Package leaflet: Information for the patient

CINACALCET 30 mg, 60 mg AND 90 mg FILM-COATED TABLETS

Read all of this leaflet carefully before you start taking 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.

•    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, pharmacist or nurse. This includes any possible side effects not listed in this leaflet. See section 4.

What is in this leaflet

1.    What Cinacalcet is and what it is used for

2.    What you need to know before you take Cinacalcet

3.    How to take Cinacalcet

4.    Possible side effects

5.    How to store Cinacalcet

6.    Contents of the pack and other information

1. What Cinacalcet is and what it is used for

Cinacalcet works by controlling the levels of parathyroid hormone (PTH), calcium and phosphorous in your body. It is used to treat problems with organs called parathyroid glands. The parathyroids are four small glands in the neck, near the thyroid gland, that produce parathyroid hormone (PTH).

Cinacalcet is used:

•    to treat secondary hyperparathyroidism in patients with serious kidney disease who need dialysis to clear their blood of waste products.

•    to reduce high levels of calcium in the blood (hypercalcaemia) in patients with parathyroid cancer.

•    to reduce high levels of calcium in the blood (hypercalcaemia) in patients with primary hyperparathyroidism when removal of the gland is not possible.

In primary and secondary hyperparathyroidism too much PTH is produced by the parathyroids glands. “Primary” means that the hyperparathyroidism is not caused by any other condition and “secondary” means that the hyperparathyroidism is caused by another condition, e.g., kidney disease. Both primary and secondary hyperparathyroidism can cause the loss of calcium in the bones, which can lead to bone pain and fractures, problems with blood and heart vessels, kidney stones, mental illness and coma.

2. What you need to know before you take Cinacalcet Do not take Cinacalcet :

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

Talk to your doctor or pharmacist or nurse before taking Cinacalcet

Before you start taking Cinacalcet, tell your doctor if you have or have ever had:

•    seizures (fits or convulsions). The risk of having seizures is higher if you have had them before

•    liver problems

•    heart failure.

Life threatening events and fatal outcomes associated with low calcium levels (hypocalcaemia) have been reported in patients treated with Cinacalcet.

Low calcium levels can have an effect on your heart rhythm. Tell your doctor if you experience an unusually fast or pounding heart beat, if you have heart rhythm problems, or if you take medicines known to cause heart rhythm problems, while taking Cinacalcet.

For additional information see section 4.

During treatment with Cinacalcet, tell your doctor:

• if you start or stop smoking, as this may affect the way Cinacalcet works.

Children and adolescents

Children under the age of 18 must not take Cinacalcet.

Other medicines and Cinacalcet

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 the following medicines.

Medicines such as these can affect how Cinacalcet works:

•    medicines used to treat skin and fungal infections (ketoconazole, itraconazole and voriconazole)

•    medicines used to treat bacterial infections (telithromycin, rifampicin and ciprofloxacin)

•    a medicine used to treat HIV infection and AIDS (ritonavir)

•    a medicine used to treat depression (fluvoxamine).

Cinacalcet may affect how medicines such as the following work:

•    medicines used to treat depression (amitriptyline, desipramine, nortriptyline and clomipramine)

•    medicines used to treat changes in heart rate (flecainide and propafenone)

•    a medicine used to treat high blood pressure (metoprolol).

Cinacalcet with food and drink

Cinacalcet should be taken with or shortly after food.

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 taking this medicine.

Cinacalcet has not been tested in pregnant women. In case of pregnancy, your doctor may decide to modify your treatment, as Cinacalcet might harm the unborn baby.

It is not known whether Cinacalcet is excreted in human milk. Your doctor will discuss with you if you should discontinue either breast-feeding or treatment with Cinacalcet.

Driving and using machines

No studies on the effects on the ability to drive and use machines have been performed. Dizziness and seizures have been reported by patients taking Cinacalcet. If you experience these, your ability to drive or operate machinery may be affected.

3. How to take Cinacalcet

Always take this medicine exactly as your doctor or pharmacist has told you. Check with your doctor or pharmacist if you are unsure. Your doctor will tell you how much Cinacalcet you must take.

Cinacalcet must be taken orally, with or shortly after food. The tablets must be taken whole and are not to be divided.

Your doctor will take regular blood samples during treatment to monitor your progress and will adjust your dose if necessary.

If you are being treated for secondary hyperparathyroidism

The usual starting dose for Cinacalcet is 30 mg (one tablet) once per day.

