Anasma Accuhaler 50 micrograms/500 micrograms/inhalation, powder for inhalation

Package leaflet: Information for the user

Introduction

Package leaflet: information for the user

Anasma Accuhaler 50 micrograms/500 micrograms/inhalation, inhalation powder

salmeterol/fluticasone propionate

Read the entire leaflet carefully before you start using this medicine, as it contains important information for you.

• Keep this leaflet, as you may need to read it again.
• If you have any questions, consult your doctor or pharmacist.
• This medicine has been prescribed for you only, and you should not give it to others, even if they have the same symptoms as you, because it could harm them.
• If you experience any adverse reactions, consult your doctor or pharmacist, even if they are adverse reactions not listed in this leaflet. See section 4.

Leaflet contents

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

1. What Anasma is and what it is used for

Anasma contains two active substances, salmeterol and fluticasone propionate:

• Salmeterol is a long-acting bronchodilator. Bronchodilators help keep the airways in the lungs open, making it easier for air to flow in and out. The effects last at least 12 hours.
• Fluticasone propionate is a corticosteroid that reduces inflammation and irritation in the lungs.

Your doctor has prescribed this medicine to help prevent breathing problems such as:

• Asthma.
• Chronic Obstructive Pulmonary Disease (COPD). Anasma Accuhaler, at a dose of 50/500 micrograms, reduces the number of exacerbations of COPD symptoms.

You should use Anasma every day as recommended by your doctor. This will ensure that the medication works effectively in controlling your asthma or COPD.

Anasma helps prevent breathlessness and wheezing. However, Anasma should not be used to relieve a sudden attack of breathlessness or wheezing. In such a case, you must use your fast-acting "rescue" medication, such as salbutamol. You should always carry your fast-acting rescue medication with you.

2. What you need to know before starting to use Anasma

Do not use Anasma

• if you are allergic to salmeterol, fluticasone propionate, or any of the other ingredients, including lactose monohydrate.

Warnings and precautions

Consult your doctor before starting treatment if you have:

• Heart problems, including rapid or irregular heartbeat.
• Overactive thyroid.
• High blood pressure.
• Diabetes mellitus (Anasma may increase blood sugar levels).
• Low levels of potassium in the blood.
• Tuberculosis (TB), either currently or in the past, or other lung infections.

Contact your doctor if you experience blurred vision or other visual disturbances.

Use of Anasma with other medicines

Inform your doctor or pharmacist if you are taking, have recently taken, or might need to take any other medicines, including those for asthma or those obtained without a prescription. This is because in some cases, Anasma should not be administered together with certain other medicines.

Tell your doctor if you are taking any of the following medicines before starting Anasma:

• β-blockers (such as atenolol, propranolol, and sotalol). β-blockers are mostly used to treat high blood pressure or other heart conditions.
• Medicines to treat infections (such as ketoconazole, itraconazol, and erythromycin), including some medicines for HIV (such as ritonavir, cobicistat). Some of these medicines may increase the amount of fluticasone propionate or salmeterol in your body. This could increase your risk of experiencing adverse effects with Anasma, including irregular heartbeats, or may worsen such effects. Therefore, your doctor will monitor you closely if you are taking these medicines.
• Corticosteroids (oral or injectable). If you have recently taken these medicines, there may be an increased risk that this medicine could affect your adrenal gland.
• Diuretics, also known as "water pills," used to treat high blood pressure.
• Other bronchodilators (such as salbutamol).
• Medicines containing xanthines. These are often used to treat asthma.

Pregnancy and breastfeeding

If you are pregnant or breastfeeding, think you may be pregnant, or plan to become pregnant, consult your doctor or pharmacist before using this medicine.

Driving and using machines

Anasma is unlikely to affect your ability to drive or operate machinery.

