25 mg and 50 mg film-coated tablets
eplerenone
What Eplerenone Teva is and what it is used for
Eplerenone Teva belongs to a group of medicines called selective aldosterone antagonists. These antagonists inhibit the effect of aldosterone, a substance that the body produces to regulate blood pressure and heart function. High levels of aldosterone can cause changes in the body that lead to heart failure.
Eplerenone Teva is used to treat your heart failure to prevent deterioration and reduce the number of hospital stays if you have:
- have had a recent heart attack, in combination with other medicines used to treat your heart failure, or
- had persistent, mild symptoms despite the treatment you have received so far.
Eplerenone contained in Eplerenone Teva may also be approved for the treatment of other conditions not mentioned in this product information. Ask your doctor, pharmacist, or other healthcare professional if you have any further questions, and always follow their instructions.
What you need to know before using Eplerenone Teva
Do not take Eplerenone Teva:
- if you are allergic to eplerenone or any of the other ingredients of this medicine (listed in section 6)
- if you have elevated levels of potassium in your blood (hyperkalemia)
- if you are taking diuretics that reduce the body’s excess fluid (potassium-sparing diuretics )
- if you have severe kidney disease
- if you have severe liver disease
- if you are taking medicines for fungal infections ( ketoconazole or itraconazole)
- if you take antiviral drugs to treat HIV – infection (nelfinavir or ritonavir)
- if you are taking antibiotics to treat bacterial infections (clarithromycin or telithromycin)
- if you are taking nefazodone to treat depression
- if you are taking medicines to treat certain heart diseases or high blood pressure(so-called angiotensin-converting enzyme (ACE) inhibitors and an angiotensin receptor blocker (ARB)) together.
Warnings and cautions
Talk to your doctor or pharmacist before taking Eplerenone Teva:
- if you have kidney or liver disease (see also “Do not take Eplerenone Teva”)
- if you are taking lithium (commonly used for depressive illness, also known as bipolar disorder )
- if you are taking tacrolimus or ciclosporin (to treat skin conditions such as psoriasis or eczema and to prevent organ rejection after organ transplantation).
Children and young people
The safety and efficacy of eplerenone in children and adolescents have not been established.
Other medicines and Eplerenone Teva
Tell your doctor or pharmacist if you are taking, have recently taken, or might take any other medicines.
- itraconazole or ketoconazole (for the treatment of fungal infections), ritonavir, nelfinavir (antiviral drugs against HIV – infection ), clarithromycin, telithromycin (drugs for bacterial infections), or nefazodone (depression) when these drugs may reduce degradation of Eplerenone Teva, thereby extending its effect in the body.
- potassium-sparing diuretics (medicines that help to reduce the body’s excess fluid) and potassium supplements (salt tablets) as these medicines increase the risk of elevated levels of potassium in the blood.
- angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) together (which are used to treat high blood pressure, heart disease, or certain kidney conditions) as these medicines may increase the risk of high levels of potassium in the blood.
- lithium (commonly used to treat manic-depressive illness, also called bipolar disorder ). The use of lithium in combination with diuretics and ACE inhibitors(used to treat high blood pressure and heart disease) has been shown to cause high levels of lithium in the blood, which can cause side effects: loss of appetite; visual disturbances; fatigue; muscle weakness; muscle twitching.
- ciclosporin or tacrolimus (to treat skin conditions such as psoriasis or eczema, and to prevent organ rejection after organ transplantation). These drugs can cause problems with the kidneys and thus increase the risk of elevated levels of potassium in the blood.
- non-steroidal anti-inflammatory drugs (so-called NSAIDs – painkillers such as ibuprofen used to treat pain, stiffness, and inflammation ). These drugs can lead to kidney problems and thus increase the risk of elevated levels of potassium in the blood.
- Trimethoprim (a medicine used to treat bacterial infections) may increase the risk of high levels of potassium in the blood.
- alpha-1 receptor blockers, such as Prazosin or alfuzosin (used for high blood pressure and certain prostate diseases) can cause a drop in blood pressure and dizziness when standing up.
- tricyclic antidepressants such as amitriptyline or amoxapine (for the treatment of depression), antipsychotics (also called neuroleptics ) such as chlorpromazine or haloperidol (for the treatment of mental illness), amifostine (used during cancer treatment), and baclofen (for the treatment of muscle spasms). These medicines can cause a drop in blood pressure and dizziness when standing up.
