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Chirocaine

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Document: Chirocaine 2.5 mg per ml, 5 mg per ml sol f inj or conc f sol f inf ENG PL change

Package leaflet: Information for the user


Chirocaine 2.5 mg/ml and 5.0 mg/ml solution for injection/concentrate for solution for infusion


Levobupivacaine


Read all of this leaflet carefully before you start taking this medicine because it contains important information for you.




What is in this leaflet


What Chirocaine is and what it is used for

What you need to know before you are given Chirocaine

How you will be given Chirocaine

Possible side effects

How to store Chirocaine

Contents of the pack and other information


1. What Chirocaine is and what it is used for



Chirocaine belongs to a group of medicines called local anaesthetics. This type of medicine is used to make an area of the body numb or free from pain.


Adults:

Chirocaine is used as a local anaesthetic to numb parts of the body before major surgery (for example as an epidural for caesarean section) and minor surgery (such as on the eye and mouth).


It is also used for pain relief:


Children:

Chirocaine can also be used with children to numb parts of the body before surgery and for pain relief after minor surgery, such as the repair of a groin hernia.

Chirocaine has not been tested in children less than 6 months of age.


2. What you need to know before you are given Chirocaine


Do not take Chirocaine:



Warnings and precautions:


Talk to your doctor or nurse before you are given Chirocaine if you have any of the diseases or conditions below. You may need to be checked more closely or given a smaller dose.



Other medicines and Chirocaine


Tell your doctor or nurse if you are taking or have recently taken or might take any other medicines. In particular, tell them if you are taking medicines for:



Pregnancy, breast-feeding and fertility


If you are pregnant, breast-feeding, think you may be pregnant or are planning to have a baby, ask your doctor or nursefor advice before taking this medicine.


Chirocaine must not be agiven for pain relief by injection into the area around the neck of the womb or cervixduring childbirth (paracervical block).


The effect of Chirocaine on the child during the early stages of pregnancy is not known. Therefore, Chirocaine should not be used during the first three months of your pregnancy, unless your doctor thinks it is necessary.


It is not known if levobupivacaine passes into breast milk, however from the experience with a similar drug, only small amounts of levobupivacaine are expected to pass into breast milk. Breast-feeding is therefore possible after having a local anaesthetic.


Driving and using machines


The use of Chirocaine can have a considerable effect on the ability to drive or use machines. You must not drive or operate machinery until all the effects of Chirocaine and the immediate effects of surgery have worn off. Make sure you get advice about this matter from the doctor or nurse who is treating you, before leaving hospital.

Important information about some of the ingredients of Chirocaine


This medicinal product contains 3.6 mg/mL sodium in the bag or ampoule solution to be taken into consideration by patients on a controlled sodium diet.


3. How you will be given Chirocaine


Your doctor will give you Chirocaine by injection through a needle or into a small tube in your back (epidural). Chirocaine can also be injected into other parts of the body to numb the area that you will have treated, such as the eye, arm or leg.


Your doctor and nurse will watch you carefully while you are being given Chirocaine.


Dosage


The amount of Chirocaine you will be given and how often it is given will depend on why it is being used and also on your health, age and weight. The smallest dose that can produce numbness in the required area will be used. The dose will be carefully worked out by your doctor.


When Chirocaine is used for pain relief during labour or for childbirth by caesarean section (an epidural), the dose used should be particularly carefully controlled.


If you get more Chirocaine than you should


If you get more Chirocaine than you should, you may have numbness of the tongue, dizziness, blurred vision, muscle twitching, severe breathing difficulties (including stopping breathing) and even fits (convulsions). If you notice any of these symptoms, tell your doctor immediately. Sometimes too much Chirocaine may also cause low blood pressure, fast or slow heartbeats and changes in your heart rhythm. Your doctor may need to give you other medicines to help stop these symptoms.

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


4. Possible Side Effects


Like all medicines, this medicine can cause side effects, although not everybody gets them. Some side effects with Chirocaine can be serious.


Tell your doctor or nurse immediately if you notice any of the following side effects.

Very common: may affect more than 1 in 10 people

feeling tired or weak, short of breath, looking pale (these are all signs of anaemia)


Common: may affect up to 1 in 10 people

problems (distress) for an unborn child


Not known: frequency cannot be estimated from the available data

serious allergic (hypersensitive) reactions which cause severe breathing difficulties, difficulty in swallowing, hives, very low blood pressure and swelling of the tongue or throat.

breathing stopping

heart block or heart stopping

loss of consciousness

paralysis

fits (convulsions)


Other side effects that may also occur:

Very common: may affect more than 1 in 10 people


Common: may affect up to 1 in 10 people


Not known; frequency cannot be estimated from the available data


Fast, slow or irregular heartbeats, and heart rhythm changes that can be seen on an ECG, have also been reported as side effects.


