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Capozide 50 Tablets

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5. How to store Capozide

•    KEEP OUT OF THE SIGHT AND REACH OF CHILDREN.

•    Do not store above 25°C.

•    Do not take the tablets after the date shown on the carton over label or blister strip.

•    If your doctor tells you to stop taking the tablets, please take them back to the pharmacist for safe disposal. Only keep the tablets if your doctor tells you to.

•    If the medicine become discoloured or show any other signs of deterioration, you should seek the advice of your pharmacist who will tell you what to do.

•    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. Further Information

What Capozide contains

•    Each tablet contains 50mg of captopril and 25mg of hydrochlorothiazide, as the active ingredients.

•    The tablets also contain microcrystalline cellulose, pregelatinised starch, stearic acid, magnesium stearate and lactose.

What Capozide looks like and contents of the pack

Capozide is white to off-white, oval, biconvex tablet; with a breakbar on one side and engraved with "C H" on the other side. The tablet can divided into equal halves.

Capozide is available in blister packs containing 30 tablets.

Product Licence holder

Procured from within the ELI and repackaged by the Parallel Import Product Licence holder: S&M Medical Ltd, Chemilines House, Alperton Lane, Wembley, HAO 1DX.

Manufacturer

This product is manufactured by Bristol-Myers Squibb, rue du Dr. Gilles, 28230 Epernon, France.

|POM PL No. 19488/0553

Leaflet revision date: 11 October 2012

Capozide Tablets is a registered trade mark ofER Squibb & Sons LLC, USA.

S553 LEAFLET CAPOZIDE 20121011

S553 LEAFLET CAPOZIDE 20121011

PACKAGE LEAFLET: INFORMATION FOR THE USER CAPOZIDE 50 TABLETS (captopril/hydrochlorothiazide)

Your medicine is known as Capozide 50 Tablets but will be referred to as Capozide throughout the following patient information leaflet.

Read all of this leaflet carefully before you start using this medicine.

•    Keep this leaflet. You may need to read it again.

•    If you have any further questions, ask your doctor or pharmacist

•    This medicine has been prescribed for you. Do not pass it on to others. It may harm them, even if their symptoms are the same as yours.

•    If any of the side effects get serious, or if you notice any side effects not listed in this leaflet, please tell your doctor or pharmacist.

In this leaflet:

1.    What are Capozide is and what it is used for

2.    Before you take Capozide

3.    How to take Capozide

4.    Possible side effects

5.    How to store Capozide

6.    Further information

1 What are Capozide is and what it is used for

Capozide is a combination of two active substances, captopril and hydrochlorothiazide.

Captopril belongs to a group of medicinal products called Angiotensin Converting Enzyme (ACE) Inhibitors. ACE inhibitors cause blood vessels to relax and the blood pressure to lower. Hydrochlorothiazide is one of a group of medicinal products called thiazide diuretics (also known as water tablets). They increase urine output and hence decrease blood pressure.

The two active substances in Capozide work together to decrease blood pressure further than if either was given alone.

Capozide is used in the treatment of high blood pressure (essential hypertension), if treatment with captopril or hydrochlorothiazide alone has not led to a sufficient decrease in blood pressure.

2 Before you take Capozide

Please read the following section attentively. It contains important

information which you and your doctor should observe prior to

taking of Capozide.

Do NOT take Capozide

•    if you are allergic (hypersensitive) to captopril or to any other ACE inhibitors or to any of the other ingredients of Capozide.

•    if you are allergic to hydrochlorothiazide or to any other sulphonamide derivatives.

•    if you have previously been treated with a medicine in the same group as Capozide (ACE inhibitors) and have had an allergic reaction which caused swelling of the arms, legs, ankles, lips, tongue and/or throat with difficulty in swallowing or breathing (angioedema) or if a member of your family has had a similar reaction.

•    if you have severe liver or kidney problems (ask your doctor if you have any doubt).

•    If you are more than 3 months pregnant. (It is also better to avoid Capozide in early pregnancy - see pregnancy section.).

Capozide should not be given to children and adolescents (< 18

years).

