Leaflet: information for the user

Telmisartán/Hidroclorotiazida ratiogen 40 mg/12,5 mg tablets EFG

Read this leaflet carefully before you start taking this medicine, as 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 Telmisartán/Hidroclorotiazida ratiogen and what is it used for

2. What you need to know before starting to take Telmisartán/Hidroclorotiazida ratiogen

3. How to take Telmisartán/Hidroclorotiazida ratiogen

4. Possible side effects

5. Storage of Telmisartán/Hidroclorotiazida ratiogen

6. Contents of the pack and additional information

Telmisartán/Hidroclorotiazida ratiogen is an association of two active principles, telmisartán and hidroclorotiazida in a tablet. Both active principles help to control high blood pressure.

-Telmisartán belongs to a group of medications known as angiotensin II receptor antagonists. Angiotensin II is a substance produced in the body that causes blood vessels to constrict, thereby increasing blood pressure.

Telmisartán blocks the effect of angiotensin II, causing blood vessels to relax and reducing blood pressure.

-Hidroclorotiazidabelongs to a group of medications known as thiazide diuretics, which increase urine production, resulting in a decrease in blood pressure.

High blood pressure, if left untreated, can damage blood vessels in various organs, which in some cases can cause a heart attack, heart failure or kidney failure, stroke or blindness. There are usually no symptoms of high blood pressure before damage occurs. Therefore, it is essential to monitor blood pressure periodically to ensure it is within the normal range.

Telmisartán/Hidroclorotiazida ratiogen is used forthe treatment of high blood pressure (essential hypertension) in adults whose blood pressure is not controlled sufficiently when using telmisartán alone.

Do not take Telmisartán/Hidroclorotiazida ratiogen:

-if you are allergic to telmisartán or any of the other components of this medication (listed in section 6).

-if you are allergic to hidroclorotiazida or other sulfonamide-derived medications.

-if you are more than 3 months pregnant. (In any case, it is better to avoid taking this medication also at the beginning of your pregnancy - see Pregnancy section).

-if you have severe liver problems such as cholestasis or biliary obstruction (liver and gallbladder drainage problems) or any other severe liver disease.

-if you have severe kidney disease.

-if your doctor determines that you have low potassium levels or high calcium levels in your blood that do not improve with treatment.

-if you have diabetes or kidney insufficiency and are being treated with a blood pressure medication that contains aliskiren.

If any of the above occurs, inform your doctor or pharmacist before taking Telmisartán/Hidroclorotiazida ratiogen.

Warnings and precautions

Consult your doctor before starting to take Telmisartán/Hidroclorotiazida ratiogen if you have or have had any of the following conditions or diseases:

-Low blood pressure (hypotension), which may occur if you are dehydrated (excessive water loss) or have a salt deficiency due to diuretic treatment, low-sodium diet, diarrhea, vomiting, or hemodialysis.

-Kidney disease or kidney transplant

-Renal artery stenosis (narrowing of the blood vessels of one or both kidneys)

-Liver disease

-Heart problems

-Diabetes

-Gout

-High aldosterone levels (water and salt retention in the body along with mineral imbalance in the blood)

-Lupus erythematosus (also known as "lupus" or "LES"), a disease in which the body's immune system attacks the body itself

-The active ingredient hidroclorotiazida may cause a rare reaction, leading to decreased vision and eye pain. These symptoms may be indicative of fluid accumulation in the eye's vascular layer (choroidal effusion) or increased eye pressure and may appear between hours and weeks after taking Telmisartán/Hidroclorotiazida ratiogen. If left untreated, it may lead to permanent vision loss.

-If you have had skin cancer or if you develop an unexpected skin lesion during treatment. The treatment with hidroclorotiazida, particularly long-term use at high doses, may increase the risk of certain types of skin cancer and lip cancer (non-melanoma skin cancer). Protect your skin from sun exposure and UV rays while taking Telmisartán/Hidroclorotiazida ratiogen.

Consult your doctor before starting to take Telmisartán/Hidroclorotiazida ratiogen:

• If you are taking any of the following medications used to treat high blood pressure (hypertension):
• • a converting enzyme inhibitor (IECA) (e.g., enalapril, lisinopril, ramipril), particularly if you have kidney problems related to diabetes.
  • aliskiren

Your doctor may monitor your renal function, blood pressure, and electrolyte levels (e.g., potassium) at regular intervals. See also the information under the heading "Do not take Telmisartán/Hidroclorotiazida ratiogen".

• If you are taking digoxina.
• If you have had respiratory or pulmonary problems (such as inflammation or fluid in the lungs) after taking hidroclorotiazida in the past. If you experience severe shortness of breath or difficulty breathing after taking Telmisartán/Hidroclorotiazida ratiogen, seek medical attention immediately.

