Package Insert: Information for the Patient

Ezetimiba/Atorvastatina Tecnigen 10 mg/10 mg Film-Coated Tablets

Ezetimiba/Atorvastatina Tecnigen 10 mg/20 mg Film-Coated Tablets

Ezetimiba/Atorvastatina Tecnigen 10 mg/40 mg Film-Coated Tablets

Ezetimiba/Atorvastatina Tecnigen 10 mg/80 mg Film-Coated Tablets

Read this package insert carefully before starting to take this medicine, as it contains important information for you.

• Keep this package insert, as you may need to read it again.
• If you have any questions, consult your doctor or pharmacist.
• This medicine has been prescribed only for you, and you should not give it to others even if they have the same symptoms as you, as it may harm them.
• If you experience any adverse effects, consult your doctor or pharmacist, even if they are not listed in this package insert. See section 4.

Ezetimibe/Atorvastatin Tecnigen is a medication that decreases high levels of cholesterol. This medication contains ezetimibe and atorvastatin.

Ezetimibe/atorvastatin is used in adults to decrease levels of total cholesterol, "bad" cholesterol (low-density lipoprotein or LDL cholesterol), and certain fatty substances called triglycerides that circulate in the blood. Additionally, this medication increases concentrations of "good" cholesterol (high-density lipoprotein or HDL cholesterol).

Ezetimibe/atorvastatin acts by reducing cholesterol in two ways. It reduces the cholesterol absorbed in the digestive tract, as well as the cholesterol that your body produces on its own.

Cholesterol is one of the fatty substances that are found in the circulatory system. Your total cholesterol is composed mainly of LDL and HDL cholesterol.

LDL cholesterol is often referred to as "bad" cholesterol because it can accumulate in the walls of your arteries, forming plaques. Over time, this accumulation of plaque can cause a narrowing of the arteries. This narrowing can make blood flow to vital organs such as the heart and brain slower or interrupted. This interruption of blood flow can trigger a heart attack or stroke.

HDL cholesterol is often referred to as "good" cholesterol because it helps prevent bad cholesterol from accumulating in the arteries and protects them from cardiovascular diseases.

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

Ezetimibe/atorvastatin is used in patients who cannot control their cholesterol levels solely with diet. While taking this medication, you should follow a cholesterol-reducing diet.

Ezetimibe/atorvastatin is used, along with a cholesterol-reducing diet, if you have:

• elevated levels of cholesterol in the blood (primary hypercholesterolemia [familial heterozygous and non-familial]) or elevated levels of fatty substances (mixed hyperlipidemia):
• • that are not well controlled with a statin alone;
  • for which a statin and ezetimibe have been used in separate tablets.

• a genetic disorder (familial hypercholesterolemia), which increases the level of cholesterol in the blood. You may also receive other treatments.

• cardiovascular disease, ezetimibe/atorvastatin reduces the risk of heart attack, stroke, coronary artery bypass grafting, or hospitalization for chest pain.

Ezetimibe/atorvastatin does not help you lose weight.

Do not takeEzetimiba/Atorvastatina Tecnigen

• if you are allergic to ezetimiba, atorvastatina or any of the other ingredients of this medicine (listed in section 6),
• if you have or have had any liver disease,
• if you have had any unexplained abnormal results in blood tests for liver function,
• if you are a woman who may become pregnant and is not using reliable contraceptive methods,
• if you are pregnant, trying to become pregnant or breastfeeding,
• if you are taking the combination of glecaprevir/pibrentasvir or ledipasvir/sofosbuvir in the treatment of hepatitis C.

Warnings and precautions

Consult your doctor or pharmacist before starting to take this medicine:

• if you have had a previous stroke with intracranial haemorrhage, or have small collections of fluid in the brain resulting from previous strokes,
• if you have kidney problems,
• if your thyroid gland has low activity (hypothyroidism),
• if you have had recurrent or unexplained muscle pain or discomfort or a personal or family history of muscle problems,
• if you have experienced muscle problems during previous treatment with other lipid-lowering medicines (e.g. other medicines containing "statins" or "fibrates"),
• if you regularly consume large amounts of alcohol,
• if you have a history of liver disease,
• if you are over 70 years old,
• if your doctor has told you that you have an intolerance to some sugars, contact him before taking this medicine,
• if you are taking or have taken in the last 7 days a medicine containing fusidic acid (used to treat bacterial infections) by mouth or injection. The combination of fusidic acid and ezetimiba/atorvastatina can cause severe muscle problems (rhabdomyolysis),
• if you have or have had myasthenia (a disease that causes generalised muscle weakness, which in some cases affects the muscles used for breathing) or myasthenia gravis (a disease that causes weakness of the eye muscles), as statins can sometimes worsen the disease or cause myasthenia (see section 4).

