ENALAPRIL TEVA-RATIOPHARM 20 mg TABLETS

Introduction

Package Leaflet: Information for the User

Enalapril Teva-ratiopharm 20 mg Tablets EFG

enalapril maleate

Contents of the Package Leaflet

1. What is Enalapril Teva-ratiopharm and what is it used for
2. What you need to know before you take Enalapril Teva-ratiopharm
3. How to take Enalapril Teva-ratiopharm
4. Possible side effects
5. Storage of Enalapril Teva-ratiopharm
6. Contents of the pack and other information

1. What is Enalapril Teva-ratiopharm and what is it used for

Enalapril Teva-ratiopharm belongs to a group of medicines called angiotensin-converting enzyme inhibitors (ACE inhibitors)

Enalapril Teva-ratiopharm is indicated for:

• Treating high blood pressure (hypertension)
• Treating symptomatic heart failure
• Preventing symptomatic heart failure

This medicine works by widening your blood vessels, which makes it easier for your heart to pump blood around the body. It usually starts to work within an hour and the effect lasts for at least 24 hours. Some people may need several weeks of treatment before they get the full effect on their blood pressure

2. What you need to know before you take Enalapril Teva-ratiopharm

Do not take Enalapril Teva-ratiopharm

• If you are allergic to enalapril maleate or any of the other ingredients of this medicine (listed in section 6)
• If you have ever been treated for an allergic reaction to a medicine similar to this one, called an ACE inhibitor
• If you have ever had swelling of the face, lips, tongue or throat that caused difficulty in swallowing or breathing (angioedema) when the cause was hereditary or unknown
• If you have diabetes or kidney problems and are taking a medicine to lower your blood pressure that contains aliskiren
• If you are more than 3 months pregnant (also, it is better to avoid Enalapril Teva-ratiopharm at the start of pregnancy, see section Pregnancy)
• If you have taken or are taking sacubitril/valsartan, a medicine used to treat a type of long-term (chronic) heart failure in adults, as the risk of angioedema (rapid swelling under the skin in an area such as the throat) is increased

Do not take this medicine if any of the above applies to you. If you are not sure, consult your doctor or pharmacist before taking this medicine

Warnings and Precautions

Consult your doctor or pharmacist before taking Enalapril Teva-ratiopharm

• If you have heart disease
• If you have a disease that affects the blood vessels of the brain
• If you have blood disorders such as low or lack of white blood cells (neutropenia/agranulocytosis), low platelet count (thrombocytopenia) or low red blood cell count (anemia)

If you have liver problems

• If you have kidney problems (including kidney transplant), are on a low-salt diet, are taking potassium supplements, potassium-sparing diuretics, salt substitutes that contain potassium, or other medicines that may increase potassium levels in the blood (such as heparin, a medicine used to prevent blood clots, trimethoprim and cotrimoxazole for bacterial infections, cyclosporin, an immunosuppressant medicine used to prevent organ rejection, or other medicines that may increase potassium levels in the blood). This may cause 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 in the blood. See also the information under the heading “Taking Enalapril Teva-ratiopharm with other medicines”
• If you are undergoing dialysis
• If you have recently had severe vomiting or severe diarrhea

• If you have diabetes, you should closely monitor your blood glucose levels, especially during the first month of treatment. Your potassium levels in the blood may also be higher

• If you have ever had an allergic reaction with swelling of the face, lips, tongue or throat with difficulty swallowing or breathing. You should be aware that black patients are more sensitive to this type of reaction to ACE inhibitors
• If you have low blood pressure (you may notice this as dizziness or fainting, especially when standing up or at the start of treatment)
• If you have a disease of the collagen vascular system (e.g. lupus erythematosus, rheumatoid arthritis or scleroderma), are being treated with medicines that suppress your immune system, are taking the medicines allopurinol or procainamide, or any combination of these

• If you are taking any of the following medicines, the risk of angioedema may increase:
• racecadotril, a medicine used to treat diarrhea
• medicines used to prevent organ rejection and cancer (e.g. sirolimus, everolimus, temsirolimus)
• vildagliptin, a medicine used to treat diabetes

