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 Tyruko is and what it is used for</li><li>What you need to know before you receive Tyruko</li><li>How Tyruko is given</li><li>Possible side effects</li><li>How to store Tyruko</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>Tyruko is used to treat multiple sclerosis (MS). It contains the active substance natalizumab. This is called a monoclonal antibody.</p><p>MS causes inflammation in the brain that damages the nerve cells. This inflammation happens when white blood cells get into the brain and spinal cord. This medicine stops the white blood cells getting through to the brain. This reduces nerve damage caused by MS.</p><p>Symptoms of multiple sclerosis The symptoms of MS vary from patient to patient, and you may experience some or none of them.</p><p>They may include: walking problems, numbness in the face, arms or legs; problems with vision; tiredness; feeling off-balance or light headed; bladder and bowel problems; difficulty in thinking and concentrating; depression; acute or chronic pain; sexual problems; stiffness and muscle spasms. When the symptoms flare up, it is called a relapse (also known as an exacerbation or an attack). When a relapse occurs, you may notice the symptoms suddenly, within a few hours, or slowly progressing over several days. Your symptoms will then usually improve gradually (this is called a remission).</p><p>How Tyruko can help In trials, this medicine approximately halved the build-up of disability caused by MS, and decreased the number of MS attacks by about two-thirds. While you are treated with this medicine you might not notice any improvement, but it may still be working to prevent your MS becoming worse.</p></div>
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<div xmlns="http://www.w3.org/1999/xhtml"><p>Before you start treatment with this medicine, it is important that you and your doctor have discussed the benefits you could expect to receive from this treatment and the risks that are associated with it.</p><p>You must not be given Tyruko</p><ul><li><p>If you are allergic to natalizumab or any of the other ingredients of this medicine (listed in section 6).</p></li><li><p>If you have been diagnosed with PML (progressive multifocal leukoencephalopathy). PML is an uncommon infection of the brain.</p></li><li><p>If your immune system has a serious problem. This may be due to disease (such as HIV), or to a medicine you are taking, or have taken in the past (see below).</p></li><li><p>If you are taking medicines that affect your immune system, including certain other medicines used to treat MS. These medicines cannot be used with Tyruko.</p></li><li><p>If you have cancer (unless it is a type of skin cancer called basal cell carcinoma).</p></li></ul><p>Warnings and precautions</p><p>You need to discuss with your doctor whether Tyruko is the most suitable treatment for you. Do this before you start taking Tyruko, and when you have been receiving Tyruko for more than two years.</p><p>Possible brain infection (PML)</p><p>Some people receiving this medicine (fewer than 1 in 100) have had an uncommon brain infection called PML (progressive multifocal leukoencephalopathy). PML can lead to severe disability or death.</p><ul><li><p>Before starting treatment, all patients will have blood tests arranged by the doctor for JC virus infection. JC virus is a common virus that does not normally make you ill. However, PML is linked to an increase of JC virus in the brain. The reason for this increase in some patients treated with Tyruko is not clear. Before and during treatment, your doctor will test your blood to check if you have antibodies to the JC virus, which are a sign that you have been infected by the JC virus.</p></li><li><p>Your doctor will arrange a Magnetic Resonance Imaging (MRI) scan, which will be repeated during treatment to rule out PML.</p></li><li><p>The symptoms of PML may be similar to an MS relapse (see section 4, Possible side effects). You can also get PML up to 6 months after stopping Tyruko treatment.</p></li><li><p>Tell your doctor as soon as possible if you notice your MS getting worse, if you notice any new symptoms while you are on Tyruko treatment or for up to 6 months afterwards.</p></li><li><p>Tell your partner or caregivers about what to look out for (see also section 4, Possible side effects). Some symptoms might be difficult to spot by yourself, such as changes in mood or behaviour, confusion, speech and communication difficulties. If you get any of these, you may need further tests. Keep looking out for symptoms in the 6 months after stopping Tyruko.</p></li><li><p>Keep the patient alert card you have been given by your doctor. It includes this information. Show it to your partner or caregivers.</p></li></ul><p>Three things can increase your risk of PML with Tyruko. If you have two or more of these risk factors, the risk is increased further:</p><ul><li><p>If you have antibodies to the JC virus in your blood. These are a sign that the virus is in your body. You will be tested before and during Tyruko treatment.</p></li><li><p>If you are treated for a long time with Tyruko, especially if it is more than two years.</p></li><li><p>If you have taken a medicine called an immunosuppressant, that reduces the activity of your immune system.</p></li></ul><p>Another condition, called JCV GCN (JC virus granule cell neuronopathy), is also caused by JC virus and has occurred in some patients receiving Tyruko. The symptoms of JCV GCN are similar to PML.