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Patient leaflets and SmPCs, drug interaction checker, official and paediatric dosages, pregnancy and breastfeeding guidance, and NHS pharmacy opening hours — all in one place.

Pharmacy Guide

Patient leaflets and SmPCs, drug interaction checker, official and paediatric dosages, pregnancy and breastfeeding guidance, and NHS pharmacy opening hours — all in one place.

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Sapropterin dihydrochloride 100 mg soluble tablets

Active substance: Sapropterin dihydrochlorideRx — prescription only

Source: electronic medicines compendium (emc)
Official leaflet: Read the PIL on emc

What it is and what it is used for

Sapropterin dihydrochloride Soluble Tablets contain the active substance sapropterin which is a synthetic copy of a body's own substance called tetrahydrobiopterin (BH4). BH4 is required by the body to use an amino acid called phenylalanine in order to build another amino acid called tyrosine. Sapropterin dihydrochloride is used to treat hyperphenylalaninaemia (HPA) or phenylketonuria (PKU) in patients of all ages. HPA and PKU are due to abnormally high levels of phenylalanine in the blood which can be harmful. Sapropterin dihydrochloride reduces these levels in some patients who respond to BH4 and can help increase the amount of phenylalanine that can be included in the diet. This medicine is also used to treat an inherited disease called BH4 deficiency in patients of all ages, in which the body cannot produce enough BH4. Because of very low BH4 levels phenylalanine is not used properly and its levels rise, resulting in harmful effects. By replacing the BH4 that the body cannot produce, sapropterin dihydrochloride reduces the harmful excess of phenylalanine in the blood and increases the dietary tolerance to phenylalanine.

What you need to know before you take it

You must continue your diet treatment as recommended by your doctor. Do not change your diet without contacting your doctor. Even if you take sapropterin dihydrochloride, if your phenylalanine blood levels are not well controlled, you can develop severe neurologic problems. Your doctor should continue to monitor your blood phenylalanine levels often during your treatment with sapropterin dihydrochloride, to make sure that your blood phenylalanine levels are not too high or too low. Other medicines and Sapropterin dihydrochloride Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines. In particular you should tell your doctor if you are using: - levodopa (used to treat Parkinson's disease) - medicines for treatment of cancer (e.g. methotrexate) - medicines for treatment of bacterial infections (e.g. trimethoprim) - medicines that cause dilation of blood vessels, (such as glyceryl trinitrate (GTN), isosorbide dinitrate (ISDN), sodium nitroprusside (SNP), molsidomin, minoxidil). Pregnancy and breast feeding If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, ask your doctor or pharmacist for advice before taking this medicine. If you are pregnant your doctor will tell you how to control phenylalanine levels adequately. If these are not strictly controlled before or when you become pregnant, this could be harmful to you and to your baby. Your doctor will monitor the restriction of dietary phenylalanine intake prior and during pregnancy. If the strict diet does not adequately reduce phenylalanine amount in your blood your doctor will consider whether you must take this medicine. You should not take this medicine if you are breast-feeding. Driving and using machines Sapropterin dihydrochloride is not expected to affect the ability to drive and use machines. Important information about some of the ingredients of Sapropterin dihydrochloride tablets This medicine contains less than 1 mmol sodium (23 mg) per tablet, that is to say essentially 'sodiumfree'.

How to take it

The table below is an example of how an appropriate dose is calculated

Body weight (kg) Number of 100 mg tablets

(dose 10 mg/kg)

