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Pharmacy Guide

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

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Soprobec 50 micrograms per actuation pressurised inhalation solution

⚠ 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 Beclometasone dipropionate may still be available. Do not stop your treatment — ask your pharmacist or GP what to use instead.

Active substance: Beclometasone dipropionate

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

What it is and what it is used for

for Soprobec pressurised inhalation solution is used to help prevent the symptoms of asthma. The active ingredient, beclometasone dipropionate, is one of a group of medicines called corticosteroids which are often referred to simply as steroids. Steroids have an antiinflammatory action reducing the swelling and irritation in the walls of the small air passages in the lungs, and so ease breathing problems.

What you need to know before you take it

e Soprobec Do not use Soprobec:

  • if you are allergic to any of the ingredients of this medicine or to any other medicines used to treat asthma.
  • to treat a sudden attack of breathlessness. It will not help. Use a quick-acting 'reliever' inhaler for this purpose and carry it with you at all times. Warnings and precautions Talk to your doctor, pharmacist or nurse before using Soprobec if any of the following applies to you:
  • you are being, or have ever been, treated for tuberculosis (TB).
  • you had thrush in your mouth.
  • you must avoid alcohol for any reason. Also, talk to your doctor, pharmacist or nurse if any of the following applies to you:
  • your asthma seems to be getting worse. Perhaps you are more wheezy and short of breath

than usual, your 'reliever' inhaler seems to be less effective, you require more puffs from your 'reliever' inhaler than usual, or you do not seem to be getting better.

  • when transferring from steroid tablets to an inhaler you find that, even if your chest is getting better, you feel generally unwell, you develop a rash, eczema or a runny nose and sneezing (rhinitis). Do not stop treatment with your inhaler unless your doctor tells you to.

If you have been treated for a long time with high doses of inhaled steroid, you may require a course of steroid tablets or possibly a steroid injection in times of stress. For example, during admission to hospital after a serious accident, before an operation, during an acute attack of asthma or if you have a chest infection or other serious illness. Your doctor will decide if you need any extra steroid treatment and will also advise you as to how long you need to take the course of steroid tablets and how you should reduce these as you get better. If you are using Soprobec instead of, or as well as taking steroid tablets, or if your doctor is trying to reduce the dose of your steroid tablets, you should carry a steroid warning card until your doctor tells you that you don't need to. Contact your doctor if you experience blurred vision or other visual disturbances. Other medicines and Soprobec: Before starting treatment, please tell your doctor if you are taking, have recently taken or might take any other medicines, including medicines obtained without a prescription. Tell your doctor if you are taking disulfiram or metronidazole, as there is a potential risk of interaction in particularly sensitive people. Remember to take these medicines and your inhalers with you if you have to go into hospital. Some medicines may increase the effects of Soprobec and your doctor may wish to monitor you carefully if you are taking these medicines (including some medicines for HIV: ritonavir, cobicistat). 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. Driving and using machines: Soprobec is not likely to affect the ability to drive or use machines. Soprobec contains alcohol: Soprobec 50 and 100 micrograms: This medicine contains 7.47 mg of alcohol (ethanol) in each actuation which is equivalent to 13% w/w. Soprobec 200 micrograms: This medicine contains 8.05 mg of alcohol (ethanol) in each actuation which is equivalent to 14% w/w. Soprobec 250 micrograms: This medicine contains 8.62 mg of alcohol (ethanol) in each actuation which is equivalent to 15% w/w. The amount of alcohol in each actuation is equivalent to less than 4 ml beer or 2 ml wine. The small amount of alcohol in this medicine will not have any noticeable effects.

How to take it

Soprobec Soprobec is available in 4 different strengths. Your doctor will have decided which strength you need. Soprobec 200 and Soprobec 250 are not suitable for children. Always use your inhaler exactly as your doctor or pharmacist has told you. You should check with your doctor or pharmacist if you are not sure. Instructions for using your inhaler are given after the dosage section. It takes a few days for your inhaler to work. It is very important that you use it regularly. Do not stop treatment even if you feel better unless told to do so by your doctor. Do not stop using

your inhaler abruptly. While you are using Soprobec your doctor will want to check your asthma regularly by carrying out simple breathing tests and may need to carry out blood tests from time to time. Dosage: The starting dose will depend on how severe your asthma is and will be decided by your doctor. It may be higher than the doses given below. Your doctor will prescribe the lowest dose of Soprobec that will control your symptoms. A device called a Volumatic spacer should always be used when:

