Atacand Plus Forte 32 mg/25 mg tablets

Package leaflet: Information for the user

Introduction

Package leaflet: information for the user

Atacand Plus Forte 32mg/25mg tablets

candesartan cilexetil/hydrochlorothiazide

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 and should not be given to other people, even if they have the same symptoms, as it may harm them.
• If you experience any adverse effects, consult your doctor or pharmacist, even if they are effects not listed in this leaflet. See section 4.

Leaflet contents:

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

1. What Atacand Plus Forte is and what it is used for

Your medicine is called Atacand Plus Forte. It is used for the treatment of high blood pressure (hypertension). It contains two active substances: candesartan cilexetil and hydrochlorothiazide. Both work together to lower blood pressure.

• Candesartan cilexetil belongs to a group of medicines called angiotensin II receptor antagonists. It helps blood vessels to relax and widen, making it easier for blood pressure to decrease.
• Hydrochlorothiazide belongs to a group of medicines called diuretics. It helps the body get rid of water and salts such as sodium through the urine. This also helps lower blood pressure.

Your doctor may prescribe Atacand Plus Forte if your blood pressure has not been adequately controlled with candesartan cilexetil or hydrochlorothiazide alone.

2. What you need to know before taking Atacand Plus Forte

Do not take Atacand Plus Forte:

• if you are allergic to candesartan cilexetil or hydrochlorothiazide or any of the other ingredients of this medicine (listed in section 6).
• if you are allergic to sulfonamides. If you are unsure whether this applies to you, consult your doctor.
• if you are more than 3 months pregnant. (It is also advisable to avoid Atacand Plus Forte during the first months of pregnancy – see Pregnancy section).
• if you have severe kidney disease.
• if you have severe liver disease or biliary obstruction (a problem with bile leaving the gallbladder).
• if you have persistently low levels of potassium in your blood.
• if you have persistently high levels of calcium in your blood.
• if you have ever had gout.
• if you have diabetes or renal insufficiency and are being treated with a blood pressure-lowering medicine containing aliskiren.

If you are unsure whether any of these apply to you, consult your doctor or pharmacist before taking Atacand Plus Forte.

Warnings and precautions

Consult your doctor or pharmacist before starting to take Atacand Plus Forte:

• if you have diabetes.
• if you have heart, liver, or kidney problems.
• if you have recently received a kidney transplant.
• if you are experiencing vomiting, have vomited frequently recently, or have diarrhoea.
• if you have a disorder of the adrenal gland called Conn’s syndrome (also known as primary hyperaldosteronism).
• if you have ever had a disease called systemic lupus erythematosus (SLE).
• if you have low blood pressure.
• if you have ever had a stroke.
• if you have had allergies or asthma.
• if you are pregnant (or think you might be pregnant). Use of Atacand Plus Forte is not recommended during early pregnancy, and you must not take it if you are more than 3 months pregnant, as it may cause serious harm to your baby when used from that stage onward (see Pregnancy section).
• if you are taking any of the following medicines used to treat high blood pressure (hypertension):
  • an angiotensin-converting enzyme inhibitor (ACE inhibitor) (e.g., enalapril, lisinopril, ramipril, etc.), particularly if you have kidney problems related to diabetes.
  • aliskiren.
• if you have had skin cancer or develop an unexpected skin lesion during treatment. Treatment with hydrochlorothiazide, particularly long-term use at high doses, may increase the risk of certain types of non-melanoma skin cancer and lip cancer. Protect your skin from exposure to sunlight and UV radiation while taking Atacand Plus Forte.
• if you experience a decrease in vision or eye pain, which could be symptoms of fluid accumulation in the vascular layer of the eye (choroidal effusion) or increased eye pressure. These may occur within hours to a week after taking Atacand Plus Forte. This could lead to permanent vision loss if not treated. Your risk may be higher if you have previously been allergic to penicillin or sulfonamides.
• if you have previously experienced breathing or lung problems (such as inflammation or fluid in the lungs) after taking hydrochlorothiazide. If you develop shortness of breath or severe difficulty breathing after taking Atacand Plus Forte, seek medical attention immediately.

Consult your doctor if you experience abdominal pain, nausea, vomiting, or diarrhoea after taking Atacand Plus Forte. Your doctor will decide whether to continue treatment. Do not stop taking Atacand Plus Forte on your own.

Your doctor may monitor your kidney function, blood pressure, and blood electrolyte levels (e.g., potassium) at regular intervals.

See also the information under the heading “Do not take Atacand Plus Forte”.

If any of these situations apply to you, your doctor may wish to see you more frequently and perform certain tests.

If you are scheduled for surgery, inform your doctor or dentist that you are taking Atacand Plus Forte. This is because Atacand Plus Forte, in combination with certain anaesthetics, may cause excessive lowering of blood pressure.

Atacand Plus Forte may increase the skin’s sensitivity to sunlight.

Children and adolescents

There is no experience with the use of Atacand Plus Forte in children (under 18 years of age). Therefore, Atacand Plus Forte should not be given to children.

Taking Atacand Plus Forte with other medicines

Inform your doctor or pharmacist if you are taking, have recently taken, or might take any other medicines, including those obtained without a prescription.