Take special care with Capozide

•    if you suffer from excessive vomiting or diarrhoea.

•    if you are on a low-salt diet and you use salt substitutes or supplements containing potassium.

•    if you have any liver or kidney problems (ask your doctor if you have any doubt).

•    if you know that you have reduced blood circulation in the heart muscle or a narrowing of the aorta (aortic stenosis) or the renal artery (renal artery stenosis).

•    if you have had shock following heart failure (cardiogenic shock).

•    if you suffer from diabetes.

Capozide may influence the effect of insulin or other antidiabetic medicines. Please ask your doctor for advice.

•    if you are using dialysis.

There have been some reports of allergic-type reactions when people using medicinal products such as Capozide undergo dialysis with certain dialysis membranes [so called High-flux-Haemodialysis-Membranes or low density lipoprotein (LDL)-apheresis with dextran sulphate absorption]. Tell your doctor before your next dialysis treatment.

•    if you are to have desensitisation treatment for wasp or bee stings.

There have been some reports of allergic-type reactions when people using medicinal products such as Capozide have such desensitisation treatment. Tell your doctor before your treatment.

•    if you suffer from lupus or lupus-like disorders.

You must tell your doctor if you think you are (or might become) pregnant. Capozide is not recommended in early pregnancy, and must not be taken if you are more than 3 months pregnant, as it may cause serious harm to your baby if used at that stage (see pregnancy section).

Medicinal products containing lithium should not be taken with Capozide without close monitoring by your doctor.

If you develop one of the following, contact your doctor immediately:

•    swelling of the arms, legs, ankles, face, lips, tongue and/or throat with difficulty swallowing or breathing,

•    any sign of infection (such as sore throat or fever) not readily responding to the usual treatment,

•    severe dizziness or fainting,

•    severe abdominal pain,

•    unusually fast or irregular heart beat,

•    jaundice (yellow skin/eyes),

•    any sudden, unexplained rash or burning, red or peeling skin.

Please inform following persons that you take Capozide:

•    the medical staff, especially the anaesthetist (if you are having an operation) if you are hospitalised.

•    your dentist before you have an anaesthetic for a dental procedure.

If you are taking Capozide for the first time you may feel lightheaded or dizzy for a short time and it may help to sit or lie down. This is unlikely to happen when you are taking the tablets regularly. If you are worried, contact your doctor.

Note:

The hydrochlorothiazide contained in this medicine could produce a positive result in a doping test.

Taking Capozide with other medicinal products

Please tell your doctor or pharmacist if you are taking or have recently taken any other medicinal products, including medicinal products obtained without a prescription. These include medicines for a cold, cough, hay fever or sinus problems as these may increase your blood pressure.

•    some pain-killers which are also called 'anti inflammatories'

(e.g. indomethacin, ibuprofen),

•    lithium (for the treatment of mental disorders),

•    carbenoxolone (for the treatment of gastrointestinal ulcers),

•    corticosteroids, corticotrophin (ACTH),

•    some laxatives,

•    injections of an antifungal (amphotericin),

•    muscle relaxants (given at the time of surgery),

•    cholestyramine resin, colestipol (for lowering blood cholesterol),

•    allopurinol (for the treatment of gout),

•    procainamide and digoxin or other cardiac glycosides (treatment for irregular pulse),

•    cytostatic or immunosuppressive agents (e.g. azathioprine and cyclophosphamide),

•    calcium salts,

•    potassium supplements or salt substitutes containing potassium, diuretics (water tablets, in particular those so called potassium sparing), other drugs which can increase potassium in your body (such as heparin),

•    drugs that reduce blood pressure by widening of the blood vessels (e.g. minoxidil),

•    carbamazepine (for the treatment of epilepsy)

•    drugs used in diabetes (insulin and oral antidiabetics such as sulphonyl ureas),

•    drugs used to treat psychotic conditions and some antidepressants,

•    or any other treatment for high blood pressure.

