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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"title" : "TEST PURPOSES ONLY - zarzio",
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"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p>What is in this leaflet</p><ol type=\"1\"><li>What Zarzio is and what it is used for</li><li>What you need to know before you use Zarzio</li><li>How to use Zarzio</li><li>Possible side effects</li><li>How to store Zarzio</li><li>Contents of the pack and other information</li></ol></div>"
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"title" : "1. What zarzio is and what it is used for",
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"text" : "1. What zarzio is and what it is used for"
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"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p>Zarzio is a white blood cell growth factor (granulocyte colony stimulating factor) and belongs to a group of proteins called cytokines. Growth factors are proteins that are produced naturally in the body but they can also be made using biotechnology for use as a medicine. Zarzio works by encouraging the bone marrow to produce more white blood cells. A reduction in the number of white blood cells (neutropenia) can occur for several reasons and makes your body less able to fight infection. Zarzio stimulates the bone marrow to produce new white cells quickly. Zarzio can be used:</p><p>to increase the number of white blood cells after treatment with chemotherapy to help prevent infections;</p><p>to increase the number of white blood cells after a bone marrow transplant to help prevent infections;</p><p>before high-dose chemotherapy to make the bone marrow produce more stem cells which can be collected and given back to you after your treatment. These can be taken from you or from a donor. The stem cells will then go back into the bone marrow and produce blood cells;</p><p>to increase the number of white blood cells if you suffer from severe chronic neutropenia to help prevent infections;</p><p>in patients with advanced HIV infection which will help reduce the risk of infections.</p></div>"
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"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><h2 id=\"do-not-use-zarzio\">Do not use Zarzio</h2><h2 id=\"if-you-are-allergic-to-filgrastim-or-any-of-the-other-ingredients-of-this-medicine-listed-in-section-6-warnings-and-precautions-talk-to-your-doctor-pharmacist-or-nurse-before-using-zarzio-please-tell-your-doctor-before-starting-treatment-if-you-have\">if you are allergic to filgrastim or any of the other ingredients of this medicine (listed in section 6). Warnings and precautions Talk to your doctor, pharmacist or nurse before using Zarzio. Please tell your doctor before starting treatment if you have:</h2><h2 id=\"osteoporosis-bone-disease\">osteoporosis (bone disease);</h2><h2 id=\"sickle-cell-anaemia-as-zarzio-may-cause-sickle-cell-crisis-please-tell-your-doctor-immediately-during-treatment-with-zarzio-if-you\">sickle cell anaemia, as Zarzio may cause sickle cell crisis. Please tell your doctor immediately during treatment with Zarzio, if you:</h2><h2 id=\"get-left-upper-belly-abdominal-pain-pain-below-the-left-rib-cage-or-at-the-tip-of-your-left-shoulder-these-may-be-symptoms-of-an-enlarged-spleen-splenomegaly-or-possibly-rupture-of-the-spleen\">get left upper belly (abdominal) pain, pain below the left rib cage or at the tip of your left shoulder [these may be symptoms of an enlarged spleen (splenomegaly), or possibly rupture of the spleen].</h2><h2 id=\"notice-unusual-bleeding-or-bruising-these-may-be-symptoms-of-a-decrease-in-blood-platelets-thrombocytopenia-with-a-reduced-ability-of-your-blood-to-clot\">notice unusual bleeding or bruising [these may be symptoms of a decrease in blood platelets (thrombocytopenia), with a reduced ability of your blood to clot].</h2><h2 id=\"have-sudden-signs-of-allergy-such-as-rash-itching-or-hives-on-the-skin-swelling-of-the-face-lips-tongue-or-other-parts-of-the-body-shortness-of-breath-wheezing-or-trouble-breathing-as-these-could-be-signs-of-a-severe-allergic-reaction-hypersensitivity\">have sudden signs of allergy such as rash, itching or hives on the skin, swelling of the face, lips, tongue or other parts of the body, shortness of breath, wheezing or trouble breathing as these could be signs of a severe allergic reaction (hypersensitivity).</h2><h2 id=\"experience-puffiness-in-your-face-or-ankles-blood-in-your-urine-or-brown-coloured-urine-or-you-notice-you-urinate-less-than-usual-glomerulonephritis\">experience puffiness in your face or ankles, blood in your urine or brown-coloured urine or you notice you urinate less than usual (glomerulonephritis).