Number of 100 mg tablets

(dose 20 mg/kg) 10 1 2 20 2 4 30 3 6 40 4 8 50 5 10 Method of administration For PKU patients, the total daily dose is taken once a day at the same time each day, preferably in the morning. For BH4 deficiency patients, the total daily dose is divided into 2 or 3 doses over the day. Use in all patients Place the prescribed number of tablets in a glass or cup of water as accurately described below and stir until dissolved. It may take a few minutes for the tablets to dissolve. To make the tablets dissolve faster you can crush them. Small particles may be visible in the solution, but they will not affect the effectiveness of the medicine. Drink the dissolved preparation of sapropterin dihydrochloride with a meal within 15 to 20 minutes of its preparation. Do not swallow the desiccant capsule contained in the bottle. Use in patients above 20 kg body weight Place the tablets in a glass or cup (120 to 240 ml) of water and stir until dissolved. Use in children up to 20 kg body weight The dose is based on body weight. This will change as your child grows. Your doctor will tell you: • the number of sapropterin dihydrochloride tablets needed for one dose • the amount of water needed to mix one dose of sapropterin dihydrochloride • the amount of solution you will need to give your child for their prescribed dose Your child should drink the solution with a meal. Give your child the prescribed amount of solution within 15 to 20 minutes after dissolving. If you are not able to give your child's dose within 15 to 20 minutes after dissolving the tablets, you will need to prepare a new solution as the unused solution should not be used beyond 20 minutes. Supplies needed to prepare and give your child's dose of Sapropterin dihydrochloride • The number of sapropterin dihydrochloride tablets needed for one dose • A medicine cup with graduation markings at 20, 40, 60 and 80 ml • A glass or cup • Small spoon or clean utensil for stirring • Oral syringe (graduated in 1 ml divisions) (10 ml syringe for administration of volumes of ≤10 ml or 20 ml syringe for administration of volumes of >10 ml) Ask your doctor for the medicine cup for dissolving the tablets and the 10 ml or 20 ml oral syringe if you do not have these supplies. Steps for preparing and taking your dose: • Place the prescribed number of tablets in the medicine cup. Pour the amount of water into the medicine cup, as instructed by your doctor (e.g. your doctor told you to use 20 ml for dissolving

one sapropterin dihydrochloride tablet). Check to make sure that the amount of liquid lines up with the amount that your doctor tells you. Stir with the small spoon or clean utensil until the tablets dissolve. • If your doctor told you to administer only a portion of the solution, point the tip of the oral syringe into the medicine cup. Slowly pull back the plunger to withdraw the amount as instructed by your doctor. • Transfer the solution by pushing on the plunger slowly until all of the solution in the oral syringe is transferred to a glass or cup for administration (e.g. if your doctor told you to dissolve two sapropterin dihydrochloride tablets in 40 ml water and administer 30 ml to your child, you would have to use the 20 ml oral syringe two times to draw up 30 ml (e.g. 20 ml + 10 ml) of the solution and transfer it to a glass or cup for administration). Use a 10 ml oral syringe for administration of volumes ≤10 ml or a 20 ml oral syringe for administration of volumes >10 ml. • If your baby is too small to drink from a glass or a cup you may administer the solution via the oral syringe. Draw up the prescribed volume from the solution prepared in the medicine cup and place the tip of the oral syringe into your baby's mouth. Point the tip of the oral syringe towards either cheek. Push on the plunger slowly, a small amount at a time, until all of the solution in the oral syringe is given. • Throw away any remaining solution. Remove the plunger from the barrel of the oral syringe. Wash both parts of the oral syringe and the medicine cup with warm water and air dry. When the oral syringe is dry, put the plunger back into the barrel. Store the oral syringe and the medicine cup for next use. If you take more Sapropterin dihydrochloride than you should If you take more sapropterin dihydrochloride than prescribed, you may experience side effects that could include headache and dizziness. Immediately contact your doctor or pharmacist if you take more sapropterin dihydrochloride than prescribed. If you forget to take Sapropterin dihydrochloride Do not take a double dose to make up for a forgotten dose. Take the next dose at the usual time. If you stop taking Sapropterin dihydrochloride Do not stop taking sapropterin dihydrochloride without prior discussion with your doctor, as phenylalanine levels in your blood may increase. If you have any further questions on the use of this medicine, ask your doctor or pharmacist.

