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, pharmacist or nurse.

-    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.

-    The full name of this medicine is Caspofungin 70mg Powder for Concentrate for Solution for Infusion but within the leaflet it will be referred to as Caspofungin Powder.

What is in this leaflet

T| What Caspofungin Powder is and what it is used for

3 What you need to know before you use Caspofungin Powder

3 How to use Caspofungin Powder

4| Possible side effects

^ How to store Caspofungin Powder

6| Contents of the pack and other information

What Caspofungin Powder is and what it is used for What Caspofungin Powder is

Caspofungin Powder contains a medicine called caspofungin. This belongs to a group of medicines called anti-fungals.

What Caspofungin Powder is used for

Caspofungin Powder is used to treat the following infections in children, adolescents and adults:

•    serious fungal infections in your tissues or organs (called 'invasive candidiasis'). This infection is caused by fungal (yeast) cells called Candida.

People who might get this type of infection include those who have just had an operation or those whose immune systems are weak. Fever and chills that do not respond to an antibiotic are the most common signs of this type of infection.

•    fungal infections in your nose, nasal sinuses or lungs (called 'invasive aspergillosis') if other anti-fungal treatments have not worked or have caused side effects. This infection is caused by a mould called Aspergillus.

People who might get this type of infection include those having chemotherapy, those who have had a transplant and those whose immune systems are weak.

•    suspected fungal infections if you have a fever and a low white cell count that have not improved on treatment with an antibiotic. People who are at risk of getting a fungal infection include those who have just had an operation or those whose immune systems are weak.

How Caspofungin Powder works

Caspofungin Powder makes fungal cells fragile and stops the fungus from growing properly. This stops the infection from spreading and gives the body's natural defences a chance to completely get rid of the infection.

3 What you need to know before you use Caspofungin Powder Do not use Caspofungin Powder

•    if you are allergic to caspofungin or any of the other ingredients of this medicine (listed in section 6).

If you are not sure, talk to your doctor, nurse or pharmacist before you are given your medicine. Warnings and precautions

Talk to your doctor, nurse or pharmacist before you are given Caspofungin Powder if:

•    you are allergic to any other medicines

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Caspofungin 70mg Powder for Concentrate for Solution for Infusion

The following information is intended for healthcare professionals only:

Instructions of how to reconstitute and dilute Caspofungin Powder:

Reconstitution of Caspofungin Powder

DO NOT USE ANY DILUENTS CONTAINING GLUCOSE as Caspofungin Powder is not stable in diluents containing glucose. DO NOT MIX OR CO-INFUSE CASPOFUNGIN POWDER WITH ANY OTHER MEDICINES, as there are no data available on the compatibility of Caspofungin Powder with other intravenous substances, additives, or medicinal products. Visually inspect the infusion solution for particulate matter or discolouration.

INSTRUCTIONS FOR USE IN ADULT PATIENTS Step 1 Reconstitution of conventional vials

To reconstitute the powder bring the vial to room temperature and aseptically add 10.5ml of water for injection. The concentrations of the reconstituted vials will be 7.2mg/ml.

The white to off-white compact lyophilised powder will dissolve completely. Mix gently until a clear solution is obtained. Reconstituted solutions should be visually inspected for particulate matter or discolouration.

Step 2 Addition of reconstituted Caspofungin Powder to patient infusion solution

Diluents for the final solution for infusion are: sodium chloride solution for injection, or lactated Ringer's solution. The solution for infusion is prepared by aseptically adding the appropriate amount of reconstituted concentrate (as shown in the table below) to a 250ml infusion bag or bottle. Reduced volume infusions in 100ml may be used, when medically necessary, for 50mg or 35mg daily doses. Do not use if the solution is cloudy or has precipitated.

• you have ever had liver problems - you might need a different dose of this medicine

•    you are already taking ciclosporin (used to help prevent organ transplant rejection or to suppress your immune system) - as your doctor may need to run extra blood tests during your treatment.

