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3. How to use Fyremadel

Fyremadel is used as part of the treatment for assisted reproduction techniques (ART) including in vitro fertilisation (IVF).

Package leaflet: Information for the user

Fyremadel 0.25 mg/0.5 ml solution for injection in pre-filled syringe

ganirelix

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 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 Fyremadel is and what it is used for

2.    What you need to know before you use Fyremadel

3.    How to use Fyremadel

4.    Possible side effects

5.    How to store Fyremadel

6.    Contents of the pack and other information

1. What Fyremadel is and what it is used for

Fyremadel belongs to a group of medicines called "anti-gonadotrophin-releasing hormones" which act against the actions of the natural gonadotrophin releasing hormone (GnRH). GnRH regulates the release of gonadotrophins (luteinising hormone (LH) and follicle stimulating hormone (FSH)). Gonadotrophins play an important role in human fertility and reproduction. In women, FSH is needed for the growth and development of follicles in the ovaries. Follicles are small round sacs that contain the egg cells. LH is needed to release the mature egg cells from the follicles and ovaries (i.e. ovulation). Fyremadel inhibits the action of GnRH, resulting in suppression of the release of especially LH.

Fyremadel is used for

In women undergoing assisted reproduction techniques, including in vitro fertilisation (IVF) and other methods, occasionally ovulation may occur too early causing a significant reduction in the chance of getting pregnant. Fyremadel is used to prevent the premature LH surge that might cause such a premature release of egg cells.

You will be giving yourself the injections and so your doctor will explain what you have to do. Always use this medicine exactly as your doctor or pharmacist has told you. If you have not understood the instructions check with your doctor or pharmacist.

Stage 1

Ovarian stimulation with follicle stimulating hormone (FSH) or corifollitropin may start at day 2 or 3 of your period.

Stage 2

The content of the syringe Fyremadel (0.25 mg) should be injected just under the skin once daily, starting on day 5 or day 6 of stimulation. Based on your ovarian response, your doctor may decide to start on another day.

Fyremadel and FSH should be administered approximately at the same time. However, the preparations should not be mixed and different injection sites must be used.

Daily treatment with Fyremadel should be continued up to the day that sufficient follicles of adequate size are present.

Stage 3

Final maturation of the egg cells in the follicles can be induced by administering human chorionic gonadotrophin (hCG). The time between two Fyremadel injections as well as the time between the last Fyremadel injection and hCG injection should not exceed 30 hours, as otherwise a premature ovulation (i.e. release of egg cells) may occur. Therefore, if you have been injecting Fyremadel in the morning you must also have Fyremadel on the day when you will receive the hCG treatment to trigger ovulation. If you have been injecting Fyremadel in the afternoon the last Fyremadel injection should be given in the afternoon prior to the day of triggering ovulation.

Instructions for use

Injection site

Fyremadel is supplied in pre-filled syringes which contain one dose. The contents should be injected slowly, just under the skin, preferably in the upper leg . Inspect the solution before use. Do not use if the solution contains particles or is not clear. If you administer the injections yourself or have it done by your partner, follow the instructions below carefully. Do not mix Fyremadel with any other medicines.

In clinical studies ganirelix was used with recombinant follicle stimulating hormone (FSH) or corifollitropin alfa, a follicle stimulant with a long duration of action.

2. What you need to know before you use Fyremadel

Do not use Fyremadel

-    if you are allergic to ganirelix or any of the other ingredients of this medicine (listed in section 6)

-    if you are hypersensitive to gonadotrophin releasing hormone (GnRH) or a GnRH analogue

-    if you have a moderate or severe kidney or liver disease

-    if you are pregnant or breast-feeding.

Warnings and precautions

Talk to your doctor or pharmacist before using Fyremadel

-    if you have an active allergic condition, please tell your doctor. Your doctor will decide, depending on the severity, if additional monitoring is required during treatment. Cases of allergic reactions have been reported, as early as with the first dose.

-    during or following hormonal stimulation of the ovaries, ovarian hyperstimulation syndrome may develop. This syndrome is related to the stimulation procedure with gonadotrophins. Please refer to the Package Leaflet of the gonadotrophin-containing medicine prescribed for you.

-    the incidence of congenital malformations after assisted reproduction techniques may be slightly higher than after spontaneous conceptions. This slightly higher incidence is thought to be related to characteristics of the patients undergoing fertility treatment (e.g. age of the woman, sperm characteristics) and to the higher incidence of multiple gestations after assisted reproduction techniques. The incidence of congenital malformations after assisted reproduction techniques using Fyremadel is not different from that after using other GnRH analogues in the course of assisted reproduction techniques.

-    there is a slightly increased risk of extra-uterine pregnancy in women with damaged fallopian tubes.

-    the efficacy and safety of Fyremadel has not been established in women weighing less than 50 kg or more than 90 kg. Ask your doctor for further information.

Children and adolescents

There is no relevant use of Fyremadel in children.

Other medicines and Fyremadel

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

Pregnancy, breast-feeding and fertility

Fyremadel should be used during controlled ovarian stimulation for assisted reproduction techniques (ART). Do not use

Fyremadel during pregnancy and breast-feeding.

Preparing the injection site

Wash your hands thoroughly with soap and water. Swab the injection site with a disinfectant (for example alcohol) to remove any surface bacteria. Clean about 5 cm (two inches) around the point where the needle will go in and let the disinfectant dry for at least one minute before proceeding.

Inserting the needle

Remove the needle cover. Pinch up a large area of skin between finger and thumb. Insert the needle at the base of the pinched-up skin at an angle of 45° to the skin surface. Use a different place for each injection.

Checking the correct needle position

Gently draw back the plunger of the syringe to check if the needle is positioned correctly. If any blood is drawn into the syringe it means the needle tip has penetrated a blood vessel. If this happens, do not continue with the injection of Fyremadel.

Remove the syringe, cover the injection site with a swab containing disinfectant and apply pressure; bleeding should stop in a minute or two. Do not use this syringe and dispose of it properly. Start again with a new syringe.

Injecting the solution

Once the needle has been correctly placed, depress the plunger slowly and steadily, so the solution is correctly injected and the skin tissues are not damaged.

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.

Driving and using machines

The effects of Fyremadel on ability to drive and use machines have not been studied.

Fyremadel contains sodium

Fyremadel contains less than 1 mmol sodium (23 mg) per injection, i.e. essentially "sodium-free".

Removing the syringe

Pull the syringe out quickly and apply pressure to the site with a swab containing disinfectant. Use the pre-filled syringe only once.

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

Austria:

Denmark:

Finland:

France:

Germany:

Italy:

The Netherlands: Norway:

Spain:

Sweden:

United Kingdom:

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This leaflet was last revised in 10/2016

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