Possible side effects

Like all medicines, this medicine can cause side effects, although not everybody gets them. Few cases of allergic reactions (such as skin rash and serious reactions) have been reported. Their frequency is not known (frequency cannot be estimated from the available data). If you have red, itchy, raised areas (hives), runny nose, fast or uneven pulse, swelling of your tongue and throat, sneezing, wheezing, serious difficulty in breathing or dizziness, you may be having a serious allergic reaction to the medicine. If you notice these signs, contact your doctor immediately. Very common side effects (may affect more than 1 in 10 people) Headache and runny nose. Common side effects (may affect up to 1 in 10 people) Sore throat, nasal congestion or stuffy nose, cough, diarrhoea, vomiting, stomach ache, too low levels of phenylalanine in blood tests, indigestion and feeling sick (nausea) (see section 2: "Warnings and precautions"). Not known side effects (frequency cannot be estimated from the available data)

Gastritis (inflammation of the lining of the stomach), oesophagitis (inflammation of the lining of the gullet). 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 Yellow Card Scheme website www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store. By reporting side effects, you can help provide more information on the safety of this medicine.

Frequently asked questions about Sapropterin dihydrochloride 100 mg soluble tablets

How do I take Sapropterin dihydrochloride 100 mg soluble tablets?

Sapropterin dihydrochloride 100 mg soluble tablets comes as tablet containing 100mg. Always follow the dose your doctor or pharmacist has given you, and read the leaflet that comes with the medicine.

What is the active substance in Sapropterin dihydrochloride 100 mg soluble tablets?

The active substance in Sapropterin dihydrochloride 100 mg soluble tablets is sapropterin dihydrochloride.

Are there equivalent medicines to Sapropterin dihydrochloride 100 mg soluble tablets?

Medicines with the same active substance, strength and form include: Sapropterin 100 mg Soluble Tablets, Sapropterin Dihydrochloride 100 mg Soluble tablet, Sapropterin Dihydrochloride 100 mg soluble tablets. In total there are 4 equivalent products. They are interchangeable only if your prescriber or pharmacist says so.

Where does this information come from?

This leaflet reproduces the patient information leaflet approved for Sapropterin dihydrochloride 100 mg soluble tablets, as published on the electronic medicines compendium (emc). The version printed inside your medicine’s packaging is the one that applies to you.

Can I get Sapropterin dihydrochloride 100 mg soluble tablets without a prescription?

Whether a medicine is available over the counter or on prescription only depends on its licence. Check the leaflet, or ask your pharmacist — they can tell you straight away.

About this leaflet

The text above reproduces the patient information leaflet approved for this medicine, restructured for easier reading.

Medical disclaimer: This page is for information only and does not replace advice from your doctor or pharmacist. Always read the leaflet supplied with your medicine. If you are unwell, call NHS 111; in an emergency, call 999.

Medicines with the same active substance: Sapropterin dihydrochloride (7 medicines)
See every medicine containing this substance, or browse the full A–Z of active substances.
⚕For healthcare professionals — Summary of Product Characteristics (SmPC)Full SmPC: dosage, interactions, contraindications, warnings+
Technical information intended for healthcare professionals (doctors and pharmacists). The Summary of Product Characteristics (SmPC) is the official document approved by the MHRA/EMA. It does not replace the patient leaflet or a doctor’s advice.

4.1. Therapeutic indications

Sapropterin dihydrochloride is indicated for the treatment of hyperphenylalaninaemia (HPA) in adults and paediatric patients of all ages with phenylketonuria (PKU) who have been shown to be responsive to such treatment (see section 4.2).

Sapropterin dihydrochloride is also indicated for the treatment of hyperphenylalaninaemia (HPA) in adults and paediatric patients of all ages with tetrahydrobiopterin (BH4) deficiency who have been shown to be responsive to such treatment (see section 4.2).

4.2. Posology and method of administration

Treatment with sapropterin dihydrochloride must be initiated and supervised by a physician experienced in the treatment of PKU and BH4 deficiency.

