Gravitate Health FHIR Implementation Guide
0.1.0 - CI Build
Gravitate Health FHIR Implementation Guide
0.1.0 - CI Build
Gravitate Health FHIR Implementation Guide, published by Gravitate Health Project. This guide is not an authorized publication; it is the continuous build for version 0.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/joofio/test-epi-composition/ and changes regularly. See the Directory of published versions
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<div xmlns="http://www.w3.org/1999/xhtml"><p>What is in this leaflet</p><ol type="1"><li>What Herwenda is and what it is used for</li><li>What you need to know before you are given Herwenda</li><li>How Herwenda is given</li><li>Possible side effects</li><li>How to store Herwenda</li><li>Contents of the pack and other information</li></ol></div>
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<div xmlns="http://www.w3.org/1999/xhtml"><p>Herwenda contains the active substance trastuzumab, which is a monoclonal antibody. Monoclonal antibodies attach to specific proteins or antigens. Trastuzumab is designed to bind selectively to an antigen called human epidermal growth factor receptor 2 (HER2). HER2 is found in large amounts on the surface of some cancer cells where it stimulates their growth. When Herwenda binds to HER2 it stops the growth of such cells and causes them to die.</p><p>Your doctor may prescribe Herwenda for the treatment of breast and gastric cancer when:</p><ul><li>You have early breast cancer, with high levels of a protein called HER2. * You have metastatic breast cancer (breast cancer that has spread beyond the original tumour) with high levels of HER2. Herwenda may be prescribed in combination with the chemotherapy medicine paclitaxel or docetaxel as first treatment for metastatic breast cancer or it may be prescribed alone if other treatments have proved unsuccessful. It is also used in combination with medicines called aromatase inhibitors with patients with high levels of HER2 and hormone-receptor-positive metastatic breast cancer (cancer that is sensitive to the presence of female sex hormones).</li><li>You have metastatic gastric cancer with high levels of HER2, when it is in combination with the other cancer medicines capecitabine or 5-fluorouracil and cisplatin.</li></ul></div>
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<div xmlns="http://www.w3.org/1999/xhtml"><p>Do not use Herwenda if:</p><ul><li>you are allergic to trastuzumab, to murine (mouse) proteins, or to any of the other ingredients of this medicine (listed in section 6).</li><li>you have severe breathing problems at rest due to your cancer or if you need oxygen treatment.</li></ul><p>Warnings and precautions</p><p>Your doctor will closely supervise your therapy.</p><p>Heart checks Treatment with Herwenda alone or with a taxane may affect the heart, especially if you have ever used an anthracycline (taxanes and anthracyclines are two other kinds of medicine used to treat cancer). The effects may be moderate to severe and could cause death. Therefore, your heart function will be checked before, during (every three months) and after (up to two to five years) treatment with Herwenda. If you develop any signs of heart failure (inadequate pumping of blood by the heart), your heart function may be checked more frequently (every six to eight weeks), you may receive treatment for heart failure or you may have to stop Herwenda treatment.</p><p>Talk to your doctor, pharmacist or nurse before you are given Herwenda if:</p><ul><li>you have had heart failure, coronary artery disease, heart valve disease (heart murmurs), high blood pressure, taken any high blood pressure medicine or are currently taking any high blood pressure medicine.</li><li>you have ever had or are currently using a medicine called doxorubicin or epirubicin (medicines used to treat cancer). These medicines (or any other anthracyclines) can damage heart muscle and increase the risk of heart problems with trastuzumab.</li><li>you suffer from breathlessness, especially if you are currently using a taxane. Trastuzumab can cause breathing difficulties, especially when it is first given. This could be more serious if you are already breathless. Very rarely, patients with severe breathing difficulties before treatment have died when they were given trastuzumab.</li><li>you have ever had any other treatment for cancer.</li></ul><p>If you receive Herwenda with any other medicine to treat cancer, such as paclitaxel, docetaxel, an aromatase inhibitor, capecitabine, 5-fluorouracil, or cisplatin you should also read the patient information leaflets for these products.</p><p>Children and adolescents Herwenda is not recommended for anyone under the age of 18 years.</p><p>Other medicines and Herwenda Tell your doctor, pharmacist or nurse if you are taking, have recently taken or might take any other medicines.