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Candesartan Cilexetil + Amlodipine + Hidrohlorothiazide Adamed

About the medicine

How to use Candesartan Cilexetil + Amlodipine + Hidrohlorothiazide Adamed

PATIENT INFORMATION LEAFLET

Enclosed patient information leaflet

Candesartan Cilexetil + Amlodipine + Hydrochlorothiazide Adamed, 16 mg + 5 mg + 12.5 mg,

hard capsules

Candesartan Cilexetil + Amlodipine + Hydrochlorothiazide Adamed, 16 mg + 10 mg + 12.5 mg, hard capsules

Candesartan cilexetil+Amlodipine+Hydrochlorothiazide

You should carefully read the contents of this leaflet before taking this medicine, as it contains important information for you.

  • You should keep this leaflet, so you can read it again later.
  • If you have any further questions, please ask your doctor.
  • 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 experience any side effects, including those not listed in this leaflet, please inform your doctor. See section 4.

Table of contents of the leaflet

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

1. What is Candesartan Cilexetil + Amlodipine + Hydrochlorothiazide Adamed and what is it used for

What Candesartan Cilexetil + Amlodipine + Hydrochlorothiazide Adamed is and what it is used for
The name of this medicine is Candesartan Cilexetil + Amlodipine + Hydrochlorothiazide Adamed. It is used to treat high blood pressure (hypertension) in adult patients.
It contains three active substances: candesartan cilexetil, amlodipine besylate, and hydrochlorothiazide.
They work together to lower blood pressure.

  • Candesartan cilexetil belongs to a group of medicines called angiotensin II receptor antagonists. It causes blood vessels to relax and widen, which helps to lower blood pressure.
  • Amlodipine, which belongs to a group of medicines called calcium channel blockers, also causes blood vessels to relax, making it easier for blood to flow through them.
  • Hydrochlorothiazide belongs to a group of medicines called diuretics (water pills). It helps the body get rid of excess water and salt (sodium) in the urine, which helps to lower blood pressure. The action of these substances helps to lower blood pressure. Candesartan Cilexetil + Amlodipine + Hydrochlorothiazide Adamed can be used to treat high blood pressure (hypertension) in adult patients whose blood pressure is adequately controlled with the individual products given simultaneously at the same doses as in the combination product.

2. Important information before taking Candesartan Cilexetil + Amlodipine + Hydrochlorothiazide Adamed

Hydrochlorothiazide Adamed

When not to take Candesartan Cilexetil + Amlodipine + Hydrochlorothiazide Adamed:

  • if you are allergic to candesartan, amlodipine, hydrochlorothiazide, dihydropyridines, sulfonamides, or any of the other ingredients of this medicine (listed in section 6).
  • If you think you may be allergic to the ingredients of Candesartan Cilexetil + Amlodipine + Hydrochlorothiazide Adamed or are unsure, you should discuss this with your doctor before taking Candesartan Cilexetil + Amlodipine + Hydrochlorothiazide Adamed.
  • if you have severe kidney problems.
  • if you are unable to produce urine (anuria).
  • if you have diabetes or kidney problems and are taking a blood pressure-lowering medicine containing aliskiren.
  • if you have low potassium or sodium levels in your blood, or high calcium levels in your blood, which have not improved with treatment.
  • if you have gout.
  • if you are more than 3 months pregnant.
  • if you have severe liver problems with cholestasis or without cholestasis (disorders of bile secretion or blockage of bile flow from the gallbladder).
  • if you have poor blood flow to the tissues, with symptoms such as low blood pressure, low heart rate, rapid heartbeat, or shock (including cardiogenic shock).
  • if you have very low blood pressure.
  • if blood flow from the heart is slowed down or blocked. This can happen when the blood vessel or valve carrying blood from the heart becomes narrowed (aortic stenosis).
  • If you have a small heart output after a heart attack (acute myocardial infarction). You should not take Candesartan Cilexetil + Amlodipine + Hydrochlorothiazide Adamed if any of the above applies to you.

Warnings and precautions

Before taking Candesartan Cilexetil + Amlodipine + Hydrochlorothiazide Adamed, talk to your doctor, pharmacist, or nurse.