Active management of dietary phenylalanine and overall protein intake while taking this medicinal product is required to ensure adequate control of blood phenylalanine levels and nutritional balance.

As HPA due to either PKU or BH4 deficiency is a chronic condition, once responsiveness is demonstrated, sapropterin dihydrochloride is intended for long-term use (see section 5.1).

Posology

PKU

The starting dose of sapropterin dihydrochloride in adult and paediatric patients with PKU is 10 mg/kg body weight once daily. The dose is adjusted, usually between 5 and 20 mg/kg/day, to achieve and maintain adequate blood phenylalanine levels as defined by the physician.

BH4 deficiency

The starting dose of sapropterin dihydrochloride in adult and paediatric patients with BH4 deficiency is 2 to 5 mg/kg body weight total daily dose. Doses may be adjusted up to a total of 20 mg/kg per day.

Sapropterin dihydrochloride is provided as 100 mg tablets. The calculated daily dose based on body weight should be rounded to the nearest multiple of 100. For instance, a calculated dose of 401 to 450 mg should be rounded down to 400 mg corresponding to 4 tablets. A calculated dose of 451 mg to 499 mg should be rounded up to 500 mg corresponding to 5 tablets.

Dose adjustment

Treatment with sapropterin may decrease blood phenylalanine levels below the desired therapeutic level. Adjustment of the sapropterin dihydrochloride dose or modification of dietary phenylalanine intake may be required to achieve and maintain blood phenylalanine levels within the desired therapeutic range.

Blood phenylalanine and tyrosine levels should be tested, particularly in the paediatric population, one to two weeks after each dose adjustment and monitored frequently thereafter, under the direction of the treating physician.

If inadequate control of blood phenylalanine levels is observed during treatment with sapropterin dihydrochloride, the patient's adherence to the prescribed treatment, and diet, should be reviewed before considering an adjustment of the dose of sapropterin.

Discontinuation of treatment should be done only under the supervision of a physician. More frequent monitoring may be required, as blood phenylalanine levels may increase. Dietary modification may be necessary to maintain blood phenylalanine levels within the desired therapeutic range.

Determination of response

It is of primary importance to initiate treatment as early as possible to avoid the appearance of non-reversible clinical manifestations of neurological disorders in paediatric patients and cognitive deficits and psychiatric disorders in adults due to sustained elevations of blood phenylalanine.

Response to this medicinal product is determined by a decrease in blood phenylalanine. Blood phenylalanine levels should be checked before administering sapropterin dihydrochloride and after 1 week of use at the recommended starting dose. If an unsatisfactory reduction in blood phenylalanine levels is observed, then the dose can be increased weekly to a maximum of 20 mg/kg/day, with continued weekly monitoring of blood phenylalanine levels over a one month period. The dietary phenylalanine intake should be maintained at a constant level during this period.

A satisfactory response is defined as a ≥30 percent reduction in blood phenylalanine levels or attainment of the therapeutic blood phenylalanine goals defined for an individual patient by the treating physician. Patients who fail to achieve this level of response within the described one month test period should be considered non-responsive, these patients should not be treated with sapropterin dihydrochloride and administration of sapropterin dihydrochloride should be discontinued.

Once responsiveness to the medicinal product has been established, the dose may be adjusted within the range of 5 to 20 mg/kg/day according to response to therapy.

It is recommended that blood phenylalanine and tyrosine levels be tested one or two weeks after each dose adjustment and monitored frequently thereafter under the direction of the treating physician.

Patients treated with sapropterin dihydrochloride must continue a restricted phenylalanine diet and undergo regular clinical assessment (such as monitoring of blood phenylalanine and tyrosine levels, nutrient intake, and psycho-motor development).

Special population

Elderly

Safety and efficacy of sapropterin dihydrochloride in patients above 65 years of age have not been established. Caution must be exercised when prescribing to elderly patients.

Renal or hepatic impairment

Safety and efficacy of sapropterin dihydrochloride in patients with renal or hepatic insufficiency have not been established. Caution must be exercised when prescribing to such patients.