•    if you have ever had any other medical problem.

If any of the above applies to you (or you are not sure), talk to your doctor, nurse or pharmacist before you are given Caspofungin Powder.

Other medicines and Caspofungin Powder

Tell your doctor, nurse or pharmacist if you are taking, have recently taken or might take any other medicines. This is because Caspofungin Powder can affect the way some other medicines work. Also some other medicines can affect the way Caspofungin Powder works.

Tell your doctor, nurse or pharmacist if you are taking any of the following medicines:

•    ciclosporin or tacrolimus (used to help prevent organ transplant rejection or to suppress your immune system) as your doctor may need to run extra blood tests during your treatment

•    some HIV medicines such as efavirenz or nevirapine

•    phenytoin or carbamazepine (used for the treatment of seizures)

•    dexamethasone (a steroid)

•    rifampicin (an antibiotic).

If any of the above apply to you (or you are not sure), talk to your doctor, nurse or pharmacist before you are given Caspofungin Powder.

Pregnancy and breast-feeding

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.

•    Caspofungin Powder has not been studied in pregnant women. It should be used in pregnancy only if the potential benefit justifies the potential risk to the unborn baby.

•    Women given Caspofungin Powder should not breast-feed.

Driving and using machines

There is no information to suggest that Caspofungin Powder affects your ability to drive or operate machinery.

How to use Caspofungin Powder

Caspofungin Powder will always be prepared and given to you by a healthcare professional. You will be given Caspofungin Powder:

•    once each day

•    by slow injection into a vein (intravenous infusion)

•    over about 1 hour.

Your doctor will determine the duration of your treatment and how much Caspofungin Powder you will be given each day. Your doctor will monitor how well the medicine works for you. If you weigh more than 80kg, you may need a different dose.

Use in children and adolescents

The dose for children and adolescents may differ from the adult dose.

If you have been given more Caspofungin Powder than you should

Your doctor will decide how much Caspofungin Powder you need and for how long each day. If you are worried that you may have been given too much Caspofungin Powder, tell your doctor or nurse straight away.

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

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* 10.5ml should be used for reconstitution of all vials

** If 70mg vial is not available, the 70mg dose can be prepared from two 50mg vials

INSTRUCTIONS FOR USE IN PAEDIATRIC PATIENTS Calculation of Body Surface Area (BSA) for paediatric dosing

Before preparation of infusion, calculate the body surface area (BSA) of the patient using the following formula: (Mosteller¹ Formula).

hosteller RD: Simplified Calculation of Body Surface Area. N Engl J Med 1987 Oct 22;317(17): 1098 (letter)

BSA (_m2) =    Height (cm) x Weight (kg)

^V    3600

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4| Possible side effects

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

Tell your doctor or nurse straight away if you notice any of the following side effects - you may

need urgent medical treatment:

•    rash, itching, feeling warm, swelling of your face, lips or throat or difficulty breathing - you may be having a histamine reaction to the medicine.

•    difficulty breathing with wheezing or a rash that gets worse - you may be having an allergic reaction to the medicine.

•    cough, serious breathing difficulties - if you are an adult and have invasive aspergillosis you may be experiencing a serious respiratory problem that could result in respiratory failure.

As with any prescription medicine, some side effects may be serious. Ask your doctor for more

information.

Other side effects in adults include

Common: may affect up to 1 in 10 people:

•    Decreased haemoglobin (decreased oxygen carrying substance in the blood), decreased white blood cells

•    Decreased blood albumin (a type of protein) in your blood, decreased potassium or low potassium levels in the blood

•    Headache

•    Inflammation of the vein

•    Shortness of breath

•    Diarrhoea, nausea or vomiting

•    Changes in some laboratory blood tests (including increased values of some liver tests)

•    Itching, rash, skin redness or sweating more than usual

•    Joint pain

•    Chills, fever

•    Itching at the injection site.

