Prestilol

Patient Information Leaflet

Warning! Keep this leaflet. The information on the immediate packaging is in a foreign language.
Prestilol (Cosimprel)
5 mg + 10 mg, film-coated tablets
Bisoprolol fumarate + Perindopril arginine
Prestilol and Cosimprel are different trade names for the same medicine.
Please read this leaflet carefully before taking this medicine, as it contains
important information for you.

• Keep this leaflet, you may need to read it again.
• If you have any further questions, please consult your doctor, pharmacist or nurse.
• This medicine has been prescribed for a specific individual. Do not pass it on to others. It may harm them even if their symptoms are the same.
• If you experience any side effects, including any not listed in this leaflet, inform your doctor, pharmacist or nurse. See section 4.

Leaflet Contents:

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

1. What Prestilol is and what it is used for

Prestilol contains two active substances in one tablet: bisoprolol fumarate and perindopril arginine.

• Bisoprolol fumarate belongs to a group of medicines called beta-blockers. Beta-blockers slow down the heart rate and make the heart more efficient at pumping blood throughout the body.
• Perindopril arginine is an angiotensin-converting enzyme (ACE) inhibitor. It works by widening blood vessels, which helps the heart pump blood more easily.

Prestilol is used to treat high blood pressure (hypertension) and/or to reduce the risk of heart events, such as heart attack, in patients with stable coronary artery disease (a condition in which blood supply to the heart is reduced or blocked) who have already had a heart attack and/or undergone a surgical procedure to improve blood supply to the heart by widening the blood vessels that supply it.
Instead of taking bisoprolol fumarate and perindopril arginine in separate tablets, the patient takes only one tablet of Prestilol, which contains both active substances in the same amounts.

2. Important information before using Prestilol

When not to use Prestilol:

• if the patient is allergic to bisoprolol or any other beta-blocker, to perindopril or any other ACE inhibitor, or to any of the other ingredients of this medicine (listed in section 6);
• if the patient has heart failure which has suddenly worsened and (or) requires hospital treatment;
• if the patient has cardiogenic shock (a severe heart condition causing very low blood pressure);
• if the patient has a heart disease characterized by slow or irregular heartbeat (second- or third-degree atrioventricular block, sinoatrial block, sick sinus syndrome);
• if the patient has a slow heart rate;
• if the patient has very low blood pressure;
• if the patient has severe asthma or severe chronic lung disease;
• if the patient has severe circulatory problems in the limbs (such as Raynaud's syndrome), which may cause tingling, paleness, or blueness of fingers and toes;
• if the patient has an untreated phaeochromocytoma, a rare adrenal gland tumour;
• if the patient has metabolic acidosis, a condition in which the blood contains too much acid;
• if during previous treatment with an ACE inhibitor the patient experienced symptoms such as: wheezing, swelling of the face, tongue or throat, severe itching, or severe skin rash, or if such symptoms occurred in a blood relative under any circumstances (a condition called angioedema);
• if the patient is more than 3 months pregnant (it is also better to avoid using Prestilol during early pregnancy – see section “Pregnancy”);
• if the patient has diabetes or kidney problems and is being treated with a blood pressure-lowering medicine containing aliskiren;
• if the patient is undergoing dialysis or another form of blood filtration. Depending on the device used, Prestilol may not be suitable for the patient;
• if the patient has kidney problems causing reduced blood supply to the kidneys (renal artery stenosis);
• if the patient has taken or is currently taking a combination medicine containing sacubitril and valsartan, used to treat heart failure, because this increases the risk of angioedema (rapid swelling of tissues under the skin in the throat area) (see “Warnings and precautions” and “Prestilol with other medicines”).

Warnings and precautions
Before starting Prestilol, discuss with your doctor or pharmacist if:

• the patient has diabetes;
• the patient has kidney problems (including patients after kidney transplant) or is undergoing dialysis;
• there are liver disorders;
• the patient has been diagnosed with aortic or mitral valve stenosis (narrowing of the main blood vessel leading from the heart), hypertrophic cardiomyopathy (a heart muscle disease), or renal artery stenosis (narrowing of arteries supplying blood to the kidneys);
• the patient has abnormally increased levels of a hormone called aldosterone in the blood (primary hyperaldosteronism);
• the patient has heart failure or any other heart disease, such as heart rhythm disorders or severe chest pain at rest (Prinzmetal's angina);
• the patient has been diagnosed with a collagenosis (connective tissue disease), such as systemic lupus erythematosus or scleroderma;
• the patient is on a low-salt diet or uses salt substitutes containing potassium (high potassium levels in blood may cause changes in heart rate);
• the patient has recently had diarrhoea or vomiting, or is dehydrated (Prestilol may cause a drop in blood pressure);
• the patient is undergoing LDL apheresis (removal of cholesterol from blood using a special device);
• the patient is undergoing allergen immunotherapy to reduce allergic reactions to bee or wasp stings;
• the patient is fasting or on a diet;
• the patient is undergoing anaesthesia and (or) surgery;
• the patient has circulatory disorders in the limbs;
• the patient has asthma or chronic lung disease;
• the patient has (or has had) psoriasis;
• the patient has an adrenal gland tumour (phaeochromocytoma);
• the patient has thyroid disorders (Prestilol may mask symptoms of hyperthyroidism);
• angioedema occurs (a severe allergic reaction with symptoms such as: swelling of the face, lips, tongue or throat, difficulty swallowing or breathing). This reaction may occur at any time during treatment. If such symptoms occur, the patient must stop taking Prestilol and contact a doctor immediately;
• in black patients, there is an increased risk of angioedema, and this medicine may be less effective in lowering blood pressure than in patients of other races;
• the patient is taking any of the following medicines used to treat high blood pressure:
  • an angiotensin II receptor antagonist (ARB) (also known as sartans – e.g. valsartan, telmisartan, irbesartan), especially if the patient has kidney problems related to diabetes;
  • aliskiren. The treating doctor may monitor kidney function, blood pressure, and blood electrolyte levels (e.g. potassium) at regular intervals. See also information under the heading “When not to use Prestilol”;
• the patient is taking any of the following medicines, which increase the risk of angioedema:
  • racecadotril (used to treat diarrhoea);
  • sirolimus, everolimus, temsirolimus, and other medicines belonging to the group of mTOR inhibitors (used to prevent rejection of transplanted organs and in cancer treatment);
  • sacubitril (available in a combination medicine containing sacubitril and valsartan), used to treat chronic heart failure;
  • linagliptin, saxagliptin, sitagliptin, vildagliptin, and other medicines belonging to the group of gliptins (used to treat diabetes).

Do not stop taking Prestilol suddenly, as this may cause a severe worsening of heart function. Treatment should not be stopped abruptly, especially in patients with coronary artery disease.
The patient must inform the doctor if she thinks she is (or might be) pregnant. Prestilol is not recommended during early pregnancy and must not be taken if the patient is more than 3 months pregnant, as the medicine may cause serious harm to the unborn child if used during this period (see section “Pregnancy”).

Children and adolescents
Prestilol is not recommended for children and adolescents under 18 years of age.

Prestilol with other medicines
Tell your doctor or pharmacist about all medicines the patient is currently taking or has recently taken, as well as any medicines the patient plans to take.
Other medicines may affect the action of Prestilol, or Prestilol may alter the effect of other medicines. This type of interaction may cause one or both medicines to be less effective. It may also increase the risk or severity of adverse effects.
Tell your doctor if the patient is taking any of the following medicines:

• medicines used to control blood pressure or heart conditions (such as amiodarone, amlodipine, clonidine, digitalis glycosides, diltiazem, disopyramide,
  felodipine, flecainide, lidocaine, methyldopa, moxonidine, procainamide, propafenone,
  quinidine, rilmenidine, verapamil);
• other medicines used to treat high blood pressure, including angiotensin II receptor antagonists (ARBs), aliskiren (see also information under “When not to use Prestilol” and “Warnings and precautions”), or diuretics (medicines that increase urine production by the kidneys);
• potassium-sparing medicines (e.g. triamterene, amiloride), potassium supplements, or salt substitutes containing potassium, or other medicines that may increase potassium levels in the body (such as heparin, a medicine used to thin the blood to prevent clots; trimethoprim and co-trimoxazole, also known as a combination medicine containing trimethoprim and sulfamethoxazole, used to treat bacterial infections);
• potassium-sparing medicines used in heart failure treatment: eplerenone and spironolactone at doses from 12.5 mg to 50 mg per day;
• sympathomimetic medicines used to treat shock (adrenaline, noradrenaline, dobutamine, isoprenaline, ephedrine);
• estramustine used to treat cancer;
• medicines most commonly used to treat diarrhoea (racecadotril) or to prevent rejection of transplanted organs (sirolimus, everolimus, temsirolimus, and other medicines belonging to the group of mTOR inhibitors). See section “Warnings and precautions”.
• sacubitril/valsartan combination medicine (used to treat chronic heart failure). See sections “When not to use Prestilol” and “Warnings and precautions”.
• lithium used to treat mania or depression;
• certain medicines used to treat depression, such as imipramine, amitriptyline, monoamine oxidase inhibitors (MAO inhibitors; except MAO-B inhibitors);
• certain medicines used to treat schizophrenia (antipsychotics);
• certain medicines used to treat epilepsy (phenytoin, barbiturates such as phenobarbital);
• anaesthetics used during surgical procedures;
• vasodilators, including nitrates (medicines that cause blood vessels to widen);
• trimethoprim used to treat infections;
• immunosuppressants (medicines that reduce the body's immune response), such as cyclosporine, tacrolimus, used to treat autoimmune disorders or after organ transplantation;
• allopurinol used to treat gout;
• parasympathomimetic medicines used to treat conditions such as Alzheimer's disease or glaucoma;
• locally applied beta-blockers used to treat glaucoma (increased eye pressure);
• mefloquine used to prevent or treat malaria;
• baclofen used to treat muscle stiffness in conditions such as multiple sclerosis;
• gold salts, particularly when administered intravenously (used to treat symptoms of rheumatoid arthritis);
• medicines used to treat diabetes, such as insulin, metformin, linagliptin, saxagliptin, sitagliptin, vildagliptin;
• non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, diclofenac, or high doses of acetylsalicylic acid, used to treat joint inflammation, headache, pain, or inflammatory conditions.

Prestilol with food and drink
It is recommended to take Prestilol before a meal.

Pregnancy and breastfeeding
If the patient is pregnant or breastfeeding, suspects she may be pregnant, or is planning to have a child, she should consult a doctor or pharmacist before using this medicine.

Pregnancy
The patient must inform the doctor if she thinks she is (or might be) pregnant. Usually, the doctor will advise stopping Prestilol before becoming pregnant or as soon as pregnancy is confirmed, and will recommend an alternative medicine. Prestilol is not recommended during early pregnancy and must not be taken after the third month of pregnancy, as it may cause serious harm to the unborn child if used beyond the third month of pregnancy.

Breastfeeding
The patient should inform the doctor if she is breastfeeding or starts breastfeeding. Prestilol is not recommended for mothers who are breastfeeding, and the doctor may choose an alternative treatment if the patient wishes to breastfeed, especially if the baby is a newborn or was born prematurely.

Driving and using machines
Prestilol usually does not affect alertness, but in some patients dizziness or weakness related to low blood pressure may occur, especially at the beginning of treatment, after a dose change, or in combination with alcohol. In such cases, the ability to drive or operate machinery may be impaired.

Prestilol contains sodium
Prestilol contains less than 1 mmol of sodium (23 mg) per tablet, which means the medicine is considered "sodium-free".

3. How to use Prestilol

This medicine should always be taken exactly as directed by your doctor or pharmacist. If you have any doubts,
you should consult your doctor or pharmacist.
The recommended dose is one tablet once daily. The tablet should be swallowed with a glass of water, in the morning
before a meal.
In some cases, your doctor may recommend half a tablet of Prestilol once daily, taken in the morning before a meal.

Patients with kidney disease
Prestilol is not recommended for patients with moderate or severe kidney disease.

Use in children and adolescents
Use in children and adolescents is not recommended.

Taking more Prestilol than recommended
If you take more tablets than recommended, contact your doctor or pharmacist immediately.
The most likely symptom of overdose is low blood pressure, which may cause dizziness or fainting (if this occurs, it may help to position the patient lying down with elevated legs), severe breathing difficulties, tremors (due to reduced blood sugar levels), and slowed heart rate.

Missed dose of Prestilol
It is important to take the medicine regularly every day, as this ensures optimal effectiveness. If you miss a dose of Prestilol, take the next dose at your usual time. Do not take a double dose to make up for a forgotten dose.

Stopping treatment with Prestilol
Do not stop treatment with Prestilol suddenly or change the dose without consulting your doctor, as this may lead to a significant worsening of heart function. Do not discontinue therapy abruptly, especially in patients with coronary artery disease.

If you have any further doubts about using this medicine, consult your doctor, pharmacist, or nurse.