</p><p>For those with a lower risk of PML, your doctor may repeat the test regularly to check that:</p><ul><li><p>You still do not have antibodies to the JC virus in your blood.</p></li><li><p>If you have been treated for more than 2 years, you still have a lower level of JC virus antibodies in your blood.</p></li></ul><p>If someone gets PML PML can be treated, and Tyruko treatment will be stopped. However, some people get a reaction as Tyruko is removed from the body. This reaction (known as IRIS or immune reconstitution inflammatory syndrome) may lead to your condition getting worse, including worsening of brain function.</p><p>Look out for other infections Some infections other than PML may also be serious and can be due to viruses, bacteria, and other causes.</p><p>Tell a doctor or nurse immediately if you think you have an infection (see also section 4, Possible side effects).</p><p>Changes in blood platelets Natalizumab may reduce platelets in the blood which are responsible for clotting. This may result in a condition called thrombocytopenia (see section 4) in which your blood may not clot quickly enough to stop bleeding. This can lead to bruising as well as other more serious problems such as excessive bleeding. You should talk to your doctor immediately if you have unexplained bruising, red or purple spots on the skin (called petechiae), bleeding from skin cuts that does not stop or oozes, prolonged bleeding from the gums or nose, blood in urine or stools, or bleeding in the whites of your eyes.</p><p>Children and adolescents Do not give this medicine to children or adolescents under the age of 18 years.</p><p>Other medicines and Tyruko Tell your doctor if you are taking, have recently taken or might take any other medicines.</p><ul><li><p>You must not be given this medicine if you are now being treated with medicines that affect your immune system, including certain other medicines to treat your MS.</p></li><li><p>You might not be able to use this medicine if you have previously had any that affect your immune system.</p></li></ul><p>Pregnancy and breast-feeding If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, ask your doctor for advice before taking this medicine.</p><ul><li><p>Do not use this medicine if you are pregnant, unless you have discussed this with your doctor. Be sure to tell your doctor immediately if you get pregnant, think you may be pregnant, or if you are planning to become pregnant.</p></li><li><p>Do not breast-feed whilst using Tyruko. Your doctor will help you decide whether you should choose to stop breast-feeding or stop using the medicine.</p></li></ul><p>The risk to the baby and benefit to the mother will be taken into consideration by your doctor.</p><p>Driving and using machines Dizziness is a very common side effect. If you are affected, do not drive or use machines.</p><p>Tyruko contains sodium Each vial of this medicine contains 2.3 mmol (or 52 mg) of sodium. After dilution for use, this medicinal product contains 17.7 mmol (or 406 mg) sodium per dose. This should be considered if you are on a controlled sodium diet.</p></div>
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<div xmlns="http://www.w3.org/1999/xhtml"><p>Tyruko IV infusion will be given to you by a doctor experienced in the treatment of MS. Your doctor may switch you directly from another medicine for MS to Tyruko if there are no problems caused by your previous treatment.</p><ul><li><p>Your doctor will order blood tests for antibodies to the JC virus and other possible problems.</p></li><li><p>Your doctor will arrange an MRI scan, which will be repeated during treatment.</p></li><li><p>To switch from some MS medicines, your doctor may advise you to wait for a certain time to ensure that most of the previous medicine has left your body.</p></li><li><p>For adults the recommended dose is 300 mg, given once every 4 weeks.</p></li><li><p>Tyruko must be diluted before it is given to you. It is given as a drip into a vein (by intravenous infusion), usually in your arm. This takes about 1 hour.</p></li><li><p>Information for medical or healthcare professionals on how to prepare and administer the medicine is provided at the end of this leaflet.</p></li></ul><p>If you stop using Tyruko Regular dosing with Tyruko is important, especially in the first few months of treatment. It is important to continue with your medicine for as long as you and your doctor decide that it is helping you. Patients who received one or two doses of Tyruko, and then had a gap in treatment of three months or more, were more likely to have an allergic reaction when restarting treatment.</p><p>Checking for allergic reactions A few patients have had an allergic reaction to this medicine. Your doctor may check for allergic reactions during the infusion and for 1 hour afterwards. See also section 4, Possible side effects.</p><p>If you miss your dose of Tyruko If you miss your usual dose of Tyruko, arrange with your doctor to receive it as soon as you can. You can then continue to receive your dose of Tyruko every 4 weeks.</p><p>Will Tyruko always work? In a few patients receiving Tyruko, the body s natural defences may stop the medicine from working properly over time, as the body develops antibodies to the medicine. Your doctor can decide whether this medicine is not working properly for you from blood tests and will stop the treatment, if necessary.</p><p>If you have any further questions on Tyruko, ask your doctor. Always use this medicine exactly as described in this leaflet or as your doctor has told you. Check with your doctor if you are not sure.