LERCAPRESS 20 mg/10 mg FILM-COATED TABLETS

2. What you need to know before you take Lercapress

Do not take Lercapress:

• If you are allergic to enalapril maleate or lercanidipine hydrochloride, or to any of the other ingredients of this medicine (listed in section 6).
• If you have ever had an allergic reaction to a type of medicine similar to those contained in Lercapress, i.e. medicines called ACE inhibitors or calcium channel blockers.
• If you have ever experienced swelling of the face, lips, mouth, tongue, or throat that has caused difficulty swallowing or breathing (angioedema) after taking a type of medicine called ACE inhibitors, or if the cause of the reaction is unknown or if it is a hereditary condition.
• If you have taken or are currently taking sacubitril/valsartan, a medicine used to treat chronic heart failure in adults, the risk of angioedema (rapid swelling of the throat) is increased.
• If you have diabetes or kidney problems and are receiving treatment with a blood pressure-lowering medicine that contains aliskiren.
• If you are pregnant for more than 3 months (it is also recommended to avoid the use of Lercapress at the start of pregnancy, see section Pregnancy).
• If you have certain heart problems:
• obstruction of blood flow from the heart
• untreated heart failure
• unstable angina (chest pain that occurs at rest or worsens progressively)
• within the first month after having a heart attack.
• If you have severe liver problems
• If you have severe kidney problems or are undergoing dialysis.
• If you are taking medicines that inhibit liver metabolism, such as:
• antifungals (such as ketoconazole or itraconazole).
• macrolide antibiotics (such as erythromycin, troleandomycin, or clarithromycin).
• antivirals (such as ritonavir).
• If you are taking another medicine called ciclosporin (used after a transplant to prevent organ rejection).
• With grapefruit or grapefruit juice.

Warnings and precautions

Consult your doctor or pharmacist before starting to take Lercapress:

• If you have low blood pressure (which can manifest as dizziness or fainting, especially when standing up).
• If you have been very ill (with excessive vomiting) or have had diarrhea recently.
• If you have a salt-restricted diet.
• If you have a heart problem.
• If you have a disorder that affects the blood vessels in the brain.
• If you have kidney problems (including kidney transplant). This can lead to high levels of potassium in the blood, which can be serious. Your doctor may need to adjust your dose of enalapril or monitor your potassium levels.
• If you have liver problems.
• If you have blood problems, such as a low or absent white blood cell count (leukopenia, agranulocytosis), a low platelet count (thrombocytopenia), or a decrease in the number of red blood cells (anemia).
• If you have a vascular disease of the collagen (e.g., lupus erythematosus, rheumatoid arthritis, or scleroderma), are undergoing immunosuppressive therapy, or are taking allopurinol or procainamide, or a combination of both medicines.
• If you are a black patient, you should be aware that these patients have a higher risk of experiencing allergic reactions with inflammation of the face, lips, tongue, or throat, accompanied by difficulty swallowing or breathing, when taking ACE inhibitors.
• If you are diabetic, you should monitor your blood sugar levels, especially during the first month of treatment. Your potassium levels may also be elevated.
• If you are taking potassium supplements, potassium-sparing diuretics, or salt substitutes that contain potassium.
• If you are over 70 years old.
• If you have an intolerance to certain sugars (lactose)

If you are taking any of the following medicines, the risk of angioedema may be increased:

• Racecadotrile, a medicine used to treat diarrhea.
• Medicines used to prevent organ rejection after a transplant or to treat cancer (e.g., temsirolimus, sirolimus, everolimus).
• Vildagliptin, a medicine used to treat diabetes.

If you are taking any of the following medicines used to treat high blood pressure:

• a blocker of the angiotensin II receptor (ARB) (also known as sartans, such as valsartan, telmisartan, or irbesartan), especially if you have kidney problems related to diabetes.
• aliskiren.

Your doctor may need to check your kidney function, blood pressure, and the amount of electrolytes (e.g., potassium) in your blood at regular intervals.

Also, see the information included under the heading “Do not take Lercapress”.

If you are going to undergo surgery or certain treatments soon

If you are going to undergo any of the following procedures, inform your doctor that you are taking Lercapress:

• any surgical procedure or if you are going to be given an anesthetic (even in the dentist's office)
• a treatment to remove cholesterol from the blood known as “LDL apheresis”
• a desensitization treatment to reduce the effect of an allergy to bees or wasps.

You should inform your doctor if you think you are (or might be) pregnant or if you are breastfeeding (see the section Pregnancy, breastfeeding, and fertility).

Children and adolescents

The safety and efficacy of Lercapress in children under 18 years have not been established.

Other medicines and Lercapress

Lercapress should not be taken with certain medicines.