</h2><p>have symptoms of inflammation of the aorta (the large blood vessel which transports blood from the heart to the body); this was reported in rare cases in cancer patients and healthy donors. The symptoms can include fever, abdominal pain, malaise, back pain and increased inflammatory markers. Tell your doctor if you experience these symptoms. Loss of response to filgrastim If you experience a loss of response or failure to maintain a response with filgrastim treatment, your doctor will investigate the reasons why including whether you have developed antibodies which neutralise filgrastim s activity. Your doctor may want to monitor you closely, see section 4 of the package leaflet. If you are a patient with severe chronic neutropenia, you may be at risk of developing cancer of the blood (leukaemia, myelodysplastic syndrome [MDS]). You should talk to your doctor about your risks of developing cancers of the blood and what testing should be done. If you develop or are likely to develop cancers of the blood, you should not use Zarzio unless instructed by your doctor. If you are a stem cell donor, you must be aged between 16 and 60 years. Take special care with other products that stimulate white blood cells. Zarzio is one of a group of products that stimulate the production of white blood cells. Your healthcare professional should always record the exact product you are using. Other medicines and Zarzio Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines. Pregnancy and breast-feeding Zarzio has not been tested in pregnant or breast-feeding women. Zarzio is not recommended during pregnancy. It is important to tell your doctor if you:</p><p>are pregnant or breast-feeding;</p><p>think you may be pregnant; or</p><p>are planning to have a baby. If you become pregnant during Zarzio treatment, please inform your doctor. Unless your doctor directs you otherwise, you must stop breast feeding if you use Zarzio. Driving and using machines Zarzio may have a minor influence on your ability to drive and use machines. This medicine may cause dizziness. It is advisable to wait and see how you feel after taking Zarzio and before driving or operating machinery. Zarzio contains sorbitol and sodium Zarzio contains sorbitol (E420). Sorbitol is a source of fructose. If you (or your child) have hereditary fructose intolerance (HFI), a rare genetic disorder, you (or your child) must not receive this medicine. Patients with HFI cannot break down fructose, which may cause serious side effects. You must tell your doctor before receiving this medicine if you (or your child) have HFI or if your child can no longer take sweet foods or drinks because they feel sick, vomit or get unpleasant effects such as bloating, stomach cramps or diarrhoea. 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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"title" : "3. How to take zarzio",
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"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p>Always use this medicine exactly as your doctor has told you. Check with your doctor, nurse or pharmacist if you are not sure. How is Zarzio given and how much should I use? Zarzio is usually given as a daily injection into the tissue just under the skin (known as a subcutaneous injection). It can also be given as a daily slow injection into the vein (known as an intravenous infusion). The usual dose varies depending on your illness and weight. Your doctor will tell you how much Zarzio you should take. Patients having a bone marrow transplant after chemotherapy: You will normally receive your first dose of Zarzio at least 24 hours after your chemotherapy and at least 24 hours after receiving your bone marrow transplant. You, or people caring for you, can be taught how to give subcutaneous injections so that you can continue your treatment at home. However, you should not attempt this unless you have been properly trained first by your health care provider. How long will I have to take Zarzio? You will need to take Zarzio until your white blood cell count is normal. Regular blood tests will be taken to monitor the number of white blood cells in your body. Your doctor will tell you how long you will need to take Zarzio. Use in children Zarzio is used to treat children who are receiving chemotherapy or who suffer from severe low white blood cell count (neutropenia). The dosing in children receiving chemotherapy is the same as for adults. If you use more Zarzio than you should Do not increase the dose your doctor has given you. If you think you have injected more than you should, contact your doctor as soon as possible. If you forget to use Zarzio If you have missed an injection, or injected too little, contact your doctor as soon as possible. Do not take a double dose to make up for any missed doses. If you have any further questions on the use of this medicine, ask your doctor, pharmacist or nurse.</p></div>"
