Karvezide 300 mg/25 mg film-coated tablets

Patient Information Leaflet

Introduction

Patient Information Leaflet: Karvezide 300mg/25mg Film-coated Tablets

Irbesartan/hydrochlorothiazide

Read the entire leaflet carefully before you start taking this medicine, as 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 could harm them.
• If you experience any adverse effects, consult your doctor or pharmacist, even if the effects are not listed in this leaflet. See section 4.

Leaflet Contents

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

1. What Karvezide is and what it is used for

Karvezide is a combination of two active substances, irbesartan and hydrochlorothiazide.

Irbesartan belongs to a group of medicines known as angiotensin-II receptor antagonists.

Angiotensin-II is a substance produced in the body that binds to receptors in blood vessels, causing them to constrict. This leads to an increase in blood pressure. Irbesartan blocks angiotensin-II from binding to these receptors, thereby relaxing blood vessels and reducing blood pressure.

Hydrochlorothiazide belongs to a group of medicines (called thiazide diuretics) that lower blood pressure by increasing the amount of urine produced.

The two active substances in Karvezide work together to achieve a greater reduction in blood pressure than either of them alone.

Karvezide is used to treat high blood pressure when treatment with irbesartan alone or hydrochlorothiazide alone does not provide adequate control of your blood pressure.

2. What you need to know before taking Karvezide

Do not take Karvezide

• if you are allergic to irbesartan or to any of the other ingredients of this medicine (listed in section 6)
• if you are allergic to hydrochlorothiazide or any other sulfonamide-derived medicine
• if you are more than 3 months pregnant. (In any case, it is better to avoid taking this medicine also during early pregnancy – see section “Pregnancy”)
• if you have severe liver or kidney problems
• if you have difficulty passing urine
• if your doctor finds that you have persistently high calcium levels or low potassium levels in your blood
• if you have diabetes or renal impairment and are being treated with a blood pressure-lowering medicine containing aliskiren.

Warnings and precautions

Talk to your doctor before starting Karvezide and in any of the following cases:

• if you have excessive vomiting or diarrhoea

• if you have kidney problems or have had a kidney transplant

• if you have heart problems

• if you have liver problems

• if you have diabetes

• if you have low blood sugar levels (symptoms may include sweating, weakness, hunger, dizziness, trembling, headache, flushing or paleness, numbness, rapid and strong heartbeat), especially if you are being treated for diabetes

• if you have lupus erythematosus (also known as lupus or SLE)

• if you have primary aldosteronism (a condition related to excessive production of the hormone aldosterone, causing sodium retention and, in turn, increased blood pressure)

• 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), 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 rays while taking Karvezide.
  • if you have previously experienced respiratory or pulmonary problems (such as inflammation or fluid in the lungs) after taking hydrochlorothiazide. If you develop shortness of breath or severe difficulty breathing after taking Karvezide, seek medical attention immediately.

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

Consult your doctor if you experience abdominal pain, nausea, vomiting, or diarrhoea after taking Karvezide. Your doctor will decide whether to continue treatment. Do not stop taking Karvezide monotherapy without medical advice.

See also the information under the heading “Do not take Karvezide”.

If you are pregnant, suspect you may be pregnant, or plan to become pregnant, you must inform your doctor. Use of Karvezide is not recommended during the first three months of pregnancy, and it must not be used from the third month of pregnancy onwards, as it may cause serious harm to your baby (see section “Pregnancy”).

You should also inform your doctor if:

• you are on a low-salt diet
• you experience any of the following signs: feeling thirsty, dry mouth, general weakness, drowsiness, muscle pain or cramps, nausea, vomiting, or rapid heartbeat, as these may indicate an excessive effect of hydrochlorothiazide (contained in Karvezide)
• you experience increased skin sensitivity to sunlight with symptoms of sunburn (such as redness, itching, swelling, blisters) occurring more quickly than usual
• you are going to have surgery (a surgical procedure) or will be given anaesthetics
• you experience decreased vision or eye pain in one or both eyes while taking Karvezide. These could be symptoms of fluid accumulation in the vascular layer of the eye (choroidal effusion) or increased eye pressure (glaucoma), which may occur within hours to a week after taking Karvezide. This may lead to permanent vision loss if not treated. If you previously had an allergy to penicillin or sulfonamides, you may be at higher risk. You must stop treatment with Karvezide and seek immediate medical attention.

The hydrochlorothiazide contained in this medicine may cause positive results in doping tests.

Children and adolescents

Karvezide must not be given to children and adolescents (under 18 years of age).

Taking Karvezide with other medicines

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

Diuretics such as hydrochlorothiazide contained in Karvezide may interact with other medicines. You must not take lithium-containing preparations together with Karvezide without medical supervision.

