- Approval Id
- d328cd2988b45fa9
- Drug Approval Emc Name
- Amversio 1 g oral powder
- Drug Name
- Amversio 1 g oral powder
- Company Name
- SERB
- Company Address
- 40, avenue George V, 75008 Paris, France
- Company Website
- http://www.serb-labo.com
- Company Telephone
- 00 33 1 73 03 20 00
- Company Medical Info Email
- medinfo.uk1@serb.eu
- Atc Code
- A16AA06
- Legal Category
- Prescription only medicine
- Authorisation Holder
- SERB S.A.
Avenue Louise 480
1050 Brussels
Belgium
- Authorisation Number
- PLGB 43956/0007
- Authorisation Date
- 24/10/2022
- Instruction Authorisation Holder
- SERB S.A.
Avenue Louise 480
1050 Brussels
Belgium
- Instruction Authorisation Number
- PLGB 43956/0007
- Instruction Authorisation Date
- 24/10/2022
- Instruction Composition
- 1 g of powder contains 1 g of betaine anhydrous.
- Instruction Dosage Form
- Oral powder.
White crystalline free flowing powder.
- Instruction Clinical Particulars
- 4.1 Therapeutic indications
Amversio is indicated as adjunctive treatment of homocystinuria, involving deficiencies or defects in:
• cystathionine beta-synthase (CBS),
• 5,10 methylene tetrahydrofolate reductase (MTHFR),
• cobalamin cofactor metabolism (cbl).
Amversio should be used as supplement to other therapies such as vitamin B6 (pyridoxine), vitamin B12 (cobalamin), folate and a specific diet.4.2 Posology and method of administration
Amversio treatment should be supervised by a physician experienced in the treatment of patients with homocystinuria.
\*\*Posology\*\*
\*\*\*Children and adults\*\*\*
The recommended total daily dose is 100 mg/kg/day given in 2 doses daily. However, the dose should be individually titrated according to plasma levels of homocysteine and methionine. In some patients doses above 200 mg/kg/day were needed to reach therapeutic goals. Caution should be exercised with up-titrating doses for patients with CBS deficiency due to the risk for hypermethioninaemia. Methionine levels should be closely monitored in these patients.
\*\*\*Special populations\*\*\*
\*Hepatic or renal impairment\*
Experience with betaine anhydrous therapy in patients with renal insufficiency or non-alcoholic hepatic steatosis has demonstrated no need to adapt the dose regimen of Amversio.
\*\*\*Therapeutic monitoring\*\*\*
The aim of treatment is to keep plasma levels of total homocysteine below 15 μmol/L or as low as possible. The steady-state response usually occurs within a month.
\*\*Method of administration\*\*
Oral use
The bottle should be lightly shaken before opening. Three measuring spoons are provided which dispense either 100 mg, 150 mg or 1 g of betaine anhydrous. It is recommended that a heaped measuring spoon is removed from the bottle and a flat surface e.g. base of a knife is drawn across the top of the measure. This will give the following doses: the green measuring spoon dispenses 100 mg, the blue measuring spoon dispenses 150 mg and the purple measuring spoon dispenses 1 g of betaine anhydrous.
The powder should be mixed with water, juice, milk, formula or food until completely dissolved and ingested immediately after mixing.4.3 Contraindications
Hypersensitivity to the active substance.4.4 Special warnings and precautions for use
Uncommon cases of severe cerebral oedema associated with hypermethioninemia were reported with betaine anhydrous therapy in patients with CBS deficiency (see section 4.8). Complete recovery was seen after treatment discontinuation:
- \*\*\*The plasma methionine concentrations should be kept below 1,000 μmol/L. It is recommended to measure plasma methionine level at start of treatment and about annually or biannually thereafter. If methionine increases particularly above the first safety threshold of 700 μmol/L, patient should be monitored more frequently and compliance with diet should be checked. In order to reduce methionine levels, modification of diet as well as dose reduction of Amversio or temporal interruption of Amversio treatment should be considered.\*\*\*
- If any symptoms of cerebral oedema like morning headaches with vomiting and/or visual changes appear, plasma methionine level and compliance to the diet should be checked and treatment with Amversio interrupted.
