• Keep this leaflet. You may need to read it again.
• If you have any further questions, please ask your doctor, pharmacist or nurse.
• This medicine has been prescribed for you only. Do not pass it on to others. It may harm them, even if their symptoms are the same as yours.
• If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side effects not listed in this leaflet (see section 4).

1. What Calquence is and what it is used for
2. What you need to know before you take Calquence
3. How to take Calquence
4. Possible side effects
5. How to store Calquence
6. Contents of the pack and other information

Calquence is a medicine used to treat cancer.

• Calquence contains the active substance acalabrutinib.
• It belongs to a group of medicines called Bruton tyrosine kinase (BTK) inhibitors.

Calquence is used to treat adults with chronic lymphocytic leukaemia (CLL).

CLL is a cancer of white blood cells called B-lymphocytes (or B-cells). These cells are part of the immune system (the body’s defences).

Calquence works by blocking BTK, a protein in the body that helps these cancer cells grow and survive. By blocking BTK, Calquence helps to kill and can reduce the number of cancer cells which can slow down the worsening of the disease.

If you have any questions about how Calquence works or why this medicine has been prescribed for you, ask your doctor, pharmacist or nurse.

• you are allergic to acalabrutinib or any of the other ingredients of this medicine (listed in section 6).

If you are not sure, talk to your doctor, pharmacist or nurse before taking Calquence.

Talk to your doctor, pharmacist or nurse before taking Calquence if you:

• have ever had unusual bruising or bleeding or are on any medicines that increase your risk of bleeding (see section 4 ‘Possible side effects’).
• have an infection (see section 4 ‘Possible side effects’)
• have recently had an operation or are about to have one. Your doctor may stop treatment with Calquence before and after a medical, surgical or dental procedure.
• have ever had hepatitis B (a liver infection) – this is because Calquence could cause hepatitis B to become active again and so that your doctor will look out for signs of this infection coming back (see section 4 ‘Possible side effects’).
• have or ever had irregular heart beat (see section 4 ‘Possible side effects’).

Talk to your doctor if you develop a new lesion or any change in the appearance of an area on the skin as you are at a high risk of developing skin cancer, see section 4. Use sun protection and make regular skin examination.

Your doctor will check your blood cell counts as needed during treatment.

Do not give this medicine to children or adolescents aged less than 18 years. This is because it has not been studied in this age group.

Tell your doctor, pharmacist or nurse if you are taking or have recently taken or might take any other medicines, especially if you take any of the following:

• antibiotics for bacterial infections – such as clarithromycin
• medicines for fungal infections – such as posaconazole, itraconazole, voriconazole
• ketoconazole – a medicine for Cushing’s syndrome (a condition in which the body produces too much of the hormone cortisol)
• medicines for HIV infections – such as indinavir and ritonavir
• medicines for hepatitis C – such as telaprevir
• rifampicin – an antibiotic for bacterial infections (Tuberculosis)
• medicine for migraines – ergotamine
• medicine for low blood sodium – conivaptan
• medicine for high blood sugars – metformin
• medicine to prevent organ rejection – cyclosporine
• medicines for fits (seizures) or epilepsy – such as carbamazepine and phenytoin
• pimozide – a medicine used for Tourette (condition which causes uncontrolled movements and outbursts of words and sounds)
• St. John’s wort – a herbal medicine for depression
• theophylline – medicine used for wheezing, shortness of breath, and chest tightness
• methotrexate – a medicine for diseases such as rheumatoid arthritis, psoriasis and ulcerative colitis, which are caused by the immune system working incorrectly.
  • This medicine should be taken at least 6 hours before or after Calquence.

You can take stomach acid reducing medicines such as antacids (calcium carbonate), histamine-2 receptor blockers (ranitidine and famotidine) and proton pump inhibitors (omeprazole) with Calquence tablets.

Calquence may make you bleed more easily. Tell your doctor, pharmacist, or nurse if you take other medicines that increase your risk of bleeding:

• Antiplatelets (medicines that act against blot clotting) such as acetylsalicylic acid and clopidogrel.
• Anticoagulants (blood thinners) such as warfarin or enoxaparin.

Talk to your doctor before taking Calquence if you are pregnant, think you may be pregnant, or are planning on having a baby. This is because Calquence may harm your unborn baby.

Do not breast-feed during treatment with Calquence and for 2 days after your last dose of Calquence. It is not known if Calquence passes into your breast milk.

Calquence is unlikely to affect the ability to drive and use machines. However, if you feel dizzy, weak or tired while taking Calquence, you must not drive or use machines.