Contact your doctor as soon as possible if you experience unexplained muscle pain, sensitivity, or muscle weakness while taking ezetimiba/atorvastatina.This is because in rare cases, muscle problems can be severe, including muscle rupture causing kidney damage. It is known that atorvastatina can cause muscle problems and muscle problems have also been reported with ezetimiba.

Also inform your doctor or pharmacist if you experience persistent muscle weakness. Further tests and additional medicines may be necessary to diagnose and treat this problem.

Consult your doctor or pharmacist before starting to take this medicine:

• if you have severe respiratory failure.

If you are in any of the above circumstances (or are unsure), consult your doctor before starting to take this medicine, as your doctor will need to perform a blood test before starting your treatment with ezetimiba/atorvastatina, and possibly during it, to predict the risk of you experiencing muscle side effects. It is known that the risk of muscle side effects, e.g. rhabdomyolysis, increases when certain medicines are taken simultaneously (see section 2 “Other medicines and Ezetimiba/Atorvastatina Tecnigen”).

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

Inform your doctor of all your medical problems, including allergies.

You should avoid the combined use of ezetimiba/atorvastatina and fibrates (certain medicines for lowering cholesterol), as the combined use of ezetimiba/atorvastatina and fibrates has not been studied.

Children

Ezetimiba/atorvastatina is not recommended for children and adolescents.

Other medicines and Ezetimiba/Atorvastatina Tecnigen

Inform your doctor or pharmacist if you are taking, have taken recently or may need to take any other medicine, including over-the-counter medicines.

There are some medicines that can modify the effect of ezetimiba/atorvastatina or whose effects may be affected by ezetimiba/atorvastatina (see section 3). This type of interaction could reduce 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 condition in which muscle is destroyed, known as “rhabdomyolysis”, which is described in section 4:

• ciclosporina (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, cholestyramine (medicines used to regulate lipid levels),
• some 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),
• some medicines used to treat hepatitis C, e.g. telaprevir, boceprevir and the combination of elbasvir/grazoprevir or ledipasvir/sofosbuvir,
• letermovir, a medicine that helps prevent cytomegalovirus infection,
• daptomycin (a medicine used to treat complicated skin and soft tissue infections and bacteremia).

** If you have to take fusidic acid orally to treat a bacterial infection, you will temporarily have to stop taking this medicine. Your doctor will tell you when you can restart your treatment with ezetimiba/atorvastatina. The use of ezetimiba/atorvastatina with fusidic acid rarely can cause muscle weakness, sensitivity or pain (rhabdomyolysis). For more information on rhabdomyolysis, see section 4.

• Other medicines that are known to interact with ezetimiba/atorvastatina
• • oral contraceptives (medicines that prevent pregnancy),
  • estiripentol (an anticonvulsant medicine used to treat epilepsy),
  • cimetidine (a medicine used for stomach acid and peptic ulcers),
  • phenazone (an analgesic),
  • antacids (products 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 for treating depression).

Taking Ezetimiba/Atorvastatina Tecnigen with food and alcohol

See section 3 for instructions on how to take Ezetimiba/Atorvastatina Tecnigen. Please note the following:

Orange juice

Do not take more than one or two small glasses of orange juice per day, as large amounts of orange juice can alter the effects of ezetimiba/atorvastatina.

Alcohol

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

Pregnancy and breastfeeding

Do not take ezetimiba/atorvastatina if you are pregnant, trying to become pregnant or think you may be pregnant. Do not take ezetimiba/atorvastatina if you may become pregnant, unless you use reliable contraceptive methods. If you become pregnant while taking ezetimiba/atorvastatina, stop taking it immediately and inform your doctor.

