using Norditropin NordiFlex have experienced hip and knee pain or have started limping. These symptoms may be caused by a disease affecting the top of the thigh bone (Legg-Calvé disease) or because the end of the bone has slipped from the cartilage (slipped capital femoral epiphysis) and may not be due to Norditropin NordiFlex.

In children with Turner syndrome, a few cases of increased growth of hands and feet compared to height have been observed in clinical trials.

A clinical trial in children with Turner syndrome has shown that high doses of Norditropin can possibly increase the risk of getting ear infections.

If any of these side effects gets serious, or if you notice any side effects not listed in this leaflet, please tell your doctor or pharmacist, as the dose may need to be reduced.

Additional side effects in adults:

Very common (may affect more than 1 in 10 adults):

• Swollen hands and feet due to fluid retention.

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

• Headache
• Feeling of skin crawling (formication) and numbness or pain mainly in fingers
• Joint pain and stiffness; muscle pain.

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

• Type 2 diabetes
• Carpal tunnel syndrome; tingling and pain in fingers and hands
• Itching (can be intense) and pain in the area of injection
• Muscle stiffness
• Breast enlargement (gynaecomastia).

Reporting of side effects

If you get any side effect, 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 Yellow Card Scheme Website: www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store. By reporting side effects you can help provide more information on the safety of this medicine.

What Norditropin NordiFlex contains

• The active substance is somatropin
• The other excipients are mannitol, histidine, poloxamer 188, phenol, water for injection, hydrochloric acid and sodium hydroxide.

What Norditropin NordiFlex looks like and contents of the pack

Norditropin NordiFlex is a clear and colourless solution for injection in a multidose disposable 1.5 ml pre-filled pen.

1 ml of solution contains 10 mg somatropin.

1 mg of somatropin corresponds to 3 IU of somatropin.

Norditropin NordiFlex is available in three strengths:

5 mg/1.5 ml, 10 mg/1.5 ml and 15 mg/1.5 ml (equivalent to 3.3 mg/ml, 6.7 mg/ml and 10 mg/ml, respectively).

Marketing Authorisation Holder and Manufacturer

Marketing Authorisation Holder

Manufacturer

This medicinal product is authorised in the Member States of the EEA under the following names:

Austria, Belgium, Cyprus, Czech Republic, Denmark, Greece, Finland, Hungary, Croatia, Ireland, Iceland, Italy, Luxembourg, Norway, Portugal, Romania, Spain, Sweden, Slovak Republic, Slovenia, United Kingdom: Norditropin NordiFlex 15 mg/1.5 ml

France: Norditropine NordiFlex 15 mg/1.5 ml

1. Check the pen

• Check the name, strength and coloured label of your Norditropin NordiFlex pen to make sure that it contains the growth hormone strength you need.
• Pull off the pen cap [A].
• Check that the solution inside the cartridge is clear and colourless by tipping the pen upside down once or twice.
• Do not use the pen if the solution inside the cartridge is unclear or cloudy.

2. Attach the needle

• Always use a new needle for each injection. This reduces the risk of contamination, infection, leakage of solution, blocked needles and inaccurate dosing. Never bend or damage the needle.
• Remove the protective paper tab from the needle.
• Screw the needle straight onto the pen [B]. Make sure the needle is on tight.

The needle has two needle caps. You need to remove them both:

• Pull off the outer needle cap and keep it to correctly remove the needle from the pen after the injection.
• Remove the inner needle cap by pulling on the central tip and throw it away.

3. Check the flow

• Before your first injection with each new pen, you need to check the flow to make sure you get the correct dose and do not inject any air:
  Select 0.075 mg [C]. This is one ‘click’ after 0.0 on the dosage selector at the end of the pen.

• Hold the pen with the needle pointing up and tap the top of the pen a few times to let any air bubbles rise to the top [D].

• Holding the pen with the needle up, press the push button at the bottom of the pen all the way in [E]. A drop of solution will appear at the needle tip.
• If no drop appears, repeat steps C to E up to 6 times until a drop appears. If there is still no drop, change the needle and repeat step C to E once more.
• Do not use the pen if a drop does not appear. Use a new pen.
• Always check the flow before the first injection with each new pen. Check the flow again if your pen has been dropped or knocked against a hard surface, or if you suspect something is wrong with it.

4. Select the dose

• Check that the dosage selector is set at 0.0. Select the number of mg your doctor has prescribed for you [F].
• The dose can be increased or decreased by turning the dosage selector in either direction. When turning the dosage selector backwards, be careful not to press the push button as solution will come out. You cannot set a dose larger than the number of mg left in the pen.

5. Inject the dose

• Use the injection method shown to you by your doctor or nurse.
• Vary the area you inject so you do not harm your skin.
• Insert the needle into your skin. Deliver the dose by pressing the push button all the way in. Be careful only to press the push button when injecting [G].
• Keep the push button fully depressed and let the needle remain under the skin for at least 6 seconds. This will ensure that the full dose has been delivered.

6. Remove the needle

• Carefully put the outer needle cap back on the needle without touching the needle. Unscrew the needle and throw it away carefully as instructed by your doctor or nurse [H].
  Never put the inner needle cap back on once you have removed it from the needle. You may accidentally stick yourself with the needle.
• Put the pen cap back on after every use.
• Always remove and dispose of the needle after each injection and store the pen without the needle attached. This reduces the risk of contamination, infection, leakage of solution, blocked needles and inaccurate dosing.
• When the pen is empty, throw it away without a needle on as advised by your doctor or nurse and local authorities.
• Caregivers must be very careful when handling used needles - to reduce the risk of needle sticks and cross-infection.

7. Maintenance

• Your Norditropin NordiFlex pen must be handled with care.
• Do not drop your pen or knock it against hard surfaces. If you drop it or suspect that something is wrong with it, always screw on a new needle and check the flow before you inject.
• Do not try to refill your pen – it is pre-filled.
• Do not try to repair your pen or pull it apart.
• Protect your pen from dust, dirt, frost and direct sunlight.
• Do not try to wash, soak or lubricate your pen. If necessary clean it with a mild detergent on a moistened cloth.
• Do not freeze your pen or store it close to any cooling element, e.g. in a refrigerator.
• See section 5 “How to store Norditropin NordiFlex” on the reverse page for information about how to store your pen.