Ivabradine Alter 7.5 mg tablets EFG

Package leaflet: Information for the user

Introduction

Package leaflet: information for the patient

Ivabradine Alter 7.5 mg 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 or pharmacist.
• This medicine has been prescribed for you only, and you should not give it to other people, 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 Ivabradine Alter is and what it is used for
2. What you need to know before taking Ivabradine Alter
3. How to take Ivabradine Alter
4. Possible adverse effects
5. How to store Ivabradine Alter
6. Contents of the pack and other information

1. What Ivabradina Alter is and what it is used for

Ivabradina Alter (ivabradine) is a heart medication used to treat:

• Symptomatic stable angina (which causes chest pain) in adult patients whose heart rate is greater than or equal to 70 beats per minute. It is used in adult patients who cannot tolerate or are unable to take heart medications known as beta-blockers. It is also used in combination with beta-blockers in adult patients whose condition is not fully controlled with a beta-blocker alone.
• Chronic heart failure in adult patients whose heart rate is greater than or equal to 75 beats per minute. It is used in combination with standard therapy, including treatment with beta-blockers, or when beta-blockers are contraindicated or not tolerated.

About stable angina (commonly known as "angina")

Stable angina is a heart condition that occurs when the heart does not receive enough oxygen. It typically appears between the ages of 40 and 50. The most common symptom of angina is chest pain or discomfort. Angina is more likely to occur when the heart beats faster, such as during physical exertion, emotional stress, exposure to cold, or after eating. This increase in heart rate can trigger chest pain in people with angina.

About chronic heart failure

Chronic heart failure is a heart condition that occurs when your heart cannot pump enough blood to meet the needs of the body. The most common symptoms of heart failure are shortness of breath, fatigue, tiredness, and swelling of the ankles.

How Ivabradina Alter works

Ivabradina Alter works primarily by reducing the heart rate by a few beats per minute. This reduces the heart's demand for oxygen, especially in situations where an angina attack is more likely to occur. In this way, Ivabradina Alter helps control and reduce the number of angina attacks.

Additionally, since elevated heart rate negatively affects heart function and prognosis in patients with chronic heart failure, the specific heart rate-lowering action of ivabradine helps improve heart function and survival prognosis in these patients.

2. What you need to know before taking Ivabradina Alter

Do not take Ivabradina Alter

• if you are allergic to ivabradine or to any of the other ingredients of this medicine (listed in section 6);
• if your resting heart rate before treatment is too slow (below 70 beats per minute);
• if you are suffering from cardiogenic shock (a heart condition treated in hospital);
• if you have a heart rhythm disorder;
• if you are having a heart attack;
• if you have very low blood pressure;
• if you have unstable angina (a severe type of angina where chest pain occurs frequently, with or without exertion);
• if you have heart failure that has recently worsened;
• if your heart rate is solely determined by your pacemaker;
• if you have severe liver problems;
• if you are taking medicines for fungal infections (such as ketoconazole, itraconazole), macrolide antibiotics (such as josamycin, clarithromycin, telithromycin or oral erythromycin), medicines for treating HIV infections (such as nelfinavir, ritonavir) or nefazodone (a medicine for treating depression) or diltiazem, verapamil (used to treat high blood pressure or angina pectoris);
• if you are a woman of childbearing age and do not use reliable contraceptive methods;
• if you are pregnant or trying to become pregnant;
• if you are breastfeeding.

Warnings and precautions

Consult your doctor or pharmacist before taking Ivabradina Alter

• if you have heart rhythm disorders (such as irregular heartbeat, palpitations, increased chest pain) or sustained atrial fibrillation (a type of irregular heartbeat), or an abnormality on the electrocardiogram (ECG) called "Long QT syndrome",
• if you experience symptoms such as fatigue, dizziness or difficulty breathing (this may indicate that your heart is beating too slowly),
• if you develop symptoms of atrial fibrillation (unusually high resting pulse (above 110 beats per minute) or irregular pulse, without apparent reason, making it difficult to measure),
• if you have recently had a stroke (cerebral attack),
• if you have mild to moderate low blood pressure,
• if you have uncontrolled blood pressure, especially after a change in your antihypertensive treatment,
• if you have severe heart failure or heart failure with an ECG abnormality called "Bundle branch block",
• if you have chronic retinal eye disease,
• if you have moderate liver problems,
• if you have severe kidney problems.

