Pharmacy Guide
Patient leaflets and SmPCs, drug interaction checker, official dosages and NHS pharmacy opening hours — all in one place.
Pharmacy Guide
Patient leaflets and SmPCs, drug interaction checker, official dosages and NHS pharmacy opening hours — all in one place.
Savene 20 mg/ml powder and solvent for concentrate for solution for infusion
⚠ This medicine appears to have been discontinued
The electronic medicines compendium (emc) no longer publishes a Summary of Product Characteristics for this product, which usually means it is no longer marketed in the UK. The patient leaflet below is kept for reference, but the product may not be available.
If you were prescribed this medicine, other products containing Dexrazoxane may still be available. Do not stop your treatment — ask your pharmacist or GP what to use instead.
What it is and what it is used for
for
Savene contains the active substance dexrazoxane, which acts as an antidote to anti-cancer medicines called anthracyclines. Most anti-cancer medicines are administered intravenously (into a vein). Occasionally an accident occurs and the medicine is infused outside the vein and into the surrounding tissue or leaks from the vein into the surrounding tissue. This event is called extravasation. It is a serious complication as it can cause severe tissue damage. Savene is used to treat anthracyline extravasation in adults. It can reduce the amount of tissue damage caused by anthracycline extravasation.
2.
What you need to know before you take it
e Savene
Do not use Savene: If you are allergic to dexrazoxane or any of the other ingredients of this medicine (listed in section 6) If you are planning to become pregnant and do not use adequate contraceptive measures If you are breast-feeding If you are given yellow-fever vaccine Warnings and precautions Talk to your doctor or nurse before using Savene: Savene should only be given to you if you have an extravasation in connection with anthracycline-containing chemotherapy. During treatment with Savene the area where the extravasation has occurred will be examined on a regular basis and you will have blood tests taken regularly to check your blood cells. If you have liver problems, your doctor will monitor your liver function during treatment. If you have kidney problems, your doctor will monitor for signs of changes to your blood cells. Children and adolescents Savene should not be administered to children below the age of 18 years.
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Other medicines and Savene Tell your doctor or nurse if you are taking, have recently taken, or might take any other medicines. In particular, tell your doctor or nurse if you are taking or may take any of the following medicines: Vaccines: you must not use Savene if you are going to receive yellow fever vaccine and it is not recommended that you use Savene if you are going to receive a vaccine containing live virus particles. A product called DMSO (which is a cream to treat some skin diseases). Phenytoin (a treatment against seizures) (Savene may reduce the effectiveness of this medicine). Anticoagulants (blood thinners) (your blood may need to be monitored more frequently). Ciclosporin or tacrolimus (both treatments lower the body's immune system and are used to prevent organ rejection after an organ transplant). Myelosuppressive medicines (decrease production of red, white, or coagulating blood cells). Pregnancy, breast-feeding and fertility If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby ask your doctor for advice before taking this medicine. Savene should not be administered if you are pregnant. You must not breast-feed while you are treated with Savene. If you are sexually active, you are advised to use effective birth control to prevent pregnancy during and for six months after treatment, whether you are male or female (see section 2 'Do not use Savene'). There is limited information about the effect of Savene on fertility – if you have a concern about this speak to you doctor. Driving and using machines Dizziness, tiredness and sudden fainting have been reported in a few patients treated with Savene. The treatment is considered to have a limited influence on the ability to drive and use machines. Savene contains potassium and sodium The Savene solvent contains 98 mg potassium in each 500 ml bottle which may be harmful to people on a low-potassium diet or who have kidney problems. If you are at risk of high potassium levels in your blood, your doctor will monitor this. Savene solvent also contains 1.61 g sodium (main component of cooking/table salt) in each 500 ml bottle. This is equivalent to 81% of the recommended maximum daily dietary intake of sodium for an adult.
3.
