Ezetimibe/atorvastatin Alter 10 mg/20 mg film-coated tablets EFG

Package leaflet: Information for the user

Introduction

Package leaflet: information for the patient

Ezetimibe/Atorvastatin Alter 10 mg/20 mg film-coated tablets EFG

Ezetimibe/Atorvastatin Alter 10 mg/40 mg film-coated tablets EFG

Ezetimibe/Atorvastatin Alter 10 mg/80 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. 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 you must 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 or pharmacist, even if they are adverse effects not listed in this leaflet. See section 4.

Leaflet contents

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

1. What Ezetimiba/Atorvastatina Alter is and what it is used for

Ezetimiba/Atorvastatina Alter is a medicine that lowers high cholesterol levels. This medicine contains ezetimibe and atorvastatin.

Ezetimibe/atorvastatin is used in adults to lower total cholesterol levels, "bad" cholesterol (LDL cholesterol), and fatty substances called triglycerides circulating in the blood. In addition, ezetimibe/atorvastatin increases levels of "good" cholesterol (HDL cholesterol).

Ezetimibe/atorvastatin works by reducing cholesterol in two ways: it reduces cholesterol absorbed in the gastrointestinal tract, as well as cholesterol produced by your body.

Cholesterol is one of the fatty substances found in the bloodstream. Your total cholesterol is made up mainly of LDL and HDL cholesterol.

LDL cholesterol is often called "bad" cholesterol because it can build up in the walls of your arteries, forming plaques. Over time, this plaque buildup can cause narrowing of the arteries. This narrowing can slow down or block blood flow to vital organs such as the heart and brain. This interruption in blood flow may trigger a heart attack or stroke.

HDL cholesterol is often called "good" cholesterol because it helps prevent bad cholesterol from building up in the arteries and protects against heart disease.

Triglycerides are another type of fat present in your blood that may increase the risk of heart disease.

Ezetimibe/atorvastatin is used in patients who cannot control their cholesterol levels with diet alone. While taking this medicine, you must continue to follow a cholesterol-lowering diet.

Ezetimibe/atorvastatin is used, together with a cholesterol-lowering diet, if you have:

? high blood levels of cholesterol (primary hypercholesterolemia [heterozygous familial and non-familial]) or high blood levels of fatty substances (mixed hyperlipidemia):

? that are not well controlled with a statin alone

? who have previously been treated with a statin and ezetimibe in separate tablets

? a hereditary condition (homozygous familial hypercholesterolemia), which increases cholesterol levels in the blood. You may also receive other treatments.

? heart disease; ezetimibe/atorvastatin reduces the risk of heart attack, stroke, surgery to improve blood flow to the heart, or hospitalization due to chest pain.

Ezetimibe/atorvastatin does not help you lose weight.

2. What you need to know before taking Ezetimiba/Atorvastatina Alter

Do not take Ezetimiba/Atorvastatina Alter

? if you are allergic to ezetimibe, atorvastatin, or any of the other ingredients of this medicine (listed in section 6),

? if you have or have ever had a liver disease,

? if you have ever had unexplained abnormal results in blood tests for liver function,

? if you are a woman of childbearing potential and are not using reliable contraceptive methods,

? if you are pregnant, trying to become pregnant, or breastfeeding,

? if you are taking the combination of glecaprevir/pibrentasvir for the treatment of hepatitis C.

Warnings and precautions

Talk to your doctor or pharmacist before taking ezetimiba/atorvastatina

? if you have previously had a stroke with intracranial hemorrhage, or have small accumulations of fluid in the brain due to previous strokes,

? if you have kidney problems,

? if your thyroid gland is underactive (hypothyroidism),

? if you have had recurrent or unexplained muscle pain or discomfort, or have a personal or family history of muscle disorders,

? if you have previously experienced muscle problems while being treated with other lipid-lowering medicines (e.g., other medicines containing "statins" or "fibrates"),

? if you regularly consume large amounts of alcohol,

? if you have a history of liver disease,

? if you are over 70 years old,

? if your doctor has told you that you have an intolerance to certain sugars, contact your doctor before taking this medicine,

? if you are taking or have taken within the last 7 days a medicine containing fusidic acid (used to treat bacterial infection) taken orally or by injection. The combination of fusidic acid and ezetimiba/atorvastatina may cause serious muscle problems (rhabdomyolysis),

? if you have or have had myasthenia (a disease causing 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).

