Lagona contains a medicine called temozolomide ,This medicine is an antitumour agent.

Lagona is used for the treatment of patients with specific forms of brain tumours:

·         In adults with newly-diagnosed glioblastoma multiforme. Lagona is first used together with radiotherapy (concomitant phase of treatment) and after that alone (monotherapy phase of treatment).

·         In children 3 years and older and adult patients with malignant glioma, such as glioblastoma multiforme or anaplastic astrocytoma. Lagona is used in these tumours if they return or get worse after standard treatment.

Do not take Lagona

·         If you are allergic (hypersensitive) to temozolomide or any of the other ingredients of Lagona (listed in section 6).

·         If you have had an allergic reaction to dacarbazine (an anticancer medicine sometimes called DTIC). Signs of allergic reaction include feeling itchy, breathlessness or wheezing, swelling of the face, lips, tongue or throat.

·         If certain kinds of blood cells are severely reduced (myelosuppression), such as your white blood cell count and platelet count. These blood cells are important for fighting infection and for proper blood clotting.

Your doctor will check your blood to make sure you have enough of these cells before you begin treatment.

Take special care with Lagona

·         You should be observed closely for the development of a serious form of chest infection called Pneumocystis Jirovecci pneumonia (PCP). If you are a newly-diagnosed patient (glioblastoma multiforme) you may be receiving Lagona for 42 days in combination with radiotherapy.

In this case, your doctor will also prescribe medicine to help you prevent this type of pneumonia (PCP).

·         If you have ever had or might now have a hepatitis B infection. This is because Lagona could cause hepatitis B to become active again, which can be fatal in some cases. Patients will be carefully checked by their doctor for signs of this infection before treatment is started.

·         If you have low counts of red blood cells (anaemia), white blood cells and platelets, or blood clotting problems before starting the treatment, or if you develop them during treatment. Your doctor may decide to reduce the dose, interrupt, stop or change your treatment. You may also need other treatments. In some cases, it may be necessary to stop treatment with Lagona. Your blood will be tested frequently during treatment to monitor the side effects of Lagona on your blood cells.

·         You may have a small risk of other changes in blood cells, including leukaemia.

·         If you have nausea (feeling sick in your stomach) and/or vomiting which are very common side effects of Lagona (see section 4 “Possible side effects”), your doctor may prescribe you a medicine (an anti-emetic) to help prevent vomiting. If you vomit frequently before or during treatment, ask your doctor about the best time to take Lagona until the vomiting is under control. If you vomit after taking your dose, do not take a second dose on the same day.

·         If you develop fever or symptoms of an infection contact your doctor immediately.

·         Do not open, crush or chew the capsules. If a capsule is damaged, avoid contact of the powder with your skin, eyes or nose. Avoid inhaling the powder. If you accidentally get some in your eyes or nose, flush the area with water.

·         If you are older than 70 years of age, you might be more prone to infection, bruising or bleeding.

·         If you have liver or kidney problems, your dose of Lagona may need to be adjusted.

Due to lack of experience, Lagona should not be used in children younger than 3 years.

Lagona may cause permanent infertility. Male patients should use effective contraceptions and not father a child for up to 6 months after stopping treatment. It is recommended to seek advice on conservation of sperm prior to treatment.

Using other medicines

Please tell your doctor or pharmacist if you are taking or have recently taken any other medicines, including medicines obtained without a prescription.

Pregnancy and breast-feeding

Tell your doctor if you are pregnant, think you might be or are planning to get pregnant. You must not be treated with Lagona during pregnancy unless clearly indicated by your doctor.

Effective contraceptive precautions must be taken by both male and female patients who are taking Lagona (see also “Take special care with Lagona” above). You should stop breast-feeding while receiving treatment with Lagona.

Driving and using machines

Lagona may make you feel tired or sleepy. In this case, do not drive or use any tools or machines.

Important information about some of the ingredients of Lagona

Lagona hard capsules contain lactose. If you have been told by your doctor that you have an intolerance to some sugars, contact your doctor before taking this medicinal product.

Dosage and duration of treatment

Your doctor will work out your dose of Lagona. This is based on your size (height and weight) and if you have a recurrent tumour and have had chemotherapy treatment in the past.

You may be given other medicines (anti-emetics) to take before and/or after taking Lagona to prevent or control nausea and vomiting.

Patients with newly-diagnosed glioblastoma multiforme:

If you are a newly-diagnosed patient, treatment will occur in two phases:

·         Treatment together with radiotherapy (concomitant phase) first,

·         Followed by treatment with only Lagona (monotherapy phase).