If you have any of these conditions, consult your doctor immediately before or during treatment with Ivabradina Alter.

Children and adolescents

Ivabradina Alter is not intended for use in children and adolescents under 18 years of age.

Taking Ivabradina Alter with other medicines

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

Make sure to inform your doctor if you are taking any of the following medicines, as dose adjustment of Ivabradina Alter or monitoring may be necessary:

• fluconazole (an antifungal medicine)
• rifampicin (an antibiotic)
• barbiturates (for sleep disorders or epilepsy)
• phenytoin (for epilepsy)
• Hypericum perforatum or St. John's Wort (herbal remedy for depression)
• Medicines that prolong the QT interval used to treat heart rhythm disorders or other conditions:
  • quinidine, disopyramide, ibutilide, sotalol, amiodarone (to treat heart rhythm disorders)
  • bepridil (to treat angina pectoris)
  • certain types of medicines for treating anxiety, schizophrenia or other psychoses (such as pimozide, ziprasidone, sertindole)
  • antimalarial medicines (such as mefloquine or halofantrine)
  • intravenous erythromycin (an antibiotic)
  • pentamidine (an antiparasitic medicine)
  • cisapride (for gastroesophageal reflux)
• Certain types of diuretics that may cause a reduction in blood potassium levels, such as furosemide, hydrochlorothiazide, indapamide (used to treat edema, high blood pressure).

Taking Ivabradina Alter with food and drinks

Avoid grapefruit juice during treatment with Ivabradina Alter.

Pregnancy, breastfeeding and fertility

Do not take Ivabradina Alter if you are pregnant or intend to become pregnant (see "Do not take Ivabradina Alter").

If you are pregnant and have taken Ivabradina Alter, consult your doctor.

Do not take Ivabradina Alter if you are of childbearing age unless you use reliable contraceptive methods (see "Do not take Ivabradina Alter").

Do not take Ivabradina Alter if you are breastfeeding (see "Do not take Ivabradina Alter"). Speak with your doctor if you are breastfeeding or intend to start breastfeeding, as breastfeeding must be discontinued if you are taking Ivabradina Alter.

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

Driving and using machines

Ivabradina Alter may cause transient luminous phenomena (a brief brightness in the visual field, see "Possible side effects"). If this occurs, take care when driving or operating machinery in situations where sudden changes in light intensity may occur, especially when driving at night.

Ivabradina Alter contains lactose and glucose

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

This medicine contains glucose (from maltodextrin). If your doctor has informed you that you have an intolerance to certain sugars, consult him before taking this medicine.

3. How to take Ivabradina Alter

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

Ivabradina Alter should be taken with breakfast and dinner.

If you are being treated for stable angina

The starting dose should not exceed one tablet of Ivabradina Alter 5 mg twice daily. If you still have angina symptoms and have tolerated the dose of 5 mg twice daily well, the dose may be increased. The maintenance dose should not exceed 7.5 mg twice daily. Your doctor will prescribe the correct dose for you. The usual dose is one tablet in the morning and one tablet in the evening. In some cases (e.g. if you are elderly), your doctor may prescribe half the dose, i.e. half a tablet of Ivabradina Alter 5 mg (corresponding to 2.5 mg of ivabradine) in the morning and half a tablet of 5 mg in the evening.

If you are being treated for chronic heart failure

The recommended initial dose is one tablet of Ivabradina Alter 5 mg twice daily, which may be increased if necessary to one tablet of Ivabradina Alter 7.5 mg twice daily. Your doctor will decide the appropriate dose for you. The usual dose is one tablet in the morning and one tablet in the evening. In some cases (e.g. if you are elderly), your doctor may prescribe half the dose, i.e. half a tablet of Ivabradina Alter 5 mg (corresponding to 2.5 mg of ivabradine) in the morning and half a tablet of 5 mg in the evening.