Contact your doctor as soon as possible if you experience unexplained muscle pain, tenderness, or muscle weakness while taking ezetimiba/atorvastatina. This is because, although rarely, muscle problems can be serious, including muscle breakdown leading to kidney damage. It is known that atorvastatin may cause muscle problems, and muscle problems have also been reported with ezetimibe.

Also inform your doctor or pharmacist if you experience persistent muscle weakness. Additional tests and treatments may be needed to diagnose and manage this condition.

Talk to your doctor or pharmacist before starting ezetimiba/atorvastatina:

• if you have severe respiratory insufficiency.

If you are in any of the above situations (or are unsure), consult your doctor before starting ezetimiba/atorvastatina, as your doctor may need to perform a blood test before starting and possibly during treatment with ezetimiba/atorvastatina to assess your risk of experiencing muscle-related adverse effects. It is known that the risk of muscle-related adverse effects, e.g., rhabdomyolysis, increases when certain medicines are taken simultaneously (see section 2 “Taking Ezetimiba/Atorvastatina Alter with other medicines”).

While taking this medicine, your doctor will monitor you for diabetes or risk of developing diabetes. This risk increases if you have high levels of sugar and fats in the blood, are overweight, and have high blood pressure.

Inform your doctor about all your medical conditions, including allergies.

The combined use of ezetimiba/atorvastatina and fibrates (certain medicines to lower cholesterol) should be avoided, as the combination of ezetimiba/atorvastatina and fibrates has not been studied.

Children

Ezetimiba/atorvastatina is not recommended in children and adolescents.

Other medicines and Ezetimiba/Atorvastatina Alter

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

Some medicines may alter the effect of ezetimiba/atorvastatina or their effects may be affected by ezetimiba/atorvastatina (see section 3). This type of interaction could reduce the effectiveness of one or both medicines. It could also increase the risk or severity of adverse effects, including a serious condition involving muscle breakdown known as “rhabdomyolysis,” described in section 4:

? cyclosporine (a medicine often used in transplant patients),

? erythromycin, clarithromycin, telithromycin, fusidic acid**, rifampicin (medicines used to treat bacterial infections),

? ketoconazole, itraconazole, voriconazole, fluconazole, posaconazole (medicines used to treat fungal infections),

? gemfibrozil, other fibrates, nicotinic acid and its derivatives, colestipol, cholestyramine (medicines used to regulate lipid levels),

? certain calcium channel blockers used to treat angina or high blood pressure, e.g., amlodipine, diltiazem,

? digoxin, verapamil, amiodarone (medicines that regulate heart rhythm),

? medicines used in the treatment of HIV, e.g., ritonavir, lopinavir, atazanavir, indinavir, darunavir, the combination of tipranavir/ritonavir, etc. (used to treat AIDS),

? some medicines used in the treatment of hepatitis C, e.g., telaprevir, boceprevir, and the combination of elbasvir/grazoprevir,

? daptomycin (a medicine used to treat complicated skin and skin structure infections and bacteremia).

** If you need to take oral fusidic acid to treat a bacterial infection temporarily, you will need to stop using this medicine. Your doctor will advise you when you can restart treatment with ezetimiba/atorvastatina. The use of ezetimiba/atorvastatina with fusidic acid may rarely cause muscle weakness, tenderness, or pain (rhabdomyolysis). For further information on rhabdomyolysis, see section 4

? Other medicines known to interact with ezetimiba/atorvastatina

? oral contraceptives (medicines that prevent pregnancy),

? stiripentol (an anticonvulsant medicine used to treat epilepsy),

? cimetidine (a medicine used for stomach acidity and peptic ulcers),

? phenazone (a painkiller),

? antacids (products for treating indigestion containing aluminium or magnesium),

? warfarin, phenprocoumon, acenocoumarol, or fluindione (medicines that prevent blood clots),

? colchicine (used to treat gout),

? St. John’s wort (a herbal medicine used to treat depression).

Taking Ezetimiba/Atorvastatina Alter with food and alcohol

See section 3 for instructions on how to take ezetimiba/atorvastatina. Please note the following:

Grapefruit juice

Do not drink more than one or two small glasses of grapefruit juice per day, as large amounts of grapefruit juice may alter the effects of this medicine.

Alcohol

Avoid excessive alcohol consumption while taking this medicine. For further details, see section 2 “Warnings and precautions”.