This medicine contains less than 1 mmol sodium (23 mg) per dose, that is to say essentially ‘sodium-free’.

• The usual dose is one tablet (100 mg) twice a day. Take doses about 12 hours apart.

• Swallow the tablet whole with water at about the same time each day.
• Do not chew, crush, dissolve or divide the tablets.
• You can take Calquence with food or between meals.
• You can check when you last took a tablet of Calquence by looking on the blister. Pictures on the blister will help you to take your dose at the right time — the sun for the morning dose and the moon for the evening dose.

If you have taken more Calquence than you should, see a doctor or go to the nearest hospital straight away. Take the tablets and this leaflet with you.

• If less than 3 hours have passed after your usual time for taking a dose, take the missed dose right away. Take the next dose at your usual time.
• If more than 3 hours have passed after your usual time for taking a dose, skip the missed dose. Take the next dose at your usual time.
• Do not take a double dose of Calquence to make up for a forgotten dose.

• Bleeding. Symptoms may be black stools or stools with blood, pink or brown urine, nosebleeds, bruising, unexpected bleeding, vomiting or coughing up blood, dizziness, weakness, confusion.
• Infections. Signs may include fever, chills, feeling weak or confused, cough, shortness of breath [Pneumonia, a very common side effect (may affect more than 1 in 10 people) or Aspergillus infections, an uncommon side effect (may affect up to 1 in 100 people)].

Common serious side effects (may affect up to 1 in 10 people)

• fast heart rate, missed heart beats, weak or uneven pulse, dizziness, feeling faint, chest discomfort or shortness of breath (signs of heart rhythm problems known as atrial fibrillation and atrial flutter).

Uncommon serious side effects (may affect up to 1 in 100 people)

• fever, chills, nausea, vomiting, confusion, shortness of breath, seizures, irregular heartbeat, dark or cloudy urine, unusual tiredness, or muscle or joint pain. This can be symptoms of tumor lysis syndrome (TLS) – a condition caused by the fast breakdown of cancer cells.

Very common (may affect more than 1 in 10 people):

• muscle or joint pain
• headache
• rash
• feeling tired (fatigue), weakness or lack of energy
• feeling sick to your stomach (nausea),vomiting, stomach pain, constipation (infrequent or hard to pass stool), diarrhoea (frequent or loose stools)
• decreased number of red blood cells, decreased number of neutrophils (a type of white blood cells) or decreased number of cells that help blood clot (platelets)
• high blood pressure
• dizziness
• headache, pressure in the eyes, nose or cheek area (sinusitis)
• sore throat and runny nose (nasopharyngitis)
• upper respiratory tract infection
• urinary tract infection (pain or burning feeling when passing urine).
• new cancers, including cancers of the skin, may happen during treatment with Calquence (see section 2 ‘What you need to know before you take Calquence’)

Common (may affect up to 1 in 10 people):

• bronchitis (does not require immediate action)
• herpes

Uncommon side effects (may affect up to 1 in 100 people)

• memory loss, trouble thinking, difficulty walking or sight loss – these may be signs of a serious brain infection (Progressive Multifocal Leukoencephalopathy or PML)
• fever, chills, weakness, confusion, being sick and yellowing of the skin or eyeballs (jaundice) –these may be signs of hepatitis B (a liver infection) becoming active again.
• lymphocytosis (a higher than normal amount of lymphocytes, a type of white blood cells, in the blood).

If you get any side effects, talk to your doctor. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via the Yellow Card Scheme website: www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store.

The active substance is acalabrutinib. Each film-coated tablet contains 100 mg of acalabrutinib (as acalabrutinib maleate).

The other ingredients are:

• Tablet core: mannitol (E421), microcrystalline cellulose (E460), low-substituted hydroxypropyl cellulose (E463) and sodium stearyl fumarate (see section 2 ‘Calquence contains sodium’).
• Tablet coating: hypromellose (E464), copovidone, titanium dioxide (E171), macrogol, medium-chain triglycerides, iron oxide yellow (E172) and iron oxide red (E172).

Calquence is an orange, 7.5 x 13 mm, oval, biconvex tablet, debossed with ‘ACA 100’ on one side and plain on the reverse.

Calquence is supplied in aluminium blisters containing either 8 or 10 film-coated tablets. On each blister there are sun/moon symbols to help you to take your dose at the right time — the sun for the morning dose and the moon for the evening dose. Both the sun and the moon blisters contain the same medicine. Each carton contains either 56 or 60 film-coated tablets.

Not all pack sizes may be marketed.