MICARDISPLUS 40 mg/12.5 mg TABLETS

2. What you need to know before you take MicardisPlus

Do not take MicardisPlus

• if you are allergic to telmisartan or any of the other ingredients of this medicine (listed in section 6).
• if you are allergic to hydrochlorothiazide or to other medicines of the sulfonamide type.
• if you are more than 3 months pregnant. (In any case, it is recommended that you avoid taking MicardisPlus at the start of your pregnancy – see section Pregnancy).
• if you have severe liver problems, such as cholestasis or biliary obstruction (problems with the drainage of bile from the liver and gall bladder) or any other severe liver disease.
• if you have severe kidney disease or anuria (less than 100 ml of urine per day).
• if your doctor has determined that you have low potassium or high calcium levels in your blood that do not improve with treatment.
• if you have diabetes or kidney insufficiency and are being treated with a blood pressure medicine that contains aliskiren.

If any of these apply to you, tell your doctor or pharmacist before taking MicardisPlus.

Warnings and precautions

Consult your doctor before taking MicardisPlus if you have or have had any of the following disorders or diseases:

• Low blood pressure (hypotension), which may occur if you are dehydrated (excessive loss of body water) or have low levels of salts due to treatment with diuretics, low-salt diet, diarrhea, vomiting, or hemofiltration.
• Kidney disease or kidney transplant.

• Renal artery stenosis (narrowing of the blood vessels to one or both kidneys).
• Liver disease.
• Heart problems.
• Diabetes.
• Gout.
• High levels of aldosterone (water and salt retention in the body, along with an imbalance of various minerals in the blood).
• Systemic lupus erythematosus (also called "lupus" or "SLE"), a disease in which the body's immune system attacks its own body.
• The active ingredient hydrochlorothiazide may cause a rare reaction, leading to decreased vision and eye pain. These symptoms may be indicative of fluid accumulation in the vascular layer of the eye (choroidal effusion) or increased pressure in your eye and may occur between hours and weeks after taking MicardisPlus. If left untreated, it may lead to permanent vision loss.
• If you have had skin cancer or if you 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 skin and lip cancer (non-melanoma skin cancer). Protect your skin from sun exposure and UV rays while taking MicardisPlus.

Consult your doctor before taking MicardisPlus:

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

• an angiotensin-converting enzyme inhibitor (ACE inhibitor) (e.g., enalapril, lisinopril, ramipril), especially if you have kidney problems associated with diabetes.
• aliskiren.

Your doctor may check your kidney function, blood pressure, and blood electrolyte levels (e.g., potassium) at regular intervals. See also the information under the heading "Do not take MicardisPlus".

• if you are taking digoxin.
• if you have had respiratory or lung problems (including inflammation or fluid in the lungs) after taking hydrochlorothiazide in the past. If you experience shortness of breath or severe difficulty breathing after taking MicardisPlus, seek medical attention immediately.

Consult your doctor if you experience abdominal pain, nausea, vomiting, or diarrhea after taking MicardisPlus. Your doctor will decide whether to continue treatment. Do not stop taking MicardisPlus on your own.

If you are pregnant, think you may be pregnant, or are planning to become pregnant, inform your doctor. MicardisPlus is not recommended during pregnancy and should not be taken after the third month of pregnancy, as it may cause serious harm to your baby if taken after this point.

Treatment with hydrochlorothiazide may cause an electrolyte imbalance in your body. Typical symptoms of fluid or electrolyte imbalance include dry mouth, weakness, lethargy, somnolence, restlessness, muscle pain or cramps, nausea, vomiting, muscle fatigue, and an abnormally fast heart rate (more than 100 beats per minute). If you experience any of these symptoms, inform your doctor.

You should also inform your doctor if you experience increased sensitivity of your skin to the sun with symptoms of sunburn (such as redness, itching, swelling, blistering) that appear more quickly than usual.

If you are going to have surgery or anesthesia, inform your doctor that you are taking MicardisPlus.

MicardisPlus may be less effective in lowering blood pressure in black patients.

Children and adolescents

MicardisPlus is not recommended for use in children and adolescents up to 18 years of age.