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"title" : "4. Possible side effects",
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"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p>Like all medicines, this medicine can cause side effects, although not everybody gets them. Please tell your doctor immediately during treatment:</p><p>if you experience an allergic reaction including weakness, drop in blood pressure, difficulty breathing, swelling of the face (anaphylaxis), skin rash, itchy rash (urticaria), swelling of the face, lips, mouth, tongue or throat (angioedema) and shortness of breath (dyspnoea).</p><p>if you experience a cough, fever and difficulty breathing (dyspnoea) as this can be a sign of Acute Respiratory Distress Syndrome (ARDS).</p><p>if you get left upper belly (abdominal) pain, pain below the left rib cage or pain at the tip of your shoulder, as there may be a problem with your spleen [enlargement of the spleen (splenomegaly) or rupture of the spleen].</p><p>if you are being treated for severe chronic neutropenia and you have blood in your urine (haematuria). Your doctor may regularly test your urine if you experience this side effect or if protein is found in your urine (proteinuria).</p><h2 id=\"if-you-have-any-of-the-following-or-combination-of-the-following-side-effects\">if you have any of the following or combination of the following side effects:</h2><p>swelling or puffiness, which may be associated with passing water less frequently, difficulty breathing, abdominal swelling and feeling of fullness, and a general feeling of tiredness. These symptoms generally develop in a rapid fashion. These could be symptoms of a condition called Capillary Leak Syndrome which causes blood to leak from the small blood vessels into your body and needs urgent medical attention.</p><h2 id=\"if-you-have-a-combination-of-any-of-the-following-symptoms\">if you have a combination of any of the following symptoms:</h2><p>fever, or shivering, or feeling very cold, high heart rate, confusion or disorientation, shortness of breath, extreme pain or discomfort and clammy or sweaty skin. These could be symptoms of a condition called sepsis (also called \"blood poisoning\"), a severe infection with whole-body inflammatory response which can be life threatening and needs urgent medical attention.</p><p>if you experience kidney injury (glomerulonephritis). Kidney injury has been seen in patients who received filgrastim. Call your doctor right away if you experience puffiness in your face or ankles, blood in your urine or brown-coloured urine or you notice you urinate less than usual. A common side effect of filgrastim use is pain in your muscles or bones (musculoskeletal pain), which can be helped by taking standard pain relief medicines (analgesics). In patients undergoing a stem cell or bone marrow transplant, Graft versus Host Disease (GvHD) may occur- this is a reaction of the donor cells against the patient receiving the transplant; signs and symptoms include rash on the palms of your hands or soles of your feet and ulcer and sores in your mouth, gut, liver, skin, or your eyes, lungs, vagina and joints. Very commonly seen in normal stem cell donors is increase in white blood cells (leukocytosis) and decrease of platelets which reduces the ability of blood to clot (thrombocytopenia), these will be monitored by your doctor. Very common side effects (may affect more than 1 in 10 people)</p><p>decrease of platelets which reduces the ability of blood to clot (thrombocytopenia)</p><p>low red blood cell count (anaemia)</p><p>headache</p><p>diarrhoea</p><p>vomiting</p><p>nausea</p><p>unusual hair loss or thinning (alopecia)</p><p>tiredness (fatigue)</p><p>soreness and swelling of the digestive tract lining which runs from the mouth to the anus (mucosal inflammation)</p><p>fever (pyrexia) Common side effects (may affect up to 1 in 10 people)</p><p>inflammation of the lung (bronchitis)</p><p>upper respiratory tract infection</p><p>urinary tract infection</p><p>decreased appetite</p><p>trouble sleeping (insomnia)</p><p>dizziness</p><p>decreased feeling of sensitivity, especially in the skin (hypoaesthesia)</p><p>tingling or numbness of the hands