Leaflet: information for the user

Ezetimiba/Simvastatinaratio10 mg/20 mg film-coated tablets

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

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

Contents of the leaflet

1. What isEzetimiba/Simvastatinaratioand what it is used for
2. What you need to know before you start takingEzetimiba/Simvastatinaratio
3. How to takeEzetimiba/Simvastatinaratio
4. Possible side effects
5. Storage ofEzetimiba/Simvastatinaratio
6. Contents of the pack and additional information

This medicationcontains the active ingredients ezetimibe and simvastatin.It is used to reduce total cholesterol, "bad" cholesterol (low-density lipoprotein, LDL) and certain types of fat called triglycerides that circulate in the blood. Additionally, it raises the levels of "good" cholesterol (high-density lipoprotein, HDL).

Ezetimibe/simvastatinacts by reducing cholesterol in two ways. The active ingredient ezetimibe reduces the cholesterol absorbed in the digestive tract. The active ingredient simvastatin, which belongs to the group of "statins," inhibits the production of cholesterol produced by the body itself.

Cholesterol is one of the fatty substances found in the bloodstream. Its total cholesterol is composed mainly of LDL and HDL.

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 slow down or interrupt blood flow to vital organs such as the heart and brain. This interruption of blood flow can cause 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 in your blood that can increase the risk of heart disease.

Ezetimibe/simvastatinis used in patients who cannot control their cholesterol levels solely with diet. While taking this medication, you must follow a cholesterol-lowering diet.

Ezetimibe/simvastatinis used, along with a cholesterol-lowering 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 single statin
• for whom 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/simvastatinreduces the risk of heart attack, stroke, coronary artery bypass grafting, or hospitalization for chest pain.

This medicationdoes not help you lose weight.

Do not take Ezetimiba/Simvastatina ratio if

• You are allergic to ezetimiba, simvastatina, or any of the other components of this medication (listed in section 6)
• You have liver problems currently
• You are pregnant or breastfeeding
• You are taking medications with one or more of the following active ingredients:

• Itraconazole, ketoconazole, posaconazole, or voriconazole (used to treat fungal infections)
• Erythromycin, clarithromycin, or telithromycin (used to treat infections)
• Protease inhibitors for HIV such as indinavir, nelfinavir, ritonavir, and saquinavir (used to treat HIV infections)
• Boceprevir or telaprevir (used to treat hepatitis C infection)
• Nefazodone (used to treat depression)
• Cobicistat
• Gemfibrozil (used to reduce cholesterol)
• Ciclosporin (used in patients with organ transplants)
• Danazol (a synthetic hormone used to treat endometriosis, a condition in which the inner lining of the uterus grows outside the uterus)

• If you are taking or have taken within the last 7 days a medication containing fusidic acid (used to treat bacterial infections) by mouth or injection. The combination of fusidic acid and ezetimiba/simvastatina may cause severe muscle problems (rhabdomyolysis)

Do not take more than 10/40 mg of ezetimiba/simvastatina if you are taking lomitapida (used to treat rare and severe cholesterol disorders)

Consult your doctor if you are unsure if your medication is mentioned above.

Warnings and precautions

Consult your doctor or pharmacist before starting to take Ezetimiba/Simvastatina ratio:

• All of your medical problems, including allergies
• If you consume large amounts of alcohol or have had liver disease at any time. Ezetimiba/Simvastatina may not be suitable for you.
• If you are scheduled for surgery. You may need to stop taking the ezetimiba/simvastatina tablets for a short period of time.
• If you are of Asian descent, as you may need a different dose.

Your doctor will make a blood test before you start taking ezetimiba/simvastatina and also if you have any symptoms of liver problems while taking ezetimiba/simvastatina. This is to check how well your liver is working.

Your doctor may also want to make blood tests to check how well your liver is working after you start treatment with ezetimiba/simvastatina.

While you are taking this medication, your doctor will monitor if 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.

Talk to your doctor if you have a severe lung disease.