Tell your doctor or pharmacist if you are taking, have recently taken, or might take any other medicines, including those obtained without a prescription. This is because when Lercapress is taken with other medicines, the effect of Lercapress or the other medicines may be altered, or certain side effects may occur more frequently.

In particular, tell your doctor or pharmacist if you are taking any of the following medicines:

• other medicines that lower blood pressure
• potassium supplements (including salt substitutes in the diet), potassium-sparing diuretics, and other medicines that may increase potassium levels in the blood (e.g., trimethoprim and sulfamethoxazole for bacterial infections; ciclosporin, an immunosuppressive medicine used to prevent organ rejection; heparin, an anticoagulant medicine used to prevent blood clots). See section “Do not take Lercapress”
• lithium (a medicine used to treat a certain type of depression)
• medicines for depression called "tricyclic antidepressants"
• medicines for the treatment of mental problems, called "antipsychotics"
• non-steroidal anti-inflammatory medicines, including COX-2 inhibitors (medicines that reduce inflammation and can be used to combat pain)
• certain medicines for pain or arthritis, including gold therapy
• certain medicines for the treatment of cough and cold and weight-reducing medicines that contain a substance called "sympathomimetic agent"
• medicines for the treatment of diabetes (including oral antidiabetic medicines and insulin), astemizole, or terfenadine (medicines for allergies)
• amiodarone, quinidine, or sotalol (medicines for the treatment of a fast heart rate)
• phenytoin, phenobarbital, or carbamazepine (medicines for epilepsy)
• rifampicin (a medicine for the treatment of tuberculosis)
• digoxin (a medicine for the treatment of heart problems)
• midazolam (a medicine to help you sleep)
• beta-blockers, e.g., metoprolol (medicines that treat high blood pressure, heart failure, and abnormal heart rhythm)
• cimetidine (given at daily doses above 800 mg, a medicine for ulcers, indigestion, or acidity)

Do not take Lercapress if you have taken or are currently taking sacubitril/valsartan, a medicine used to treat chronic heart failure in adults, as the risk of angioedema (rapid swelling of the throat) is increased.

If you are taking any of the following medicines, the risk of angioedema may be increased:

• Racecadotrile, a medicine used to treat diarrhea.
• Medicines used to prevent organ rejection after a transplant or to treat cancer (e.g., temsirolimus, sirolimus, everolimus).
• Vildagliptin, a medicine used to treat diabetes.

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

• If you are taking an angiotensin II receptor blocker (ARB) or aliskiren (see also the information included under the headings “Do not take Lercapress” and “Warnings and precautions”).

Taking Lercapress with food, drinks, and alcohol

• Lercapress should be taken at least 15 minutes before meals.
• A fatty meal significantly increases the levels of the medicine in the blood.
• Alcohol may increase the effect of Lercapress. During treatment with Lercapress, you should not consume alcohol.
• Lercapress should not be taken with grapefruit or grapefruit juice, as it may increase its anti-hypertensive effect (see “Do not take Lercapress”).

Pregnancy, breastfeeding, and fertility

Pregnancy and fertility

You should inform your doctor if you think you are (or might be) pregnant. Your doctor will normally advise you to stop taking Lercapress before you become pregnant or as soon as you know you are pregnant and will recommend that you take another medicine instead of Lercapress. The use of Lercapress is not recommended in women who can become pregnant or at the start of pregnancy, and it should not be taken if you are pregnant for more than 3 months, as it can seriously harm the fetus if used after the third month of pregnancy.

Breastfeeding

Lercapress should not be taken during breastfeeding.

Driving and using machines

If you experience dizziness, weakness, or drowsiness with this medicine, you should not drive or operate machinery.

Lercapress contains lactose and sodium

If your doctor has told you that you have an intolerance to some sugars, contact your doctor before taking this medicine.

This medicine contains less than 23 mg of sodium (1 mmol) per tablet; this is essentially “sodium-free”.

3. How to take Lercapress

Follow exactly the instructions of administration of this medicine given to you by your doctor. If you are not sure, consult your doctor or pharmacist again.

Adults:unless your doctor has told you otherwise, the recommended dose is one tablet once a day, at the same time each day. The tablet should be taken preferably in the morning, at least 15 minutes before breakfast. The tablets should be swallowed whole with water. See “Taking Lercapress with food, drinks, and alcohol”.

Patient with kidney problems/elderly:your doctor will decide the dose of medicine that you should take, depending on how well your kidneys are working.

If you take more Lercapress than you should

Do not exceed the prescribed dose. If you have taken more than you should or in case of overdose, consult your doctor or pharmacist immediately, or call the Toxicology Information Service, telephone (91) 562 04 20, or go to the hospital immediately. Take the package and the leaflet of the medicine with you to the healthcare professional. A dose higher than the correct one may cause a significant drop in blood pressure and your heart may beat irregularly or faster.