  • adults, the elderly and adolescents 16 years of age and older are taking total daily doses of Soprobec of 1,000 micrograms or more,
  • when Soprobec is used in children and adolescents 15 years of age and under whatever dose has been prescribed. Soprobec 50 micrograms The common starting dose is: Adults and the elderly: 200 micrograms (4 puffs) twice a day Children: 100 micrograms (2 puffs) twice a day Usually the most you would take in a day is: Adults and the elderly: 800 micrograms (16 puffs) Children: 400 micrograms (8 puffs) The total daily dose may be divided into 2, 3 or 4 doses per day. Soprobec 100 micrograms The common starting dose is: Adults and the elderly: 200 micrograms (2 puffs) twice a day Children: 100 micrograms (one puff) twice a day Usually the most you would take in a day is: Adults and the elderly: 800 micrograms (8 puffs) Children: 400 micrograms (4 puffs) The total daily dose may be divided into 2, 3 or 4 doses per day. Soprobec 200 micrograms The common starting dose is: Adults and the elderly only: 200 micrograms (1 puff) twice a day Usually the most you would take in a day is: 800 micrograms (4 puffs) The total daily dose may be divided into 2, 3 or 4 doses per day. This product strength is not suitable for children Soprobec 250 micrograms The common starting dose is: Adults and the elderly only: 500 micrograms (2 puffs) twice a day Usually the most you would take in a day is: 2,000 micrograms (8 puffs) The total daily dose may be divided into 2, 3 or 4 doses per day. This product strength is not suitable for children

If you use more Soprobec than you should: Tell your doctor as soon as possible. Your doctor may want to check the cortisol levels in your blood and therefore, may need to take a blood sample (cortisol is a steroid hormone which occurs naturally in the body). It is important that you take your dose as stated on the pharmacist's label or as advised by your doctor. You should not increase or decrease your dose without seeking medical advice.

If you forget to use Soprobec: Do not take a double dose to make up for a forgotten dose. Take the next dose when it is due. Do not take more puffs than you were told to take. Method of Administration Soprobec is for inhalation use. Instructions for use: It is important that you know how to use your inhaler properly. Your doctor, nurse or pharmacist will show you how to use your inhaler correctly and will check regularly that you are using your inhaler correctly. You must follow their instructions carefully, so that you know how, when and how many puffs to inhale and how often you must use your inhaler. The instructions should be on the pharmacist's label and are given in this leaflet. If you are not sure what to do or have problems inhaling then ask your doctor, nurse or pharmacist for advice.

1. To remove the mouthpiece cover, hold between the thumb and forefinger, squeeze gently and pull apart as shown. Check inside and outside to make sure that the mouthpiece is clean, and that there are no foreign objects.

Testing Your Inhaler: If the inhaler is new or if it has not been used for three days or more, one puff should be released into the air to make sure that it works. 2. Hold the inhaler upright as shown, with your thumb on the base, below the mouthpiece. Breathe out as far as is comfortable.

3. Place the mouthpiece in your mouth between your teeth and close your lips around it but do not bite it.

4. Just after starting to breathe in through your mouth press down on the top of the inhaler to release a puff while still breathing in steadily and deeply

5. Hold your breath; take the inhaler from your mouth and your finger from the top of the inhaler. Continue holding your breath for a few seconds or as long as is comfortable. Breathe out slowly. 6. If you are to take another puff, keep the inhaler upright and wait about half a minute before repeating steps 2 to 5.

7. After use always replace the mouthpiece cover to keep out dust and fluff. Replace firmly and snap into position.

Important: Do not rush steps 2, 3, 4 and 5. It is important that you start to breathe in as slowly as possible just before operating the inhaler. Practice in front of a mirror for the first few times. If you see 'mist' coming from the top of the inhaler or the sides of your mouth, beclometasone will not get into your lungs as it should. Take another puff, carefully following the instructions from Step 2 onwards. People with weak hands or children may find it easier to hold the inhaler with both hands. Put the two forefingers on top of the inhaler and both thumbs on the bottom below the mouthpiece. If you find it difficult to operate the inhaler while starting to breathe in you may use the Volumatic spacer device. Ask your doctor, pharmacist or a nurse about this device. However, the Volumatic spacer device must always be used if:

  • You are an adult, elderly or an adolescent 16 years of age and older and are taking total daily doses of Soprobec of 1,000 micrograms or more,
  • Soprobec is used in children and adolescents 15 years of age and younger, whatever dose has been prescribed.

