Kleder

Package leaflet: Information for the patient

Kleder, 5 mg, hard capsules
Kleder, 10 mg, hard capsules
Kleder, 15 mg, hard capsules
Kleder, 20 mg, hard capsules
Kleder, 25 mg, hard capsules
Lenalidomide
Please read all of this leaflet carefully before taking this medicine because it contains important information for you.

• Keep this leaflet. You may need to read it again.
• Talk to your doctor or pharmacist if you have any further questions.
• This medicine has been prescribed for you only. Do not pass it on to others. It may harm them, even if their symptoms are the same as yours.
• If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. See section 4.

Contents of the leaflet

1. What Kleder is and what it is used for
2. Important information before taking Kleder
3. How to take Kleder
4. Possible side effects
5. How to store Kleder
6. Contents of the pack and other information

1. What Kleder is and what it is used for

What Kleder is
Kleder contains the active substance lenalidomide. This medicine belongs to a group of medicines that affect the function of the immune system.
What Kleder is used for
Kleder is used in adults to treat:

• multiple myeloma,
• myelodysplastic syndromes,
• mantle cell lymphoma,
• follicular lymphoma.

Multiple myeloma
Multiple myeloma is a type of cancer that affects a certain type of white blood cells called plasma cells. These cells accumulate in the bone marrow and divide uncontrollably. This may lead to damage of bones and kidneys.
Multiple myeloma is generally incurable, but it is possible to achieve a temporary significant reduction or elimination of signs and symptoms of the disease. This is called a “response”.
Newly diagnosed multiple myeloma in patients after bone marrow transplant
In this indication, Kleder is used as monotherapy for maintenance treatment after achieving an adequate response following transplantation.
Newly diagnosed multiple myeloma – in patients who are not eligible for treatment with bone marrow transplant
Kleder is taken in combination with other medicines. These may include:

• a chemotherapy medicine called “bortezomib”;
• an anti-inflammatory medicine called “dexamethasone”;
• a chemotherapy medicine called “melphalan”;
• an immunosuppressive medicine called “prednisone”.
  The patient starts treatment with additional medicines and then continues with Kleder alone.

If the patient is 75 years of age or older, or has moderate to severe kidney impairment, the doctor will perform thorough assessments before starting treatment.
Multiple myeloma – in previously treated patients
Kleder is taken in combination with an anti-inflammatory medicine called “dexamethasone”.
Kleder may stop the progression of signs and symptoms of multiple myeloma. It has also been shown to delay the recurrence of multiple myeloma after treatment.
Myelodysplastic syndromes (MDS)
Myelodysplastic syndromes (MDS) are a group of different blood and bone marrow disorders. Abnormal blood cells are present, which do not function properly. Patients may experience various subjective and objective symptoms, including low number of red blood cells (anaemia), need for blood transfusions, and risk of infection.
Kleder as monotherapy is used to treat adult patients diagnosed with MDS if all of the following conditions are met:

• the patient requires regular blood transfusions due to low red blood cell count (“transfusion-dependent anaemia”);
• the patient has an abnormality in bone marrow cells called “isolated cytogenetic abnormality of deletion 5q”. This means the patient’s body does not produce enough healthy blood cells;
• the patient has previously been treated with other therapies that were inappropriate or insufficiently effective.

Taking Kleder may lead to an increase in the number of healthy blood cells produced by the body by reducing the number of abnormal cells:

• this may lead to a reduction in the number of required blood transfusions. It may become possible that blood transfusions are no longer needed.

Mantle cell lymphoma (MCL)
MCL is a cancer of part of the immune system (lymphatic tissue). It affects a certain type of white blood cells called B-lymphocytes or B-cells. Mantle cell lymphoma is a disease characterised by uncontrolled growth of B-lymphocytes, leading to their accumulation in lymphatic tissue, bone marrow, or blood.
Kleder as monotherapy is used to treat adult patients who have been previously treated with other medicines.
Follicular lymphoma (FL)
Follicular lymphoma (FL) is a slowly growing malignant tumour affecting B-lymphocytes. These are a type of white blood cells that help the body fight infections. In patients with FL, excessive numbers of B-lymphocytes may accumulate in the blood, bone marrow, lymph nodes, and spleen.
Kleder is taken together with another medicine called “rituximab” in the treatment of adult patients with previously treated follicular lymphoma.
How Kleder works
Kleder works by affecting the function of the immune system and directly attacking cancer cells. The medicine works in several different ways:

• by inhibiting the growth of cancer cells,
• by inhibiting the development of blood vessels in the tumour,
• by stimulating part of the immune system to attack cancer cells.