Consult your doctor if you experience abdominal pain, nausea, vomiting, or diarrhea after taking telmisartán/hidroclorotiazida. Your doctor will decide whether to continue treatment. Do not stop taking telmisartán/hidroclorotiazida.

If you are pregnant, if you suspect you may be pregnant, or if you plan to become pregnant, inform your doctor. Do not take Telmisartán/Hidroclorotiazida ratiogen at the beginning of your pregnancy (first 3 months) and do not administer it after the third month of pregnancy because it may cause serious harm to your baby, see Pregnancy section.

The treatment with hidroclorotiazida may cause an electrolyte imbalance in your body. Typical symptoms of a fluid or electrolyte imbalance include dry mouth, weakness, lethargy, drowsiness, restlessness, muscle pain or cramps, nausea, vomiting, muscle fatigue, and an irregularly fast heart rate (more than 100 beats per minute). If you experience any of these symptoms, inform your doctor.

You must also inform your doctor if you experience increased skin sensitivity to the sun with symptoms of sunburn (such as redness, itching, swelling, and blistering) that appear more quickly than usual.

If you are to undergo surgery (surgery) or anesthesia, inform your doctor that you are taking Telmisartán/Hidroclorotiazida ratiogen.

Telmisartán/Hidroclorotiazida ratiogen may be less effective in lowering blood pressure in black patients.

Children and adolescents

Telmisartán/Hidroclorotiazida ratiogen is not recommended for use in children and adolescents up to 18 years of age.

Use in athletes

This medication contains hidroclorotiazida, which may produce a positive result in doping control tests.

Other medications and Telmisartán/Hidroclorotiazida ratiogen

Inform your doctor or pharmacist if you are taking, have taken recently, or may need to take any other medication. Your doctor may need to change the dose of those other medications or take other precautions. In some cases, you may need to discontinue the use of some of these medications, especially if you are taking them with Telmisartán/Hidroclorotiazida ratiogen, the following medications:

-Medications containing lithium for the treatment of certain types of depression

- Medications associated with low potassium levels in the blood (hypokalemia) such as other diuretics, laxatives (e.g., ricin oil), corticosteroids (e.g., prednisone), ACTH (adrenocorticotropic hormone), amphotericin (antifungal medication), carbenoxolone (used in the treatment of mouth ulcers), penicillin G sodium (antibiotic), and aspirin and derivatives.

- Medications that may increase potassium levels in the blood such as potassium-sparing diuretics, potassium supplements, salt substitutes containing potassium, IECA inhibitors, cyclosporine (immunosuppressant), and other medications such as heparin sodium (anticoagulant).

-Medications affected by changes in potassium levels in the blood such as heart medications (e.g., digoxina) or medications to control heart rhythm (e.g., quinidine, disopyramide, amiodarone, sotalol), medications used to treat mental disorders (e.g., thioridazine, chlorpromazine, levomepromazine)and other medications such as some antibiotics (e.g., enoxacin, pentamidine) or some medications to treat allergic reactions (e.g., terfenadine).

• Diabetes medications (insulins or oral agents such as metformin).
• Colestiramina and colestipol, medications to reduce blood cholesterol levels.
• Medications to increase blood pressure such as noradrenaline
• Muscle relaxants, such as tubocurarina.
• Calcium and/or vitamin D supplements.
• Anticholinergic medications (medications used to treat a variety of disorders such as gastrointestinal spasms, urinary spasms, asthma, motion sickness, muscle spasms, Parkinson's disease, and as an aid to anesthesia) such as atropine and biperiden.
• Amantadina (medication used to treat Parkinson's disease and also to treat or prevent certain diseases caused by viruses).-Other medications used to treat high blood pressure, corticosteroids, analgesics, (such as nonsteroidal anti-inflammatory drugs [NSAIDs]), medications to treat cancer, gout, or arthritis.
  

- If you are taking an IECA or aliskiren (see also the information under the headings "Do not take Telmisartán/Hidroclorotiazida ratiogen" and "Warnings and precautions").

-Digoxina.

Telmisartán/Hidroclorotiazida ratiogen may increase the effect of other medications to lower blood pressure or medications that may potentially lower blood pressure (e.g., baclofen, amifostine). Additionally, the decrease in blood pressure may be exacerbated by alcohol, barbiturates, narcotics, or antidepressants. You may notice this effect as dizziness when standing up. Inform your doctor about the need to adjust the dose of your other medications while taking Telmisartán/Hidroclorotiazida ratiogen.

The effect of Telmisartán/Hidroclorotiazida ratiogen may be reduced when using NSAIDs (nonsteroidal anti-inflammatory drugs, e.g., aspirin or ibuprofen).

Taking Telmisartán/Hidroclorotiazida with food and alcohol

You can take this medication with or without food.