Pregnancy and breast-feeding Pregnancy

You must tell your doctor if you think you are (or might become) pregnant. Your doctor will normally advise you to stop taking Capozide before you become pregnant or as soon as you know you are pregnant and will advise you to take another medicine instead of Capozide. Capozide is not recommended during pregnancy, and must not be taken when more than 3 months pregnant, as it may cause serious harm to your baby if used after the third month of pregnancy.

Breastfeeding

Tell your doctor if you are breast-feeding or about to start breastfeeding. Capozide is not recommended for mothers who are breastfeeding.

Driving and using machines

Caution is necessary when driving or operating machinery if side effects occur such as light-headedness, dizziness or tiredness. This applies in particular at the start of the treatment, when the dosage is changed or if you have had any alcohol.

Important information about some of the ingredients of Capozide

Lactose (lactose monohydrate)

Capozide contains lactose monohydrate (see “Further information”). If you have been told by your doctor that you have an intolerance to some sugars (e.g. lactose), contact your doctor before taking this medicine.

3 How to take Capozide

Always take Capozide exactly as your doctor has told you. You should ask your doctor or pharmacist if you are not sure how to take these tablets.

Your doctor has prescribed Capozide since previous treatment for high blood pressure did not provide appropriate blood pressure reduction. Your doctor will inform you how to switch from the previous treatment to Capozide.

The usual dose is 1 tablet Capozide a day (corresponding to 50 mg captopril and 25 mg hydrochlorothiazide). The maximum daily dose of 1 tablet Capozide should not be exceeded.

Method of administration

Capozide tablets are for oral use only.

The tablets should be swallowed with a sufficient amount of fluid (e.g. one glass of water). You can take Capozide with or without food. You should try to take your daily dose at about the same time each day, preferably in the morning. It is important that you continue to take Capozide until your doctor tells you otherwise.

Special populations: If you suffer from moderate kidney disease, diabetes, or if you have less salt or water in your body, your doctor may prescribe a lower dose of Capozide for you, such as % tablet Capozide (corresponding to 25 mg captopril and 12.5 mg hydrochlorothiazide).

Elderly patients: your doctor may prescribe a lower dose of Capozide for you, such as % tablet Capozide (corresponding to 25 mg captopril and 12.5 mg hydrochlorothiazide).

If you have the impression that the effect of Capozide is too strong or too weak, talk to your doctor or pharmacist.

If you take more Capozide than you should

If you have accidentally taken too many tablets, or a child has swallowed some, contact your doctor or pharmacist immediately. Take the empty container and any remaining tablets with you.

If you take more than you should you may experience the following: passing water more frequently, a change in the levels of some components in your blood, a large drop in your blood pressure, a reduced awareness of yourself or your surrounding (which includes coma), fits, a weakness in the muscles, an irregular or slower heartbeat or reduced kidney function.

If another person has taken too many tablets and has fainted, lay the person down and rest the person's feet higher than the person's head.

If you forget to take Capozide

If you accidentally miss a daily dose, just take the next dose as prescribed. Do not take a double dose to make up for the missed tablet.

If you have any further questions about the use of this medicinal product, ask your doctor or pharmacist.

4 Possible side effects

Like all medicinal products, Capozide can cause side effects, although not everybody gets them.

Stop taking Capozide and seek medical attention immediately if you experience any of the following:

•    swelling of the arms, legs, ankles, face, lips, tongue and/or throat with difficulty in swallowing or breathing, sore throat or fever,

•    severe dizziness or fainting,

•    severe abdominal pain,

• unusually fast or irregular heart beat,

• jaundice (yellow skin/eyes),

•    sudden unexplained skin reactions such as rash, burning, red or peeling skin.

Below you will find separated side effects presented in order of decreasing seriousness that were observed with captopril and/or other ACE inhibitors and side effects that were observed with hydrochlorothiazide.

Following side effects were commonly observed (occurring in more than 1 in 100 but fewer than 1 in 10 patients) that may occur with captopril and other ACE inhibitors:

•    sleep disorders,

•    taste impairment, dizziness,

•    dry, irritating (non-productive) cough, breathing problems,

•    nausea, vomiting, gastric irritations, abdominal pain, diarrhoea, constipation, dry mouth,

•    skin problems such as itchiness and rash, hair loss.