2. Important information before taking Kleder
Before starting treatment with Kleder, read carefully the leaflets of all medicinal products taken in combination with Kleder.
When not to take Kleder:

• If the patient is pregnant, suspects she is pregnant, or plans to become pregnant, because Kleder is expected to be harmful to the unborn child (see section 2 “Pregnancy, breastfeeding and contraception – information for women and men”).
• If the patient may become pregnant, unless she uses all required contraceptive measures (see section 2 “Pregnancy, breastfeeding and contraception – information for women and men”). If the patient may become pregnant, the doctor will always document that necessary measures have been taken and will ensure the patient is informed.
• If the patient is allergic to lenalidomide or any of the other ingredients of this medicine listed in section 6. If allergy is suspected, ask your doctor for advice.

If any of these points apply to you, do not take Kleder. If in doubt, consult your doctor.
Warnings and precautions
Before starting to take Kleder, talk to your doctor, pharmacist, or nurse if:

• you have previously had blood clots – this means an increased risk of developing blood clots in veins and arteries during treatment;
• you have any signs of infection, such as cough or fever;
• you currently have or have previously had a viral infection, particularly hepatitis B virus, varicella-zoster virus (chickenpox and shingles), or HIV. If in doubt, consult your doctor. Treatment with Kleder may cause reactivation of the virus in patients who are carriers. This leads to recurrence of infection. Your doctor will check whether you have previously had hepatitis B;
• you have kidney problems – your doctor may adjust the dose of Kleder;
• you have had a heart attack (heart attack), blood clot, if you smoke, have high blood pressure, or high cholesterol levels;
• you experienced allergic reactions while taking thalidomide (another medicine used to treat multiple myeloma), such as rash, itching, swelling, dizziness, or breathing difficulties;
• you previously had a combination of any of the following symptoms: widespread rash, skin redness, high body temperature, flu-like symptoms, increased liver enzyme activity, blood abnormalities (eosinophilia), swollen lymph nodes – these are symptoms of a severe skin reaction called drug rash with eosinophilia and systemic symptoms, also known as “DRESS” or “drug hypersensitivity syndrome” (see also section 4 “Possible side effects”).

If any of the above apply to you, consult your doctor, pharmacist, or nurse.
If at any time during or after treatment the patient experiences:

• vision disturbances, loss of vision or double vision, difficulty speaking, weakness of hand or leg, change in walking or balance disturbances, persistent numbness, reduced sensation or loss of sensation, memory loss or disorientation, immediately inform your doctor or nurse. These may be symptoms of a severe and potentially fatal brain disease called progressive multifocal leukoencephalopathy (PML). If the patient had such symptoms before treatment with lenalidomide, inform the doctor of any changes in these symptoms.
• shortness of breath, fatigue, dizziness, chest pain, rapid heartbeat, or swelling of legs or ankles. These may be symptoms of a serious condition known as pulmonary hypertension (see section 4).

Tests and examinations
Regular blood tests will be performed before and during treatment with Kleder. This is because Kleder may cause a decrease in the number of blood cells involved in fighting infections (white blood cells) and blood clotting (platelets).
Your doctor will ask you to have blood tests:

• before treatment;
• weekly for the first 8 weeks of treatment;
• then at least once a month.