- Glucocorticoids, such as hydrocortisone or prednisone (used to treat inflammation and certain skin conditions) and tetracosactide (used mainly to diagnose and treat adrenal cortex disorders ) may reduce the blood pressure-lowering effect of Eplerenone Teva.
- digoxin (for heart disease). The levels of digoxin in the blood can increase when taken together with Eplerenone Teva.
- warfarin (used to prevent blood clots): caution is warranted during warfarin treatment as high levels of warfarin in the blood may cause changes in the effect of Eplerenone Teva in the body.
- erythromycin (used to treat bacterial infections), saquinavir (antiviral drugs for the treatment of HIV – infection ), fluconazole (for the treatment of fungal infections), amiodarone, diltiazem, and verapamil (for cardiac problems, high blood pressure) decreases degradation of eplerenone and thus prolonging Eplerenone Teva effect in the body.
- St. John’s wort (herbal medicine), rifampicin (for the treatment of bacterial infections), carbamazepine, phenytoin, and phenobarbital (medicines for epilepsy, among others ) can increase the breakdown of eplerenone and thus reduce its effect.
Eplerenone Teva with food and drink
Eplerenone Teva can be taken with or without food.
Pregnancy and breastfeeding
If you are pregnant or breast-feeding, think you may be pregnant, or are planning to have a baby, ask your doctor or pharmacist for advice before taking this medicine. The effect of eplerenone during human pregnancy has not been studied.
It is not known whether eplerenone is excreted in human breast milk. Discuss with your doctor before deciding whether to stop breastfeeding or stop taking the medicine.
Driving and using machines
You may feel dizzy after taking Eplerenone Teva. If this happens, do not drive or use any tools or machines.
You are responsible for assessing whether you are fit to drive a motor vehicle or perform work that requires sharpened attention. One of the factors that can affect your ability in these respects is the use of drugs due to their effects and/or side effects. Descriptions of these effects and side effects can be found in other sections. Read all the information in this leaflet for guidance. If you are not sure, talk to your doctor or pharmacist.
Eplerenone Teva contains lactose monohydrate
Eplerenone Teva contains lactose monohydrate (a sugar). If you have been told by your doctor that you have an intolerance to some sugars, contact your doctor before taking this medicine.
3. How to use Eplerenone Teva
Always take this medicine exactly as your doctor or pharmacist has told you. Ask your doctor or pharmacist if you are unsure.
Eplerenone Teva can be taken with food or on an empty stomach. Swallow the tablets whole along with a copious amount of liquid.
Eplerenone Teva is normally given with other heart failure medicines, e.g. beta-blockers. The recommended starting dose is one 25 mg tablet once a day, which after about 4 weeks is increased to 50 mg once a day (either as a 50 mg tablet or two 25 mg tablets). The maximum dose is 50 mg daily.
Potassium levels in the blood should be monitored before treatment with Eplerenone Teva, during the first week of treatment, and one month after starting a treatment or changing the dose. Dose one may need to be adjusted by your doctor, depending on the potassium levels in your blood.
If you have mild renal impairment, you should start with a 25 mg tablet every day. And if you have moderate kidney function, you should start with a 25 mg tablet every other day. These doses can be adjusted if your doctor recommends it depending on the levels of potassium in your blood.
Eplerenone Teva is not recommended for patients with severe renal impairment.
The starting dose does not need to be adjusted in patients with mild to moderate hepatic impairment. If you have liver or kidney problems, your blood potassium levels may need to be checked more often (see also “Do not take Eplerenone Teva”).
Elderly: No adjustment of the starting dose is required.
Use for children and adolescents
Eplerenone Teva is not recommended for children and adolescents.
If you use more Eplerenone Teva then you should
If you have ingested too much medicine or if e.g. If a child has inadvertently ingested the medicine, contact a doctor, hospital, or the Poison Information Center for risk assessment and advice.
If you have taken too much of your medicine, the most likely symptoms will be low blood pressure (may manifest as a “slight” feeling in your head, dizziness, blurred vision, weakness, acute unconsciousness) or hyperkalemia, elevated levels of potassium in the blood ( may cause muscle cramps, diarrhea, nausea, dizziness or headache).