You must inform your doctorif you are taking any of the following medicines for high blood pressure:
an ACE inhibitor (e.g., enalapril, lisinopril, ramipril), especially in patients with kidney problems related to diabetes.

  • aliskiren.
  • an ACE inhibitor and a medicine belonging to a group of medicines called mineralocorticoid receptor antagonists (MRAs) at the same time (see "Candesartan Cilexetil + Amlodipine + Hydrochlorothiazide Adamed with other medicines"). These medicines are used to treat heart failure. Your doctor may regularly check your kidney function, blood pressure, and electrolyte levels (e.g., potassium). See also the information under "When not to take Candesartan Cilexetil + Amlodipine + Hydrochlorothiazide Adamed" You must contact your doctorif you have any of the following health problems:
  • Kidney problems, kidney transplant, or dialysis.
  • Liver disease.
  • Previous heart attack or stroke.
  • Coronary artery disease or cerebral artery disease.
  • Heart failure or problems with heart valves or heart muscle.
  • Very high blood pressure (hypertensive crisis).
  • Appearance of skin cancer or unexpected skin changes during treatment. Treatment with hydrochlorothiazide, especially long-term and with high doses, may increase the risk of certain types of skin cancer and lip cancer (non-melanoma skin cancer). During treatment with Candesartan Cilexetil + Amlodipine + Hydrochlorothiazide Adamed, you should protect your skin from sun exposure and UV radiation.
  • Severe vomiting, diarrhea, treatment with high doses of diuretics (water pills), or a low-sodium diet.
  • High potassium levels in the blood.
  • Adrenal gland problems.
  • Diabetes.
  • Systemic lupus erythematosus (an autoimmune disease).
  • Allergies or asthma.
  • Skin reactions, such as sunburn or rash after sun exposure or using a sunbed.
  • You must contact your doctorif you experience any of the following symptoms:

    • Severe, persistent diarrhea causing significant weight loss. Your doctor may assess your symptoms and decide how to continue your blood pressure treatment.
    • Blurred vision or eye pain. These may be symptoms of fluid accumulation in the vascular layer of the eye (excessive fluid accumulation between the choroid and sclera) or increased eye pressure, which can occur within a few hours to a week after taking Candesartan Cilexetil + Amlodipine + Hydrochlorothiazide Adamed. If left untreated, they can lead to permanent vision loss (severe visual disturbances).
    • If you have previously had breathing or lung problems (including pneumonia or fluid in the lungs) after taking hydrochlorothiazide. If you experience severe shortness of breath or difficulty breathing after taking Candesartan Cilexetil + Amlodipine + Hydrochlorothiazide Adamed, you should see your doctor immediately.

    If you experience abdominal pain, nausea, vomiting, or diarrhea after taking Candesartan Cilexetil + Amlodipine + Hydrochlorothiazide Adamed, you should discuss this with your doctor.
    Your doctor will decide on further treatment. Do not stop taking Candesartan Cilexetil + Amlodipine + Hydrochlorothiazide Adamed on your own.
    If you are scheduled for surgery, you should tell your doctor or dentist that you are taking Candesartan Cilexetil + Amlodipine + Hydrochlorothiazide Adamed. This is because Candesartan Cilexetil + Amlodipine + Hydrochlorothiazide Adamed, in combination with certain anesthetics, may cause a significant drop in blood pressure.
    As with other blood pressure-lowering medicines, excessive lowering of blood pressure may lead to heart attack or stroke. Therefore, your doctor will closely monitor your blood pressure.

    Candesartan Cilexetil + Amlodipine + Hydrochlorothiazide Adamed may increase cholesterol and uric acid levels in the blood (a cause of gout - a painful swelling of the joints). Your doctor may order blood tests.
    This medicine may cause changes in the levels of certain chemicals in the blood, called electrolytes. Your doctor may order periodic blood tests to measure the levels of these substances. Symptoms of electrolyte changes include: thirst, dry mouth, muscle cramps or spasms, muscle weakness, low blood pressure (hypotension), feeling of weakness, lethargy, fatigue, drowsiness, or restlessness, nausea, vomiting, decreased need to urinate, rapid heartbeat. You must inform your doctor if you notice any of these symptoms.
    If you need to have tests to check your parathyroid function, you should stop taking Candesartan Cilexetil + Amlodipine + Hydrochlorothiazide Adamed before the tests are performed.
    If you are pregnant or think you may be pregnant (or plan to become pregnant), you should not take Candesartan Cilexetil + Amlodipine + Hydrochlorothiazide Adamed in early pregnancy and should not take it after the third month of pregnancy, as it may have very harmful effects on the baby (see "Pregnancy and breastfeeding").