or feet (paraesthesia)</p><p>low blood pressure (hypotension)</p><p>high blood pressure (hypertension)</p><p>cough</p><p>coughing up blood (haemoptysis)</p><p>pain in your mouth and throat (oropharyngeal pain)</p><p>nose bleeds (epistaxis)</p><p>constipation</p><p>oral pain</p><p>enlargement of the liver (hepatomegaly)</p><p>rash</p><p>redness of the skin (erythema)</p><p>muscle spasm</p><p>pain when passing urine (dysuria)</p><p>chest pain</p><p>pain</p><p>generalised weakness (asthenia)</p><p>generally feeling unwell (malaise)</p><p>swelling in the hands and feet (oedema peripheral)</p><p>increase of certain enzymes in the blood</p><p>changes in blood chemistry</p><p>transfusion reaction Uncommon side effects (may affect up to 1 in 100 people)</p><p>increase in white blood cells (leukocytosis)</p><p>allergic reaction (hypersensitivity)</p><p>rejection of transplanted bone marrow (graft versus host disease)</p><p>high uric acid levels in the blood, which may cause gout (hyperuricaemia) (Blood uric acid increased)</p><p>liver damage caused by blocking of the small veins within the liver (veno-occlusive disease)</p><p>lungs do not function as they should, causing breathlessness (respiratory failure)</p><p>swelling and/or fluid in the lungs (pulmonary oedema)</p><p>inflammation of the lungs (interstitial lung disease)</p><p>abnormal x-rays of the lungs (lung infiltration)</p><p>bleeding from the lung (pulmonary haemorrhage)</p><p>lack of absorption of oxygen in the lung (hypoxia)</p><p>bumpy skin rash (rash maculo-papular)</p><p>disease which causes bones to become less dense, making them weaker, more brittle and likely to break (osteoporosis)</p><p>injection site reaction Rare side effects (may affect up to 1 in 1,000 people):</p><p>severe pain in the bones, chest, gut or joints (sickle cell anaemia with crisis)</p><p>sudden life-threatening allergic reaction (anaphylactic reaction)</p><p>pain and swelling of the joints, similar to gout (pseudogout)</p><p>a change in how your body regulates fluids within your body and may result in puffiness (fluid volume disturbances)</p><p>inflammation of the blood vessels in the skin (cutaneous vasculitis)</p><p>plum-coloured, raised, painful sores on the limbs and sometimes the face and neck with a fever (Sweets syndrome)</p><p>worsening of rheumatoid arthritis</p><p>unusual change in the urine</p><p>bone density decreased</p><p>inflammation of the aorta (the large blood vessel which transports blood from the heart to the body), see section 2. 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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"title" : "5. How to store zarzio",
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"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p>Keep this medicine out of the sight and reach of children. Do not use this medicine after the expiry date which is stated on the carton and on the syringe label after EXP. The expiry date refers to the last day of that month. Store in a refrigerator (2 C - 8 C). Keep the pre-filled syringe in the outer carton in order to protect from light. Accidental freezing will not harm Zarzio. The syringe can be removed from the refrigerator and left at room temperature for a single period of maximum 8 days (but not above 25 C). At the end of this period, the product should not be put back in the refrigerator and should be disposed of. Do not use this medicine if you notice discolouration, cloudiness or particles, it should be a clear, colourless to slightly yellowish liquid. 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" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><h2 id=\"what-zarzio-contains\">What Zarzio contains</h2><h2 id=\"the-active-substance-is-filgrastim-zarzio-30-mu05-ml-solution-for-injection-or-infusion-in-pre-filled-syringe-each-pre-filled-syringe-contains-30-mu-filgrastim-in-05-ml-corresponding-to-60-muml-zarzio-48-mu05-ml-solution-for-injection-or-infusion-in-pre-filled-syringe-each-pre-filled-syringe-contains-48-mu-filgrastim-in-05-ml-corresponding-to-96-muml\">The active substance is filgrastim. Zarzio 30 MU/0.5 mL solution for injection or infusion in pre-filled syringe: Each pre-filled syringe contains 30 MU filgrastim in 0.5 mL, corresponding to 60 MU/mL. Zarzio 48 MU/0.5 mL solution for injection or infusion in pre-filled syringe: Each pre-filled syringe contains 48 MU filgrastim in 0.5 mL, corresponding to 96 MU/mL.