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 Mektovi is and what it is used for</li><li>What you need to know before you take Mektovi</li><li>How to take Mektovi</li><li>Possible side effects</li><li>How to store Mektovi</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>Mektovi is an anti-cancer medicine that contains the active substance binimetinib. It is used in adults in combination with another medicine containing encorafenib to treat a type of skin cancer called melanoma when it has</p><ul><li>a particular change (mutation) in a gene responsible for producing a protein called BRAF, and</li><li>spread to other parts of the body or cannot be removed by surgery.</li></ul><p>Mutations in the BRAF gene can produce proteins that cause the melanoma to grow. Mektovi targets another protein called MEK that stimulates cancer cell growth. When Mektovi is used in combination with encorafenib (which targets the changed BRAF protein), the combination slows down or stops the growth of your cancer.</p></div>
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<div xmlns="http://www.w3.org/1999/xhtml"><p>Before starting treatment your doctor will check for BRAF mutation.</p><p>As Mektovi is to be used in combination with encorafenib, read the encorafenib leaflet carefully as well as this leaflet.</p><p>Do not take Mektovi</p><ul><li>if you are allergic to binimetinib or any of the other ingredients of this medicine (listed in section 6).</li></ul><p>Warnings and precautions<br/>Talk to your doctor, pharmacist or nurse before taking Mektovi about all of your medical conditions, particularly if you have any of the following:</p><ul><li>heart problems</li><li>bleeding problems or if you are taking medicines that may cause bleeding</li><li>eye problems including glaucoma or increased pressure in your eyes</li><li>muscle problems</li><li>high blood pressure</li><li>blood clots</li><li>lung or breathing problems</li><li>liver problems</li></ul><p>Tell your doctor if you have ever had blockage in the vein carrying blood away from the eye (retinal vein occlusion), as Mektovi is not recommended in such cases.</p><p>Tell your doctor if you have had a different type of cancer than melanoma, as binimetinib when taken with encorafenib may worsen certain other types of cancers.</p><p>Tell your doctor, pharmacist or nurse immediately if you get the following while you are taking this medicine:</p><ul><li><p>Heart problems: Mektovi can make your heart work less well, or make existing heart problems worse. Your doctor will check that your heart is working properly before and during your treatment with this medicine. Talk to your doctor immediately if you have any symptoms of heart problems such as feeling dizzy, tired, lightheaded, if you have shortness of breath, if you feel like your heart is pounding, racing, beating irregularly or if you have swelling in the legs.</p></li><li><p>Bleeding problems: Mektovi may cause serious bleeding problems. Talk to your doctor immediately if you have any symptoms of bleeding problems such as coughing up of blood, blood clots, vomit containing blood or that looks like coffee grounds , red or black stools that look like tar, passing blood in the urine, stomach (abdominal) pain, unusual vaginal bleeding. Also tell your doctor if you have headache, dizziness or weakness.</p></li><li><p>Eye problems: Mektovi can cause serious eye problems. Talk to your doctor immediately if you get blurred vision, loss of vision or other vision changes (such as coloured dots in your vision), halo (seeing blurred outline around objects). Your doctor will examine your eyes for any problems with your sight while you are taking Mektovi.</p></li><li><p>Muscle problems: Mektovi can cause breakdown of muscle (rhabdomyolysis). Your doctor will run blood tests to check for muscle problems before and during treatment. As a precaution, drink plenty of fluids during treatment. Talk to your doctor immediately if you get muscle pain, cramps, stiffness, spasm, dark urine.</p></li><li><p>High blood pressure: Mektovi can raise blood pressure. Your doctor or nurse will check your blood pressure before and during treatment with Mektovi. Talk to your doctor immediately if you get severe headache, feel dizzy, lightheaded or if your blood pressure measured on a home blood pressure device is much higher than usual.