Arrox Plus 40 mg/10 mg film-coated tablets

Package leaflet: Information for the user

Introduction

Package leaflet: information for the patient

Arrox Plus 10 mg/10 mg film-coated tablets

Arrox Plus 20 mg/10 mg film-coated tablets

Arrox Plus 40 mg/10 mg film-coated tablets

rosuvastatin/ezetimibe

Read the entire leaflet carefully before you start taking this medicine because it contains important information for you.

• Keep this leaflet as you may need to read it again.
• If you have any questions, ask your doctor or pharmacist.
• This medicine has been prescribed for you only and must not be given to other people, even if they have the same symptoms as you, because it may harm them.
• If you experience any adverse effects, consult your doctor or pharmacist, even if they are adverse effects not listed in this leaflet. See section 4.

Leaflet contents

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

1. What Arrox Plus is and what it is used for

Arrox Plus contains two different active substances in a single film-coated tablet. One of the active substances is rosuvastatin, which belongs to a group of medicines called statins; the other active substance is ezetimibe.

Arrox Plus is a medicine used in adult patients to reduce levels of total cholesterol, "bad" cholesterol (LDL cholesterol), and fatty substances called triglycerides circulating in the blood. In addition, Arrox Plus increases levels of "good" cholesterol (HDL cholesterol).

Rosuvastatin/ezetimibe works to reduce cholesterol in two ways: by decreasing cholesterol absorbed from the digestive tract and by reducing cholesterol produced by the body itself.

Cholesterol is one of many fatty substances circulating in the blood. Total cholesterol is made up mainly of LDL and HDL cholesterol.

For most people, high cholesterol levels do not affect how they feel, as they produce no symptoms. However, if left untreated, fatty deposits can build up in the walls of blood vessels, narrowing them.

Sometimes these narrowed blood vessels can become blocked, cutting off blood supply to the heart or brain, which could result in a heart attack or stroke. By lowering cholesterol levels, your risk of having a heart attack, stroke, or other related health problems can be reduced.

Rosuvastatin/ezetimibe is used in patients who cannot control their cholesterol levels through diet alone. While taking this medicine, you must continue to follow a cholesterol-lowering diet. Your doctor may prescribe this medicine if you are already taking rosuvastatin and ezetimibe at the same dose level.

Arrox Plus is used together with your cholesterol-lowering diet if you have:

• high blood cholesterol levels (primary hypercholesterolemia)

• heart disease, in which case this medicine reduces the risk of heart attack, stroke, surgery to increase blood flow to the heart, or hospitalization due to chest pain.

This medicine does not help you lose weight.

You should continue taking this medicine even if your cholesterol levels are at the desired level, as it prevents cholesterol levels from rising again and causing fatty deposits to accumulate.

However, you must stop taking it if your doctor instructs you to do so, or if you become pregnant.

2. What you need to know before taking Arrox Plus

Do not take Arrox Plus if:

• you are allergic to rosuvastatin, ezetimibe, or any of the other ingredients of this medicine (listed in section 6),
• you have liver disease,
• you have severe kidney problems,
• you have repeated or unexplained muscle pain or cramps (myopathy),
• you are taking a medicine called cyclosporine (used, for example, after organ transplantation),
• you are pregnant or breastfeeding. If you become pregnant while taking this medicine, stop taking it immediately and inform your doctor. Women should avoid becoming pregnant during treatment with this medicine by using an appropriate contraceptive method,
• you are taking the combination of sofosbuvir / velpatasvir / voxilaprevir (medicines used for the viral liver infection called hepatitis C),
• you have ever developed a severe skin rash or peeling of the skin, blisters, and/or mouth sores after taking this medicine or other medicines containing rosuvastatin.

