ASTUCOR 5 mg/10 mg FILM-COATED TABLETS

2. What you need to know before you take Astucor

Do not take Astucor

• if you are allergic (hypersensitive) to amlodipine or atorvastatin or to any other calcium channel blocker or to any of the other ingredients of this medicine (listed in section 6)
• if you currently have a disease that affects the liver (if in the past you had a disease that affected the liver, see the "Warnings and precautions" section below)
• if you have had unexplained abnormal results in blood tests for liver function
• if you are pregnant, trying to become pregnant, or during breastfeeding
• if you are taking any of the following medicines: ketoconazole, itraconazole (medicines used to treat fungal infections or mycosis), telithromycin (an antibiotic)
• if you have low blood pressure (hypotension)
• if you have narrowing of the cardiac valve of the aorta (aortic stenosis) or cardiogenic shock (a situation where the heart is unable to provide enough blood to the body)
• if you suffer from heart failure after a heart attack
• if you use the combination of glecaprevir/pibrentasvir for the treatment of hepatitis C.

Warnings and precautions

Consult your doctor, pharmacist, or nurse before starting to take Astucor

• if you have severe respiratory failure
• if you are taking or have taken in the last 7 days a medicine that contains fusidic acid (used to treat bacterial infections), orally or by injection. The combination of fusidic acid and Astucor can cause serious muscle problems (rhabdomyolysis).
• if you have kidney problems
• if you have an underactive thyroid gland (hypothyroidism)
• if you have repeated or unexplained muscle pain, personal or family history of hereditary muscle problems
• if you have had muscle problems in the past while taking other cholesterol-lowering medicines (e.g., statins or fibrates)
• if you regularly drink large amounts of alcohol
• if you have had liver disease in the past
• if you are over 70 years old.
• if you have had a previous stroke with bleeding in the brain or have small fluid-filled sacs in the brain due to previous strokes.
• if you have or have had myasthenia (a disease that causes generalized muscle weakness that can affect the muscles used for breathing) or ocular myasthenia (a disease that causes weakness of the eye muscles), as statins can sometimes worsen the disease or cause myasthenia to appear (see section 4).

In any of these cases, your doctor will indicate whether you should have blood tests before and possibly during treatment with Astucor to calculate the risk of muscle side effects. It is known that the risk of suffering muscle side effects, such as rhabdomyolysis, increases when taking certain medicines (see "Other medicines and Astucor" section).

Also, inform your doctor or pharmacist if you experience constant muscle weakness. Additional tests and medications may be necessary to diagnose and treat this problem.

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

Other medicines and Astucor

Tell your doctor or pharmacist if you are taking, have recently taken, or might take any other medicines. There are some medicines that can interact with Astucor. This interaction can mean that one or both medicines are less effective. It can also increase the risk or severity of side effects, including serious muscle damage known as rhabdomyolysis and myopathy (described in section 4):

• Some antibiotics, such as rifampicin, fusidic acid, or "macrolide antibiotics", such as erythromycin, clarithromycin, telithromycin, or medicines for treating fungal infections, such as ketoconazole, itraconazole
• Medicines for controlling lipid levels: fibrates (e.g., gemfibrozil) or colestipol
• Medicines for controlling heart rhythm, such as amiodarone, diltiazem, and verapamil
• Anticonvulsants, such as carbamazepine, phenobarbital, phenytoin, fosphenytoin, primidone
• Medicines used to modify the functioning of your immune system, such as cyclosporine, tacrolimus, sirolimus, temsirolimus, and everolimus
• Medicines used in the treatment of HIV infection, such as ritonavir, lopinavir, atazanavir, indinavir, darunavir, tipranavir combined with ritonavir, etc., nelfinavir
• Some medicines used in the treatment of hepatitis C, such as telaprevir, boceprevir, and the combination of elbasvir/grazoprevir, ledipasvir/sofosbuvir
• Letermovir, a medicine that helps prevent diseases caused by cytomegalovirus
• Medicines used in the treatment of depression, such as nefazodone and imipramine
• Medicines used in the treatment of mental disorders, such as neuroleptics
• Medicines for treating heart failure, such as beta-blockers
• Medicines for treating high blood pressure, such as angiotensin II antagonists, ACE inhibitors, verapamil, and diuretics
• Alpha-blockers used in the treatment of high blood pressure and prostate problems.
• Other medicines that are known to interact with Astucor include ezetimibe (which reduces cholesterol), warfarin (which reduces blood clotting), oral contraceptives, stiripentol (an anticonvulsant for treating epilepsy), cimetidine (used for heartburn and peptic ulcer), phenazone (a pain reliever), colchicine (used for treating gout), and antacids (indigestion products containing aluminum or magnesium).
• Amifostine (used for cancer treatment)
• Sildenafil (for erectile dysfunction)
• Dantrolene and baclofen (muscle relaxants)
• Corticosteroids
• Over-the-counter medicines that contain St. John's Wort (Hypericum perforatum).
• If you need to take oral fusidic acid to treat a bacterial infection, you will need to stop using this medicine. Your doctor will tell you when you can restart treatment with Astucor. The use of Astucor with fusidic acid can cause muscle weakness, sensitization, or pain (rhabdomyolysis). For more information on rhabdomyolysis, see section 4.