- If symptoms of cerebral oedema recur after re-introduction of treatment then betaine anhydrous therapy should be discontinued indefinitely.
To minimise the risk of potential drug interactions, it is advisable to leave 30 minutes between the intake of betaine anhydrous and amino acids mixtures and/or medicinal products containing vigabatrin and GABA analogues (see section 4.5).4.5 Interaction with other medicinal products and other forms of interaction
No interaction studies have been performed.
Based on in vitro data, betaine anhydrous might interact with amino acids mixtures and medicinal products containing vigabatrin and GABA analogues.4.6 Fertility, pregnancy and lactation
\*\*Pregnancy\*\*
Data on a limited number of exposed pregnancies indicate no adverse event of betaine anhydrous on pregnancy or on the health of the foetus/newborn child. To date, no other relevant epidemiologic data are available. Animal reproduction studies have not been conducted. During pregnancy, administering betaine anhydrous in addition to pyridoxine, folate, anticoagulant and diet under close monitoring of plasma homocysteine would be compatible with good maternal and foetal outcomes. However, Amversio should not be used during pregnancy unless clearly necessary.
\*\*Breast-feeding\*\*
It is not known whether betaine anhydrous is excreted in human milk (although its metabolic precursor, choline, occurs at high levels in human milk). Because of lack of data, caution should be exercised when prescribing Amversio to breast-feeding women.
\*\*Fertility\*\*
No data is available.4.7 Effects on ability to drive and use machines
Amversio has no or negligible influence on the ability to drive and use machines.4.8 Undesirable effects
\*\*Summary of the safety profile\*\*
In general, adverse reactions seen with betaine anhydrous therapy appeared to be not serious and are mainly related to the gastrointestinal system. Gastrointestinal disorders like diarrhoea, glossitis, nausea, stomach discomfort, vomiting and dental disorders may occur uncommonly.
The most commonly reported adverse reaction during treatment is blood methionine increased. Complete recovery was seen after treatment discontinuation (see section 4.4).
\*\*Tabulated list of adverse reactions\*\*
Reported adverse reactions are listed below, by system organ class and by frequency.
Frequencies are defined as\*:\* 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). Within each frequency grouping, adverse reactions are presented in order of decreasing seriousness.
| | |
| --- | --- |
| Metabolism and nutrition disorders | Uncommon: anorexia |
| Psychiatric disorders | Uncommon: agitation, irritability |
| Nervous system disorders | Uncommon: brain oedema\\* |
| Gastrointestinal disorders | Uncommon: diarrhoea, glossitis, nausea, stomach discomfort, vomiting |
| Skin and subcutaneous tissue disorders | Uncommon: hair loss, hives, skin odour abnormal |
| Renal and urinary disorders | Uncommon: urinary incontinence |
| Investigations | Very common: blood methionine increased\\* |
\*\*Description of selected adverse reactions\*\*
\\*Uncommon cases of severe cerebral oedema and hypermethioninemia were reported within 2 weeks to 6 months of starting betaine anhydrous therapy in patients with CBS deficiency, with complete recovery after treatment discontinuation.
Symptoms of cerebral oedema include morning headaches with vomiting and/or visual changes.
High increases in plasma methionine levels in a range from 1,000 to 3,000 μmol/L were noted in these patients. As cerebral oedema has also been reported in patients with hypermethioninemia, secondary hypermethioninemia due to betaine anhydrous therapy has been postulated as a possible mechanism of action.
For specific recommendations, see section 4.4.
\*\*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 on the MHRA website www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store.4.9 Overdose
No case of overdose has been reported.
- Instruction Pharmacology
- 5.1 Pharmacodynamic properties
Pharmacotherapeutic group: Other alimentary tract and metabolism products, amino acids and derivatives, ATC code: A16AA06.
\*\*Mechanism of action\*\*
Betaine anhydrous was shown to lower plasma homocysteine levels in the three types of homocystinuria, i.e. CBS deficiency; MTHFR deficiency and cbl defect. The extent of this effect was dependent on the absolute degree of hyperhomocysteinemia, being higher in severe hyperhomocysteinemia.
\*\*Pharmacodynamic effects\*\*
Betaine anhydrous acts as a methyl group donor in the remethylation of homocysteine to methionine in patients with homocystinuria. As a result, plasma levels of homocysteine should decrease in these patients, to 20-30% of pre-treatment levels.