Young children may find it difficult to use the inhaler properly and will require help. Using the inhaler with the Volumatic spacer device with a face mask may help in children under 5 years. Tell your doctor, nurse or pharmacist if you have any difficulties. Cleaning: It is important to clean your inhaler at least once a week, to stop it blocking up.

  • Pull the metal canister out of the plastic case of the inhaler and remove the mouthpiece cover.
  • Rinse the plastic case and the mouthpiece cover in warm water. If you use a mild liquid detergent, rinse carefully with clean water before drying. Do not put the metal canister into water.
  • Leave to dry thoroughly in a warm place. Avoid excessive heat.
  • Replace the canister and mouthpiece cover.

It is important that you also read the Package leaflet which is supplied with your Volumatic spacer device and that you follow the instructions on how to use the Volumatic and on how to clean it, carefully.

Possible side effects

Like all medicines, Soprobec can cause side effects, although not everybody gets them. Stop using Soprobec and contact your doctor immediately if:  you get allergic reactions including skin rashes, hives, itching or redness, or swelling of the face, eyes, lips and throat.  you notice an immediate increase in wheezing, shortness of breath and cough straight after using your inhaler, stop using Soprobec and use a quick-acting 'reliever' inhaler immediately. Contact your doctor straightaway. Your doctor will review your asthma and may change your treatment and may prescribe a different inhaler to treat your asthma. The following side effects have been reported. Tell your doctor as soon as possible if you suffer from any of these side effects but do not stop treatment unless told to do so. Your doctor will try to prevent these effects by prescribing Soprobec in the lowest dose possible to control your asthma. Very common (may affect more than 1 in 10 people)  Candidiasis in the mouth and / or throat (thrush). This is more likely if the daily dose taken is greater than 400 micrograms. Thrush can be treated with anti-fungal medicines whilst you continue to use Soprobec. Brushing your teeth, or thoroughly rinsing your mouth with water immediately after each dose may help prevent thrush. Common (may affect up to 1 in 10 people)  Hoarse voice or a sore throat or tongue. Using a Volumatic spacer device or rinsing your mouth with water immediately after using your inhaler may help prevent this. Uncommon (may affect up to 1 in 100 people)  Rash, hives, pruritus and / or erythema. Very rare (may affect up to 1 in 10,000 people)  Allergies, which manifest with swelling of the eyelids, face, lips and / or throat (angioedema).  Respiratory disturbances such as dyspnea (feeling of shortness of breath or difficulty breathing) and / or bronchospasm (narrowing of the walls of the bronchi with decreased air intake).  Anaphylactic or anaphylactoid reactions (severe allergic reactions that can make breathing difficult or alter your level of consciousness).  Children and adolescents may grow more slowly and may need to have their height checked regularly by their doctor. This occurs particularly after treatment with Soprobec at high doses over a long period of time.  Rounded face (full moon) (Cushing's syndrome).  A decrease in bone mineral density (thinning and weakening of the bones).  Eye problems which include the formation of cataracts and glaucoma (increased pressure in the eye).  Paradoxical bronchospasm. Frequency not known: 

Sleeping problems, depression or feeling worried, restless, nervous, over-excited or irritable. These effects are more likely to appear in children.  

Blurry vision

Headache,

Nausea

  • If you become unwell or develop symptoms such as loss of appetite, abdominal pain, weight

loss, tiredness, nausea (feeling sick), vomiting (being sick), feeling faint, sweating and possible convulsions (fits), you should consult your doctor. This is particularly important if you have been exposed to stress such as surgery, infection, an acute attack of asthma, or other serious illness. Your doctor may carry out blood test from time to time to monitor the levels of steroids in your body. 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 the Yellow Card Scheme at 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.

How to store it

Soprobec

  • Keep this medicine out of the sight and reach of children.
  • Do not use Soprobec after the expiry date which is stated on the carton and label. The expiry date refers to the last day of that month.
  • Do not freeze.
  • Store in the original package in order to protect from the light.
  • If the inhaler gets very cold, take the metal canister out of the plastic case and warm it in your

hands for a few minutes before use. Never use anything else to warm it up.