Your doctor may need to adjust your dose and/or take other precautions:

If you are taking an angiotensin-converting enzyme inhibitor (ACE inhibitor) or aliskiren (see also information under the headings “Do not take Karvezide” and “Warnings and precautions”).

You may need blood tests if you are taking:

• potassium supplements
• salt substitutes containing potassium
• potassium-sparing medicines or other diuretics (tablets that increase urine production)
• certain laxatives
• medicines used to treat gout
• vitamin D supplements
• medicines to control heart rhythm
• medicines for diabetes (oral agents such as repaglinide or insulin)
• carbamazepine (a medicine used to treat epilepsy)

It is also important to inform your doctor if you are taking other medicines to lower your blood pressure, steroids, cancer treatments, painkillers, medicines for arthritis, or cholestyramine or colestipol resins to reduce blood cholesterol.

Taking Karvezide with food, drink and alcohol

Karvezide can be taken with or without food.

Due to the hydrochlorothiazide contained in Karvezide, if you drink alcohol while taking this medicine, you may experience increased dizziness upon standing, especially when getting up from a sitting position.

Pregnancy, breastfeeding and fertility

Pregnancy

Inform your doctor if you are pregnant, suspect you may be pregnant, or plan to become pregnant. Your doctor will generally advise you to stop taking Karvezide before becoming pregnant or as soon as pregnancy occurs, and will recommend an alternative antihypertensive medicine. Karvezide is not recommended during early pregnancy and must not be used from the third month of pregnancy onwards, as it may cause serious harm to your baby when used from that time.

Breastfeeding

Inform your doctor if you are planning to breastfeed or are currently breastfeeding, as Karvezide is not recommended for women during this period. Your doctor may choose a more suitable treatment if you wish to breastfeed, especially if the infant is a newborn or premature.

Driving and using machines

Karvezide is unlikely to affect your ability to drive or operate machinery. However, during treatment for high blood pressure, dizziness or fatigue may occasionally occur. If you experience these symptoms, speak with your doctor before driving or operating machinery.

Karvezide contains lactose. If your doctor has diagnosed you with an intolerance to certain sugars (e.g. lactose), consult him before taking this medicine.

Karvezide contains sodium. This medicine contains less than 1 mmol of sodium (23 mg) per tablet, i.e., essentially "sodium-free".

3. How to take Karvezide

Follow exactly the instructions for using this medicine provided by your doctor. If you are unsure, consult your doctor or pharmacist again.

Dosage

The recommended dose of Karvezide is one tablet daily. Generally, your doctor will prescribe Karvezide when previous treatments have not sufficiently reduced your blood pressure. Your doctor will advise you on how to switch from previous treatments to Karvezide.

Method of administration

Karvezide is administered orally. The tablets should be swallowed with a sufficient amount of liquid (e.g. a glass of water). You may take Karvezide with or without food. You should try to take your daily dose at the same time each day. It is important that you continue taking Karvezide unless your doctor advises you otherwise.

Maximum blood pressure-lowering effect should be achieved within 6–8 weeks after starting treatment.

If you take more Karvezide than you should

If you accidentally take too many tablets, contact your doctor immediately.

Children must not take Karvezide

Karvezide must not be given to children under 18 years of age. If a child swallows any tablets, contact your doctor immediately.

If you forget to take Karvezide

If you accidentally miss a dose, simply take your next dose at the usual time. Do not take a double dose to make up for missed doses.

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

4. Possible adverse effects

Like all medicines, Karvezide can cause adverse effects, although not everyone experiences them.

Some of these effects may be serious and may require immediate medical attention.

Rarely, cases of skin allergic reactions (rash, urticaria) have been reported in patients treated with irbesartan, as well as localized swelling of the face, lips and/or tongue. If you experience any of the above symptoms or have difficulty breathing, stop taking Karvezide and contact your doctor immediately.

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

Frequent: may affect up to 1 in 10 people
Uncommon: may affect up to 1 in 100 people

The adverse effects reported in clinical studies for patients treated with Karvezide were:

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

• nausea/vomiting
• urinary abnormalities
• fatigue
• dizziness (including dizziness upon standing from a lying or sitting position)
• blood tests may show elevated levels of an enzyme that measures muscle and heart function (creatine kinase) or elevated levels of substances that measure kidney function (blood urea nitrogen, creatinine).

If any of these adverse effects cause you problems, consult your doctor.

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

• diarrhea
• low blood pressure
• fainting
• tachycardia
• flushing
• swelling due to fluid retention (edema)
• sexual dysfunction (disturbances in sexual function)
• blood tests may show low levels of sodium and potassium in your blood.

If any of these adverse effects cause you problems, consult your doctor.

