Leaflet: information for the patient

Ivabradina Tarbis 5 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, consult your doctor or pharmacist.
• This medicine has been prescribed for you only, and you must 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.

1. What is Ivabradina Tarbis and what it is used for

2. What you need to know before starting to take Ivabradina Tarbis

3. How to take Ivabradina Tarbis

4. Possible side effects

5. Storage of Ivabradina Tarbis

6. Contents of the pack and additional information

Ivabradina is a heart medication that serves to treat:

• Stable angina pectoris (causing chest pain) in adult patients whose heart rate is 70 beats per minute or higher. It is used in adult patients who cannot tolerate or take heart medications called beta-blockers. It is also used in association with beta-blockers in adult patients whose condition is not fully controlled with a beta-blocker.
• Chronic heart failure in adult patients whose heart rate is 75 beats per minute or higher. It is used in association with standard treatment, including treatment with beta-blockers or when beta-blockers are contraindicated or not tolerated.

About stable angina (usually known as “angina”)

Stable angina is a heart disease that occurs when the heart does not receive enough oxygen. It usually appears between the ages of 40 and 50. The most common symptom of angina is chest pain or discomfort. Angina is more likely to appear when the heart beats faster in situations such as exercise, emotion, exposure to cold, or after eating. This increase in heart rate can cause chest pain in people with angina.

About chronic heart failure:

Chronic heart failure is a heart disease that occurs when your heart cannot pump enough blood to the rest of the body. The most common symptoms of heart failure are difficulty breathing, fatigue, tiredness, and swelling of the ankles.

How does Ivabradina work?

Ivabradina primarily acts by reducing the heart rate by a few beats per minute. This reduces the heart's need for oxygen, especially in situations where angina attacks are more likely to occur. In this way, Ivabradina tablets help control and reduce the number of angina attacks.

Additionally, as a high heart rate negatively affects the functioning of the

heart and the vital prognosis in patients with chronic heart failure, the specific action of lowering the heart rate by Ivabradina helps to improve the functioning of the heart and the vital prognosis in these patients.

Do not take Ivabradina tablets

• if you are allergic to ivabradina or any of the other ingredients of this medicine (listed in section 6);
• if your resting heart rate before treatment is too slow (below 70 beats per minute);
• if you are experiencing cardiogenic shock (a heart problem treated in the hospital);
• if you have a heart rhythm disorder;
• if you are having a heart attack;
• if you have very low blood pressure;
• if you have unstable angina (a severe type of angina in which chest pain appears very frequently with or without exercise);
• if you have recently worsened heart failure;
• if your heart rate is exclusively determined by your pacemaker;
• if you have severe liver problems;
• if you are taking medications for fungal infections (such as ketoconazole, itraconazole), macrolide antibiotics (such as josamycin, clarithromycin, telithromycin, or oral erythromycin), HIV infection medications (such as nelfinavir, ritonavir), or nefazodone (a medication for depression) or diltiazem, verapamil (used to treat high blood pressure or angina);
• if you are a fertile woman and do not use reliable contraceptive methods;
• if you are pregnant or trying to become pregnant;
• if you are breastfeeding.

Warnings and precautions

Consult your doctor or pharmacist before starting to take Ivabradina tablets:

• if you have heart rhythm disorders (such as irregular heartbeat, palpitations, increased chest pain) or sustained atrial fibrillation (a type of irregular heartbeat), or an electrocardiogram (ECG) anomaly called "prolonged QT syndrome",
• if you have symptoms such as fatigue, dizziness, or difficulty breathing (this may indicate that your heart is beating too slowly),
• if you have symptoms of atrial fibrillation (an unusual resting pulse above 110 beats per minute or irregular, without apparent reason, that makes it difficult to measure),
• if you have had a recent stroke (cerebral attack),
• if you have mild to moderate low blood pressure,
• if you have uncontrolled high blood pressure, especially after a change in your antihypertensive treatment,
• if you have severe heart failure or heart failure with an ECG anomaly called "branch block",
• if you have chronic retinal disease of the eye,
• if you have moderate liver problems,
• if you have severe kidney problems.

