Lenalidomide Tarbis 25 mg hard capsules EFG

Package leaflet: Information for the user

Introduction

Package leaflet: information for the patient

Lenalidomida Tarbis 25 mg hard capsules EFG

lenalidomide

Read the entire leaflet carefully before you start taking 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, ask your doctor or pharmacist.
• This medicine has been prescribed for you only, and you should not give it to other people, even if they have the same symptoms as you, because it may 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 Lenalidomida Tarbis is and what it is used for
2. What you need to know before taking Lenalidomida Tarbis
3. How to take Lenalidomida Tarbis
4. Possible adverse effects
5. How to store Lenalidomida Tarbis
6. Contents of the pack and other information

1. What Lenalidomida Tarbis is and what it is used for

What Lenalidomida Tarbis is

Lenalidomida Tarbis contains the active substance "lenalidomida". This medicine belongs to a group of medicines that affect how the immune system works.

What Lenalidomida Tarbis is used for

Lenalidomida Tarbis is used in adults for:

• Multiple myeloma
• Myelodysplastic syndromes (MDS)
• Follicular lymphoma

Multiple myeloma

Multiple myeloma is a type of cancer that affects a specific type of white blood cells called plasma cells. These cells accumulate in the bone marrow and multiply uncontrollably. This can damage bones and kidneys.

Multiple myeloma is generally incurable. However, signs and symptoms can be greatly reduced or may disappear for a period of time. This is called "remission".

Newly diagnosed myeloma: in patients who have undergone a bone marrow transplant, lenalidomide is used as maintenance treatment after adequate recovery from the bone marrow transplant.

Newly diagnosed multiple myeloma: in patients who cannot be treated with a bone marrow transplant

Lenalidomide is taken with other medicines, including:

• a chemotherapy medicine called "bortezomib";
• an anti-inflammatory called "dexamethasone";
• a chemotherapy medicine called "melphalan"; and
• an immunosuppressant called "prednisone".

You will take these medicines at the beginning of treatment and then continue taking lenalidomide alone.

If you are 75 years of age or older or have moderate to severe kidney problems, your doctor will monitor you carefully before starting treatment.

Multiple myeloma: in previously treated patients

Lenalidomide is taken together with an anti-inflammatory called "dexamethasone".

Lenalidomide may slow the worsening of signs and symptoms of multiple myeloma. It has also been shown to delay the return of multiple myeloma after treatment.

Myelodysplastic syndromes (MDS)

MDS are a group of different blood and bone marrow disorders. Blood cells become abnormal and do not function properly. Patients may experience a variety of signs and symptoms, including low red blood cell count (anaemia), need for blood transfusions, and risk of infection.

Lenalidomide is used to treat adult patients diagnosed with MDS when all of the following apply:

• you require regular blood transfusions to treat low red blood cell levels ("transfusion-dependent anaemia")
• you have an abnormality in bone marrow cells called "isolated 5q cytogenetic abnormality". This means your body does not produce enough healthy blood cells
• previous treatments you have used are not suitable or have not worked well enough.

Lenalidomide can increase the number of healthy red blood cells your body produces by reducing the number of abnormal cells:

• this may reduce the number of blood transfusions needed. Blood transfusions may no longer be required.

Follicular lymphoma (FL)

FL is a slow-growing cancer that affects B-lymphocytes. These are a type of white blood cell that helps the body fight infections. In people with FL, too many of these B-lymphocytes may accumulate in the blood, bone marrow, lymph nodes, and spleen.

Lenalidomide is used in combination with another medicine called "rituximab" for the treatment of adult patients who have received prior treatment for follicular lymphoma.

How Lenalidomida Tarbis works

Lenalidomide works by affecting the body's immune system and directly attacking cancer cells.

It acts in several ways:

• stops the development of cancer cells;
• inhibits the growth of blood vessels in cancer;
• stimulates part of the immune system to attack cancer cells

2. What you need to know before starting Lenalidomida Tarbis

You must read the package leaflet of all medications you are going to take in combination with Lenalidomida Tarbis before starting treatment with Lenalidomida Tarbis.