If you forget to take Lercapress

• If you forget to take your tablet, do not take the missed dose.
• Take the next dose following the usual schedule.
• Do not take a double dose to make up for the missed doses.

If you stop taking Lercapress

• Do not stop taking your medicine unless your doctor tells you to.
• If you have any further questions on the use of this medicine, ask your doctor or pharmacist.

4. Possible Adverse Effects

Like all medicines, this medicine can cause adverse effects, although not all people suffer from them. This medicine may cause the following adverse effects:

Some adverse effects can be serious.

Tell your doctor immediately if you notice any of the following adverse effects:

An allergic reaction accompanied by swelling of the face, lips, tongue, or throat that can cause difficulty breathing or swallowing;

When you start taking Lercapress, you may feel weakness or dizziness, or notice that your vision becomes blurred; this is caused by a sudden drop in blood pressure, and if it occurs, it will be useful for you to lie down. If you are concerned, consult your doctor.

Adverse Effects Observed with Lercapress

Frequent (may affect up to 1 in 10 people)

Cough, feeling of dizziness, headache.

Uncommon (may affect up to 1 in 100 people)

Changes in blood parameter values, such as a decrease in platelet count, increase in blood potassium concentration, nervousness (anxiety), feeling of dizziness when standing up, vertigo, rapid heartbeat, rapid or irregular heartbeat (palpitations), sudden reddening of the face, neck, or upper chest (erythema), low blood pressure, abdominal pain, constipation, feeling sick (nausea), increase in liver enzyme levels, skin reddening, joint pain, increased urination frequency, feeling of weakness, fatigue, feeling of heat, ankle swelling.

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

Anemia, allergic reactions, ringing in the ears (tinnitus), fainting, dry throat, sore throat, indigestion, salty sensation on the tongue, diarrhea, dry mouth, gum inflammation, allergic reaction with swelling of the face, lips, tongue, or throat that causes difficulty swallowing or breathing, skin rash, hives, nocturia, production of large amounts of urine, impotence.

Additional Adverse Effects Observed with Enalapril or Lercanidipine Alone

Enalapril

Very common (affects more than 1 in 10 people)

Blurred vision, feeling of dizziness, weakness or discomfort, and cough.

Frequent (affects less than 1 in 10 people)

Depression, headache, fainting (syncope), chest pain, dizziness due to low blood pressure, changes in heart rate, rapid heartbeats, angina, shortness of breath, alterations in taste, increase in blood creatinine levels (usually detected by analysis), high blood potassium levels, diarrhea, abdominal pain, fatigue, rash, allergic reaction with inflammation of the face, lips, tongue, or throat with difficulty swallowing or breathing.

Uncommon (affects less than 1 in 100 people)

Anemia (including aplastic anemia and hemolytic anemia), sudden drop in blood pressure, confusion, nervousness, somnolence or insomnia, sensation of pins and needles in the skin or numbness, myocardial infarction (possibly caused by very low blood pressure in certain high-risk patients, including those with coronary or cerebral blood supply problems), stroke (possibly due to very low blood pressure in high-risk patients), runny nose, sore throat and hoarseness, asthma associated with chest tightness, slowing of food movement through the intestine (ileus), pancreatitis, feeling sick (vomiting), indigestion, constipation, stomach irritation (gastric irritation), dry mouth, ulcer, anorexia, itching or hives, hair loss, renal function alteration, renal failure, increased sweating, high protein levels in urine (measured by analysis), muscle cramps, feeling of general discomfort, high temperature (fever), low blood sugar or sodium levels, high urea levels in blood (all measured by blood analysis), reddening, rapid or irregular heartbeats (palpitations), vertigo (feeling of dizziness), ringing in the ears (tinnitus), impotence.

Rare (affects less than 1 in 1,000 people)

Changes in blood parameter values, such as a decrease in white blood cell count, bone marrow depression, autoimmune diseases, strange dreams or sleep disorders, Raynaud's phenomenon (in which hands and feet can become intensely cold and turn white due to low blood flow), nasal inflammation, pneumonia, liver problems, such as decreased liver function, liver inflammation, jaundice (yellowing of skin or eyes), increase in liver enzyme or bilirubin levels (measured by blood analysis), erythema multiforme (red spots of different shapes that appear on the skin), Stevens-Johnson syndrome and toxic epidermal necrolysis (a severe skin condition in which the skin reddens and scales form, blisters or open sores form), exfoliative dermatitis/erythroderma (severe skin rash with scaling or peeling of skin), pemphigus (small blisters filled with fluid on the skin), decreased urine production, male breast enlargement (gynecomastia), inflamed glands in the neck, armpits, or groin, fluid accumulation or other substances in the lungs (as seen on X-rays), cheek, gum, tongue, lip, or throat inflammation.