Betaine anhydrous has also been shown to increase plasma methionine and S-adenosyl methionine (SAM) levels in patients with MTHFR deficiency and cbl defects. In CBS-deficient patients without dietary restriction of methionine, excessive accumulation of methionine has been observed.
Betaine anhydrous supplementation was shown to improve the metabolic abnormalities in the cerebrospinal fluid of patients with homocystinuria.
\*\*Clinical efficacy and safety\*\*
Elevated homocysteine plasma levels are associated with cardiovascular events (such as thrombosis), osteoporosis, skeletal abnormalities, and optic lens dislocation. In observational studies, clinical improvement (cardiovascular and neurodevelopmental) was reported by the treating physician in about 75% of patients taking betaine anhydrous. Most of these patients were also receiving other treatments such as vitamin B6 (pyridoxine), vitamin B12 (cobalamin) and folate with variable biochemical responses. In most cases, adding betaine anhydrous resulted in a further reduction in plasma homocysteine level. It is likely that due to the multiple nature of therapy (dietary, pharmaceutical, supportive) in these patients, there may be an element of overestimation in the clinical effects of betaine anhydrous treatment. Late detection of homocystinuria in symptomatic state is responsible for residual morbidity due to irreversible damage to connective tissue (ophthalmological, skeletal) that cannot be corrected by further therapy. The available clinical data do not allow correlating posology and clinical efficacy. There is no evidence of development of tolerance.
In a few cases, increased plasma methionine levels were associated with cerebral oedema (see sections 4.4 and 4.8).
Monitoring plasma homocysteine levels has demonstrated that the onset of action of betaine anhydrous occurred within several days and that a steady-state response was achieved within one month.
\*\*Paediatric population\*\*
In paediatric patients less than 10 years of age, the usual effective dose regimen is 100 mg/kg/day given in 2 doses daily; increasing the frequency above twice daily and/or the dose above 150 mg/kg/day does not improve the homocysteine-lowering effect.
Monitoring betaine plasma concentrations does not help to define the efficacy of treatment, since these concentrations do not directly correspond to the flux through the cytosolic betaine homocysteine methyl transferase pathway.5.2 Pharmacokinetic properties
The pharmacokinetic data of homocystinuric patients on long-term betaine anhydrous supplementation are very similar to those of healthy volunteers. This demonstrates that differences in betaine anhydrous kinetics are most probably due to betaine anhydrous depletion in untreated homocystinuria and are only meaningful for the initial treatment.
\*\*Absorption\*\*
The absolute bioavailability of betaine anhydrous has not been determined. In healthy adult volunteers (age between 21 to 49 years), after a single oral dose of betaine anhydrous (50 mg/kg), absorption was rapid (tmax = 0.9 ± 0.3 hours and a Cmax = 0.9 ± 0.2 mM).
After a repeated dose regimen of 100 mg/kg/day for 5 days, the absorption kinetics did not change.
\*\*Distribution\*\*
Betaine anhydrous was rapidly distributed into a relatively large volume (V/F = 1.3 l/kg).
After a repeated dose regiment of 100 mg/kg/day for 5 days, the distribution half-life was prolonged significantly (up to 36 h), indicating saturable transport and redistribution processes.
\*\*Biotransformation\*\*
Betaine anhydrous is a methyl group donor.
\*\*Elimination\*\*
With a slow elimination rate (mean half-life = 14 h, mean total body clearance, CL/F, = 84 ml/h/kg), renal clearance is negligible (5% of total body clearance), assuming 100% bioavailability.5.3 Preclinical safety data
At high doses, a CNS depressant effect and irritation of the gastrointestinal tract was seen in rats. Long term carcinogenicity and reproductive toxicity studies have not been conducted on betaine anhydrous. A standard battery of genotoxicity test reveals no specific hazard for humans.
- Instruction Pharmaceutical Particulars
- 6.1 List of excipients
None.6.2 Incompatibilities
Not applicable.6.3 Shelf life
Unopened bottle: 3 years.
After the first opening: 3 months.6.4 Special precautions for storage
This medicinal product does not require any special temperature storage conditions.
Store in the original package.
