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PACKAGE LEAFLET: INFORMATION FOR THE USER

Meropenem 500 mg Powder for Solution for Injection or Infusion Meropenem 1 g Powder for Solution for Injection or Infusion

(Meropenem trihydrate)

In this leaflet:

1.    What Meropenem is and what it is used for

2.    Before you use Meropenem

3.    How to use Meropenem

4.    Possible side effects

5.    How to store Meropenem

6.    Further information

1.    WHAT MEROPENEM IS AND WHAT IT IS USED FOR

Meropenem belongs to a group of medicines called carbapenem antibiotics. It works by killing bacteria, which can cause serious infections.

•    Infection affecting the lungs (pneumonia)

•    Lung and bronchial infections in patients suffering from cystic fibrosis

•    Certain types of urinary tract infections

•    Certain types of infections in the abdomen

•    Infections that you can catch during or after the delivery of your baby

•    Certain types of skin and soft tissues infections

•    Acute bacterial infection of the brain (meningitis).

Meropenem may be used in the management of neutropenic patients (patients with a low level of white blood cells) with a fever that is suspected to be due to a bacterial infection.

2.    BEFORE YOU USE MEROPENEM Do not use Meropenem

>    if you are allergic (hypersensitive) to Meropenem or any of the other ingredients of Meropenem (listed in Section 6 Further information).

>    If you are allergic (hypersensitive) to other antibiotics such as penicillins, cephalosporins, or carbapenems as you may also be allergic to Meropenem

Take special care with Meropenem

Check with your doctor before using Meropenem:

>    if you have health problems, such as liver or kidney problems.

>    if you have had severe diarrhoea after taking other antibiotics.

You may develop a positive test (Coombs test) which indicates the presence of antibodies that may destroy red blood cells. Your doctor will discuss this with you.

If you are not sure if any of the above applies to you, talk to your doctor or nurse before using Meropenem.

Using other medicines

Please tell your doctor if you are taking or have recently taken any other medicines, including medicines obtained without a prescription and herbal medicines.

This is because Meropenem can affect the way some medicines work and some medicines can have an effect on Meropenem.

In particular, tell your doctor or nurse if you are taking any of the following medicines:

>    Probenecid (used to treat gout).

>    Sodium valproate (used to treat epilepsy). Meropenem should not be used because it may decrease the effect of sodium valproate.

Pregnancy and breast-feeding

It is important that you tell your doctor if you are pregnant or are planning to become pregnant before receiving Meropenem. It is preferable to avoid the use of Meropenem during pregnancy.

Your doctor will decide whether you should use Meropenem.

It is important that you tell your doctor if you are breast-feeding or if you intend to breast-feed before receiving Meropenem. Small amounts of this medicine pass into the breast milk . Therefore, your doctor will decide whether you should use Meropenem while breast-feeding.

Ask your doctor for advice before taking any medicine.

Driving and using machines

No studies on the effect on the ability to drive and use machines have been performed. If you are receiving this medicine, it is unlikely that you are well enough to drive. Please ask your doctor for further advice.

Important information about some of the ingredients of Meropenem

Meropenem contains sodium.

Meropenem 500 mg: This medicinal product contains approximately 2.0 mEq (approx. 45 mg) of sodium per 500 mg dose which should be taken into consideration by patients on a controlled sodium diet.

Meropenem 1.0 g: This medicinal product contains approximately 4.0 mEq (approx. 90 mg) of sodium per 1.0 g dose which should be taken into consideration by patients on a controlled sodium diet.

If you have a condition which requires you to monitor your sodium intake please inform your doctor or nurse.

3. HOW TO USE MEROPENEM

Adults

>    The dose depends on the type of infection that you have, where the infection is in the body and how serious the infection is. Your doctor will decide on the dose that you need.

>    The dose for adults is usually between 500 mg (milligrams) and 2 g (gram). You will usually receive a dose every 8 hours. However you may receive a dose less often if your kidneys do not work very well.

Children and adolescents

>    The dose for children over 3 months old and up to 12 years of age is decided using the age and weight of the child. The usual dose is between 10 mg and 40 mg of Meropenem for each kilogram (kg) that the child weighs. A dose is usually given every 8 hours. Children who weigh over 50 kg will be given an adult dose.

