EZETIMIBE/ATORVASTATIN Sandoz 10 mg/20 mg FILM-COATED TABLETS

Introduction

Package Leaflet: Information for the Patient

Ezetimibe/Atorvastatin Sandoz Pharmaceutical 10 mg/10 mg

film-coated tablets EFG

Ezetimibe/Atorvastatin Sandoz Pharmaceutical 10 mg/20 mg

film-coated tablets EFG

Ezetimibe/Atorvastatin Sandoz Pharmaceutical 10 mg/40 mg

film-coated tablets EFG

Ezetimibe/Atorvastatin Sandoz Pharmaceutical 10 mg/80 mg

film-coated tablets EFG

ezetimibe/atorvastatin

Read all of this leaflet carefully before you start taking this medicine because it contains important information for you.

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

Contents of the pack

1. What Ezetimibe/Atorvastatin Sandoz Pharmaceutical is and what it is used for
2. What you need to know before you take Ezetimibe/Atorvastatin Sandoz Pharmaceutical
3. How to take Ezetimibe/Atorvastatin Sandoz Pharmaceutical
4. Possible side effects
5. Storage of Ezetimibe/Atorvastatin Sandoz Pharmaceutical
6. Contents of the pack and other information

1. What Ezetimibe/Atorvastatin Sandoz Pharmaceutical is and what it is used for

Ezetimibe/Atorvastatin Sandoz Pharmaceutical is a medicine that lowers high cholesterol levels. Ezetimibe/Atorvastatin Sandoz Pharmaceutical contains ezetimibe and atorvastatin.

Ezetimibe/atorvastatin is used in adults to lower the levels of total cholesterol, "bad" cholesterol (LDL cholesterol) and certain fats (triglycerides) that are found in the blood. It also raises the levels of "good" cholesterol (HDL cholesterol).

Ezetimibe/atorvastatin works by reducing cholesterol in two ways. It reduces the amount of cholesterol absorbed in the gut and the amount of cholesterol produced by the body.

Cholesterol is one of the fatty substances that can be found in the bloodstream. Your total cholesterol is made up mainly of LDL and HDL cholesterol.

LDL cholesterol is often called "bad" cholesterol because it can build up in the walls of your arteries, forming plaques. Over time, this can lead to a narrowing of the arteries, which can reduce or block the flow of blood to vital organs such as the heart and brain. This blocking of the flow of blood can lead to a heart attack or stroke.

HDL cholesterol is often called "good" cholesterol because it helps prevent "bad" cholesterol from building up in the arteries and protects against heart disease.

Triglycerides are another type of fat found in the blood that can increase the risk of heart disease.

Ezetimibe/atorvastatin is used in patients who cannot control their cholesterol levels by diet alone. While you are taking this medicine, you should also follow a low-cholesterol diet.

Ezetimibe/atorvastatin is used in addition to your diet to lower cholesterol if you have:

• high levels of cholesterol in the blood (primary hypercholesterolaemia [heterozygous familial and non-familial]) or high levels of fats in the blood (mixed hyperlipidaemia)
• that are not well controlled with a statin alone,
• for which you have used a statin and ezetimibe in separate tablets.
• a hereditary disease (homozygous familial hypercholesterolaemia) that increases the level of cholesterol in your blood. You may also receive other treatments.
• heart disease. Ezetimibe/atorvastatin reduces the risk of heart attack, stroke, surgery to increase blood flow to the heart, or hospitalization for chest pain.

Ezetimibe/atorvastatin does not help you lose weight.

2. What you need to know before you take Ezetimibe/Atorvastatin Sandoz Pharmaceutical

Do not take Ezetimibe/Atorvastatin Sandoz Pharmaceutical if:

• you are allergic to ezetimibe, atorvastatin or any of the other ingredients of this medicine (listed in section 6),
• you have or have ever had liver disease,
• you have had any unexplained abnormal blood test results showing liver problems,
• you are a woman who can become pregnant and are not using reliable contraception,
• you are pregnant or breast-feeding,
• you are taking the combination of glecaprevir/pibrentasvir for the treatment of hepatitis C.