Other medicines and MicardisPlus

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

• Medicines containing lithium for treating certain types of depression.
• Medicines associated with low potassium levels in the blood (hypokalemia), such as other diuretics, laxatives (e.g., castor oil), corticosteroids (e.g., prednisone), ACTH (adrenocorticotropic hormone), amphotericin (an antifungal medicine), carbenoxolone (used to treat mouth ulcers), benzylpenicillin sodium (an antibiotic), and acetylsalicylic acid and its derivatives.
• Iodinated contrast product used in the context of an imaging examination.
• Medicines that may increase potassium levels in the blood, such as potassium-sparing diuretics, potassium supplements, salt substitutes containing potassium, ACE inhibitors, cyclosporin (an immunosuppressive medicine), and other medicines like heparin sodium (an anticoagulant).
• Medicines whose effects are influenced by changes in potassium levels in the blood, such as heart medicines (e.g., digoxin) or medicines that control your heart rate (e.g., quinidine, disopyramide, amiodarone, sotalol), medicines used for mental disorders (e.g., thioridazine, chlorpromazine, levomepromazine), and other medicines like certain antibiotics (e.g., sparfloxacin, pentamidine) or certain medicines for treating allergic reactions (e.g., terfenadine).
• Medicines for treating diabetes (insulins or oral agents like metformin).
• Colestyramine and colestipol, medicines for reducing blood fat levels.
• Medicines for increasing blood pressure, such as noradrenaline.
• Muscle relaxants, such as tubocurarine.
• Calcium and/or vitamin D supplements.
• Anticholinergic medicines (medicines used to treat a variety of disorders, such as gastrointestinal spasms, bladder spasms, asthma, dizziness, muscle spasms, Parkinson's disease, and as an aid to anesthesia) like atropine and biperiden.
• Amantadine (a medicine used to treat Parkinson's disease and also to treat or prevent certain viral diseases).
• Other medicines used to treat high blood pressure, corticosteroids, painkillers (such as non-steroidal anti-inflammatory drugs [NSAIDs]), medicines for treating cancer, gout, or arthritis.
• If you are taking an ACE inhibitor or aliskiren (see also the information under the headings "Do not take MicardisPlus" and "Warnings and precautions").
• Digoxin.

MicardisPlus may increase the blood-pressure-lowering effect of other medicines used to treat high blood pressure or medicines that may potentially lower blood pressure (e.g., baclofen, amifostine). Additionally, the decrease in blood pressure may be increased by alcohol, barbiturates, narcotics, or antidepressants. You may notice this effect as dizziness when standing up. You should consult your doctor if you need to adjust the dose of your other medicines while taking MicardisPlus.

The effect of MicardisPlus may be reduced when using NSAIDs (non-steroidal anti-inflammatory drugs, e.g., aspirin or ibuprofen).

Taking MicardisPlus with food and drink

You can take MicardisPlus with or without food.

Avoid drinking alcohol until you have talked to your doctor. Alcohol may further lower your blood pressure and/or increase the risk of feeling dizzy or weak.

Pregnancy and breast-feeding

Pregnancy

Inform your doctor if you are pregnant, think you may be pregnant, or are planning to become pregnant. Your doctor will normally advise you to stop taking MicardisPlus before you become pregnant or as soon as you know you are pregnant, and will advise you to take another medicine to lower your blood pressure instead. MicardisPlus is not recommended during pregnancy, and should not be taken after the third month of pregnancy, as it may cause serious harm to your baby if taken after this point.

Breast-feeding

Inform your doctor if you are breast-feeding or about to start breast-feeding, as MicardisPlus is not recommended for use during breast-feeding. Your doctor may decide to prescribe a different treatment if you want to breast-feed.

Driving and using machines

Some people feel dizzy, faint, or feel like everything is spinning when taking MicardisPlus. If you experience any of these effects, do not drive or use machines.

MicardisPlus contains sodium

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

MicardisPlus contains lactose

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

MicardisPlus contains sorbitol

This medicine contains 169 mg of sorbitol in each tablet.

3. How to take MicardisPlus

Take this medicine exactly as your doctor has told you. If you are not sure, ask your doctor or pharmacist.

The recommended dose is one tablet per day. Try to take the tablet at the same time each day. You can take MicardisPlus with or without food. The tablets should be swallowed whole with a little water or other non-alcoholic drink. It is important that you take MicardisPlus every day until your doctor tells you to stop.

If your liver is not working properly, the usual dose should not exceed 40 mg of telmisartan once a day.