Avoid drinking alcohol until you have spoken with your doctor. Alcohol may further lower your blood pressure and/or increase the risk of feeling dizzy or weak.

Pregnancy and breastfeeding

Pregnancy

You must inform your doctor if you are pregnant, if you suspect you may be pregnant, or if you plan to become pregnant. Your doctor will advise you to stop taking Telmisartán/Hidroclorotiazida ratiogen before becoming pregnant or as soon as you become pregnant, and will recommend taking another antihypertensive medication instead. Telmisartán/Hidroclorotiazida ratiogen is not recommended for use during pregnancy and should not be administered after the third month of pregnancy because it may cause serious harm to your baby when administered from that point onwards.

Lactation

Inform your doctor if you plan to start or are breastfeeding because Telmisartán/Hidroclorotiazida ratiogen is not recommended for use in women during this period. Your doctor may decide to administer a more suitable treatment if you want to breastfeed.

Driving and operating machinery

Some patients may feel dizzy or tired when taking Telmisartán/Hidroclorotiazida ratiogen. If you feel dizzy or tired, do not drive or operate machinery.

Telmisartán/Hidroclorotiazida ratiogen contains sodium

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

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

The recommended dose is one tablet per day. Try to take one tablet every day at the same time. You can take telmisartán/hidroclorotiazida with or without food. The tablets should be swallowed with a little water or other non-alcoholic beverage. It is essential to take telmisartán/hidroclorotiazida every day until your doctor tells you otherwise.

If your liver does not function correctly, the usual dose should not exceed 40 mg/12.5 mg once a day.

If you take more Telmisartán/Hidroclorotiazida ratiogen than you should

If you accidentally take too many tablets, you may experience symptoms such as low blood pressure and rapid heartbeats. Additionally, slow heartbeats, dizziness, vomiting, and reduced renal function, including renal failure, have been described. Due to the hydrochlorothiazide component, you may also experience notably low blood pressure and low potassium levels in the blood, which can lead to nausea, drowsiness, and muscle cramps and/or irregular heartbeats associated with the concomitant use of medications such as digitalis or certain antiarrhythmic treatments. Contact your doctor or pharmacist immediately or the hospital's emergency service.

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 Telmisartán/Hidroclorotiazida ratiogen

If you forget to take the medication, do not worry. Take the dose as soon as you remember and continue as before. If you miss a dose, take your normal dose the next day. Do not take a double dose to compensate for the missed doses.

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.

Some side effects can be serious and require immediate medical attention:

If you experience any of the following symptoms, you should visit your doctor immediately:

Sepsis* (also known as "blood infection"), is a serious infection that involves a systemic inflammatory reaction, rapid skin and mucous membrane swelling (angioedema), blister and peeling on the skin's surface (toxic epidermal necrolysis);these side effects are rare (can affect up to 1 in 1,000 people) but are extremely serious and patients should stop taking the medicine and visittheir doctor immediately. If these side effects are not treated, they can be fatal. An increased incidence of sepsis has been observed with telmisartan alone; however, it cannot be ruled out for Telmisartán/Hidroclorotiazida ratiogen.

Possible side effects of Telmisartán/Hidroclorotiazida ratiogen:

Frequent side effects(can affect up to 1 in 10 people)

Dizziness.

Infrequent side effects(can affect up to 1 in 100 people)

Decreased potassium levels in the blood, anxiety, fainting (syncope), tingling and numbness (paresthesia), dizziness (vertigo), rapid heart rate (tachycardia), heart rhythm disturbances, low blood pressure, sudden drop in blood pressure upon standing, shortness of breath (dyspnea), diarrhea, dry mouth, flatulence, back pain, muscle spasms, muscle pain, erectile dysfunction (inability to achieve ormaintain an erection), chest pain and increased uric acid levels in the blood.

Rare side effects(can affect up to 1 in 1,000 people)

Pneumonia (bronchitis), activation or worsening of systemic lupus erythematosus (a disease in which the body's immune system attacks the body, causing joint pain, skin rashes, and fever), sore throat, sinusitis, feeling of sadness (depression), difficulty sleeping (insomnia), vision disturbances, difficulty breathing, abdominal pain, constipation, indigestion (dyspepsia), general discomfort (vomiting), stomach inflammation (gastritis), liver function disturbances (patients in Japan are more prone to experiencing this side effect), skin redness (erythema), allergic reactions such as itching or rashes, increased sweating, hives (urticaria), joint pain (arthralgia) and limb pain, muscle cramps, pseudogripal disease, pain, low sodium levels,increased creatinine levels, liver enzymes or creatine phosphokinase in the blood.

Very rare side effects(can affect up to 1 in 10,000 people):

Acute respiratory distress (the signs include severe difficulty breathing, fever, weakness, and confusion).