During the concomitant phase, your doctor will start Lagona at a dose of 75 mg/m2 (usual dose). You will take this dose every day for 42 days (up to 49 days) in combination with radiotherapy. The Lagona dose may be delayed or stopped, depending on your blood counts and how you tolerate your medicine during the concomitant phase. Once the radiotherapy is completed, you will interrupt treatment for 4 weeks. This will give your body a chance to recover. Then, you will start the monotherapy phase.

During the monotherapy phase, the dose and way you take Lagona will be different. Your doctor will work out your exact dose. There may be up to 6 treatment periods (cycles). Each one lasts 28 days. You will take your new dose of Lagona alone once daily for the first 5 days (“dosing days”) of each cycle. The first dose will be 150 mg/m2. Then you will have 23 days without Lagona. This adds up to a 28- day treatment cycle. After Day 28, the next cycle will begin. You will again take Lagona once daily for 5 days followed by 23 days without Lagona. The Lagona dose may be adjusted, delayed or stopped depending on your blood counts and how you tolerate your medicine during each treatment cycle.

Patients with tumours that have returned or worsened (malignant glioma, such as glioblastoma multiforme or anaplastic astrocytoma) taking Lagona only:

A treatment cycle with Lagona lasts 28 days. You will take Lagona alone once daily for the first 5 days. This daily dose depends on whether or not you have received chemotherapy before.

If you have not been previously treated with chemotherapy, your first dose of Lagona will be 200 mg/m2 once daily for the first 5 days. If you have been previously treated with chemotherapy, your first dose of Lagona will be 150 mg/m2 once daily for the first 5 days. Then, you will have 23 days without Lagona. This adds up to a 28-day treatment cycle.

After Day 28, the next cycle will begin. You will again receive Lagona once daily for 5 days, followed by 23 days without Lagona.

Before each new treatment cycle, your blood will be tested to see if the Lagona dose needs to be adjusted. Depending on your blood test results, your doctor may adjust your dose for the next cycle.

How to take Lagona

Take your prescribed dose of Lagona once a day, preferably at the same time each day.

Take the capsules on an empty stomach; for example, at least one hour before you plan to eat breakfast. Swallow the capsule(s) whole with a glass of water. Do not open or chew the capsules. If a capsule is damaged, avoid contact with your skin, eyes or nose. If it occurs, wash the affected area thoroughly.

Depending on the prescribed dose, you may have to take more than one capsule together, eventually with different strengths (content of active substance, in mg). The colour of the capsule cap is different for each strength (see in the table below).

You should make sure you fully understand and remember the following:

·         How many capsules you need to take every dosing day. Ask your doctor or pharmacist to write it down (including the colour).

·         Which days are your dosing days.

Review the dose with your doctor each time you start a new cycle, since it may be different from the last cycle.

Always take Lagona exactly as your doctor has told you. It is very important to check with your doctor or pharmacist if you are not sure. Errors in how you take this medicine may have serious health consequences.

If you take more Lagona than you should

If you accidentally take more Lagona capsules than you were told to, contact your doctor or pharmacist immediately.

If you forget to take Lagona

Take the missed dose as soon as possible during the same day. If a full day has gone by, check with your doctor. Do not take a double dose to make up for a forgotten dose, unless your doctor tells you to do so.

If you have any further questions on the use of this product, ask your doctor or pharmacist.

Like all medicines, Lagona can cause side effects, although not everybody gets them.

Contact your doctor immediately if you have any of the following:

·         A severe allergic (hypersensitive) reaction (hives, wheezing or other breathing difficulty),

·         Uncontrolled bleeding,

·         Seizures (convulsions),

·         Fever,

·         A severe headache that does not go away.

Lagona treatment can cause a reduction in certain kinds of blood cells.

This may cause you to have increased bruising or bleeding, anaemia (a shortage of red blood cells), fever, and reduced resistance to infections. The reduction in blood cell counts is usually short-lived. In some cases, it may be prolonged and may lead to a very severe form of anaemia (aplastic anaemia). Your doctor will monitor your blood regularly for any changes, and will decide if any specific treatment is needed. In some cases, your Lagona dose will be reduced or treatment stopped.

Side effects from clinical studies:

Side effects may occur with certain frequencies, which are defined as follows:

·         Very common: may affect more than 1 in 10 people

·         Common: may affect up to 1 in 10 people

·         Uncommon: may affect up to 1 in 100 people

·         Rare: may affect up to 1 in 1,000 people

·         Very rare: may affect up to 1 in 10,000 people

·         Not known: frequency cannot be estimated from the available data.