Also, do not take Arrox Plus 40 mg/10 mg (the highest dose):

• If you have moderate kidney problems (if in doubt, consult your doctor).
• If your thyroid gland is not working properly (hypothyroidism).
• If you have repeated or unexplained muscle pain or cramps, personal or family history of muscle disorders, or have experienced muscle problems during treatment with other cholesterol-lowering medicines.
• If you regularly consume large amounts of alcohol.
• If you are of Asian origin (Japanese, Chinese, Filipino, Vietnamese, Korean, or Indian).
• If you are taking other medicines called fibrates to lower cholesterol (see "Other medicines and Arrox Plus").

If you are in any of the above situations (or if you are unsure), consult your doctor.

Warnings and precautions

Consult your doctor or pharmacist before starting this medicine if:

• you have kidney problems,
• you have liver problems,
• you have repeated or unexplained muscle pain or cramps, a personal or family history of muscle disorders, or previous muscle problems during treatment with other cholesterol-lowering medicines. Inform your doctor immediately if you experience unexplained muscle pain or cramps, especially if accompanied by malaise or fever. Also inform your doctor or pharmacist if you experience persistent muscle weakness,
• you are of Asian origin (e.g., Japanese, Chinese, Filipino, Vietnamese, Korean, or Indian). Your doctor must determine the appropriate dose for you,
• you are taking medicines for infections, including HIV (AIDS virus) or hepatitis C, such as lopinavir/ritonavir, atazanavir, simeprevir, ombitasvir, paritaprevir, dasabuvir, velpatasvir, grazoprevir, elbasvir, glecaprevir, and/or pibrentasvir. See “Other medicines and Arrox Plus”,
• you have severe respiratory failure,
• you are taking other medicines called fibrates to lower cholesterol; see “Other medicines and Arrox Plus”,
• you are scheduled for surgery. You may need to stop taking rosuvastatin/ezetimibe temporarily,
• you regularly consume large amounts of alcohol,
• your thyroid gland is not functioning properly (hypothyroidism),
• you are over 70 years old (as your doctor must choose the appropriate dose of rosuvastatin/ezetimibe for you),
• you are taking or have taken within the last 7 days a medicine called fusidic acid (a medicine for bacterial infection) taken orally or by injection. The combination of fusidic acid and rosuvastatin/ezetimibe may cause serious muscle problems (rhabdomyolysis),
• you are taking regorafenib (a medicine for treating cancer),
• you have or have had myasthenia (a disease characterized by generalized muscle weakness, which in some cases affects the muscles used for breathing) or ocular myasthenia (a disease causing weakness of the eye muscles), as statins may sometimes worsen the condition or trigger the onset of myasthenia (see section 4).

If you are in any of the above situations (or if you are unsure): consult your doctor or pharmacist before starting any dose of this medicine.

In a small number of people, statins may affect the liver. This is detected by a simple blood test showing increased levels of liver enzymes. For this reason, your doctor will usually perform blood tests (liver function test) during treatment with this medicine. It is important that you attend your doctor’s appointments for these tests.

While taking this medicine, your doctor will monitor you closely if you have diabetes or are at risk of developing diabetes. You may be at risk of developing diabetes if you have high levels of sugar and fats in your blood, are overweight, and have high blood pressure.

Severe skin reactions, including Stevens-Johnson syndrome and drug reaction with eosinophilia and systemic symptoms (DRESS), have been reported in association with rosuvastatin treatment. Stop using this medicine and seek immediate medical attention if you notice any of the symptoms described in section 4.

Children and adolescents

This medicine is not suitable for children and adolescents under 18 years of age.

Other medicines and Arrox Plus

Inform your doctor or pharmacist if you are taking, have recently taken, or might need to take any other medicines.