Uncommon: may affect up to 1 in 100 people:

•    Changes in some laboratory blood tests (including disease of blood clotting, platelets, red blood cells and white blood cells)

•    Loss of appetite, increase in amount of body fluid, imbalance of salt in the body, high sugar level in the blood, low calcium level in the blood, low magnesium level in the blood, increase in acid level in the blood

•    Disorientation, feeling nervous, being unable to sleep

•    Feeling dizzy, decreased feeling or sensitivity (especially in the skin), shaking, feeling sleepy, change in the way things taste, tingling or numbness

•    Blurred vision, increase in tears, swollen eyelid, yellowing of the whites of the eyes

•    Sensation of fast or irregular heartbeats, rapid heartbeat, irregular heartbeat, abnormal heart rhythm, heart failure

•    Flushing, hot flush, high blood pressure, low blood pressure, redness along a vein which is extremely tender when touched

•    Tightening of the bands of muscle around the airways resulting in wheezing or coughing (bronchospasm), fast breathing rate, shortness of breath that wakes you up, shortage of oxygen in the blood, abnormal breath sounds, crackling sounds in the lungs, wheezing, nasal congestion, cough, throat pain

•    Belly pain, upper belly pain, bloating, constipation, difficulty swallowing, dry mouth, indigestion, passing gas, stomach discomfort, swelling due to build-up of fluid around the belly

•    Decreased flow of bile, enlarged liver, yellowing of the skin and/or whites of the eyes (jaundice), liver injury caused by a drug or chemical, liver disorder

•    Abnormal skin tissue, generalised itching, hives, rash of varying appearance, abnormal skin, red often itchy spots on your arms and legs and sometimes on the face and the rest of the body

•    Back pain, pain in an arm or leg, bone pain, muscle pain, muscle weakness

•    Loss of kidney function, sudden loss of kidney function

•    Catheter site pain, injection site complaints (redness, hard lump, pain, swelling, irritation, rash, hives, leaking of fluid from the catheter into the tissue), inflammation of vein at injection site

•    Increased blood pressure and alterations in some laboratory blood tests (including kidney electrolyte and clotting tests), increased levels of the medicines you are taking that weaken the immune system

•    Chest discomfort, chest pain, feeling of body temperature change, generally feeling unwell, general pain, swelling of the face, swelling of the ankles, hands or feet, swelling, tenderness, feeling tired.

Side effects in children and adolescents

Very common: may affect more than 1 in 10 people:

•    Fever.

Other side effects reported since this medicine has been on the market

Not known: frequency cannot be estimated:

•    Liver problems

•    Swelling of the ankles, hands or feet

•    Increased calcium levels in the blood have been reported.

Reporting of side effects

If you get any side effects, talk to your doctor, nurse 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

By reporting side effects you can help provide more information on the safety of this medicine.

^ How to store Caspofungin Powder

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 the vial as EXP. The expiry date refers to the last day of that month.

Unopened vials: Store in a refrigerator (2°C to 8°C).

Once Caspofungin Powder has been prepared, it should be used straight away. This is because it does not contain any ingredients to stop the growth of bacteria. Only a trained healthcare professional who has read the complete directions should prepare the medicine (please see below "Instructions of how to reconstitute and dilute Caspofungin Powder").

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.

6| Contents of the pack and other information What Caspofungin Powder contains

-    The active substance is caspofungin. Each vial of Caspofungin Powder contains caspofungin acetate equivalent to 70mg caspofungin.

-    The other ingredients are sucrose, mannitol, succinic acid and sodium hydroxide (please see section 2. What you need to know before you are given Caspofungin Powder).

What Caspofungin Powder looks like and contents of the pack

Caspofungin Powder is a sterile, white to off-white compact powder.

Each pack contains one vial of powder.

Marketing Authorisation Holder

Actavis Group PTC ehf.