Do not take Lenalidomida Tarbis:

• if you are pregnant, think you might be pregnant, or intend to become pregnant, as Lenalidomide is expected to be harmful to the fetus (see section 2, “Pregnancy, breastfeeding and contraception: information for women and men”);
• if you are capable of becoming pregnant, unless you follow all necessary measures to prevent pregnancy (see section 2, “Pregnancy, breastfeeding and contraception: information for women and men”). If you are capable of becoming pregnant, your doctor will document with each prescription that all necessary precautions have been taken and will provide you with this confirmation;
• if you are allergic to lenalidomide or to any of the other components of this medicine (listed in section 6). If you think you may be allergic, consult your doctor.

If any of these conditions apply to you, do not take Lenalidomida. If in doubt, consult your doctor.

Warnings and precautions

Consult your doctor, pharmacist, or nurse before starting Lenalidomida Tarbis if:

• you have ever had blood clots; during treatment, you have an increased risk of developing blood clots in veins and arteries;
• you have signs of infection such as cough or fever;
• you have or have previously had a viral infection, especially hepatitis B, varicella zoster, or HIV. If in doubt, consult your doctor. Treatment with Lenalidomide may reactivate the virus in patients who carry it, leading to recurrence of the infection. Your doctor should check whether you have ever had hepatitis B infection;
• you have kidney problems; your doctor may adjust your dose of Lenalidomida;
• you have had a heart attack, previously had a blood clot, or if you smoke, have high blood pressure, or high cholesterol levels;
• you have had an allergic reaction while using thalidomide (another medicine used to treat multiple myeloma), such as skin rash, itching, swelling, dizziness, or breathing problems;
• you have previously experienced a combination of any of the following symptoms: widespread rash, skin redness, high body temperature, flu-like symptoms, elevated liver enzymes, blood abnormalities (eosinophilia), swollen lymph nodes (signs of a serious skin reaction called drug reaction with eosinophilia and systemic symptoms, also known as DRESS syndrome or drug hypersensitivity syndrome) (see also section 4 “Possible side effects”).

If any of the above conditions apply to you, inform your doctor, pharmacist, or nurse before starting treatment.

At any time during or after treatment, inform your doctor or nurse immediately if you experience:

• blurred vision, loss of vision, or double vision, difficulty speaking, weakness in one arm or leg, change in walking pattern or balance problems, persistent numbness, reduced sensation, or loss of sensation, memory loss, or confusion. These may be symptoms of a serious and potentially life-threatening brain disease known as progressive multifocal leukoencephalopathy (PML). If you have any of these symptoms before starting treatment with Lenalidomida, inform your doctor if you notice any changes in these symptoms.
• shortness of breath, fatigue, dizziness, chest pain, faster heartbeat, or swelling in legs or ankles. These may be symptoms of a serious condition known as pulmonary hypertension (see section 4).

Tests and monitoring

Before starting and during treatment with Lenalidomida, you will have regular blood tests. This is because Lenalidomide may cause a decrease in blood cells that help fight infections (white blood cells) and those involved in blood clotting (platelets).

Your doctor will request blood tests:

• before starting treatment;
• every week during the first 8 weeks of treatment;
• thereafter, at least once a month.

You may be evaluated for signs of cardiopulmonary problems before and during treatment with lenalidomide.

For patients with MDS taking lenalidomide:

If you have MDS, you may be more likely to develop a more advanced disease called acute myeloid leukemia (AML). In addition, it is unknown how lenalidomide affects your chances of developing AML. Therefore, your doctor may perform blood tests to detect signs that could better predict your likelihood of developing AML during treatment with lenalidomide.

For patients with FL taking Lenalidomida

Your doctor will request blood tests:

• before treatment;
• every week during the first 3 weeks (1 cycle) of treatment;
• then every 2 weeks during cycles 2 to 4 (see section 3 “Treatment cycle” for more information);
• after this, at the beginning of each cycle and
• at least once a month.

Your doctor may check whether you have a high total tumor burden in the body, including in the bone marrow. This could lead to a condition in which tumors break down and release unusual levels of chemicals into the blood, which in turn may cause kidney failure (this condition is called “tumor lysis syndrome”).

Your doctor may examine you for skin changes such as red spots or rashes.