    Candesartan Cilexetil + Amlodipine + Hydrochlorothiazide Adamed with other medicines

    You should tell your doctor about all medicines you are currently taking or have recently taken, as well as any medicines you plan to take, i.e.

    • Other blood pressure-lowering medicines, as the effect of Candesartan Cilexetil + Amlodipine + Hydrochlorothiazide Adamed may be enhanced. Your doctor may change the dose and/or take other precautions: If you are taking an ACE inhibitor or aliskiren (see also the information under "When not to take Candesartan Cilexetil + Amlodipine + Hydrochlorothiazide Adamed" and "Warnings and precautions").
    • An ACE inhibitor with certain other medicines used to treat heart failure, known as MRAs (e.g., spironolactone, eplerenone).
    • Lithium (a medicine used to treat mood swings and certain types of depression), taken with Candesartan Cilexetil + Amlodipine + Hydrochlorothiazide Adamed, may show increased toxicity. If you need to take lithium, your doctor will check your lithium levels in the blood.
    • Antiepileptic medicines, such as carbamazepine (antiepileptic and anticonvulsant medicines).
    • Diltiazem, verapamil, used to treat irregular heart rhythms and high blood pressure.
    • Rifampicin, erythromycin, clarithromycin, used to treat tuberculosis and other infections.
    • St. John's Wort (Hypericum perforatum), a herbal medicine used to treat depression.
    • Cisapride, used to stimulate gastric and intestinal motility.
    • Difemanil, used to treat slow heart rate or to reduce sweating.
    • Halofantrine, used to treat malaria.
    • Vincamine (given intravenously) used to improve blood flow in the nervous system.
    • Amantadine, used to treat Parkinson's disease.
    • Potassium supplements, salt substitutes containing potassium, diuretics (water pills), heparin (to thin the blood and prevent blood clots),
    • Laxatives,
    • Steroids, adrenocorticotropic hormone (ACTH), carbenoxolone (a medicine used to treat mouth ulcers and stomach ulcers), penicillin - an antibiotic). Taking these medicines with Candesartan Cilexetil + Amlodipine + Hydrochlorothiazide Adamed may change potassium levels in the blood.
    • Trimethoprim/sulfamethoxazole (a combination of antibiotics).
    • Non-steroidal anti-inflammatory medicines (NSAIDs, medicines used to relieve pain, swelling, and other symptoms of inflammation, including arthritis), taken with Candesartan Cilexetil + Amlodipine + Hydrochlorothiazide Adamed, may increase the risk of kidney failure. NSAIDs may weaken the effect of Candesartan Cilexetil + Amlodipine + Hydrochlorothiazide Adamed. With high doses of salicylates, there may be an increased risk of toxic effects on the central nervous system.
    • Sleeping medicines, sedatives, and antidepressants, as taking these medicines with Candesartan Cilexetil + Amlodipine + Hydrochlorothiazide Adamed may cause a sudden drop in blood pressure when changing position from sitting to standing.
    • Cholestyramine, a medicine used to lower cholesterol levels in the blood, as it may reduce the effect of Candesartan Cilexetil + Amlodipine + Hydrochlorothiazide Adamed. Your doctor may recommend taking Candesartan Cilexetil + Amlodipine + Hydrochlorothiazide Adamed at least 4 hours before cholestyramine.
    • Certain antacids (medicines used to neutralize stomach acid), as they may slightly reduce the effect of Candesartan Cilexetil + Amlodipine + Hydrochlorothiazide Adamed.
    • Certain muscle relaxants, such as baclofen and tubocurarine.
    • Anticholinergic medicines, such as atropine and bipiperidine.
    • Calcium supplements.
    • Dantrolene (an intravenous medicine used to treat severe body temperature disorders).
    • Simvastatin, used to lower cholesterol and fat levels in the blood.
    • Medicines used to control the body's immune response, such as tacrolimus, sirolimus, temsirolimus, everolimus, and cyclosporine, which allow the body to accept a transplanted organ.
    • Medicines used to treat certain mental disorders, such as thioridazine, chlorpromazine, levomepromazine, trifluperazine, cyanemazine, sulpiride, amisulpride, pimozide, sultopride, tiapride, droperidol, or haloperidol.
    • Medicines used to treat low blood sugar (e.g., diazoxide) or high blood pressure (e.g., beta-blockers, methyldopa), as Candesartan Cilexetil + Amlodipine + Hydrochlorothiazide Adamed may affect the action of these medicines.
    • Medicines used to treat irregular heart rhythms, such as dofetilide or ibutilide.
    • Medicines used to treat HIV/AIDS (e.g., ritonavir, indinavir, nelfinavir).
    • Medicines used to treat fungal infections (e.g., ketoconazole, itraconazole, amphotericin).
    • Medicines used to treat heart conditions, such as quinidine, hydroquinidine, disopyramide, amiodarone, sotalol, bepridil, or digitalis glycosides.
    • Medicines used to treat cancer, such as amifostine, cyclophosphamide, or methotrexate.
    • Medicines that increase blood pressure (e.g., noradrenaline) and slow the heart rate.
    • Medicines used to treat infections, such as tetracycline antibiotics or sparfloxacin and pentamidine.
    • Medicines used to treat seasonal allergic reactions, such as mizolastine or terfenadine.
    • Medicines used to treat gout, such as probenecid, sulfinpyrazone, and allopurinol.
    • Medicines used to lower fat levels in the blood, such as cholestyramine and colestipol.
    • Medicines used to lower blood sugar levels, such as metformin or insulin.