</p><p>It may take up to 7 months for Herwenda to be removed from the body. Therefore you should tell your doctor, pharmacist or nurse that you have had Herwenda if you start any new medicine in the 7 months after stopping treatment.</p><p>Pregnancy</p><ul><li>If you are pregnant, think you may be pregnant or are planning to have a baby, ask your doctor, pharmacist or nurse for advice before taking this medicine.</li><li>You should use effective contraception during treatment with Herwenda and for at least 7 months after treatment has ended.</li><li>Your doctor will advise you of the risks and benefits of taking Herwenda during pregnancy. In rare cases, a reduction in the amount of (amniotic) fluid that surrounds the developing baby within the womb has been observed in pregnant women receiving trastuzumab. This condition may be harmful to your baby in the womb and has been associated with the lungs not developing fully resulting in foetal death.</li></ul><p>Breast-feeding Do not breast-feed your baby during Herwenda therapy and for 7 months after the last dose as Herwenda may pass to your baby through your breast milk.</p><p>Ask your doctor or pharmacist for advice before taking any medicine.</p><p>Driving and using machines Herwenda may affect your ability to drive a car or operate machines. If during treatment you experience symptoms, such as dizziness, sleepiness, chills or fever, you should not drive or use machines until these symptoms disappear.</p><p>Herwenda contains sodium This medicine contains less than 1 mmol sodium (23 mg) per dose, that is to say essentially sodium-free .</p></div>
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<div xmlns="http://www.w3.org/1999/xhtml"><p>Before starting the treatment your doctor will determine the amount of HER2 in your tumour. Only patients with a large amount of HER2 will be treated with Herwenda. Herwenda should only be given by a doctor or nurse. Your doctor will prescribe a dose and treatment regimen that is right for you. The dose of Herwenda depends on your body weight.</p><p>Herwenda intravenous formulation is not for subcutaneous use and should be given as an intravenous infusion only.</p><p>Herwenda is given as an intravenous infusion ( drip ) directly into your veins. The first dose of your treatment is given over 90 minutes and you will be observed by a health professional while it is being given in case you have any side effects. If the first dose is well tolerated, the next doses may be given over 30 minutes (see section 2 under Warnings and precautions ). The number of infusions you receive will depend on how you respond to the treatment. Your doctor will discuss this with you.</p><p>For early breast cancer, metastatic breast cancer and metastatic gastric cancer, Herwenda is given every 3 weeks. Herwenda may also be given once a week for metastatic breast cancer.</p><p>In order to prevent medication errors it is important to check the vial labels to ensure that the medicine being prepared and given is Herwenda (trastuzumab) and not another trastuzumab-containing product (e.g. trastuzumab emtansine or trastuzumab deruxtecan).</p><p>If you stop using Herwenda Do not stop using this medicine without talking to your doctor first. All doses should be taken at the right time every week or every three weeks (depending on your dosing schedule). This helps your medicine work as well as it can.</p><p>It may take up to 7 months for Herwenda to be removed from your body. Therefore your doctor may decide to continue to check your heart functions, even after you finish treatment.</p><p>If you have any further questions on the use of this medicine, ask your doctor, pharmacist or nurse.</p></div>
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<div xmlns="http://www.w3.org/1999/xhtml"><p>Like all medicines, this medicine can cause side effects, although not everybody gets them. Some of these side effects may be serious and may lead to hospitalisation.</p><p>During a Herwenda infusion, chills, fever and other flu like symptoms may occur. These are very common (may affect more than 1 in 10 people). Other infusion-related symptoms are: feeling sick (nausea), vomiting, pain, increased muscle tension and shaking, headache, dizziness, breathing difficulties, high or low blood pressure, heart rhythm disturbances (palpitations, heart fluttering or irregular heart beat), swelling of the face and lips, rash and feeling tired. Some of these symptoms can be serious and some patients have died (see section 2 under Warnings and precautions ).</p><p>These effects mainly occur with the first intravenous infusion ( drip into your vein) and during the first few hours after the start of the infusion. They are usually temporary. You will be observed by a healthcare professional during the infusion and for at least six hours after the start of the first infusion and for two hours after the start of other infusions. If you develop a reaction, they will slow down or stop the infusion and may give you treatment to counteract the side effects. The infusion may be continued after the symptoms improve.