Tell your doctor if you are taking any of the following medicines:

• Cyclosporine (used, for example, after organ transplantation to prevent organ rejection. The effect of rosuvastatin increases when used together). Do not take rosuvastatin/ezetimibe if you are taking cyclosporine.
• Anticoagulants, such as warfarin, acenocoumarol, or phenindione (their anticoagulant effects and risk of bleeding may increase when taken with this medicine), ticagrelor, or clopidogrel.
• Other cholesterol-lowering medicines called fibrates, which also correct triglyceride levels in blood (e.g., gemfibrozil and other fibrates).
• Colestipol or cholestyramine (cholesterol-lowering medicines), as they affect how ezetimibe works.
• Regorafenib (used to treat cancer).
• Darolutamide (used to treat cancer).
• Any of the following medicines used to treat viral infections, including HIV or hepatitis C, alone or in combination (see “Warnings and precautions”): ritonavir, lopinavir, atazanavir, sofosbuvir, voxilaprevir, simeprevir, ombitasvir, paritaprevir, dasabuvir, velpatasvir, grazoprevir, elbasvir, glecaprevir, pibrentasvir.
• Medicines for indigestion containing aluminum and magnesium (used to neutralize stomach acid, as they reduce plasma levels of rosuvastatin).
• Erythromycin (an antibiotic).
• Fusidic acid. If you need to take oral fusidic acid to treat a bacterial infection, you must temporarily stop taking this medicine. Your doctor will advise you when it is safe to resume rosuvastatin/ezetimibe. Taking this medicine with fusidic acid may rarely cause muscle weakness, pain, or tenderness (rhabdomyolysis). More information on rhabdomyolysis can be found in section 4.
• An oral contraceptive (the pill).
• Hormone replacement therapy (increasing hormone levels in the blood).

If you go to hospital or receive treatment for another illness, tell the medical staff that you are taking this medicine.

Pregnancy and breastfeeding

If you are pregnant or breastfeeding, think you might be pregnant, or plan to become pregnant, consult your doctor or pharmacist before using this medicine.

Do not take Arrox Plus if you are pregnant, think you might be pregnant, or plan to become pregnant. If you become pregnant while taking this medicine, stop taking it immediately and inform your doctor. Women should use contraceptive methods during treatment with this medicine.

Do not take Arrox Plus if you are breastfeeding, as it is unknown whether the medicine passes into breast milk.

Driving and using machines

This medicine is not expected to affect your ability to drive or use machines. However, some people may feel dizzy after taking this medicine. If you feel dizzy, do not drive or operate machinery.

Arrox Plus contains lactose and sodium

This medicine contains lactose. If your doctor has informed you that you have an intolerance to certain sugars, consult with them before taking this medicine.

This medicine contains less than 23 mg of sodium (1 mmol) per tablet; this is essentially "sodium-free".

3. How to take Arrox Plus

Follow exactly the instructions for use of this medicine as given by your doctor or pharmacist. If you are unsure, consult your doctor or pharmacist again.

You should continue to maintain a low-cholesterol diet and exercise while taking this medicine.

The recommended dose for adults is one tablet daily.

You may take it at any time of day, with or without food. Swallow the tablet whole with water.

Try to take the tablets at the same time every day to help you remember.

This medicine is not suitable for initiating treatment. The start of treatment or dose adjustments, if necessary, should only be done by taking the components separately; once the appropriate doses have been established, switching to the appropriate fixed-dose combination of rosuvastatin/ezetimibe is possible.

If your doctor has prescribed rosuvastatin/ezetimibe together with another cholesterol-lowering medicine containing the active substance cholestyramine or any other medicine containing a bile acid sequestrant, you must take rosuvastatin/ezetimibe at least 2 hours before or 4 hours after taking those medicines.

Regular cholesterol level checks

It is important that you visit your doctor regularly for cholesterol checks to ensure that your cholesterol levels have normalized and remain at appropriate levels.

If you take more Arrox Plus than you should

Contact your doctor or the nearest hospital emergency department, as you may require medical assistance.

In case of overdose or accidental ingestion, consult immediately your doctor or pharmacist, or call the Toxicology Information Service, telephone 91 562 04 20, indicating the medicine and the amount ingested.

If you forget to take Arrox Plus

Do not worry. Miss the forgotten dose and take the next scheduled dose at the usual time. Do not take a double dose to make up for missed doses.

If you stop taking Arrox Plus

Consult your doctor if you wish to discontinue treatment with this medicine. Your cholesterol levels may rise again if you stop taking this medicine.