    Taking Candesartan Cilexetil + Amlodipine + Hydrochlorothiazide Adamed with food, drink, and alcohol

    Candesartan Cilexetil + Amlodipine + Hydrochlorothiazide Adamed can be taken with or without food.
    Patients taking Candesartan Cilexetil + Amlodipine + Hydrochlorothiazide Adamed should not consume grapefruit juice or eat grapefruits. Grapefruits and grapefruit juice may increase the levels of the active substance amlodipine in the blood, which may cause unpredictable enhancement of the blood pressure-lowering effect of Candesartan Cilexetil + Amlodipine + Hydrochlorothiazide Adamed.
    When taking Candesartan Cilexetil + Amlodipine + Hydrochlorothiazide Adamed, you should be cautious when drinking alcohol, as some people may feel weak or dizzy. In such cases, you should not drink alcohol.

    Elderly

    In patients over 65 years of age, the doctor will regularly check blood pressure after each dose increase to ensure that it has not been excessively lowered.

    Pregnancy, breastfeeding, and fertility

    If you are pregnant, breastfeeding, think you may be pregnant, or plan to become pregnant, you should consult your doctor before taking this medicine.
    Pregnancy
    Usually, your doctor will advise you to stop taking Candesartan Cilexetil + Amlodipine + Hydrochlorothiazide Adamed before planned pregnancy or as soon as you know you are pregnant, and will prescribe a different medicine instead of Candesartan Cilexetil + Amlodipine + Hydrochlorothiazide Adamed. You should not take Candesartan Cilexetil + Amlodipine + Hydrochlorothiazide Adamed during pregnancy and should not take it after the third month of pregnancy, as it may have very harmful effects on the baby.
    If you become pregnant while taking Candesartan Cilexetil + Amlodipine + Hydrochlorothiazide Adamed, you should inform your doctor immediately and schedule a consultation with him.
    Breastfeeding
    Amlodipine and hydrochlorothiazide have been shown to pass into breast milk in small amounts. If you are breastfeeding or plan to breastfeed, you should consult your doctor before taking Candesartan Cilexetil + Amlodipine + Hydrochlorothiazide Adamed, and your doctor may choose a different treatment for you if you want to breastfeed, especially if your baby is newborn or premature.
    Fertility
    Clinical data on the potential impact of Candesartan Cilexetil + Amlodipine + Hydrochlorothiazide Adamed on fertility are insufficient.