  • Medicines should not be disposed of via wastewater or household waste. Ask your pharmacist how to dispose of medicines no longer required. These measures will help to protect the environment. Warning: The canister contains a pressurised liquid. Keep away from heat and direct sunlight, do not expose to high temperatures (above 50°C) and do not puncture or burn (incinerate), even when empty.

Contents of the pack and other information

What Soprobec contains The active substance of your inhaler is beclometasone dipropionate. Each puff contains 50, 100, 200 or 250 micrograms of beclometasone dipropionate. The other ingredients are glycerol, ethanol and the CFC-free propellant norflurane (HFC-134a). This medicine contains fluorinated greenhouse gases. 50mcg: Each inhaler contains 11.808 g of HFC-134a corresponding to 0.017 tonne CO2 equivalent (global warming potential = 1430) 100 mcg: Each inhaler contains 11.796 g of HFC-134a corresponding to 0.017 tonne CO2 equivalent (global warming potential = 1430) 200 mcg: Each inhaler contains 11.634 g of HFC-134a corresponding to 0.017 tonne CO2 equivalent (global warming potential = 1430) 250 mcg: Each inhaler contains 11.484 g of HFC-134a corresponding to 0.016 tonne CO2 equivalent (global warming potential = 1430) To help protect the environment, the inhaler contains the CFC-free propellant HFC-134a, which replaces completely the chlorofluorocarbon (CFC) propellants and appears to have a less damaging effect on the ozone layer. The only differences you might notice from your previous CFC-containing inhaler are the taste and the feel of the spray in your mouth.

What Soprobec looks like and content of the pack 50mcg: Soprobec is a pressurised inhalation solution contained in an aluminium can with cream coloured plastic actuator and dark brown colour protective cap. Each pack contains either a single inhaler, or two inhalers. Each canister contains 200 puffs. 100mcg: Soprobec is a pressurised inhalation solution contained in an aluminium can with grey coloured plastic actuator and light pink colour protective cap. Each pack contains either a single inhaler, or two inhalers. Each canister contains 200 puffs. 200mcg: Soprobec is a pressurised inhalation solution contained in an aluminium can with pink coloured plastic actuator and red colour protective cap. Each pack contains either a single inhaler, or two inhalers. Each canister contains 200 puffs. 250mcg: Soprobec is a pressurised inhalation solution contained in an aluminium can with light maroon coloured plastic actuator and grey colour protective cap. Each pack contains either a single inhaler, or two inhalers. Each canister contains 200 puffs. Not all pack sizes may be marketed. Marketing Authorisation Holder and Manufacturer Marketing Authorisation Holder Glenmark Pharmaceuticals Europe Limited Laxmi House, 2B Draycott Avenue, Kenton, Middlesex HA3 0BU United Kingdom Manufacturer Glenmark Pharmaceuticals Europe Limited Building 2, Croxley Green Business Park, Croxley Green, Hertfordshire WD18 8YA, United Kingdom Glenmark Pharmaceuticals s.r.o. Fibichova 143 56617 Vysoke Myto Czech Republic Synoptis Industrial Sp. z o.o. ul. Rabowicka 15, 62-020 Swarzędz Poland The leaflet was last revised in 11/2024. Volumatic is a registered trademark of the GlaxoSmithKline Group of Companies.

Frequently asked questions about Soprobec 50 micrograms per actuation pressurised inhalation solution

How do I take Soprobec 50 micrograms per actuation pressurised inhalation solution?

Soprobec 50 micrograms per actuation pressurised inhalation solution comes as inhaler containing 50mcg. 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 Soprobec 50 micrograms per actuation pressurised inhalation solution?

The active substance in Soprobec 50 micrograms per actuation pressurised inhalation solution is beclometasone dipropionate.

Are there equivalent medicines to Soprobec 50 micrograms per actuation pressurised inhalation solution?

Medicines with the same active substance, strength and form include: Clenil Modulite 50 micrograms inhaler (with Dose Indicator), Clenil Modulite 50 micrograms inhaler (without Dose Indicator), Kelhale 50 micrograms per actuation pressurised inhalation solution. 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 Soprobec 50 micrograms per actuation pressurised inhalation solution, 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 Soprobec 50 micrograms per actuation pressurised inhalation solution 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: Beclometasone dipropionate (44 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

Soprobec is indicated for the maintenance treatment of asthma, when the use of pressurised metered dose inhaler is appropriate.