Pregnancy and breastfeeding

Do not take ezetimiba/atorvastatina if you are pregnant, trying to become pregnant, or think you may be pregnant. Do not take ezetimiba/atorvastatina if you could become pregnant unless you are using reliable contraceptive methods. If you become pregnant while taking ezetimiba/atorvastatina, stop taking it immediately and inform your doctor.

Do not take ezetimiba/atorvastatina if you are breastfeeding.

The safety of ezetimiba/atorvastatina during pregnancy and breastfeeding has not been established.

Consult your doctor or pharmacist before taking this medicine.

Driving and using machines

Ezetimiba/atorvastatina is not expected to affect your ability to drive or use machines. However, it should be noted that some people may experience dizziness after taking ezetimiba/atorvastatina.

Ezetimiba/Atorvastatina Alter 10 mg/20 mg and 10 mg/40 mg contains lactose

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

Ezetimiba/Atorvastatina Alter contains sodium

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

3. How to take Ezetimiba/Atorvastatina Alter

Follow exactly the instructions for use of this medicine as given by your doctor. Your doctor will determine the appropriate tablet strength for you, depending on your current treatment and your personal risk situation. If in doubt, consult your doctor or pharmacist again.

? Before starting to take ezetimiba/atorvastatina, you should already be following a cholesterol-lowering diet.

? You must continue this cholesterol-lowering diet while taking ezetimiba/atorvastatina.

How much to take

The recommended dose is one tablet of ezetimiba/atorvastatina once daily by oral administration.

Method of administration

Take ezetimiba/atorvastatina at any time of day. You may take it with or without food.

If your doctor has prescribed ezetimiba/atorvastatina together with colestyramine or any other bile acid sequestrant (medicines that reduce cholesterol levels), you must take ezetimiba/atorvastatina at least 2 hours before or 4 hours after taking the bile acid sequestrant.

If you take more Ezetimiba/Atorvastatina Alter than you should

Consult your doctor or pharmacist.

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

If you forget to take Ezetimiba/Atorvastatina Alter

Do not take an extra dose; the following day, take your usual amount of ezetimiba/atorvastatina at the usual time.

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.

If you experience any of the following serious adverse effects or symptoms, stop taking your tablets immediately and contact your doctor right away or go to the nearest hospital emergency department.

? severe allergic reactions causing swelling of the face, tongue, and throat, which may cause severe breathing difficulties

? a serious illness characterized by extensive skin peeling and inflammation, blistering of the skin, mouth, eyes, genitals, and fever; skin rash with pink or red spots, particularly on the palms of the hands or soles of the feet, which may progress to blistering

? muscle weakness, tenderness, pain, or muscle rupture, or change in urine color to red-brown, and especially if occurring together with a feeling of malaise or high temperature, which may be due to abnormal muscle breakdown that can be potentially life-threatening and lead to kidney problems

? lupus-like syndrome (including rash, joint disorders, and effects on blood cells)

Consult your doctor as soon as possible if you experience problems associated with unexpected or unusual bleeding or bruising, as this may indicate liver disease.

The following adverse effects have been reported as common (may affect up to 1 in 10 patients):

? diarrhea,

? muscle pain.

The following adverse effects have been reported as uncommon (may affect up to 1 in 100 patients):

? flu,

? depression; sleep disturbances; sleep disorders,

? dizziness; headache; tingling sensation,

? slow heart rate,

? hot flushes,

? choking sensations,

? abdominal pain; bloating; constipation; indigestion; flatulence; frequent bowel movements; stomach inflammation; nausea; stomach discomfort; gastric distress,

? acne; hives,

? joint pain; back pain; leg cramps; muscle fatigue, spasms, or weakness; pain in arms and legs,

? unusual weakness; feeling of tiredness or malaise; swelling, especially in the ankles (edema),

? increased liver or muscle function tests (CK) in laboratory blood tests,

? weight gain.

The following adverse effects have been reported with unknown frequency (frequency cannot be estimated from available data):

• myasthenia gravis (a disease causing generalized muscle weakness, which in some cases affects muscles used for breathing),
• ocular myasthenia (a disease causing weakness of the eye muscles).

Consult your doctor if you develop worsening weakness in the arms or legs after periods of activity, double vision or drooping eyelids, difficulty swallowing, or difficulty breathing.