    Driving and using machines

    During treatment for high blood pressure, you may experience drowsiness, nausea, or dizziness, or headache. If you experience any of these symptoms, you should not drive or operate machinery. You should consult your doctor.

    Candesartan Cilexetil + Amlodipine + Hydrochlorothiazide Adamed contains lactose

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

    Candesartan Cilexetil + Amlodipine + Hydrochlorothiazide Adamed contains azorubine (E122) and yellow-orange (E110)

    They may cause allergic reactions.

    3. How to take Candesartan Cilexetil + Amlodipine + Hydrochlorothiazide Adamed

    You should always take this medicine exactly as your doctor has told you. If you are not sure, ask your doctor.

    • The recommended dose is one capsule of the prescribed strength per day.
    • The capsule can be taken with or without food. The capsule should be swallowed with a liquid (e.g., a glass of water). The capsule should not be chewed. Do not take the capsule with grapefruit juice or grapefruits.
    • It is preferable to take the daily dose at the same time each day, e.g., at breakfast time.

    Children and adolescents:
    Candesartan Cilexetil + Amlodipine + Hydrochlorothiazide Adamed should not be used in children and adolescents under 18 years of age, as the safety and efficacy of this medicine have not been established in this age group.
    Elderly:
    Particular caution should be exercised in the elderly due to their susceptibility to disturbances in electrolyte balance.
    Kidney problems:
    When Candesartan Cilexetil + Amlodipine + Hydrochlorothiazide Adamed is used in patients with mild or moderate kidney problems, it is recommended to periodically monitor kidney function. Candesartan Cilexetil + Amlodipine + Hydrochlorothiazide Adamed is contraindicated in patients with severe kidney problems.
    Liver problems:
    It is recommended to closely monitor blood pressure and kidney function in patients with liver problems. Candesartan Cilexetil + Amlodipine + Hydrochlorothiazide Adamed is contraindicated in patients with severe liver problems.

    What to do if you take more Candesartan Cilexetil + Amlodipine + Hydrochlorothiazide Adamed than you should

    Hydrochlorothiazide Adamed

    If you take more capsules than prescribed, you may experience low blood pressure with symptoms such as dizziness, rapid or slow heartbeat.
    Excess fluid may accumulate in the lungs (pulmonary edema), causing shortness of breath, which can occur 24-48 hours after taking the medicine.
    If you take more capsules than prescribed or a child accidentally swallows several capsules, you should immediately see a doctor or go to the nearest emergency room, taking the medicine package or this leaflet with you.
    If you forget to take Candesartan Cilexetil + Amlodipine + Hydrochlorothiazide Adamed
    If you miss a dose, take your normal dose the next day at the usual time. Do not take a double dose to make up for a missed dose.
    If you stop taking Candesartan Cilexetil + Amlodipine + Hydrochlorothiazide Adamed
    It is important to continue taking Candesartan Cilexetil + Amlodipine + Hydrochlorothiazide Adamed unless your doctor tells you to stop. If you have any further questions about taking this medicine, ask your doctor.

    4. Possible side effects

    Like all medicines, Candesartan Cilexetil + Amlodipine + Hydrochlorothiazide Adamed can cause side effects, although not everybody gets them.
    You should stop taking Candesartan Cilexetil + Amlodipine + Hydrochlorothiazide Adamed and immediatelysee your doctor if you experience any of the following serious side effects after taking this medicine :