</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>Speak to your doctor or nurse immediately if you notice any of the following.</p><p>Signs of a brain infection</p><ul><li>Changes in personality and behaviour such as confusion, delirium or loss of consciousness</li><li>Seizures (fits)</li><li>Headache</li><li>Nausea / vomiting</li><li>Stiff neck</li><li>Extreme sensitivity to bright light</li><li>Fever</li><li>Rash (anywhere on the body)</li></ul><p>These symptoms may be caused by an infection of the brain (encephalitis or PML) or its covering layer (meningitis).</p><p>Signs of other serious infections</p><ul><li>An unexplained fever</li><li>Severe diarrhoea</li><li>Shortness of breath</li><li>Prolonged dizziness</li><li>Headache</li><li>Weight loss</li><li>Listlessness</li><li>Impaired vision</li><li>Pain or redness of the eye(s)</li></ul><p>Signs of an allergic reaction</p><ul><li>Itchy rash (hives)</li><li>Swelling of your face, lips or tongue</li><li>Difficulty breathing</li><li>Chest pain or discomfort</li><li>Increase or decrease in your blood pressure (your doctor or nurse will notice this if they are monitoring your blood pressure)</li></ul><p>These are most likely during or shortly after the infusion.</p><p>Signs of a possible liver problem</p><ul><li>Yellowing of your skin or the whites of your eyes</li><li>Unusual darkening of the urine</li><li>Abnormal liver function test</li></ul><p>Speak to a doctor or nurse immediately if you get any of the side effects listed above, or if you think you have an infection. Show your patient alert card and this package leaflet to any doctor or nurse who treats you, not only to your neurologist.</p><p>Other side effects</p><p>Very common (may affect more than 1 in 10 people)</p><ul><li>Urinary tract infection</li><li>Sore throat and runny or blocked up nose</li><li>Headache</li><li>Dizziness</li><li>Feeling sick (nausea)</li><li>Joint pain</li><li>Tiredness</li><li>Dizziness, feeling sick (nausea), itching and chills during or shortly after infusion</li></ul><p>Common (may affect up to 1 in 10 people)</p><ul><li>Anaemia (decrease in your red blood cells which can make your skin pale and can make you feel breathless or lacking energy)</li><li>Allergy (hypersensitivity)</li><li>Shivering</li><li>Itchy rash (hives)</li><li>Being sick (vomiting)</li><li>Fever</li><li>Difficulty breathing (dyspnoea)</li><li>Reddening of the face or body (flushing)</li><li>Herpes infections</li><li>Discomfort around the place you have had your infusion. You could experience bruising, redness, pain, itching or swelling</li></ul><p>Uncommon (may affect up to 1 in 100 people)</p><ul><li>Severe allergy (anaphylactic reaction)</li><li>Progressive multifocal leukoencephalopathy (PML)</li><li>Inflammatory disorder after discontinuation of the medicinal product</li><li>Facial swelling</li><li>An increase in the number of white blood cells (eosinophilia)</li><li>Reduction in blood platelets</li><li>Easy bruising (purpura)</li></ul><p>Rare (may affect up to 1 in 1,000 people)</p><ul><li>Herpes infection in the eye</li><li>Severe anaemia (decrease in your red blood cells which can make your skin pale and can make you feel breathless or lacking energy).</li><li>Severe swelling under the skin</li><li>High levels of bilirubin in the blood (hyperbilirubinaemia) which may cause symptoms such as yellowing of your eyes or skin, fever and tiredness</li></ul><p>Not known (frequency cannot be estimated from the available data)</p><ul><li>Unusual infections (so-called opportunistic infections )</li><li>Damage to your liver</li></ul><p>Speak to your doctor as soon as possible if you think you have an infection. You will also find this information in the patient alert card you have been given by your doctor.</p><p>Reporting of side effects If you get any side effects, talk to your doctor. 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 label and carton. The expiry date refers to the last day of that month.</p><p>Unopened vial: Store in a refrigerator. Do not freeze. Keep the vial in the outer carton in order to protect from light.</p><p>Diluted solution: After dilution, immediate use is recommended. If not used immediately, the diluted solution must be stored at 2 C to 8 C and infused within 24 hours of dilution.</p><p>Do not use this medicine if you notice particles in the liquid and/or the liquid in the vial is discoloured.</p></div>
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<div xmlns="http://www.w3.org/1999/xhtml"><p>What Tyruko contains<br/>The active substance is natalizumab. Each 15 mL vial of concentrate contains 300 mg natalizumab (20 mg/mL). When diluted, the solution for infusion contains approximately 2.6 mg per mL of natalizumab.</p><p>The other ingredients are: Sodium chloride (see section 2 Tyruko contains sodium ) Histidine Histidine monohydrochloride Polysorbate 80 (E 433) water for injections</p><p>What Tyruko looks like and contents of the pack Tyruko is a colourless, clear to slightly opalescent solution (sterile concentrate). Each carton contains one glass vial.</p><p>Marketing Authorisation Holder and Manufacturer</p><p>Sandoz GmbH Biochemiestrasse 6250 Kundl Austria</p><p>This leaflet was last revised in .</p><p>Other sources of information</p><p>Detailed information on this medicine is available on the European Medicines Agency web site:</p></div>
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</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="Tyruko 300 mg 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.
