Leaflet: information for the user

Ixia Plus 20 mg/12.5 mg film-coated tablets

Olmesartan medoxomil / Hydrochlorothiazide

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 prescribedonlyfor you, and you must not give it to others even if they have the same symptomsas you, as it may harm them.

-Ifyou experienceside effects, consult your doctor or pharmacist,even if they are not listed in this leaflet. See section 4.

Ixia Plus contains two active ingredients, olmesartan medoxomil and hydrochlorothiazide, which are used in the treatment of high blood pressure (hypertension):

• Olmesartan medoxomil belongs to a group of medications called angiotensin II receptor antagonists. It reduces blood pressure by relaxing blood vessels.

• Hydrochlorothiazide belongs to a group of medications called thiazide diuretics. It reduces blood pressure by contributing to the elimination of excess fluids, increasing urine production by the kidneys.

Ixia Plus will only be given if treatment with Ixia (olmesartan medoxomil) alone has not adequately controlled your blood pressure. The concurrent administration of both active ingredients in Ixia Plus contributes to reducing blood pressure more than if each active ingredient were administered alone.

You may already be taking medications to treat high blood pressure, but your doctor may believe it necessary for you to take Ixia Plus to lower it further.

High blood pressure can be controlled with medications like Ixia Plus tablets. Your doctor may also have recommended that you make some lifestyle changes to help lower your blood pressure (for example, losing weight, quitting smoking, reducing alcohol consumption, and reducing the amount of salt in your diet). Your doctor may also have recommended that you engage in regular exercise, such as walking or swimming. It is essential to follow your doctor's advice.

Do not take Ixia Plus

• If you are allergic to olmesartan medoxomil or hydrochlorothiazide, or to any of the other ingredients of this medicine (listed in section 6) or to substances similar to hydrochlorothiazide (sulfonamides).
• If you are more than 3 months pregnant. (It is also best to avoid Ixia Plus at the start of pregnancy - see Pregnancy section).
• If you have severe kidney problems.
• If you have diabetes or kidney failure and are being treated with a blood pressure-lowering medicine that contains aliskiren.
• If you have low levels of potassium or sodium in your blood, high levels of calcium or uric acid in your blood (with symptoms of gout or kidney stones), that do not improve with treatment.
• If you have severe liver problems, or yellowing of the skin and eyes (jaundice), or problems with bile drainage from the gallbladder (biliary obstruction, for example, due to gallstones).

If you think you have any of these conditions, or are unsure, do not take the tablets. Talk to your doctor and follow their advice.

Warnings and precautions

Consult your doctor before starting to use Ixia Plus.

Before taking the tablets, tell your doctor if you are taking any of the following medicines used to treat high blood pressure (hypertension):

• An angiotensin-converting enzyme inhibitor (ACE inhibitor) (for example enalapril, lisinopril, ramipril), particularly if you have kidney problems related to diabetes.
• Aliskiren.

Your doctor may check your kidney function, blood pressure, and electrolyte levels in your blood (for example, potassium) at regular intervals.

See also the information under the heading “Do not take Ixia Plus”.

Before taking the tablets, tell your doctor if you have any of the following health problems:

• Mild to moderate kidney problems or if you have recently had a kidney transplant.
• Liver disease.
• Heart failure or problems with heart valves or heart muscle.
• Severe vomiting (feeling dizzy) or diarrhoea, that is severe or lasts for several days.
• Treatment with high doses of medicines that increase urine production (diuretics), or if you are on a low-salt diet.
• Problems with the adrenal glands (for example, primary aldosteronism).
• Diabetes.
• Lupus erythematosus (an autoimmune disease).
• Allergy or asthma.
• If you have had skin cancer or if you develop an unexpected skin lesion during treatment. Treatment with hydrochlorothiazide, 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 the sun and UV rays while taking Ixia Plus.
• If you have had respiratory or lung problems (such as inflammation or fluid in the lungs) after taking hydrochlorothiazide in the past. If you experience severe shortness of breath or difficulty breathing after taking Ixia Plus, see your doctor immediately.

