Eplerenone Bluefish 25 mg film-coated tablets EFG

Package leaflet: Information for the user

Introduction

Package leaflet: information for the user

Eplerenona Bluefish 25 mg film-coated tablets EFG

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, pharmacist, or nurse.
• This medicine has been prescribed for you only, and you should not give it to others, even if they have the same symptoms as you, because it could harm them.
• If you experience any adverse effects, consult your doctor, pharmacist, or nurse, even if they are effects not listed in this leaflet. See section 4.

Leaflet contents

1. What Eplerenona Bluefish is and what it is used for.

2. What you need to know before taking Eplerenona Bluefish.

3. How to take Eplerenona Bluefish.

4. Possible side effects.

5. How to store Eplerenona Bluefish.

6. Contents of the pack and other information.

1. What Eplerenone Bluefish is and what it is used for

Eplerenone belongs to a group of medicines known as selective aldosterone blockers. These blockers inhibit the action of aldosterone, a substance produced by the body that regulates blood pressure and heart function. High levels of aldosterone can cause changes in your body that may lead to heart failure.

Eplerenone is used to treat heart failure to prevent worsening of the condition and reduce hospitalization in patients who have:

1. recently suffered a myocardial infarction, in combination with other medicines used to treat your heart failure, or

2. persistent mild symptoms, despite ongoing treatment.

2. What you need to know before taking Eplerenona Bluefish

Do not take Eplerenona Bluefish

• if you are allergic to eplerenone or any of the other ingredients of this medicine (listed in section 6),
• if you have high levels of potassium in your blood (hyperkalaemia),
• if you are taking medicines from groups that help your body eliminate excess fluid (potassium-sparing diuretics),
• if you have severe renal impairment,
• if you have severe hepatic impairment,
• if you are taking medicines used to treat fungal infections (ketoconazole or itraconazol),
• if you are taking medicines used to treat HIV infection (nelfinavir or ritonavir),
• if you are taking antibiotics used to treat bacterial infections (clarithromycin or telithromycin),
• if you are taking nefazodone for depression,
• if you are simultaneously taking medicines used to treat certain heart conditions or hypertension (such as angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor antagonists (ARA)).

Warnings and precautions

Talk to your doctor, pharmacist, or nurse before taking Eplerenona Bluefish,

• if you have kidney or liver disease (see also “Do not take Eplerenona Bluefish”),
• if you are taking lithium (commonly used for manic-depressive disorders, also called bipolar disorder),
• if you are taking tacrolimus or cyclosporine (used to treat skin diseases such as psoriasis or eczema and to prevent rejection of transplanted organs).

Children and adolescents

The safety and efficacy of eplerenone in children and adolescents have not been established.

Other medicines and Eplerenona Bluefish

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

• Itraconazole or ketoconazole (used to treat fungal infections), ritonavir, nelfinavir (antiviral medicines for treating HIV), clarithromycin, telithromycin (used to treat bacterial infections), or nefazodone (used to treat depression), as these medicines reduce the metabolism of Eplerenona Bluefish, thereby prolonging its effect in the body.

• Potassium-sparing diuretics (medicines that help your body eliminate excess fluid) or potassium supplements (salt tablets), as these medicines increase the risk of developing high potassium levels in the blood.

• Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor antagonists (ARA) taken together (used to treat high blood pressure, heart disease, or certain kidney diseases), as these medicines may increase the risk of high potassium levels in the blood.

• Lithium (commonly used for manic-depressive disorders, also called bipolar disorder). The use of lithium together with diuretics and ACE inhibitors (used to treat high blood pressure and heart disease) has been shown to cause excessively high levels of lithium in the blood, which may lead to the following adverse reactions: loss of appetite, visual disturbances, fatigue, muscle weakness, and muscle cramps.

• Cyclosporine or tacrolimus (used to treat skin diseases such as psoriasis or eczema and to prevent rejection of transplanted organs). These medicines may cause kidney problems and thus increase the risk of high potassium levels in the blood.

• Non-steroidal anti-inflammatory drugs (NSAIDs – certain painkillers such as ibuprofen, used to relieve pain, stiffness, and inflammation). These medicines may cause kidney problems and thus increase the risk of high potassium levels in the blood.

• Trimethoprim (used to treat bacterial infections) may increase the risk of high potassium levels in the blood.