Anasma Accuhaler contains lactose

Anasma Accuhaler contains up to 12.5 milligrams of lactose monohydrate per dose. The amount of lactose in this medicine is generally not expected to cause problems in people with lactose intolerance. However, it may cause allergic reactions in patients who are allergic to cow's milk protein. If your doctor has informed you that you have an intolerance to certain sugars, please consult with him before using this medicine.

3. How to use Anasma

Follow exactly the administration instructions for this medicine given by your doctor or pharmacist. If in doubt, consult your doctor or pharmacist again.

• Use Anasma every day until your doctor tells you to stop. Do not take more than the recommended dose. If in doubt, consult your doctor or pharmacist.
• Do not stop taking Anasma or reduce your dose without first speaking to your doctor.
• Anasma must be inhaled through the mouth into the lungs.
• You may not taste or feel the powder on your tongue, even if you have used the Accuhaler correctly.

For asthma

Adults and adolescents aged 12 years and older

• Anasma 50/100 Accuhaler: One inhalation twice daily
• Anasma 50/250 Accuhaler: One inhalation twice daily
• Anasma 50/500 Accuhaler: One inhalation twice daily

Children aged 4 to 12 years

• Anasma 50/100 Accuhaler: One inhalation twice daily
• Anasma is not recommended for use in children under 4 years of age.

For adults with Chronic Obstructive Pulmonary Disease (COPD)

• Anasma 50/500 Accuhaler: One inhalation twice daily

Your symptoms may become well controlled with Anasma taken twice daily. If so, your doctor may decide to reduce your dose to once daily. The dose may be changed to:

• once at night if you have nocturnal symptoms,
• once in the morning if you have diurnal symptoms.

It is very important that you follow your doctor's instructions on how many doses and how often you should take your medication.

If you are using Anasma to treat asthma, your doctor will want to monitor your symptoms regularly.

If your asthma worsens or you have increasing difficulty breathing, see your doctor immediately. You may notice more wheezing or breathlessness more often, or find that you need to use your fast-acting rescue medication more frequently. If any of these occur, you should continue using Anasma, but do not increase the number of inhalations. Your respiratory condition may worsen and you may become seriously ill. See your doctor, as you may need additional treatment.

Instructions for use

• Your doctor, nurse, or pharmacist should show you how to use your inhaler. They should periodically check that you are using it correctly. Incorrect or inappropriate use of the Anasma Accuhaler may result in your asthma or COPD not improving as expected.
• This Accuhaler contains blisters containing Anasma in powder form.
• There is a dose counter on the top of the Accuhaler indicating how many doses remain. It counts down to 0. Numbers from 5 to 0 will appear in red to warn you that few doses remain. Once the counter reaches 0, your inhaler is empty.

Using your inhaler

1. To open the Accuhaler, hold the outer case with one hand and place the thumb of the other hand in the designated thumb grip. Push the thumb away from you as far as it will go. You will hear a "click". This opens a small aperture in the mouthpiece.

2. Hold the device with the mouthpiece facing you. You may hold it with either your right or left hand. Slide the lever away from you. You will hear a "click". This delivers the dose of medication into the mouthpiece.

Each time the lever is slid back, a blister is opened and the powder is prepared for inhalation. Do not play with the lever, as this opens the blisters and wastes medication.

3. Keep the Accuhaler away from your mouth. Breathe out as fully as possible. Do not breathe into the Accuhaler.

4. Place the mouthpiece in your lips; inhale steadily and deeply through the Accuhaler, not through your nose.

Remove the Accuhaler from your mouth.

Hold your breath for about 10 seconds, or as long as possible.

Breathe out slowly.

5. After use, rinse your mouth with water, spit it out, and/or brush your teeth. This may help prevent mouth ulcers and hoarseness.

6. To close the Accuhaler, slide the lever toward you with your thumb as far as it will go. You will hear a "click".

The lever will automatically return to its original position.

The Accuhaler is now ready for reuse.

As with all inhalers, caregivers should ensure that children using Anasma Accuhaler follow the correct inhalation technique described above.

