Acebis

Package Leaflet: Information for the Patient

ACEBIS, 2.5 mg + 1.25 mg, hard capsules
ACEBIS, 2.5 mg + 2.5 mg, hard capsules
ACEBIS, 5 mg + 2.5 mg, hard capsules

ACEBIS, 5 mg + 5 mg, hard capsules

ACEBIS, 10 mg + 5 mg, hard capsules

ACEBIS, 10 mg + 10 mg, hard capsules

ramipril + bisoprolol fumarate

Read the package leaflet carefully before taking the medicine, as it contains important information for you.

• You should keep this leaflet, you may need to read it again.
• If you have any further questions, ask your doctor, pharmacist, or nurse.
• This medicine has been prescribed for you only. Do not pass it on to others. It may harm them, even if their symptoms are the same as yours.
• If you get any side effects, talk to your doctor, pharmacist, or nurse. This includes any possible side effects not listed in this leaflet. See section 4.

Contents of the package leaflet

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

1. What ACEBIS is and what it is used for

ACEBIS contains two active substances - bisoprolol fumarate and ramipril - in one capsule.

• Ramipril is an angiotensin-converting enzyme (ACE) inhibitor. It works by widening the blood vessels, making it easier for the heart to pump blood to the body.
• Bisoprolol fumarate belongs to a group of medicines called beta-blockers (beta-adrenergic blocking agents). Beta-blockers slow the heart rate and increase the efficiency of the heart in pumping blood to the body.

ACEBIS is used to treat high blood pressure (hypertension) and/or chronic heart failure with left ventricular dysfunction (a condition where the heart is not able to pump enough blood to meet the body's needs, resulting in shortness of breath and swelling) and/or to reduce the risk of heart events, such as heart attack, in patients with chronic coronary artery disease (a condition where blood flow to the heart is reduced or blocked) who have had a heart attack and/or have had a procedure to improve blood flow to the heart by widening the blood vessels that supply it, or diabetes with at least one other cardiovascular risk factor.

2. Important information before taking ACEBIS

When not to take ACEBIS:

• if you are allergic to bisoprolol or any other beta-blocker, ramipril or any other ACE inhibitor, or any of the other ingredients of this medicine (listed in section 6),
• if you have severe heart failure that has suddenly worsened and may require hospital treatment,
• if you have cardiogenic shock (a serious heart condition caused by very low blood pressure),
• if you have a heart condition characterized by a slow or irregular heart rate (second or third degree atrioventricular block, sinoatrial block, sick sinus syndrome),
• if you have a slow heart rate,
• if you have very low blood pressure,
• if you have severe asthma or severe chronic obstructive pulmonary disease (COPD),
• if you have serious blood circulation problems in your limbs (such as Raynaud's syndrome), which may cause tingling, pallor, or cyanosis of the fingers and toes,
• if you have an untreated phaeochromocytoma (a rare tumor of the adrenal gland),
• if you have metabolic acidosis (a condition where the blood contains too much acid),
• if you have had angioedema (a severe allergic reaction with swelling of the face, lips, tongue, or throat, and difficulty breathing or swallowing) during previous treatment with an ACE inhibitor, or if you or a member of your family have had angioedema in any other circumstances,
• if you are pregnant more than 3 months (ACEBIS is not recommended in early pregnancy - see "Pregnancy"),
• if you have diabetes or kidney problems and are treated with aliskiren, a medicine that lowers blood pressure,
• if you are on dialysis or undergoing another type of blood filtration. Depending on the device used, ACEBIS may not be suitable for you.
• if you have kidney problems where blood flow to the kidneys is reduced (renal artery stenosis),
• if you are being treated with sacubitril/valsartan, a medicine used to treat heart failure (see "Warnings and precautions" and "Other medicines and ACEBIS").

Warnings and precautions

Before taking ACEBIS, talk to your doctor or pharmacist if:

• you have diabetes,
• you have kidney problems (including a kidney transplant) or are on dialysis,
• you have liver problems,
• you have a narrowing of the aortic valve and mitral valve (narrowing of the main blood vessel leaving the heart) or hypertrophic cardiomyopathy (a heart muscle disease) or renal artery stenosis (narrowing of the artery supplying the kidney with blood),
• you have an abnormally high level of a hormone called aldosterone in your blood (primary aldosteronism),
• you have heart failure or any other heart problems, such as minor arrhythmias or severe chest pain at rest (Prinzmetal's angina),
• you have a connective tissue disease (such as systemic lupus erythematosus or scleroderma),
• you are on a low-salt diet or are taking salt substitutes that contain potassium (too much potassium in the blood can cause changes in heart rate),
• you have recently had diarrhea or vomiting or are dehydrated (ACEBIS may cause a drop in blood pressure),
• you are going to have LDL apheresis (a procedure to remove cholesterol from the blood using a special device),
• you are currently undergoing desensitization treatment or are planning to undergo desensitization treatment to reduce the effects of an allergy to bee or wasp stings,
• you are on a strict diet or fasting,
• you are going to have anesthesia and/or major surgery,
• you have circulation problems in your limbs,
• you have asthma or COPD,
• you have (or have had) psoriasis,
• you have an adrenal gland tumor (pheochromocytoma),
• you have thyroid problems (ACEBIS may mask the symptoms of hyperthyroidism),
• you have angioedema (a severe allergic reaction with swelling of the face, lips, tongue, or throat, and difficulty breathing or swallowing). This can occur at any time during treatment. If you experience these symptoms, stop taking ACEBIS and contact your doctor immediately.
• you are black, as you may be at higher risk of angioedema, and this medicine may be less effective in lowering your blood pressure than in patients of other races,
• you are taking any of the following medicines for high blood pressure:
• angiotensin II receptor antagonists (ARBs) (also known as sartans - e.g., valsartan, telmisartan, irbesartan), especially if you have kidney problems related to diabetes.
• aliskiren. Your doctor may check your kidney function, blood pressure, and electrolyte levels (such as potassium) at regular intervals. See also the information under "When not to take ACEBIS".
• you are taking any of the following medicines - the risk of angioedema is increased:
• racecadotril (used to treat diarrhea),
• sirolimus, everolimus, temsirolimus, and other medicines in the class of mTOR inhibitors (used to prevent organ rejection),
• sacubitril (available in fixed-dose combination with valsartan), used to treat chronic heart failure.

Do not stop taking ACEBIS suddenly, as this can cause serious worsening of your heart condition. Do not stop treatment suddenly, especially in patients with coronary artery disease.
Your doctor will advise you to stop taking ACEBIS before you become pregnant or as soon as you know you are pregnant and will prescribe another medicine instead of ACEBIS. Do not take ACEBIS during the first trimester of pregnancy and do not take it after the third month of pregnancy, as it may seriously harm your baby (see "Pregnancy").

Children and adolescents

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

Other medicines and ACEBIS

Tell your doctor or pharmacist about all the medicines you are taking now or have recently taken, and about any medicines you plan to take.
There are medicines that can affect the way ACEBIS works or that can have their effect changed by ACEBIS. This type of interaction can make one or both medicines less effective. It can also increase the risk or worsen side effects.
Remember to tell your doctor if you are taking any of the following medicines:

• medicines used to control blood pressure or heart diseases (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 the information under "When not to take ACEBIS" and "Warnings and precautions") or diuretics (medicines that increase the amount of urine produced by the kidneys),
• potassium-sparing medicines (such as triamterene, amiloride), potassium supplements, or salt substitutes containing potassium, other medicines that can increase potassium levels in the body (such as heparin and cotrimoxazole, also known as trimethoprim/sulfamethoxazole),
• potassium-sparing medicines used to treat heart failure: eplerenone and spironolactone at doses of 12.5 mg to 50 mg per day,
• sympathomimetic medicines used to treat shock (adrenaline, noradrenaline, dobutamine, isoprenaline, ephedrine),
• estramustine used in cancer therapy,
• medicines used to treat diarrhea (racecadotril) or to prevent organ rejection (sirolimus, everolimus, temsirolimus, and other medicines in the class of mTOR inhibitors). See "Warnings and precautions".
• sacubitril/valsartan (used to treat chronic heart failure). See "When not to take ACEBIS" and "Warnings and precautions".
• lithium used to treat mania or depression,
• certain medicines used to treat depression, such as imipramine, amitriptyline, monoamine oxidase inhibitors (MAOIs) (except MAO-B inhibitors),
• certain medicines used to treat schizophrenia (antipsychotics),
• certain medicines used to treat epilepsy (phenytoin, barbiturates such as phenobarbital),
• anesthetics used in surgical procedures,
• vasodilators, including nitrates,
• trimethoprim used to treat infections,
• immunosuppressants (medicines that weaken the body's defense mechanisms), such as cyclosporine, tacrolimus, used to treat autoimmune disorders or after organ transplantation,
• allopurinol used to treat gout,
• parasympathomimetic medicines used to treat diseases such as Alzheimer's disease or glaucoma,
• beta-blockers used topically to treat glaucoma (increased pressure in the eye),
• mefloquine used to prevent or treat malaria,
• baclofen used to treat muscle stiffness in diseases such as multiple sclerosis,
• gold salts, especially when given 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 medicines (NSAIDs), such as ibuprofen or diclofenac, or high doses of aspirin used to treat arthritis, headache, pain, or inflammation.