    • Sudden wheezing, chest pain, shortness of breath, or difficulty breathing
    • Swelling of the eyelids, face, or lips
    • Swelling of the tongue and throat, causing severe breathing difficulties
    • Severe skin reactions, including intense skin rash, hives, redness of the skin all over the body, severe itching, blistering, and peeling of the skin, inflammation of the mucous membranes (Stevens-Johnson syndrome, toxic epidermal necrolysis) or other allergic reactions
    • Heart attack, irregular heartbeat
    • Pancreatitis, which can cause severe abdominal and back pain, and a very bad feeling
    • Candesartan Cilexetil + Amlodipine + Hydrochlorothiazide Adamed may cause a decrease in white blood cell count. This may lead to reduced resistance to infections, and you may notice fatigue, infection, or fever. In such cases, you should contact your doctor. Your doctor may order periodic blood tests to check if Candesartan Cilexetil + Amlodipine + Hydrochlorothiazide Adamed has affected your blood (agranulocytosis).
    • Sudden severe eye pain, redness of the eyes, vision disturbances, or blurred vision, and nausea/vomiting. This may be a sign of fluid accumulation in the eye (between the choroid and sclera) or acute glaucoma with a narrow angle of filtration, which can occur with a sudden increase in eye pressure. Immediate treatment is necessary to alleviate symptoms and prevent permanent vision loss (severe visual disturbances).

    Candesartan Cilexetil + Amlodipine + Hydrochlorothiazide Adamed is a combination of three active substances. The following side effects are known for each of them separately.
    To give you an idea of how often side effects may occur, they are listed as very common, common, uncommon, rare, very rare, and not known.

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

    • Edema (fluid retention).

    Common (may affect up to 1 in 10 people)

    • Hypokalemia (low potassium levels in the blood), especially with high doses,
    • Increased lipid levels in the blood,
    • Respiratory tract infections,
    • Hyperglycemia (high blood sugar),
    • Hyperuricemia (high uric acid levels),
    • Somnolence,
    • Dizziness, vertigo, headache,
    • Visual disturbances (including double vision),
    • Palpitations (irregular heartbeat),
    • Flushing (including feeling hot),
    • Shortness of breath,
    • Abdominal pain, nausea, vomiting,
    • Changes in bowel habits, constipation, diarrhea,
    • Rash, hives,
    • Edema of the ankles,
    • Muscle cramps,
    • Feeling tired, weak,

    Uncommon (may affect up to 1 in 100 people)

    • Depression, mood changes (including anxiety), insomnia,
    • Tremors,
    • Vomiting,
    • Taste disturbances,
    • Fainting,
    • Numbness, paresthesia (abnormal sensation),
    • Tinnitus,
    • Irregular heart rhythms (including slow heart rate (bradycardia)),
    • Rapid heartbeat (ventricular tachycardia) and irregular heartbeat (atrial fibrillation),
    • Low blood pressure (hypotension), orthostatic hypotension (low blood pressure, which may be increased by drinking alcohol, taking anesthetics, or sedatives),
    • Low magnesium levels in the blood, high calcium levels in the blood, disturbances in acid-base balance with low chloride levels, low phosphate levels in the blood, low sodium levels in the blood,
    • Cough,
    • Rhinitis,
    • Dry mouth,
    • Alopecia, excessive sweating, pruritus, skin discoloration, photosensitivity reactions,
    • Malaise,
    • Chest pain, pain, back pain,
    • Arthralgia,
    • Myalgia,
    • Urinary disturbances, nocturia, increased frequency of urination,
    • Impotence, discomfort in the breast area or breast enlargement in men, erectile dysfunction,
    • Decreased appetite,
    • Weight gain or weight loss,
    • Photosensitivity reactions.

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

    • Thrombocytopenia (abnormally low platelet count), sometimes with bleeding into the skin (purpura),
    • Shortness of breath with cough and feeling tired or coughing up blood
    • Vasculitis with symptoms such as rash, purple spots on the skin, fever
    • Gastrointestinal disturbances,
    • Pancreatitis
    • Confusion,
    • Sleep disturbances,
    • Jaundice, yellowing of the skin and whites of the eyes (yellow or greenish discoloration of the skin and eyes),
    • Kidney failure or kidney problems,
    • Fever,

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

    • Blood disorders, such as neutropenia (low neutrophil count, a type of white blood cell),
    • Bone marrow suppression (reduced bone marrow activity),
    • Severe shortness of breath
    • Red spots and blisters on the skin resembling a target, fatigue, fever, joint pain or kidney problems - the most common symptoms of a condition called lupus erythematosus.
    • Rash with red, non-itchy, flaky patches
    • Hemolytic anemia,
    • Allergic reactions,
    • Vasculitis (inflammation and destruction of blood vessels),
    • High potassium levels,
    • Increased muscle tone,
    • Peripheral neuropathy,
    • Gastritis,
    • Intestinal angioedema: swelling in the intestine with symptoms such as abdominal pain, nausea, vomiting, and diarrhea,
    • Gingival hyperplasia,
    • Increased liver enzyme activity, liver problems, hepatitis.

