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תיוטפה רימזר 15 מ"ג THIOTEPA RIEMSER 15 MG (THIOTEPA)

תרופה במרשם תרופה בסל נרקוטיקה ציטוטוקסיקה

צורת מתן:

תוך-ורידי : I.V

צורת מינון:

אבקה להכנת תמיסה מרוכזת לעירוי : POWDER FOR CONCENTRATE FOR SOLUTION FOR INFUSION

Adverse reactions : תופעות לוואי

4.8   Undesirable effects

Summary of the safety profile
The safety of thiotepa has been examined through a review of adverse events reported in published data from clinical trials. In these studies, a total of 6,588 adult patients and 902 paediatric patients received thiotepa for conditioning treatment prior to haematopoietic progenitor cell transplantation.

Serious toxicities involving the haematologic, hepatic and respiratory systems were considered as expected consequences of the conditioning regimen and transplant process. These include infection and Graft-versus host disease (GvHD) which, although not directly related, were the major causes of morbidity and mortality, especially in allogeneic HPCT.
The most frequently adverse reactions reported in the different conditioning treatments including thiotepa are: infections, cytopenia, acute GvHD and chronic GvHD, gastrointestinal disorders, haemorrhagic cystitis, and mucosal inflammation.

Leukoencephalopathy
Cases of leukoencephalopathy have been observed following treatment with thiotepa in adult and paediatric patients with multiple previous chemotherapies, including methotrexate and radiotherapy. Some cases had a fatal outcome.


Tabulated list of adverse reactions
Adults

The adverse reactions considered at least possibly related to conditioning treatment including thiotepa, reported in adult patients as more than an isolated case, are listed below by system organ class and by frequency. Within each frequency grouping, undesirable effects are presented in order of decreasing seriousness. Frequencies are defined as: very common (≥1/10), common (≥1/100 to <1/10), uncommon (≥1/1,000 to <1/100), rare (≥1/10,000 to <1/1,000), very rare (<1/10,000), not known (cannot be estimated from the available data).

System organ
Very common           Common                 Uncommon class                                                                                   Not Known 
Infections and     Infection                                    Toxic shock infestations       susceptibility                               syndrome increased
Sepsis
Neoplasms                                Treatment related benign,                                  second malignancy malignant and unspecified
(incl cysts and polyps)
Blood and          Leukopenia lymphatic          Thrombocytopenia system             Febrile neutropenia disorders          Anaemia
Pancytopenia
Granulocytopenia

Immune system      Acute graft versus    Hypersensitivity disorders          host disease
Chronic graft versus host disease
Endocrine                                Hypopituitarism disorders
Metabolism and     Anorexia nutrition          Decreased appetite disorders          Hyperglycaemia
Psychiatric        Confusional state     Anxiety                Delirium disorders          Mental status                                Nervousness changes                                      Hallucination
Agitation



Nervous system     Dizziness          Intracranial                            Leukoencephalopath- disorders          Headache           aneurysm                                y Vision blurred     Extrapyramidal
Encephalopathy     disorder
Convulsion         Cognitive disorder
Paraesthesia       Cerebral haemorrhage
Eye disorders      Conjunctivitis     Cataract
Ear and            Hearing impaired labyrinth          Ototoxicity disorders          Tinnitus
Cardiac            Arrhythmia         Tachycardia          Cardiomyopathy disorders                             Cardiac failure      Myocarditis Vascular           Lymphoedema        Haemorrhage disorders          Hypertension       Embolism
Respiratory,       Idiopathic         Pulmonary oedema     Hypoxia thoracic and       pneumonia          Cough mediastinal        syndrome           Pneumonitis disorders          Epistaxis
Gastrointestinal   Nausea             Constipation         Gastrointestinal disorders          Stomatitis         Gastrointestinal     ulcer
Oesophagitis       perforation
Vomiting           Ileus
Diarrhoea
Dyspepsia
Abdominal pain
Enteritis
Colitis
Hepatobiliary      Venoocclusive disorders          liver disease
Hepatomegaly
Jaundice
Skin and           Rash               Erythema             Pigmentation       Severe toxic skin subcutaneous       Pruritus                                disorder           reactions tissue disorders   Alopecia                                Erythrodermic      including cases of psoriasis          Stevens- Johnson syndrome and toxic epidermal necrolysis
Musculoskeletal    Back pain and connective     Myalgia tissue disorders   Arthralgia
Renal and          Cystitis           Dysuria urinary            haemorrhagic       Oliguria disorders                             Renal failure
Cystitis
Haematuria
Reproductive       Azoospermia        Menopausal system and         Amenorrhoea        symptoms breast disorders   Vaginal            Infertility female haemorrhage        Infertility male



