Clodronate disodium and lidocaine hydrochloride Ig Farmaceutici: detailed information

Package leaflet: Information for the patient

CLODRONATE DISODIUM AND LIDOCAINE HYDROCHLORIDE IG FARMACEUTICI 200 mg +

40 mg injection solution
Clodronate disodium – Lidocaine hydrochloride
Generic medicine
Please read all of this leaflet carefully before you start using this medicine, as it contains important information for you.

Keep this leaflet. 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. Do not give it to other people, even if their symptoms are the same as yours, as it may be harmful.
If you experience any side effects, including those not listed in this leaflet, tell your doctor or pharmacist. See section 4.

Contents of this leaflet:

What CLODRONATE DISODIUM AND LIDOCAINE HYDROCHLORIDE IG FARMACEUTICI is and what it is used for
What you need to know before using CLODRONATE DISODIUM AND LIDOCAINE HYDROCHLORIDE IG FARMACEUTICI
How to use CLODRONATE DISODIUM AND LIDOCAINE HYDROCHLORIDE IG FARMACEUTICI
Possible side effects
How to store CLODRONATE DISODIUM AND LIDOCAINE HYDROCHLORIDE IG FARMACEUTICI
Contents of the pack and other information

1. What CLODRONATE DISODIUM AND LIDOCAINE HYDROCHLORIDE IG FARMACEUTICI is and what it is used for
CLODRONATE DISODIUM AND LIDOCAINE HYDROCHLORIDE IG FARMACEUTICI is a medicine that contains clodronic acid, an active substance belonging to a group of drugs used to treat bone diseases called bisphosphonates.
CLODRONATE DISODIUM AND LIDOCAINE HYDROCHLORIDE IG FARMACEUTICI is used in women for the prevention and treatment of bone thinning (osteoporosis) after menopause (the period of permanent cessation of menstrual cycles).

2. What you need to know before using CLODRONATE DISODIUM AND LIDOCAINE HYDROCHLORIDE

IG FARMACEUTICI
Do not use CLODRONATE DISODIUM AND LIDOCAINE HYDROCHLORIDE IG FARMACEUTICI:

If you are allergic to clodronic acid or to any of the other ingredients of this medicine (listed in section 6).
If you are taking other bisphosphonates, medicines similar to CLODRONATE DISODIUM AND LIDOCAINE HYDROCHLORIDE IG FARMACEUTICI.
If you are allergic to lidocaine or to other amide-type local anesthetics, such as for example: bupivacaine,

mepivacaine, ropivacaine, levobupivacaine.

If you have a heart disease causing loss of consciousness (Adam-Stokes syndrome).
If you have a heart rhythm disorder (Wolff-Parkinson-White syndrome, atrial fibrillation, sinoatrial, atrioventricular or intraventricular block).
If you have weak heart function unable to supply adequate blood flow to the body (acute heart failure).
If you suffer from a condition of reduced blood volume (hypovolemia).

This medicine is for intramuscular use only (to be injected into a muscle) and must not be administered
into a blood vessel (intravenously). Accidental injection into a vein increases the risk of serious adverse
reactions due to high blood levels of the anesthetic lidocaine (see section 3. If you use more CLODRONATE
DISODIUM AND LIDOCAINE HYDROCHLORIDE IG FARMACEUTICI than you should).
Warnings and precautions
Talk to your doctor or pharmacist before using CLODRONATE DISODIUM AND LIDOCAINE
HYDROCHLORIDE IG FARMACEUTICI.
Before and during treatment, your doctor will ask you to undergo blood tests to monitor kidney and liver
function (see section 4. Possible side effects). It is important that you drink adequate amounts of fluids
during treatment with this medicine, especially if you have kidney problems (see section 3. How to use
CLODRONATE DISODIUM AND LIDOCAINE HYDROCHLORIDE IG FARMACEUTICI).
In particular, inform your doctor if:
You have high levels of calcium in your blood.