You should avoid the combined use of ezetimiba/simvastatina and fibrates (certain medications to reduce cholesterol), as the combined use of ezetimiba/simvastatina and fibrates has not been studied.

Consult your doctor immediately if you experience pain, sensitivity to pressure, or muscle weakness that is unexplained. This is because, in rare cases, muscle problems can be severe, including muscle failure which causes kidney damage; and very rarely, deaths have occurred.

The risk of muscle failure is higher with high doses of ezetimiba/simvastatina, especially the dose of 10/80 mg. The risk of muscle failure is also higher in certain patients. Inform your doctor in the following situations:

• If you have kidney problems
• If you have thyroid problems
• If you are over 65 years old
• If you are a woman
• If you have had muscle problems during treatment with cholesterol-lowering medications called "statins" (such as simvastatina, atorvastatina, and rosuvastatina) or fibrates (such as gemfibrozilo or bezafibrato).
• If you or your close relatives have a hereditary muscle disorder
• If you have or have had myasthenia (a condition that causes generalized muscle weakness that, in some cases, affects the muscles used for breathing) or myasthenia gravis (a condition that causes eye muscle weakness), as statins can sometimes worsen the condition or cause myasthenia (see section 4).

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

Children and adolescents

• Ezetimiba/simvastatina is not recommended for children under 10 years old.

Taking Ezetimiba/Simvastatina ratio with other medications

Inform your doctor if you are taking, have taken recently, or may need to take any other medication with any of the following active ingredients. Taking ezetimiba/simvastatina with any of the following medications may increase the risk of muscle problems (some of these are already included in the section above "Do not take Ezetimiba/Simvastatina ratio if").

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

• Ciclosporin (often used in transplant patients)
• Danazol (a synthetic hormone used to treat endometriosis, a condition in which the inner lining of the uterus grows outside the uterus)
• Medications with an active ingredient such as itraconazole, ketoconazole, fluconazole, posaconazole, or voriconazole (used to treat fungal infections)
• Fibrates with an active ingredient such as gemfibrozil and bezafibrato (used to reduce cholesterol)
• Erythromycin, clarithromycin, or telithromycin (used to treat bacterial infections)
• Protease inhibitors for HIV, such as indinavir, nelfinavir, ritonavir, and saquinavir (used to treat HIV infections)
• Antivirals for hepatitis C such as boceprevir, telaprevir, elbasvir, or grazoprevir (used to treat hepatitis C infection)
• Nefazodone (used to treat depression)
• Medications with the active ingredient cobicistat
• Amiodarone (used to treat irregular heart rhythm)
• Verapamil, diltiazem, or amlodipine (used to treat high blood pressure, chest pain associated with heart disease, or other heart conditions)
• Lomitapida (used to treat rare and severe cholesterol disorders)
• Daptomycin (a medication used to treat skin and skin structure infections and bacteremia). It is possible that muscle-related side effects may be more severe when this medication is taken during treatment with simvastatina (e.g., ezetimiba/simvastatina). Your doctor may decide that you should stop taking ezetimiba/simvastatina for a time
• Large doses (1 gram or more per day) of niacin or nicotinic acid (also used to reduce cholesterol)
• Colchicine (used to treat gout)

As with the medications mentioned above, inform your doctor or pharmacist if you are taking or have taken recently other medications, even those purchased without a prescription. In particular, inform your doctor if you are taking any of the following:

• Medications with an active ingredient to prevent blood clot formation, such as warfarin, fluindione, phenprocoumon, or acenocoumarol (anticoagulants)
• Colestiramine (also used to reduce cholesterol), as it affects how ezetimiba/simvastatina works
• Fenofibrate (also used to reduce cholesterol)
• Rifampicin (used to treat tuberculosis)
• Ticagrelor (antiplatelet medication)

You should also inform any doctor who prescribes a new medication that you are taking ezetimiba/simvastatina.

Taking Ezetimiba/Simvastatina ratio with food and drinks

The juice of grapefruit contains one or more components that alter the metabolism of some medications, including ezetimiba/simvastatina. You should avoid consuming grapefruit juice, as it may increase the risk of muscle problems.