Astucor may reduce your blood pressure even more if you are already taking other medicines to treat high blood pressure.

Tell your doctor or pharmacist if you are using or have recently used other medicines, including those bought without a prescription.

Taking Astucor with food, drinks, and alcohol

Astucor can be taken at any time of the day, with or without food.

Grapefruit juice

Do not drink more than one or two glasses of grapefruit juice per day, as large quantities of grapefruit juice can alter the effects of Astucor.

Alcohol

Avoid drinking too much alcohol while taking Astucor. See the details in the "Warnings and precautions" section.

Pregnancy, breastfeeding, and fertility

Do not take Astucor if you are pregnant, breastfeeding, or trying to become pregnant. When taking Astucor or any other medicine, women of childbearing age should take adequate contraceptive measures. Consult your doctor or pharmacist before using this medicine.

It has been shown that amlodipine passes into breast milk in small amounts.

Driving and using machines

Do not drive or operate machinery if you feel dizzy after taking this medicine.

Astucor contains sodium

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

3. How to take Astucor

Follow the instructions for taking this medicine exactly as stated in this leaflet or as directed by your doctor. If you are unsure, ask your doctor or pharmacist.

Adults

The usual initial dose of Astucor for adults is one 5 mg/10 mg tablet per day. If necessary, your doctor may increase the dose to one 10 mg/10 mg tablet per day.

Astucor should be swallowed whole with a little water. The tablets can be taken orally at any time of the day, with or without food. However, try to take your tablet at the same time every day.

Follow your doctor's dietary recommendations, especially regarding fat restriction in the diet, quitting smoking, and regular exercise.

If you think the effect of the Astucor tablets is too strong or too weak, tell your doctor or pharmacist.

Use in children and adolescents

This medicine is not recommended for children and adolescents.

If you take more Astucor than you should

If you accidentally take too many Astucor tablets (more than your usual daily dose), consult your doctor or the nearest hospital or call the Toxicology Information Service, telephone 91 562 04 20 (indicating the medicine and the amount taken).

Excess fluid may accumulate in the lungs (pulmonary edema) causing difficulty breathing, which can develop up to 24-48 hours after ingestion.

Bring the remaining tablets, the package, and the complete box so that hospital staff can easily identify the medicine you have taken.

If you forget to take Astucor

If you forget to take a dose, take the next scheduled dose at the correct time.

Do not take a double dose to make up for forgotten doses.

If you stop taking Astucor

Do not stop taking Astucor unless your doctor tells you to. If you have any other questions about the use of this medicine or want to stop treatment, ask your doctor or pharmacist.

4. Possible side effects

Like all medicines, this medicine can cause side effects, although not everybody gets them.

If you experience any of the following, stop taking Astucor and contact your doctor immediately:

• Swelling of the face, tongue, and airways that can cause great difficulty breathing
• If you have unexplained muscle weakness, muscle pain on palpation, pain or rupture in the muscles, or a change in the color of the urine to reddish-brown and at the same time, you feel unwell or have a fever. (Very rarely, this combination of effects can be a potentially life-threatening condition called rhabdomyolysis)
• Lupus-like syndrome (including rash, joint disorders, and effects on blood cells).

Very common (may affect more than 1 in 10 people)

• Swelling of arms, hands, legs, joints, or feet

Common (may affect up to 1 in 10 people)

• Allergic reaction
• Headache (especially at the start of treatment), dizziness, feeling tired, drowsiness
• Irregular heartbeat, flushing
• Palpitations (abnormal sensation of the heartbeat), difficulty breathing
• Inflammation of the nasal passages, sore throat, nosebleeds
• Feeling unwell, abdominal pain, indigestion, changes in bowel habits (including diarrhea, constipation, and flatulence)
• Pain in muscles and joints, muscle cramps and spasms, back pain, pain in the limbs.