Following uncommon side effects were observed (occurring in more than 1 in 1000 but fewer than 1 in 100 patients) that may occur with captopril and other ACE inhibitors:

•    heart problems such as an unusually fast or irregular heart beat, chest pain (angina), feeling your heartbeat,

•    low blood pressure, impaired circulation in the fingers (Raynaud's syndrome), flushing or pale skin,

•    swellings of the hands, face, lips or tongue,

•    chest pain, tiredness, feeling unwell.

Following rare side effects were observed (occurring in less than 1 in 1000 but more than 1 in 10.000 patients) that may occur with captopril and other ACE inhibitors:

•    loss of appetite (anorexia),

•    drowsiness, headache, an abnormal sensation on your skin such as a burning or prickle,

•    mouth problems such as sore mouth and mouth ulcers,

•    allergic reaction in the gut causing severe abdominal pain (intestinal angioedema),

•    kidney problems, increased or decreased urination.

Following very rare side effects were observed (occurring in 1 or less in 10.000 patients including isolated reports) that may occur with captopril and other ACE inhibitors:

•    side effects affecting the blood and its components such as:

•    anaemia (reduced red blood cell count that may cause decrease in performance and tiredness),

•    lack of certain types of white blood cells which may cause infection, sore throat, fever or bleeding (neutropenia, agranulocytosis, pancytopenia),

•    a reduced ability of the blood to clot (thrombocytopenia) which may cause bleeding or bruising

•    confusion, depression,

•    stroke, fainting,

•    blurred vision,

•    heart attack,

•    chest problems (including:

•    difficulty in breathing or wheezing,

•    a blocked or runny nose, a type of pneumonia, caused by changes in the blood or a condition which causes cough, fever, shortness of breath and wheezing,

•    swollen tongue, stomach ulcers, pancreatitis (inflammation of the pancreas which may cause a stomach ache),

•    impaired liver function, including jaundice which causes the skin and eyes to turn yellow, and inflammation of the liver (hepatitis),

•    severe skin reactions such as:

•    allergic reactions which cause the skin to itch and turn red (urticaria),

•    a severe rash all over the body (Stevens-Johnson syndrome),

•    an allergic rash which causes pink-red patches which may have clear centres (erythema multiforme),

•    sensitivity of the skin to light,

•    a reddening of the skin (erythroderma),

•    a series of skin reactions which can cause fluid-filled patches to form (pemphigoid reactions),

•    a condition causing the skin to scale or peel (exfoliative dermatitis),

•    pains in the muscles and joints,

•    kidney problems,

•    impotence, swelling of the breasts in men,

•    fever,

•    changes in laboratory test values.

Following side effects that were observed with hydrochlorothiazide,

the second active substance contained in Capozide include:

•    swollen salivary glands,

•    side effects affecting the blood and its components which may cause:

•    decrease in performance,

•    tiredness

•    infection,

•    sore throat or fever due to a lack of white blood cells,

•    a reduced ability for the blood to clot which may cause bleeding or bruising

•    loss of appetite (anorexia), sugar in the urine, abnormal changes in your blood components such as sugar, uric acid (gout), sodium, potassium, high levels of cholesterol and other lipids in the blood,

•    restlessness, depression, sleep disturbances,

•    pins and needles, light-headedness,

•    problems with the eyes and vision such as 'yellow vision' and blurred vision,

•    dizziness,

•    low blood pressure, heart problems such as an irregular heart beat,

•    circulation problems such as inflammed blood vessels including those in the skin and other organs (necrotising angiitis),

•    lung and breathing problems such as respiratory distress,

•    gastric irritation, diarrhoea, constipation, pancreatitis,

•    jaundice which causes the skin and eyes to turn yellow,

•    severe skin reactions such as:

•    sensitivity of the skin to light,

•    rash,

•    a condition that causes a characteristic red, blotchy, butterflyshaped rash over the cheeks and nose (lupus and lupus-like reactions),

•    allergic reactions which cause the skin to itch and turn red (urticaria),

•    an over-reaction of the body's natural defence system (hypersensitivity reactions),

•    muscle spasm,

•    kidney problems,

•    fever, weakness.

