Fostipur Kit 150 IU powder and solvent for injection solution

Patient Information Leaflet

Introduction

Patient Information Leaflet

Fostipur Kit 150 UI powder and solvent for injectable solution

Urofollitropin

Read this entire leaflet carefully before you start using this medicine, because 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 may harm them.
• If you experience any adverse effects, consult your doctor or pharmacist, even if they are adverse effects not listed in this leaflet. See section 4.

Leaflet contents

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

1. What Fostipur Kit is and what it is used for

• Fostipur Kit is used to stimulate ovulation in women who do not ovulate and who
  do not respond to other treatments (clomiphene citrate).

• In the induction of multifollicular development (and therefore, of multiple oocytes) in
  women undergoing fertility treatments.

Urofollitropin is a highly purified follicle-stimulating hormone belonging to a group of medicines called gonadotropins.

This medicine must be used under the supervision of your doctor.

2. What you need to know before using Fostipur Kit

Before starting treatment, the fertility of the couple should be evaluated.

Do not use Fostipur Kit

• If you are allergic to urofollitropin or to any of the other ingredients of this medicine (listed in section 6).
• Enlargement of the ovaries or ovarian cysts not caused by a

hormonal disorder (polycystic ovary syndrome).

• Unexplained bleeding.
• Ovarian, uterine, or breast cancer.
• Abnormal swelling (tumor) of the pituitary gland or hypothalamus (in the brain).

You must not use this medicine if you have conditions such as premature menopause, malformation of the genital organs, or tumors of the uterus that would prevent a normal pregnancy.

Warnings and precautions

Although there is no information available on allergic reactions with Fostipur Kit, you should inform your doctor if you have ever had an allergic reaction to similar medicines.

This treatment increases the risk of developing a condition known as ovarian hyperstimulation syndrome (OHSS) (see Possible side effects). If ovarian hyperstimulation occurs, treatment must be stopped and you must avoid becoming pregnant. Early signs of ovarian hyperstimulation include pain in the lower abdomen, as well as nausea (feeling unwell), vomiting, and weight gain. If these symptoms occur, you should be examined by your doctor as soon as possible. In severe, although rare, cases, the ovaries may enlarge and fluid may accumulate in the abdomen or chest.

The medicine used to trigger the final release of mature eggs (containing human chorionic gonadotropin, hCG) may increase the likelihood of developing OHSS. Therefore, hCG should not be used when ovarian hyperstimulation is developing, and you should avoid sexual intercourse, even when using barrier contraceptive methods, for at least 4 days.

It should be noted that women with fertility problems have a higher rate of spontaneous abortion than the general population.

The occurrence of multiple pregnancies and births in patients receiving ovulation induction treatment is increased compared to natural conception. However, this risk can be reduced by using the recommended dose.

There is a slightly increased risk of ectopic pregnancy (pregnancy outside the uterus) in women with damaged Fallopian tubes.

Multiple pregnancies and parental characteristics in fertility treatments (e.g., maternal age, sperm characteristics) may be associated with a higher risk of birth abnormalities.

Treatment with Fostipur Kit, as well as pregnancy itself, may increase the risk of thrombosis. Thrombosis is the formation of a blood clot in a blood vessel, most often in the veins of the legs or in the lungs.

Consult your doctor before starting treatment, especially:

• if you already know you have an increased risk of thrombosis;
• if you or a close family member has ever had thrombosis;
• if you are significantly overweight.

This medicine is prepared from human urine. The risk of transmitting infection or disease cannot be completely eliminated. However, this risk is minimized by virus elimination steps during the manufacturing process, particularly for AIDS, Herpes virus, and Papillomavirus.

No cases of viral contamination have been reported.

Use of Fostipur Kit with other medicines

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

Pregnancy and breastfeeding

Fostipur Kit must not be used if you are pregnant or breastfeeding.

Fostipur Kit contains sodium

This medicine contains less than 1 mmol of sodium (23 mg) per dose, i.e., essentially "sodium-free".

3. How to use Fostipur Kit

Dosage and duration of treatment:

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

Women who do not ovulate and have irregular or incomplete menstrual periods:

If you are menstruating, treatment should begin within 7 days after the start of menstruation (the first 7 days of the menstrual cycle).

