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

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

Vafseo increases the level of a substance called “Hypoxia-Inducible Factor” (HIF), which increases the production of red blood cells when oxygen levels are low. By raising HIF levels, Vafseo increases the production of red blood cells and raises the levels of haemoglobin.

This improves the oxygen supply to your body and may reduce your anaemia symptoms.

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

Talk to your doctor, or pharmacist before taking Vafseo:

• if you had blood clots in the past and/or have risk factors for blood clots. This medicine increases the production of red blood cells, and this may increase the risk of developing blood clots. Examples of risk factors are:
  • being overweight
  • diabetes
  • heart diseases
  • being off your feet for a long time because of surgery or illness
  • taking oral contraceptives
  It is important that you tell your doctor about previous heart attack, stroke, blood clots or risk factors so your doctor can decide if this medicine is a suitable treatment for your anaemia.
  Talk to your doctor immediately if you think you have developed a blood clot. You can find a description of possible blood clot symptoms below in section 4.
• if you have high blood pressure (hypertension). Vafseo may worsen your high blood pressure. Therefore, it is very important that you take your high blood pressure medicines regularly and that you frequently check your blood pressure.
• if you have severe liver disease
• if you have convulsion or fit or possible warning signs that a convulsion may occur, such as headache, irritability, fear, confusion or unusual feelings
• if you are converting from high doses of erythropoiesis-stimulating agent (ESA), because you might require red blood cell transfusion or supplemental ESA while the doctor is adjusting your Vafseo dose.

Blood tests

Chronic kidney disease can cause anaemia, which may increase the risk of heart and blood vessels problems and even death. Therefore, it is important to treat your anaemia. Your doctor will regularly check the amount of haemoglobin in your blood.

The treatment may increase liver enzymes. Your doctor will regularly check the amount of these enzymes in your blood at the start of your treatment, monthly for the first 3 months of your treatment and then as needed.

Do not give Vafseo to children and adolescents aged under 18 years. There is not enough information about its use in this age group.

Tell your doctor or pharmacist if you are taking, have recently taken, or might take any other medicines. Vafseo may affect the way other medicines work, and medicines may affect how Vafseo works.

In particular tell your doctor or pharmacist if you have taken, or are taking any of the following medicines:

• medicines to reduce phosphate levels in your blood (called phosphate binders) such as sevelamer carbonate or calcium acetate and medicines or supplements that contain iron such as ferric citrate, sucroferric oxyhydroxide, ferrous sulphate, sodium ferrous citrate.
• probenecid, a medicine used to treat gout
• sulfasalazine, a medicine to treat severe bowel and rheumatic joint inflammation
• medicines known as statins to reduce cholesterol levels in your blood (examples include simvastatin, rosuvastatin, fluvastatin or pitavastatin)
• furosemide or olmesartan, medicines used to treat high blood pressure
• nelfinavir, efavirenz or zidovudine, medicines used to treat HIV
• topotecan, a medicine used to treat cancer
• famotidine, a medicine to treat stomach ulcers
• methotrexate, a medicine used to treat cancer and autoimmune disorders
• sitagliptin, a medicine to treat diabetes
• celecoxib, a medicine to treat pain and inflammation
• warfarin, a medicine used to stop blood clotting
• phenytoin, a medicine used to treat epilepsy
• benzylpenicillin, a medicine used to treat infections
• teriflunomide, a medicine used to treat multiple sclerosis
• p-aminohippuric acid, a diagnostic substance used in tests involving the kidney
• bupropion, a medicine used to treat depression

Your doctor will decide how you should use these medicines during your treatment with Vafseo.

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.

It is not known whether vadadustat passes into human milk.

Your doctor will decide whether you can take Vafseo during pregnancy or breast feeding.

It is not known if Vafseo has an effect on your fertility.

Vafseo is unlikely to affect your ability to drive and use machines.

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

• Take your Vafseo dose once every day
• Vafseo can be taken with food or between meals
• Vafseo film-coated tablets are taken by mouth with water
• Take your Vafseo tablet whole and without chewing or crushing the tablet.
• You can take Vafseo at any time before, during, or after dialysis

Phosphate binders and Vafseo

If you are treated with phosphate binders which do not include iron (such as sevelamer carbonate or calcium acetate) or medicines containing calcium, magnesium or aluminium you should take Vafseo at least 1 hour before or 2 hours after taking those medicines, because otherwise vadadustat will not be properly absorbed by your body. If the phosphate binder you are taking contains iron, see the information below.