If you take more MicardisPlus than you should

If you accidentally take too many tablets, you may experience symptoms such as low blood pressure and a fast heart rate. Slow heart rate, dizziness, vomiting, and reduced kidney function, including kidney failure, have also been reported. Due to the hydrochlorothiazide component, you may also experience very low blood pressure and low potassium levels in the blood, which can lead to nausea, drowsiness, and muscle cramps and/or irregular heartbeats associated with the simultaneous use of medicines like digitalis or certain anti-arrhythmic treatments. Contact your doctor or pharmacist or the nearest hospital emergency department immediately.

If you forget to take MicardisPlus

If you forget to take a dose, do not worry. Take it as soon as you remember and then continue as before. If you do not take your tablet one day, take your normal dose the next day. Donottake a double dose to make up for forgotten doses.

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.

Some adverse effects can be serious and require immediate medical attention:

If you experience any of the following symptoms, you should visit your doctor immediately:

Sepsis* (frequently called "blood infection", a serious infection that involves an inflammatory reaction of the entire body), rapid swelling of the skin and mucous membranes (angioedema including fatal outcome), blistering and peeling of the outer layer of the skin (toxic epidermal necrolysis); these adverse effects are rare (may affect up to 1 in 1,000 people) or very rare (toxic epidermal necrolysis; may affect up to 1 in 10,000 people), but are extremely serious and patients should stop taking the medicine and visit their doctor immediately. If these adverse effects are not treated, they can be fatal. An increase in the incidence of sepsis has been observed with telmisartan alone; however, it cannot be ruled out for MicardisPlus.

Possible Adverse Effects of MicardisPlus:

Common Adverse Effects (may affect up to 1 in 10 people)

Dizziness.

Uncommon Adverse Effects (may affect up to 1 in 100 people)

Decrease in blood potassium levels, anxiety, fainting (syncope), tingling sensation, numbness (paresthesia), sensation that everything is spinning (vertigo), rapid heartbeat (tachycardia), heart rhythm disturbances, low blood pressure, sudden decrease in blood pressure when standing up, shortness of breath (dyspnea), diarrhea, dry mouth, flatulence, back pain, muscle spasms, muscle pain, erectile dysfunction (inability to have or maintain an erection), chest pain, and increased blood uric acid levels.

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

Inflammation of the airways leading to the lungs (bronchitis), sore throat, inflammation of the paranasal sinuses, increased uric acid levels, low sodium levels, feeling of sadness (depression), difficulty falling asleep (insomnia), sleep disorder, vision disturbance, blurred vision, breathing difficulties, abdominal pain, constipation, abdominal distension (dyspepsia), nausea (vomiting), stomach inflammation (gastritis), liver function disorder (Japanese patients show a greater tendency to experience this adverse effect), skin redness (erythema), allergic reactions such as itching or rash, increased sweating, hives (urticaria), joint pain (arthralgia), and limb pain (leg pain), muscle cramps, activation or worsening of systemic lupus erythematosus (a disease in which the body's immune system attacks the body itself, causing joint pain, skin rashes, and fever), pseudo-flu syndrome, pain, increased blood creatinine, liver enzymes, or creatine phosphokinase levels.

Adverse reactions reported for one of the individual components may be potential adverse reactions of MicardisPlus, although they have not been observed in clinical trials with this product.

Telmisartan

The following additional adverse effects have been reported in patients taking telmisartan alone:

Uncommon Adverse Effects (may affect up to 1 in 100 people)

Upper respiratory tract infection (e.g., sore throat, sinusitis, common cold), urinary tract infections, bladder infection, red blood cell deficiency (anemia), high potassium levels, slow heart rate (bradycardia), cough, kidney function disorder including acute kidney failure, weakness.

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

Low platelet count (thrombocytopenia), increased white blood cell count (eosinophilia), severe allergic reactions (e.g., hypersensitivity, anaphylactic reactions), low blood sugar levels (in diabetic patients), drowsiness, stomach upset, eczema (a skin disorder), drug rash, toxic skin rash, tendon pain (symptoms of pseudotendinitis), decreased hemoglobin (a blood protein).

Very Rare Adverse Effects (may affect up to 1 in 10,000 people)

Progressive lung tissue fibrosis (interstitial lung disease)**

Frequency Not Known (cannot be estimated from available data)

Intestinal angioedema: swelling in the intestine has been reported, which occurs with symptoms such as abdominal pain, nausea, vomiting, and diarrhea after using similar products.

• This may have been a casual finding or be related to a currently unknown mechanism.

** Cases of progressive lung tissue fibrosis have been reported during telmisartan treatment. However, it is unknown whether telmisartan was the cause.