• Alpha-1 blockers, such as prazosin or alfuzosin (used to treat high blood pressure and certain prostate conditions), may lead to a drop in blood pressure and dizziness upon standing.

• Tricyclic antidepressants, such as amitriptyline or amoxapine (for the treatment of depression), antipsychotics (known as neuroleptics) such as chlorpromazine or haloperidol (for the treatment of psychiatric disorders), amifostine (used during cancer chemotherapy), and baclofen (used to treat muscle spasms). These medicines may lead to a drop in blood pressure and dizziness upon standing.

• Glucocorticoids, such as hydrocortisone or prednisone (used to treat inflammation and certain skin diseases), and tetracosactide (used mainly to diagnose and treat adrenal cortex disorders), may reduce the blood pressure-lowering effect of Eplerenona Bluefish.

• Digoxin (used in the treatment of heart conditions). Blood levels of digoxin may increase when taken together with Eplerenona Bluefish.

• Warfarin (an anticoagulant medicine): Caution is required when administering warfarin doses, as high warfarin levels in the blood may cause changes in the effect of Eplerenona Bluefish in the body.

• Erythromycin (used to treat bacterial infections), saquinavir (an antiviral medicine for treating HIV infections), fluconazole (used to treat fungal infections), amiodarone, diltiazem, and verapamil (for the treatment of heart problems and high blood pressure) may reduce the metabolism of Eplerenona Bluefish, thereby prolonging its effect in the body.

• Hypericum perforatum (St. John’s wort) (herbal medicine), rifampicin (used to treat bacterial infections), carbamazepine, phenytoin, and phenobarbital (used, among others, to treat epilepsy) may increase the metabolism of Eplerenona Bluefish and thus reduce its effect.

Taking Eplerenona Bluefish with food and drink

Eplerenona Bluefish can be taken with or without food.

Pregnancy and breastfeeding

If you are pregnant or breastfeeding, think you may be pregnant, or plan to become pregnant, consult your doctor or pharmacist before using this medicine. The effect of Eplerenona Bluefish during pregnancy has not been evaluated in humans.

It is unknown whether eplerenone is excreted in breast milk. Your doctor will decide with you whether to discontinue treatment or breastfeeding.

Driving and using machines

After taking Eplerenona Bluefish, you may feel dizzy. If this occurs, do not drive or operate machinery.

Eplerenona Bluefish contains lactose

This medicine contains lactose monohydrate (a type of sugar). If your doctor has told you that you have an intolerance to certain sugars, consult him before taking this medicine.

Eplerenona Bluefish contains sodium

This medicine contains less than 1 mmol of sodium (23 mg) per 25 mg and 50 mg tablet; hence, it is essentially “sodium-free”.

3. How to take Eplerenona Bluefish

Follow exactly the instructions given by your doctor or pharmacist for taking this medicine. If in doubt, consult your doctor or pharmacist again.

Eplerenone tablets may be taken with or without food. Swallow the tablets whole with plenty of water.

Eplerenone is usually administered together with other medications for heart failure, for example, beta-blockers. The usual initial dose is one 25 mg tablet once daily, increasing after approximately 4 weeks to 50 mg daily (one 50 mg tablet or two 25 mg tablets). The maximum dosage regimen is 50 mg once daily.

Blood potassium levels should be measured before starting treatment with eplerenone, during the first week, and one month after starting treatment or after any dose adjustment. Your doctor may adjust the dose based on your blood potassium levels.

Patients with renal or hepatic impairment

If you have mild renal impairment, treatment should be initiated with one 25 mg tablet daily. If you have moderate renal impairment, treatment should be initiated with one 25 mg tablet every other day. These doses may be adjusted, as directed by your doctor, according to your blood potassium levels. Eplerenone is not recommended in patients with severe renal disease.

No initial dose adjustment is required in patients with mild to moderate hepatic impairment. If you have any liver or kidney disease, you may require more frequent blood potassium monitoring (see also "Do not take Eplerenona Bluefish").

Elderly patients

No initial dose adjustment is required in elderly patients.

Use in children and adolescents

Eplerenone is not recommended in children and adolescents.

If you take more Eplerenona Bluefish than you should

If you take more eplerenone than you should, inform your doctor or pharmacist immediately. If you have taken too much medicine, the most likely symptoms are low blood pressure (manifested as dizziness, blurred vision, weakness, acute loss of consciousness) or hyperkalaemia, high levels of potassium in the blood (manifested by muscle cramps, diarrhoea, nausea, dizziness or headache).