4.2. Posology and method of administration

Posology

The starting dose of inhaled beclometasone dipropionate should be adjusted to the severity of the disease. The dose may then be adjusted until control is achieved and then should be titrated to the lowest dose at which effective control of asthma is maintained.

Adults (including the elderly): The usual starting dose is 200 micrograms twice daily. In severe cases this may be increased to 600 to 800 micrograms daily. This may then be reduced when the patient's asthma has stabilised. The total daily dosage should be administered as two to four divided doses.

The Volumatic™ spacer device must always be used when Soprobec is administered to adults and adolescents 16 years of age and older taking total daily doses of 1000 micrograms or greater.

Children: The usual starting dose is 100 micrograms twice daily. Depending on the severity of asthma, the daily dose may be increased up to 400 micrograms administered in two to four divided doses.

Soprobec must always be used with the Volumatic™ spacer device when administered to children and adolescents 15 years of age and under, whatever dose has been prescribed.

Patients with hepatic or renal impairment: No dosage adjustment is needed in patients with hepatic or renal impairment.

Method of Administration

Soprobec is for inhalation use.

To ensure proper administration of the medicinal product, the patient should be shown how to use the inhaler correctly by a physician or other health professional. Correct use of the pressurised metered dose inhaler is essential in order that treatment is successful. The patient should be advised to read the Package Leaflet carefully and follow the instructions for use as given in the Leaflet.

Testing the inhaler

Before using the inhaler for the first time or if the inhaler has not been used for 3 days or more, the patient should release one actuation into the air in order to ensure that the inhaler is working properly. Whenever possible patients should stand or sit in an upright position when inhaling from their inhaler.

Instructions for Use

1. Patients should remove the protective cap from the mouthpiece and check that the mouthpiece is clean and free from dust and dirt or any other foreign objects.

2. Patients should breathe out as slowly and deeply as possible.

3. Patients should hold the canister vertically with its body upwards and put the lips around the mouthpiece without biting the mouthpiece

4. At the same time, patients should breathe in slowly and deeply through the mouth. After starting to breathe in, they should press down on the top of the inhaler to release one puff.

5. Patients should hold the breath for about 5 to 10 seconds or as long as comfortable, and then breathe out slowly. If another dose is required, they should be advised to wait 30 seconds before repeating the procedure just described. Finally, they should remove the inhaler from the mouth and breathe out slowly. Patients should not breathe out into the inhaler.

IMPORTANT: patients should not perform steps 2 to 5 too quickly.

After use, patients should close the inhaler with protective cap.

If mist appears following inhalation, either from the inhaler or from the sides of the mouth, the procedure should be repeated from step 2.

For patients with weak hands it may be easier to hold the inhaler with both hands. Therefore, the index fingers should be placed on the top of the inhaler canister and both thumbs on the base of the inhaler.

Patients should rinse their mouth or gargle with water or brush the teeth after inhaling (see section 4.4).

Patients who find it difficult to co-ordinate actuation with inspiration of breath should be told to use a Volumatic™ spacer device to ensure proper administration of the product.

Young children may find it difficult to use the inhaler properly and will require help. Using the inhaler with the Volumatic™ spacer device with a face mask may help in children under 5 years.

The patient should be told of the importance of cleaning the inhaler at least weekly to prevent any blockage and to carefully follow the instructions on cleaning the inhaler printed on the Patient Information Leaflet. The inhaler must not be washed or put in water.

The patient should be told also to refer to the Patient Information Leaflet accompanying the Volumatic™ spacer device for the correct instructions on its use and cleaning.

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

Patients should be properly instructed on the use of the inhaler to ensure that the drug reaches the target areas within the lungs. Patients should be reminded to take Soprobec daily as prescribed even when asymptomatic.

Soprobec should not be used for treatment of acute asthma attacks patients. For such cases patients should be advised to have their rapid-acting bronchodilator available at all times.

It is recommended that treatment with Soprobec should not be stopped abruptly.

If patients find the treatment ineffective medical attention must be sought. Increasing use of rescue bronchodilators indicates a worsening of the underlying condition and warrants a reassessment of the asthma therapy. Sudden and progressive deterioration in control of asthma is potentially life- threatening and the patient should undergo urgent medical assessment.