Your doctor may adjust the dose of Lenalidomida or interrupt your treatment depending on the results of your blood tests and your overall condition. If you are a newly diagnosed patient, your doctor may also evaluate your treatment based on your age and other pre-existing conditions.

Blood donation

You must not donate blood during treatment or for at least 7 days after treatment ends.

Children and adolescents

Lenalidomida is not recommended for use in children and adolescents under 18 years of age.

Elderly patients and patients with kidney problems

If you are 75 years of age or older or have moderate to severe kidney problems, your doctor will carefully evaluate you before starting treatment.

Other medicines and Lenalidomida Tarbis

Inform your doctor or nurse if you are taking, have recently taken, or might need to take any other medicines. This is because Lenalidomide may affect how other medicines work. In addition, some medicines may affect how Lenalidomide works.

Specifically, inform your doctor or nurse if you are taking any of the following medicines:

• certain medicines used to prevent pregnancy, such as oral contraceptives, as they may stop working;
• certain medicines used for heart problems, such as digoxin;
• certain medicines used to thin the blood, such as warfarin.

Pregnancy, breastfeeding and contraception: information for women and men

Pregnancy

Women taking Lenalidomida

• You must not take Lenalidomida if you are pregnant, as it is expected to be harmful to the fetus.
• You must not become pregnant while taking Lenalidomida. Therefore, you must use effective contraceptive methods if there is any possibility you could become pregnant (see “Contraception”).
• If you become pregnant during treatment with Lenalidomida, you must stop treatment and inform your doctor immediately.

Men taking Lenalidomida

• If your partner becomes pregnant while you are taking Lenalidomida, you must inform your doctor immediately. It is advisable that your partner seeks medical advice.
• You must also use effective contraceptive methods (see “Contraception”).

Breastfeeding

You must not breastfeed while taking Lenalidomida, as it is unknown whether Lenalidomide passes into breast milk.

Contraception

For women taking Lenalidomida

Before starting treatment, ask your doctor whether you are capable of becoming pregnant, even if you think this is unlikely.

If you are capable of becoming pregnant:

• you will undergo pregnancy tests under medical supervision (before each treatment cycle, at least every 4 weeks during treatment, and for at least 4 weeks after treatment ends), unless it has been confirmed that your fallopian tubes have been surgically closed to prevent eggs from reaching the uterus (tubal ligation);

And

• you must use effective contraceptive methods starting at least 4 weeks before beginning treatment, throughout treatment, and for at least 4 weeks after treatment ends. Your doctor will advise you on the most appropriate contraceptive methods.

For men taking Lenalidomida

Lenalidomide is present in human semen. If your partner is pregnant or could become pregnant and is not using an effective contraceptive method, you must use condoms during treatment and for at least 7 days after treatment ends, even if you have had a vasectomy. You must not donate semen or sperm during treatment and for at least 7 days after treatment ends.

Driving and using machines

Do not drive or operate machinery if you feel dizzy, tired, drowsy, have vertigo, or blurred vision after taking Lenalidomida.

Lenalidomida Tarbis contains lactose

If your doctor has informed you that you have an intolerance to certain sugars, consult with him before taking this medicine.

Lenalidomida Tarbis contains sodium

This medicine contains less than 1 mmol of sodium (23 mg) per hard capsule; this is essentially “sodium-free.”

3. How to take Lenalidomida Tarbis

Lenalidomide must be prescribed and administered by a healthcare professional experienced in the treatment of multiple myeloma, MDS, or FL.

• When lenalidomide is used for the treatment of multiple myeloma in patients who are not eligible for bone marrow transplantation or who have received prior treatments, it is taken in combination with other medications (see section 1 “What Lenalidomida Tarbis is used for”).
• When lenalidomide is used for the treatment of multiple myeloma in patients who have undergone bone marrow transplantation or for the treatment of patients with MDS, it is taken alone.
• When lenalidomide is used for the treatment of follicular lymphoma, it is taken in combination with another medicine called “rituximab”.

Always follow exactly the dosing instructions for lenalidomide provided by your doctor. If in doubt, consult your doctor or pharmacist.