4. Possible adverse effects

Like all medicines, this medicine can cause adverse effects, although not everyone will experience them.
You must stop taking this medicine and contact your doctor immediately if
any of the following adverse effects occur:

• severe dizziness or fainting caused by low blood pressure (common – may occur in up to 1 in 10 patients);
• worsening of heart failure causing significant shortness of breath and/or fluid retention in the body (common – may occur in up to 1 in 10 patients);
• swelling of the face, lips, mouth, tongue or throat, difficulty breathing (angioedema; uncommon – may occur in up to 1 in 100 patients);
• sudden onset of wheezing, chest pain, shortness of breath or difficulty breathing (bronchospasm; uncommon – may occur in up to 1 in 100 patients);
• extremely rapid or irregular heartbeat, chest pain (angina pectoris) or heart attack (very rare – may occur in up to 1 in 10,000 patients);
• muscle weakness in arms or legs, or difficulty speaking, which may be signs of stroke (very rare – may occur in up to 1 in 10,000 patients);
• pancreatitis, which may cause severe abdominal pain radiating to the back and general malaise (very rare – may occur in up to 1 in 10,000 patients);
• yellowing of the skin or eyes (jaundice), which may be a sign of liver inflammation (very rare – may occur in up to 1 in 10,000 patients);
• rash often starting with red, itchy spots on the face, arms or legs (erythema multiforme; very rare – may occur in up to 1 in 10,000 patients).

Prestilol is generally well tolerated, but as with other medicines, patients may experience various adverse effects, particularly at the beginning of treatment.
You should immediately inform your doctor or pharmacist if any of the following adverse effects occur in the patient:
Very common (may occur in more than 1 in 10 patients):

• slow heartbeat.

Common (may occur in up to 1 in 10 patients):

• headache;
• central dizziness;
• vestibular dizziness;
• taste disturbances;
• tingling;
• numbness of hands or feet;
• visual disturbances;
• tinnitus (sensation of hearing sounds);
• cold sensation in hands or feet;
• cough;
• shortness of breath;
• gastrointestinal disturbances such as nausea, vomiting, abdominal pain, indigestion or difficulty digesting, diarrhoea, constipation;
• allergic reactions such as rashes, itching;
• painful muscle cramps;
• feeling of fatigue;
• exhaustion.

Uncommon (may occur in up to 1 in 100 patients):

• mood changes;
• sleep disturbances;
• depression;
• dry mouth;
• severe itching or severe rash;
• formation of clusters of blisters on the skin;
• increased sensitivity of the skin to light (photosensitivity reaction);
• sweating;
• kidney disorders;
• impotence;
• increased number of eosinophils (a type of white blood cells);
• drowsiness;
• fainting;
• palpitations;
• tachycardia;
• irregular heart rate (atrioventricular conduction disorders);
• vasculitis;
• dizziness upon standing;
• muscle weakness;
• joint pain;
• muscle pain;
• chest pain;
• malaise;
• peripheral oedema;
• fever;
• falls;
• changes in laboratory test results: high potassium levels in blood, which resolves after discontinuation of treatment, low sodium levels, hypoglycaemia (very low blood sugar levels) in diabetic patients, increased blood urea levels, increased blood creatinine levels.

Rare (may occur in up to 1 in 1,000 patients):

• acute kidney failure;
• dark urine, nausea or vomiting, muscle cramps, confusion and seizures. These may be symptoms of a condition called SIADH (syndrome of inappropriate antidiuretic hormone secretion);
• reduced or no urine output;
• sudden redness of the face and neck;
• nightmares, hallucinations;
• decreased tear production (dry eyes);
• hearing problems;
• hepatitis, which may cause yellowing of the skin or whites of the eyes;
• allergic rhinitis, sneezing;
• allergy-like reactions: itching, hot flushes, rash;
• worsening of psoriasis;
• changes in laboratory test results: increased liver enzyme activity, high bilirubin levels in serum, abnormal blood lipid levels.

Very rare (may occur in up to 1 in 10,000 patients):

• confusion;
• eye irritation and redness (conjunctivitis);
• eosinophilic pneumonia (a rare type of lung inflammation);
• pancreatitis (which may cause severe epigastric pain radiating to the back);
• hair loss;
• onset or worsening of psoriasis, psoriasiform rash;
• blood count changes such as decreased white blood cells and red blood cells, decreased haemoglobin concentration, decreased platelet count.

Frequency not known (cannot be estimated from available data):

• bluish discoloration, numbness and pain in fingers or toes (Raynaud's phenomenon).