Pregnancy and breastfeeding

Do not take ezetimiba/simvastatina if you are pregnant, trying to become pregnant, or think you may be pregnant. If you become pregnant while taking ezetimiba/simvastatina, stop taking it immediately and inform your doctor. Do not take ezetimiba/simvastatina if you are breastfeeding, as it is unknown whether this medication passes into breast milk.

Consult your doctor or pharmacist before using any medication.

Driving and operating machines

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

Ezetimiba/Simvastatina ratio contains lactose

If your doctor has told you that you have an intolerance to certain sugars, consult with them before taking this medication.

Ezetimiba/Simvastatina ratio contains sodium

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

Your doctor will determine the appropriate dose for you, depending on your current treatment and your personal risk situation.

The tablets do not have a notch and should not be divided.

Follow exactly the administration instructions for this medication as indicated by your doctor or pharmacist. In case of doubt, consult your doctor or pharmacist again.

• Before starting to take ezetimiba/simvastatina, you must be following a diet to reduce cholesterol.
• You will need to continue with this cholesterol-lowering diet while taking ezetimiba/simvastatina.

Adults: the dose is1 tabletof ezetimiba/simvastatina once a day by mouth.

Use in adolescents(10 to 17 years old): the dose is1 tabletof ezetimiba/simvastatina once a day by mouth (do not exceed a maximum dose of 10mg/40mg once a day).

The ezetimiba/simvastatina 10mg/80mg dose is only recommended for adult patients with very high cholesterol levels and a high risk of heart disease problems who have not achieved treatment goals with lower doses.

Take ezetimiba/simvastatina at night. You can take it with or without food.

If your doctor has prescribed ezetimiba/simvastatina along with another cholesterol-lowering medication that contains the active ingredient colestiramine or any other bile acid sequestrant, you should take ezetimiba/simvastatina at least 2 hours before or 4 hours after taking the bile acid sequestrant.

If you take more Ezetimiba/Simvastatina ratiothan you should

In case of overdose or accidental ingestion, consult the Toxicological Information Service. Phone: 91 562 04 20, consult your doctor or pharmacist.

If you forgot to take Ezetimiba/Simvastatina ratio

Do not take a double dose to make up for the missed doses, take your usual amount of Ezetimiba/Simvastatinaratioat the usual time.

If you interrupt the treatment with Ezetimiba/Simvastatina ratio

Talk to your doctor or pharmacist because your cholesterol may increase again.

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

Like all medicines, this medicine can cause side effects, although not everyone will experience them (see section 2 “What you need to know before starting to takeEzetimiba/Simvastatina ratio”).

The following side effects were reported to be frequent (can affect up to 1 in 10 people):

• Muscle pain
• Laboratory blood test elevations in liver function (transaminases) and/or muscle (CK)

The following side effects were reported to be infrequent (can affect up to 1 in 100 people):

• Liver function elevations in blood tests; uric acid elevations in the blood; blood clotting time elevations; proteinuria; weight loss
• Dizziness; headache; tingling sensation
• Abdominal pain; indigestion; flatulence; nausea; vomiting; abdominal distension; diarrhea; dry mouth; heartburn
• Rash; itching; urticaria
• Joint pain; muscle pain, hypersensitivity, weakness, or spasms; neck pain; arm and leg pain; back pain
• Unusual fatigue or weakness; feeling tired; chest pain; swelling, especially of the hands and feet
• Sleep disturbances; difficulty sleeping

In addition, the following side effects were reported in people taking ezetimiba/simvastatina or medications containing the active ingredients ezetimiba or simvastatina:

• Low red blood cell count (anemia), reduction in blood cell count, which can cause hematoma/hemorrhage (thrombocytopenia)
• Numbness or weakness of the arms and legs; poor memory, memory loss, confusion
• Respiratory problems, including persistent cough and/or difficulty breathing or fever
• Constipation
• Pancreatitis, often with intense abdominal pain
• Hepatitis with the following symptoms: yellowing of the skin and eyes, itching, dark urine, pale stools, feeling tired or weak, loss of appetite; liver insufficiency; gallstones or inflammation of the gallbladder (which can cause abdominal pain, nausea, vomiting)
• Hair loss; red, swollen, and sometimes blistered rash, sometimes with target lesions (erythema multiforme)
• Blurred vision and vision deterioration (can affect up to 1 in 1,000 people)
• Rash that can occur on the skin or ulcers in the mouth (drug-induced lichenoid eruptions) (can affect up to 1 in 10,000 people)
• Hypersensitivity reactions, which can include: allergic reactions, including swelling of the face, lips, tongue, and/or throat, which can cause difficulty breathing or swallowing and require immediate treatment (angioedema), joint pain or inflammation, inflammation of blood vessels, atypical hematomas, skin eruptions, and swelling, urticaria, skin sensitivity to sunlight, fever, hot flashes, difficulty breathing, and general discomfort, lupus-like syndrome (including skin rash, joint problems, and effects on white blood cells). A severe allergic reaction can occur very rarely (can affect up to 1 in 10,000 people) that causes difficulty breathing or dizziness and requires immediate treatment (anaphylaxis)
• Muscle pain, sensitivity to pressure, weakness, or muscle cramps; muscle failure; muscle rupture (can affect up to 1 in 10,000 people); tendon problems, sometimes complicated by tendon rupture
• Gynecomastia (breast enlargement in men) (can affect up to 1 in 10,000 people)
• Loss of appetite
• Hot flashes; high blood pressure
• Pain
• Erectile dysfunction
• Depression
• Alterations in some liver function blood tests

With some statins, the following additional adverse events have been reported:

• Sleep disturbances, including nightmares
• Sexual dysfunction
• 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 medicine
• Constant muscle pain, sensitivity, or weakness, which may not disappear after stopping ezetimiba/simvastatina treatment (unknown frequency)

Consult your doctor immediately if you experience unexplained muscle pain, sensitivity to pressure, or weakness. This is because, in rare cases, muscle problems can be severe, including muscle failure, which can cause kidney damage; and very rarely, deaths have occurred.

• 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.

Reporting of 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 prospectus. 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 medicine.

Keep this medication out of the sight and reach of children

Do not use this medicationafter the expiration date that appears on the box, bottle or blister pack after [CAD]. The expiration date is the last day of the month indicated.

Do not store above 25°C.

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

Composition of Ezetimiba/Simvastatinaratio10 mg/ 20 mg

• The active principles are ezetimiba and simvastatina. Each tablet contains 10 mg of ezetimiba and 20 mg of simvastatina.
• The other components are:Tablet core:lactose monohydrate, hypromellose, croscarmellose sodium, microcrystalline cellulose, ascorbic acid, anhydrous citric acid, butylated hydroxyanisole, propyl gallate, and magnesium stearate.Pigment mixture:lactose monohydrate, yellow iron oxide (E172), red iron oxide (E172), and black iron oxide (E172).

Appearance of the product and content of the container

Ezetimiba/Simvastatinaratio10 mg/ 20 mg tablets EFG areround, biconvex, light brown, speckled, 8 mm in diameter, engraved with “512” on one face.

Packaging sizes:

Blister pack:

28, 30, 50, 90, 98, and 100 tablets

Bottle HDPE:

28, 30, 90, and 100 tablets.

The HDPE bottles contain a capsule with a desiccant. This capsule should not be removed from the bottle.

Only some packaging sizes may be commercially available.

Marketing authorization holder and responsible manufacturer

Marketing authorization holder

ratiopharm España, S.A.

C/Anabel Segura, 11. Edificio Albatros B, 1st floor.

Alcobendas, 28108 - Madrid

Responsible manufacturer

Balkanpharma-Dupnitsa AD

3 Samokovsko Shosse Str., Dupnitsa 2600

Bulgaria

Last review date of this leaflet:April 2021

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