Cleaning your inhaler

To clean, wipe the mouthpiece of the Accuhaler with a dry tissue.

If you use more Anasma than you should

It is very important to use the inhaler exactly as instructed. If you have accidentally taken a higher dose than recommended, consult your doctor or pharmacist. You may notice your heart beating faster than normal and feel tremors. You may also experience dizziness, headache, muscle weakness, and joint pain.

If you have used large doses over long periods, you should seek advice from your doctor or pharmacist. This is because high concentrations of Anasma may reduce the amount of steroid hormones produced by the adrenal gland.

In case of overdose, contact your doctor or pharmacist immediately or call the Toxicology Information Service at: 91 562 04 20, indicating the medicine and the amount taken.

If you forget to use Anasma

Do not take a double dose to make up for missed doses. Take the next dose at your usual time.

If you stop treatment with Anasma

It is very important that you use Anasma every day as instructed. Continue taking it until your doctor tells you to stop. Do not stop treatment with Anasma abruptly. This could cause your breathing to worsen.

Additionally, if you stop taking Anasma suddenly or reduce your dose, you could (very rarely) develop problems with your adrenal gland (adrenal insufficiency), which sometimes causes adverse effects.

These adverse effects may include any of the following:

• Stomach pain.
• Tiredness and loss of appetite, feeling unwell.
• Malaise and diarrhea.
• Weight loss.
• Headache or drowsiness.
• Low blood sugar levels.
• Low blood pressure and seizures (fits).

When your body is under stress due to fever, trauma (e.g., traffic accident), infection, or surgery, adrenal insufficiency may worsen, and you may experience any of the adverse effects listed above.

If you experience any adverse effects, consult your doctor or pharmacist. To prevent these symptoms, your doctor may prescribe an additional dose of oral corticosteroids during that time (such as prednisolona).

If you have any further questions about using this medicine, ask your doctor, nurse, or pharmacist.

4. Possible adverse effects

Like all medicines, this medicine can cause adverse effects, although not everyone experiences them. To reduce the occurrence of adverse effects, your doctor will prescribe the lowest dose of Anasma that controls your asthma or Chronic Obstructive Pulmonary Disease (COPD).

Allergic reactions: you may notice that your breathing suddenly worsens immediately after using Anasma. You may experience wheezing, coughing, or shortness of breath. You may also notice itching, rash (urticaria), and swelling (usually of the face, lips, tongue, or throat). You may also suddenly feel that your heart is beating very fast, feel faint, or dizzy (which may lead to collapse or loss of consciousness). If you experience any of these effects, or if they occur suddenly after using Anasma, stop taking Anasma and contact your doctor immediately. Allergic reactions to Anasma are uncommon (affecting fewer than 1 in 100 people).

Pneumonia (lung infection) in patients with COPD (common adverse effect)

Inform your doctor if you experience any of the following symptoms while inhaling Anasma, as they could be signs of a lung infection:

• Fever or chills
• Increased mucus production, change in the color of mucus
• Increased coughing or worsening breathing difficulties

Other adverse effects listed below:

Very common (may affect more than 1 in 10 people)

• Headache, which usually improves with continued treatment.
• An increased number of colds has been reported in patients with Chronic Obstructive Pulmonary Disease (COPD).

Common (may affect less than 1 in 10 people)

• Oral and throat candidiasis (itching, yellowish creamy lesions), pain in the tongue, hoarseness, and throat irritation. Rinsing the mouth with water and spitting it out and/or brushing teeth immediately after each dose of medication may help.

For treatment of candidiasis, your doctor may prescribe antifungal medication (to treat fungal infections).

• Joint pain and swelling, and muscle pain.
• Muscle cramps.

The following adverse effects have been reported in patients with Chronic Obstructive Pulmonary Disease (COPD):

• Bruising and fractures.
• Sinus inflammation (feeling of pressure or congestion in the nose, cheeks, and behind the eyes, sometimes with pulsating pain).
• Decreased blood potassium levels (you may experience irregular heartbeat, muscle weakness, cramps).