The dose consists of 1 injection per day, under the skin (subcutaneously).

The usual initial dose is 75 IU to 150 IU of FSH (Fostipur Kit) per day. This dose may be increased if necessary, by 37.5 IU to 75 IU at intervals of 7 days or, preferably, 14 days, to achieve an adequate response.

The maximum daily dose of FSH should generally not exceed 225 IU.

If your doctor does not observe an adequate response after 4 weeks of treatment, this treatment cycle should be discontinued. For the next cycle, your doctor will advise you to start with a higher initial dose.

When a good response is achieved (satisfactory follicular growth), you will receive only one injection of another medicine (hCG), used to induce final follicular maturation and release of the eggs. This will occur 24–48 hours after the last injection of Fostipur Kit. It is recommended to have sexual intercourse on the same day as the hCG administration and the following day.

If an excessive ovarian response occurs, treatment must be stopped and hCG will not be administered (see Possible side effects). For the next cycle, your doctor will advise you to start with a lower initial dose.

Women undergoing ovarian stimulation for multiple follicular development prior to in vitro fertilization or other assisted reproductive techniques:

Situation 1 – If you are menstruating

Treatment should begin on day 2 or 3 of your menstrual period (the first 2 or 3 days of the menstrual cycle).

The dose consists of 1 subcutaneous injection per day.

A commonly used dose for superovulation is 150 to 225 IU of Fostipur Kit per day. Treatment continues, with dose adjustments based on your response, until adequate follicular development is achieved. This is usually reached by day 10 of treatment (an average of 5 to 20 days) and is assessed by blood sampling and/or ultrasound examinations.

The maximum dose is generally 450 IU/day.

Once adequate follicular development is achieved, a single injection of a medicine used to induce final follicular maturation will be given; this medicine contains up to 10,000 IU of human chorionic gonadotropin (hCG). It will be administered 24–48 hours after the last injection of Fostipur Kit.

Egg retrieval will take place approximately 35 hours later.

Situation 2 – When a gonadotropin-releasing hormone (GnRH) agonist is used

Fostipur Kit should be administered approximately 2 weeks after starting the GnRH agonist treatment. Both treatments are continued until adequate follicular development is achieved. One daily subcutaneous injection of Fostipur Kit is given. For example, after 2 weeks of treatment with a GnRH agonist, 150 to 225 IU of Fostipur Kit may be administered for the first 7 days. The dose will then be adjusted according to ovarian response.

Instructions for administration:

Fostipur Kit is administered by injection under the skin (subcutaneously).

Each vial is for single use only, and the injection must be administered immediately after preparation.

After proper instruction and practice, your doctor may ask you to self-administer the Fostipur Kit injection.

First, your doctor must:

• Allow you to practice self-administering the subcutaneous injection.
• Indicate the suitable sites for self-injection.
• Instruct you on how to carefully prepare the solution for injection.
• Explain how to prepare the correct dose to be administered.

Before you self-administer the Fostipur Kit injection, carefully read the following instructions:

How to prepare and inject 1 vial of Fostipur Kit, using 1 vial of powder:

The solution must be prepared immediately before the injection. Each vial is for single use only. The medicine must be reconstituted under aseptic conditions.

Fostipur Kit must be reconstituted only with the solvent provided in the kit.

Prepare a clean surface and wash your hands before reconstituting the solution. It is important that both your hands and the materials you will use are as clean as possible.

Lay out the following materials on a clean surface:

• 2 alcohol swabs (not included in the package),
• 1 vial containing Fostipur Kit powder,
• 1 pre-filled syringe with solvent,
• 1 needle for preparing the injection,
• 1 fine needle for subcutaneous injection.

Reconstitution of the injection solution using 1 vial of powder

Preparing the solution for injection:

Remove the cap from the pre-filled syringe; insert the reconstitution needle (long needle) into the syringe. Carefully place the syringe on a clean surface and avoid contact with the needle.