Contact your doctor if you experience any of the following symptoms:

• Severe, persistent diarrhoea that causes significant weight loss. Your doctor will assess your symptoms and decide how to continue your blood pressure treatment.
• Decreased vision or eye pain. These may be symptoms offluid accumulation in the vascular layer of the eye (choroidal haemorrhage) orincreased pressure in the eye and may occur from a few hours to several weeks after taking Ixia Plus. This can lead to permanent vision loss if not treated.

Your doctor may want to see you more often and do some tests if you have any of these problems.

Consult your doctor if you experience abdominal pain, nausea, vomiting, or diarrhoea after taking Ixia Plus. Your doctor will decide whether to continue treatment. Do not stop taking Ixia Plus on your own.

Ixia Plus may cause an increase in blood levels of fats and uric acid (which causes gout - painful swelling of the joints) in your blood. Your doctor will probably want to do blood tests from time to time to check for these possible changes.

You may experience changes in the levels of certain chemicals in your blood called electrolytes. Your doctor will probably want to do blood tests from time to time to check for this possible change. Some signs of electrolyte changes are: thirst, dry mouth, muscle pain or cramps, tired muscles, low blood pressure (hypotension), feeling weak, slow, tired, drowsy, or restless, nausea, vomiting, decreased need to urinate, rapid heart rate.Tell your doctor if you notice any of these symptoms.

Like any other medicine that lowers blood pressure, an excessive decrease in blood pressure in patients with heart or brain blood flow problems can cause a heart attack or stroke. Your doctor will carefully monitor your blood pressure.

If you are to have tests of parathyroid function, stop taking Ixia Plus before the tests are done.

It is reported to athletes that this medicine contains a component that may give a positive analytical result for doping control.

Inform your doctor if you are pregnant or think you may be pregnant. Ixia Plus is not recommended for use at the start of pregnancy, and should not be taken if you are more than 3 months pregnant, as it may cause serious harm to your baby if taken at this stage (see Pregnancy section).

Children and adolescents

Ixia Plus is not recommended for children and adolescents under 18 years.

Use of Ixia Plus with other medicines

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

Particularly, inform your doctor or pharmacist about any of the following medicines:

• Other blood pressure-lowering medicines (anti-hypertensives), as they may increase the effect of Ixia Plus.

Your doctor may need to adjust your dose and/or take other precautions:

If you are taking an angiotensin-converting enzyme inhibitor (ACE inhibitor) or aliskiren (see also the information under the headings “Do not take Ixia Plus” and “Warnings and precautions”).

• Medicines that may alter potassium levels in the blood if used at the same time as Ixia Plus. These include:

-Potassium supplements (as well as salt substitutes that contain potassium).

-Medicines that increase urine production (diuretics).

-Heparin (to thin the blood).

-Laxatives.

-Glucocorticoids.

-Adrenocorticotropic hormone (ACTH).

-Carbenoxolone (medicine for the treatment of mouth and stomach ulcers).

-Penicillin G sodium (antibiotic also called benzylpenicillin sodium).

-Some analgesics such as aspirin or salicylates.

• Lithium (medicine used to treat mood changes and some types of depression) if used at the same time as Ixia Plus may increase its toxicity. If you have to take lithium, your doctor will measure your lithium levels in the blood.
• Non-steroidal anti-inflammatory drugs (NSAIDs) (medicines used to relieve pain, swelling, and other symptoms of inflammation, including arthritis), used at the same time as Ixia Plus may increase the risk of kidney failure and reduce the effect of Ixia Plus.
• Sedatives, hypnotics, and antidepressants, used with Ixia Plus may cause a sudden drop in blood pressure when standing up.
• Some medicines such as baclofen and tubocurarine, used as muscle relaxants.
• Amifostine and other medicines used to treat cancer, such as cyclophosphamide or methotrexate.
• Colestiramine and colestipol, medicines to lower blood fat levels.
• Anticholinergic medicines, such as atropine and biperiden.
• Colesevelam hydrochloride, a medicine that lowers blood cholesterol levels, as it may reduce the effect of Ixia Plus. Your doctor may advise you to take Ixia Plus at least 4 hours before colesevelam hydrochloride.
• Medicines such as thioridazine, chlorpromazine, levomepromazine, trifluoperazine, ciamemazine, sulpiride, amisulpride, pimozide, sultopride, tiapride, droperidol, or haloperidol, used to treat certain psychiatric disorders.
• Some medicines such as quinidine, hydroquinidine, disopyramide, amiodarone, sotalol, or digital, used to treat heart problems.
• Medicines such as mizolastine, pentamidine, terfenadine, dofetilide, ibutilide, or erythromycin injectables, that may change heart rhythm.