Before starting lenalidomide treatment and during treatment, the patient may be evaluated for diseases affecting the circulatory and respiratory systems.
Patients with MDS taking Kleder
If the patient has myelodysplastic syndromes, there is an increased chance of developing a severe disease called acute myeloid leukaemia. Furthermore, it is not known how Kleder affects the likelihood of developing acute myeloid leukaemia. Therefore, your doctor may perform tests and check for signs that may better predict the risk of acute myeloid leukaemia during treatment with Kleder.
Patients with MCL taking Kleder
Your doctor will ask you to have blood tests:

• before treatment;
• weekly for the first 8 weeks (2 cycles) of treatment;
• then every 2 weeks during cycles 3 and 4 (more information in section 3 “Treatment cycle”);
• then at the beginning of each cycle and
• at least once a month.

Patients with FL taking Kleder
Your doctor will ask you to have blood tests:

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

Your doctor may perform a test to check whether the patient has a large amount of tumour tissue in the body, including bone marrow. This may lead to a situation where tumour tissue begins to die and causes an abnormal increase in the concentration of various substances in the blood, which may lead to kidney failure (a condition called tumour lysis syndrome).
Your doctor may examine the patient to check for skin changes such as red spots or rash.
Your doctor may change the dose of Kleder or stop treatment based on the results of blood tests and the patient’s general condition. If the disease has been recently diagnosed, the doctor may also assess treatment based on the patient’s age and other pre-existing conditions.
Blood donation
During treatment and for at least 7 days after treatment ends, the patient must not donate blood.
Children and adolescents
Kleder is not recommended for use in children and adolescents under 18 years of age.
Elderly patients and patients with kidney problems
If the patient is 75 years of age or older, or has moderate to severe kidney problems, the doctor will perform thorough assessments before starting treatment.
Kleder with other medicines
Tell your doctor or nurse about all medicines you are currently taking or have recently taken. This is necessary because Kleder may affect the action of other medicines. Also, some other medicines may affect the way Kleder works.
In particular, inform your doctor or nurse if the patient is taking the following medicines:

• certain contraceptives, such as oral contraceptives, because 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
Applies to women taking Kleder

• Do not take Kleder if you are pregnant, because it is expected to be harmful to the unborn child.
• Women must not become pregnant while taking Kleder.
• Therefore, women who may become pregnant must use an effective method of contraception (see “Contraception”).
• If you become pregnant while taking Kleder, you must stop treatment immediately and inform your doctor.

Applies to men taking Kleder

• If the partner of a man undergoing treatment with Kleder becomes pregnant, she should immediately inform the doctor. The patient’s partner should seek medical advice.
• Men must also use an effective method of contraception (see “Contraception”).

Breastfeeding
Do not breastfeed while taking Kleder, because it is not known whether Kleder passes into human milk.
Contraception
Applies to women taking Kleder
Before starting treatment, ask your doctor about the possibility of becoming pregnant, even if you consider it unlikely.
Women who may become pregnant:

• will undergo pregnancy tests performed under the supervision of a doctor (before each treatment, at least every 4 weeks during treatment, and at least 4 weeks after treatment ends), except in cases where the fallopian tubes have been cut and blocked to prevent the egg from reaching the uterus (tubal sterilisation)
  AND

• must use effective methods of contraception for at least 4 weeks before starting treatment, during treatment, and for at least 4 weeks after treatment ends. Your doctor will advise you on appropriate contraceptive methods.

Applies to men taking Kleder
Kleder passes into human semen. If a woman is pregnant or may become pregnant and is not using an effective contraceptive method, her partner should use a condom during treatment and for at least 7 days after treatment ends. This also applies to men who have had a vasectomy. During treatment and for at least 7 days after treatment ends, the patient must not donate semen.
Driving and using machines
Do not drive or operate machinery if you experience dizziness, fatigue, drowsiness, balance disturbances due to vertigo, or blurred vision after taking Kleder.
Kleder contains lactose and sodium.
Kleder contains lactose. If you have been previously diagnosed with intolerance to certain sugars, you should contact your doctor before taking this medicine.
The medicine contains less than 1 mmol (23 mg) of sodium per capsule, meaning the medicine is considered “sodium-free”.

3. How to use Kleder

Kleder must be administered by medical personnel experienced in
the treatment of multiple myeloma, MDS, MCL, or FL.