Iron containing products and Vafseo

If you take medicines containing iron or phosphate binders containing iron you should take Vafseo at least 1 hour before those products. Vadadustat will not be properly absorbed by your body if you do not follow these instructions.

Your doctor will tell you what dose of Vafseo to take. Treatment with Vafseo will start at a daily dose of 300 mg. Thereafter, your doctor may either increase or decrease your daily dose in steps of 150 mg. The lowest dose is 150 mg per day and the highest dose is 600 mg per day.

Always take Vafseo as prescribed by your doctor.

It is important that your doctor regularly checks the amount of haemoglobin in your blood. Based on these test results your doctor may increase or lower your dose. If the amount of haemoglobin in your blood becomes too high your treatment will be stopped. Do not restart your treatment until your doctor tells you to do so and use only the dose your doctor prescribes.

Your doctor will monitor your liver enzyme levels (ALT, AST, and bilirubin) before your treatment starts, and monthly thereafter for at least 3 months.

If you take more tablets or a higher dose than you should, contact your doctor straight away.

• Do not take a double dose to make up for a forgotten dose. Do not take more than one dose in one day.
• Take the forgotten dose as soon as possible and take the next dose on the next scheduled day.
• If you do not remember that you have missed a dose until the next day, skip the missed dose and take the next dose.

If you stop taking Vafseo, your anaemia may get worse. Do not stop taking this medicine unless your doctor tells you to do so.

Contact your doctor straight away if you get any of the following:

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

• High blood pressure (hypertension)
• Blood clots (thromboembolic events) which may lead to:
  • heart attack (myocardial infarction, with symptoms such as pain in chest and/or other parts of the body, feeling dizzy, shortness of breath, feeling or being sick, sense of anxiety
  • stroke (cerebrovascular accident), with symptoms such as sudden severe headache, seizures (fits), loss of coordination, loss of balance
  • blood clot in a blood vessel in the lungs (pulmonary embolism), with symptoms such as pain in your chest or upper back, difficulty breathing, coughing up blood
  • blood clot in a vein, such as in the leg (known as deep vein thrombosis), with symptoms such as painful swelling and redness
  • “mini stroke” (TIA), with symptoms such as speech and visual disturbance, and numbness or weakness in the face, arms and legs
  • stenosis (arteriovenous fistula thrombosis and arteriovenous graft thrombosis), with symptoms such as purplish, bulging veins seen through the skin, similar to varicose veins.

Talk to your doctor if you get any of the following side effects:

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

• diarrhoea

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

• headache
• seizures
• low blood pressure (hypotension)
• hypersensitivity
• cough
• constipation
• feeling sick
• vomiting
• increased liver enzymes

Uncommon (may affect up to 1 in 100 people):

• increased amount of a breakdown product of red blood cells (bilirubin) in your blood

If you get any side effects, talk to your doctor or pharmacist. 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. By reporting side effects you can help provide more information on the safety of this medicine.

The active substance is vadadustat.

Vafseo 150 mg film-coated tablets:

• Each film-coated tablet contains 150 mg vadadustat.

Vafseo 300 mg film-coated tablets:

• Each film-coated tablet contains 300 mg vadadustat.

Vafseo 450 mg film-coated tablets

• Each film-coated tablet contains 450 mg vadadustat

The other ingredients are:

Tablet core

Microcrystalline cellulose, sodium starch glycolate, hypromellose, colloidal silicon dioxide, magnesium stearate.

Tablet coating:

Polyvinyl alcohol (E1203), macrogol (E 1521)/polyethylene glycol (PEG), talc.

Vafseo 150 mg film-coated tablets

Titanium dioxide

Vafseo 300 mg film-coated tablets

Titanium dioxide, yellow iron oxide

Vafseo 450 mg film-coated tablets

Titanium dioxide, iron oxide red and ferrosoferric oxide

Vafseo 150 mg film-coated tablets are round and white, debossed with “VDT” on one side and “150” on the other side.

Vafseo 300 mg film-coated tablets are oval and yellow, debossed with “VDT” on one side and “300” on the other side.

Vafseo 450 mg film-coated tablets are oval and pink, debossed with “VDT” on one side and “450” on the other side.

Vafseo film-coated tablets are supplied in cartons containing 28 or 98 film-coated tablets in PVC/aluminium foil blisters.