If you meet any of these conditions, consult your doctor immediately before or during treatment with Ivabradina tablets.

Children

Ivabradina tablets are not intended for use in children and adolescents under 18 years old.

Use of Ivabradina tablets with other medications

Inform your doctor or pharmacist if you are taking, have taken recently, or may need to take any other medication.

Make sure to inform your doctor if you are taking any of the following medications, as it may be necessary to adjust the dose of Ivabradina tablets or monitor:

• fluconazole (an antifungal medication)
• rifampicin (an antibiotic)
• barbiturates (for sleep problems or epilepsy)
• phenytoin (for epilepsy)
• Hypericum perforatum or St. John's Wort (a medicinal plant for the treatment of depression).
• Medications that prolong the QT interval to treat heart rhythm disorders or other alterations:
• • quinidine, disopyramide, ibutilide, sotalol, amiodarone (for treating heart rhythm disorders)
  • bepridil (for treating angina)
  • certain types of medications for treating anxiety, schizophrenia, or other psychoses (such as pimozide, ziprasidone, sertindole)
  • antimalarial medications (such as mefloquine or halofantrine)
  • intravenous erythromycin (an antibiotic)
  • pentamidine (an antiparasitic medication)
  • cisapride (for gastroesophageal reflux).
• Some types of diuretics that may cause a reduction in potassium levels in the blood, such as furosemide, hydrochlorothiazide, indapamide (used to treat edema, high blood pressure).

Taking Ivabradina tablets with food and drinks

Avoid grapefruit juice during treatment with Ivabradina tablets.

Pregnancy and lactation

Do not take Ivabradina tablets if you are pregnant or intend to become pregnant (see "Do not take Ivabradina tablets").

If you are pregnant and have taken Ivabradina tablets, consult your doctor.

Do not take Ivabradina tablets if you are fertile and do not use reliable contraceptive methods (see "Do not take Ivabradina tablets").

Do not take Ivabradina tablets if you are breastfeeding (see "Do not take Ivabradina tablets"). Talk to your doctor if you are breastfeeding or intend to start breastfeeding, as you should stop breastfeeding if you are taking Ivabradina tablets.

If you are pregnant or breastfeeding, think you may be pregnant, or intend to become pregnant, consult your doctor or pharmacist before using this medication.

Driving and operating machinery

Ivabradina tablets may cause transient visual phenomena (a

fleeting luminosity in the field of vision, see "Possible side effects"). If this happens,

be careful when driving or using machinery in situations where sudden changes in light intensity may occur,

especially when driving at night.

Ivabradina Tarbis contains lactose

If your doctor has told you that you have a certain sugar intolerance, consult with him before taking this medication.

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

Ivabradina tablets should be taken with breakfast and dinner.

If you are being treated for stable angina

The initial dose should not exceed one Ivabradina 5 mg tablet twice a day. If you still have angina symptoms and have tolerated the 5 mg dose twice a day well, the dose can be increased. The maintenance dose should not exceed 7.5 mg twice a day. Your doctor will prescribe the correct dose for you. The usual dose is one tablet in the morning and one tablet at night. In some cases (e.g., if you are an elderly patient), your doctor may prescribe half the dose, i.e., half a 5 mg Ivabradina tablet (corresponding to 2.5 mg of Ivabradina) in the morning and half a 5 mg tablet at night.

If you are being treated for chronic heart failure

The recommended initial normal dose is one 5 mg Ivabradina tablet twice a day, increasing if necessary to one 7.5 mg Ivabradina tablet twice a day. Your doctor will decide on the suitable dose for you. The usual dose is one tablet in the morning and one tablet at night. In some cases (for example, if you are an elderly person), your doctor may prescribe half the dose, i.e., half a 5 mg Ivabradina tablet (corresponding to 2.5 mg of Ivabradina) in the morning and half a 5 mg tablet at night.

If you take more Ivabradina tablets than you should

A high dose of Ivabradina tablets can make you feel tired or have difficulty breathing due to your heart beating too slowly.If this happens, contact your doctor immediately.

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 Ivabradina tablets

If you forgot to take a dose of Ivabradina tablets, take the next dose at the scheduled time. Do not take a double dose to compensate for the missed doses.