If you are taking lenalidomide together with other medications, you should consult the package leaflet of those other medicines for additional information about their use and side effects.

Treatment cycle

Lenalidomide is taken on certain days during a 3-week period (21 days).

• A “treatment cycle” consists of 21 days.
• Depending on the day of the cycle, you will take one or more medications. However, on some days you will not take any medication.
• After completing each 21-day cycle, you must start a new “cycle” for the following 21 days.

Or

Lenalidomide is taken on certain days during a 4-week period (28 days).

• A “treatment cycle” consists of 28 days.
• Depending on the day of the cycle, you will take one or more medications. However, on some days you will not take any medication.
• After completing each 28-day cycle, you must start a new “cycle” for the following 28 days.

How much Lenalidomida Tarbis to take

Before starting treatment, your doctor will inform you:

• of the dose of lenalidomide you must take;
• of the dose of any other medications you must take together with this medicine, if applicable;
• on which days of the treatment cycle you should take each medicine.

How and when to take Lenalidomida Tarbis

• Swallow the capsules whole, preferably with water.
• Do not break, open, or chew the capsules. If the powder from a broken lenalidomide capsule comes into contact with the skin, wash the skin immediately and thoroughly with water and soap.
• Healthcare professionals, caregivers, and family members should wear disposable gloves when handling the blister pack or capsule. Afterwards, gloves should be carefully removed to avoid skin exposure, placed into a sealed polyethylene plastic bag, and disposed of according to local requirements. Hands should then be thoroughly washed with water and soap. Pregnant women or women who suspect they may be pregnant must not handle the blister pack or capsule.
• The capsules may be taken with or without food.
• You should take lenalidomide at approximately the same time each day on the scheduled days.

Taking this medicine

To remove the capsule from the blister:

• Press only one end of the capsule so that it comes out through the foil.
• Do not press in the center of the capsule, as this may break it.

Duration of treatment with Lenalidomida Tarbis

Lenalidomide is taken in treatment cycles, each cycle lasting 21 or 28 days (see “Treatment cycle” above). You must continue the treatment cycles until your doctor tells you to stop.

If you take more Lenalidomida Tarbis than you should

If you take more lenalidomide than prescribed, inform your doctor immediately.

If you forget to take Lenalidomida Tarbis

If you forget to take lenalidomide at your usual time and:

• less than 12 hours have passed: take the capsule immediately;
• more than 12 hours have passed: do not take the capsule. Take the next capsule the following day at your usual time.

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

4. Possible adverse effects

Like all medicines, this medicine can cause adverse effects, although not everyone will experience them.

If you experience any of the following serious adverse effects, stop treatment with Lenalidomida Tarbis and seek medical attention immediately, as you may require urgent medical treatment:

• Hives, rash, swelling of the eyes, mouth or face, difficulty breathing or itching, which may be symptoms of severe allergic reactions known as angioedema and anaphylactic reaction.
• Severe allergic reaction that may start as a rash in one area but spreads, causing extensive skin loss throughout the body (Stevens-Johnson syndrome and/or toxic epidermal necrolysis).
• Widespread rash, high body temperature, elevated liver enzymes, blood abnormalities (eosinophilia), swollen lymph nodes, and effects on other organs (drug reaction with eosinophilia and systemic symptoms, also known as DRESS syndrome or drug hypersensitivity syndrome). See also section 2.

Contact your doctor immediately if you notice any of the following serious adverse effects:

• Fever, chills, sore throat, cough, mouth ulcers, or any other sign of infection, including in the bloodstream (sepsis).
• Bleeding (haemorrhage) or bruising (haematoma) not due to injury.
• Chest (thoracic) or leg pain.
• Difficulty breathing.
• Bone pain, muscle pain, confusion, or fatigue, which may be due to high levels of calcium in the blood.

Lenalidomide may reduce the number of white blood cells that fight infections and also reduce blood cells that help blood to clot (platelets), which may lead to bleeding disorders such as nosebleeds and bruising. Lenalidomide may also cause blood clots in veins (thrombosis).

Other adverse effects

It is important to note that a small number of patients may develop other types of cancer, and this risk may increase with treatment with Lenalidomide. Therefore, your doctor should carefully evaluate the benefits and risks before prescribing Lenalidomide.