If you take more Ivabradina Alter than you should

An overdose of Ivabradina Alter may make you feel tired or short of breath due to your heart beating too slowly. If this happens, contact your doctor immediately.

In case of overdose or accidental ingestion, contact your doctor, pharmacist, or call the Toxicology Information Service at telephone number 91.562.04.20, indicating the medicine and the amount taken.

If you forget to take Ivabradina Alter

If you forget to take a dose of Ivabradina Alter, take the next dose at the scheduled time. Do not take a double dose to make up for forgotten doses.

The calendar printed on the blister pack containing the tablets will help you remember when you last took a tablet of Ivabradina Alter.

If you stop taking Ivabradina Alter

Treatment for stable angina or chronic heart failure is usually lifelong; therefore, you should consult your doctor before stopping this medicine.

If you think that the effect of Ivabradina Alter is too strong or too weak, inform your doctor or pharmacist.

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 may cause adverse effects, although not everyone experiences them.

The frequency of the possible adverse effects listed below is defined using the following system:

very common: may affect more than 1 in 10 people
common: may affect up to 1 in 10 people
uncommon: may affect up to 1 in 100 people
rare: may affect up to 1 in 1,000 people
very rare: may affect up to 1 in 10,000 people
frequency not known: frequency cannot be estimated from the available data

The most common adverse reactions with this medicine are dose-dependent and related to its mechanism of action:

Very common

Luminous visual phenomena (brief episodes of increased brightness, almost always caused by sudden changes in light intensity). These may also be described as halos, colored flashes, image fragmentation, or multiple images. These usually appear during the first two months of treatment, after which they may recur repeatedly and resolve during or after treatment.

Common

Changes in heart function (symptoms include slowing of the heart rate). This occurs especially during the first 2 to 3 months after starting treatment.

Other adverse effects reported include:

Common

Rapid, irregular contraction of the heart, sensation of abnormal heartbeat, uncontrolled blood pressure, headache, dizziness, and blurred vision (cloudy vision).

Uncommon

Palpitations and extra heartbeats, sensation of dizziness (nausea), constipation, diarrhea, abdominal pain, sensation of spinning (vertigo), difficulty breathing (dyspnea), muscle cramps, changes in laboratory tests: elevated blood levels of uric acid, excess eosinophils (a type of white blood cell), and elevated blood creatinine levels (a muscle breakdown product), skin rash, angioedema (such as swelling of the face, tongue, or throat, difficulty breathing or swallowing), low blood pressure, fainting, feeling of fatigue, feeling of weakness, abnormal electrocardiogram, double vision, visual disturbance.

Rare

Urticaria, itching, skin redness, malaise.

Very rare

Irregular heartbeats.

Reporting of adverse effects:

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

5. Storage of Ivabradine 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 a SIGRE collection point at your pharmacy. If you are unsure, ask your pharmacist how to dispose of containers and medicines you no longer need. This way, you will help protect the environment.

6. Contents of the pack and other information

Composition of Ivabradine Alter

• The active substance is ivabradine (as hydrochloride).

Each tablet contains 7.5 mg of ivabradine (equivalent to 8.085 mg of ivabradine hydrochloride).

• The other components are: monohydrate lactose, pregelatinized corn starch, corn maltodextrin, anhydrous colloidal silica (E551), and magnesium stearate (E470b).

Appearance of the product and contents of the pack

Ivabradine Alter 7.5 mg are white or almost white, round, biconvex tablets, smooth on both sides.

The tablets are supplied in PA/Al/PVC-Aluminum blisters, calendared in packs of 56 tablets.

Marketing Authorization Holder and Manufacturer

Laboratorios Alter, S.A.

C/ Mateo Inurria 30

28036 Madrid

Spain

Date of the most recent review of this leaflet: September 2016.

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