Warnings and precautions

Tell your doctor or pharmacist before you start taking ezetimibe/atorvastatin if:

• you have had a previous stroke with bleeding in the brain, or have small pockets of fluid in the brain caused by previous strokes,
• you have kidney problems,
• your thyroid gland does not produce enough hormones (hypothyroidism),
• you have had muscle pain or weakness or have a history of muscle problems,
• you have previously experienced muscle problems while taking other lipid-lowering medicines (e.g. other medicines containing "statins" or "fibrates"),
• you regularly drink large amounts of alcohol,
• you have a history of liver disease,
• you are over 70 years old,
• if your doctor has told you that you have an intolerance to some sugars, contact them before taking this medicine,
• if you have or have had muscle weakness (myasthenia gravis) or muscle weakness in the eyes (ocular myasthenia), as statins can sometimes worsen this condition or trigger the onset of myasthenia gravis (see section 4),
• you are taking or have taken in the last 7 days a medicine containing fusidic acid (used to treat bacterial infections) by mouth or by injection. The combination of fusidic acid and atorvastatin/ezetimibe can cause muscle problems (rhabdomyolysis).

Contact your doctor as soon as possible if you experience unexplained muscle pain, tenderness or weakness while taking ezetimibe/atorvastatin.This is because, on rare occasions, muscle problems can be serious, including muscle breakdown resulting in kidney damage. Atorvastatin can cause muscle problems and muscle problems have also been reported with ezetimibe.

Also, tell your doctor or pharmacist if you experience persistent muscle weakness. You may need further tests and additional medicines to diagnose and treat this condition.

Tell your doctor or pharmacist before you start taking ezetimibe/atorvastatin:

• if you have severe respiratory problems.

If you are in any of the above situations (or are unsure), consult your doctor or pharmacist before taking ezetimibe/atorvastatin, as your doctor will need to perform a blood test before starting your treatment and possibly during treatment to predict the risk of muscle side effects. It is known that the risk of muscle side effects, e.g. rhabdomyolysis (breakdown of skeletal muscle tissue), increases when certain medicines are taken at the same time (see section 2 "Other medicines and Ezetimibe/Atorvastatin Sandoz Pharmaceutical").

While you are taking this medicine, your doctor will check if you have diabetes or are at risk of developing diabetes. This risk of diabetes increases if you have high levels of sugar and fats in the blood, are overweight, and have high blood pressure.

Tell your doctor about all your medical problems, including allergies.

The combined use of ezetimibe/atorvastatin and fibrates (medicines used to lower cholesterol) should be avoided, as the combined use of ezetimibe/atorvastatin and fibrates has not been studied.

Children

Ezetimibe/atorvastatin is not recommended for children and adolescents.

Other medicines and Ezetimibe/Atorvastatin Sandoz Pharmaceutical

Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines, including those obtained without a prescription.

There are some medicines that can affect the way ezetimibe/atorvastatin works, or their effects can be altered by ezetimibe/atorvastatin (see section 3). This type of interaction could decrease the effectiveness of one or both medicines. On the other hand, it could also increase the risk or severity of side effects, including a serious disorder in which muscle tissue is destroyed, known as "rhabdomyolysis", which is described in section 4:

• cyclosporin (a medicine often used in transplant patients),
• erythromycin, clarithromycin, telithromycin, fusidic acid**, rifampicin (medicines used to treat bacterial infections),
• ketoconazole, itraconazole, voriconazole, fluconazole, posaconazole (medicines used to treat fungal infections),
• gemfibrozil, other fibrates, nicotinic acid, derivatives, colestipol, colestyramine (medicines used to regulate lipid levels),
• certain calcium channel blockers used to treat angina or high blood pressure, e.g. amlodipine, diltiazem,
• digoxin, verapamil, amiodarone (medicines that regulate heart rhythm),
• medicines used to treat HIV, e.g. ritonavir, lopinavir, atazanavir, indinavir, darunavir, the combination of tipranavir/ritonavir, etc. (used to treat AIDS),
• certain medicines used to treat hepatitis C, e.g. telaprevir, boceprevir, and the combination of elbasvir/grazoprevir,
• daptomycin (a medicine used to treat complicated skin and skin structure infections and bacteraemia).

