Patient Information Leaflet: Information for the Patient

ivabradina cinfa 7.5 mg Film-Coated Tablets

ivabradina hydrochloride

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.

1. What ivabradina cinfa is and what it is used for

2. What you need to know before you start taking ivabradina cinfa

3. How to take ivabradina cinfa

4. Possible side effects

5. Storage of ivabradina cinfa

6. Contents of the pack and additional information

ivabradina cinfa 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 disease 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 pectoris (usually known as “angina”)

Stable angina pectoris is a heart disease that occurs when the heart does not receive enough oxygen. It usually appears in ages between 40 and 50 years. The most frequent 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 your body. The most frequent symptoms of heart failure are difficulty breathing, fatigue, tiredness, and swelling of the ankles.

How does ivabradina cinfa 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 cinfa helps to control and reduce the number of angina attacks.

Furthermore, as a high heart rate negatively affects heart function and vital prognosis in patients with chronic heart failure, the specific action of ivabradina's heart rate reduction helps to improve heart function and vital prognosis in these patients.

Do not take ivabradina cinfa

• 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 where chest pain appears 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 cinfa.

• If you have heart rhythm disorders (such as irregular heartbeat, palpitations, or 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.

Children and adolescents

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

Taking ivabradina cinfa with other medicines

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

Make sure to inform your doctor if you are taking any of the following medicines, as it may be necessary to adjust the dose of ivabradina 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 treating depression).
• Medicines 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 blood potassium levels, such as furosemide, hydrochlorothiazide, indapamide (used to treat edema, high blood pressure).

Taking ivabradina cinfa with food and drinks

Avoid grapefruit juice during treatment with ivabradina.

Pregnancy and breastfeeding

If you are pregnant or breastfeeding, consult your doctor or pharmacist before using this medicine.

Do not take ivabradina if you are pregnant or trying to become pregnant (see "Do not take ivabradina cinfa").

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

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

Do not take ivabradina if you are breastfeeding (see "Do not take ivabradina cinfa"). Talk to your doctor if you are breastfeeding or plan to start breastfeeding, as you should stop breastfeeding if you are taking ivabradina.

Driving and operating machinery

Ivabradina may cause transient visual phenomena (a brief luminosity in the field of vision, see "Possible side effects"). If this happens, be careful when driving or operating machinery in situations where sudden changes in light intensity may occur, especially when driving at night.

ivabradina cinfa contains lactose

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

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 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, 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 recommended 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 ivabradina 5 mg tablet twice a day, increasing if necessary to one ivabradina 7.5 mg tablet twice a day. Your doctor will decide on the suitable dose for you. The normal 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 cinfa than you should

A high dose of ivabradina 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 cinfa

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

If you interrupt the treatment with ivabradina cinfa

Generally, the 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 is too strong or weak, inform your doctor or pharmacist.

If you have any other doubts 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.

The frequency of the possible side effects listed below is defined using the following system:

Very common: may affect more than 1 in 10 people.

Common: may affect up to 1 in 10 people.

Uncommon: may affect up to 1 in 100 people. Rare: may affect up to 1 in 1,000 people.

Very rare: may affect up to 1 in 10,000 people.

Frequency not known: cannot be estimated from available data.

The most frequent adverse reactions with this medicine are dose-dependent and related to its mechanism of action:

Very common:

Phenomena of visual brightness (brief moments of increased brightness, caused almost always by sudden changes in light intensity). They can also be described as a halo, flashes of color, image decomposition, or multiple images. These generally appear during the first two months of treatment, after which they may occur repeatedly and resolve during or after treatment.

Common:

Modification of heart function (symptoms are a slowing of heart rate). This occurs especially in the first 2 to 3 months after starting treatment.

Other adverse reactions have also been reported:

Common:

Irregular rapid heart contractions, abnormal heart palpitations, uncontrolled blood pressure, headache, dizziness, and blurred vision (hazy vision).

Uncommon:

Palpitations and additional heartbeats, sensation of dizziness (nausea), constipation, diarrhea, abdominal pain, sensation of spinning (vertigo), difficulty breathing (dyspnea), muscle spasms, changes in laboratory tests: elevated blood levels of uric acid, an excess of eosinophils (a type of white blood cell), and elevated blood levels of creatinine (a muscle degradation product), skin rash, angioedema (like facial, tongue, or throat inflammation, difficulty breathing or swallowing), low blood pressure, fainting, feeling of fatigue, feeling of weakness, abnormal electrocardiogram, double vision, visual alteration.

Rare:

Urticaria, itching, skin redness, indisposition.

Very rare:

Irregular heartbeats.

Reporting of adverse reactions

If you experience any type of adverse reaction, consult your doctor or pharmacist, even if it is a possible adverse reaction 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 adverse reactions, 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 packaging, after CAD. The expiration date is the last day of the month indicated.

This medication does not require special storage conditions.

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

Ivabradina cinfa composition

- The active ingredient is ivabradina (as chlorhydrate).

A coated tablet contains 7.5 mg of ivabradina (equivalent to 8.085 mg of ivabradina as chlorhydrate).

- The other components in the tablet core are: lactose monohydrate, microcrystalline cellulose, crospovidone, anhydrous colloidal silica, magnesium stearate and in the tablet coating: Opadry Y-1-7000, Yellow Iron Oxide (E-172) and Brown Iron Oxide (E-172).

Product appearance and packaging content

Coated tablet, salmon-colored, cylindrical, biconvex, and with the logo “Ih7” on one side.

The tablets are presented in Aluminio/PVC/PVDC blisters and Aluminio/aluminio blisters of 14, 28, 56, 84, 98, 100 or 112 tablets.

Only some packaging sizes may be commercially marketed.

Marketing authorization holder and Responsible for manufacturing

Laboratorios Cinfa, S.A.

Carretera Olaz-Chipi, 10. Industrial Park Areta

31620 Huarte (Navarra) - Spain

Last review date of this leaflet: December 2019

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/

You can access detailed and updated information on this medication by scanning the QR code included in the leaflet and packaging with your smartphone. You can also access this information at the following internet address: https://cima.aemps.es/cima/dochtml/p/81280/P_81280.html

QR code to: https://cima.aemps.es/cima/dochtml/p/81280/P_81280.html