If you are being treated for parathyroid cancer or primary hyperparathyroidism

The usual starting dose for Cinacalcet is 30 mg (one tablet) twice per day.

If you take more Cinacalcet than you should

If you take more Cinacalcet than you should you must contact your doctor immediately. Possible signs of overdose include numbness or tingling around the mouth, muscle aches or cramps and seizures.

If you forget to take Cinacalcet

Do not take a double dose to make up for a forgotten dose.

If you have forgotten a dose of Cinacalcet, you should take your next dose as normal.

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

4. Possible side effects

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

If you start to get numbness or tingling around the mouth, muscle aches or cramps and seizures you should tell you doctor immediately. These may be signs that your calcium levels are too low (hypocalcaemia).

Very common: may affect more than 1 in 10 people

•    nausea and vomiting, these side effects are normally quite mild and do not last for long.

Common: may affect up to 1 in 10 people

•    dizziness

•    numbness or tingling sensation (paraesthesia)

•    loss (anorexia) or decrease of appetite

•    muscle pain (myalgia)

•    weakness (asthenia)

•    rash

•    reduced testosterone levels

•    high potassium levels in the blood (hyperkalaemia)

•    allergic reactions (hypersensitivity)

•    headache

•    seizures (convulsions or fits)

•    low blood pressure (hypotension)

•    upper respiratory infection

•    breathing difficulties (dyspnoea)

•    cough

•    indigestion (dyspepsia)

•    diarrhoea

•    abdominal pain, abdominal pain - upper

•    constipation

•    muscle spasms

•    back pain

•    low calcium levels in the blood (hypocalcaemia).

Not known: frequency cannot be estimated from available data

•    hives (urticaria)

•    swelling of the face, lips, mouth, tongue or throat which may cause difficulty in swallowing or breathing (angioedema)

•    unusually fast or pounding heart beat which may be associated with low levels of calcium in your blood (QT prolongation and ventricular arrhythmia secondary to hypocalcaemia).

After taking Cinacalcet a very small number of patients with heart failure had worsening of their condition and/or low blood pressure (hypotension).

Children and adolescents

The use of Cinacalcet in children and adolescents has not been established. A fatal outcome was reported in an adolescent clinical trial patient with very low calcium levels in the blood (hypocalcaemia).

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 Cinacalcet

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

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

This medicinal product does not require any special storage conditions.

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 Cinacalcet contains

•    The active substance is cinacalcet. Each film-coated tablet contains 30 mg, 60 mg or 90 mg of cinacalcet (as hydrochloride).

•    The other ingredients are: pre-gelatinised maize starch microcrystalline cellulose crospovidone magnesium stearate colloidal anhydrous silica

•    The tablets are coated with:

Opadry green [containing polyvinyl alcohol, titanium dioxide (E171), macrogol 3350, talc, yellow iron oxide (E172), indigo carmine aluminium lake (E132)]

What Cinacalcet looks like and contents of the pack

Cinacalcet is a light green to green film-coated tablet. They are oval-shaped and have “C30”, “C60” or “C90” marked on one side and plain on the other side.

Cinacalcet is available in blisters of 30 mg, 60 mg or 90 mg film-coated tablets. Each blister pack contains either 14, 28, 30 or 84 tablets in a carton.

Cinacalcet is also available in unit dose blisters of 30 mg, 60 mg or 90 mg film-coated tablets. Each unit dose blister pack contains either 14, 28, 30 or 84 tablets in a carton.

Cinacalcet is available in bottles of 30 mg, 60 mg or 90 mg film-coated tablets, inside a carton. Each bottle holds 30 tablets. Bottles are available with or without a silica gel desiccant. Do not eat the desiccant.

Not all pack sizes may be marketed.

Marketing Authorisation Holder

Teva UK Limited, Eastbourne, East Sussex, BN22 9AG, United Kingdom Manufacturer

Teva Operations Poland Sp. z.o.o, ul. Mogilska 80. , Krakow, 31-546, Poland *OR

Merckle GmbH, Ludwig-Merckle-StraBe 3, Blaubeuren, 89143, Germany *OR

Teva Pharma B.V., Swensweg 5, Haarlem, 2031 GA, The Netherlands *OR

PLIVA Hrvatska d.o.o. (PLIVA Croatia Ltd.), Prilaz baruna Filipovica 25, Zagreb, 10000, Croatia

This leaflet was last revised in 12/2015.

PL 00289/1968 PL 00289/1969 PL 00289/1970