• Oral anti-diabetic medicines, such as metformin, or insulin, used to lower blood sugar levels.
• Beta-blockers and diazoxide, medicines used to treat high blood pressure or low blood sugar levels, respectively, as Ixia Plus may intensify the effect of increasing blood sugar levels produced by these medicines.
• Metildopa, a medicine used to treat high blood pressure.
• Medicines such as noradrenaline, used to increase blood pressure and decrease heart rate.
• Difemanil, used to treat slow heart rate or reduce sweating.
• Medicines such as probenecid, sulfinpyrazone, and allopurinol, used to treat gout.
• Calcium supplements.
• Amantadine, an antiviral medicine.
• Ciclosporin, a medicine used to prevent organ transplant rejection.
• Antibiotics of the tetracycline group, or enoxacin.
• Amphotericin, a medicine used to treat fungal infections.
• Some antacids, used to treat excess stomach acid, such as aluminium hydroxide and magnesium, as they may slightly reduce the effect of Ixia Plus.
• Cisapride, used to increase movement of food in the stomach and intestine.
• Halofantrine, used to treat malaria.

Taking Ixia Plus with food and drinks

Ixia Plus can be taken with or without food.

Be careful when drinking alcohol while taking Ixia Plus, as some people feel weak or dizzy. If this happens, do not drink any alcohol, including wine, beer, or alcoholic drinks.

Black patients

Like other similar medicines, the blood pressure-lowering effect of Ixia Plus is somewhat less in black patients.

Pregnancy and breastfeeding

Pregnancy

Inform your doctor if you are pregnant, (or if you suspect you may be). Your doctor will usually advise you to stop taking Ixia Plus before becoming pregnant or as soon as you know you are pregnant, and will recommend that you take another medicine instead of Ixia Plus. Ixia Plus is not recommended for use during pregnancy, and should not be taken after the third month of pregnancy, as it may cause serious harm to your baby if taken at this stage.

Breastfeeding

Inform your doctor if you are breastfeeding or plan to start. Ixia Plus is not recommended for use during breastfeeding, and your doctor will choose another treatment for you if you wish to breastfeed.

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

Use in athletes

It is reported to athletes that this medicine contains a component (hydrochlorothiazide) that may give a positive analytical result for doping control.

Driving and operating machines

You may feel drowsy or dizzy while taking Ixia Plus for high blood pressure. If this happens, do not drive or operate machines until the symptoms have disappeared. Consult your doctor.

Ixia Plus contains lactose

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

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

The recommended doseis 1 Ixia Plus 20 mg/12.5 mg tablet per day. If blood pressure is not adequately controlled, your doctor may change the dose to 1 Ixia Plus 20 mg/25 mg tablet per day.

Take the tablets with water. If possible, take your doseat the same time every day, for example, at breakfast time. It is essential that you continue taking Ixia Plus until your doctor tells you to stop.

If you take more Ixia Plus than you should

If you take more tablets than you should take or if a child accidentally ingests one or more tablets, contact your doctor immediately or go to the nearest hospital emergency department and bring the medication packaging with you.

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

If you forget to take Ixia Plus

If you forget to take a daily dose, take the usual dose the next day.Do nottake a double dose to compensate for the missed doses.

If you interrupt treatment with Ixia Plus

It is essential to continue taking Ixia Plus, unless your doctor tells you to stop treatment.

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

Like all medications, this medication may cause side effects, although not everyone will experience them.

However, the following side effects may be serious:

• In rare cases, an allergic reaction may occur, which can affect the entire body, with inflammation of the face, mouth, and/or larynx, along with itching and skin rash.If this happens, stop taking Ixia Plus and consult your doctor immediately.