Reykjavikurvegi 76-78 220 HafnarfjorSur Iceland

Manufacturer

Xellia Pharmaceuticals ApS Dalslandsgade 11 2300 Copenhagen S Denmark

This leaflet was last revised in June 2016.

If you would like a leaflet with larger text, please contact 01271 385257.

Common: may affect up to 1 in 10 people:

•    Headache

•    Fast heartbeat

•    Flushing, low blood pressure

•    Changes in some laboratory blood tests, including increased values of some liver tests

•    Itching, rash

•    Catheter site pain

•    Chills.

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Preparation of the 70mg/m² infusion for paediatric patients >3 months of age (using a 70mg vial)

1.    Determine the actual loading dose to be used in the paediatric patient by using the patient's BSA (as calculated above) and the following equation:

BSA (m²) X 70mg/m² = Loading Dose.

The maximum loading dose on Day 1 should not exceed 70mg regardless of the patient's calculated dose.

2.    Equilibrate the refrigerated vial of Caspofungin Powder to room temperature.

3.    Aseptically add 10.5ml of water for injection.^{a b} This will give a final caspofungin concentration in the vial of 7.2mg/ml.

4.    Remove the volume of medicine equal to the calculated loading dose (Step 1) from the vial.

Aseptically transfer this volume (ml)^c of reconstituted Caspofungin Powder to an IV bag (or bottle) containing 250ml of 0.9%, 0.45%, or 0.225% Sodium Chloride Injection, or Lactated Ringers Injection. Alternatively, the volume (ml)^c of reconstituted Caspofungin Powder can be added to a reduced volume of 0.9%, 0.45%, or 0.225% Sodium Chloride Injection or Lactated Ringers Injection, not to exceed a final concentration of 0.5mg/ml.

Preparation of the 50mg/m² infusion for paediatric patients >3 months of age (using a 70mg vial)

1.    Determine the actual daily maintenance dose to be used in the paediatric patient by using the patient's BSA (as calculated above) and the following equation:

BSA (m²) X 50mg/m² = Daily Maintenance Dose.

The daily maintenance dose should not exceed 70mg regardless of the patient's calculated dose.

2.    Equilibrate the refrigerated vial of Caspofungin Powder to room temperature.

3.    Aseptically add 10.5ml of water for injection.^{a b} This will give a final caspofungin concentration in the vial of 7.2mg/ml.

4.    Remove the volume of medicine equal to the calculated daily maintenance dose (Step 1) from the vial. Aseptically transfer this volume (ml)^c of reconstituted Caspofungin Powder to an IV bag (or bottle) containing 250ml of 0.9%, 0.45%, or 0.225% Sodium Chloride Injection, or Lactated Ringers Injection. Alternatively, the volume (ml)^c of reconstituted Caspofungin Powder can be added to a reduced volume of 0.9%, 0.45%, or 0.225% Sodium Chloride Injection or Lactated Ringers Injection, not to exceed a final concentration of 0.5mg/ml.

Actavis, Barnstaple, EX32 8NS, UK

Storage and shelf-life after reconstitution/dilution

Reconstituted concentrate: Physical and chemical stability has been demonstrated for 24 hours at 25°C.

Diluted solution for infusion: Physical and chemical stability has been demonstrated for 24 hours at 25°C and for 48 hours at 2 to 8°C when diluted with sodium chloride solution 9mg/ml (0.9%), 4.5mg/ml (0.45%), or 2.25mg/ml (0.225%) for infusion, or lactated Ringer's solution.

The total in-use period should not exceed 24 hours if stored at 25°C or 48 hours if stored at 2 to 8°C.

From a microbiological point of view, the product should be used immediately. If not used immediately, in use storage times and conditions prior to use are the responsibility of the user and would normally not be longer than 24 hours at 2 to 8°C, unless reconstitution and dilution have taken place in controlled validated aseptic conditions.

Actavis, Barnstaple, EX32 8NS, UK

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