Atacand Plus Forte may affect how some medicines work, and some medicines may influence the effect of Atacand Plus Forte. If you are taking certain medicines, your doctor may need to carry out blood tests from time to time.

In particular, inform your doctor if you are taking any of the following medicines, as your doctor may need to adjust your dose and/or take other precautions:

• Other medicines to lower blood pressure, including beta-blockers, medicines containing aliskiren, diazoxide, and angiotensin-converting enzyme (ACE) inhibitors such as enalapril, captopril, lisinopril, or ramipril.
• Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen, diclofenac, celecoxib, or etoricoxib (medicines for pain and inflammation relief).
• Acetylsalicylic acid (if taking more than 3 g per day) (a medicine for pain and inflammation relief).
• Potassium supplements or salt substitutes containing potassium (medicines to increase potassium levels in the blood).
• Calcium or vitamin D supplements.
• Medicines to lower cholesterol, such as colestipol or cholestyramine.
• Medicines for diabetes (tablets or insulin).
• Medicines to control heart rhythm (antiarrhythmics), such as digoxin and beta-blockers.
• Medicines that may be affected by blood potassium levels, such as certain antipsychotics.
• Heparin (a medicine to increase blood fluidity).
• Diuretics (medicines to promote urine elimination).
• Laxatives.
• Penicillin or cotrimoxazole (also known as trimethoprim/sulfamethoxazole) (antibiotic medicines).
• Amphotericin (for the treatment of fungal infections).
• Lithium (a medicine for mental health disorders).
• Steroids such as prednisolone.
• Pituitary hormone (ACTH).
• Medicines for cancer treatment.
• Amantadine (for the treatment of Parkinson’s disease or serious viral infections).
• Barbiturates (a type of sedative, also used to treat epilepsy).
• Carbenoxolone (for the treatment of oesophageal disease or oral ulcers).
• Anticholinergic agents such as atropine and biperidene.
• Cyclosporine, a medicine used in organ transplantation to prevent organ rejection.
• Other medicines that may enhance the antihypertensive effect, such as baclofen (a medicine for relieving spasms), amifostine (used in cancer treatment), and certain antipsychotics.
• If you are taking an angiotensin-converting enzyme (ACE) inhibitor or aliskiren (see also information under the headings “Do not take Atacand Plus Forte” and “Warnings and precautions”).

Taking Atacand Plus Forte with food, drinks, and alcohol

• You may take Atacand Plus Forte with or without food.
• When Atacand Plus Forte is prescribed for you, consult your doctor before consuming alcohol. Alcohol may make you feel faint or dizzy.

Pregnancy and breastfeeding

Breast-feeding

Inform your doctor if you are breast-feeding or are planning to start breast-feeding. The use of Atacand Plus Forte is not recommended during breast-feeding, and your doctor will choose an alternative treatment if you wish to breast-feed.

Consult your doctor or pharmacist before taking any medicine.

Driving and using machines

Some patients may feel tired or dizzy when taking Atacand Plus Forte. If this happens to you, do not drive or operate tools or machinery.

Atacand Plus Forte contains lactose

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

Use in athletes: this medicine contains hydrochlorothiazide, which may produce positive results in doping control tests.

3. How to take Atacand Plus Forte

Follow exactly the instructions given by your doctor for taking this medicine. If you have any doubts, consult your doctor or pharmacist. It is important that you continue taking Atacand Plus Forte every day.

The usual dose is one tablet once daily.

Swallow the tablet with a glass of water.

Try to take the tablet at the same time each day. This will help you remember to take it.

If you take more Atacand Plus Forte than you should

If you have taken more Atacand Plus Forte than prescribed by your doctor, contact your doctor or pharmacist immediately.

You may also call the Toxicology Information Service at telephone number: 91 562 04 20, stating the medication and the amount ingested.

If you forget to take Atacand Plus Forte

Do not take a double dose to make up for forgotten doses. Simply take the next dose as scheduled.

If you stop taking Atacand Plus Forte

If you stop taking Atacand Plus Forte, your blood pressure may rise again. Therefore, do not stop taking Atacand Plus Forte without first consulting your doctor.

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

4. Possible adverse effects

Like all medicines, Atacand Plus Forte may cause adverse effects, although not everyone experiences them.

It is important that you are aware of the possible adverse effects. Some of the adverse effects of Atacand Plus Forte are due to candesartan cilexetil, while others are due to hydrochlorothiazide.

Stop taking Atacand Plus Forte and see a doctor immediately if you experience any of the following allergic reactions:

• Difficulty breathing, with or without swelling of the face, lips, tongue, and/or throat.
• Swelling of the face, lips, tongue, and/or throat, which may cause difficulty swallowing.
• Severe itching of the skin (with skin rash).

Atacand Plus Forte may cause a decrease in white blood cells. Your resistance to infections may be reduced, and you may feel tired, have an infection, or develop a fever. If this occurs, inform your doctor. Your doctor may perform periodic blood tests to ensure that Atacand Plus Forte is not affecting your blood (agranulocytosis).