>    Meropenem will be given to you as an injection or infusion into a large vein.

>    Your doctor or nurse will normally give Meropenem to you.

>    However, some patients, parents and carers are trained to give Meropenem at home. Instructions for doing this are provided in this leaflet (in the section called ‘Instructions for giving Meropenem to yourself or someone else at home’). Always use Meropenem exactly as your doctor has told you. You should check with your doctor if you are not sure.

>    Your injection should not be mixed with or added to solutions that contain other medicines.

>    The injection may take about 5 minutes or between 15 and 30 minutes. Your doctor will tell you how to give Meropenem.

>    You should normally have your injections at the same times each day.

If you use more Meropenem than you should

Tell your doctor or nurse straight away if you think you have been given too much of this medicine. If you are being given this medicine at home, contact your doctor or nearest hospital straight away

If you forget to use Meropenem

Tell your doctor or nurse straight away if you think you have not been given this medicine at right time. However, if you think it is almost time for next injection, make sure that your doctor or nurse skip the missed injection.

Ensure that you have not been given double dose (two injections at the same time) to make up for a forgotten dose.

If you stop using Meropenem

This medicine needs to be given as a series of injections over a few days. Your doctor will decide when this medicine could be stopped.

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

4. POSSIBLE SIDE EFFECTS

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

The frequency of possible side effects listed below is defined using the following convention:

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).

Severe allergic reactions

If you have a severe allergic reaction, stop having Meropenem and see a doctor straight away. You

may need urgent medical treatment. The signs may include a sudden onset of:

>    Sudden onset of a severe rash or blistering or peeling skin. This may be associated with a high fever and joint pains.

>    Severe rash, itching or hives on the skin.

>    Swelling of the face, lips, tongue or other parts of the body.

>    Shortness of breath, wheezing or trouble breathing.

Damage to red blood cells (not known)

The signs include:

>    Being breathless when you do not expect it.

>    Red or brown urine.

^ If you notice any of the above, see a doctor straight away.

Other possible side effects:

Common

>    Abdominal (stomach) pain.

>    Feeling sick (nausea).

>    Being sick (vomiting).

>    Diarrhoea.

>    Headache.

>    Skin rash, itchy skin.

>    Pain and inflammation.

>    Increased numbers of platelets in your blood (shown in a blood test).

>    Changes in blood tests, including tests that show how well your liver is working.

Uncommon

>    Changes in your blood. These include reduced numbers of platelets (which may make you bruise more easily), increased numbers of some white blood cells, decreased numbers of other white cells and increased amounts of a substance called ‘bilirubin’. Your doctor may do blood tests from time to time.

>    Changes in blood tests, including tests that show how well your kidney is working.

>    A tingling feeling (pins and needles).

>    Infections of the mouth or the vagina that are caused by a fungus (thrush).

Rare

>    Fits (convulsions).

Possible side effects frequency not known

>    Inflammation of the bowel with diarrhoea.

>    Sore veins where Meropenem is injected.

>    Other changes in your blood. The symptoms include frequent infections, high temperature and sore throat. Your doctor may do blood tests from time to time.

>    Serious hypersensitivity reactions involving fever, skin rash, and changes in the blood tests that check how the liver is working (increased levels of liver enzymes) and an increase in a type of white blood cell (eosinophilia) and enlarged lymph nodes. These may be signs of a multi-organ sensitivity disorder known as DRESS 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 or nurse.

5. HOW TO STORE MEROPENEM

Keep out of the reach and sight of children.

Do not use Meropenem after the expiry date which is stated on the container. The expiry date refers to the last day of that month.

Do not store above 25°C

After reconstitution: The reconstituted solutions for intravenous injection or infusion should be used immediately. The time interval between the beginning of reconstitution and the end of intravenous injection or infusion should not exceed one hour.

Do not freeze the reconstituted solution.

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. FURTHER INFORMATION

What Meropenem Powder for Solution for Injection or Infusion contains

The active substance is meropenem.

Each vial contains Meropenem trihydrate equivalent to 500 mg anhydrous Meropenem.

Each vial contains Meropenem trihydrate equivalent to 1 g anhydrous Meropenem.

The other ingredient is anhydrous sodium carbonate.