Adverse effects reported since Karvezide has been marketed

Since Karvezide has been marketed, some adverse effects have been reported. Adverse effects observed with frequency not known are: headache, tinnitus (ringing in the ears), cough, taste disturbances, indigestion, joint and muscle pain, liver function abnormalities and kidney failure, elevated levels of potassium in the blood, and allergic reactions such as rash, urticaria, swelling of the face, lips, mouth, tongue or throat. Rare cases of jaundice (yellowing of the skin and/or whites of the eyes) have also been observed.

As with all fixed-dose combinations of two active substances, adverse effects associated with each individual component cannot be excluded.

Adverse effects associated solely with irbesartan

In addition to the adverse effects described above, chest pain, severe allergic reactions (anaphylactic shock), decreased number of red blood cells (anemia – symptoms may include fatigue, headache, shortness of breath during exertion, dizziness and pallor), decreased platelet count (a blood cell essential for blood clotting), and low blood sugar levels have also been observed.

Rare (may affect up to 1 in 1,000 people): intestinal angioedema: swelling in the intestine presenting symptoms such as abdominal pain, nausea, vomiting, and diarrhea.

Adverse effects associated with hydrochlorothiazide in monotherapy

Loss of appetite; stomach irritation; stomach cramps; constipation; jaundice (yellowing of the skin and/or whites of the eyes); inflammation of the pancreas characterized by severe upper abdominal pain, often with nausea and vomiting; sleep disorders; depression; blurred vision; lack of white blood cells, which may lead to frequent infections and fever; decreased platelet count (blood cells essential for blood clotting), decreased number of red blood cells (anemia) characterized by fatigue, headache, shortness of breath during exertion, dizziness and pallor; kidney disease; lung disorders including pneumonia or fluid accumulation in the lungs; increased sensitivity of the skin to sunlight; inflammation of blood vessels; a skin disease characterized by peeling of the skin over the entire body; cutaneous lupus erythematosus, identified by a rash that may appear on the face, neck and scalp; allergic reactions; muscle weakness and spasms; changes in heart rhythm; reduction in blood pressure after a change in body position; swelling of the salivary glands; high blood sugar levels; sugar in the urine; increases in certain types of blood fats; high levels of uric acid in the blood, which may cause gout.

Very rare: Acute breathing difficulty (signs include severe shortness of breath, fever, weakness and confusion).

Frequency not known (cannot be estimated from available data): Skin and lip cancer (non-melanoma skin cancer), decreased vision or eye pain due to increased pressure (possible signs of fluid accumulation in the vascular layer of the eye (choroidal effusion) or acute angle-closure glaucoma).

It is known that adverse effects associated with hydrochlorothiazide may increase with higher doses of hydrochlorothiazide.

Reporting of adverse effects

If you experience any adverse effect, talk to 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 national reporting system listed in Appendix V. By reporting adverse effects, you can help provide more information on the safety of this medicine.

5. Storage of Karvezide

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

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

Do not store above 30 °C.

Store in the original packaging to protect from moisture.

Medicines should not be disposed of via wastewater or household waste. Ask your pharmacist how to dispose of medicines and packaging that you no longer need. This will help protect the environment.

6. Contents of the pack and other information

Composition of Karvezide

• The active substances are irbesartan and hydrochlorothiazide. Each Karvezide 300 mg/25 mg film-coated tablet contains 300 mg of irbesartan and 25 mg of hydrochlorothiazide.
• The other components are lactose monohydrate, microcrystalline cellulose, sodium croscarmellose, hypromellose, colloidal silicon dioxide, magnesium stearate, titanium dioxide, polyethylene glycol 3350, red, yellow and black iron oxides, pregelatinized starch, carnauba wax. See section 2 "Karvezide contains lactose".

Appearance of the product and contents of the pack

Karvezide 300 mg/25 mg film-coated tablets are pink, biconvex, oval-shaped tablets, with a heart-shaped breakline on one side and the number 2788 engraved on the other.

Karvezide 300 mg/25 mg film-coated tablets are available in blister packs containing 14, 28, 30, 56, 84, 90 or 98 film-coated tablets. It is also available in unit-dose blister packs of 56 x 1 film-coated tablet for hospital supply.

Only certain pack sizes may be marketed.

Marketing Authorization Holder

Sanofi Winthrop Industrie

82 avenue Raspail

94250 Gentilly

France

Manufacturer

SANOFI WINTHROP INDUSTRIE

1, rue de la Vierge

Ambarès & Lagrave

F-33565 Carbon Blanc Cedex - France

SANOFI WINTHROP INDUSTRIE

30-36 Avenue Gustave Eiffel

37100 Tours – France

For further information about this medicine, please contact the local representative of the Marketing Authorization Holder:

Date of the most recent review of this leaflet:

Detailed information on this medicine is available on the European Medicines Agency website: http://www.ema.europa.eu.