Adverse reactions reported for one of the individual components may be potential adverse reactions of Telmisartán/Hidroclorotiazida ratiogen, although they have not been observed in clinical trials with this product.

Telmisartán

The following additional side effects have been described in patients taking telmisartán alone:

Infrequent side effects(can affect up to 1 in 100 people)

Upper respiratory tract infection (e.g. sore throat, sinusitis, common cold), urinary tract infections, anemia, high potassium levels, slow heart rate (bradycardia), cough, kidney function disturbances including acute kidney failure, weakness.

Rare side effects(can affect up to 1 in 1,000 people)

Low platelet count (thrombocytopenia), increased certain white blood cells (eosinophilia), severe allergic reactions (e.g. hypersensitivity, anaphylactic reactions, skin rash), low blood sugar levels (in diabetic patients),sleepiness,stomach discomfort, eczema (a skin disorder), arthritis, tendon inflammation, decreased hemoglobin (a blood protein).

Very rare side effects(can affect up to 1 in 10,000 people)

Progressive fibrosis of lung tissue (interstitial lung disease) **

Unknown frequency (cannot be estimated from available data):

Intestinal angioedema: intestinal inflammation has been reported, presenting symptoms such as abdominal pain, nausea, vomiting, and diarrhea after use of similar products.

* This may have been a chance finding or related to an unknown mechanism.

** Cases of progressive fibrosis of lung tissue have been reported during telmisartan use. However, it is unknown if telmisartan was the cause.

Hidroclorotiazida

The following additional side effects have been described in patients taking hidroclorotiazida alone:

Frequent side effects(can affect up to 1 in 10 people)

Nausea, low magnesium levels in the blood.

Rare side effects(can affect up to 1 in 1,000 people)

Low platelet count, which increases the risk of bleeding and hematoma formation (small red or purple marks on the skin or other tissues caused by bleeding), high calcium levels in the blood, headache.

Very rare side effects(can affect up to 1 in 10,000 people)

Increased pH (alteration of acid-base balance) due to low chloride levels in the blood.

Unknown frequency(cannot be estimated from available data)

Salivary gland inflammation,skin cancer and lip cancer (non-melanoma skin cancer),decreased number (or even absence) of blood cells, including low red and white blood cell counts, severe allergic reactions (e.g. hypersensitivity, anaphylactic reactions), decreased or loss of appetite, restlessness, dizziness, blurred or yellowish vision,decreased vision and eye pain (possible signs of fluid accumulation in the eye's vascular layer (choroidal hemorrhage) or acute myopia or acute angle-closure glaucoma), vascular inflammation (necrotizing vasculitis), pancreatitis, stomach discomfort, yellowing of the skin or eyes (jaundice), pseudolupus syndrome (a condition that mimics a disease called systemic lupus erythematosus in which the body's immune system attacks the body), skin disorders such as vascular inflammation of the skin, increased sensitivity to sunlight, skin rash, lip, eye, or mouth blistering, skin peeling, fever (possible signs of erythema multiforme), weakness, kidney inflammation or function disturbances, glucose in the urine (glucosuria), fever, electrolyte imbalance, high cholesterol levels in the blood, decreased blood volume, increased glucose levels in the blood, difficulty controlling glucose levels in the blood/orine in patients with diabetes mellitus, or blood fat.

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 leaflet.

You can also report them directly through the Spanish System for 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 medication after the expiration date that appears on the box after “CAD”. The expiration date is the last day of the month indicated.

For Al/Al blisters

This medication does not require special storage conditions.

For Al/PVC/PVDC blisters

Do not store at a temperature above 30°C.

Medicines should not be disposed of through drains or in the trash. Deposit the containers and medicines you no longer need at your local SIGRE collection point at your usual pharmacy. Ask your pharmacist how to dispose of the containers and medicines you no longer need. By doing so, you will help protect the environment.

Telmisartan/Hydrochlorothiazide ratiopharm Composition

The active principles are telmisartan and hydrochlorothiazide. Each tablet contains 40 mg of telmisartan and 12.5 mg of hydrochlorothiazide.

The other components are magnesium stearate, meglumine, microcrystalline cellulose, povidone, potassium hydroxide, sodium carboxymethyl starch (type A) and mannitol (E421).

Appearance of the product and content of the packaging

Telmisartan/Hydrochlorothiazide ratiopharm 40 mg/12.5 mg tablets are oval and concave tablets, 6.55 x 13.6 mm in size with TH engraved on one face.

Packaging sizes

Blister: 28 tablets

Marketing authorization holder and manufacturer

Marketing authorization holder

Teva Pharma, S.L.U.

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

28108 Alcobendas, Madrid

Spain

Manufacturer

Actavis Ltd.

BLB016

Bulebel Industrial Estate

Zejtun ZTN 3000 Malta

Last review date of this leaflet: March 2025

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/