• When Kleder is used to treat multiple myeloma in patients who are not eligible for bone marrow transplantation or who have previously received other treatment, the medicine is used in combination with other drugs (see section 1 “Why Kleder is used”).
• When Kleder is used to treat multiple myeloma in patients after bone marrow transplantation, or in patients with MDS or MCL, the medicine is used as monotherapy.
• When Kleder is used to treat follicular lymphoma, it is administered together with another medicine called “rituximab”.

Kleder should always be used as directed by the physician. If in doubt, consult the
physician or pharmacist.
If the patient is taking Kleder together with other medicines, they should read the package leaflet
included with those medicines to obtain information about their use and effects.
Treatment cycle
Kleder is taken on specific days within a period of three weeks (21 days).

• Each 21-day period is referred to as a treatment cycle.
• Depending on the day of the cycle, the patient may take one or more medicines. However, on certain days, the patient will not take any medicines.
• After completion of each 21-day cycle, the patient should start a new 21-day cycle. OR Kleder is taken on specific days within a period of four weeks (28 days).
• Each 28-day period is referred to as a treatment cycle.
• Depending on the day of the cycle, the patient may take one or more medicines. However, on certain days, the patient will not take any medicines.
• After completion of each 28-day cycle, the patient should start a new 28-day cycle.

What dose of Kleder should be taken
Before starting treatment, the physician will inform the patient:

• how much Kleder should be taken;
• how many other medicines should be taken in combination with Kleder, if additional medicines are required;
• on which days of the cycle each medicine should be taken.

How and when to take Kleder

• Swallow the capsule whole, preferably with water.
• Do not crush, open, or chew the capsules. If the powder from a damaged Kleder capsule comes into contact with the skin, wash the skin immediately and thoroughly with soap and water.
• Healthcare professionals, caregivers, and family members should wear disposable gloves when handling the blister pack or capsule. Gloves should then be carefully removed to avoid skin exposure, placed in a sealed polyethylene plastic bag, and disposed of according to local regulations. Hands should then be washed thoroughly with soap and water. Pregnant women or women who suspect they may be pregnant should not handle the blister pack or capsule.
• Capsules may be taken with or without food.
• Kleder should be taken at approximately the same time each day on which the dose is scheduled.

How to take Kleder
To remove the capsule from the blister:

• press only on one side of the capsule to push it through the foil;
• do not press on the center of the capsule, as this may damage it.

Duration of treatment with Kleder
Kleder is administered in treatment cycles; each cycle lasts 21 or 28 days (see above, “Treatment cycle”). Treatment cycles should continue until the physician decides to discontinue treatment.
Overdose of Kleder
If a dose of Kleder higher than prescribed is taken, inform the physician immediately.
Missed dose of Kleder
If a dose of Kleder has been missed at the scheduled time and

• less than 12 hours have passed since then: take the capsule immediately;
• more than 12 hours have passed since then: do not take the capsule. Take the next capsule at the scheduled time on the following day.

If there are any further doubts regarding the use of this medicine, consult the
physician or pharmacist.

4. Possible adverse reactions

Like any medicine, this medicine can cause adverse reactions, although not everyone will experience them.
If any of the following serious adverse reactions occur, stop taking Kleder immediately and seek medical advice without delay – immediate treatment may be required:

• urticaria, rash, swelling of the eyes, lips or face, breathing difficulties or itching, which may be symptoms of severe allergic reactions known as angioedema and anaphylactic reaction;
• severe allergic reaction possibly starting as a rash in one area, spreading over the entire body and associated with extensive skin peeling (Stevens-Johnson syndrome and/or toxic epidermal necrolysis);
• widespread rash, high fever, increased liver enzyme activity, blood abnormalities (eosinophilia), swollen lymph nodes and involvement of other organs (drug rash with eosinophilia and systemic symptoms, also known as "DRESS" or "drug hypersensitivity syndrome"). See also section 2.

Immediately inform your doctor if any of the following serious adverse reactions occur:

• fever, chills, sore throat, cough, mouth ulcers or any other signs of infection (including blood infections (sepsis));
• bleeding or bruising without injury;
• chest pain or leg pain;
• shortness of breath;
• bone pain, muscle weakness, confusion or fatigue, which may result from high calcium levels in the blood.