Hydrochlorothiazide

The following additional adverse effects have been reported in patients taking hydrochlorothiazide alone:

Very Common Adverse Effects (may affect up to 1 in 10 people)

High blood fat levels.

Common Adverse Effects (may affect up to 1 in 10 people)

Nausea, low magnesium levels in the blood, decreased appetite.

Uncommon Adverse Effects (may affect up to 1 in 100 people)

Acute kidney failure.

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

Low platelet count (thrombocytopenia), which increases the risk of bleeding and bruising (small purple-red marks on the skin or other tissues caused by bleeding), high calcium levels in the blood, high blood sugar levels, headache, abdominal discomfort, yellowing of the skin or eyes (jaundice), excess bile substances in the blood (cholestasis), photosensitivity reaction, uncontrolled blood glucose levels in patients with a diagnosis of diabetes mellitus, sugar in the urine (glucosuria).

Very Rare Adverse Effects (may affect up to 1 in 10,000 people)

Abnormal breakdown of red blood cells (hemolytic anemia), inability of the bone marrow to function properly, reduction of white blood cells (leukopenia, agranulocytosis), severe allergic reactions (e.g., hypersensitivity), increased blood pH due to low chloride levels (acid-base imbalance, hypochloremic alkalosis), acute respiratory distress (symptoms include severe shortness of breath, fever, weakness, and confusion), pancreatitis, pseudo-lupus syndrome (a disorder that resembles a disease called systemic lupus erythematosus in which the body's immune system attacks the body itself), blood vessel inflammation (necrotizing vasculitis).

Frequency Not Known (cannot be estimated from available data)

Skin and lip cancer (non-melanoma skin cancer), blood cell deficiency (aplastic anemia), vision loss and eye pain (possible signs of fluid accumulation in the vascular layer of the eye [choroidal effusion] or acute angle-closure glaucoma), skin disorders such as blood vessel inflammation of the skin, increased sensitivity to sunlight, skin rash, skin redness, blistering of the lips, eyes, or mouth, skin peeling, fever (possible signs of erythema multiforme), weakness, kidney function disorder.

In isolated cases, low sodium levels have been reported, accompanied by symptoms related to the brain or nerves (nausea, progressive disorientation, lack of interest or energy).

Reporting Adverse Effects

If you experience any adverse effect, consult 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 included in Appendix V. By reporting adverse effects, you can contribute to providing more information on the safety of this medicine.

5. Storage of MicardisPlus

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

Do not use this medicine after the expiration date stated on the carton after "EXP". The expiration date is the last day of the month indicated.

This medicine does not require any special storage temperature. Store in the original packaging to protect it from moisture. Remove your MicardisPlus tablet from the sealed blister pack just before taking it.

Occasionally, the outer layer of the blister pack may separate from the inner layer between the blister pack cavities. If this is detected, no action is required on your part.

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

6. Package Contents and Additional Information

MicardisPlus Composition

• The active ingredients are telmisartan and hydrochlorothiazide. Each tablet contains 40 mg of telmisartan and 12.5 mg of hydrochlorothiazide.
  • The other ingredients are lactose monohydrate, magnesium stearate, cornstarch, meglumine, microcrystalline cellulose, povidone K25, red iron oxide (E172), sodium hydroxide, sodium carboxymethylcellulose (type A), and sorbitol (E420).

Product Appearance and Package Contents

MicardisPlus 40 mg/12.5 mg tablets are oblong, two-layer tablets, red and white, with the company anagram and the code 'H4' engraved.

MicardisPlus is available in blister packs containing 14, 28, 56, 84, or 98 tablets, or in single-dose blister packs containing 28 x 1, 30 x 1, or 90 x 1 tablets.

Not all pack sizes may be marketed in your country.

Marketing Authorization HolderManufacturer

Boehringer Ingelheim International GmbH Boehringer Ingelheim Hellas Single

Binger Str. 173 Member S.A.

55216 Ingelheim am Rhein 5th km Paiania‑Markopoulo

Germany Koropi Attiki, 19441

Greece

and

Rottendorf Pharma GmbH

Ostenfelder Strasse 51 - 61

59320 Ennigerloh

Germany

and

Boehringer Ingelheim France

100-104 Avenue de France

75013 Paris

France

You can request more information about this medicine by contacting the local representative of the marketing authorization holder:

Date of Last Revision of this Leaflet:

Other Sources of Information

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