You suffer from kidney disease (renal insufficiency).
You are being treated with CLODRONATE DISODIUM AND LIDOCAINE HYDROCHLORIDE IG FARMACEUTICI for cancer or osteoporosis, and you are undergoing dental treatment or need dental surgery. Also inform your dentist that you are being treated with CLODRONATE DISODIUM AND LIDOCAINE HYDROCHLORIDE IG FARMACEUTICI (see section 4. Possible side effects), as preventive dental treatment may be required.
You suffer from heart diseases (particularly rhythm disorders with slow heart rate and heart failure) or if you have had heart surgery.
You suffer from liver disease.
You, or someone in your family, suffer from a condition causing a marked increase in body temperature following the use of local anesthetics such as lidocaine (malignant familial hyperthermia).
You experience thigh, hip or groin pain or weakness during treatment, as this could be an early sign of a possible femoral fracture (see section
4. Possible side effects).
You suffer from seizures (epilepsy). Your doctor will closely monitor you for any symptoms.
You suffer from respiratory or pulmonary disorders.
You suffer from a disease causing muscle weakness (myasthenia gravis).
You have porphyria (a rare inherited blood disorder affecting the skin and nervous system).
Children and adolescents
The safety and efficacy of this medicine in pediatric patients have not been established.
Other medicines and CLODRONATE DISODIUM AND LIDOCAINE HYDROCHLORIDE IG
FARMACEUTICI
Inform your doctor or pharmacist if you are taking, have recently taken, or might take any other
medicine.
This is particularly important if:
You are taking other bisphosphonates, medicines used to treat bone diseases, as concomitant use of CLODRONATE DISODIUM AND LIDOCAINE HYDROCHLORIDE IG FARMACEUTICI with other bisphosphonates is contraindicated (see section 2. Do not use CLODRONATE DISODIUM AND LIDOCAINE HYDROCHLORIDE IG FARMACEUTICI).
You are taking non-steroidal anti-inflammatory drugs (NSAIDs), medicines used to treat inflammation (particularly diclofenac), as kidney problems may occur.
You are taking aminoglycosides, medicines used to treat infections, as calcium levels in the blood may decrease (hypocalcemia).
You are taking estramustine, a medicine used to treat prostate cancer (a gland in men that produces seminal fluid), as blood levels of estramustine may increase.
You are taking medicines used to treat heart disorders including irregular heartbeat, such as beta-blockers (e.g. propranolol), calcium channel blockers (e.g. amiodarone), or sodium channel blockers, as lidocaine may remain in circulation longer.
You are taking cimetidine, a medicine mainly used to treat gastritis and gastric ulcer (a lesion of the stomach wall); fluvoxamine (a medicine used for depression); antiviral medicines such as ritonavir; medicines for treating infections such as macrolide antibiotics (erythromycin) or other antibiotics like ciprofloxacin; antifungal medicines such as ketoconazole, itraconazole, as blood levels of lidocaine may increase.
You are taking barbiturates such as phenobarbital; medicines used to treat epilepsy such as carbamazepine; phenytoin; primidone; oral contraceptives or hormone replacement therapy, as blood levels of lidocaine may decrease.
You are being treated with digitalis, medicines used to treat heart rhythm disorders, as
the risk of heart rhythm disturbances may increase.
You are taking muscle relaxants used during general anesthesia, such as suxamethonium.

The solution is incompatible with alkaline solutions or oxidizing solutions.
Pregnancy, breastfeeding and fertility
If you are pregnant, think you may be pregnant or are planning to become pregnant, or if you are breastfeeding,
ask your doctor or pharmacist for advice before using this medicine.
Pregnancy
Avoid using CLODRONATE DISODIUM AND LIDOCAINE HYDROCHLORIDE IG FARMACEUTICI
during pregnancy and if you are of childbearing age and not using effective contraception (medicines used to
prevent pregnancy).
Breastfeeding
It is not known whether clodronic acid passes into breast milk, whereas lidocaine is excreted in
breast milk in small amounts. Therefore, during treatment with CLODRONATE DISODIUM AND
LIDOCAINE HYDROCHLORIDE IG FARMACEUTICI, breastfeeding must be discontinued.
Fertility
It is not known whether clodronic acid and lidocaine have effects on human fertility.
Driving and using machines
CLODRONATE DISODIUM AND LIDOCAINE HYDROCHLORIDE IG FARMACEUTICI may cause
visual disturbances that could affect your ability to
drive or operate machinery.
If you experience one or more of the symptoms listed in section 4 or if you use more CLODRONATE DISODIUM AND
LIDOCAINE HYDROCHLORIDE IG FARMACEUTICI than you should, avoid driving and using
machinery.
CLODRONATE DISODIUM AND LIDOCAINE HYDROCHLORIDE IG FARMACEUTICI contains
sodium
This medicine contains 32 mg of sodium (the main component of table salt) per .
This corresponds to 1.6% of the maximum daily recommended dietary intake for an adult.