</p></li><li><p>Blood clots: Mektovi can cause blood clots in your arms or legs, and if a clot travels to your lungs it could lead to death. Talk to your doctor immediately if you get chest pain, sudden shortness of breath, trouble breathing, pain in your legs with or without swelling, swelling in your arms and legs, or a cool, pale arm or leg. If necessary, your doctor may interrupt your treatment or stop it altogether.</p></li><li><p>Lung or breathing problems: This medicine may cause lung or breathing problems including inflammation of the lungs (pneumonitis or interstitial lung disease); signs and symptoms can include: cough, shortness of breath or fatigue. If necessary, your doctor may interrupt your treatment or stop it altogether.</p></li><li><p>Skin changes: Mektovi, when taken with encorafenib, may cause other types of skin cancer such as cutaneous squamous cell carcinoma. Your doctor will check your skin before initiation of treatment, every 2 months during treatment, and for up to 6 months after you stop taking these medicines to look for any new skin cancer. Tell your doctor immediately if you detect any skin changes during and after the treatment including: new wart, skin sore or reddish bump that bleeds or does not heal, or a change in size or colour of a mole. Additionally, your doctor needs to check for squamous cell carcinoma on your head, neck, mouth and lymph glands, and you will have CT scans regularly. This is a precaution in case a squamous cell carcinoma develops inside your body. Genital examinations (for women) and anal examinations are also recommended before the initiation and at the end of your treatment.</p></li><li><p>Liver problems: Mektovi can cause abnormal blood tests related to your liver (raised levels of liver enzymes). Your doctor will run blood tests to check your liver before and during treatment.</p></li></ul><p>Children and adolescents Mektovi is not recommended for children and adolescents under 18 years of age. This medicine has not been studied in this age group.</p><p>Other medicines and Mektovi Tell your doctor, pharmacist or nurse if you are taking, have recently taken or might take any other medicines.<br/>Some medicines may affect how Mektovi works or make it more likely that you will have side effects. In particular, tell your doctor if you are taking anything in this list or any other medicines:</p><ul><li>some medicines to treat bacterial infections such as rifampicin, ciprofloxacin</li><li>some medicines typically used to treat epilepsy such as phenobarbital, phenytoin, carbamazepine</li><li>some medicines to treat HIV such as indinavir, atazanavir</li><li>a medicine for carcinoma treatment called sorafenib</li><li>an herbal treatment for depression: St. John s wort</li><li>medicine used to treat depression such as duloxetine</li><li>medicine typically used to treat high cholesterol such as pravastatin</li><li>a medicine used to treat breathing problems, theophylline.</li></ul><p>Pregnancy Mektovi is not recommended during pregnancy. It may cause permanent harm or birth defects to an unborn baby. If you are pregnant, think you may be pregnant or are planning to have a baby, ask your doctor for advice before taking this medicine. If you are a woman who could become pregnant, you must use reliable contraception while you are taking Mektovi, and you must continue to use reliable contraception at least 1 month after taking your last dose. Contact your doctor straightaway if you become pregnant while taking Mektovi.</p><p>Breast-feeding Mektovi is not recommended while breast-feeding. It is not known if Mektovi passes into breast milk. If you are breast-feeding, or planning to breast-feed, ask your doctor for advice before taking this medicine.</p><p>Driving and using machines Mektovi can affect your ability to drive or use machines. Avoid driving or using machines if you have any problems with your vision or have any other side effects that can affect your ability to drive or use machines (see section 4), while taking Mektovi. Talk to your doctor if you are not sure you can drive.</p><p>Mektovi contains lactose If you have been told by your doctor that you have an intolerance to some sugars, talk to your doctor before taking this medicine.</p></div>