• Increased sugar levels in the blood (if you have diabetes, you should continue to carefully monitor your blood sugar levels), increased creatine kinase in the blood, blood test results that show your liver function may be abnormal.
• Vision problems (including double vision), blurred vision

Uncommon (may affect up to 1 in 100 people)

• Hepatitis (inflammation of the liver)
• Rhinitis

• Loss of appetite, decreased blood sugar levels (if you have diabetes, you should continue to carefully monitor your blood sugar levels), weight gain or loss
• Difficulty sleeping, having nightmares, mood changes (including anxiety), depression, tremors, sensory nerve damage (decreased sensitivity) of the arms and legs, memory loss
• Ringing or buzzing in the ears
• Weakness, increased sweating, low blood pressure
• Dry mouth, changes in taste, vomiting, belching
• Hair loss, bruising or small spots on the skin, skin discoloration, decreased skin sensitivity to touch or pain, numbness or tingling in the fingers of the hands and feet, skin rash, hives, or itching
• Urinary disorders (including excessive urination at night and increased frequency of urination)
• Impotence, abnormal development of the breasts in men
• Feeling unwell, muscle fatigue, pancreatitis (inflammation of the pancreas that causes stomach pain), pain, neck pain, chest pain
• Positive urine tests for white blood cells
• Abnormal heart rhythm
• Cough

Rare (may affect up to 1 in 1,000 people)

• unexpected bleeding or bruising
• severe muscle inflammation, pain or cramps, muscle rupture that can rarely lead to rhabdomyolysis (destruction of muscle cells) and abnormal muscle breakdown. Abnormal muscle breakdown may not always disappear, even after stopping Astucor, and can be life-threatening and cause kidney problems
• decrease in blood platelet count
• liver disorders (yellowing of the skin and whites of the eyes)
• severe allergic skin reactions, skin redness, blistering rash, skin peeling that can spread rapidly to the rest of the body and may start with flu-like symptoms accompanied by high fever (toxic epidermal necrolysis)
• inflammation of the deep layers of the skin - including inflammation of the lips, eyelids, and tongue
• inflammation or swelling of the skeletal muscle, blistering rash, sudden and severe skin inflammation in one area
• tendon inflammation, tendon injury
• confusion

Very rare (may affect up to 1 in 10,000 people):

• allergic reaction - symptoms may include sudden wheezing, chest pain or tightness, swelling of the eyelids, face, lips, mouth, tongue, or throat, difficulty breathing, collapse
• reduction in white blood cell count
• increased muscle tension or stiffness
• heart attack, inflammation of small blood vessels, stomach pain (gastritis)
• gum overgrowth, gum bleeding
• hearing loss, liver failure
• photosensitivity (skin sensitivity to light)

Frequency not known: cannot be estimated from the available data

• persistent muscle weakness

• sexual dysfunction
• respiratory problems including persistent cough and/or difficulty breathing or fever
• disorders of the combination of stiffness, tremor, and/or movement disorders
• diabetes. This is more likely if you have high levels of sugar and fat in the blood, are overweight, and have high blood pressure. Your doctor will monitor you while you are taking this medication.
• severe myasthenia (a disease that causes generalized muscle weakness that, in some cases, affects the muscles used for breathing).
• ocular myasthenia (a disease that causes weakness of the eye muscles).

Consult your doctor if you experience weakness in your arms or legs that worsens after periods of activity, double vision, or drooping eyelids, difficulty swallowing, or difficulty breathing.

Reporting of side effects

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

5. Storage of Astucor

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

Do not use Astucor after the expiration date stated on the blister and carton after CAD. The expiration date is the last day of the month indicated.

Do not store above 30°C.

Medicines should not be disposed of via wastewater or household waste. Deposit the packaging and any unused medication in the SIGRE collection point at the pharmacy. If in doubt, ask your pharmacist how to dispose of the packaging and any unused medication. This will help protect the environment.

6. Package contents and additional information

Astucor composition

The active ingredients are amlodipine and atorvastatin. The 5mg/10mg Astucor tablets contain 5mg of amlodipine as amlodipine besylate and 10mg of atorvastatin as atorvastatin calcium trihydrate.

The other ingredients are: calcium carbonate (E-170), sodium croscarmellose, microcrystalline cellulose (E-460i), pregelatinized maize starch (corn starch), polysorbate 80, hypromellose (E-463), colloidal anhydrous silica (E-551), and magnesium stearate (E-470b).

The coating of the 5mg/10mg Astucor tablets contains: Opadry II White 85F28751 [polyvinyl alcohol, titanium dioxide (E-171), macrogol 3000, and talc (E-553b)].

Product appearance and package contents

The 5mg/10mg Astucor tablets are white, oval-shaped, and marked with CDT 051.

Astucor tablets are available in cartons with blisters containing 28 or 200 tablets.

Only some pack sizes may be marketed.

Marketing authorization holder and manufacturer

Marketing authorization holder

Almirall, S.A.

General Mitre, nº 151

08022 – Barcelona

Spain

Manufacturer

Klocke Pharma-Service GmbH

Strassburger Strasse 77

Appenweier 77767

Germany

or

Pfizer Manufacturing Deutschland GmbH

Mooswaldallee 1

79108 – Freiburg Im Breisgau

Germany

or

Mylan Hungary Kft.

Mylan utca 1

Komárom, 2900

Hungary

Date of last revision of this leaflet: March 2023

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