Kleder may reduce the number of white blood cells that fight infection, as well as blood cells involved in blood clotting (platelets), which may lead to bleeding disorders such as nosebleeds and bruising. Kleder may also cause blood clots in veins (venous thrombosis).
Other adverse reactions
It should be noted that in a small number of patients other types of tumours may develop, and that the risk of this may possibly increase due to treatment with Kleder. Therefore, your treating physician should carefully assess the benefits and risks before prescribing Kleder.
Very common adverse reactions (may affect more than 1 in 10 people):

• reduced number of red blood cells, which may lead to anaemia causing fatigue and weakness;
• rashes, itching;
• muscle cramps, muscle weakness, muscle pain, tenderness in muscles, bone pain, joint pain, back pain, limb pain;
• generalised swelling, including swelling of hands and feet;
• weakness, fatigue;
• fever and flu-like symptoms, including fever, muscle pain, headache, earache, cough and chills;
• numbness, tingling or burning sensation of the skin, pain in hands or feet, dizziness, tremor;
• reduced appetite, altered taste;
• increased pain, enlargement or redness around a tumour;
• weight loss;
• constipation, diarrhoea, nausea, vomiting, abdominal pain, heartburn;
• low levels of potassium or calcium and (or) sodium in the blood;
• underactive thyroid gland;
• leg pain (which may indicate thrombosis), chest pain or shortness of breath (which may indicate presence of blood clots in the lungs, so-called pulmonary embolism);
• all types of infections, including sinus infection, lung infection and upper respiratory tract infections;
• shortness of breath;
• blurred vision;
• cloudy vision (cataract);
• kidney problems, including impaired kidney function or inability to maintain normal kidney function;
• abnormal liver test results;
• increased liver function test values;
• changes in blood proteins leading to swelling of arteries (vasculitis);
• increased blood sugar levels (diabetes);
• decreased blood sugar levels;
• headache;
• nosebleeds;
• dry skin;
• depression, mood changes, sleep problems;
• cough;
• low blood pressure;
• vague feeling of physical discomfort, malaise;
• painful inflammation of the mouth, dry mouth;
• dehydration.

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

• breakdown of red blood cells (haemolytic anaemia);
• certain types of skin tumours;
• bleeding from gums, stomach or intestines;
• increased blood pressure, slow, fast or irregular heartbeat;
• increased levels of substances resulting from normal and abnormal breakdown of red blood cells;
• increased levels of a protein indicating inflammation in the body;
• darkening of the skin, skin discolouration due to bleeding under the skin, usually caused by bruising; blood-filled skin swelling, bruising;
• increased levels of uric acid in the blood;
• skin eruptions, redness of the skin, skin cracking, peeling or flaking, urticaria;
• excessive sweating, night sweats;
• difficulty swallowing, sore throat, problems with voice quality or voice changes;
• rhinitis (nasal congestion);
• passing significantly more or less urine than normal, or inability to control the timing of urination;
• blood in the urine;
• shortness of breath, especially when lying down (which may indicate heart failure);
• erectile problems;
• stroke, fainting, dizziness (inner ear disorder causing a sensation that everything is spinning), transient loss of consciousness;
• chest pain spreading to arms, neck, jaw, back or abdomen, sweating and breathlessness, nausea or vomiting, which may be symptoms of a heart attack (myocardial infarction);
• muscle weakness, lack of energy;
• neck pain, chest pain;
• chills;
• joint swelling;
• slowed or blocked flow of bile from the liver;
• low levels of phosphates or magnesium in the blood;
• difficulty speaking;
• liver damage;
• balance disorders, difficulty moving;
• deafness, tinnitus (ringing in the ears);
• nerve pain, unpleasant abnormal sensations, especially in response to touch;
• excess iron in the body;
• thirst;
• confusion;
• toothache;
• falls that may lead to injury.