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<div xmlns="http://www.w3.org/1999/xhtml"><p>How much to take<br/>Always take this medicine exactly as your doctor or pharmacist has told you. Check with your doctor or pharmacist if you are not sure.</p><p>The recommended dose of Mektovi is 45 mg (3 tablets of 15 mg) twice daily, taken about 12 hours apart (corresponding to a daily dose of 90 mg). You will also receive treatment with another medicine, encorafenib.</p><p>If you get serious side effects (such as heart, eye or skin problems) your doctor may lower the dose or stop treatment temporarily or permanently.</p><p>How to take Mektovi Swallow the tablets whole with water. Mektovi can be taken with food or between meals.</p><p>If you are sick<br/>If you vomit at any time after taking Mektovi, do not take an additional dose. Take the next dose as scheduled.</p><p>If you take more Mektovi than you should If you take more tablets than you should, contact your doctor, pharmacist or nurse straightaway. If possible, show them this leaflet and the medicine package.</p><p>If you forget to take Mektovi If you miss a dose of Mektovi, take it as soon as you remember. However, if the missed dose is more than 6 hours late, skip that dose and take your next dose at the usual time. Then continue taking your tablets at regular times as usual. Do not take a double dose to make up for a forgotten dose.</p><p>If you stop taking Mektovi It is important to take Mektovi for as long as your doctor prescribes it. Do not stop taking this medicine unless your doctor tells you to.</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.</p><p>Serious side effects</p><p>Mektovi may cause serious side effects. Tell your doctor immediately if you have any of the following serious side effects, either for the first time or if they get worse (see also section 2).</p><p>Heart problems: Mektovi can affect how well your heart works (left ventricular ejection fraction decrease); signs and symptoms can include:</p><ul><li>feeling dizzy, tired or lightheaded</li><li>shortness of breath</li><li>feeling like your heart is pounding, racing or beating irregularly</li><li>swelling in the legs</li></ul><p>High blood pressure: Mektovi can increase blood pressure. Tell your doctor immediately if you get severe headache, feel dizzy or lightheaded or if your blood pressure measured on a home blood pressure device is much higher than usual.</p><p>Blood clots: Mektovi may cause blood clots (venous thromboembolism including pulmonary embolism); signs and symptoms can include:</p><ul><li>chest pain</li><li>sudden shortness of breath or trouble breathing</li><li>pain in your legs with or without swelling</li><li>swelling in your arms and legs</li><li>a cool, pale arm or leg</li></ul><p>Eye problems: Mektovi can cause fluid to leak under the retina in the eye, leading to detachment of different layers in the eye (retinal pigment epithelial detachment) which could lead to:</p><ul><li>blurred vision, loss of vision, or other vision changes (such as coloured dots in your vision)</li><li>halo (seeing blurred outline around objects)</li><li>eye pain, swelling or redness</li></ul><p>Muscle problems: Mektovi can cause breakdown of muscles (rhabdomyolysis) which can lead to kidney damage and can be fatal; signs and symptoms can include:</p><ul><li>muscle pain, cramps, stiffness or spasm</li><li>dark urine</li></ul><p>Bleeding problems: Mektovi can cause serious bleeding problems. Tell your doctor right away if you have any unusual bleeding or signs of bleeding, including:</p><ul><li>headaches, dizziness or weakness</li><li>coughing up of blood or blood clots</li><li>vomit containing blood or that looks like coffee grounds</li><li>red or black stools that look like tar</li><li>passing blood in the urine</li><li>stomach (abdominal) pain</li><li>unusual vaginal bleeding</li></ul><p>Other skin cancers: When Mektovi is taken with encorafenib, the patient may develop different types of skin cancer such as cutaneous squamous cell carcinoma. Usually, these skin cancers (see also section 2) are confined to a small area and can be removed with surgery and treatment with Mektovi (and encorafenib) can continue without interruption.</p><p>Other side effects when Mektovi and encorafenib are taken together Besides the serious side effects mentioned above, people taking Mektovi and encorafenib together may also get the following side effects.