DECTOVA Solution for infusion Ref.[27672] Active ingredients: Zanamivir

Renal impairment

Zanamivir is eliminated by renal clearance, therefore the dose of Dectova when administered intravenously must be reduced in patients with renal impairment (see section 4.2). All patients must have their renal function assessed before and regularly during treatment.

Serious hypersensitivity reactions

Anaphylactic reactions and serious skin reactions (including erythema multiforme, toxic epidermal necrolysis and Stevens-Johnson syndrome) have been reported with zanamivir (see section 4.8). If any hypersensitivity reaction occurs during infusion of Dectova, the infusion must be stopped immediately and appropriate management should be instituted.

Neuropsychiatric events

Influenza can be associated with a variety of neurological and behavioural symptoms. Neuropsychiatric events, including seizures, delirium, hallucination and abnormal behaviour, have been reported during administration of zanamivir in patients with influenza, especially in children and adolescents. Therefore, patients should be closely monitored for behavioural changes and the benefits and risks of continuing treatment should be carefully evaluated for each patient (see section 4.8).

Resistance in immunocompromised patients

Treatment emergent resistance is rare with zanamivir (see section 5.1). Selection of influenza resistant viruses is more likely to occur following treatment with antiviral medicinal products in immunocompromised patients, including treatment with Dectova; it is, therefore, important to monitor for resistance and consider switching to alternative therapies where appropriate.

Limitations of the clinical data

The efficacy of Dectova for the treatment of complicated influenza A or B virus infection in adults and children aged from 6 months has been inferred from:

• the in vitro activity of zanamivir;
• clinical and virological activity of zanamivir compared to placebo in a human influenza challenge study;
• levels of zanamivir in broncho-epithelial lining fluid and serum zanamivir from a broncho-alveolar lavage study;
• serum zanamivir levels from patients with complicated influenza (see section 5.1).

Risk of bacterial infections

Dectova has not been shown to reduce the risk of bacterial complications associated with influenza infection.

Excipients

This medicinal product contains 70.8 mg sodium per vial, equivalent to 3.54% of the WHO recommended maximum daily intake of 2 g sodium for an adult.

The potential for interactions with other medicines is low, based on the known elimination pathway of zanamivir.

Zanamivir is not a substrate, inhibitor or inducer of cytochrome P450 isoenzymes nor a substrate or inhibitor of renal and hepatic transporters at clinically relevant concentrations (see section 5.2).

There was no evidence of interaction with oral oseltamivir in a clinical study.

Pregnancy

There are limited data from the use of zanamivir in pregnant women. Animal studies do not indicate direct or indirect harmful effects with respect to reproductive toxicity (see section 5.3).

Reproductive studies performed in rats and rabbits indicated that placental transfer of zanamivir occurs and there was no evidence of teratogenicity. Results from a rat peri- and postnatal study showed no clinically meaningful impairment of offspring development. However, there is no information on placental transfer in humans.

As experience is limited, the use of Dectova in pregnancy should only be considered if the possible benefit to the patient is thought to outweigh any possible risk to the foetus.

Breast-feeding

It is unknown whether zanamivir is excreted in human milk. In rats, zanamivir has been shown to be secreted in low amounts into milk.

As experience is limited, the use of zanamivir in breast-feeding mothers should be considered only if the possible benefit to the mother is thought to outweigh any possible risk to the child.

Fertility

Animal studies indicate no clinically meaningful effects of zanamivir on male or female fertility.

Dectova has no or negligible influence on the ability to drive and use machines.

Summary of the safety profile

The safety profile of Dectova is based primarily on data from a single Phase II and a single Phase III study, with support from Phase I studies, a compassionate use programme, and adverse drug reactions reported for inhaled zanamivir. The frequency of adverse reactions is based on the number of reports in the adult population receiving zanamivir 600 mg twice daily intravenously in the Phase II and Phase III studies. Adverse reactions are listed by MedDRA system organ class.

The most commonly reported adverse reactions considered possibly or probably related to Dectova are alanine aminotransferase increased (2%), aspartate aminotransferase increased (1%), hepatocellular injury (1%), diarrhoea (1%) and rash (1%). The most important serious adverse reaction was hepatocellular injury, observed in two patients (<1%).

Tabulated list of adverse reactions

The frequency of adverse reactions is defined using the following convention: 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) and not known (cannot be estimated from available data).

Paediatric population

The adverse reaction profile in the paediatric population is based on 71 patients aged ≥6 months to <18 years in the Phase II study. Overall, the safety profile in paediatric patients was similar to that observed in adults in the clinical studies.

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. Healthcare professionals are asked to report any suspected adverse reactions via the Yellow Card Scheme Website: http://www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store.

Dectova must not be mixed with other medicinal products except those mentioned in section 6.6.

Dectova should not be administered simultaneously with other intravenous medicinal products or prepared in solutions containing glucose or other electrolytes (see section 6.6).