Do not take ezetimiba/atorvastatina if you are breastfeeding.

The safety of ezetimiba/atorvastatina during pregnancy and breastfeeding has not been proven.

Consult your doctor or pharmacist before taking this medicine.

Driving and using machines

Ezetimiba/atorvastatina is not expected to interfere with your ability to drive or use machines. However, some people may experience dizziness after taking ezetimiba/atorvastatina.

Ezetimiba/Atorvastatina Tecnigen contains lactose

The tablets of Ezetimiba/Atorvastatina Tecnigen contain a sugar called lactose. If your doctor has told you that you have an intolerance to certain sugars, consult your doctor before taking this medicine.

Ezetimiba/Atorvastatina Tecnigen contains sodium

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

Follow exactly the administration instructions for this medication as indicated by your doctor. Your doctor will determine the appropriate dose per tablet for you, depending on your current treatment and personal risk situation. In case of doubt, consult your doctor or pharmacist again.

What quantity should you take

The recommended dose is one tablet of ezetimiba/atorvastatina once a day taken orally.

Form of administration

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

If your doctor has prescribed ezetimiba/atorvastatina along with colestiramine or any other bile acid sequestrant (medications that reduce cholesterol levels), you should take ezetimiba/atorvastatina at least 2 hours before or 4 hours after taking the bile acid sequestrant.

If you take more Ezetimiba/Atorvastatina Tecnigen than you should

Consult with your doctor or pharmacist.

In case of overdose or accidental ingestion, consult your doctor or pharmacist immediately or call the Toxicological Information Service, phone: 91 562 04 20, indicating the medication and the amount ingested.

If you forgot to take Ezetimiba/Atorvastatina Tecnigen

Do not take an extra dose; the next day, take your usual amount of ezetimiba/atorvastatina at the usual time.

If you have any other questions about the use of this medication, ask your doctor or pharmacist.

Like all medicines, this medicine can cause side effects, although not everyone will experience them.

If you experience any of the following serious side effects or symptoms, stop taking your tablets and immediately inform your doctor, or go to the nearest hospital emergency service.

• Severe allergic reactions that cause swelling of the face, tongue, and throat and may cause severe difficulty breathing.
• Severe disease whose symptoms are intense peeling 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 may lead to blistering.
• Weakness, sensitivity, pain, or muscle rupture or change in urine color to brown-red, and especially if it occurs at the same time, feeling unwell or high temperature that may be caused by abnormal muscle destruction that can be potentially fatal and trigger kidney problems.
• Lupus-like syndrome (including 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 may be indicative of liver disease.

The following frequent side effects (may affect up to 1 in 10 patients) have been reported:

• Diarrhea,
• Muscle pain.

The following infrequent side effects (may affect up to 1 in 100 patients) have been reported:

• Flu,
• Depression; sleep disorders; sleep disturbances,
• Dizziness; headache; tingling sensation,
• Slow heart rate,
• Angina,
• Shortness of breath,
• Abdominal pain; abdominal swelling; constipation; indigestion; flatulence; frequent bowel movements; stomach inflammation; nausea; stomach discomfort; stomach upset,
• Acne; hives,
• Joint pain; back pain; muscle cramps in the legs; muscle fatigue, spasms, or weakness; pain in the arms and legs,
• Unusual weakness; feeling tired or unwell; inflammation, especially in the ankles (edema),
• Increased levels of some liver or muscle function tests (CK) in laboratory blood tests,
• Weight gain.

In addition, the following side effects have been reported in people taking ezetimibe/atorvastatin tablets, ezetimibe, or atorvastatin:

• Allergic reactions that include inflammation of the face, lips, tongue, and/or throat that may cause difficulty breathing or swallowing (requiring immediate medical treatment),
• Red, sometimes target-shaped, skin rash,
• Liver problems,
• Cough,
• Heartburn,
• Loss of appetite; lack of appetite,
• High blood pressure,
• Itchy skin rash and hives; allergic reactions that include the appearance of skin rash and hives,
• Tendon injury,
• Bile stones or inflammation of the gallbladder (which may cause abdominal pain, nausea, or vomiting),
• Pancreatitis, often accompanied by severe abdominal pain,
• Decreased blood cell count, which may cause bruising or bleeding (thrombocytopenia),
• Runny nose; nasal bleeding,
• Neck pain; chest pain; sore throat,
• Increased or decreased blood sugar levels (if you have diabetes, you should closely monitor your blood glucose levels),
• Nightmares,
• Numbness or tingling in the fingers of the hands and feet,
• Decreased sensitivity to pain or touch,
• Altered sense of taste; dry mouth,
• Memory loss,
• Tinnitus and/or headache; hearing loss,
• Vomiting,
• Belching,
• Hair loss,
• High temperature,
• Presence of white blood cells in urine tests,
• Blurred vision; visual disturbances,
• Gynecomastia (breast enlargement in men),
• Myasthenia gravis (a disease that causes generalized muscle weakness, which in some cases affects the muscles used for breathing),
• Myasthenia ocular (a disease that causes weakness of the eye muscles).

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

Possible side effects reported with some statins

• Sexual dysfunction,
• Depression,
• Respiratory problems, including persistent cough and/or shortness of breath or fever,
• Diabetes. It is more likely if you have high blood sugar and fat levels, obesity, and high blood pressure. Your doctor will monitor you while taking this medication,
• Constant muscle pain, sensitivity, or weakness, and especially if it occurs at the same time, feeling unwell or high temperature that may not disappear after stopping ezetimibe/atorvastatin treatment (frequency unknown).

Reporting side effects

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

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

Do not use this medication after the expiration date that appears on the box or on the blister after “CAD”. The expiration date is the last day of the month indicated.

This medication does not require special conditions for conservation.

Medications should not be disposed of through drains or in the trash. Dispose of the packaging and medications you no longer need at the SIGRE collection point at the pharmacy. If in doubt, ask your pharmacist how to dispose of the packaging and medications you no longer need. By doing so, you will help protect the environment.

Composition of Ezetimiba/Atorvastatina Tecnigen

The active principles are ezetimiba and atorvastatina. Each film-coated tablet contains 10 mg of ezetimiba and 10 mg, 20 mg, 40 mg or 80 mg of atorvastatina (as atorvastatina calcium trihydrate).

The other components (excipients) are: calcium carbonate; anhydrous colloidal silica; sodium croscarmellose; hydroxypropylcellulose; lactose monohydrate; povidone; magnesium stearate; microcrystalline cellulose; polisorbate 80 and sodium lauryl sulfate (E487).

The coating material contains: hypromelose, lactose monohydrate, titanium dioxide, macrogol and talc.

Appearance of the product and contents of the package

Film-coated tablets, in the form of a capsule, biconvex and white to off-white in color.

Ezetimiba/Atorvastatina Tecnigen 10 mg/10 mg tablets: with the code “1T” on one face.

Ezetimiba/Atorvastatina Tecnigen 10 mg/20 mg tablets: with the code “2T” on one face.

Ezetimiba/Atorvastatina Tecnigen 10 mg/40 mg tablets: with the code “4T” on one face.

Ezetimiba/Atorvastatina Tecnigen 10 mg/80 mg tablets: with the code “8T” on one face.

Package sizes:

Blister packs of 30 film-coated tablets in aluminum/aluminum.

Holder of the marketing authorization and responsible for manufacturing

Holder of the marketing authorization:

Tecnimede España Industria Farmacéutica S.A.

Avda. de Bruselas, nº 13.3ºD

28108 - Alcobendas (Madrid)

Spain

Responsible for manufacturing:

Delorbis Pharmaceuticals Limited

17 Athinon Street. Ergates Industrial Area

2643 Ergates.

Cyprus

This medicine is authorized in the member states of the European Economic Area with the following names:

Netherlands:

Ezetimibe/Atorvastatine Tecnigen 10 mg/10 mg filmomhulde tabletten

Ezetimibe/Atorvastatine Tecnigen 10 mg/20 mg filmomhulde tabletten

Ezetimibe/Atorvastatine Tecnigen 10 mg/40 mg filmomhulde tabletten

Ezetimibe/Atorvastatine Tecnigen 10 mg/80 mg filmomhulde tabletten

Last review date of this leaflet:November 2023.

The detailed information of this medicine is available on the website of the Spanish Agency for Medicines and Medical Devices (AEMPS) http://www.aemps.gob.es