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

• A decrease in the number of red blood cells, which may lead to anaemia causing tiredness and weakness.
• Skin rash, itching.
• Muscle cramps, muscle weakness, muscle pain, muscle discomfort, bone pain, joint pain, back pain, limb pain.
• Generalised swelling, including swelling of the arms and legs.
• Weakness, fatigue.
• Fever and flu-like symptoms including fever, muscle pain, headache, earache, cough, and chills.
• Numbness, tingling or burning sensation in the skin, pain in hands or feet, dizziness, tremor.
• Loss of appetite, changes in taste.
• Increased pain, size of tumour or redness around the tumour.
• Weight loss.
• Constipation, diarrhoea, nausea, vomiting, stomach pain, heartburn.
• Low levels of potassium, calcium and/or sodium in the blood.
• Underactive thyroid function.
• Leg pain (which could be a symptom of thrombosis), chest pain or difficulty breathing (which could be a symptom of blood clots in the lungs, called pulmonary embolism).
• Infections of all types, including infection of the sinuses around the nose (sinusitis), lung infection, and upper respiratory tract infections.
• Difficulty breathing.
• Blurred vision.
• Clouding of the eye (cataracts).
• Kidney problems including kidneys not functioning properly or unable to maintain normal function.
• Abnormal liver function tests.
• High values in liver function tests.
• Changes in a blood protein which may cause swelling of the arteries (vasculitis).
• Increased blood sugar levels (diabetes).
• Decreased blood sugar levels.
• Decrease in blood sugar levels.
• Headache.
• Nosebleeds.
• Dry skin.
• Depression, mood changes, difficulty sleeping.
• Cough.
• Low blood pressure.
• A general feeling of discomfort, feeling unwell.
• Painful inflammation of the mouth, dry mouth.
• Dehydration.

Common adverse effects (may affect up to 1 in 10 people):

• Destruction of red blood cells (haemolytic anaemia).
• Certain types of skin tumours.
• Bleeding from gums, stomach or intestines.
• High blood pressure, slow, fast or irregular heartbeat.
• Increase in a substance released following normal or abnormal destruction of red blood cells.
• Increase in a type of protein indicating inflammation in the body.
• Darkening of skin colour; skin discolouration due to internal bleeding, usually caused by bruising; skin inflammation due to blood accumulation; bruising.
• Increased uric acid in the blood.
• Skin rashes, redness of the skin, cracked skin, peeling or flaking of the skin, hives.
• Increased sweating, night sweats.
• Difficulty swallowing, sore throat, difficulty maintaining voice quality or voice changes.
• Runny nose.
• Marked increase or decrease in urine output compared to normal, or inability to control urination.
• Blood in the urine.
• Difficulty breathing, especially when lying down (which could be a symptom of heart failure).
• Difficulty achieving an erection.
• Stroke, fainting, dizziness (inner ear disorder causing a spinning sensation), temporary loss of consciousness.
• Chest pain spreading to arms, neck, jaw, back or stomach, sweating, shortness of breath, nausea or vomiting, which may be symptoms of a heart attack (myocardial infarction).
• Muscle weakness, lack of energy.
• Neck pain, chest pain.
• Chills.
• Swelling of the joints.
• Slowed or blocked bile flow from the liver.
• Low levels of phosphate or magnesium in the blood.
• Difficulty speaking.
• Liver damage.
• Loss of balance, movement difficulties.
• Hearing loss, ringing in the ears (tinnitus).
• Nerve pain, abnormal and unpleasant sensation, especially on touch.
• Excess iron in the body.
• Thirst.
• Confusion.
• Toothache.
• Falls that may cause injuries.