</p><p>Very common (may affect more than 1 in 10 people)</p><ul><li>reduced red blood cell count (anaemia)</li><li>problem with the nerves resulting in pain, loss of sensation or tingling in hands and feet</li><li>headache</li><li>dizziness</li><li>bleeding at various sites in the body</li><li>problems with your vision (visual impairment)</li><li>stomach pain</li><li>diarrhoea</li><li>being sick (vomiting)</li><li>feeling sick (nausea)</li><li>constipation</li><li>itching</li><li>dry skin</li><li>hair loss or thinning (alopecia)</li><li>skin rash of various types</li><li>thickening of the outer layers of the skin</li><li>joint pain (arthralgia)</li><li>muscle pain, weakness or spasm</li><li>back pain</li><li>pain in the extremities</li><li>fever</li><li>swelling of the hands or feet (peripheral oedema), localised swelling</li><li>fatigue</li><li>abnormal blood test results for liver function</li><li>abnormal blood test result related to blood creatine kinase, indicating damage to heart and muscle</li></ul><p>Common (may affect up to 1 in 10 people)</p><ul><li>some types of skin tumours such as skin papilloma and basal cell carcinoma</li><li>allergic reaction that may include swelling of the face and difficulty breathing</li><li>changes in the way things taste</li><li>inflammation of the eye (uveitis)</li><li>inflammation of the colon (colitis)</li><li>redness, chapping or cracking of the skin</li><li>inflammation of the fatty layer under the skin, symptoms include tender skin nodules</li><li>skin rash with a flat discoloured area or raised bumps like acne (dermatitis acneiform)</li><li>redness, skin peeling or blisters on hand and feet (palmar plantar erythrodysesthesia or hand and foot syndrome)</li><li>kidney failure</li><li>abnormal kidney test results (creatinine elevations)</li><li>abnormal blood test results for liver function (blood alkaline phosphatase)</li><li>abnormal blood test results for pancreas function (amylase, lipase)</li><li>increased skin sensitivity to sunlight</li></ul><p>Uncommon (may affect up to 1 in 100 people)</p><ul><li>weakness and paralysis of face muscles</li><li>inflammation of the pancreas (pancreatitis) causing severe abdominal pain</li></ul><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 blister and the carton after EXP. The expiry date refers to the last day of that month.</p><p>This medicine does not require any special storage conditions.</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 Mektovi contains</p><ul><li>The active substance is binimetinib. Each film-coated tablet contains 15 mg of binimetinib.</li><li>The other ingredients are:</li></ul><ul><li></li></ul><p>Tablet core: lactose monohydrate, cellulose microcrystalline (E460i), silica colloidal anhydrous (E551), croscarmellose sodium (E468) and magnesium stearate (E470b). See section 2 Mektovi contains lactose . *<br/>Tablet film-coat: poly(vinyl alcohol) (E1203), macrogol 3350 (E1521), titanium dioxide (E171), talc (E533b), iron oxide yellow (E172) and iron oxide black (E172).</p><p>What Mektovi looks like and contents of the pack Mektovi film-coated tablets are yellow/dark yellow, unscored biconvex, oval film-coated tablets debossed with A on one side and 15 on the other side.</p><p>Mektovi is available in packs of 84 tablets (7 blisters of 12 tablets each) or 168 tablets (14 blisters of 12 tablets each).<br/>Not all pack sizes may be marketed.</p><p>Marketing Authorisation Holder<br/>PIERRE FABRE MEDICAMENT Les Cauquillous 81500 Lavaur France</p><p>Manufacturer PIERRE FABRE MEDICAMENT PRODUCTION Site Progipharm, Rue du Lyc e<br/>45500 GIEN<br/>France</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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<div xmlns="http://www.w3.org/1999/xhtml"><a name="MedicinalProductDefinition_mp1fc6739ba81d50a7087579c92c2a7274"> </a><p class="res-header-id"><b>Generated Narrative: MedicinalProductDefinition mp1fc6739ba81d50a7087579c92c2a7274</b></p><a name="mp1fc6739ba81d50a7087579c92c2a7274"> </a><a name="hcmp1fc6739ba81d50a7087579c92c2a7274"> </a><a name="mp1fc6739ba81d50a7087579c92c2a7274-en-US"> </a><p><b>identifier</b>: <code>http://ema.europa.eu/identifier</code>/EU/1/18/1315/001 84 film-coated tablets</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>: Mektovi 15 mg film-coated tablets</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>
</text>
<identifier>
<system value="http://ema.europa.eu/identifier"/>
<value value="EU/1/18/1315/001 84 film-coated tablets"/>
</identifier>
<type>
<coding>
<system value="http://hl7.org/fhir/medicinal-product-type"/>
<code value="MedicinalProduct"/>
<display value="Medicinal Product"/>
</coding>
</type>
<domain>
<coding>
<system value="http://hl7.org/fhir/medicinal-product-domain"/>
<code value="Human"/>
<display value="Human use"/>
</coding>
</domain>
<status>
<coding>
<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="Mektovi 15 mg film-coated tablets"/>
<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.