**If you have to take fusidic acid by mouth to treat a bacterial infection, you will have to stop using this medicine temporarily. Your doctor will tell you when you can restart treatment with ezetimibe/atorvastatin. The use of this medicine with fusidic acid can rarely cause muscle weakness, tenderness, or pain (rhabdomyolysis). For more information on rhabdomyolysis, see section 4.

• Other medicines that are known to interact with ezetimibe/atorvastatin
• oral contraceptives (medicines to prevent pregnancy),
• stiripentol (an anticonvulsant medicine used to treat epilepsy),
• cimetidine (a medicine used for stomach acidity and peptic ulcers),
• phenazone (a pain reliever),
• antacids (medicines for the treatment of indigestion that contain aluminium or magnesium)
• warfarin, phenprocoumon, acenocoumarol, or fluindione (medicines that prevent blood clotting),
• colchicine (used to treat gout),
• St. John's Wort (a medicine used to treat depression).

Taking Ezetimibe/Atorvastatin Sandoz Pharmaceutical with food and alcohol

See section 3 for instructions on how to take ezetimibe/atorvastatin. Please note the following:

Grapefruit juice

Do not drink more than one or two small glasses of grapefruit juice per day, as large amounts of grapefruit juice can alter the effects of ezetimibe/atorvastatin.

Alcohol

Avoid excessive alcohol consumption while taking this medicine. For more details, see section 2 "Warnings and precautions".

Pregnancy and breast-feeding

Do not take ezetimibe/atorvastatin if you are pregnant, think you may be pregnant, or are planning to become pregnant. Do not take ezetimibe/atorvastatin if you can become pregnant, unless you use reliable contraception. If you become pregnant while taking ezetimibe/atorvastatin, stop taking it immediately and tell your doctor.

Do not take ezetimibe/atorvastatin if you are breast-feeding.

The safety of ezetimibe/atorvastatin during pregnancy and breast-feeding has not been established.

Ask your doctor or pharmacist for advice before taking this medicine.

Driving and using machines

Ezetimibe/atorvastatin is not expected to affect your ability to drive or use machines. However, it should be noted that some people experience dizziness after taking ezetimibe/atorvastatin.

Ezetimibe/Atorvastatin10mg/10mg, 10mg/20mg, and 10 mg/40 mg

Ezetimibe/Atorvastatin Sandoz Pharmaceuticalcontains lactose

The tablets of Ezetimibe/Atorvastatin Sandoz Pharmaceutical contain a sugar called lactose. If your doctor has told you that you have an intolerance to some sugars, contact them before taking this medicine.

Ezetimibe/Atorvastatin Sandoz Pharmaceutical contains sodium

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

3. How to take Ezetimibe/Atorvastatin Sandoz Pharmaceutical

Follow the instructions for administration of this medicine exactly as told by your doctor. Your doctor will determine the appropriate dose of tablets for you, depending on your current treatment and your personal risk situation. If in doubt, consult your doctor or pharmacist again.

• Before starting to take ezetimibe/atorvastatin, you should be following a cholesterol-lowering diet.
• You should continue with this cholesterol-lowering diet while taking ezetimibe/atorvastatin.

How much to take

The recommended dose is one ezetimibe/atorvastatin tablet by mouth once a day.

When to take it

Take ezetimibe/atorvastatin at any time of the day. You can take it with or without food.

If your doctor has prescribed ezetimibe/atorvastatin with colestyramine or any other bile acid sequestrant (medicines that lower cholesterol levels), you should take ezetimibe/atorvastatin at least 2 hours before or 4 hours after taking the bile acid sequestrant.

If you take more Ezetimibe/Atorvastatin Sandoz Pharmaceutical than you should

Consult your doctor or pharmacist.

In case of overdose or accidental ingestion, consult your doctor or pharmacist immediately or call the Toxicology Information Service, telephone: 91 562 04 20, indicating the medicine and the amount taken.

If you forget to take Ezetimibe/Atorvastatin Sandoz Pharmaceutical

Do not take a double dose to make up for forgotten doses. Take the normal dose at the usual time the next day.

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 serious adverse effects or symptoms, stop taking your tablets and inform your doctor immediately, or go to the emergency department of the nearest hospital.