If you interrupt treatment with Ivabradina tablets

Generally, treatment for angina or chronic heart failure is lifelong, so you should consult your doctor before stopping this medication.

If you think the action of Ivabradina tablets is too strong or too weak, inform your doctor or pharmacist.

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

pharmacist.

Likeallmedicines,thismedicinecancausesideeffects,althoughnoteveryonewillexperiencethem.

Thefrequencyofpossiblesideeffectslistedbelowisdefinedusingthefollowingscheme:

Veryfrequent:canaffectmorethan1in10people.

Frequent:canaffectupto1in10people.

Rare:canaffectupto1in100people.Veryrare:canaffectupto1in1,000people.

Veryrare:canaffectupto1in10,000people.

Unknownfrequency:thefrequencycannotbeestimatedfromavailabledata.

Themostfrequentadversereactionswiththismedicinearedose-dependentandarerelatedtoitsmechanismofaction:

Frequent:

Visualphenomena(briefmomentsofincreasedluminosity,causednearlyalwaysbybrusquechangesinlightintensity).Theycanalsobedescribedasahalo,flashesofcolors,imagedecomposition,ormultipleimages.Thesegenerallyappearduringthefirsttwomonthsoftreatmentafterwhichtheymayoccurrepeatedlyandresolveduringoraftertreatment.

Frequent:

Cardiacfunctionalteration(symptomsareaslowingofheartrate).Thishappensespeciallyinthefirst2to3monthsafterthestartoftreatment.

Otheradverseeffectshavebeenreported:

Frequent:

Irregularrapidheartcontraction,abnormalheartbeatsensation,uncontrolledbloodpressure,headache,dizziness,andblurredvision(cloudyvision).

Rare:

Palpitationsandadditionalheartbeats,nausea,constipation,diarrhea,abdominalpain,sensationofspinning(dizziness),difficultybreathing(dyspnea),musclecramps,changesinanalyticaltests:highbloodlevelsofuricacid,eosinophilia(atypeofwhitebloodcell),andhighbloodlevelsofcreatinine(aproductofmuscledegradation),skineruption,angioedema(inflammationoftheface,lips,orthroat,difficultybreathingorswallowing),lowbloodpressure,syncope,sensationoffatigue,sensationofweakness,abnormalelectrocardiogram,doublevision,visualdisturbance.

Rare::

Urticaria,pruritus,skinredness,indisposition.

Veryrare:

Irregularheartbeats.

Reportingofadversereactions

Ifyouexperienceanytypeofadversereaction,consultyourdoctororpharmacist,evenifitisapossibleadversereactionthatdoesnotappearinthisleaflet.YoucanalsoreportthemdirectlythroughtheSpanishSystemofPharmacovigilanceforHumanUse:https://www.notificaram.es.Byreportingadversereactions,youcancontributetoprovidingmoreinformationonthesafetyofthismedicine.

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

Do not use this medication after the expiration date that appears on the packaging, 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 thrown down the 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 Ivabradina Tarbis

• The active ingredient is ivabradina (as chlorhydrate).

Ivabradina 5 mg: a film-coated tablet contains 5 mg of ivabradina (equivalent to 5.390 mg of ivabradina as chlorhydrate).

• Other components in the tablet core are: lactose monohydrate, magnesium stearate, cornstarch, maltodextrin, anhydrous colloidal silica, and in the tablet coating: lactose monohydrate, hypromellose, titanium dioxide, macrogol 4000, yellow iron oxide (E 172), red iron oxide (E 172).

Appearance of the product and content of the packaging:

The Ivabradina Tarbis 5 mg tablets are presented in the form of film-coated tablets, salmon-colored, oblong, biconvex, with a breaking line on one face.

The tablets are presented in blisters containing 56 film-coated tablets.

Holder of the marketing authorization

Tarbis Farma, S.L.

Gran Vía Carlos III, 94

08028 Barcelona (Spain)

Responsible for manufacturing

Noucor Health, S.A.

Av. Camí Reial, 51-57

08184 Palau-solità i Plegamans (Spain)

Last review date of this leaflet: February 2017

The 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