Tritace 10

Package leaflet: Information for the user

Warning! Keep this leaflet. The information on the immediate packaging is in a foreign language.
TRITACE 10 (Tritace)
10 mg, tablets
Ramiprilum
Tritace 10 and Tritace are different trade names for the same medicine.
Please read this leaflet carefully before using the medicine, as it contains
important information for the patient.

• Keep this leaflet, so that you can read it again if necessary.
• If you have any doubts, consult your doctor or pharmacist.
• This medicine has been prescribed for a specific individual. Do not give it to others. The medicine may harm another person, even if their symptoms are the same.
• If you experience any adverse effects, including any not listed in this leaflet, tell your doctor, pharmacist or nurse. See section 4.

Leaflet contents

1. What Tritace 10 is and what it is used for
2. What you need to know before taking Tritace 10
3. How to take Tritace 10
4. Possible side effects
5. How to store Tritace 10
6. Contents of the pack and other information

1. What Tritace 10 is and what it is used for

Tritace 10 contains the active substance ramipril. It belongs to a group of medicines called ACE inhibitors (angiotensin-converting enzyme inhibitors).

Tritace 10 works by:

• reducing the body's production of substances that increase blood pressure,
• reducing tension and widening blood vessels,
• helping the heart pump blood around the body more easily.

Tritace 10 may be used:

• to treat high blood pressure (hypertension),
• to reduce the risk of heart attack or stroke,
• to reduce or delay the progression of kidney function impairment (regardless of whether the patient has diabetes),
• to treat heart failure (when the heart does not pump enough blood to the rest of the body),
• to treat patients after a heart attack complicated by heart failure.

2. Important information before using Tritace 10

When not to use Tritace 10

• If the patient is allergic to ramipril, any other ACE inhibitor, or any of the other ingredients of this medicine (listed in section 6). Symptoms of an allergic reaction may include: rash, difficulty swallowing or breathing, swelling of the lips, face, throat, or tongue.
• If the patient has ever experienced a severe allergic reaction called "angioedema". Symptoms include: itching, hives, red spots on the palms, soles, and throat, swelling of the throat and tongue, swelling around the eyes and lips, difficulty breathing and swallowing.
• If the patient is taking or has taken sacubitril in combination with valsartan, a medicine used to treat chronic (long-term) heart failure in adults.
• If the patient is undergoing dialysis or other types of blood filtration. Depending on the type of equipment used, Tritace 10 may not be suitable.
• If the patient has kidney dysfunction due to reduced blood flow to the kidneys (renal artery stenosis).
• During the last 6 months of pregnancy (see section below "Pregnancy and breastfeeding").
• If blood pressure is very low or unstable – the doctor may recommend frequent blood pressure monitoring.
• If the patient has diabetes or kidney problems and is being treated with a blood pressure-lowering medicine containing aliskiren.

If any of the above situations apply, do not use Tritace 10.
If in doubt about using this medicine, consult a doctor before starting Tritace 10.

Warnings and precautions
Before starting Tritace 10, discuss this with your doctor or pharmacist.

• If the patient has heart, liver, or kidney disease.
• If the patient has recently lost a significant amount of electrolytes or fluids (due to vomiting, diarrhoea, excessive sweating, a low-sodium diet, prolonged use of diuretics (water tablets), or dialysis).
• If the patient is scheduled for treatment to reduce allergic reactions to bee or wasp venom (desensitisation).
• If the patient is to receive medicines used in anaesthesia. These may be used during surgical or dental procedures. It may be necessary to stop taking Tritace 10 one day before the procedure; if in doubt, contact your doctor.
• If the patient has high potassium levels in the blood (as shown in blood test results).
• If the patient is taking medicines or has conditions that may lower sodium levels in the blood. The doctor may recommend regular blood tests, particularly to monitor blood sodium levels, especially in elderly patients.
• If the patient is taking medicines that may increase the risk of angioedema (a severe allergic reaction), such as mTOR inhibitors (e.g. temsirolimus, everolimus, sirolimus), vildagliptin, neprilysin inhibitors (NEP) (such as racecadotril), or sacubitril in combination with valsartan (sacubitril with valsartan – see section 2 "When not to use Tritace 10").
• If the patient has collagenosis, such as scleroderma or systemic lupus erythematosus.
• Inform the doctor if pregnant, suspecting pregnancy, or planning pregnancy. Tritace 10 is not recommended during the first three months of pregnancy, and after the third month of pregnancy, this medicine may harm the unborn child (see section below "Pregnancy and breastfeeding").
• If the patient is taking any of the following medicines used to treat high blood pressure:
• an angiotensin II receptor antagonist (AIIRA), also known as a sartan – for example, valsartan, telmisartan, irbesartan, especially if the patient has kidney problems related to diabetes,
• aliskiren. The doctor may recommend regular monitoring of kidney function, blood pressure, and blood electrolyte levels (e.g. potassium). See also the subsection "When not to use Tritace 10".