Taking ACEBIS with food, drink, and alcohol

It is recommended to take ACEBIS before a meal.

Pregnancy and breastfeeding

If you are pregnant or breastfeeding, think you may be pregnant, or are planning to have a baby, ask your doctor or pharmacist for advice before taking this medicine.
Pregnancy
Tell your doctor if you are pregnant or think you may be pregnant. Your doctor will usually advise you to stop taking ACEBIS before you become pregnant or as soon as you know you are pregnant and will prescribe another medicine instead of ACEBIS. Do not take ACEBIS during the first trimester of pregnancy and do not take it after the third month of pregnancy, as it may seriously harm your baby.
Breastfeeding
Tell your doctor if you are breastfeeding or planning to breastfeed. ACEBIS is not recommended for breastfeeding mothers, and your doctor may choose another treatment for you if you want to breastfeed, especially if your baby is newborn or premature.

Driving and using machines

ACEBIS usually does not affect alertness, but some patients may experience dizziness or weakness due to low blood pressure, especially at the beginning of treatment or when changing medication, as well as in combination with alcohol. If these changes occur, the ability to drive or operate machinery may be impaired.
Lactose
ACEBIS 2.5 mg + 1.25 mg contains 40.97 mg of lactose (20.49 mg of glucose and 20.49 mg of galactose) per dose. This should be taken into account in patients with diabetes.
ACEBIS 2.5 mg + 2.5 mg contains 40.97 mg of lactose (20.49 mg of glucose and 20.49 mg of galactose) per dose. This should be taken into account in patients with diabetes.
ACEBIS 5 mg + 2.5 mg contains 81.94 mg of lactose (40.97 mg of glucose and 40.97 mg of galactose) per dose. This should be taken into account in patients with diabetes.
ACEBIS 5 mg + 5 mg contains 81.94 mg of lactose (40.97 mg of glucose and 40.97 mg of galactose) per dose. This should be taken into account in patients with diabetes.
ACEBIS 10 mg + 5 mg contains 163.88 mg of lactose (81.94 mg of glucose and 81.94 mg of galactose) per dose. This should be taken into account in patients with diabetes.
ACEBIS 10 mg + 10 mg contains 163.88 mg of lactose (81.94 mg of glucose and 81.94 mg of galactose) per dose. This should be taken into account in patients with diabetes.
Sodium
ACEBIS contains less than 1 mmol of sodium (23 mg) per capsule, which means it is essentially "sodium-free".

3. How to take ACEBIS

Always take this medicine exactly as your doctor or pharmacist has told you. If you are not sure, ask your doctor or pharmacist.
The recommended dose is one capsule once a day. The capsule should be swallowed in the morning before a meal, with a glass of water.
Patients with kidney disease
Your doctor will adjust the dose of ACEBIS if you have moderate kidney disease. ACEBIS is not recommended in patients with severe kidney disease.
Patients with liver problems
Your doctor will carefully monitor you if you have mild or moderate liver disease when starting treatment with ACEBIS.

Use in children and adolescents

ACEBIS is not recommended for children and adolescents.

Taking more than the prescribed dose of ACEBIS

If you have taken more capsules than prescribed, contact your doctor or pharmacist immediately.
The most likely effect of overdose is low blood pressure, which can cause dizziness or fainting (in which case lying down with your legs raised may help), severe breathing difficulties, tremors (due to low blood sugar), and slow heart rate.

Missing a dose of ACEBIS

It is important to take your medicine every day, as regular treatment is more effective. However, if you miss a dose of ACEBIS, take the next dose at the usual time. Do not take a double dose to make up for a missed dose.

Stopping treatment with ACEBIS

Do not stop taking ACEBIS suddenly or change your dose without consulting your doctor, as this can cause serious worsening of your heart condition. Do not stop treatment suddenly, especially in patients with coronary artery disease.
If you have any further questions on the use of this medicine, ask your doctor, pharmacist, or nurse.