• Ixia Plus may cause a significant drop in blood pressure in susceptible patients or as a result of an allergic reaction. Less frequently, dizziness or fainting may occur.If this happens, stop taking Ixia Plus, consult your doctor immediately, and remain lying down in a horizontal position.

• Unknown frequency: If you experience yellowing of the whites of the eyes, dark urine, skin itching, even if you started treatment with Ixia Plus some time ago,contact your doctor immediatelywho will evaluate your symptoms and decide how to continue treatment for high blood pressure.

Ixia Plus is a combination of two active principles. The following information, first, describes the side effects reported so far with the Ixia Plus combination (in addition to those already mentioned) and, second, the known side effects of the two active principles separately.

These are other side effects known so far with Ixia Plus:

If these effects occur, they are often mild anddo not need to interrupt treatment.

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

Dizziness, weakness, headache, fatigue, chest pain, swelling of ankles, feet, legs, hands, or arms.

Rare side effects (may affect up to 1 in 100 people):

Fast and intense heart palpitations, hives, eczema, dizziness, cough, indigestion, abdominal pain, nausea, vomiting, diarrhea, muscle cramps, and muscle pain, joint pain, arm and leg pain, back pain, erectile dysfunction in men, blood in urine.

Some changes in blood tests have also been observed, including:

Increased levels of cholesterol in the blood, increased urea or uric acid in the blood, increased creatinine, increased or decreased levels of potassium in the blood, increased levels of calcium in the blood, increased blood sugar, increased values of liver function tests. Your doctor will monitor you through a blood test and tell you if you need to take any measures.

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

Unpleasant sensation,altered consciousness, skin swelling (hives), acute renal failure.

Some changes in blood test results have also been observed, including:

Increased urea nitrogen in the blood, decreased values of hemoglobin and hematocrit. Your doctor will monitor you through a blood test and tell you if you need to take any measures.

Additional side effects reported with the use of olmesartan medoxomil or hydrochlorothiazide alone, but not with Ixia Plus or at a higher frequency:

Olmesartan medoxomil:

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

Bronchitis, cough, congestion and nasal secretion, sore throat, abdominal pain, indigestion, diarrhea, nausea, gastroenteritis, joint or bone pain, back pain, blood in urine, urinary tract infection, flu-like symptoms, pain.

Some changes in blood test results have also been observed, including:

Increased levels of cholesterol in the blood, increased urea or uric acid in the blood, increased levels of liver or muscle function.

Rare side effects (may affect up to 1 in 100 people):

Fast and intense allergic reactions that can affect the entire body and may cause breathing problems, as well as a rapid drop in blood pressure that can even lead to fainting (anaphylactic reactions), inflammation of the face, angina (chest pain or discomfort, known as angina pectoris), unpleasant sensation, skin rash, hives, itching, exanthema (skin rash), skin swelling (hives).

Some changes in blood test results have also been observed, including:

Reduced number of a type of blood cell, called platelets (thrombocytopenia).

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

Renal function deterioration, lack of energy; intestinal angioedema: swelling in the intestine that occurs with symptoms such as abdominal pain, nausea, vomiting, and diarrhea.

Some changes in blood test results have also been observed, including:

Increased potassium in the blood

Hydrochlorothiazide:

Very frequent side effects (may affect more than 1 in 10 people):

Changes in blood tests, including: increased cholesterol in the blood and increased uric acid levels.

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

Confusion, abdominal pain, stomach discomfort, feeling of swelling, diarrhea, nausea, vomiting, constipation, glucose excretion in urine.

Some changes in blood test results have also been observed, including:

Increased levels of creatinine, urea, calcium, and sugar in the blood, decreased levels of chloride, potassium, magnesium, and sodium in the blood. Increased serum amylase (hyperamylasemia).

Rare side effects (may affect up to 1 in 100 people):

Severe loss of appetite, severe difficulty breathing, skin allergic reactions (hypersensitivity reactions), worsening of pre-existing myopia, erythema, light sensitivity reactions, itching, purple spots on the skin due to small hemorrhages (purpura), skin swelling (hives).