How to take it
Savene
Savene will be given to you under the control of a doctor experienced in the use of anti-cancer treatments. Recommended dose The dose will depend on your height, weight and kidney function. Your doctor will calculate your body surface area in square meter (m2) to determine the dose you should receive. The recommended adult dose (with normal kidney function) is: Day 1: 1000 mg/m2 Day 2: 1000 mg/m2 Day 3: 500 mg/m2 Your doctor may reduce your dose if you have kidney problems. Savene will be given by infusion into one of your veins. The infusion will last 1-2 hours.
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Frequency of administration You will receive your infusion once daily for 3 consecutive days. The first infusion will be given as soon as possible and within the first six hours after extravasation of an anthracycline medicine. Savene infusion will be given at the same time every day of your treatment. Savene will not be used again at the time of your next anthracycline cycle, except if extravasation occurs again. If you receive more Savene than you should If you receive more Savene than you should, you will be closely monitored with specific attention to your blood cells, potential gastro-intestinal signs, skin reactions and hair loss. If Savene comes into contact with the skin, the affected area should immediately be rinsed thoroughly with water. 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 can be serious and need immediate medical attention. The following serious side effect has been reported in patients during treatment with Savene (frequency not known): • Allergic reactions, symptoms of which could be itching (pruritis), rash, facial/throat swelling, wheezing, breathlessness or difficult breathing, changes in levels of consciousness, hypotension, sudden fainting If you get any of the above symptoms, seek medical advice immediately. Other possible side effects are listed below: Very common: may affect more than 1 in 10 people • Nausea • Reactions at the site of injection (pain at the site, red, swollen or painful skin at the site or hardening of the skin at the site) • Reduction in the number of white blood cells and platelets • Infection (after an operation or other infections) Common: may affect up to 1 in 10 people • Vomiting • Diarrhoea • Feeling tired, feeling sleepy, feeling dizzy, sudden fainting • Reduction in any of your senses (sight, smell, hearing, touch, taste) • Fever • Inflammation of the blood vessel where the treatment is given (phlebitis) • Inflammation of a blood vessel just under the skin, often with a small blood clot • Blood clot in the vein, usually in an arm or leg • Inflammation in the mouth • Dry mouth • Hair loss • Itching (pruritus) • Weight loss, loss of appetite • Muscle pain, tremor (uncontrolled muscle movement) • Vaginal bleeding • Difficulties in breathing 4
• • • •
Pneumonia (lung infection) Swelling in arms or legs (oedema) Wound complications Changes in liver function (these may be seen in test results)
Reporting of side effects If you get any side effects, talk to your doctor or nurse. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via: United Kingdom 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.
5.
How to store it
Savene
Keep this medicine out of the sight and reach of children. Do not use this medicine after the expiry date which is stated on the carton, powder vial label, and solvent bottle label after 'EXP'. The expiry date refers to the last day of that month. Store below 25 °C. Keep the powder vials and solvent bottles in the outer carton in order to protect from light.
6.
Contents of the pack and other information
What Savene contains The active substance is dexrazoxane. Each vial contains 500 mg dexrazoxane as 589 mg dexrazoxane hydrochloride. The other ingredient(s) are: The solvent which contains sodium chloride, potassium chloride, magnesium chloride hexahydrate, sodium acetate trihydrate, sodium gluconate, sodium hydroxide and water for injections. What Savene looks like and contents of the emergency kit The Savene kit consists of Savene powder for concentrate (white to off-white powder) and Savene solvent. One emergency kit contains 10 vials of Savene powder and 3 bottles of Savene solvent supplied with 3 bottle hangers. The concentration of dexrazoxane following reconstitution with 25 ml Savene solvent is 20 mg/ml. The concentrate is slightly yellow. Marketing Authorisation Holder and Manufacturer Marketing Authorisation Holder CNX Therapeutics Limited 3 Bunhill Row London EC1Y 8YZ UK
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Manufacturer Cenexi-Laboratoires Thissen SA Rue de la Papyrée 2-4-6 B-1420 Braine-L'Alleud Belgium This leaflet was last revised in 08/2024.
6
The following information is intended for healthcare professionals only. Preparation guide for use with Savene 20 mg/ml powder and solvent for concentrate for solution for infusion It is important that you read the entire content of this procedure prior to the preparation of Savene.