</h2><p>The other ingredients are glutamic acid, sorbitol (E420), polysorbate 80, sodium hydroxide and water for injections. See section 2 Zarzio contains sorbitol and sodium . What Zarzio looks like and contents of the pack Zarzio is a clear, colourless to slightly yellowish solution for injection or infusion in pre-filled syringe. Zarzio is available in packs containing 1, 3, 5 or 10 pre-filled syringes with injection needle and a needle safety guard. Not all pack sizes may be marketed. Marketing Authorisation Holder Sandoz GmbH Biochemiestr. 6250 Kundl Austria Manufacturer Sandoz GmbH Biochemiestr. 6336 Langkampfen Austria Novartis Pharmaceutical Manufacturing GmbH Biochemiestrasse 6336 Langkampfen Austria For any information about this medicine, please contact the local representative of the Marketing Authorisation Holder: Belgi /Belgique/Belgien Sandoz nv/sa T l/Tel: +32 2 722 97 Lietuva Sandoz Pharmaceuticals d.d filialas Tel: +370 5 2636</p><p>.: +359 2 970 47 Luxembourg/Luxemburg Sandoz nv/sa T l/Tel.: +32 2 722 97 esk republika Sandoz s.r.o. Tel: +420 225 775 Magyarorsz g Sandoz Hung ria Kft. Tel.: +36 1 430 2Danmark/Norge/ sland/Sverige Sandoz A/S Tlf: +45 63 95 10 Malta Sandoz Pharmaceuticals d.d. Tel: +35699644Deutschland Hexal AG Tel: +49 8024 908 0 Nederland Sandoz B.V. Tel: +31 36 52 41 Eesti Sandoz d.d. Eesti filiaal Tel: +372 665 2 sterreich Sandoz GmbH Tel: +43 5338 2 SANDOZ HELLAS . . : +30 216 600 5Polska Sandoz Polska Sp. z o.o. Tel.: +48 22 209 70 Espa a Sandoz Farmac utica, S.A. Tel: +34 900 456 Portugal Sandoz Farmac utica Lda. Tel: +351 21 000 86 France Sandoz SAS T l: +33 1 49 64 48 Rom nia Sandoz Pharmaceuticals SRL Tel: +40 21 407 51 Hrvatska Sandoz d.o.o. Tel: +385 1 23 53 Slovenija Sandoz farmacevtska dru ba d.d. Tel: +386 1 580 29 Ireland Rowex Ltd. Tel: + 353 27 50Slovensk republika Sandoz d.d. - organiza n zlo ka Tel: +421 2 48 20 0Italia Sandoz S.p.A. Tel: +39 02 96Suomi/Finland Sandoz A/S Puh/Tel: +358 10 6133<br/>Sandoz Pharmaceuticals d.d. : +357 22 69 0United Kingdom (Northern Ireland) Sandoz GmbH Tel: +43 5338 2Latvija Sandoz d.d. Latvia fili le Tel: +371 67 892 This leaflet was last revised in . Detailed information on this medicine is available on the European Medicines Agency web site:</p></div>"
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"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"MedicinalProductDefinition_mp1bb79447a2309ad6bd5c05b14a8deec5\"> </a><p class=\"res-header-id\"><b>Generated Narrative: MedicinalProductDefinition mp1bb79447a2309ad6bd5c05b14a8deec5</b></p><a name=\"mp1bb79447a2309ad6bd5c05b14a8deec5\"> </a><a name=\"hcmp1bb79447a2309ad6bd5c05b14a8deec5\"> </a><a name=\"mp1bb79447a2309ad6bd5c05b14a8deec5-en-US\"> </a><p><b>identifier</b>: <code>http://ema.europa.eu/identifier</code>/EU/1/08/495/001</p><p><b>type</b>: <span title=\"Codes:{http://hl7.org/fhir/medicinal-product-type MedicinalProduct}\">Medicinal Product</span></p><p><b>domain</b>: <span title=\"Codes:{http://hl7.org/fhir/medicinal-product-domain Human}\">Human use</span></p><p><b>status</b>: <span title=\"Codes:{http://hl7.org/fhir/publication-status active}\">active</span></p><p><b>legalStatusOfSupply</b>: <span title=\"Codes:{https://spor.ema.europa.eu/rmswi 100000072084}\">Medicinal product subject to medical prescription</span></p><blockquote><p><b>name</b></p><p><b>productName</b>: Zarzio 30 MU/0.5 mL solution for injection or infusion in pre-filled syringe</p><p><b>type</b>: <span title=\"Codes:{https://spor.ema.europa.eu/lists/220000000000 220000000001}\">Full name</span></p><blockquote><p><b>part</b></p><p><b>part</b>: nan</p><p><b>type</b>: <span title=\"Codes:{https://spor.ema.europa.eu/lists/220000000000 220000000002}\">Invented name part</span></p></blockquote><blockquote><p><b>part</b></p><p><b>part</b>: nan</p><p><b>type</b>: <span title=\"Codes:{https://spor.ema.europa.eu/lists/220000000000 220000000003}\">Scientific name part</span></p></blockquote><blockquote><p><b>part</b></p><p><b>part</b>: nan</p><p><b>type</b>: <span title=\"Codes:{https://spor.ema.europa.eu/lists/220000000000 220000000004}\">Strength part</span></p></blockquote><blockquote><p><b>part</b></p><p><b>part</b>: nan</p><p><b>type</b>: <span title=\"Codes:{https://spor.ema.europa.eu/lists/220000000000 220000000005}\">Pharmaceutical dose form part</span></p></blockquote><h3>Usages</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Country</b></td><td><b>Jurisdiction</b></td><td><b>Language</b></td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:{urn:iso:std:iso:3166 EU}\">EU</span></td><td><span title=\"Codes:{urn:iso:std:iso:3166 EU}\">EU</span></td><td><span title=\"Codes:{urn:ietf:bcp:47 en}\">en</span></td></tr></table></blockquote></div>"
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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.