Keep the bottle tightly closed in order to protect from moisture.6.5 Nature and contents of container
White opaque HDPE bottle with a child resistant polypropylene cap with an induction seal liner.
Each pack contains 1 bottle with 180 g of powder and three measuring spoons.
The green measuring spoon dispenses 100 mg.
The blue measuring spoon dispenses 150 mg.
The purple measuring spoon dispenses 1 g.6.6 Special precautions for disposal and other handling
Any unused medicinal product or waste material should be disposed of in accordance with local requirements.
- Instruction Content
- ## Composition
1 g of powder contains 1 g of betaine anhydrous.
## Pharmaceutical Form
Oral powder.
White crystalline free flowing powder.
## Clinical Particulars
4.1 Therapeutic indications
Amversio is indicated as adjunctive treatment of homocystinuria, involving deficiencies or defects in:
• cystathionine beta-synthase (CBS),
• 5,10 methylene tetrahydrofolate reductase (MTHFR),
• cobalamin cofactor metabolism (cbl).
Amversio should be used as supplement to other therapies such as vitamin B6 (pyridoxine), vitamin B12 (cobalamin), folate and a specific diet.4.2 Posology and method of administration
Amversio treatment should be supervised by a physician experienced in the treatment of patients with homocystinuria.
\*\*Posology\*\*
\*\*\*Children and adults\*\*\*
The recommended total daily dose is 100 mg/kg/day given in 2 doses daily. However, the dose should be individually titrated according to plasma levels of homocysteine and methionine. In some patients doses above 200 mg/kg/day were needed to reach therapeutic goals. Caution should be exercised with up-titrating doses for patients with CBS deficiency due to the risk for hypermethioninaemia. Methionine levels should be closely monitored in these patients.
\*\*\*Special populations\*\*\*
\*Hepatic or renal impairment\*
Experience with betaine anhydrous therapy in patients with renal insufficiency or non-alcoholic hepatic steatosis has demonstrated no need to adapt the dose regimen of Amversio.
\*\*\*Therapeutic monitoring\*\*\*
The aim of treatment is to keep plasma levels of total homocysteine below 15 μmol/L or as low as possible. The steady-state response usually occurs within a month.
\*\*Method of administration\*\*
Oral use
The bottle should be lightly shaken before opening. Three measuring spoons are provided which dispense either 100 mg, 150 mg or 1 g of betaine anhydrous. It is recommended that a heaped measuring spoon is removed from the bottle and a flat surface e.g. base of a knife is drawn across the top of the measure. This will give the following doses: the green measuring spoon dispenses 100 mg, the blue measuring spoon dispenses 150 mg and the purple measuring spoon dispenses 1 g of betaine anhydrous.
The powder should be mixed with water, juice, milk, formula or food until completely dissolved and ingested immediately after mixing.4.3 Contraindications
Hypersensitivity to the active substance.4.4 Special warnings and precautions for use
Uncommon cases of severe cerebral oedema associated with hypermethioninemia were reported with betaine anhydrous therapy in patients with CBS deficiency (see section 4.8). Complete recovery was seen after treatment discontinuation:
- \*\*\*The plasma methionine concentrations should be kept below 1,000 μmol/L. It is recommended to measure plasma methionine level at start of treatment and about annually or biannually thereafter. If methionine increases particularly above the first safety threshold of 700 μmol/L, patient should be monitored more frequently and compliance with diet should be checked. In order to reduce methionine levels, modification of diet as well as dose reduction of Amversio or temporal interruption of Amversio treatment should be considered.\*\*\*
- If any symptoms of cerebral oedema like morning headaches with vomiting and/or visual changes appear, plasma methionine level and compliance to the diet should be checked and treatment with Amversio interrupted.
- If symptoms of cerebral oedema recur after re-introduction of treatment then betaine anhydrous therapy should be discontinued indefinitely.
To minimise the risk of potential drug interactions, it is advisable to leave 30 minutes between the intake of betaine anhydrous and amino acids mixtures and/or medicinal products containing vigabatrin and GABA analogues (see section 4.5).4.5 Interaction with other medicinal products and other forms of interaction
No interaction studies have been performed.