Children and adolescents
Tritace 10 is not recommended for children and adolescents under 18 years of age, as the safety and efficacy of Tritace 10 have not been established.
If any of the above situations apply (or there is uncertainty), contact a doctor before starting Tritace 10.

Tritace 10 and 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. Tritace 10 may affect the action of other medicines, and other medicines may affect the action of Tritace 10.
Inform the doctor if the patient is taking any of the following medicines. These may reduce the effectiveness of Tritace 10:

• Pain-relieving and anti-inflammatory medicines (e.g. non-steroidal anti-inflammatory drugs [NSAIDs], such as ibuprofen or indomethacin, and aspirin).
• Medicines used to treat low blood pressure, shock, heart failure, asthma, or allergies, such as: ephedrine, noradrenaline, or adrenaline. The doctor will monitor the patient's blood pressure.

Inform the doctor if the patient is taking any of the following medicines. These may increase the risk of adverse effects when taken together with Tritace 10:

• sacubitril in combination with valsartan – used to treat chronic (long-term) heart failure in adults (see section 2 "When not to use Tritace 10"),
• pain-relieving and anti-inflammatory medicines (e.g. non-steroidal anti-inflammatory drugs [NSAIDs], such as: ibuprofen or indometacin, and aspirin),
• medicines used in cancer treatment (chemotherapy),
• medicines used to prevent organ transplant rejection, such as cyclosporine,
• diuretics (water tablets), such as furosemide,
• medicines that increase potassium levels in the blood, such as: spironolactone, triamterene, amiloride, potassium salts, trimethoprim used alone or in combination with sulfamethoxazole (used to treat bacterial infections), and heparin (a blood-thinning medicine),
• corticosteroid anti-inflammatory medicines, such as prednisolone,
• allopurinol (used to reduce uric acid levels in the blood),
• procainamide (used for heart rhythm disorders),
• temsirolimus (used to treat cancer),
• sirolimus, everolimus (used to prevent transplant rejection),
• vildagliptin (used to treat type 2 diabetes),
• racecadotril (used to treat diarrhoea),
• the doctor may recommend a dose adjustment and/or additional precautions if the patient is taking an angiotensin II receptor antagonist (AIIRA) or aliskiren (see also subsections "When not to use Tritace 10" and "Warnings and precautions").

Inform the doctor if the patient is taking any of the following medicines. Their effects may be altered when taking Tritace 10:

• antidiabetic medicines, such as oral glucose-lowering agents and insulin. Tritace 10 may lower blood glucose levels. Blood glucose levels should be monitored regularly during treatment with Tritace 10.
• lithium (used for psychiatric disorders). Tritace 10 may increase lithium levels in the blood. The doctor will recommend monitoring lithium levels in the blood.

If any of the above conditions apply (or if there is any uncertainty), consult a doctor before starting Tritace 10.

Tritace 10 with food and alcohol

• Drinking alcohol while taking Tritace 10 may cause dizziness and a feeling of lightheadedness. If in doubt about the amount of alcohol that can be consumed while taking Tritace 10, discuss with your doctor the possibility of combined effects of blood pressure-lowering medicines and alcohol.
• Tritace 10 can be taken with or without food.

Pregnancy and breastfeeding

Pregnancy
If the patient is pregnant or breastfeeding, suspects she may be pregnant, or is planning a pregnancy, she should consult a doctor before using this medicine. Tritace 10 should not be used during the first 12 weeks of pregnancy and must not be used from week 13 of pregnancy, as its use during pregnancy may harm the unborn child. If pregnancy occurs while taking Tritace 10, inform the doctor immediately. Before planning a pregnancy, therapy should be changed to an appropriate alternative treatment.