Uncommon (may affect less than 1 in 100 people)

• Increased blood sugar (glucose) levels (hyperglycemia). If you have diabetes, your blood sugar levels will need to be monitored more frequently, and your usual diabetes treatment may need to be adjusted if necessary.
• Cataracts (clouding of the eye's lens).
• Very fast heartbeat (tachycardia).
• Tremors and a fast or irregular heartbeat (palpitations). These adverse effects are usually harmless and decrease with continued treatment.
• Chest pain.
• Feeling of anxiety (occurs mainly in children).
• Sleep disorders.
• Skin rash.
• Allergic skin rash.

Rare (may affect less than 1 in 1,000 people)

• Worsening breathing difficulty (or wheezing) immediately after using Anasma. If this happens, stop using Anasma. Use your fast-acting "rescue" inhaler to improve your breathing and contact your doctor immediately.

• Anasma may increase the normal production of steroid hormones, particularly if you have been taking high doses for long periods of time. Effects include:

• Growth retardation in children and adolescents.

• Decreased bone mineral density.

• Glaucoma.

• Weight gain.

• Rounded face (moon face) (Cushing's syndrome).

Your doctor will regularly monitor for any of these adverse effects and ensure you are taking the lowest effective dose of Anasma to control your asthma.

• Behavioral changes such as hyperactivity and irritability (these effects occur mainly in children).
• Irregular heartbeat or extra heartbeats (arrhythmias). Consult your doctor, but do not stop taking Anasma unless your doctor tells you to.
• Fungal infection of the esophagus (throat), which may cause difficulty swallowing.

Frequency not known, but may also occur:

• Depression or aggression. These effects are more likely to occur in children.
• Blurred vision.

Reporting of adverse effects

If you experience any adverse effects, consult your doctor or pharmacist, even if they are possible adverse effects not listed in this leaflet. You may also report them directly via the Spanish Pharmacovigilance System for Human Medicines: www.notificaRAM.es. By reporting adverse effects, you can help provide more information on the safety of this medicine.

5. Storage of Anasma

Keep this medicine out of the sight and reach of children.

Do not use Anasma after the expiry date stated on the label and the carton after EXP. The expiry date refers to the last day of the month indicated.

Do not store above 30°C.

Medicines should not be disposed of via wastewater or household waste. Dispose of unused or expired containers and medicines at the SIGRE collection point at your pharmacy. If you are in doubt, ask your pharmacist how to properly dispose of unused or unwanted containers and medicines. This will help protect the environment.

6. Contents of the pack and other information

Composition of Anasma

• Each pre-dispensed dose contains 50 micrograms of salmeterol (as salmeterol xinafoate) and 500 micrograms of fluticasone propionate.
• The other component is lactose monohydrate (contains milk proteins).

Nature and content of the container

Anasma Accuhaler contains a strip of blisters. The blisters protect the inhaled powder from atmospheric effects.

Each dose is pre-dispensed.

The devices are supplied in packs of 1 Accuhaler x 60 inhalations.

Marketing Authorisation Holder and Manufacturer

Marketing Authorisation Holder:

GlaxoSmithKline, S.A.

P.T.M. C/ Severo Ochoa, 2

28760 Tres Cantos (Madrid)

Tel: +34 900 202 700

[email protected]

Manufacturer:

Glaxo Wellcome Production

Zone Industrielle nº 2, 23 Rue Lavoisier, La Madeleine, 27000 Evreux, France

Tel: +33 2 3223 5500

Fax: +33 2 3223 5558

or

Aspen Bad Oldesloe GmbH

Industriestrasse 32-36, 23843 Bad Oldesloe, Germany

This leaflet was last reviewed in July 2020.

Detailed and up-to-date information on this medicine is available on the website of the Spanish Agency of Medicines and Medical Devices (AEMPS) http://www.aemps.gob.es/