</p><p>Occasionally, symptoms start later than six hours after the infusion begins. If this happens to you, contact your doctor immediately. Sometimes, symptoms may improve and then get worse later.</p><p>Serious side effects Other side effects can occur at any time during treatment with Herwenda, not just related to an infusion. Tell a doctor or nurse straight away, if you notice any of the following side effects:</p><ul><li>Heart problems can sometimes occur during treatment and occasionally after treatment has stopped and can be serious. They include weakening of the heart muscle possibly leading to heart failure, inflammation of the lining around the heart and heart rhythm disturbances. This can lead to symptoms such as breathlessness (including breathlessness at night), cough, fluid retention (swelling) in the legs or arms, palpitations (heart fluttering or irregular heart beat) (see section 2. Heart checks).</li></ul><p>Your doctor will monitor your heart regularly during and after treatment but you should tell your doctor immediately if you notice any of the above symptoms.</p><ul><li>Tumour lysis syndrome (a group of metabolic complications occurring after cancer treatment characterized by high blood levels of potassium and phosphate, and low blood levels of calcium). Symptoms may include kidney problems (weakness, shortness of breath, fatigue and confusion), heart problems (fluttering of the heart or a faster or slower heartbeat), seizures, vomiting or diarrhoea and tingling in the mouth, hands or feet.</li></ul><p>If you experience any of the above symptoms when your treatment with Herwenda has finished, you should see your doctor and tell them that you have previously been treated with Herwenda.</p><p>Very common (may affect more than 1 in 10 people):</p><ul><li><p>infections</p></li><li><p>diarrhoea</p></li><li><p>constipation</p></li><li><p>heartburn (dyspepsia)</p></li><li><p>fatigue</p></li><li><p>skin rashes</p></li><li><p>chest pain</p></li><li><p>abdominal pain</p></li><li><p>joint pain</p></li><li><p>low counts of red blood cells and white blood cells (which help fight infection) sometimes with fever</p></li><li><p>muscle pain</p></li><li><p>conjunctivitis</p></li><li><p>watery eyes</p></li><li><p>nose bleeds</p></li><li><p>runny nose</p></li><li><p>hair loss</p></li><li><p>tremor</p></li><li><p>hot flush</p></li><li><p>dizziness</p></li><li><p>nail disorders</p></li><li><p>weight loss</p></li><li><p>loss of appetite</p></li><li><p>inability to sleep (insomnia)</p></li><li><p>altered taste</p></li><li><p>low platelet count</p></li><li><p>bruising</p></li><li><p>numbness or tingling of the fingers and toes, which occasionally may extend to the rest of the limb</p></li><li><p>redness, swelling or sores in your mouth and/or throat</p></li><li><p>pain, swelling, redness or tingling of hands and/or feet</p></li><li><p>breathlessness</p></li><li><p>headache</p></li><li><p>cough</p></li><li><p>vomiting</p></li><li><p>nausea</p></li></ul><p>Common (may affect up to 1 in 10 people):</p><ul><li>allergic reactions</li><li>throat infections</li><li>bladder and skin infections</li><li>inflammation of the breast</li><li>inflammation of the liver</li><li>kidney disorders</li><li>increased muscle tone or tension (hypertonia)</li><li>pain in the arms and/or legs</li><li>itchy rash</li><li>sleepiness (somnolence)</li><li>haemorrhoids</li><li>itchiness</li><li>dry mouth and skin</li><li>dry eyes</li><li>sweating</li><li>feeling weak and unwell</li><li>anxiety</li><li>depression</li><li>asthma</li><li>infection of lungs</li><li>lung disorders</li><li>back pain</li><li>neck pain</li><li>bone pain</li><li>acne</li><li>leg cramps</li></ul><p>Uncommon (may affect up to 1 in 100 people):</p><ul><li>deafness</li><li>bumpy rash</li><li>wheezing</li><li>inflammation or scarring of the lungs</li></ul><p>Rare (may affect up to 1 in 1 000 people):</p><ul><li>jaundice</li><li>anaphylactic reactions</li></ul><p>Not known (frequency cannot be estimated from the available data):</p><ul><li>abnormal or impaired blood clotting</li><li>high potassium levels</li><li>swelling or bleeding at the back of the eyes</li><li>shock</li><li>abnormal heart rhythm</li><li>respiratory distress</li><li>respiratory failure</li><li>acute accumulation of fluid in the lungs</li><li>acute narrowing of the airways</li><li>abnormally low oxygen levels in the blood</li><li>difficulty in breathing when lying flat</li><li>liver damage</li><li>swelling of the face, lips and throat</li><li>kidney failure</li><li>abnormally low levels of fluid around baby in womb</li><li>failure of the lungs of the baby to develop in the womb</li><li>abnormal development of the kidneys of the baby in the womb</li></ul><p>Some of the side effects you experience may be due to your underlying cancer. If you receive Herwenda in combination with chemotherapy, some of them may also be due to the chemotherapy.</p><p>If you get any side effects, talk to your doctor, pharmacist or nurse.</p><p>Reporting of side effects If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via the national reporting system listed in Appendix V. By reporting side effects you can help provide more information on the safety of this medicine.</p></div>