4. Possible side effects

Like all medicines, ACEBIS can cause side effects, although not everybody gets them.
Stop taking the medicine and tell your doctor immediately if you experience any of the following side effects:

• severe dizziness or fainting due to low blood pressure (common - may affect up to 1 in 10 people),
• worsening of heart failure causing increased shortness of breath and/or fluid retention (common - may affect up to 1 in 10 people),
• swelling of the face, lips, mouth, tongue, or throat, difficulty breathing (angioedema) (uncommon - may affect up to 1 in 100 people),
• sudden wheezing, chest pain, shortness of breath, or difficulty breathing (bronchospasm) (uncommon - may affect up to 1 in 100 people),
• abnormal or irregular heartbeats, chest pain (angina pectoris), or heart attack (uncommon - may affect up to 1 in 100 people),
• weakness or numbness in the arms or legs or problems with speech, which may be signs of a possible stroke (frequency not known - cannot be estimated from the available data),
• pancreatitis, which can cause severe abdominal pain radiating to the back, accompanied by a very bad feeling (rare - may affect up to 1 in 10,000 people),
• jaundice (yellowing of the skin or eyes), which can be a sign of liver inflammation (rare - may affect up to 1 in 1,000 people),
• skin rash, which often starts with red, itchy patches on the face, hands, or feet (erythema multiforme) (frequency not known - cannot be estimated from the available data).

ACEBIS is usually well tolerated, but, like all medicines, it can cause side effects, especially at the beginning of treatment.

If you experience any of the following side effects, tell your doctor or pharmacist:

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

• slow heart rate.

Common (may affect up to 1 in 10 people):

• headache,
• dizziness,
• fainting, low blood pressure (hypotension), especially when standing up quickly or sitting up,
• numbness in the hands or feet,
• feeling cold in the hands or feet,
• cough,
• shortness of breath,
• sinusitis or bronchitis,
• chest pain,
• gastrointestinal disorders, such as nausea, vomiting, abdominal pain, difficulty swallowing, or indigestion, diarrhea, constipation,
• allergic reactions, such as skin rash, itching,
• muscle cramps, muscle pain (myalgia),
• feeling tired or weak,
• fatigue,
• blood tests showing high levels of potassium in the blood.

Uncommon (may affect up to 1 in 100 people):

• peripheral dizziness,
• taste disorders,
• tingling (paresthesia),
• vision disorders,
• tinnitus (ringing in the ears),
• stuffy nose, difficulty breathing, or worsening of asthma,
• nasal congestion,
• sudden flushing (especially of the face),
• mood changes,
• sleep disorders,
• depression,
• dry mouth,
• sweating,
• kidney problems,
• increased urine production during the day than usual,
• impotence,
• high levels of eosinophils (a type of white blood cell),
• drowsiness,
• palpitations,
• rapid heart rate (tachycardia),
• irregular heart rate (atrioventricular conduction disorders),
• muscle weakness,
• joint pain (arthralgia),
• localized swelling (peripheral edema),
• fever,
• loss of appetite (anorexia),
• changes in laboratory parameters: increased levels of certain white blood cells (eosinophilia), increased levels of urea in the blood, increased levels of creatinine in the blood, increased liver enzyme activity, increased bilirubin levels in the blood,
• high levels of protein in the urine,
• mouth ulcers,
• breast enlargement in men.

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

• nightmares, hallucinations,
• reduced tear secretion (dry eyes),
• redness, itching, swelling, or tearing of the eyes,
• hearing problems,
• liver inflammation, which can cause yellowing of the skin or eyes,
• blood vessel inflammation,
• changes in laboratory parameters: increased fat levels, decreased red blood cell count, white blood cell count, or hemoglobin levels.

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

• confusion,
• pancreatitis (which can cause severe abdominal pain radiating to the back),
• hair loss,
• appearance or worsening of a scaly skin rash (psoriasis), psoriasis-like rash,
• increased sensitivity of the skin to sunlight (photosensitivity reaction),

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

• discoloration, numbness, and pain in the fingers and toes (Raynaud's phenomenon),
• low levels of sodium, very low levels of sugar in the blood (hypoglycemia) in patients with diabetes,
• tongue inflammation.

When taking ACE inhibitors, the following side effects may occur: thickening of the urine (dark color), nausea, or vomiting, muscle cramps, confusion, and seizures, which may be caused by abnormal secretion of antidiuretic hormone (ADH). If you experience these symptoms, contact your doctor as soon as possible.

Reporting side effects

If you get any side effects, talk to your doctor, pharmacist, or nurse. This includes any possible side effects not listed in this leaflet.
Side effects can be reported to the Department of Drug Safety Monitoring of the Office for Registration of Medicinal Products, Medical Devices, and Biocidal Products
Jerozolimskie Avenue 181C

• 02-222 Warsaw Tel.: +48 22 49 21 301 Fax: +48 22 49 21 309 Website: https://smz.ezdrowie.gov.pl Side effects can also be reported to the marketing authorization holder.