Additionally, the following adverse effects have been reported in patients taking ezetimibe/atorvastatin, ezetimibe, or atorvastatin tablets:

? allergic reactions including swelling of the face, lips, tongue, and/or throat, which may cause difficulty breathing or swallowing (requiring immediate medical treatment),

? red rash, sometimes target-shaped,

? liver problems,

? cough,

? heartburn,

? decreased appetite; loss of appetite,

? high blood pressure,

? skin rash and itching; allergic reactions including rash and hives,

? tendon injury,

? gallstones or inflammation of the gallbladder (which may cause abdominal pain, nausea, or vomiting),

? inflammation of the pancreas, often accompanied by severe abdominal pain,

? decreased blood cell counts, which may lead to bruising or bleeding (thrombocytopenia),

? nasal inflammation; nosebleeds,

? neck pain; chest pain; sore throat,

? increased or decreased blood sugar levels (if you have diabetes, you should closely monitor your blood glucose levels),

? nightmares,

? numbness or tingling in fingers and toes,

? decreased sensitivity to pain or touch,

? altered sense of taste; dry mouth,

? memory loss,

? ringing in the ears and/or head; hearing loss,

? vomiting,

? burping,

? hair loss,

? high temperature,

? presence of white blood cells in urine tests,

? blurred vision; visual disturbances,

? gynecomastia (enlargement of breast tissue in men).

Possible adverse effects reported with some statins

? sexual dysfunction,

? depression,

? respiratory problems, including persistent cough and/or choking sensations or fever,

? diabetes. This is more likely if you have high levels of blood sugar and fats, are overweight, or have high blood pressure. Your doctor will monitor you while you are taking this medicine,

? persistent muscle pain, tenderness, or weakness, and especially if occurring together with malaise or high temperature that does not resolve after stopping ezetimibe/atorvastatin treatment (frequency not known).

Reporting of adverse effects

If you experience any adverse effects, consult your doctor or pharmacist, even if they are possible adverse effects not listed in this leaflet. You can also report them directly through the national reporting system: Spanish Pharmacovigilance System for Human Medicines (Sistema Español de Farmacovigilancia de Medicamentos de Uso Humano): https://www.notificaram.es. By reporting adverse effects, you can help provide more information on the safety of this medicine.

5. Storage of Ezetimibe/Atorvastatin Alter

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

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

This medicine does not require any special storage conditions.

Medicines must not be disposed of via wastewater or household waste. Dispose of empty containers and unused medicines at the SIGRE Point located at your pharmacy. If in doubt, ask your pharmacist how to dispose of containers and medicines you no longer need. This will help protect the environment.

6. Contents of the pack and other information

Composition of Ezetimiba/Atorvastatina Alter

The active substances are ezetimibe and atorvastatin. Each film-coated tablet contains 10 mg of ezetimibe and 20 mg, 40 mg or 80 mg of atorvastatin (as atorvastatin calcium trihydrate).

The other components are: microcrystalline cellulose, mannitol, calcium carbonate, sodium croscarmellose, hydroxypropylcellulose, polysorbate 80, yellow iron oxide (E-172), magnesium stearate, povidone and sodium lauryl sulfate.

The tablet coating contains: monohydrate lactose (Ezetimiba/Atorvastatina Alter 10 mg/20 mg and 10 mg/40 mg), hypromellose (E-464), titanium dioxide (E-171), macrogol; and talc and yellow iron oxide (E-172) (Ezetimiba/Atorvastatina Alter 10 mg/80 mg).

Appearance of the product and contents of the pack

Ezetimiba/Atorvastatina Alter 10 mg/20 mg tablets are film-coated, oval-shaped, biconvex, white tablets with approximate dimensions of 11.6 x 7.1 mm.

Ezetimiba/Atorvastatina Alter 10 mg/40 mg tablets are film-coated, capsule-shaped, biconvex, white tablets with approximate dimensions of 16.1 x 6.1 mm.

Ezetimiba/Atorvastatina Alter 10 mg/80 mg tablets are film-coated, oblong, biconvex, yellow tablets with approximate dimensions of 19.1 x 7.6 mm.

The tablets are available in blister packs made of OPA/Al/PVC//Al, in pack sizes of 30 tablets.

Marketing Authorization Holder

Laboratorios Alter, S.A.

C/ Mateo Inurria 30

28036 Madrid

Spain

Manufacturer

ELPEN Pharmaceutical Co. Inc.

Marathonos Ave. 95, Pikermi Attiki, 19009

Greece

or

ELPEN Pharmaceutical Co. Inc.

Zapani, Block 1048, Keratea, 190 01

Greece

Date of the most recent revision of this leaflet: January 2024

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