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

Salivary gland inflammation and pain, decreased number of white blood cells, decreased number of platelets in the blood, anemia, bone marrow depression, restlessness, depression, sleep problems, feeling of loss of interest (apathy), tingling and numbness, seizures, yellowish perception of objects when looking at them, blurred vision, dry eyes, irregular heartbeat, inflammation of blood vessels, blood clots (thrombosis or embolism), pulmonary inflammation, fluid accumulation in the lungs, pancreatitis, jaundice, biliary tract infection, symptoms of lupus erythematosus such as skin rash, joint pain, and cold hands and fingers, skin allergic reactions, skin peeling and blistering, non-infectious kidney inflammation (interstitial nephritis), fever, muscle weakness (which sometimes causes movement alteration).

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

Electrolyte imbalance that can cause abnormally low chloride levels in the blood (hypochloremic alkalosis), intestinal obstruction (paralytic ileus).

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

Side effects of unknown frequency (cannot be estimated from available data):

Decreased vision or eye pain (possible signs of fluid accumulation in the vascular layer of the eye (choroidal hemorrhage) or acute angle-closure glaucoma).

Skin and lip cancer (non-melanoma skin cancer).

Reporting of side effects

If you experience any type of side effect, consult your doctor or pharmacist, 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 Vigilance 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.

No special storage conditions are required.

Do not use this medication after the expiration date shown on the packaging and blister (after “CAD.:”).The expiration date is the last day of the month indicated.

Medicines should not be disposed of through the drains or in the trash. Dispose of the packaging and unused medications at the SIGRE point of the pharmacy.In case of doubt, ask your pharmacist how to dispose of the packaging and unused medications. By doing so, you will help protect the environment.

Composition of Ixia Plus

The active ingredients are:

Ixia Plus 20 mg/12.5 mg: each film-coated tablet contains 20 mg of olmesartan medoxomil and 12.5 mg of hydrochlorothiazide.

The other components (excipients) are: microcrystalline cellulose, lactose monohydrate*, hypromellose low-substitution, hypromellose, magnesium stearate, titanium dioxide (E 171), talc, hypromellose, and iron(III) oxides (E 172).

*See previous section “Ixia Plus contains lactose”

Appearance of the product and contents of the package

Ixia Plus 20 mg/12.5 mg is presented in the form of film-coated tablets, yellowish-red, round, 8.5 mm in diameter, with the inscription “C22” on one side.

Ixia Plus film-coated tablets are presented in packages of 14, 28, 30, 56, 84, 90, 98, and 10 x 28 tablets, and in packages with pre-cut single-dose blisters of 10, 50, and 500 tablets.

Not all packages are marketed.

Holder of the marketing authorization:

MENARINI INTERNATIONAL OPERATIONS LUXEMBOURG, S.A.

1 Avenue de la Gare L-1611

Luxembourg

Local representative:

Laboratorios Menarini, S.A.

Alfonso XII, 587 - Badalona (Barcelona) Spain

Responsible for manufacturing:

DAIICHI SANKYO EUROPE GmbH

Luitpoldstrasse 1

85276 Pfaffenhofen

Germany

or

BERLIN-CHEMIE AG

Glienicker Weg 125, D-12489 Berlin

Germany

or

QUALIPHAR N.V.

Rijksweg 9, 2880 Bornem

Belgium

or

Menarini - Von Heyden GmbH

Leipziger Strasse 7-13, 01097 Dresden

Germany

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

Austria: Mencord Plus

Belgium: Belsar Plus

Cyprus: Olartan-plus

Czech Republic: Sarten Plus H

Estonia: Mesar plus

Germany: Votum plus

Greece: Olartan-plus

France: CoOlmes, Alteis Duo

Hungary: Laresin Plus

Ireland: Omesar Plus

Italy: Olprezide

Latvia: Mesar plus

Lithuania: Mesar plus

Luxembourg: Belsar Plus

Malta: Omesar plus

Poland: Revival Plus

Portugal: Olsar Plus

Slovakia: Tenzar Plus

Slovenia: Co-Tensiol

Spain: Ixia Plus

Last review date of this leaflet:01/2025

Other sources of information

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