Paediatric population

The posology is the same in adults, children, and adolescents.

Method of administration

Sapropterin dihydrochloride tablets should be administered with a meal to increase the absorption.

For patients with PKU, sapropterin dihydrochloride should be administered as a single daily dose, and at the same time each day preferably in the morning.

For patients with BH4 deficiency, divide the total daily dose into 2 or 3 administrations, distributed over the day.

Patients should be advised not to swallow the desiccant capsule found in the bottle.

The prescribed number of tablets should be placed in a glass or cup of water and stirred until dissolved. It may take a few minutes for the tablets to dissolve. To make the tablets dissolve faster they can be crushed. Small particles may be visible in the solution and will not affect the effectiveness of the medicinal product. The solution should be drank within 15 to 20 minutes.

Patients above 20 kg body weight

The prescribed number of tablets should be placed in a glass or cup with 120 to 240 ml of water and stirred until dissolved.

Children up to 20 kg body weight

The measuring devices required for dosing in children up to 20 kg body weight (i.e. cup with graduations at 20, 40, 60, 80 ml; 10 ml and 20 ml oral syringes with graduation at 1 ml divisions) are not included in the sapropterin dihydrochloride pack. These devices are supplied to the specialized paediatric centers for inborn errors of metabolism to be provided to the caregivers of the patients.

Depending on the dose (in mg/kg/day) the appropriate number of tablets should be dissolved in a volume of water as depicted in Tables 1-4, whereby the volume of the solution to be administered is calculated according to the prescribed total daily dose. The prescribed number of tablets for a 2, 5, 10 and 20 mg/kg/day dose should be placed in a cup (that shows the appropriate graduation markings at 20, 40, 60 and 80 ml) with the amount of water as depicted in Tables 1-4 and stirred until dissolved.

If only a portion of this solution needs to be administered, an oral syringe should be used to withdraw the volume of solution to be administered. The solution may then be transferred to another cup for administration of the medicinal product. For small infants an oral syringe can be used. A 10 ml oral syringe should be used for administration of volumes of ≤10 ml and a 20 ml oral syringe for administration of volumes of >10 ml.

Table 1: 2 mg/kg per day dosing table for children weighing up to 20 kg

Weight (kg)

Total dose (mg/day)

Number of tablets to be dissolved (100 mg strength only)

Volume of dissolution (ml)

Volume of solution to be administered (ml)*

2

4

1

80

3

3

6

1

80

5

4

8

1

80

6

5

10

1

80

8

6

12

1

80

10

7

14

1

80

11

8

16

1

80

13

9

18

1

80

14

10

20

1

80

16

11

22

1

80

18

12

24

1

80

19

13

26

1

80

21

14

28

1

80

22

15

30

1

80

24

16

32

1

80

26

17

34

1

80

27

18

36

1

80

29

19

38

1

80

30

20

40

1

80

32

*Reflects volume for total daily dose.

Discard unused solution within 20 minutes for tablet solution.

Table 2: 5 mg/kg per day dosing table for children weighing up to 20 kg

Weight (kg)

Total dose (mg/day)

Number of tablets to be dissolved (100 mg strength only)

Volume of dissolution (ml)

Volume of solution to be administered (ml)*

2

10

1

40

4

3

15

1

40

6

4

20

1

40

8

5

25

1

40

10

6

30

1

40

12

7

35

1

40

14

8

40

1

40

16

9

45

1

40

18

10

50

1

40

20

11

55

1

40

22

12

60

1

40

24

13

65

1

40

26

14

70

1

40

28

15

75

1

40

30

16

80

1

40

32

17

85

1

40

34

18

90

1

40

36

19

95

1

40

38

20

100

1

40

40

*Reflects volume for total daily dose.

Discard unused solution within 20 minutes for tablet solution.