3. How to use CLODRONATE DISODIUM AND LIDOCAINE HYDROCHLORIDE IG FARMACEUTICI

FARMACEUTICI
Use this medicine exactly as instructed by your doctor, who will determine the correct dose according to the severity of your condition and the duration of treatment. If in doubt, consult your doctor or pharmacist (see section DOSAGE, METHOD AND DURATION OF ADMINISTRATION at the end of this Package Leaflet).
Clodronic acid is primarily eliminated via the kidneys. Therefore, during treatment with clodronic acid, it is necessary to maintain adequate fluid intake.

Method of administration
CLODRONATE DISODIUM AND LIDOCAINE HYDROCHLORIDE IG FARMACEUTICI is for intramuscular use only (i.e. to be injected into a muscle). To avoid accidental intravascular injection, it is recommended to aspirate before injecting the medicine.
Avoid massaging the injection site.

If you use more CLODRONATE DISODIUM AND LIDOCAINE HYDROCHLORIDE IG FARMACEUTICI than you should
If you accidentally take an excessive dose of CLODRONATE DISODIUM AND LIDOCAINE HYDROCHLORIDE IG FARMACEUTICI, contact your doctor or go immediately to the nearest hospital.
Symptoms of overdose may include:

increased blood creatinine levels and kidney disease (renal dysfunction) (with high doses of clodronic acid administered intravenously),
elevated blood nitrogen levels (uraemia),
liver damage,
decreased blood calcium levels (hypocalcaemia).

In case of accidental intravascular injection, the following symptoms of lidocaine overdose may occur:

drowsiness,
euphoria (state of excessive excitement),
sedation (physical and mental relaxation),
loss of sensation in parts of the body (paraesthesia),
muscle spasms (sudden, involuntary muscle contractions),
uncontrolled body movements (convulsions),
reduced blood flow to the body (cardiocirculatory collapse).

Treatment
The doctor will manage the symptoms with appropriate specific therapies.

If you forget to use CLODRONATE DISODIUM AND LIDOCAINE HYDROCHLORIDE IG FARMACEUTICI
Do not take a double dose to make up for the missed dose.

If you stop treatment with CLODRONATE DISODIUM AND LIDOCAINE HYDROCHLORIDE IG FARMACEUTICI
If you have any doubts about using this medicine, consult your doctor or pharmacist.

4. Possible side effects

Like all medicines, this medicine can cause side effects, although not everybody will experience them.
If you experience any eye or vision problems during treatment, STOP taking the medicine and consult an ophthalmologist immediately.
Inform your doctor immediately if you experience:

pain or sores in the mouth or jaw and/or maxilla (facial bones), as these may be early signs of serious problems (bone tissue death in the jaw and/or maxilla), usually associated with tooth extraction and/or local infection (see section 2. Warnings and precautions).

The possible side effects listed below are categorized by frequency:
Common (may affect up to 1 in 10 people):

decreased calcium levels in the blood, without symptoms (asymptomatic hypocalcaemia),
diarrhoea, nausea, vomiting (usually mild in intensity),
increased transaminase levels in the blood (a test to assess liver function), usually within normal limits.