Based on in vitro data, betaine anhydrous might interact with amino acids mixtures and medicinal products containing vigabatrin and GABA analogues.4.6 Fertility, pregnancy and lactation
\*\*Pregnancy\*\*
Data on a limited number of exposed pregnancies indicate no adverse event of betaine anhydrous on pregnancy or on the health of the foetus/newborn child. To date, no other relevant epidemiologic data are available. Animal reproduction studies have not been conducted. During pregnancy, administering betaine anhydrous in addition to pyridoxine, folate, anticoagulant and diet under close monitoring of plasma homocysteine would be compatible with good maternal and foetal outcomes. However, Amversio should not be used during pregnancy unless clearly necessary.
\*\*Breast-feeding\*\*
It is not known whether betaine anhydrous is excreted in human milk (although its metabolic precursor, choline, occurs at high levels in human milk). Because of lack of data, caution should be exercised when prescribing Amversio to breast-feeding women.
\*\*Fertility\*\*
No data is available.4.7 Effects on ability to drive and use machines
Amversio has no or negligible influence on the ability to drive and use machines.4.8 Undesirable effects
\*\*Summary of the safety profile\*\*
In general, adverse reactions seen with betaine anhydrous therapy appeared to be not serious and are mainly related to the gastrointestinal system. Gastrointestinal disorders like diarrhoea, glossitis, nausea, stomach discomfort, vomiting and dental disorders may occur uncommonly.
The most commonly reported adverse reaction during treatment is blood methionine increased. Complete recovery was seen after treatment discontinuation (see section 4.4).
\*\*Tabulated list of adverse reactions\*\*
Reported adverse reactions are listed below, by system organ class and by frequency.
Frequencies are defined as\*:\* 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). Within each frequency grouping, adverse reactions are presented in order of decreasing seriousness.
| | |
| --- | --- |
| Metabolism and nutrition disorders | Uncommon: anorexia |
| Psychiatric disorders | Uncommon: agitation, irritability |
| Nervous system disorders | Uncommon: brain oedema\\* |
| Gastrointestinal disorders | Uncommon: diarrhoea, glossitis, nausea, stomach discomfort, vomiting |
| Skin and subcutaneous tissue disorders | Uncommon: hair loss, hives, skin odour abnormal |
| Renal and urinary disorders | Uncommon: urinary incontinence |
| Investigations | Very common: blood methionine increased\\* |
\*\*Description of selected adverse reactions\*\*
\\*Uncommon cases of severe cerebral oedema and hypermethioninemia were reported within 2 weeks to 6 months of starting betaine anhydrous therapy in patients with CBS deficiency, with complete recovery after treatment discontinuation.
Symptoms of cerebral oedema include morning headaches with vomiting and/or visual changes.
High increases in plasma methionine levels in a range from 1,000 to 3,000 μmol/L were noted in these patients. As cerebral oedema has also been reported in patients with hypermethioninemia, secondary hypermethioninemia due to betaine anhydrous therapy has been postulated as a possible mechanism of action.
For specific recommendations, see section 4.4.
\*\*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 on the MHRA website www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store.4.9 Overdose
No case of overdose has been reported.
## Pharmacological Properties
5.1 Pharmacodynamic properties
Pharmacotherapeutic group: Other alimentary tract and metabolism products, amino acids and derivatives, ATC code: A16AA06.
\*\*Mechanism of action\*\*
Betaine anhydrous was shown to lower plasma homocysteine levels in the three types of homocystinuria, i.e. CBS deficiency; MTHFR deficiency and cbl defect. The extent of this effect was dependent on the absolute degree of hyperhomocysteinemia, being higher in severe hyperhomocysteinemia.
\*\*Pharmacodynamic effects\*\*
Betaine anhydrous acts as a methyl group donor in the remethylation of homocysteine to methionine in patients with homocystinuria. As a result, plasma levels of homocysteine should decrease in these patients, to 20-30% of pre-treatment levels.
Betaine anhydrous has also been shown to increase plasma methionine and S-adenosyl methionine (SAM) levels in patients with MTHFR deficiency and cbl defects. In CBS-deficient patients without dietary restriction of methionine, excessive accumulation of methionine has been observed.
Betaine anhydrous supplementation was shown to improve the metabolic abnormalities in the cerebrospinal fluid of patients with homocystinuria.