    Not known (cannot be estimated from the available data)

    • Aplastic anemia (a condition in which the bone marrow is damaged and blood cell production is impaired),
    • Extrapyramidal disorders (a group of clinical syndromes characterized by excessive movement or reduced voluntary and involuntary movement, not associated with weakness or spasticity),
    • Acute kidney failure,
    • Skin cancer and lip cancer (non-melanoma skin cancer).

    Reporting side effects

    If you experience any side effects, including those not listed in this leaflet, you should inform your doctor.
    Side effects can be reported directly 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
    Phone: +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.
    By reporting side effects, you can help provide more information on the safety of this medicine.

    5. How to store Candesartan Cilexetil + Amlodipine + Hydrochlorothiazide Adamed

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

    6. Contents of the pack and other information

    What Candesartan Cilexetil + Amlodipine + Hydrochlorothiazide Adamed contains

    The active substances of Candesartan Cilexetil + Amlodipine + Hydrochlorothiazide Adamed are:
    Candesartan Cilexetil + Amlodipine + Hydrochlorothiazide Adamed, 16 mg+5 mg+12.5 mg, hard capsules
    The active substances in one capsule are: 16 mg of candesartan cilexetil, 5 mg of amlodipine (as amlodipine besylate), and 12.5 mg of hydrochlorothiazide.
    Candesartan Cilexetil + Amlodipine + Hydrochlorothiazide Adamed 16 mg+10 mg+12.5 mg hard capsules
    The active substances in one capsule are: 16 mg of candesartan cilexetil, 10 mg of amlodipine (as amlodipine besylate), and 12.5 mg of hydrochlorothiazide.
    Other ingredients are:
    Filler: lactose monohydrate, cornstarch, hydroxypropyl cellulose, calcium carmellose, macrogol (type 8000), cornstarch, magnesium stearate
    Capsule shell (16 mg+5 mg+12.5 mg):

    • Body: titanium dioxide (E 171), gelatin
    • Cap: orange-yellow (E 110), titanium dioxide (E 171), gelatin

    Capsule shell (16 mg+10 mg+12.5 mg):

    • Body: titanium dioxide (E 171), gelatin
    • Cap: azorubine (E 122), orange-yellow (E 110), titanium dioxide (E 171), gelatin

    Ink: shellac, iron oxide black (E 172), propylene glycol, concentrated ammonia, potassium hydroxide.

    What Candesartan Cilexetil + Amlodipine + Hydrochlorothiazide Adamed looks like and contents of the pack

    Candesartan Cilexetil + Amlodipine + Hydrochlorothiazide Adamed 16 mg+5 mg+12.5 mg hard capsules
    Hard gelatin capsule, size "0"; white body with black print "1", orange cap with black print "CAH", filled with white or off-white powder Candesartan Cilexetil + Amlodipine + Hydrochlorothiazide Adamed 16 mg+10 mg+12.5 mg hard capsules
    Hard gelatin capsule, size "0"; white body with black print "2", red cap with black print "CAH", filled with white or off-white powder
    Available in packs of 7, 10, 28, 30, 60, 90, and 100 hard capsules.
    Not all pack sizes may be marketed.