Rare (may affect up to 1 in 1,000 people):

decreased calcium levels in the blood, with symptoms (symptomatic hypocalcaemia),
increased levels of parathyroid hormone (a hormone regulating calcium levels) in the blood, associated with low blood calcium,
increased alkaline phosphatase levels in the blood (a test to assess bone and liver conditions),
increased transaminase levels in the blood (a test to assess liver function) more than twice the upper normal limit, without other liver function abnormalities,
allergic reactions manifesting as skin reactions,
unusual femur fracture (long leg bone), particularly in patients receiving long-term treatment for osteoporosis. Contact your doctor if you experience pain or weakness in the thigh, hip or groin, as this could be an early sign of a possible femur fracture.

Very rare (may affect up to 1 in 10,000 people):

consult your doctor if you experience ear pain, ear discharge and/or ear infection. These events could be signs of bone damage in the ear.

The following side effects may also occur, for which the frequency cannot be determined from available data:
Effects related to the eyes

inflammation of the conjunctiva, the membrane covering the eye and the inner surface of the eyelids (conjunctivitis);
eye inflammation (episcleritis, scleritis and uveitis).
Episcleritis and scleritis have been reported with other drugs belonging to the same class as clodronic acid (adverse class reaction of bisphosphonates).

Effects related to the lungs

breathing problems in patients with aspirin-sensitive asthma (a medicine used to treat fever, pain and inflammation);
allergic reactions manifesting as respiratory problems.

Effects related to the kidneys and urinary tract

kidney disease (renal failure), severe kidney damage. Rarely, and especially in association with NSAIDs (medicines used to treat inflammation and pain), renal failure has led to death (more frequently with concomitant use of diclofenac). See section 2. Other medicines and CLODRONATO DISODICO E LIDOCAINA CLORIDRATO IG FARMACEUTICI.

Effects related to bones and muscles

severe bone, joint and muscle pain. The onset of symptoms varies from days to several months after starting treatment with CLODRONATO DISODICO E LIDOCAINA CLORIDRATO IG FARMACEUTICI;
pain or sores in the mouth or jaw and/or maxilla (facial bones). These may be early signs of serious problems (bone tissue death in the jaw and/or maxilla), usually associated with tooth extraction and/or local infection (see section 2. Warnings and precautions). In most cases, this occurred in cancer patients.

Effects related to the injection site

tenderness at the injection site, particularly with prolonged treatment duration.

Side effects specific to lidocaine
The following side effects are associated with lidocaine; however, sufficient data are not available to determine the frequency of the individual effects listed. Side effects are generally due to either allergic reactions or excessively high blood concentrations resulting from accidental intravascular injection and/or overdose.
This may occasionally cause central nervous system excitation and occasional cardiovascular depression (see section 2. Warnings and precautions).
Immune system disorders
Severe allergic reaction (anaphylactoid), swelling of the larynx leading to breathing difficulty (bronchospasm), and drop in blood pressure (cardiorespiratory collapse) due to anaphylactic shock.
Nervous system disorders
Symptoms of excitation or depression associated with dizziness, drowsiness, visual disturbances, tremors followed by altered consciousness, seizures, coma, prolonged contraction of jaw muscles leading to tight closure of the jaw and maxilla (trismus), altered sensation in limbs or other body parts (paraesthesia).
Psychiatric disorders
Anxiety, disorientation.
Cardiac disorders
Slowed heart rate (bradycardia), heart rhythm disturbances (arrhythmias), myocardial depression up to cardiac arrest.
Eye disorders
Pupil dilation (mydriasis), blurred vision, double vision (diplopia).
Gastrointestinal disorders
Nausea, vomiting.
Respiratory, thoracic and mediastinal disorders
Difficulty breathing (dyspnoea), reduced breathing rate (respiratory depression).
Vascular disorders
Low blood pressure (hypotension), high blood pressure (hypertension), interruption of normal blood circulation due to cardiac arrest and reduced blood flow (circulatory collapse).
Skin and subcutaneous tissue disorders
Sudden skin redness (various types of skin rash), itchy rash with raised bumps (urticaria), itching.
Ear and labyrinth disorders
Ringing in the ears (tinnitus), increased sensitivity to relatively quiet sounds (hyperacusis).
Reporting of side effects
If you experience any side effect, including those not listed in this leaflet, talk to your doctor or pharmacist. You may also report side effects directly via the national reporting system at https://www.aifa.gov.it/content/segnalazioni-reazioni-avverse.
By reporting side effects, you can help provide more information on the safety of this medicine.