• If you are taking any of the following medicines used to treat high blood pressure:
• an angiotensin II receptor antagonist (ARB) (also known as “sartans” - e.g. valsartan, telmisartan, irbesartan), especially if you have kidney problems related to diabetes
• aliskiren

Your doctor may need to 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 Enalapril Teva-ratiopharm”

You should inform your doctor if you think you are pregnant (or might be). Normally, your doctor will advise you to stop taking enalapril before you become pregnant or as soon as you know you are pregnant and will advise you to take a different medicine instead of Enalapril Teva-ratiopharm. Enalapril Teva-ratiopharm is not recommended at the start of pregnancy and must not be taken if you are more than 3 months pregnant, as it may cause serious harm to your baby if used after the third month of pregnancy

You should be aware that this medicine is less effective at lowering blood pressure in black patients than in non-black patients

If you are not sure if any of the above applies to you, consult your doctor or pharmacist before taking this medicine

If you are about to undergo a procedure

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

• any surgery or if you are going to receive anesthetics (even at the dentist)
• a treatment to remove cholesterol from your blood called “LDL apheresis”
• a desensitization treatment to reduce the effect of an allergy to bee or wasp stings

If any of the above applies to you, consult your doctor or dentist before starting the procedure

Taking Enalapril Teva-ratiopharm with other medicines

Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines, including herbal treatments. This is because enalapril may affect the way other medicines work and some medicines may affect the way enalapril works. Your doctor may need to change your dose and/or take other precautions

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

• An angiotensin II receptor antagonist (ARB) or aliskiren (see also the information under the headings “Do not take Enalapril Teva-ratiopharm” and “Warnings and Precautions”

• Other medicines to lower blood pressure, such as beta blockers or water tablets (diuretics)
• Potassium supplements (including salt substitutes), potassium-sparing diuretics, and other medicines that may increase potassium levels in the blood (e.g. trimethoprim and cotrimoxazole for bacterial infections; cyclosporin, an immunosuppressant medicine used to prevent organ rejection; and heparin, a medicine used to thin the blood to prevent clots). See also the information in the section “Warnings and Precautions”

• Medicines for diabetes (including oral antidiabetics and insulin)
• Lithium (a medicine used to treat certain types of depression)
• Medicines for depression called “tricyclic antidepressants”
• Medicines for mental problems called “antipsychotics”
• Certain medicines for coughs and colds and weight loss medicines that contain a substance called “sympathomimetic medicine”
• Certain medicines for pain or arthritis, including gold treatment

• An mTOR inhibitor (e.g. temsirolimus, sirolimus, everolimus; medicines used to treat certain types of cancer or to prevent the immune system from rejecting a transplanted organ). See also the information in the section “Warnings and Precautions”
• A medicine that contains sacubitril/valsartan, racecadotril, or vildagliptin. This may increase the risk of angioedema (swelling of the face, lips, tongue, or throat with difficulty swallowing or breathing). See also “Do not take Enalapril Teva-ratiopharm” and “Warnings and Precautions”

• Non-steroidal anti-inflammatory medicines (NSAIDs), including COX-2 inhibitors (medicines that reduce inflammation and may be used to help relieve pain)
• Aspirin (acetylsalicylic acid)
• Medicines used to dissolve blood clots (thrombolytics)
• Alcohol

If you are not sure if any of the above applies to you, consult your doctor or pharmacist before taking enalapril

Taking Enalapril Teva-ratiopharm with food, drinks, and alcohol

Enalapril can be taken with or without food. Most people take enalapril with a little water

Pregnancy, Breast-feeding, and Fertility

If you are pregnant or breast-feeding, think you may be pregnant, or are planning to have a baby, ask your doctor or pharmacist for advice before taking this medicine

Pregnancy

You should inform your doctor if you think you are pregnant (or might be). Normally, your doctor will advise you to stop taking enalapril before you become pregnant or as soon as you know you are pregnant and will advise you to take a different medicine instead of Enalapril Teva-ratiopharm. Enalapril Teva-ratiopharm is not recommended at the start of pregnancy and must not be taken if you are more than 3 months pregnant, as it may cause serious harm to your baby if used after the third month of pregnancy