If you have any further questions about the use of this medicine, ask your doctor or pharmacist.

4. Possible adverse effects

Like all medicines, this medicine can cause adverse effects, although not everyone will experience them.

It is important that you are aware of what these adverse effects may be.

Stop taking Arrox Plus and seek immediate medical attention if you experience any of the following symptoms:

• any unexplained muscle pain, tenderness, or weakness lasting longer than expected. This is because muscle problems, including destruction of muscle fibres leading to kidney damage, can be serious and may result in a potentially life-threatening condition (rhabdomyolysis). This is rare (may affect up to 1 in 1,000 people);
• severe allergic reactions (angioedema), signs of which include swelling of the face, lips, tongue and/or throat, difficulty swallowing and breathing, and intense skin itching (with hives). This is rare (may affect up to 1 in 1,000 people);
• a serious disorder with blistering of the skin, mouth, eyes, and genitals (Stevens-Johnson syndrome). Frequency unknown (cannot be estimated from available data);
• if you develop a lupus-like syndrome (including skin rash, joint disorders, and effects on blood cells). This is rare (may affect up to 1 in 1,000 people);
• if you experience muscle rupture. This is rare (may affect up to 1 in 1,000 people);
• red, non-elevated, target-shaped or circular spots on the trunk, often with central blisters, skin peeling, and ulcers in the mouth, throat, nose, genitals, and eyes. These severe skin rashes may be preceded by fever and flu-like symptoms (Stevens-Johnson syndrome). Frequency unknown (cannot be estimated from available data);
• widespread rash, high body temperature, and enlarged lymph nodes (DRESS syndrome or drug hypersensitivity syndrome). Frequency unknown (cannot be estimated from available data).

Other adverse effects

Frequent adverse effects (may affect up to 1 in 10 people)

• headache;
• constipation;
• general malaise;
• muscle pain;
• weakness;
• dizziness;
• diabetes. This is more likely if you have high levels of blood sugar and lipids, are overweight, and have high blood pressure. Your doctor will monitor you while you are taking this medicine;
• stomach pain;
• diarrhoea;
• flatulence (excess gas in the gastrointestinal tract);
• feeling tired;
• elevated levels in certain blood tests of liver function (transaminases);
• increased amount of protein in the urine, which usually returns to normal without the need to discontinue treatment with rosuvastatin/ezetimibe (only with rosuvastatin 40 mg).

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

• skin rash, itching, urticaria;
• elevated levels in certain blood tests of muscle function (Creatine Kinase test);
• cough;
• indigestion;
• heartburn;
• joint pain;
• muscle spasms;
• neck pain;
• decreased appetite;
• pain;
• chest pain;
• hot flushes;
• high blood pressure;
• tingling sensation;
• dry mouth;
• stomach inflammation;
• back pain;
• muscle weakness;
• pain in arms and legs;
• swelling, especially of the hands and feet;
• increased amount of protein in the urine, which usually returns to normal without the need to discontinue treatment with rosuvastatin/ezetimibe (only with rosuvastatin 10 mg and 20 mg).

Rare adverse effects (may affect up to 1 in 1,000 people)

• inflammation of the pancreas, causing severe stomach pain that may spread to the back;
• decreased number of platelets in the blood, which may cause bruising or bleeding (thrombocytopenia).

Very rare adverse effects (may affect up to 1 in 10,000 people)

• jaundice (yellowing of the skin and eyes);
• liver inflammation (hepatitis);
• traces of blood in the urine;
• nerve damage in arms and legs (such as numbness);
• memory loss;
• enlargement of the breasts in men (gynaecomastia).