Breastfeeding
The patient should not use Tritace 10 if breastfeeding.

Before taking any medicine, consult a doctor or pharmacist.

Driving and using machines
Dizziness may occur while taking Tritace 10. The risk of dizziness is higher at the beginning of treatment with Tritace 10 and after increasing the dose. If the patient experiences dizziness, they should not drive, use tools, or operate machinery.

Tritace 10 contains sodium
This medicine contains less than 1 mmol (23 mg) of sodium per tablet, meaning it is considered "sodium-free".

3. How to use Tritace 10

This medicine should always be taken as directed by your doctor. If in doubt, consult your doctor or pharmacist.
Available on the market are: Tritace 2.5 (2.5 mg), Tritace 5 (5 mg), and Tritace 10 (10 mg).
Dosage
Treatment of arterial hypertension

• The usual starting dose is 1.25 mg or 2.5 mg once daily.
• Your doctor may adjust the dose until adequate blood pressure control is achieved.
• The maximum dose is 10 mg once daily.
• If you are taking diuretics (water pills), your doctor may discontinue or reduce the dose of the diuretic before starting treatment with Tritace 10.

Prevention of myocardial infarction or stroke

• The usual starting dose is 2.5 mg once daily.
• Your doctor may decide to increase the dose.
• The usual maintenance dose is 10 mg once daily.

Reduction or delay of renal function deterioration

• The usual starting dose is 1.25 mg or 2.5 mg once daily.
• Your doctor may modify the dosage.
• The usual maintenance dose is 5 mg or 10 mg once daily.

Treatment of heart failure

• The usual starting dose is 1.25 mg once daily.
• Your doctor may adjust the dosage.
• The maximum dose is 10 mg per day. It is recommended to administer the medicine in two divided doses.

Post-myocardial infarction treatment

• The usual starting dose is 1.25 mg to 2.5 mg once daily.
• Your doctor may adjust the dosage.
• The usual dose is 10 mg per day. It is recommended to administer the medicine in two divided doses.

Elderly patients
Your doctor will recommend a lower than usual starting dose, which will then be gradually increased.
Administration of the medicine

• This medicine should be taken orally, at the same time each day.
• Tablets should be swallowed with liquid.
• Do not crush or chew the tablets.

Taking more Tritace 10 than prescribed
Contact your doctor or go to the nearest hospital emergency department immediately.
Do not drive yourself—ask someone to take you to the hospital or call an ambulance. Bring the medicine packaging with you so the doctor knows which medicine was taken.
Missed dose of Tritace 10

• If you miss a dose, take the next scheduled dose at the usual time.
• Do not take a double dose to make up for the missed dose.

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

4. Possible adverse reactions

Like all medicines, this medicine can cause adverse reactions, although not everyone will experience them.
If the patient notices any of the following severe adverse reactions, treatment with Tritace 10 must be
discontinued and medical advice must be sought immediately – urgent medical care may be required:

• Swelling of the face, lips or throat causing difficulty in swallowing or breathing, together with itching and rash. These may be symptoms of a severe allergic reaction to Tritace 10.
• Severe skin reactions, including rash, mouth ulcers, worsening of pre-existing skin disorders, redness, blisters or peeling of the skin (such as Stevens-Johnson syndrome, toxic epidermal necrolysis or erythema multiforme).

If any of the following conditions occur, contact a doctor promptly:

• Rapid heartbeat, irregular or stronger heartbeat (palpitations), chest pain, feeling of pressure in the chest, or worsening of severe conditions, including myocardial infarction or stroke.
• Shortness of breath or cough. These may indicate lung disorders.
• Easy bruising, longer than usual bleeding time, any signs of bleeding (e.g. bleeding gums), purplish spots on the skin, or more frequent infections, sore throat and fever, fatigue, weakness, dizziness or pale skin. These may indicate blood or bone marrow disorders.
• Severe abdominal pain which may radiate to the back. These may be symptoms of pancreatitis.
• Fever, chills, weakness, loss of appetite, abdominal pain, nausea, yellowing of the skin or whites of the eyes (jaundice). These may be symptoms of liver disorders, such as hepatitis or liver damage.