If any of these symptoms occur, you should contact your doctor as soon as possible.
Reporting of adverse effects
If any adverse effects occur, including any not listed in this leaflet, inform your doctor, pharmacist or nurse. Adverse effects can be reported directly to the Department of Monitoring Adverse Drug Reactions of the Office for Registration of Medicinal Products, Medical Devices and Biocidal Products
Al. Jerozolimskie 181C
02-222 Warsaw
Tel: +48 22 49 21 301
Fax: +48 22 49 21 309
Website: https://smz.ezdrowie.gov.pl
Reporting adverse effects helps provide more information on the safety of this medicine.

5. How to store Prestilol

Keep this medicine out of sight and reach of children.
Do not use this medicine after the expiry date stated on the packaging. The expiry date refers to the last day of the stated month.
No special storage instructions apply.
After first opening the container, Prestilol should be used within 60 days.
Medicines must not be disposed of via wastewater or household waste. Ask your pharmacist how to dispose of medicines no longer required. This will help protect the environment.

6. Contents of the packaging and other information

What Prestilol contains

• The active substances are bisoprolol fumarate and perindopril arginine. Each Prestilol tablet contains 5 mg of bisoprolol fumarate, equivalent to 4.24 mg of bisoprolol, and 10 mg of perindopril arginine, equivalent to 6.790 mg of perindopril.
• The other ingredients are: microcrystalline cellulose PH 102, calcium carbonate, pregelatinized maize starch, sodium carboxymethylstarch (type A), colloidal anhydrous silica, magnesium stearate, sodium croscarmellose, glycerol, hypromellose, macrogol 6000, titanium dioxide (E 171), yellow iron oxide (E 172), red iron oxide (E 172).

What Prestilol looks like and contents of the pack
Prestilol is a pink-beige, elongated, two-layer, film-coated tablet with a score line to facilitate splitting, marked with " " on one side and "5/10" on the other side of the tablet.
The tablet may be divided into two equal parts.
Tablets are available in containers containing 30 or 90 tablets (3 containers of 30 tablets each), packaged in cardboard boxes.
For more detailed information, please contact the marketing authorisation holder or the parallel importer.
Marketing Authorisation Holder in France, the country of export:
Les Laboratoires Servier, 50, rue Carnot, 92284 Suresnes cedex, France
Manufacturer:
Les Laboratoires Servier Industrie, 905 route de Saran, 45520 Gidy, France
Servier (Ireland) Industries Ltd, Gorey Road, Arklow - Co. Wicklow, Ireland
Anpharm Przedsiębiorstwo Farmaceutyczne S.A., Annopol 6B, 03-236 Warsaw, Poland
EGIS Pharmaceuticals PLC, Mátyás király u. 65, H-9900 Körmend, Hungary
Parallel importer:
Delfarma Sp. z o.o., ul. Św. Teresy od Dzieciątka Jezus 111, 91-222 Łódź, Poland
Repackaged in:
Delfarma Sp. z o.o., ul. Św. Teresy od Dzieciątka Jezus 111, 91-222 Łódź, Poland
Marketing authorisation numbers in France, the country of export: 34009 300 675 5 0
34009 300 675 6 7
Parallel import authorisation number: 182/23
This medicinal product is authorised for sale in the European Economic Area countries under the following names:
Belgium Bipressil 5 mg/10 mg comprimé pelliculé
Bulgaria Prestilol 5 mg/10 mg филмирани таблетки
Croatia Prestilol 5 mg/10 mg filmom obložene tablete
Cyprus Cosyrel 5 mg/10 mg επικαλυμμένα με λεπτό υμένιο δισκία
Czech Republic Cosyrel 5 mg/10 mg, potahované tablety
Estonia Prestilol
Finland Cosyrel 5 mg/10 mg Tabletti, kalvopäällysteinen
France Cosimprel 5 mg/10 mg, comprimé pelliculé
Greece Cosyrel 5 mg/10 mg επικαλυμμένα με λεπτό υμένιο δισκία
Hungary Cosyrel 5 mg/10 mg filmtabletta
Ireland Cosimprel 5 mg/10 mg film-coated tablet
Italy Cosyrel
Latvia Prestilol 5 mg/10 mg apvalkotās tabletes
Lithuania Cosimprel 5 mg/10 mg plėvele dengtos tabletės
Luxembourg Bipressil 5 mg/10 mg comprimé pelliculé
Netherlands Cosimprel 5 mg/10 mg filmomhulde tabletten
Poland Prestilol
Portugal Cosyrel 5 mg/10 mg
Romania Cosyrel 5 mg/10 mg comprimate filmate
Slovakia Prestilol 5 mg/10 mg filmom obalené tablety
Slovenia Cosyrel 5 mg/10 mg filmsko obložene tablete