If you forget to use Eplerenone Teva
If it is soon time for your next dose, skip the missed tablet and take the next one as usual. Otherwise, take it as soon as you remember, provided it is more than 12 hours until you take the next tablet. Then return to your regular medication. Do not take a double dose to make up for a forgotten tablet.
If you stop using Eplerenone Teva
It is important to continue taking Eplerenone Teva as prescribed unless your doctor tells you to stop your treatment.
If you have any further questions on the use of this product, ask your doctor or pharmacist.
4. Possible side effects
Like all medicines, this medicine can cause side effects, although not everybody gets them.
If you experience any of the following, seek medical attention immediately:
- swelling of the face, tongue, or throat
- difficulty swallowing
- hives and difficulty breathing
These are symptoms of angioneurotic edema, a less common (may affect up to 1 in 100 people) side effect.
Other reported side effects include:
Common (may affect up to 1 in 10 people):
- high potassium levels in the blood (symptoms include muscle cramps, diarrhea, nausea, dizziness, or headache)
- fainting
- dizziness
- increased level of cholesterol in the blood
- insomnia (difficulty sleeping)
- headache
- heart problems such as irregular heartbeat and heart failure
- cough
- constipation
- low blood pressure
- diarrhea
- nausea
- vomiting
- impaired renal function
- rash
- itching
- back pain
- impotence
- muscle twitching
- increased level of urea in the blood
- increased content of creatinine in the blood which may indicate problems with the kidneys
Uncommon (may affect up to 1 in 100 people):
- infection
- eosinophilia (increase in certain white blood cells )
- decreased sodium levels in the blood
- dehydration
- increase in triglycerides (blood fats) in the blood
- fast heartbeat
- inflammation of the gallbladder
- lowered blood pressure which can sometimes cause dizziness, e.g. if you get up
- thrombosis (blood clot) in the legs
- sore throat
- gas formation
- underactive thyroid gland
- elevated blood sugar
- the decreased sensation on touch
- increased sweating
- pain in muscles and bones
- feeling sick
- kidney inflammation
- enlarged breasts in men
- changes in certain blood test results
5. How to store Eplerenone Teva
Keep this medicine out of the sight and reach of children.
No special storage instructions.
Do not use this medicine after the expiry date which is stated on the carton and blister after EXP.
The expiration date is the last day of the specified month.
Medicines should not be disposed of via wastewater or household waste. Ask your pharmacist how to dispose of medicines no longer required. These measures will help to protect the environment.
6. Contents of the packaging and other information
Content declaration
- The active substance is eplerenone.25 mg: 1 film-coated tablet contains 25 mg eplerenone.50 mg: 1 film-coated tablet contains 50 mg eplerenone.
- The other ingredients are lactose monohydrate, microcrystalline cellulose, crospovidone (type A), sodium lauryl sulfate, talc (E553b), and magnesium stearate. The tablet coating contains poly (vinyl alcohol) (E1203), titanium dioxide (E171), macrogol 3350 (E1521), talc (E553b), yellow iron oxide (E172), and red iron oxide (E172).
What the medicine looks like and the contents of the pack
- Film-coated tablets
- 25 mg: yellow, diamond-shaped, biconvex film-coated tablet, approximately 6.4 mm wide and 7.4 mm long, debossed with “E25” on one side and unmarked on the other side.50 mg: yellow, diamond-shaped, biconvex film-coated tablet, approximately 8.0 mm wide and 9.5 mm long, debossed with “E50” on one side and unmarked on the other side.
- Eplerenone Teva film-coated tablets are available in opaque PVC / PVdC / Al blisters of 1, 10, 20, 28, 30, 50, 56, 60, 90, 100 or 200 tablets and in opaque PVC / PVdC / Al perforated unit blisters containing 20×1, 30×1, 50×1, 90×1, 100×1 or 200×1 tablets. 25 mg: The tablets are also available in calendar packs of 30 and 100 tablets respectively. 50 mg: The tablets are also available in calendar packs of 100 tablets.
Not all pack sizes may be marketed.
Manufacturer:
TEVA Pharmaceutical Works Private Limited Company
Pallagi Street
4042 Debrecen
Hungary