Table 3: 10 mg/kg per day dosing table for children weighing up to 20 kg

Weight (kg)

Total dose (mg/day)

Number of tablets to be dissolved (100 mg strength only)

Volume of dissolution (ml)

Volume of solution to be administered (ml)*

2

20

1

20

4

3

30

1

20

6

4

40

1

20

8

5

50

1

20

10

6

60

1

20

12

7

70

1

20

14

8

80

1

20

16

9

90

1

20

18

10

100

1

20

20

11

110

2

40

22

12

120

2

40

24

13

130

2

40

26

14

140

2

40

28

15

150

2

40

30

16

160

2

40

32

17

170

2

40

34

18

180

2

40

36

19

190

2

40

38

20

200

2

40

40

*Reflects volume for total daily dose.

Discard unused solution within 20 minutes for tablet solution.

Table 4: 20 mg/kg per day dosing table for children weighing up to 20 kg

Weight (kg)

Total dose (mg/day)

Number of tablets to be dissolved (100 mg strength only)

Volume of dissolution (ml)

Volume of solution to be administered (ml)*

2

40

1

20

8

3

60

1

20

12

4

80

1

20

16

5

100

1

20

20

6

120

2

40

24

7

140

2

40

28

8

160

2

40

32

9

180

2

40

36

10

200

2

40

40

11

220

3

60

44

12

240

3

60

48

13

260

3

60

52

14

280

3

60

56

15

300

3

60

60

16

320

4

80

64

17

340

4

80

68

18

360

4

80

72

19

380

4

80

76

20

400

4

80

80

*Reflects volume for total daily dose.

Discard unused solution within 20 minutes for tablet solution.

For cleaning, the plunger should be removed from the barrel of the oral syringe. Both parts of the oral syringe and the cup should be washed with warm water and air dry. When the oral syringe is dry, the plunger should be put back into the barrel. The oral syringe and the cup should be stored for next use.

4.3. Contraindications

Hypersensitivity to the active substance or to any of the excipients listed in section 6.1.

4.4. Special warnings and precautions for use

Dietary intake

Patients treated with sapropterin dihydrochloride must continue a restricted phenylalanine diet and undergo regular clinical assessment (such as monitoring of blood phenylalanine and tyrosine levels, nutrient intake, and psycho-motor development).

Low blood phenylalanine and tyrosine levels

Sustained or recurrent dysfunction in the phenylalanine-tyrosine-dihydroxy-L-phenylalanine (DOPA) metabolic pathway can result in deficient body protein and neurotransmitter synthesis. Prolonged exposure to low blood phenylalanine and tyrosine levels during infancy has been associated with impaired neurodevelopmental outcome. Active management of dietary phenylalanine and overall protein intake while taking sapropterin dihydrochloride is required to ensure adequate control of blood phenylalanine and tyrosine levels and nutritional balance.

Health disturbances

Consultation with a physician is recommended during illness as blood phenylalanine levels may increase.

Convulsions disorders

Caution should be exercised when prescribing sapropterin dihydrochloride to patients receiving treatment with levodopa. Cases of convulsion, exacerbation of convulsion, increased excitability and irritability have been observed during co-administration of levodopa and sapropterin in BH4-deficient patients (see section 4.5).

Discontinuation of treatment

Rebound, as defined by an increase in blood phenylalanine levels above pre-treatment levels, may occur upon cessation of treatment.

Sodium content

This medicinal product contains less than 1 mmol sodium (23 mg) per tablet, that is to say essentially 'sodium-free'.

4.5. Interaction with other medicinal products and other forms of interaction

Although concomitant administration of inhibitors of dihydrofolate reductase (e.g. methotrexate, trimethoprim) has not been studied, such medicinal products may interfere with BH4 metabolism. Caution is recommended when using such medicinal products while taking sapropterin dihydrochloride.

BH4 is a cofactor for nitric oxide synthetase. Caution is recommended during concomitant use of sapropterin dihydrochloride with all medicinal products that cause vasodilation, including those administered topically, by affecting nitric oxide (NO) metabolism or action including classical NO donors (e.g. glyceryl trinitrate (GTN), isosorbide dinitrate (ISDN), sodium nitroprusside (SNP), molsidomin), phosphodiesterase type 5 (PDE-5) inhibitors and minoxidil.