Rarely, some side effects may be long-term or permanent.


Reporting of side effects


If you get any side effects, talk to your doctoror 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.


5.How to store Chirocaine



Medicines should not be disposed of through wastewater or household waste. These measures will help to protect the environment.


6. Contents of the pack and other information


What Chirocaine contains


The active substance is levobupivacaine (as hydrochloride).


Chirocaine 2.5 mg/ml solution for injection/concentrate for solution for infusion: One ml contains 2.5 mg levobupivacaine (as hydrochloride). Each ampoule contains 25 mg in 10 ml.


Chirocaine 5 mg/ml solution for injection/concentrate for solution for infusion: One ml contains 5 mg levobupivacaine (as hydrochloride). Each ampoule contains 50 mg in 10 ml.


The other ingredients are water for injections, sodium chloride, sodium hydroxide and a small quantity of hydrochloric acid.


What Chirocainelooks like and contents of the pack


Chirocaine solution for injection / concentrate for solution for infusion is available in strengths containing 2.5 mg or 5.0 mg of levobupivacaine per ml. It is a clear, colourless solution, in polypropylene ampoules. Each ampoule contains 25 mg or 50 mg levobupivacaine in a 10 ml ampoule. It is supplied in packs of 5, 10 or 20 ampoules. Not all pack size may be marketed.


Marketing Authorisation Holder


[To be completed nationally]


Manufacturer


AbbVie S.r.l., S.R. 148 Pontina km 52 s.n.c., 04011 Campoverde di Aprilia (LT), Italy


This medicinal product is authorised in the Member States of the EEA under the following names:


Chirocaine: Sweden, Portugal, Latvia, Netherlands, France, UK, Ireland, Finland, Greece, Slovenia, Belgium, Bulgaria, Czech Republic, Luxembourg, Italy, Croatia, Slovakia.

Chirocane: Spain


This leaflet was last revised in

2016-10-27

Detailed information on this medicine is available on the website of {MS/Agency}

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The following information is intended for medical or health professionals only:


Chirocaine 2.5 mg/ml or 5.0 mg/ml solution for injection/concentrate for solution for infusion.


Instructions for use and handling


Chirocaine 2.5mg/ml or 5.0mg/ml solution for injection/concentrate for solution for infusion is intended for single use only. Discard any unused solution.


From a microbiological point of view, the product should be used immediately. If not used immediately, in-use storage times and conditions prior to use are the responsibility of the user.


There is limited safety experience with levobupivacaine therapy for periods exceeding 24 hours.


Shelf life after first opening: The product should be used immediately.


Shelf life after dilution in sodium chloride solution 0.9%: Chemical and physical in-use stability has been demonstrated for 7 days at 20-22°C.



As for all parenteral medicinal products, the solution/dilution should be inspected visually prior to use. Only clear solutions without visible particles should be used.


A sterile blister container should be chosen when a sterile ampoule surface is required. Ampoule surface is not sterile if sterile blister is pierced.


Dilutions of levobupivacaine standard solutions should be made with sodium chloride 9 mg/ml (0.9%) solution for injection using aseptic techniques.

Clonidine 8.4 g/ml, morphine 0.05 mg/ml and fentanyl 4 g/ml have been shown to be compatible with levobupivacaine in sodium chloride 9 mg/ml (0.9%) solution for injection. Chemical and physical in-use stability with clonidine, morphine or fentanyl has been demonstrated for 40 hours at 20-22°C.


Chirocaine must not be mixed with any other medicinal products except those listed above. Dilution with alkaline solutions such as sodium bicarbonate may result in precipitation.


Method of administration


Levobupivacaine should be administered only by, or under the supervision of, a clinician having the necessary training and experience.


Please refer to the summary of product characteristics for posology information.


Careful aspiration before and during injection is recommended to prevent intravascular injection.


Aspiration should be repeated before and during administration of a bolus dose, which should be injected slowly and in incremental doses, at a rate of 7.5–30 mg/min, while closely observing the patient’s vital functions and maintaining verbal contact.


If toxic symptoms occur, the injection should be stopped immediately.


CHIROCAINE®

LEVOBUPIVICAINE HCL

2. 5 mg/ml AND 5.0 mg/ml


1. Read the label carefully. Shake down any contents from the neck.


2. Hold ampoule in palm of hand waist height. Hold arrow on ampoule held between thumb and forefinger (thumb away from you). TWIST QUICKLY AND SHARPLY TOWARDS YOU (anti-clockwise).


3. Push firmly the tapered luer tip of syringe into ampoule.


4.


5. Gently push the ampoule towards you with the forefinger and withdraw the content slowly, taking special care at first.