Systemic effects of inhaled corticosteroids may occur, particularly when prescribed at high doses for prolonged periods. These effects are much less likely to occur than with oral corticosteroids. Possible systemic effects include Cushing's syndrome, cushingoid features, adrenal suppression, growth retardation in children and adolescents, decrease in bone mineral density, cataract and glaucoma and more rarely, a range of psychological or behavioural effects including psychomotor hyperactivity, sleep disorders, anxiety, depression or aggression (particularly in children). It is important that the dose of inhaled corticosteroid is titrated to the lowest dose at which effective control of asthma is maintained.

It is recommended that the height of children receiving prolonged treatment with inhaled corticosteroids is regularly monitored. If growth is slowed, therapy should be reviewed with the aim of reducing the dose of inhaled corticosteroids, if possible, to the lowest dose at which effective control of asthma is maintained. In addition, consideration should also be given to referring the patient to a paediatric respiratory specialist.

Prolonged treatment of patients with high doses of inhaled corticosteroids may result in adrenal suppression and acute adrenal crisis. Situations which could potentially trigger acute adrenal crisis, include trauma, surgery, infection or any rapid reduction in dosage. Presenting symptoms are typically vague and may include anorexia, abdominal pain, weight loss, tiredness, headache, nausea, vomiting, hypotension, decreased level of consciousness, hypoglycaemia, and seizures. Additional systemic corticosteroid cover should be considered during periods of stress or elective surgery.

Care should be taken when transferring patients to Soprobec therapy, particularly if there is any reason to suppose that adrenal function is impaired from previous systemic steroid therapy.

Patients transferring from oral to inhaled corticosteroids may remain at risk of impaired adrenal reserve for a considerable time. Patients who have required high dose emergency corticosteroid therapy in the past or have received prolonged treatment with high doses of inhaled corticosteroids may also be at risk. This possibility of residual impairment should always be borne in mind in emergency and elective situations likely to produce stress, and appropriate corticosteroid treatment must be considered. The extent of the adrenal impairment may require specialist advice before elective procedures.

Patients weaned off oral steroids whose adrenocortical function is impaired should carry a steroid warning card indicating that they may need supplementary systemic steroids during periods of stress, eg. worsening asthma attacks, chest infections, major intercurrent illness, surgery, trauma, etc.

Replacement of systemic steroid treatment with inhaled therapy sometimes unmasks allergies such as allergic rhinitis or eczema previously controlled by the systemic drug. These allergies should be symptomatically treated with antihistamine and / or topical preparations, including topical steroids.

As with all inhaled corticosteroids, special care is necessary in patients with active or quiescent pulmonary tuberculosis.

As with other inhalation therapy, paradoxical bronchospasm may occur with an immediate increase in wheezing, shortness of breath and cough after dosing. This should be treated immediately with a fast-acting inhaled bronchodilator. Soprobec should be discontinued immediately, the patient assessed and, if necessary, alternative therapy institute.

To reduce the risk of Candida infection, patients should be recommended to rinse their mouth properly after each drug administration.

Special care is necessary in patients with viral, bacterial and fungal infections of the eye, mouth or respiratory tract..

Visual disturbance

Visual disturbance may be reported with systemic and topical corticosteroid use. If a patient presents with symptoms such as blurred vision or other visual disturbances, the patient should be considered for referral to an ophthalmologist for evaluation of possible causes which may include cataract, glaucoma or rare diseases such as central serous chorioretinopathy (CSCR) which have been reported after use of systemic and topical corticosteroids.

This medicine contains 7.47 mg of alcohol (ethanol) in each actuation which is equivalent to 13% w/w. The amount of alcohol in each actuation is equivalent to less than 4 ml beer or 2 ml wine. The small amount of alcohol in this medicine will not have any noticeable effects.

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

Soprobec contains a small amount of ethanol. There is a theoretical potential for interaction in particularly sensitive patients taking disulfiram or metronidazole.

If used concomitantly with other systemic or intranasal steroids, a complementary suppressive effect of adrenal function occurs.

Beclomethasone is less dependent on CYP3A metabolism than some other corticosteroids, and in general interactions are unlikely; however the possibility of systemic effects with concomitant use of strong CYP3A inhibitors (e.g. ritonavir, cobicistat) cannot be excluded, and therefore caution and appropriate monitoring is advised with the use of such agents.

4.6. Fertility, pregnancy and lactation

Fertility

In fertility study in rats, beclomethasone dipropionate caused decreased conception rates at an oral dose of 16 mg/kg/day. Impairment of fertility, as evidenced by inhibition of the estrous cycle in dogs, was observed at an oral dose of 0.5 mg/kg/day. No inhibition of the estrous cycle in dogs was seen following 12 months of exposure to beclomethasone dipropionate by the inhalation route at an estimated daily dose of 0.33 mg/kg/day.