5. How to store CLODRONATE DISODIUM AND LIDOCAINE HYDROCHLORIDE IG

PHARMACEUTICALS
Keep this medicine out of the sight and reach of children.
This medicine does not require any special storage conditions.
Do not use this medicine after the expiry date stated on the carton after Exp. The expiry date refers to the last day of that month.
Do not dispose of any medicine via wastewater or household waste. Ask your pharmacist how to dispose of medicines you no longer use. This will help protect the environment.

6. Package contents and other information

What CLODRONATE DISODIUM AND LIDOCAINE HYDROCHLORIDE IG FARMACEUTICI contains

The active substances are disodium clodronate (disodium salt of clodronic acid) 200 mg and lidocaine hydrochloride 40 mg.
The other components are sodium hydrogen carbonate (see section 2. CLODRONATE DISODIUM AND LIDOCAINE HYDROCHLORIDE IG FARMACEUTICI contains sodium), water for injections.

Description of the appearance of CLODRONATE DISODIUM AND LIDOCAINE HYDROCHLORIDE IG FARMACEUTICI and package contents
Injectable solution, clear and colourless, in packs of 3 - 6 - 9 - 12 vials for intramuscular use.
Marketing Authorization Holder
IG Farmaceutici di Irianni Giuseppe, Via San Rocco 6, 85033 Episcopia (PZ).
Manufacturer
Biomedica Foscama Industria Chimico-farmaceutica S.p.A. - Via Morolense 87 - 03013 Ferentino (FR)

The following information is intended exclusively for physicians or healthcare professionals:
DOSAGE, METHOD AND DURATION OF ADMINISTRATION
The dosage, depending on the clinical condition and mineralometric values, may vary as follows:
CLODRONATE DISODIUM AND LIDOCAINE HYDROCHLORIDE IG FARMACEUTICI every 14–28 days, for 1 year or longer, depending on the patient's condition.
CLODRONATE DISODIUM AND LIDOCAINE HYDROCHLORIDE IG FARMACEUTICI can be used in patients who have never previously received clodronate treatment.
When switching from administration of clodronate 100 mg + lidocaine 33 mg to CLODRONATE DISODIUM AND LIDOCAINE HYDROCHLORIDE IG FARMACEUTICI 200 mg + 40 mg, administration of one vial of CLODRONATE DISODIUM AND LIDOCAINE HYDROCHLORIDE IG FARMACEUTICI 200 mg + 40 mg every 14 days may be used as an alternative dosing regimen in patients already being treated with one 100 mg vial per week.
Administration of one vial of CLODRONATE DISODIUM AND LIDOCAINE HYDROCHLORIDE IG FARMACEUTICI 200 mg + 40 mg every 28 days may be used as an alternative dosing regimen in patients already being treated with one 100 mg vial every two weeks.
The optimal duration of bisphosphonate treatment for osteoporosis has not been established. The need for continued treatment should be periodically reassessed for each individual patient based on potential benefits and risks, particularly after 5 years or more of use.

Special populations
Children
The safety and efficacy of the medicinal product in paediatric patients have not been established.

Elderly
There are no specific dosage recommendations for elderly patients. Clinical studies conducted have included patients over 65 years of age, and no age-specific adverse events have been reported in this group.

Patients with renal impairment
Clodronate is primarily eliminated via the renal route. Therefore, it should be used with caution in patients with renal impairment. Dose reduction of clodronate is recommended as follows:

Renal impairment degree: Creatinine clearance, ml/min	Dosage reduction, %
50-80	25
12-50	25-50
<12	50

It is recommended to administer clodronate before haemodialysis, to reduce the dose by 50% on dialysis-free days, and to limit the treatment regimen to 5 days. It should be noted that peritoneal dialysis removes clodronate poorly from the circulation.
The solution is incompatible with alkaline solutions or oxidising solutions.