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

If you forget to take Eplerenona Bluefish

If it is almost time for your next dose, skip the missed dose and take the next tablet at the scheduled time. Otherwise, take the tablet as soon as you remember, provided that there are more than 12 hours until the time for the next dose. Resume your regular dosing schedule. Do not take a double dose to make up for a missed dose.

If you stop taking Eplerenona Bluefish

It is important to continue taking eplerenone as directed, unless your doctor advises you to stop treatment.

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 everybody will experience them.

If any of the following occur:

Seek immediate medical attention,

• swelling of the face, tongue or throat,
• difficulty swallowing,
• blisters and difficulty breathing.

These are symptoms of angioedema, an uncommon adverse effect (may affect up to 1 in 100 patients).

Other reported adverse effects include:

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

• elevated blood potassium levels (these symptoms include muscle cramps, diarrhea, nausea, dizziness or headache),
• dizziness,
• fainting,
• elevated blood cholesterol levels,
• insomnia (difficulty sleeping),
• headache,
• heart-related discomfort such as irregular heartbeat and heart failure,
• cough,
• constipation,
• low blood pressure,
• diarrhea,
• nausea,
• vomiting,
• abnormal kidney function,
• rash,
• itching,
• back pain,
• weakness,
• muscle spasms,
• increased levels of urea in blood,
• increased creatinine levels in blood, which may indicate kidney problems.

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

• infection,
• eosinophilia (increase in certain white blood cells),
• low blood sodium levels,
• dehydration,
• elevated blood triglyceride (fats) levels,
• rapid heartbeat,
• inflammation of the gallbladder,
• drop in blood pressure that may cause dizziness upon standing,
• thrombosis (blood clot) in the legs,
• sore throat,
• flatulence,
• underactive thyroid,
• increased blood glucose,
• reduced sense of touch,
• increased sweating,
• musculoskeletal pain,
• weakness and general malaise,
• kidney inflammation,
• breast enlargement in men,
• changes in certain blood test results.

Reporting of adverse effects

If you experience any adverse effect, consult your doctor, pharmacist, or nurse, 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 Medicines: www.notificaRAM.es. By reporting adverse effects, you can help provide more information on the safety of this medicine.

5. Storage of Eplerenone Bluefish

Keep this medicine out of sight and reach of children.

This medicine does not require any special storage conditions.

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

Medicines must not be disposed of via wastewater or household waste.

Dispose of unused containers and medicines at the SIGRE point located in pharmacies. If in doubt, ask your pharmacist how to dispose of unused containers and medicines. This will help protect the environment.

6. Contents of the pack and other information

Composition of Eplerenone Bluefish

• The active substance is eplerenone. Each tablet contains 25 mg of eplerenone.
• The other components are monohydrate lactose, microcrystalline cellulose, sodium croscarmellose (Type A), hypromellose (Benecel E3), talc and magnesium stearate.

The yellow opadry coating of Eplerenone Bluefish 25 mg film-coated tablets contains macrogol/PEG 6000, HPMC 2910/hypromellose 5cP, talc (E553b), titanium dioxide (E171), yellow iron oxide (E172) and red iron oxide (E172).

Appearance of Eplerenone Bluefish and contents of the pack

Eplerenone Bluefish 25 mg film-coated tablets are presented as round, biconvex, yellow tablets, marked with "E25" on one side.

Eplerenone Bluefish film-coated tablets are available in cartons with PVC opaque/white Al blisters containing 10, 20, 28, 30, 50, 90, 100, and 200 tablets.

Only some pack sizes may be marketed.

Marketing Authorization Holder

Bluefish Pharmaceuticals AB
P.O. Box 49013
100 28 Stockholm
Sweden

Manufacturer

Pharmathen S.A.
Dervenakion 6, Pallini 15351, Attikis
Greece

and Pharmathen International S.A.
Industrial Park Sapes Rodopi Perfecture, Block No. 5, Rodopi, 69300
Greece

Local Representative:

Bluefish Pharma S.L.U.,
P.O. Box 36007, 2832094 Madrid,
Branch Office 36

This medicinal product is authorized in EU Member States under the following names:

Date of the most recent review of this leaflet: September 2023

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