• severe allergic reactions that cause swelling of the face, tongue, and throat and can cause great difficulty breathing,
• severe disease whose symptoms are intense exfoliation and skin inflammation, blister formation on the skin, mouth, eyes, genitals, and fever, skin rash with pink or red spots, especially on the palms of the hands or soles of the feet, which can lead to blisters,
• weakness, sensitivity, pain, or muscle rupture, change in urine color to reddish-brown, and especially if it occurs at the same time, a feeling of discomfort or high temperature that can be caused by abnormal muscle destruction that can be potentially fatal and lead to kidney problems,
• lupus-like syndrome (which includes skin rash, joint disorders, and effects on blood cells).

Consult your doctor as soon as possible if you experience problems associated with the unexpected or unusual appearance of bleeding or bruising, as this fact may be indicative of liver disease.

The following frequent adverse effects were reported (may affect up to 1 in 10 people):

• diarrhea,
• muscle pain.

The following infrequent adverse effects were reported (may affect up to 1 in 100 people):

• flu,
• depression, sleep problems, sleep disorder,
• dizziness, headache, tingling sensation,
• slow heart rate,
• hot flashes,
• breathing difficulties,
• abdominal pain, abdominal swelling, constipation, indigestion, flatulence, frequent bowel movements, stomach inflammation, nausea, stomach discomfort, stomach upset,
• acne, hives,
• joint pain, back pain, leg cramps, muscle fatigue, muscle spasms or weakness, pain in arms and legs,
• unusual weakness, feeling of tiredness or discomfort, swelling, especially in the ankles (edema),
• increased levels of some liver or muscle function tests (CK) in laboratory blood tests,
• weight gain.

Additionally, the following adverse effects have been reported in people taking ezetimibe/atorvastatin, or ezetimibe or atorvastatin tablets alone:

• allergic reactions that include swelling of the face, lips, tongue, and/or throat that can cause difficulty breathing or swallowing (which requires immediate treatment),
• elevated red rash, sometimes with target-like lesions,
• liver problems,
• cough,
• heartburn,
• decreased appetite, loss of appetite,
• high blood pressure,
• skin rash and itching, allergic reactions including skin rash and hives,
• tendon injuries,
• gallstones or gallbladder inflammation (which can cause abdominal pain, nausea, vomiting),
• pancreatitis, often with severe abdominal pain,
• reduction in blood cell count, which can cause bruising/bleeding (thrombocytopenia),
• nasal passage inflammation, nosebleeds,
• neck pain, pain, chest pain, throat pain,
• increases and decreases in blood sugar levels (if you have diabetes, you should continue to carefully monitor your blood sugar levels),
• having nightmares,
• numbness or tingling in the fingers and toes,
• reduced sensitivity to pain or touch,
• change in taste, dry mouth,
• memory loss,
• ringing in the ears and/or head, hearing loss,
• vomiting,
• belching,
• hair loss,
• increased temperature,
• positive urine tests for white blood cells,
• blurred vision, visual disturbances,
• gynecomastia (breast enlargement in men).

Possible adverse effects observed with some statins:

• sexual difficulties,
• depression,
• respiratory problems such as persistent cough and/or difficulty breathing or fever,
• diabetes. This is more likely if you have high levels of sugars and fats in your blood, are overweight, and have high blood pressure. Your doctor will monitor you while you are taking this medicine,
• muscle pain, sensitivity, or weakness that is constant and particularly if you feel unwell or have a high fever that may not go away after stopping [ezetimibe/atorvastatin] (frequency not known).
• myasthenia gravis (a disease that causes general muscle weakness, including in some cases the muscles used for breathing).
• ocular myasthenia (a disease that causes weakness in the eye muscles).

Consult your doctor if you experience weakness in your arms or legs that worsens after periods of activity, double vision, or drooping eyelids, difficulty swallowing, or breathing difficulties.

Adverse Effect Reporting

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 leaflet. 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 Ezetimibe/Atorvastatin Sandoz Pharmaceutical

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

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

This medicine does not require special storage conditions.

Medicines should not be thrown away through wastewater or household waste. Deposit the packaging 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 packaging and medicines you no longer need. This way, you will help protect the environment.

6. Package Contents and Additional Information

Composition ofEzetimibe/Atorvastatin Sandoz Pharmaceutical

Ezetimibe/Atorvastatin Sandoz Pharmaceutical 10 mg/10 mg: each film-coated tablet contains 10 mg of ezetimibe and 10 mg of atorvastatin (as atorvastatin calcium trihydrate).