1.
FORMULATION
Savene is supplied as: 1. Savene powder for concentrate 2. Solvent for Savene Savene powder must be reconstituted in 25 ml Savene solvent to obtain a concentrate that must be further diluted in the remaining Savene solvent prior to administration.
2.
RECOMMENDATION FOR THE SAFE HANDLING
Savene is an anti-cancer agent and the normal procedures for proper handling and disposal of anticancer medicines should be adopted, namely: Personnel should be trained to reconstitute the medicine Pregnant staff should be excluded from working with this medicine Personnel handling this medicine during reconstitution should wear protective clothing including mask, goggles and gloves Accidental contact with the skin or eyes should be treated immediately and thoroughly with copious amounts of water
3.
PREPARATION FOR THE INTRAVENOUS ADMINISTRATION
3.1 Reconstitution of Savene powder to prepare a concentrate 3.1.1 Using a syringe fitted with a needle, withdraw aseptically 25 ml from the Savene solvent bottle. 3.1.2 Inject the entire contents of the syringe into the vial containing the Savene powder. 3.1.3 Remove the syringe and needle and mix manually by repeated inversions until the powder is fully dissolved. Do not shake. 3.1.4 Allow the vial with the concentrate to stand for 5 minutes at room temperature and check if the solution is homogenous and clear. The concentrate is slightly yellow. The concentrate contains 20 mg dexrazoxane per ml and should be used immediately for further dilution. It contains no antibacterial preservative. 3.1.5 Keep and store the opened solvent bottle under aseptic conditions because it is needed for dilution of the concentrate. 3.2 Dilution of the concentrate 3.2.1 Up to four vials containing Savene concentrate may be necessary to obtain the required dose for the patient. Based on the required dose for the patient expressed in mg, withdraw aseptically the corresponding volume containing 20 mg dexrazoxane per ml from the appropriate number of vials containing concentrate. Use a graduated syringe filled with a needle. 3.2.2 Inject the required volume back into the opened Savene solvent bottle (see point 3.1.5). The solution must not be mixed with any other medicines. 3.2.3 Mix the solution by agitating gently the infusion bottle. 3.2.4 Savene should be administered aseptically as a 1-2 hours infusion under room temperature and normal light conditions. 3.2.5 As with all parenteral products, Savene concentrate and infusion solution should be inspected visually for particulate matter and discoloration prior to administration. Solutions containing a precipitate should be discarded. 7
4.
STORAGE
4.1 –
Before reconstitution and dilution: Store below 25 C. Keep the powder vials and solvent bottles in the outer carton in order to protect from light.
4.2 –
After reconstitution and dilution: Chemical and physical in-use stability after reconstitution and subsequent dilution in the solvent has been demonstrated for 4 hours when stored at 2 to 8 C. In order to avoid the potential contamination of the medicine by microbes, the product should be used immediately. If the medicine is not used immediately, it should be kept at a temperature of 2 to 8 C (in the refrigerator) and no longer than 4 hours.
–
5.
DISPOSAL
All items for preparation, administration or cleaning, including gloves, as well as liquid waste should be disposed of in accordance with local requirements.
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Frequently asked questions about Savene 20 mg/ml powder and solvent for concentrate for solution for infusion
How do I take Savene 20 mg/ml powder and solvent for concentrate for solution for infusion?
Savene 20 mg/ml powder and solvent for concentrate for solution for infusion comes as infusion containing 20mg/ml. 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 Savene 20 mg/ml powder and solvent for concentrate for solution for infusion?
The active substance in Savene 20 mg/ml powder and solvent for concentrate for solution for infusion is dexrazoxane.
Where does this information come from?
This leaflet reproduces the patient information leaflet approved for Savene 20 mg/ml powder and solvent for concentrate for solution for infusion, 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 Savene 20 mg/ml powder and solvent for concentrate for solution for infusion 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.