Pregnancy

There is no experience of the use of this product in pregnancy and lactation in humans. It should not be used in pregnancy or lactation unless the expected benefits to the mother are thought to outweigh any potential risks to the fetus or neonate.

There is inadequate evidence of safety of beclometasone dipropionate in human pregnancy. Administration of corticosteroids to pregnant animals can cause abnormalities of fetal development including cleft palate and intra-uterine growth retardation. There may therefore, be a risk of such effects in the human fetus. It should be noted, however, that the fetal changes in animals occur after relatively high systemic exposure. Beclometasone dipropionate is delivered directly to the lungs by the inhaled route and so avoids the high level of exposure that occurs when corticosteroids are given by systemic routes.

Lactation

No specific studies examining the transfer of beclometasone dipropionate into the milk of lactating animals have been performed. It is reasonable to assume that beclometasone dipropionate is secreted in milk, but at the dosages used for direct inhalation there is low potential for significant levels in breast milk.

There is no experience with or evidence of safety of propellant HFA-134a in human pregnancy or lactation. However, studies of the effect of HFA-134a on reproductive function and embryofetal development in animals have revealed no clinically relevant adverse effects.

4.7. Effects on ability to drive and use machines

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

4.8. Undesirable effects

Adverse events are listed below by system class and frequency. Frequencies are defined as: very common (≥1/10), common (≥1/100 and <1/10), uncommon (≥1/1,000 and <1/100), rare (≥1/10,000 and <1/1,000), very rare (≤1/10,000), unknown (frequency cannot be estimated from the available data).

System organ Class

Adverse Reaction

Frequency

Infections and Infestations

Oral candidiasis (of the mouth and throat)

Very Common

Immune System Disorders

Hypersensitivity reaction with the following manifestations:

Rash, urticaria, pruritus, erythema

Uncommon

Oedema of the eyes, face, lips and throat, anaphylactic / anaphylactoid reactions

Very Rare

Endocrine Disorders

Cushing's syndrome, cushingoid features, Adrenal suppression*, growth retardation* (in children and adolescents), bone density decreased*

Very Rare

Psychiatric Disorders (see section 4.4 Special warnings and precautions for use)

Psychomotor hyperactivity, sleep disorders, anxiety, depression, aggression, behavioural disorders (predominantly in children)

Unknown

Nervous System Disorders

Headache

Unknown

Eye Disorders

Cataract*, glaucoma*

Very Rare

Vision, blurred*

Not known

Respiratory, Thoracic and Mediastinal Disorders

Hoarseness, throat irritation

Common

Paradoxial bronchospasm **, wheezing, dyspnoea, cough

Very Rare

Gastrointestinal Disorders

Nausea

Unknown

*Systemic reactions are a possible response to inhaled corticosteroids, especially when a high dose is prescribed for a prolonged time (see section 4.4 Special warnings and precautions for use).

** See section 4.4

Candidiasis of the mouth and throat occurs in some patients, the incidence increasing with doses greater than 400 micrograms beclometasone dipropionate per day. Patients with high blood levels of Candida precipitins, indicating a previous infection, are most likely to develop this complication. Patients may find it helpful to rinse their mouth thoroughly with water after inhalation.

Symptomatic oral candidiasis can be treated with topical antifungal therapy while continuing with Soprobec.

Hoarseness or throat irritation may occur in some patients. These patients should be advised to rinse the mouth out with water immediately after inhalation. Use of the Volumatic™ spacer device may be considered.

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

4.9. Overdose

There is no specific treatment for beclomethasone dipropionate overdose. In case of overdose, the patient must receive the necessary support treatment and appropriate follow-up.

Acute: Inhalation of doses in excess of those recommended may lead to temporary suppression of adrenal function. This does not require emergency action. In these patients treatment should be continued at a dose sufficient to control asthma; adrenal function recovers in a few days and can be verified by measuring plasma cortisol.

Chronic: Use of inhaled beclometasone dipropionate in daily doses in excess of 1,500 micrograms over prolonged periods may lead to adrenal suppression. Monitoring of adrenal reserve may be indicated. Treatment should be continued at a dose sufficient to control asthma.

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