What Meropenem Powder for Solution for Injection or Infusion looks like and contents of the pack

Meropenem is a white to pale yellow crystalline powder for solution for injection or infusion in vial. Pack sizes of 1 or 10 vials.

Marketing Authorisation Holder and Manufacturer

Marketing Authorisation Holder:

Ranbaxy (UK) Limited 5th floor, Hyde Park, Hayes 3 11 Millington Road Hayes, UB3 4AZ United Kingdom

Manufacturer:

Terapia SA 124 Fabricii Street

Instructions for giving Meropenem to yourself or someone else at home

Some patients, parents and carers are trained to give Meropenem at home.

Warning - You should only give this medicine to yourself or someone else at home after a doctor or nurse has trained you.

>    The medicine must be mixed with another liquid (the diluent). Your doctor will tell you how much of the diluent to use.

>    Use the medicine straight after preparing it. Do not freeze it.

How to prepare this medicine

1.    Wash your hands and dry them very well. Prepare a clean working area.

2.    Remove the Meropenem bottle (vial) from the packaging. Check the vial and the expiry date. Check that the vial is intact and has not been damaged.

3.    Remove the coloured cap and clean the grey rubber stopper with an alcohol wipe. Allow the rubber stopper to dry.

4.    Connect a new sterile needle to a new sterile syringe, without touching the ends.

5.    Draw up the recommended amount of sterile ‘Water for Injections’ into the syringe. The amount of

Please note: If your prescribed dose of Meropenem is more than 1g, you will need to use more than 1 vial

of Meropenem. You can then draw the liquid in the vials into the one syringe.

6.    Put the needle of the syringe through the centre of the grey rubber stopper and inject the recommended amount of Water for Injections into the vial or vials of Meropenem.

7.    Remove the needle from the vial and shake the vial continuously in the palm of your hand for one minute. Allow to rest. Shake the vial for a further minute. Stand and check the clarity of the solution. If required, shake for further one minute or until all the powder has dissolved. Clean the grey rubber stopper once more with a new alcohol wipe and allow the rubber stopper to dry.

8.    With the plunger of the syringe pushed fully into the syringe, put the needle back through the grey rubber stopper. You must then hold both the syringe and the vial and turn the vial upside down.

9.    Keeping the end of the needle in the liquid, pull back the plunger and draw all the liquid in the vial into the syringe.

10.    Remove the needle and syringe from the vial and throw the empty vial away in a safe place.

11.    Hold the syringe upright, with the needle pointing upwards. Tap the syringe so that any bubbles in the liquid rise to the top of the syringe.

12.    Remove any air in the syringe by gently pushing the plunger until all the air has gone.

13.    If you are using Meropenem at home, dispose of any needles and infusion lines that you have used in an appropriate way. If your doctor decides to stop your treatment, dispose of any unused Meropenem in an appropriate way.

Giving the injection

You can either give this medicine through a short cannula or venflon, or through a port or central line.

Giving Meropenem through a short cannula or venflon

1.    Remove the needle from the syringe and throw the needle away carefully in your sharps bin.

2.    Wipe the end of the short cannula or venflon with an alcohol wipe and allow it to dry. Open the cap on your cannula and connect the syringe.

3.    Slowly push the plunger of the syringe to give the antibiotic steadily over about 5 minutes.

4.    Once you have finished giving the antibiotic and the syringe is empty, remove the syringe and use a flush as recommended by your doctor or nurse.

5.    Close the cap of your cannula and carefully throw the syringe away in your sharps bin.

Giving Meropenem through a port or central line

1.    Remove the cap on the port or line, clean the end of the line with an alcohol wipe and allow it to dry.

2.    Connect the syringe and slowly push the plunger on the syringe to give the antibiotic steadily over about 5 minutes.

3.    Once you have finished giving the antibiotic, remove the syringe and use a flush as recommended by your doctor or nurse.

4.    Place a new clean cap on your central line and carefully throw the syringe away in your sharps bin.

Giving Meropenem as intravenous infusion

Meropenem can be given by intravenous infusion over approximately 15 to 30 minutes. For intravenous infusion, meropenem vials may be directly constituted with sodium chloride 9 mg/ml (0.9 %) solution for infusion or glucose 50 mg/ml (5 %) solution for infusion, to a final concentration of 1 to 20 mg/ml.