- Source: electronic medicines compendium (emc), Datapharm
- Active substance: dexrazoxane
- Official document: view the original leaflet on emc →
⚕For healthcare professionals — Summary of Product Characteristics (SmPC)Full SmPC: dosage, interactions, contraindications, warnings+
4.1. Therapeutic indications
Savene is indicated in adults for the treatment of anthracycline extravasation.
4.2. Posology and method of administration
Savene must be administered under the supervision of a physician experienced in the use of anti-cancer medicinal products.
Posology
Treatment should be given once daily for 3 consecutive days. The recommended dose is:
Day 1: 1000 mg/m2
Day 2: 1000 mg/m2
Day 3: 500 mg/m2
The first infusion should be initiated as soon as possible, within the first six hours after the accident.
Treatment Day 2 and Day 3 should start at the same hour (+/- 3 hours) as Day 1.
For patients with a body surface area of more than 2 m2 the single dose should not exceed 2000 mg.
Renal impairment
In patients with moderate to severe renal impairment (creatinine clearance <40 mL/min) the Savene dose should be reduced by 50% (see section 4.4 and 5.2).
Hepatic impairment
Dexrazoxane has not been studied in patients with impaired hepatic function and its use in such patients is not recommended (see section 4.4).
Elderly
Safety and efficacy have not been evaluated in the elderly and the use of dexrazoxane in such patients is not recommended.
Paediatric population
The safety and efficacy of Savene in children below the age of 18 years have not been established and no data are available.
Method of administration
For intravenous use after reconstitution and dilution.
For instructions on reconstitution and dilution of the medicinal product before administration, see section 6.6.
The indicated dose should be administered as an intravenous infusion over 1-2 hours into a large vein of an extremity or area other than the one affected by the extravasation. Cooling procedures such as ice packs should have been removed from the area at least 15 minutes before the Savene administration in order to allow sufficient blood flow.
4.3. Contraindications
• Hypersensitivity to the active substance or to any of the excipients listed in section 6.1.
• Women of childbearing potential not using contraceptive measures (see section 4.6).
• Breast-feeding (see section 4.6).
• Concomitant vaccination with yellow fever vaccine (see section 4.5).
4.4. Special warnings and precautions for use
Continuous monitoring
Local examination should be performed on a regular basis after treatment until resolution.
If there is suspicion of extravasation by vesicant compounds other than anthracyclines through the same IV access, e.g. vincristine, mitomycin, and vinorelbine, Savene would not be effective against the effects from these compounds.
Since Savene will be administered to patients undergoing cytotoxic therapy with anthracyclines its cytotoxic potential (especially resulting in reversible haematological toxicity with a nadir occurring on days 11-12) will therefore add to that of the other chemotherapy administered. Haematological monitoring should therefore be undertaken regularly.
Hepatic and renal-function monitoring
Since liver dysfunction (increases in transaminases and bilirubin) may occur (especially after doses of above 1000 mg/m2 dexrazoxane), it is recommended that routine liver function tests be performed before each administration of dexrazoxane in patients with known liver function disorders (see section 4.2).
Since renal dysfunction may decrease the rate of elimination of dexrazoxane, patients with impaired renal function should be monitored for signs of haematological toxicity (see section 4.2 for dosing recommendations in patients with moderate to severe renal impairment (creatinine clearance <40 mL/min)).
Anaphylactic reaction
Anaphylactic reaction including angioedema, skin reactions, bronchospasm, respiratory distress, hypotension and loss of consciousness have been observed in patients treated with dexrazoxane and anthracyclines (see section 4.8). Previous history of allergy to dexrazoxane should be carefully considered prior to administration (see section 4.3).
Women of child-bearing potential/Contraception in males and females
Since dexrazoxane possesses mutagenic activity and is used with anthracyclines known to have cytotoxic, mutagenic and embryotoxic properties, both sexually active men and women of childbearing potential should be advised not to father a child/become pregnant and must use effective contraceptive measures during and up to 6 months after treatment. Women must inform their doctor immediately if they become pregnant (see section 4.3 and 4.6).
Potassium and sodium contents
Savene solvent contains 98 mg potassium per 500 ml bottle. This must be taken into consideration by patients with reduced kidney function or patients on a controlled potassium diet. Plasma potassium level must be closely monitored in patients at risk of hyperkalaemia.