    Marketing authorization holder and manufacturer

    Marketing authorization holder

    Adamed Pharma S.A.
    Pieńków, ul. M. Adamkiewicza 6A
    05-152 Czosnów
    tel.: +48 22 732 77 00

    Manufacturer

    Adamed Pharma S.A.
    ul. Marszałka J. Piłsudskiego 5
    95-200 Pabianice

    This medicinal product is authorized in the Member States of the European Economic Area under the following names:

    This medicinal product is approved in the countries of the European Economic Area under the following names:

    Greece: CARDITRAT PLUS
    Italy: LODICAND HCTZ
    Portugal: Candesartan cilexetil/Amlodipine/Hydrochlorothiazide Adamed
    Croatia: Kandesartan cilexetil/amlodipin/hidroklorotiazid Adamed

    Date of last revision of the leaflet: January 2025

    • Country of registration
    • Active substance
    • Prescription required
      Yes
    • Importer
      Adamed Pharma S.A.

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    • Anxiety, depression, and stress-related conditions.

    Dr. Agapova helps patients manage complex neurological symptoms like pain, numbness, weakness, poor sleep, and emotional distress. Her consultations focus on accurate diagnosis, clear explanation of findings, and tailored treatment plans.

    If you’re struggling with chronic pain, migraines, nerve disorders, or sleep problems, Dr. Agapova offers professional guidance to restore your well-being.

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    Yevgen Yakovenko

    General surgery11 years of experience

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    Areas of medical expertise:

    • Acute and chronic pain: headaches, muscle and joint pain, back pain, abdominal pain, postoperative pain. Identifying the cause, selecting treatment, and creating a care plan.
    • Internal medicine: heart, lungs, gastrointestinal tract, urinary system. Management of chronic conditions, symptom control, second opinions.
    • Pre- and postoperative care: risk assessment, decision-making support, follow-up after surgery, rehabilitation strategies.
    • General and paediatric surgery: hernias, appendicitis, congenital conditions, both planned and urgent surgeries.
    • Injuries and trauma: bruises, fractures, sprains, soft tissue damage, wound care, dressing, referral when in-person care is required.
    • Oncological surgery: diagnosis review, treatment planning, and long-term follow-up.
    • Obesity treatment and weight management: a medical approach to weight loss, including assessment of underlying causes, evaluation of comorbidities, development of a personalised plan (nutrition, physical activity, pharmacotherapy if needed), and ongoing progress monitoring.
    • Imaging interpretation: analysis of ultrasound, CT, MRI, and X-ray results, surgical planning based on imaging data.
    • Second opinions and medical navigation: clarifying diagnoses, reviewing current treatment plans, helping patients choose the best course of action.

    Experience and qualifications:

    • 12+ years of clinical experience in university hospitals in Germany and Spain.
    • International education: Ukraine – Germany – Spain.
    • Member of the German Society of Surgeons (BDC).
    • Certified in radiological diagnostics and robotic surgery.
    • Active participant in international medical conferences and research.

    Dr Yakovenko explains complex topics in a clear, accessible way. He works collaboratively with patients to analyse health issues and make evidence-based decisions. His approach is grounded in clinical excellence, scientific accuracy, and respect for each individual.

    If you are unsure about a diagnosis, preparing for surgery, or want to discuss your test results – Dr Yakovenko will help you evaluate your options and move forward with confidence.

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    Jonathan Marshall Ben Ami

    Family medicine8 years of experience

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    Dr. Ben Ami offers expert diagnosis, treatment, and follow-up for:

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    • Urinary tract infections and other common infections.
    • Management of chronic diseases: high blood pressure, diabetes, thyroid disorders.
    • Acute conditions requiring urgent medical attention.
    • Headaches, migraines, and minor injuries.
    • Wound care, health check-ups, and ongoing prescriptions.

    With a patient-focused and evidence-based approach, Dr. Ben Ami supports individuals at all stages of life — offering clear medical guidance, timely interventions, and continuity of care.

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    Salome Akhvlediani

    Pediatrics11 years of experience

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    • Fever, infections, cough, sore throat, and digestive issues.
    • Preventive care – vaccinations, regular check-ups, and health monitoring.
    • Allergies, asthma, and skin conditions.
    • Nutritional advice and healthy development support.
    • Sleep difficulties, fatigue, and behavioural concerns.
    • Ongoing care for chronic or complex health conditions.
    • Guidance for parents and follow-up after medical treatment.

    Dr Akhvlediani combines professional care with a warm, attentive approach – helping children stay healthy and supporting parents at every stage of their child’s growth.

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