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<div xmlns="http://www.w3.org/1999/xhtml"><p>Keep this medicine out of the sight and reach of children.</p><p>Do not use this medicine after the expiry date which is stated on the outer carton and on the vial label after EXP. The expiry date refers to the last day of that month.</p><p>Store in a refrigerator (2 C 8 C).</p><p>Keep the vial in the outer carton in order to protect from light.</p><p>Infusion solutions should be used immediately after dilution. If not used immediately, in-use storage times and conditions prior to use are the responsibility of the user, and would not normally be longer than 24 hours at 2 C 8 C. Do not freeze the reconstituted solution.</p><p>Do not use this medicine if you notice any particulate matter or discolouration prior to administration.</p><p>Do not throw away any medicines via wastewater or household waste. Ask your pharmacist how to throw away medicines you no longer use. These measures will help protect the environment.</p></div>
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<div xmlns="http://www.w3.org/1999/xhtml"><p>What Herwenda contains</p><ul><li><p>The active substance is trastuzumab. Each vial contains 150 mg trastuzumab that has to be dissolved in 7.2 mL of water for injections. The resulting solution contains approximately 21 mg/mL trastuzumab.</p></li><li><p>The other ingredient(s) are L-histidine hydrochloride monohydrate, L-histidine, , -trehalose dihydrate, polysorbate 20 (E 432).</p></li></ul><p>What Herwenda looks like and contents of the pack</p><p>Herwenda is a powder for concentrate for solution for infusion, which is supplied in a glass vial with a rubber stopper containing 150 mg of trastuzumab. The powder is a white to pale yellow pellet. Each carton contains 1 vial of powder.</p><p>Marketing Authorisation Holder</p><p>Sandoz GmbH Biochemiestr. 6250 Kundl Austria</p><p>Manufacturer<br/>Novartis Pharma GmbH Roonstra e 90429 Nuremberg Germany</p><p>Novartis Farmac utica, S.A. Gran V a de les Corts Catalanes, 08013 Barcelona Spain</p><p>This leaflet was last revised in</p><p>Detailed information on this medicine is available on the European Medicines Agency web site:</p></div>
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<system value="http://hl7.org/fhir/publication-status"/>
<code value="active"/>
<display value="active"/>
</coding>
</status>
<legalStatusOfSupply>
<coding>
<system value="https://spor.ema.europa.eu/rmswi"/>
<code value="100000072084"/>
<display
value="Medicinal product subject to medical prescription"/>
</coding>
</legalStatusOfSupply>
<name>
<productName
value="Herwenda 150 mg powder for concentrate for solution for infusion"/>
<type>
<coding>
<system value="https://spor.ema.europa.eu/lists/220000000000"/>
<code value="220000000001"/>
<display value="Full name"/>
</coding>
</type>
<part>
<part value="nan"/>
<type>
<coding>
<system
value="https://spor.ema.europa.eu/lists/220000000000"/>
<code value="220000000002"/>
<display value="Invented name part"/>
</coding>
</type>
</part>
<part>
<part value="nan"/>
<type>
<coding>
<system
value="https://spor.ema.europa.eu/lists/220000000000"/>
<code value="220000000003"/>
<display value="Scientific name part"/>
</coding>
</type>
</part>
<part>
<part value="nan"/>
<type>
<coding>
<system
value="https://spor.ema.europa.eu/lists/220000000000"/>
<code value="220000000004"/>
<display value="Strength part"/>
</coding>
</type>
</part>
<part>
<part value="nan"/>
<type>
<coding>
<system
value="https://spor.ema.europa.eu/lists/220000000000"/>
<code value="220000000005"/>
<display value="Pharmaceutical dose form part"/>
</coding>
</type>
</part>
<usage>
<country>
<coding>
<system value="urn:iso:std:iso:3166"/>
<code value="EU"/>
<display value="EU"/>
</coding>
</country>
<jurisdiction>
<coding>
<system value="urn:iso:std:iso:3166"/>
<code value="EU"/>
<display value="EU"/>
</coding>
</jurisdiction>
<language>
<coding>
<system value="urn:ietf:bcp:47"/>
<code value="en"/>
<display value="en"/>
</coding>
</language>
</usage>
</name>
</MedicinalProductDefinition>
</resource>
</entry>
</Bundle>
IG © 2021+ Gravitate Health Project. Package hl7.eu.fhir.ghepi#0.1.0 based on FHIR 5.0.0. Generated 2024-10-14
Links: Table of Contents |
QA Report
The Gravitate Health project has received funding from the IMI 2 Joint Undertaking under grant agreement No 945334.
This joint undertaking receives support from the EU H2020 research and innovation programme and EFPIA.