Savene solvent also contains 1.61 g sodium per 500 ml bottle, equivalent to 81% of the WHO recommended maximum daily intake of 2 g sodium for an adult.
4.5. Interaction with other medicinal products and other forms of interaction
Concomitant use contraindicated:
Yellow fever vaccine: Risk of fatal generalised vaccinial disease (see section 4.3).
Concomitant use not recommended:
• Other live attenuated vaccines: risk of systemic, possible fatal disease. This risk is increased in subjects who are already immunosuppressed by their underlying disease or by concomitant chemotherapy. Use an inactivated vaccine where this exists (poliomyelitis).
• Dimethylsulfoxide (DMSO) should not be used in patients who are administered dexrazoxane to treat anthracycline extravasation (see section 5.3)
• Phenytoin: cytotoxic agents may reduce the absorption of phenytoin leading to an exacerbation of convulsions. Dexrazoxane is not recommended in combination with phenytoin.
Concomitant use to assess carefully:
Ciclosporin, tacrolimus: Excessive immunosuppression with risk of lymphoproliferative disease.
Interactions common to all cytotoxics:
• Due to an increased thrombotic risk in patients with malignant diseases, the use of anticoagulants treatment is frequent. Patients treated with anticoagulants should be monitored more frequently as cytotoxic agents may interact with oral anticoagulants.
• Dexrazoxane may add to the toxicity induced by the chemotherapy cycle during which the accident took place, requiring careful monitoring of haematological parameters (see section 4.4).
Interaction specific to dexrazoxane:
When tested in five major cytochrome P450 isoenzymes CYP1A, CYP2C9, CYP2C19, CYP2D6 and CYP3A4, none of these were inhibited by dexrazoxane.
Co-administration of doxorubicin (50 to 60 mg/m2) or epirubicin (60 to 100 mg/m2) did not affect dexrazoxane pharmacokinetics significantly. In studies, dexrazoxane did not affect the pharmacokinetics of doxorubicin. There is limited evidence from studies that suggests epirubicin clearance may be increased when dexrazoxane is pre-administered, this occurred at high doses of epirubicin (120-135 mg/m2). Note that in these studies dexrazoxane was administered prior to anthracyline administration.
4.6. Fertility, pregnancy and lactation
Women of childbearing potential/Contraception in males and females
Since dexrazoxane possesses mutagenic activity and is used with anthracyclines known to have cytotoxic, mutagenic and embryotoxic properties, both sexually active men and women of childbearing potential should be advised not to father a child/become pregnant and must use effective contraceptive measures during and up to 6 months after treatment. Women must inform their doctor immediately if they become pregnant (see section 4.3).
Pregnancy
There are no data from the use of dexrazoxane in pregnant women. Dexrazoxane may cause foetal harm when administered to pregnant women. Studies in animals have shown reproductive toxicity (see section 5.3). Dexrazoxane should not be administered to pregnant women unless clearly necessary.
Breast-feeding
It is not known whether dexrazoxane is excreted in human milk. Because of the potential for serious adverse reactions in breast-fed infants exposed to dexrazoxane, breast-feeding is contraindicated during Savene therapy (see section 4.3).
Fertility
There are limited fertility data from animal studies available, but testicular changes were observed in rats and rabbits following repeat dosing (see section 5.3).
4.7. Effects on ability to drive and use machines
Dizziness, somnolence and syncope have been reported in a few patients included in Savene studies TT01 and TT02 (see section 4.8). Dexrazoxane has minor influence on the ability to drive and use machines.
4.8. Undesirable effects
A number of published reports comprising more than 1000 patients have demonstrated a uniform pattern of dose dependent adverse reactions. Most common adverse reactions are nausea/vomiting, bone marrow suppression (neutropenia, thrombocytopenia), injection site reactions, diarrhoea, stomatitis and increase in hepatic transaminases (ALT/AST). All adverse reactions have been rapidly reversible.