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

• bleeding inside the skull;
• circulatory problems;
• loss of vision;
• loss of sexual desire (libido);
• passing large amounts of urine, accompanied by bone pain and weakness, which may be symptoms of kidney disease (Fanconi syndrome);
• yellowing of the skin, mucous membranes or eyes (jaundice), pale-coloured stools, dark-coloured urine, itchy skin, rash, abdominal pain or swelling – may be symptoms of liver damage (liver failure);
• abdominal pain, bloating or diarrhoea, which may be symptoms of inflammation of the large intestine (so-called colitis or typhlitis);
• kidney cell damage (called tubular necrosis);
• change in skin colour, sensitivity to sunlight;
• tumour lysis syndrome – metabolic complications that may occur during cancer treatment, and sometimes even without treatment. These complications are caused by products released from dying cancer cells and may include: changes in blood chemistry; high levels of potassium, phosphate and uric acid, and low calcium levels, leading to kidney dysfunction, irregular heart rhythm, seizures, and sometimes death;
• increased blood pressure in blood vessels leading to the lungs (pulmonary hypertension).

Unknown frequency adverse reactions (frequency cannot be estimated from available data)

• sudden or mild but progressively worsening pain in the upper abdomen and/or back, lasting for several days, usually accompanied by nausea, vomiting, fever and rapid heartbeat – these symptoms may occur in association with pancreatitis;
• wheezing, shortness of breath or dry cough, possibly due to inflammation of lung tissue;
• rare cases of muscle breakdown (muscle pain, weakness or swelling) leading to kidney problems (rhabdomyolysis) have been observed, some occurring when Kleder was administered concomitantly with a statin (a type of medicine that lowers blood cholesterol levels);
• skin disease caused by inflammation of small blood vessels, associated with joint pain and fever (leucocytoclastic vasculitis);
• perforation of the stomach or intestinal wall; this may lead to a very serious infection. Inform your doctor if you experience severe stomach pain, fever, nausea, vomiting, blood in stool or changes in bowel habits;
• viral infections, including shingles (a viral disease causing a painful skin rash with blisters) and reactivation of hepatitis B virus infection (which may cause yellowing of the skin and eyes, dark brown urine, abdominal pain on the right side, fever, nausea and vomiting);
• rejection of solid organ transplant (e.g. kidney, heart).

Reporting of adverse reactions
If any adverse effects occur, including any not listed in this leaflet, tell your doctor, pharmacist or nurse. Adverse reactions can also be reported directly to the Department of Monitoring Adverse Drug Reactions, Office for Registration of Medicinal Products, Medical Devices and Biocidal Products:
Al. Jerozolimskie 181C, 02-222 Warsaw, tel.: 22 49-21-301, fax: 22 49-21-309, website:
https://smz.ezdrowie.gov.pl.
Adverse reactions can also be reported to the responsible entity.
Reporting adverse reactions helps provide more information on the safe use of the medicine.

5. How to store Kleder

Keep this medicine out of sight and reach of children.
Do not use this medicine after the expiry date stated on the blister and the cardboard
pack after the word "EXP". The expiry date refers to the last day of the stated month.
No special storage conditions are required for this medicine.
Do not use this medicine if you notice any damage or signs of tampering with the packaging.
Medicines should not be disposed of via wastewater or household waste. Unused
medicines should be returned to a pharmacy, which will accept them. This will help protect the environment.

6. Contents of the package and other information

What Kleder contains
Kleder 5 mg, hard capsules:

• The active substance is lenalidomide. Each capsule contains 5 mg of lenalidomide.
• Other ingredients are:
  • capsule contents: lactose (see section 2), microcrystalline cellulose, sodium croscarmellose, and magnesium stearate;
  • capsule shell: brilliant blue FCF (E 133), iron oxide red (E 172), iron oxide yellow (E 172), titanium dioxide (E 171), and gelatin;
  • printing ink: shellac, iron oxide black (E 172), propylene glycol, and potassium hydroxide.

Kleder 10 mg, hard capsules:

• The active substance is lenalidomide. Each capsule contains 10 mg of lenalidomide.
• Other ingredients are:
  • capsule contents: lactose (see section 2), microcrystalline cellulose, sodium croscarmellose, and magnesium stearate;
  • capsule shell: iron oxide black (E 172), iron oxide yellow (E 172), titanium dioxide (E 171), and gelatin;
  • printing ink: shellac, iron oxide black (E 172), propylene glycol, and potassium hydroxide.