Ezetimibe/Atorvastatin Sandoz Pharmaceutical 10 mg/20 mg: each film-coated tablet contains 10 mg of ezetimibe and 20 mg of atorvastatin (as atorvastatin calcium trihydrate).

Ezetimibe/Atorvastatin Sandoz Pharmaceutical 10 mg/40 mg: each film-coated tablet contains 10 mg of ezetimibe and 40 mg of atorvastatin (as atorvastatin calcium trihydrate).

Ezetimibe/Atorvastatin Sandoz Pharmaceutical 10 mg/80 mg: each film-coated tablet contains 10 mg of ezetimibe and 80 mg of atorvastatin (as atorvastatin calcium trihydrate).

The other components are:

Tablet core:

Microcrystalline cellulose 101 (E460), mannitol (E421), calcium carbonate (E170), sodium croscarmellose (E468), hydroxypropylcellulose (E463), polysorbate 80 (E433), yellow iron oxide (E172), magnesium stearate (E470b), povidone K29/32 (E1201), sodium lauryl sulfate (E487).

Tablet coating

Ezetimibe/Atorvastatin Sandoz Pharmaceutical 10 mg/10 mg, 10 mg/20 mg, 10 mg/40 mg:

Opadry white OY-L28900 consisting of:

Lactose monohydrate,

Hypromellose 2910 (E464),

Titanium dioxide (E171),

Macrogol 4000 (E1521).

Ezetimibe/Atorvastatin Sandoz Pharmaceutical 10 mg/80 mg: DrCoat FCU consisting of:

Hypromellose 2910,

Titanium dioxide (E171),

Talc (E553b),

Macrogol 400,

Yellow iron oxide (E172).

Product Appearance and Package Contents

Ezetimibe/Atorvastatin Sandoz Pharmaceutical 10 mg/10 mg:

white, round, biconvex film-coated tablets with a diameter of approximately 8.1 mm.

Ezetimibe/Atorvastatin Sandoz Pharmaceutical 10 mg/20 mg:

white, oval, biconvex film-coated tablets with dimensions of approximately 11.6 x 7.1 mm.

Ezetimibe/Atorvastatin Sandoz Pharmaceutical 10 mg/40 mg:

white, capsule-shaped, biconvex film-coated tablets with dimensions of approximately 16.1 x 6.1 mm.

Ezetimibe/Atorvastatin Sandoz Pharmaceutical 10 mg/80 mg:

yellow, oblong, biconvex film-coated tablets with dimensions of approximately 19.1 x 7.6 mm.

Ezetimibe/Atorvastatin Sandoz Pharmaceutical 10 mg/10 mg, 10 mg/20 mg, 10 mg/40 mg:

Packaging of 30, 90, and 100 film-coated tablets in OPA/Al/PVC//Al blisters.

Packaging of 30x1, 90x1, and 100x1 film-coated tablets in single-dose OPA/Al/PVC//Al blisters.

Ezetimibe/Atorvastatin Sandoz Pharmaceutical 10 mg/80 mg:

Packaging of 30, multiple packaging of 90 (2 packages of 45) and 100 (2 packages of 50) film-coated tablets in OPA/Al/PVC//Al blisters.

Packaging of 30x1, multiple packaging of 90x1 (2 packages of 45x1) and 100x1 (2 packages of 50x1) film-coated tablets in OPA/Al/PVC//Al blisters.

Only some package sizes may be marketed.

Marketing Authorization Holder and Manufacturer

Marketing Authorization Holder

Sandoz Farmacéutica, S.A.

Centro Empresarial Parque Norte

Edificio Roble

C/ Serrano Galvache, 56

28033 Madrid

Spain

Manufacturer

ELPEN Pharmaceutical Co. Inc.

Marathonos Avenue 95

Pikermi Attiki, 19009

Greece

or

Lek Pharmaceuticals d.d

Verovskova ulica 57

1526 Ljubljana

Slovenia

or

ELPEN Pharmaceutical Co. Inc.

Zapani, Block 1048,

Keratea, 190 01

Greece

Date of the Last Revision of this Leaflet:March 2024

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