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 Stimufend is and what it is used for</li><li>What you need to know before you use Stimufend</li><li>How to use Stimufend</li><li>Possible side effects</li><li>How to store Stimufend</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>Stimufend contains the active substance pegfilgrastim. Pegfilgrastim is a protein produced by biotechnology in bacteria called E. coli. It belongs to a group of proteins called cytokines, and is very similar to a natural protein (granulocyte-colony stimulating factor) produced by your own body.<br/>Stimufend is used to reduce the duration of neutropenia (low white blood cell count) and the occurrence of febrile neutropenia (low white blood cell count with a fever) which can be caused by the use of cytotoxic chemotherapy (medicines that destroy rapidly growing cells). White blood cells are important as they help your body fight infection. These cells are very sensitive to the effects of chemotherapy which can cause the number of these cells in your body to decrease. If white blood cells fall to a low level there may not be enough left in the body to fight bacteria and you may have an increased risk of infection. Your doctor has given you Stimufend to encourage your bone marrow (part of the bone which makes blood cells) to produce more white blood cells that help your body fight infection.</p></div>
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<div xmlns="http://www.w3.org/1999/xhtml"><p>Do not use Stimufend</p><p>if you are allergic to pegfilgrastim, filgrastim or any of the other ingredients of this medicine (listed in section 6).<br/>Warnings and precautions Talk to your doctor, pharmacist or nurse before using Stimufend:</p><p>if you experience an allergic reaction including weakness, drop in blood pressure, difficulty<br/>breathing, swelling of the face (anaphylaxis), redness and flushing, skin rash and areas of the skin that itch.</p><p>if you have an allergy to latex. The needle cap on the pre-filled syringe contains a derivative of<br/>latex and may cause severe allergic reactions.</p><p>if you experience a cough, fever and difficulty breathing. This can be a sign of Acute Respiratory Distress Syndrome (ARDS).</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 could be symptoms of a condition called Capillary Leak Syndrome which causes blood to leak from the small blood vessels into your body. See section 4.<br/>if you get left upper abdominal pain or pain at the tip of your shoulder. This may be a sign of a problem with your spleen (splenomegaly).</p><p>if you have recently had a serious lung infection (pneumonia), fluid in the lungs (pulmonary oedema), inflammation of the lungs (interstitial lung disease) or an abnormal chest x-ray (lung infiltration).</p><p>if you are aware of any altered blood cell counts (e.g. increase in white blood cells or anaemia) or decreased blood platelet counts, which reduces the ability of your blood to clot (thrombocytopenia). Your doctor may want to monitor you more closely.</p><p>if you have sickle cell anaemia. Your doctor may monitor your condition more closely.</p><p>if you are a patient with breast cancer or lung cancer, Stimufend in combination with chemotherapy and/or radiation therapy may increase your risk of a precancerous blood condition called myelodysplastic syndrome (MDS) or a blood cancer called acute myeloid leukaemia (AML). Symptoms may include tiredness, fever, and easy bruising or bleeding.</p><p>if you 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 these could be signs of a severe allergic reaction.</p><p>if you have symptoms of inflammation of aorta (the large blood vessel which transports blood from the heart to the body), this has been reported rarely 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 those symptoms. Your doctor will check your blood and urine regularly as Stimufend can harm the tiny filters inside your kidneys (glomerulonephritis). Severe skin reactions (Stevens-Johnson syndrome) have been reported with the use of pegfilgrastim. Stop using pegfilgrastim and seek medical attention immediately if you notice any of the symptoms described in section 4. You should talk to your doctor about your risks of developing cancers of the blood. If you develop or are likely to develop cancers of the blood, you should not use Stimufend, unless instructed by your doctor. Loss of response to pegfilgrastim If you experience a loss of response or failure to maintain a response with pegfilgrastim treatment, your doctor will investigate the reasons why including whether you have developed antibodies which neutralise pegfilgrastim s activity. Other medicines and Stimufend Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines. Pregnancy and breast-feeding Ask your doctor or pharmacist for advice before taking any medicine. Stimufend has not been tested in pregnant women. It is important to tell your doctor if you:</p><p>are pregnant;</p><p>think you may be pregnant; or</p><p>are planning to have a baby. If you become pregnant during Stimufend treatment, please inform your doctor. Unless your doctor directs you otherwise, you must stop breast-feeding if you use Stimufend. Driving and using machines Stimufend has no or negligible effect on the ability to drive or use machines. Stimufend contains sorbitol (E420) and sodium acetate This medicine contains 30 mg sorbitol in each 6 mg dose, which is equivalent to 50 mg/ml.<br/>This medicine contains less than 1 mmol sodium (23 mg) per 6 mg dose, that is to say essentially sodium-free .</p></div>