5. How to store ACEBIS

Keep this medicine out of the sight and reach of children.
Do not use this medicine after the expiry date which is stated on the blister and carton after EXP. The expiry date refers to the last day of that month.
Do not store above 30°C. Do not store in the refrigerator or freeze.
Medicines should not be disposed of via wastewater or household waste. Ask your pharmacist how to dispose of medicines no longer required. These measures will help protect the environment.

6. Contents of the pack and other information

What ACEBIS contains

• The active substances are ramipril and bisoprolol fumarate.
• The other ingredients are: Contents of the capsule:lactose monohydrate, polyvinyl alcohol, sodium croscarmellose (E468), sodium stearyl fumarate, microcrystalline cellulose, calcium hydrogen phosphate anhydrous, crospovidone type A, colloidal anhydrous silica, magnesium stearate

AquaPolish P yellow :hypromellose (E 464), hydroxypropylcellulose (E463), medium-chain triglycerides, talc (E 553b), titanium dioxide (E 171) ,yellow iron oxide (E 172).
Capsule shell: titanium dioxide (E 171), gelatin, red iron oxide (E 172) – [in capsules 10 mg+10 mg, 10 mg+5 mg, 5 mg+5 mg, 5 mg+2.5 mg], yellow iron oxide (E 172) – [in capsules 10 mg+5 mg, 5 mg+5 mg, 5 mg+2.5 mg, 2.5 mg+2.5 mg 2.5 mg+1.25 mg], quinoline yellow (E 104) – [in capsules 5 mg+2.5 mg, 2.5 mg+2.5 mg, 2.5 mg+1.25 mg].
Ink: shellac (E904), black iron oxide (E172), propylene glycol, concentrated ammonia, potassium hydroxide.

What ACEBIS looks like and contents of the pack

ACEBIS 2.5 mg + 1.25 mg, hard capsules
The capsule has a yellow cap with black printing "2.5 mg" and a white body with black printing "1.25 mg".
Contents of the 2.5 mg + 1.25 mg capsule: ramipril in the form of a white or almost white powder and bisoprolol fumarate in the form of one yellow, biconvex, film-coated, round tablet
ACEBIS 2.5 mg + 2.5 mg, hard capsules
The capsule has a yellow cap with black printing "2.5 mg" and a yellow body with black printing "2.5 mg".
Contents of the 2.5 mg + 2.5 mg capsule: ramipril in the form of a white or almost white powder and bisoprolol fumarate in the form of one yellow, biconvex, film-coated, round tablet
ACEBIS 5 mg + 2.5 mg, hard capsules
The capsule has an orange cap with black printing "5 mg" and a yellow body with black printing "2.5 mg".
Contents of the 5 mg + 2.5 mg capsule: ramipril in the form of a white or almost white powder and bisoprolol fumarate in the form of one yellow, biconvex, film-coated, round tablet
ACEBIS 5 mg + 5 mg, hard capsules
The capsule has an orange cap with black printing "5 mg" and an orange body with black printing "5 mg".
Contents of the 5 mg + 5 mg capsule: ramipril in the form of a white or almost white powder and bisoprolol fumarate in the form of one yellow, biconvex, film-coated, round tablet
ACEBIS 10 mg + 5 mg, hard capsules
The capsule has a reddish-brown cap with black printing "10 mg" and an orange body with black printing "5 mg".
Contents of the 10 mg + 5 mg capsule: ramipril in the form of a white or almost white powder and bisoprolol fumarate in the form of one yellow, biconvex, film-coated, round tablet
ACEBIS 10 mg + 10 mg, hard capsules
The capsule has a reddish-brown cap with black printing "10 mg" and a reddish-brown body with black printing "10 mg".
Contents of the 10 mg + 10 mg capsule: ramipril in the form of a white or almost white powder and bisoprolol fumarate in the form of two yellow, biconvex, film-coated, round tablets
BOPA/Aluminum/PVC/Aluminum blisters.
The blisters and patient information leaflet are packaged in a cardboard box.
Capsules are available in packs of:
10, 30, 60, or 100 capsules.
Not all pack sizes may be marketed.

Marketing authorization holder and manufacturer

Marketing authorization holder

Manufacturer

Adamed Pharma S.A.
Marszałka Józefa Piłsudskiego 5
95-200 Pabianice
Date of last revision of the leaflet:May 2023