Other possible adverse effects include:

Frequent (May affect up to 1 in 10 people)

• Changes in blood test results:

• Reduction in blood sodium levels. If severe, you may feel weak, lack energy, or experience muscle cramps.

• Increase or decrease in blood potassium levels, especially if you already have kidney problems or heart failure. If this condition is severe, you may feel tired, weak, have irregular heartbeats, or experience tingling sensations.

• Increase in blood levels of cholesterol, glucose, or uric acid.

• Presence of glucose in urine.

• Dizziness or weakness.

• Headache.

• Respiratory infection.

Uncommon (May affect up to 1 in 100 people)

• Low blood pressure. This may cause dizziness or fainting.

• Loss of appetite, diarrhea, constipation, stomach irritation.

• Skin rash, hives, skin reaction due to sensitivity to sunlight.

Rare (May affect up to 1 in 1,000 people)

• Jaundice (yellowing of the skin and whites of the eyes). If this occurs, contact your doctor immediately.
• Effects on kidney function, especially if you already have kidney problems or heart failure.
• Difficulty sleeping, depression, or restlessness.
• Tingling or prickling sensations in arms and legs.
• Blurred vision for a short period of time.
• Abnormal heartbeats.
• Breathing difficulties (including lung inflammation and fluid in the lungs).
• High temperature (fever).
• Inflammation of the pancreas. This causes moderate to severe stomach pain.
• Muscle cramps.
• Damage to blood vessels causing red or purple spots on the skin.
• Decrease in red blood cells, white blood cells, or platelets. You may feel tired, have an infection, fever, or bruise easily.
• Severe skin reaction developing rapidly, causing blisters and skin peeling, possibly with mouth ulcers.

Very rare (May affect up to 1 in 10,000 people)

• Acute breathing difficulty (symptoms include severe shortness of breath, fever, weakness, and confusion). Intestinal angioedema: swelling in the intestine causing symptoms such as abdominal pain, nausea, vomiting, and diarrhea.
• Swelling of the face, lips, tongue, and/or throat.
• Itching.
• Back pain, joint pain, and muscle pain.
• Changes in liver function, including liver inflammation (hepatitis). You may feel tired, have yellowing of the skin and whites of the eyes, and flu-like symptoms.
• Cough.
• Nausea.

Not known (frequency cannot be estimated from available data)

• Sudden onset of myopia.
• Decreased vision or eye pain due to elevated pressure (possible signs of fluid accumulation in the vascular layer of the eye (choroidal effusion) or acute angle-closure glaucoma).
• Systemic and cutaneous lupus erythematosus (an allergic condition causing fever, joint pain, and skin rashes that may include redness, blisters, peeling, and lumps).
• Diarrhea.
• Skin and lip cancer (non-melanoma skin cancer).

Reporting of adverse effects

If you experience any adverse effect, consult your doctor or pharmacist, even if it is a possible adverse effect not listed in this leaflet. You may also report them directly via the Spanish Pharmacovigilance System for Human Medicinal Products: www.notificaram.es. By reporting adverse effects, you can help provide more information on the safety of this medicine.

5. Storage of Atacand Plus Forte

• Keep out of the sight and reach of children.

• This medicine does not require any special storage temperature.

• Do not use Atacand Plus Forte after the expiry date stated on the carton or blister. The expiry date is the last day of the month indicated.

Medicines should not be disposed of via wastewater 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 Atacand Plus Forte

• The active substances are candesartan cilexetil and hydrochlorothiazide. The tablets contain 32 mg of candesartan cilexetil and 25 mg of hydrochlorothiazide.
• The other components are calcium carmellose, hydroxypropylcellulose, lactose monohydrate, magnesium stearate, maize starch, macrogol, red iron oxide (E172), and yellow iron oxide (E172).

Appearance of the product and contents of the pack

Atacand Plus Forte 32 mg/25 mg tablets are pink, oval-shaped tablets of 6.5 mm x 11 mm, with a score line and the imprint A/CD on one side and a pressure-sensitive score line on the other. The tablet can be divided into two equal parts by breaking it along the score line.

Atacand Plus Forte 32 mg/25 mg tablets are available in blisters of 28, 56 or 98 tablets.

Not all pack sizes may be marketed in all countries.

Marketing Authorization Holder and Manufacturer

Marketing Authorization Holder:

CHEPLAPHARM Arzneimittel GmbH
Ziegelhof 24
17489 Greifswald
Germany

Manufacturer:

Klocke Pharma-Service GmbH
Straßburger Str. 77
77767 Appenweier
Germany

CHEPLAPHARM Arzneimittel GmbH
Ziegelhof 23-24
17489 Greifswald
Germany

AstraZeneca AB, S-152 57, Södertälje, Sweden

Local Representative:

Laboratorios Rubió, S.A.
Industria, 29
Pol. Ind. Comte de Sert
08755 Castellbisbal (Barcelona)
Spain

This medicinal product is authorized in the European Economic Area member states under the following names:

Date of the most recent review of this leaflet: 01/2025

Other sources of information Detailed and up-to-date information about this medicinal product is available on the website of the Spanish Agency for Medicines and Health Products (AEMPS) http://www.aemps.gob.es/