General            Pyrexia                  Multi-organ failure disorders and      Asthenia                 Pain administration     Chills site conditions    Generalised oedema
Injection site inflammation
Injection site pain
Mucosal inflammation
Investigation      Weight increased         Blood creatinine
Blood bilirubin          increased increased                Blood urea
Transaminases            increased increased                Gamma-
Blood amylase            glutamyltransferase increased                increased
Blood alkaline phosphatase increased
Aspartate aminotransferase increased



Paediatric population
The adverse reactions considered at least possibly related to conditioning treatment including thiotepa, reported in paediatric patients as more than an isolated case, are listed below by system organ class and by frequency. Within each frequency grouping, undesirable effects are presented in order of decreasing seriousness. Frequencies are defined as: very common (≥1/10), common (≥1/100 to <1/10), uncommon (≥1/1,000 to <1/100), rare (≥1/10,000 to <1/1,000), very rare (<1/10,000), not known (cannot be estimated from the available data).


System organ class                       Very common          Common              Not known 
Infections and infestations              Infection            Thrombocytopenic susceptibility       purpura increased
Sepsis
Neoplasms benign, malignant and                               Treatment related unspecified (incl cysts and polyps)                           second malignancy
Blood and lymphatic system               Thrombocytopenia disorders                                Febrile neutropenia
Anaemia
Pancytopenia
Granulocytopenia
Immune system disorders                  Acute graft versus host disease
Chronic graft versus host disease

Endocrine disorders                  Hypopituitarism
Hypogonadism
Hypothyroidism
Metabolism and nutrition disorders   Anorexia
Hyperglycaemia
Psychiatric disorders                Mental status       Mental disorder changes             due to a general medical condition
Nervous system disorders             Headache            Ataxia               Leukoencephalopathy Encephalopathy
Convulsion
Cerebral haemorrhage
Memory impairment
Paresis
Ear and labyrinth disorders          Hearing impaired
Cardiac disorders                    Cardiac arrest      Cardiovascular insufficiency
Cardiac failure
Vascular disorders                   Haemorrhage         Hypertension Respiratory, thoracic and            Pneumonitis         Idiopathic           Pulmonary arterial mediastinal disorders                                    pneumonia            hypertension syndrome
Pulmunary haemorrage
Pulmonary oedema
Epistaxis
Hypoxia
Respiratory arrest
Gastrointestinal disorders           Nausea              Enteritis
Stomatitis          Intestinal
Vomiting            obstruction
Diarrhoea
Abdominal pain
Hepatobiliary disorders              Venoocclusive       Liver failure liver disease
Skin and subcutaneous tissue         Rash                                     Severe toxic skin disorders                            Erythema                                 reactions including Desquamation                             cases of Stevens-
Pigmentation                             Johnson syndrome disorder                                 and toxic epidermal necrolysis
Musculoskeletal and connective       Growth tissue disorders                     retardation
Renal and urinary disorders          Bladder disorders   Renal failure Cystitis haemorrhagic
General disorders and                Pyrexia administration site conditions       Mucosal inflammation
Pain
Multi-organ failure


Investigation                        Blood bilirubin      Blood urea increased            increased
Transaminases        Blood electrolytes increased            abnormal
Blood creatinine     Prothrombin time increased            ratio increased
Aspartate aminotransferase increased
Alanine aminotransferase increased

Reporting of suspected adverse reactions
Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Any suspected adverse events should be reported to the Ministry of Health according to the National Regulation by using an online form https://sideeffects.health.gov.il


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