Other adverse reactions
Inform your doctor if any of the following symptoms become severe or persist for more than a few days.
Common (may affect less than 1 in 10 patients)

• headache or feeling tired,
• dizziness; risk is higher at the beginning of treatment with Tritace 10 and after dose increase,
• fainting, hypotension (abnormally low blood pressure), especially after sudden change from lying to sitting or standing position,
• dry, persistent cough, sinusitis or bronchitis, shortness of breath,
• abdominal or intestinal pain, diarrhoea, indigestion, nausea or vomiting,
• rash with or without raised lesions,
• chest pain,
• muscle cramps or muscle pain,
• increased potassium levels in blood tests.

Uncommon (may affect less than 1 in 100 patients)

• balance disorders (dizziness),
• skin itching and sensory disturbances such as numbness, tingling, pricking, burning sensation or crawling sensation on the skin (paraesthesiae),
• loss or disturbances of taste sensation,
• sleep disturbances,
• depression, anxiety, nervousness or restlessness,
• nasal congestion, breathing difficulties or worsening of asthma,
• intestinal swelling known as "intestinal angioedema", presenting with abdominal pain, vomiting and diarrhoea,
• heartburn, constipation or dry mouth,
• increased urine output during the day,
• excessive sweating,
• loss or decrease of appetite (anorexia),
• rapid or irregular heartbeat,
• swelling of hands and feet; may indicate retention of larger than normal amounts of fluid,
• sudden flushing of the face,
• blurred vision,
• joint pain,
• fever,
• impotence, decreased libido in men and women,
• increased number of certain white blood cells (eosinophilia) in blood tests,
• blood test results indicating changes in liver, pancreas or kidneys.

Rare (may affect less than 1 in 1,000 patients)

• feeling of uneasiness, disorientation, confusion,
• red, swollen tongue,
• excessive skin peeling, itchy nodular rash,
• nail disorders (e.g. loosening or separation of the nail from the nail bed),
• rash or skin bruising,
• skin spots and cold extremities,
• redness, itching, swelling and tearing of the eyes,
• hearing disturbances and tinnitus,
• weakness,
• decreased number of red blood cells, white blood cells or platelets, or decreased haemoglobin levels in blood tests.

Very rare (may affect less than 1 in 10,000 patients)

• photosensitivity (increased sensitivity to sunlight).

Other reported adverse reactions
If any of the symptoms listed below become severe or persist for more than a few days, inform your doctor.

• difficulty concentrating,
• lip swelling,
• detection of low blood cell counts in blood tests,
• detection of lower than normal sodium levels in blood tests,
• concentrated urine (dark in colour), nausea or vomiting, muscle cramps, confusion and seizures, which may result from inappropriate ADH secretion (antidiuretic hormone – vasopressin). If any of the above symptoms occur, contact your doctor immediately,
• colour changes in fingers upon cold exposure and tingling or pain upon warming (Raynaud's phenomenon),
• breast enlargement in men,
• slowed or impaired reactions,
• burning sensation,
• disturbances of smell,
• hair loss.

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

5. How to store Tritace 10

Keep this medicine out of the 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 specified month.
No special storage conditions are required for this medicine.
Medicines must not be disposed of via wastewater or household waste. Ask your pharmacist how to dispose of medicines no longer required. Doing so helps protect the environment.

6. Contents of the pack and other information

What Tritace 10 contains
The active substance is ramipril. Each tablet contains 10 mg of ramipril.
The other ingredients are: hypromellose, pregelatinized starch, corn starch, microcrystalline cellulose,
sodium stearyl fumarate.

What Tritace 10 looks like and contents of the pack
White or almost white, elongated, divisible tablets measuring 7 x 4.5 mm, with "HMO/HMO" embossed on one side. The tablet can be divided into equal doses.
The tablets are packed in blisters made of PVC/Aluminium foil, containing 28 tablets per carton box.

For more detailed information, please contact the responsible party or the parallel importer.

Responsible party in Ireland, country of export:
sanofi-aventis Ireland Ltd. T/A SANOFI
Citywest Business Campus
Dublin 24
Ireland

Manufacturer:
Sanofi S.r.l.
Strada Statale 17km: 22, 67019 Scoppito (AQ), Italy
S.C. ZENTIVA S.A.
B-dul Theodor Pallady nr. 50, Sector 3, Bucharest, 032266, Romania
Delpharm Dijon
6, Boulevard de l’Europe, 21800 Quetigny, France

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

Authorisation number in Ireland, country of export: PA 540/84/8
Parallel import authorisation number: 97/20