Lagona in combination treatment with radiotherapy in newly-diagnosed glioblastoma

Patients receiving Lagona in combination with radiotherapy may experience different side effects than patients taking Lagona alone. The following side effects may occur, and may require medical attention.

Very common: loss of appetite, headache, constipation, nausea (feeling sick in your stomach), vomiting, rash, hair loss, tiredness.

Common: oral infections, wound infection, reduced number of blood cells (neutropenia, thrombocytopenia, lymphopenia, leukopenia), increased sugar in the blood, loss of weight, change in mental status or alertness, anxiety/depression, sleepiness, difficulty speaking, impaired balance, dizziness, confusion, forgetfulness, difficulty concentrating, inability to fall asleep or stay asleep, tingling sensation, bruising, shaking, abnormal or blurry vision, double vision, hearing impairment, shortness of breath, cough, blood clot in the legs, fluid retention, swollen legs, diarrhoea, stomach or abdominal pain, heartburn, upset stomach, difficulty swallowing, dry mouth, skin irritation or redness, dry skin, itching, muscle weakness, painful joints, muscle aches and pains, frequent urination, difficulty with holding your urine, allergic reaction, fever, radiation injury, face swelling, pain, abnormal taste, abnormal liver function tests.

Uncommon: flu-like symptoms, red spots under the skin, low potassium level in the blood, weight gain, mood swings, hallucination and memory impairment, partial paralysis, impaired coordination, impaired sensations, partial loss of vision, dry or painful eyes, deafness, infection of the middle ear, ringing in the ears, earache, palpitations (when you can feel your heart beat), blood clot in the lung, high blood pressure, pneumonia, inflammation of your sinuses, bronchitis, a cold or the flu, swollen stomach, difficulty controlling your bowel movements, haemorrhoids, peeling skin, increased skin sensitivity to sunlight, change in skin colour, increased sweating, muscle damage, back pain, difficulty in urinating, vaginal bleeding, sexual impotence, absent or heavy menstrual periods, vaginal irritation, breast pain, hot flushes, shivering, discolouration of your tongue, change in your sense of smell, thirst, tooth disorder.

Lagona monotherapy in recurrent or progressive glioma

The following side effects may occur, and may require medical attention.

Very common: reduced number of blood cells (neutropenia or lymphopenia, thrombocytopenia), loss of appetite, headache, vomiting, nausea (feeling sick in your stomach), constipation, tiredness.

Common: loss of weight, sleepiness, dizziness, tingling sensation, shortness of breath, diarrhoea, abdominal pain, upset stomach, rash, itching, hair loss, fever, weakness, shivering, feeling unwell, pain, change in taste.

Uncommon: reduced number of blood cell counts (pancytopenia, anaemia, leukopenia).

Rare: cough, infections including pneumonia.

Very rare: skin redness, urticaria (hives), skin eruption, allergic reactions.

Other side effects:

Cases of elevations of liver enzymes have been commonly reported. Cases of increased bilirubin, problems with bile flow (cholestasis), hepatitis and injury to the liver, including fatal liver failure, have been uncommonly reported.

Very rare cases of severe rash with skin swelling, including on the palms of the hands and soles of the feet, or painful reddening of the skin and/or blisters on the body or in the mouth have been observed. Tell your doctor immediately if this occurs.

Very rare cases of lung side effects have been observed with Lagona.

Patients usually present with shortness of breath and cough. Tell your doctor if you notice any of these symptoms.

In very rare cases, patients taking Lagona and medicines like it may have a small risk of developing secondary cancers, including leukaemia.

New or reactivated (recurring) cytomegalovirus infections and reactivated hepatitis B virus infections have been uncommonly reported. Cases of brain infections caused by herpes virus (meningoencephalitis herpetic), including fatal cases, have been uncommonly reported.

Cases of diabetes insipidus have been uncommonly reported. Symptoms of diabetes insipidus include passing a lot of urine and feeling thirsty.

If any of the side effects gets serious, or if you notice any side effects not listed in this leaflet, please tell your doctor or pharmacist.

Keep out of the reach and sight of children.

Do not use Lagona after the expiry date which is stated on the label and carton. The expiry date refers to the last day of that month.

HDPE Bottle presentation:

Store below 30 °C.

Store in the original bottle in order to protect from moisture.

Keep the bottle tightly closed.

Sachet presentation

Store below 30 °C.

Medicines should not be disposed via wastewater or household waste. Ask you pharmacist how to dispose of medicines no longer required. These measures will help to protect the environment.