Breast-feeding

Tell your doctor if you are breast-feeding or about to start breast-feeding. While taking enalapril, breast-feeding is not recommended in newborns (first few weeks after birth), and especially in premature babies. In the case of an older baby, your doctor should advise you on the benefits and risks of taking enalapril, compared to other treatments, while breast-feeding

Driving and using machines

You may feel dizzy or drowsy while taking this medicine. If this happens, do not drive or use tools or machines

Enalapril Teva-ratiopharm contains lactose and sodium

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

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

3. How to take Enalapril Teva-ratiopharm

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

Remember to take your medicine

It is very important that you continue to take this medicine for as long as your doctor prescribes it

Do not take more tablets than your doctor has told you to

The recommended dose is:

Hypertension

The initial recommended dose is usually 5 to 20 mg once a day

Some patients may need a lower initial dose

The usual long-term dose is 20 mg once a day

The maximum long-term dose is 40 mg once a day

Heart Failure

The initial recommended dose is usually 2.5 mg once a day

Your doctor will gradually increase the dose until the appropriate dose for you is reached

The usual long-term dose is 20 mg a day in one or two divided doses

The maximum long-term dose is 40 mg once a day, divided into two doses

Patients with kidney problems

Your dose of medicine will depend on how well your kidneys are working:

• mild kidney problems - 5 mg to 10 mg a day
• severe kidney problems - 2.5 mg a day
• if you are undergoing dialysis - 2.5 mg a day. On days when you are not undergoing dialysis, your dose may change depending on how low your blood pressure is

Elderly patients

Your doctor will decide on the dose and will base it on how well your kidneys are working

Use in children

Experience with the use of enalapril in children with high blood pressure is limited. If the child can swallow tablets, the dose will be calculated based on the child's weight and blood pressure. The usual initial doses are:

• between 20 kg and 50 kg - 2.5 mg a day
• over 50 kg - 5 mg a day

The dose may be changed according to the child's needs:

• a maximum of 20 mg a day can be used in children who weigh between 20 kg and 50 kg
• a maximum of 40 mg a day can be used in children who weigh over 50 kg

This medicine is not recommended in newborn babies (first few weeks after birth) or in pediatric patients with kidney problems

If you take more Enalapril Teva-ratiopharm than you should

If you take more enalapril than you should, contact your doctor or pharmacist immediately

Take the medicine pack with you

In case of an overdose, the most likely symptom is a feeling of dizziness or lightheadedness due to a sudden or excessive drop in blood pressure

In case of overdose or accidental ingestion, consult the Toxicology Information Service. Telephone: 91 562 04 20, stating the medicine and the amount taken

If you forget to take Enalapril Teva-ratiopharm

You should continue to take this medicine as prescribed by your doctor. Do not take a double dose to make up for forgotten doses

If you stop taking Enalapril Teva-ratiopharm

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.

If you experience any of the following symptoms, stop taking this medicine and consult your doctor immediately:

• swelling of the face, lips, tongue, or throat that can cause difficulty breathing or swallowing,
• swelling of the hands, feet, or ankles,
• if you develop a red rash on the skin with swelling (hives).

You should be aware that black patients have a higher risk of suffering from this type of reaction. If you experience any of the above reactions, stop taking it and talk to your doctor immediately.

When you start taking this medicine, you may feel loss of consciousness or feel dizzy. If this happens, lying down can help. This is due to a decrease in your blood pressure. This will improve as you continue taking the medicine. If you are concerned, please talk to your doctor.

Other adverse effects include:

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

• feeling of dizziness, weakness, or vomiting
• cough
• blurred vision

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

• dizziness due to low blood pressure, chest pain, changes in heart rhythm, angina pectoris, rapid heartbeats
• headache, depression
• difficulty breathing
• fatigue
• diarrhea, abdominal pain
• rash, allergic reactions with swelling of the face, lips, tongue, or throat with difficulty swallowing or breathing

• high levels of potassium in the blood, high levels of creatinine in the blood (both are usually detected in an analysis).