Caution should be exercised when prescribing sapropterin dihydrochloride to patients receiving treatment with levodopa. Cases of convulsion, exacerbation of convulsion, increased excitability and irritability have been observed during co-administration of levodopa and sapropterin in BH4-deficient patients.

4.6. Fertility, pregnancy and lactation

Pregnancy

There are limited amount of data from the use of sapropterin dihydrochloride in pregnant women. Animal studies do not indicate direct or indirect harmful effects with respect to pregnancy, embryonal/foetal development, parturition or postnatal development.

Available disease-associated maternal and/or embryofoetal risk data from the Maternal Phenylketonuria Collaborative Study on a moderate amount of pregnancies and live births (between 300-1,000) in PKU-affected women demonstrated that uncontrolled phenylalanine levels above 600 μmol/l are associated with a very high incidence of neurological, cardiac, facial dysmorphism, and growth anomalies.

Maternal blood phenylalanine levels must therefore be strictly controlled before and during pregnancy. If maternal phenylalanine levels are not strictly controlled before and during pregnancy, this could be harmful to the mother and the foetus. Physician-supervised restriction of dietary phenylalanine intake prior to and throughout pregnancy is the first choice of treatment in this patient group.

The use of sapropterin dihydrochloride should be considered only if strict dietary management does not adequately reduce blood phenylalanine levels. Caution must be exercised when prescribing to pregnant women.

Breast-feeding

It is not known whether sapropterin or its metabolites are excreted in human breast milk. Sapropterin dihydrochloride should not be used during breast-feeding.

Fertility

In preclinical studies, no effects of sapropterin on male and female fertility were observed.

4.7. Effects on ability to drive and use machines

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

4.8. Undesirable effects

Summary of the safety profile

Approximately 35% of the 579 patients aged 4 years and over who received treatment with sapropterin dihydrochloride (5 to 20 mg/kg/day) in the clinical trials for sapropterin dihydrochloride experienced adverse reactions. The most commonly reported adverse reactions are headache and rhinorrhoea.

In a further clinical trial, approximately 30% of the 27 children aged below 4 years who received treatment with sapropterin dihydrochloride (10 or 20 mg/kg/day) experienced adverse reactions. The most commonly reported adverse reactions are “amino acid level decreased” (hypophenylalaninaemia), vomiting and rhinitis.

Tabulated list of adverse reactions

In the pivotal clinical trials and in the post-marketing experience for sapropterin dihydrochloride, the following adverse reactions have been identified.

The following definitions apply to the frequency terminology used hereafter:

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 available data)

Within each frequency grouping, adverse reactions are presented in order of decreasing seriousness.

Immune system disorders

Not known:

Hypersensitivity reactions (including serious allergic reactions) and rash

Metabolism and nutrition disorders

Common:

Hypophenylalaninaemia

Nervous system disorders

Very common:

Headache

Respiratory, thoracic and mediastinal disorders

Very common:

Common:

Rhinorrhoea

Pharyngolaryngeal pain, nasal congestion, cough

Gastrointestinal disorders

Common:

Not known:

Diarrhoea, vomiting, abdominal pain, dyspepsia, nausea

Gastritis, oesophagitis

Paediatric population

Frequency, type and severity of adverse reactions in children were essentially similar to those in adults.

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 Yellow Card Scheme Website: www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store

4.9. Overdose

Headache and dizziness have been reported after the administration of sapropterin dihydrochloride above the recommended maximum dose of 20 mg/kg/day. Treatment of overdose should be directed to symptoms. A shortening of the QT interval (-8.32 msec) was observed in a study with a single supra-therapeutic dose of 100 mg/kg (5 times the maximum recommended dose); this should be taken into consideration in managing patients who have a pre-existing shortened QT interval (e.g. patients with familial short QT syndrome).

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