Very rare (affects less than 1 in 10,000 people)

Intestinal inflammation (intestinal angioedema).

Frequency not known (cannot be estimated from available data)

Excessive production of antidiuretic hormone that causes fluid retention, leading to weakness, fatigue, or confusion.

A set of symptoms has been reported that may include one or more of the following: fever, blood vessel inflammation (serositis, vasculitis), muscle pain (myalgia, myositis), joint pain (arthralgia/arthritis). A rash, photosensitivity, or other skin manifestations may occur.

Lercanidipine

Some of these adverse effects can be serious. If you experience any of these adverse effects, consult your doctor.

Rare (affects less than 1 in 1,000 people)

Chest pain (pain in the chest caused by lack of blood supply to the heart), allergic reactions (with symptoms such as itching, rash, hives), fainting.

Patients with pre-existing angina pectoris may experience an increase in frequency, duration, or severity of attacks associated with treatment with the group of medicines to which lercanidipine belongs. Isolated cases of myocardial infarction may be observed.

Other possible adverse effects:

Frequent (may affect up to 1 in 10 people): headache, rapid or irregular heartbeats (palpitations), sudden reddening of the face, neck, or upper chest, ankle swelling.

Uncommon (may affect up to 1 in 100 people): dizziness, low blood pressure, heartburn, discomfort, stomach pain, skin rash, itching, muscle pain, increased urination, weakness or fatigue.

Rare (may affect up to 1 in 1,000 people): somnolence, vomiting, diarrhea, hives, increased urination frequency, chest pain.

Frequency not known (cannot be estimated from available data): gum swelling, changes in liver function (detected by blood analysis), cloudy fluid (when performing hemodialysis through a tube into the abdomen), swelling of the face, lips, tongue, or throat that can cause difficulty breathing or swallowing.

If any of the adverse effects worsen, or if you experience any type of adverse effect that does not appear in this leaflet, inform your doctor or pharmacist. You can consult your doctor or pharmacist for more information about adverse effects, as they have a more complete list of adverse effects.

Reporting Adverse Effects

If you experience any type of adverse effect, consult your doctor or pharmacist, even if it is a possible adverse effect that does not appear in this leaflet. You can also report them directly through the Spanish Pharmacovigilance System for Human Use Medicines: www.notificaRAM.es. By reporting adverse effects, you can contribute to providing more information on the safety of this medicine.

5. Storage of Lercapress

Keep this medicine out of sight and reach of children.

Do not use this medicine after the expiration date that appears on the blister pack and on the packaging after CAD. The expiration date is the last day of the month indicated.

Store in the original packaging to protect it from light and moisture. Do not store above 25°C.

Medicines should not be disposed of through wastewater or household waste. Deposit the packaging and medicines you no longer need at the SIGRE collection point in the pharmacy. Ask your pharmacist how to dispose of the packaging and medicines you no longer need. This will help protect the environment.

6. Package Contents and Additional Information

Lercapress Composition

The active ingredients are enalapril maleate and lercanidipine hydrochloride.

Each film-coated tablet contains: 20 mg of enalapril maleate (equivalent to 15.29 mg of enalapril) and 10 mg of lercanidipine hydrochloride (equivalent to 9.44 mg of lercanidipine).

The other ingredients are:

Core: lactose monohydrate, microcrystalline cellulose, sodium starch glycolate type A, povidone K30, sodium bicarbonate, and magnesium stearate.

Film coating: hypromellose 5 cP, titanium dioxide (E171), talc, macrogol 6000, yellow quinoline aluminum lake (E104), and yellow iron oxide (E172).

Appearance of the Product and Package Contents

Lercapress 20 mg/10 mg film-coated tablets are 8.5 mm, yellow, circular, and biconvex.

Lercapress 20 mg/10 mg is available in packs of 7, 14, 28, 30, 35, 42, 50, 56, 90, 98, and 100 tablets.

Not all pack sizes may be marketed.

Marketing Authorization Holder and Manufacturer

Marketing Authorization Holder

Recordati Ireland, Ltd. Raheens East, Ringaskiddy Co. Cork - Ireland.

Local Representative:

Casen Recordati, S.L. Autovía de Logroño, km 13,300. 50180 Utebo (Zaragoza). Spain.

Manufacturer

RECORDATI Industria Chimica e Farmaceutica S.p.A. – Via Matteo Civitali 1 – I-20148 Milan, Italy

Doppel Farmaceutici S.r.l., Via Volturno 48, Quinto de’Stampi, 20089 Rozzano (MI), Italy

This medicine is authorized in the Member States of the EEA under the following trade names:

Germany Carmen ACE

Italy Atover

Spain Lercapress

Date of the last revision of this leaflet 07/2021

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