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<div xmlns="http://www.w3.org/1999/xhtml"><p>Stimufend is for use in adults aged 18 and over. Always take this medicine exactly as your doctor has told you. Check with your doctor or pharmacist if you are not sure. The recommended dose is one 6 mg subcutaneous injection (injection under your skin) using a pre- filled syringe and it should be given at least 24 hours after your last dose of chemotherapy at the end of each chemotherapy cycle.<br/>Injecting Stimufend yourself Your doctor may decide that it would be more convenient for you to inject Stimufend yourself. Your doctor or nurse will show you how to inject yourself. Do not try to inject yourself if you have not been trained. For further instructions on how to inject yourself with Stimufend, please read the section at the end of this leaflet. Do not shake Stimufend vigorously as this may affect its activity. If you use more Stimufend than you should If you use more Stimufend than you should contact your doctor, pharmacist or nurse. If you forget to inject Stimufend If you are injecting yourself and have forgotten your dose of Stimufend, you should contact your doctor to discuss when you should inject the next dose.<br/>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. Please tell your doctor immediately if you have any of the following or combination of the following side effects:</p><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 an uncommon (may affect up to 1 in 100 people) condition called Capillary Leak Syndrome which causes blood to leak from the small blood vessels into your body and needs urgent medical attention. Very common side effects (may affect more than 1 in 10 people):</p><p>bone pain. Your doctor will tell you what you can take to ease the bone pain.</p><p>nausea and headaches. Common side effects (may affect up to 1 in 10 people):</p><p>pain at the site of injection.</p><p>general aches and pains in the joints and muscles.</p><p>some changes may occur in your blood, but these will be detected by routine blood tests. Your white blood cell count may become high for a short period of time. Your platelet count may become low which might result in bruising. Uncommon side effects (may affect up to 1 in 100 people):</p><p>allergic-type reactions, including redness and flushing, skin rash, and raised areas of the skin that itch.</p><p>serious allergic reactions, including anaphylaxis (weakness, drop in blood pressure, difficulty breathing, swelling of the face).</p><p>increased spleen size.</p><p>spleen rupture. Some cases of splenic rupture were fatal. It is important that you contact your doctor immediately if you experience pain in the upper left side of the abdomen or left shoulder pain since this may relate to a problem with your spleen.</p><p>breathing problems. If you have a cough, fever and difficulty breathing please tell your doctor.</p><p>Sweet s syndrome (plum-coloured, raised, painful lesions on the limbs and sometimes the face and neck with fever) has occurred but other factors may play a role.</p><p>cutaneous vasculitis (inflammation of the blood vessels in the skin).</p><p>damage to the tiny filters inside your kidneys (glomerulonephritis).</p><p>redness at the site of injection.</p><p>coughing up blood (haemoptysis)</p><p>blood disorders (myelodysplastic syndrome [MDS] or acute myeloid leukaemia [AML]).<br/>Rare side effects (may affect up to 1 in 1,000 people):</p><p>inflammation of aorta (the large blood vessel which transports blood from the heart to the body), see section 2.<br/>bleeding from the lung (pulmonary haemorrhage).</p><p>Stevens-Johnson syndrome, which can appear as reddish target-like or circular patches often with central blisters on the trunk, skin peeling, ulcers of mouth, throat, nose, genitals and eyes and can be preceded by fever and flu-like symptoms. Stop using Stimufend if you develop these symptoms and contact your doctor or seek medical attention immediately. See also 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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<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). Stimufend may be exposed to room temperature (not above 30 C) for a maximum single period of up to 72 hours. Stimufend left at room temperature for more than 72 hours should be discarded. For all questions about storage, ask your doctor, nurse or pharmacist. Do not freeze.<br/>Keep the pre-filled syringe in the outer carton in order to protect from light. Do not use this medicine if you notice it is cloudy or there are particles in it. 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"><h2 id="what-stimufend-contains">What Stimufend contains</h2><h2 id="the-active-substance-is-pegfilgrastim-each-pre-filled-syringe-contains-6-mg-of-pegfilgrastim-in-06-ml-of-solution">The active substance is pegfilgrastim. Each pre-filled syringe contains 6 mg of pegfilgrastim in 0.6 mL of solution.</h2><p>The other ingredients are sodium acetate, sorbitol (E420), polysorbate 20, glacial acetic acid and water for injections. See section 2 Stimufend contains sorbitol (E420) and sodium acetate .<br/>What Stimufend looks like and contents of the pack Stimufend is a clear, colourless solution for injection in a pre-filled syringe (6 mg/0.6 mL). Each pack contains 1 glass pre-filled syringe with an attached stainless steel needle and needle cap. The pre-filled syringe is provided with an automatic needle guard. Marketing Authorisation Holder<br/>Fresenius Kabi Deutschland GmbH Else-Kroener Strasse 1 61352 Bad Homburg v.d.Hoehe Germany Manufacturer Fresenius Kabi Austria GmbH Hafnerstrasse 8055 Graz Austria This leaflet was last revised in Other sources of information Detailed information on this medicine is available on the European Medicines Agency web site:</p></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
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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.