The following information is based on two clinical studies, TT01 and TT02, of Savene administered to extravasation patients already receiving cycles of chemotherapeutic agents.
The adverse reactions were those typically seen with standard chemotherapy and also with dexrazoxane: Nausea/vomiting in about one third of the patients, neutropenia and thrombocytopenia in about half of the patients, more rarely increased concentration of liver enzymes (ALT/AST).
Adverse reactions observed in the two studies are listed below.
Incidence of adverse reactions (MedDRA) in studies TT01 and TT02 (n=80 patients)
(Note that numbers for Blood and Lymphatic System Disorders are described in a separate table of laboratory examinations)
Adverse reactions reported are listed according to the following frequency:
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)
System Organ Classes (SOC)
Frequency
Adverse reactions
Infections and infestations
Very common
Postoperative infection
Common
Infection
Neutropenic infection
Immune system disorders
Not known
Anaphylactic reactions
Not known
Hypersensitivity
Metabolism and nutrition disorders
Common
Decreased appetite
Nervous system disorders
Common
Dizziness
Sensory loss
Syncope
Tremor
Vascular disorders
Common
Phlebitis
Superficial thrombophlebitis
Venous thrombosis limb
Respiratory, thoracic and mediastinal disorders
Common
Dyspnoea
Pneumonia
Gastrointestinal disorders
Very common
Nausea
Common
Vomiting
Diarrhoea
Stomatitis
Dry mouth
Skin and subcutaneous tissue disorders
Common
Alopecia
Pruritus
Musculoskeletal and connective tissue disorders
Common
Myalgia
Reproductive system and breast disorders
Common
Vaginal haemorrhage
General disorders and administration site conditions
Very common
Injection site pain
Common
Pyrexia
Injection site phlebitis
Injection site erythema
Fatigue
Injection site induration
Injection site swelling
Peripheral oedema
Somnolence
Investigations
Common
Weight decreased
Injury, poisoning and procedural complications
Common
Wound complication
Incidence of laboratory abnormalities in TT01 and TT02 (n=80 patients)
Lab test
No of patients with post baseline value
CTC grade 3-4
N
%
Haemoglobin
80
2
2.5%
WBC
80
36
45.0%
Neutrophils
78
36
46.2%
Platelets
80
17
21.3%
Sodium (Hypo)
79
5
6.3%
Potassium (Hypo)
79
2
2.5%
Potassium (Hyper)
79
0
0.0%
Alkaline Phosphatase
77
0
0.0%
Bilirubin
77
1
1.3%
AST
57
2
3.5%
ALT
71
3
3.9%
Creatinine
76
2
2.6%
LDH
78
0
0.0%
Calcium Total (Hypo)
28
2
7.1%
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 reaction 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
Signs and symptoms of overdosage are likely to consist of leucopenia, thrombocytopenia, nausea, vomiting, diarrhoea, skin reactions and alopecia. Treatment should be symptomatic.
🇷🇴 Known in Romania as
Medicines sold in Romania with the same active substance: Cunoscut în România ca
- CYRDANAX 20 mg/ml prescriptionDEXRAZOXANUM · injection / infusion
Same active substance. The strength, the form and whether you need a prescription can differ. Always ask a pharmacist before you switch. Romanian medicines in the UK →
🇵🇱 Known in Poland as
Medicines sold in Poland with the same active substance: W Polsce znany jako
- CardioxaneDexrazoxanum · injection / infusion
- SaveneDexrazoxanum · injection / infusion
- CyrdanaxDexrazoxanum · injection / infusion
Same active substance. The strength, the form and whether you need a prescription can differ. Always ask a pharmacist before you switch. Polish medicines in the UK →
💬 Ask about this leaflet
Ask anything about Savene 20 mg/ml powder and solvent for concentrate for solution for infusion. The assistant answers only from this leaflet — if the leaflet does not cover it, it will say so. It does not give medical advice.
Answers come from the patient leaflet published on the electronic medicines compendium (emc). They are not medical advice. Ask a pharmacist or your GP if you are unsure. For urgent help call NHS 111, or 999 in an emergency.