Frequency not known (cannot be estimated from available data)

• difficulty breathing;
• oedema (swelling);
• sleep disturbances, including insomnia and nightmares;
• sexual dysfunction;
• respiratory problems including persistent cough and/or difficulty breathing or fever;
• tendon injuries;
• persistent muscle weakness;
• urticaria and target-shaped skin lesions (erythema multiforme);
• gallstones or inflammation of the gallbladder (which may cause abdominal pain, nausea, vomiting);
• myasthenia gravis (a condition causing generalized muscle weakness, which in some cases affects muscles used for breathing);
• ocular myasthenia (a condition causing weakness of the eye muscles);
• consult your doctor if you experience worsening weakness in arms or legs after periods of activity, double vision or drooping eyelids, difficulty swallowing, or difficulty breathing.

Reporting of adverse effects

If you experience any adverse effects, talk to your doctor or pharmacist, even if they are possible adverse effects not listed in this leaflet. You can also report them directly via the Spanish Pharmacovigilance System for Human Medicines: https://www.notificaram.es. By reporting adverse effects, you can help provide more information on the safety of this medicine.

5. Storage of Arroxibe

Keep this medicine out of the sight and reach of children.

This medicine does not require any special storage temperature.

Store in the original packaging to protect it from light and moisture.

Do not use this medicine after the expiry date stated on the carton or blister pack after EXP. The expiry date refers to the last day of the month indicated.

Medicines must not be disposed of via wastewater drains or household waste. Return any unused medicines and their containers to the SIGRE point at your pharmacy. If you are unsure, ask your pharmacist how to dispose of medicines and containers you no longer need. This will help protect the environment.

6. Contents of the pack and other information

Composition of Arrox Plus

• The active substances are rosuvastatin (as rosuvastatin calcium) and ezetimibe.

Arrox Plus 10 mg/10 mg: Each film-coated tablet contains rosuvastatin calcium, equivalent to 10 mg of rosuvastatin, and 10 mg of ezetimibe.

Arrox Plus 20 mg/10 mg: Each film-coated tablet contains rosuvastatin calcium, equivalent to 20 mg of rosuvastatin, and 10 mg of ezetimibe.

Arrox Plus 40 mg/10 mg: Each film-coated tablet contains rosuvastatin calcium, equivalent to 40 mg of rosuvastatin, and 10 mg of ezetimibe.

• The other components are:

Tablet core

Lactose monohydrate, croscarmellose sodium, povidone, sodium lauryl sulfate, microcrystalline cellulose, hypromellose, anhydrous colloidal silica, magnesium stearate.

Tablet coating

Arrox Plus 10 mg/10 mg: Hypromellose, titanium dioxide (E171), yellow iron oxide (E172), macrogol, talc.

Arrox Plus 20 mg/10 mg: Hypromellose, titanium dioxide (E171), talc, macrogol, yellow iron oxide (E172).

Arrox Plus 40 mg/10 mg: Lactose monohydrate, hypromellose, titanium dioxide (E171), macrogol.

Appearance of the product and contents of the pack

Arrox Plus 10 mg/10 mg: Film-coated tablets, round, biconvex, beige in colour, with an approximate diameter of 10 mm and the imprint "EL 4" on one side.

Arrox Plus 20 mg/10 mg: Film-coated tablets, round, biconvex, yellow in colour, with an approximate diameter of 10 mm and the imprint "EL 3" on one side.

Arrox Plus 40 mg/10 mg: Film-coated tablets, round, biconvex, white in colour, with an approximate diameter of 10 mm and the imprint "EL 2" on one side.

OPA/Al/PVC//Al blisters packed in cardboard boxes.

Pack sizes of 30 film-coated tablets.

Marketing Authorisation Holder

Laboratorios Alter, S.A.

C/ Mateo Inurria 30

28036 Madrid

Spain

Manufacturer

Elpen Pharmaceutical Co. Inc.

Marathonos Ave. 95

19009 Pikermi Attiki

Greece

or

Elpen Pharmaceutical Co. Inc.

Zapani, Block 1048

190 01 Keratea

Greece

Date of the most recent review of this leaflet: May 2023.

Detailed information about this medicine is available on the website of the Spanish Agency for Medicines and Health Products (AEMPS) https://www.aemps.gob.es/.