Uncommon adverse effects (may affect up to 1 in 100 people):

• Bleeding inside the skull.
• Circulatory problems.
• Loss of vision.
• Loss of sexual desire (libido).
• Excretion of large amounts of urine with bone pain and weakness, which may be symptoms of a kidney disorder (Fanconi syndrome).
• Yellow pigmentation of the skin, mucous membranes or eyes (jaundice), pale stools, dark urine, itchy skin, skin rash, stomach pain or swelling; these may be symptoms of liver damage (hepatic failure).
• Stomach pain, abdominal swelling or diarrhoea, which may be symptoms of inflammation of the large intestine (called colitis or typhlitis).
• Damage to kidney cells (called renal tubular necrosis).
• Changes in skin colour, sensitivity to sunlight.
• Tumour lysis syndrome – metabolic complications may occur during cancer treatment and sometimes even without treatment. These complications arise from the breakdown products of dying tumour cells and may include: changes in blood biochemistry, high levels of potassium, phosphate, uric acid, and low calcium levels, leading to changes in kidney function and heart rhythm, seizures, and sometimes death.
• Increased blood pressure in the blood vessels supplying the lungs (pulmonary hypertension).

Adverse effects with unknown frequency (cannot be estimated from available data):

• Sudden or mild pain in the upper abdomen and/or back that worsens over several days, possibly accompanied by nausea, vomiting, fever, and rapid pulse. These symptoms may be due to inflammation of the pancreas.
• Wheezing or whistling when breathing, difficulty breathing, or dry cough, which may be symptoms caused by inflammation of lung tissue.
• Rare cases of muscle breakdown (muscle pain, weakness or swelling) have been observed, which may lead to kidney problems (rhabdomyolysis), some of them when Lenalidomide is administered with a statin (a type of medicine used to lower cholesterol).
• A skin disease caused by inflammation of small blood vessels, accompanied by joint pain and fever (leucocytoclastic vasculitis).
• Perforation of the wall of the stomach or intestine. This may lead to a severe infection. Inform your doctor if you have severe stomach pain, fever, nausea, vomiting, blood in stools, or changes in bowel habits.
• Viral infections, including herpes zoster (also known as shingles, a viral disease causing a painful blistering skin rash) and reactivation of hepatitis B infection (which may cause yellowing of the skin and eyes, dark brown urine, stomach pain on the right side, fever, nausea or feeling unwell).
• Rejection of solid organ transplants (such as kidney, heart).

Reporting of adverse effects

If you experience any adverse effect, talk to your doctor, pharmacist or nurse, even if it is a possible adverse effect not listed in this leaflet. You can also report them directly via the Spanish Pharmacovigilance System for Human Medicines: https://www.notificaram.es. By reporting adverse effects, you help provide more information on the safety of this medicine.

5. Storage of Lenalidomida Tarbis

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

Do not use this medicine after the expiry date stated on the blister and carton after “CAD”/“EXP”. The expiry date refers to the last day of the month indicated.

This medicine does not require any special storage conditions.

Do not use this medicine if you notice any visible signs of deterioration or evidence of improper handling.

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

6. Contents of the pack and other information

Composition of Lenalidomide

The active substance is lenalidomide. Each capsule contains 25 mg of lenalidomide.

The other components are:

Contents of the capsules: Anhydrous lactose (see section 2), microcrystalline cellulose, sodium croscarmellose, and magnesium stearate.

Capsule shell: Gelatin and titanium dioxide (E171).

Printing ink: Shellac, black iron oxide (E172), and potassium hydroxide.

Nature and contents of the container

Lenalidomida Tarbis 25 mg hard capsules have an opaque white cap and an opaque white body, size “0” hard gelatin capsules, printed with 'H' on the cap and 'L7' on the body, filled with whitish to pale yellow powder.

The capsules are supplied in blisters containing 7 and 21 capsules.

Only some pack sizes may be marketed.

Marketing Authorization Holder and Manufacturer

Marketing Authorization Holder

Tarbis Farma S.L.

Gran Vía Carlos III, 94

08028 Barcelona

Spain

Manufacturer

Pharmadox Healthcare Ltd.

KW20A Kordin Industrial Park

Paola, PLA 3000

Malta

or

Amarox Pharma B.V.,

Rouboslaan 32,

2252 TR Voorschoten,

The Netherlands

This medicinal product is authorized in the European Economic Area member states under the following names:

The Netherlands: Lenalidomide Amarox 25 mg harde capsules

Spain: Lenalidomida Tarbis 25 mg cápsulas duras EFG

Date of the most recent review of this leaflet: March 2026

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/