\*\*Clinical efficacy and safety\*\*
Elevated homocysteine plasma levels are associated with cardiovascular events (such as thrombosis), osteoporosis, skeletal abnormalities, and optic lens dislocation. In observational studies, clinical improvement (cardiovascular and neurodevelopmental) was reported by the treating physician in about 75% of patients taking betaine anhydrous. Most of these patients were also receiving other treatments such as vitamin B6 (pyridoxine), vitamin B12 (cobalamin) and folate with variable biochemical responses. In most cases, adding betaine anhydrous resulted in a further reduction in plasma homocysteine level. It is likely that due to the multiple nature of therapy (dietary, pharmaceutical, supportive) in these patients, there may be an element of overestimation in the clinical effects of betaine anhydrous treatment. Late detection of homocystinuria in symptomatic state is responsible for residual morbidity due to irreversible damage to connective tissue (ophthalmological, skeletal) that cannot be corrected by further therapy. The available clinical data do not allow correlating posology and clinical efficacy. There is no evidence of development of tolerance.
In a few cases, increased plasma methionine levels were associated with cerebral oedema (see sections 4.4 and 4.8).
Monitoring plasma homocysteine levels has demonstrated that the onset of action of betaine anhydrous occurred within several days and that a steady-state response was achieved within one month.
\*\*Paediatric population\*\*
In paediatric patients less than 10 years of age, the usual effective dose regimen is 100 mg/kg/day given in 2 doses daily; increasing the frequency above twice daily and/or the dose above 150 mg/kg/day does not improve the homocysteine-lowering effect.
Monitoring betaine plasma concentrations does not help to define the efficacy of treatment, since these concentrations do not directly correspond to the flux through the cytosolic betaine homocysteine methyl transferase pathway.5.2 Pharmacokinetic properties
The pharmacokinetic data of homocystinuric patients on long-term betaine anhydrous supplementation are very similar to those of healthy volunteers. This demonstrates that differences in betaine anhydrous kinetics are most probably due to betaine anhydrous depletion in untreated homocystinuria and are only meaningful for the initial treatment.
\*\*Absorption\*\*
The absolute bioavailability of betaine anhydrous has not been determined. In healthy adult volunteers (age between 21 to 49 years), after a single oral dose of betaine anhydrous (50 mg/kg), absorption was rapid (tmax = 0.9 ± 0.3 hours and a Cmax = 0.9 ± 0.2 mM).
After a repeated dose regimen of 100 mg/kg/day for 5 days, the absorption kinetics did not change.
\*\*Distribution\*\*
Betaine anhydrous was rapidly distributed into a relatively large volume (V/F = 1.3 l/kg).
After a repeated dose regiment of 100 mg/kg/day for 5 days, the distribution half-life was prolonged significantly (up to 36 h), indicating saturable transport and redistribution processes.
\*\*Biotransformation\*\*
Betaine anhydrous is a methyl group donor.
\*\*Elimination\*\*
With a slow elimination rate (mean half-life = 14 h, mean total body clearance, CL/F, = 84 ml/h/kg), renal clearance is negligible (5% of total body clearance), assuming 100% bioavailability.5.3 Preclinical safety data
At high doses, a CNS depressant effect and irritation of the gastrointestinal tract was seen in rats. Long term carcinogenicity and reproductive toxicity studies have not been conducted on betaine anhydrous. A standard battery of genotoxicity test reveals no specific hazard for humans.
## Pharmaceutical Particulars
6.1 List of excipients
None.6.2 Incompatibilities
Not applicable.6.3 Shelf life
Unopened bottle: 3 years.
After the first opening: 3 months.6.4 Special precautions for storage
This medicinal product does not require any special temperature storage conditions.
Store in the original package.
Keep the bottle tightly closed in order to protect from moisture.6.5 Nature and contents of container
White opaque HDPE bottle with a child resistant polypropylene cap with an induction seal liner.
Each pack contains 1 bottle with 180 g of powder and three measuring spoons.
The green measuring spoon dispenses 100 mg.
The blue measuring spoon dispenses 150 mg.
The purple measuring spoon dispenses 1 g.6.6 Special precautions for disposal and other handling
Any unused medicinal product or waste material should be disposed of in accordance with local requirements.