	Remove the colored plastic cap from the powder vial by gently pushing it upward. Disinfect the rubber stopper by wiping it with an alcohol swab and allow it to dry.
	Take the syringe, remove the protective needle cap, and slowly inject the solvent into the powder vial through the center of the rubber stopper. Press the plunger firmly downward to ensure all the solution is delivered onto the powder. The syringe plunger has a safety stop to prevent accidental dislodgement and to improve syringe handling during injection administration. DO NOT SHAKE, but gently swirl the vial in your hands until the powder is completely dissolved, taking care to avoid foaming.
	Once the powder is fully dissolved (which generally happens immediately), slowly withdraw the solution into the syringe. With the needle still inserted, turn the vial upside down. Ensure the needle tip is below the liquid level. Gently pull back the plunger to draw all the solution into the syringe. Check that the reconstituted solution is clear and colorless.

Preparation of higher doses using more than 1 vial of powder

If your doctor has recommended higher doses, you can achieve this by using more than 1 vial of powder with a pre-filled solvent syringe.

When reconstituting more than 1 vial of Fostipur Kit, after completing step 4 described above, draw the reconstituted content from the first vial back into the syringe and slowly inject it into a second vial. Repeat steps 2 to 4 for the second and any additional vials until the contents of the required number of vials—corresponding to the prescribed dose—are dissolved (within the limit of the maximum total dose of 450 IU, equivalent to a maximum of 6 vials of Fostipur Kit 75 IU, 3 vials of Fostipur Kit 150 IU, or 2 vials of Fostipur Kit 225 IU).

Your doctor may increase your dose by 37.5 IU, which represents half a vial of Fostipur Kit 75 IU.

To do this, reconstitute the contents of the 75 IU vial according to steps 2 to 3 described above, and withdraw half of this reconstituted solution (0.5 ml) into the syringe as described in step 4.

In this case, you will have two preparations to inject: the first reconstituted preparation in 1 ml and the second containing 37.5 IU in 0.5 ml.

Both preparations must be injected using their respective syringes, according to the following steps.

The solution must be clear and colourless.

Inject the medicine subcutaneously:

	When the syringe already contains the prescribed dose, put on the needle protective cap. Remove the needle from the syringe and replace it with the fine needle for subcutaneous injection, including the protective cap. Firmly push the fine needle onto the syringe barrel. Then, turn it slightly to ensure it is fully screwed on, thereby creating a secure seal.
	Remove the needle protective cap. Hold the syringe with the needle pointing upward and gently tap the sides of the syringe to move any air bubbles to the top. Push the plunger until a drop of liquid appears at the tip of the needle. • Do not use if particles are present or if the solution is cloudy.

The injection site:

•Your doctor or nurse will have indicated to you which part of your body you can use to inject the medicine. The most common sites are the thigh or the lower abdominal wall below the navel.

• Clean the injection site with a cotton ball containing alcohol.

Inserting the needle:

Pinch the skin firmly. With the other hand, insert the needle with a dart-like motion, at an angle of 45° or 90°.

Injection of the solution:

• Inject it under the skin as you have been taught. Do not inject it directly into a vein. Push the plunger slowly and steadily, so that the solution is injected correctly and the skin is not damaged.

Take all the time you need to inject the prescribed volume of solution. As described in the preparation of the solution, depending on the dose prescribed by your doctor, you may not need to use the entire volume of the solution.

Removal of the needle:

• Remove the syringe quickly and press the injection site with a disinfectant swab. Gently massage the area while still applying pressure; this helps disperse the Fostipur Kit solution and relieves discomfort.

Disposal of all used materials:

Any unused product or waste material must be disposed of in accordance with local requirements (after the injection, all needles and empty syringes must be discarded into an appropriate container).

If you use more Fostipur Kit than you should

The effects of an overdose of Fostipur Kit are unknown, although ovarian hyperstimulation syndrome may occur (see Possible side effects). If you have administered more Fostipur Kit than you should, contact your doctor or pharmacist.

In case of overdose or accidental ingestion, contact your doctor or pharmacist immediately, or call the Toxicology Information Service at telephone number: 915 620 420, stating the name of the medicine and the amount ingested.

If you forget to use Fostipur Kit

Administer the next injection at the time scheduled. Do not use a double dose to make up for missed doses.

If you stop using Fostipur Kit

Do not stop treatment on your own initiative. Always consult your doctor if you are considering stopping this medicine. If you have any further questions about the use of this medicine, consult your doctor or pharmacist.

4. Possible adverse effects

Like all medicines, Fostipur Kit can cause adverse effects, although not everyone will experience them.

The following adverse effects are important and will require immediate action if experienced.