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

• flushing
• sudden drop in blood pressure
• rapid and arrhythmic heartbeats (palpitations)
• myocardial infarction or stroke possibly due to excessively low blood pressure in high-risk patients (patients with alterations in heart and/or brain blood flow)
• anemia (including aplastic and hemolytic anemia)
• confusion, drowsiness, or inability to sleep, nervousness,
• feeling of itching or numbness in your skin
• vertigo (feeling of dizziness)
• ringing in the ears (tinnitus)
• runny nose, sore throat, or hoarseness
• asthma-associated chest tightness
• slow movement of food through your intestine (ileus), pancreatitis, vomiting, indigestion, constipation, anorexia
• irritated stomach (gastric irritation), dry mouth, ulcer

• muscle cramps
• reduced kidney function or kidney failure
• increased sweating
• itching or hives
• hair loss
• malaise (general discomfort), elevated temperature (fever)
• impotence
• high levels of protein in your urine (determined in an analysis)
• low levels of sugar or sodium in the blood, high levels of urea in the blood (all determined in a blood analysis).

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

• "Raynaud's phenomenon" in which your hands and feet can become very cold and white due to low blood flow
• changes in blood values, such as a lower number of white or red blood cells, lower hemoglobin, lower platelet count in the blood
• bone marrow depression,
• inflamed glands in the neck, armpits, or groin.
• autoimmune diseases
• sleep disturbances or sleep problems
• fluid or substance accumulation in the lungs (as seen on X-rays)
• nasal inflammation
• lung inflammation causing difficulty breathing (pneumonia)
• inflammation of the cheeks, gums, tongue, lips, throat
• reduced amount of urine produced
• target-shaped rash (erythema multiforme)
• "Stevens-Johnson syndrome" and "toxic epidermal necrolysis" (a severe skin disorder in which you have red and scaly skin, ulcers with blisters or open sores), exfoliative dermatitis/erythroderma (severe skin rash with scaling or peeling), pemphigus (small fluid-filled blisters on the skin)

• liver or bile duct problems such as decreased liver function, liver inflammation, jaundice (yellowish color of the skin or eyes), elevated liver enzyme or bilirubin levels (determined in an analysis)
• breast enlargement in men (gynecomastia).

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

• Intestinal angioedema (swelling in the intestine)

Frequency Not Known(frequency cannot be estimated from available data)

• overproduction of antidiuretic hormone, leading to fluid retention, causing weakness, fatigue, or confusion
• a symptomatic complex has been reported that may include all or some of the following symptoms: fever, blood vessel inflammation (serositis, vasculitis), muscle pain (myalgia, myositis), joint pain (arthralgia/arthritis). Rash, photosensitivity, or other skin manifestations may occur.

Reporting of Adverse Effects:

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

5. Storage of Enalapril Teva-ratiopharm

Keep this medicine out of sight and reach of children.

Do not store above 30°C. Store in the original package.

Do not use this medicine after the expiration date indicated on the package after CAD. The expiration date is the last day of the month indicated.

Medicines should not be disposed of via wastewater or household waste. Deposit the packages and medicines you no longer need at the SIGRE point in the pharmacy. In case of doubt, ask your pharmacist how to dispose of the packages and medicines you no longer need. This will help protect the environment.

6. Package Contents and Additional Information

Composition of Enalapril Teva-ratiopharm 20 mg tablets

The active ingredient of this medicine is enalapril maleate 20 mg. Each tablet contains 20 mg of enalapril maleate as the active ingredient.

The other ingredients are sodium croscarmellose, lactose monohydrate, magnesium stearate, pregelatinized starch (from corn), sodium bicarbonate, red iron oxide (E-172), yellow iron oxide (E-172), and corn starch.

Appearance of the Product and Package Contents:

Enalapril Teva-ratiopharm 20 mg are circular, flat, scored, light orange tablets. They are available in packages of 28 tablets.

Marketing Authorization Holder and Manufacturer:

Marketing Authorization Holder:

Teva Pharma, S.L.U.

Anabel Segura 11, Edificio Albatros B, 1st floor

Alcobendas, 28108 Madrid (Spain).

Manufacturer:

Teva Pharma, S.L.U.

Malpica Industrial Estate, c/C nº4

1. Zaragoza, Spain.

Date of the Last Revision of this Prospectus:February 2022

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/

You can access detailed and updated information about this medicine by scanning the QR code included in the packaging with your mobile phone (smartphone). You can also access this information at the following internet address: https://cima.aemps.es/cima/dochtml/p/66076/P_66076.html