Kleder 15 mg, hard capsules:

• The active substance is lenalidomide. Each capsule contains 15 mg of lenalidomide.
• Other ingredients are:
  • capsule contents: lactose (see section 2), microcrystalline cellulose, sodium croscarmellose, and magnesium stearate;
  • capsule shell: iron oxide black (E 172), iron oxide red (E 172), iron oxide yellow (E 172), titanium dioxide (E 171), and gelatin;
  • printing ink: shellac, iron oxide black (E172), propylene glycol, and potassium hydroxide.

Kleder 20 mg, hard capsules:

• The active substance is lenalidomide. Each capsule contains 20 mg of lenalidomide.
• Other ingredients are:
  • capsule contents: lactose (see section 2), microcrystalline cellulose, sodium croscarmellose, and magnesium stearate;
  • capsule shell: iron oxide red (E 172), iron oxide yellow (E 172), iron oxide black (E 172), titanium dioxide (E 171), and gelatin;
  • printing ink: shellac, iron oxide black (E 172), propylene glycol, and potassium hydroxide.

Kleder 25 mg, hard capsules:

• The active substance is lenalidomide. Each capsule contains 25 mg of lenalidomide.
• Other ingredients are:
  • capsule contents: lactose (see section 2), microcrystalline cellulose, sodium croscarmellose, and magnesium stearate;
  • capsule shell: titanium dioxide (E 171) and gelatin;
  • printing ink: shellac, iron oxide black (E 172), propylene glycol, and potassium hydroxide.

What Kleder looks like and contents of the pack
Kleder 5 mg, hard capsules have a green, opaque cap and a light brown, opaque body, capsule size No. 2, 18–19 mm, printed in black ink with “LP” on the cap and “638” on the body; the capsule is filled with white powder.
Kleder 10 mg, hard capsules have a yellow, opaque cap and a grey, opaque body, capsule size No. 0, 21–22 mm, printed in black ink with “LP” on the cap and “639” on the body; the capsule is filled with white powder.
Kleder 15 mg, hard capsules have a brown, opaque cap and a grey, opaque body, capsule size No. 2, 18–19 mm, printed in black ink with “LP” on the cap and “640” on the body; the capsule is filled with white powder.
Kleder 20 mg, hard capsules have a dark red, opaque cap and a light grey, opaque body, capsule size No. 1, 19–20 mm, printed in black ink with “LP” on the cap and “641” on the body; the capsule is filled with white powder.
Kleder 25 mg, hard capsules have a white, opaque cap and a white, opaque body, capsule size No. 0, 21–22 mm, printed in black ink with “LP” on the cap and “642” on the body; the capsule is filled with white powder.
PVC/ACLAR/aluminium blisters containing 7 capsules per blister, packed in cardboard cartons.
Kleder 5 mg, 10 mg and 15 mg
Pack sizes: 7 or 21 capsules. Not all pack sizes may be marketed.
Kleder 20 mg and 25 mg
Pack size: 21 capsules.

Marketing Authorisation Holder and Manufacturer
Marketing Authorisation Holder
Stada Arzneimittel AG
Stadastrasse 2–18
61118 Bad Vilbel, Germany

Manufacturers/Importers
Pharmadox Healthcare Ltd.
KW20A Kordin Industrial Park,
Paola PLA 3000, Malta
Adalvo Ltd.
Malta Life Sciences Park
Building 1, Level 4
Sir Temi Zammit Buildings
San Gwann SGN 3000, Malta
STADA Arzneimittel AG
Stadastrasse 2 – 18
61118 Bad Vilbel
Germany
STADAPHARM GmbH
Feodor-Lynen-Str. 35
30625 Hannover,
Germany

This medicinal product is authorised in the European Economic Area countries under the following names:
Iceland Kleder 2.5 mg hard capsules
Kleder 5 mg hard capsules
Kleder 7.5 mg hard capsules
Kleder 10 mg hard capsules
Kleder 15 mg hard capsules
Kleder 20 mg hard capsules
Kleder 25 mg hard capsules
Italy, Poland Kleder