You must stop taking Fostipur Kit and see your doctor immediately if any of the following occur:

Frequent, may affect up to 1 in 10 people:

• Ovarian Hyperstimulation Syndrome (see Section 2 of Additional Information)

The following adverse effects have also been reported:

Frequent, may affect up to 1 in 10 people:

• Headache,

• feeling of abdominal bloating,

• constipation,

• pain at the injection site.

Uncommon, may affect up to 1 in 100 people:

• Increased activity of the thyroid gland,
• mood changes,
• fatigue,
• dizziness,
• difficulty breathing (dyspnea),
• nosebleeds,
• nausea, indigestion, abdominal pain,
• redness, itching,
• hot flushes,
• cystitis,
• breast enlargement, breast pain,
• difficulty in stopping bleeding.

Redness, pain, and bruising at the injection site may occur (frequency not known).

See Section 2 of Additional Information regarding the risk of blood clots, ectopic pregnancy, multiple pregnancies, and miscarriages.

If you consider any of the adverse effects you experience to be severe, or if you notice any adverse effects not listed in this leaflet, inform your doctor or pharmacist.

Reporting of adverse effects:

If you experience any type of adverse effect, consult your doctor or pharmacist, even if it is a possible adverse effect not listed in this leaflet. You may also report them directly via the Spanish Pharmacovigilance System for Human Medicinal Products: https://www.notificaram.es.

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

5. Storage of Fostipur Kit

Keep this medicine out of sight and reach of children.

Do not store above 25°C. Keep the vial and the pre-filled solvent syringe in the outer packaging to protect from light.

Do not use this medicine after the expiry date stated on the cardboard box and on the vial.

Use immediately after reconstitution.

Do not use Fostipur Kit if the solution appears not to be clear. After reconstitution, the solution must be clear and colourless.

Medicines must not be disposed of via wastewater or household waste. Unused medicines and waste materials should be returned to the SIGRE collection point at your pharmacy. If in doubt, ask your pharmacist how to dispose of any unused medicines and packaging. This will help protect the environment.

6. Contents of the pack and other information

Composition of Fostipur Kit

The active substance is urofollitropin.

Each vial contains 150 IU of urofollitropin (follicle-stimulating hormone, FSH): 1 ml of reconstituted solution contains 150 IU, 300 IU, or 450 IU of urofollitropin when 1, 2, or 3 vials of product are reconstituted, respectively, in 1 ml of solvent.

The specific in vivo activity is equal to or greater than 5000 IU of FSH per mg of protein.

Other components are:

Powder: lactose monohydrate.

Solvent: sodium chloride and water for injections.

Appearance of the product and contents of the pack

Fostipur Kit is supplied as a powder and solvent for injectable solution.

Cartons containing 1, 5, or 10 kits. Each kit contains: 1 vial with powder containing 150 IU of urofollitropin, 1 pre-filled syringe with 1 ml of solvent, 1 needle for reconstitution, and 1 needle for subcutaneous injection.

The powder appears as a white to off-white solid mass, and the solvent is clear and colourless.

Marketing Authorization Holder and Manufacturer

Marketing Authorization Holder

IBSA Farmaceutici Italia srl
Via Martiri di Cefalonia 2
26900 Lodi (Italy)

Manufacturer

IBSA Farmaceutica Italia, Srl, Via Martiri di Cefalonia, 2 - 26900 Lodi (Italy)

You can request further information regarding this medicinal product from the local representative of the Marketing Authorization Holder:

Instituto Bioquimico Iberico IBSA S.L.
Avenida Diagonal 605,
8th Floor, Local 1,
08028 Barcelona (Spain)

This medicinal product is authorized in the Member States of the European Economic Area under the following names (concentrations and pharmaceutical forms are identical in all countries; only the trade names differ):

Austria: Fostimon PFS
Belgium: Fostimon
Cyprus: Fostimon PFS
Denmark: Fostimon Set
Finland: Fostimon Set
France: Fostimonkit
Luxembourg: Fostimon
Ireland: Fostimon PFS
Netherlands: Fostimon Set
Norway: Fostimon Set
Spain: Fostipur Kit
Sweden: Fostimon Set
United Kingdom: Fostimon PFS

Date of the most recent review of this leaflet: February 2024

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