If any of the side effects become severe, or if you notice any side

effects not listed in this leaflet, please tell your doctor or pharmacist.

S553 LEAFLET CAPOZIDE 20121011

•    KEEP OUT OF THE SIGHT AND REACH OF CHILDREN.

•    Do not store above 25°C.

•    Do not take the tablets after the date shown on the carton over label or blister strip.

•    If your doctor tells you to stop taking the tablets, please take them back to the pharmacist for safe disposal. Only keep the tablets if your doctor tells you to.

•    If the medicine become discoloured or show any other signs of deterioration, you should seek the advice of your pharmacist who will tell you what to do.

•    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. Further Information

What Captopril Tablets contain

•    Each tablet contains 50mg of captopril and 25mg of hydrochlorothiazide, as the active ingredients.

•    The tablets also contain microcrystalline cellulose, pregelatinised starch, stearic acid, magnesium stearate and lactose.

What Captopril Tablets look like and contents of the pack

Captopril Tablets are white to off-white, oval, biconvex tablet; with a breakbar on one side and engraved with "C H" on the other side. The tablet can divided into equal halves.

Captopril Tablets are available in blister packs containing 30 tablets.

Product Licence holder

Procured from within the ELI and repackaged by the Product Licence holder: S&M Medical Ltd, Chemilines House, Alperton Lane, Wembley, HAO 1DX.

Manufacturer

This product is manufactured by Bristol-Myers Squibb, rue du Dr. Gilles, 28230 Epernon, France.

[POlvj PL No. 19488/0553

Leaflet revision date: 11 October 2012

S553 LEAFLET captopril 20121011

S553 LEAFLET captopril 20121011

PACKAGE LEAFLET: INFORMATION FOR THE USER CAPTOPRIL AND HYDROCHLOROTHIAZIDE 50mg/25mg TABLETS

Your medicine is known as Captopril and Hydrochlorothiazide 50mg/25mg Tablets but will be referred to as Captopril Tablets throughout the following patient information leaflet.

Read all of this leaflet carefully before you start using this medicine.

•    Keep this leaflet. You may need to read it again.

•    If you have any further questions, ask your doctor or pharmacist

•    This medicine has been prescribed for you. Do not pass it on to others. It may harm them, even if their symptoms are the same as yours.

•    If any of the side effects get serious, or if you notice any side effects not listed in this leaflet, please tell your doctor or pharmacist.

In this leaflet:

1.    What are Captopril Tablets are and what they are used for

2.    Before you take Captopril Tablets

3.    How to take Captopril Tablets

4.    Possible side effects

5.    How to store Captopril Tablets

6.    Further information

1 What are Captopril Tablets are and what they are used for

Captopril Tablets are combination of two active substances, captopril and hydrochlorothiazide.

Captopril belongs to a group of medicinal products called Angiotensin Converting Enzyme (ACE) Inhibitors. ACE inhibitors cause blood vessels to relax and the blood pressure to lower. Hydrochlorothiazide is one of a group of medicinal products called thiazide diuretics (also known as water tablets). They increase urine output and hence decrease blood pressure.

The two active substances in Captopril Tablets work together to decrease blood pressure further than if either was given alone.

Captopril Tablets are used in the treatment of high blood pressure (essential hypertension), if treatment with captopril or hydrochlorothiazide alone has not led to a sufficient decrease in blood pressure.

2 Before you take Captopril Tablets

Please read the following section attentively. It contains important

information which you and your doctor should observe prior to

taking of Captopril Tablets.

Do NOT take Captopril Tablets

•    if you are allergic (hypersensitive) to captopril or to any other ACE inhibitors or to any of the other ingredients of Captopril Tablets.

•    if you are allergic to hydrochlorothiazide or to any other sulphonamide derivatives.

•    if you have previously been treated with a medicine in the same group as Captopril Tablets (ACE inhibitors) and have had an allergic reaction which caused swelling of the arms, legs, ankles, lips, tongue and/or throat with difficulty in swallowing or breathing (angioedema) or if a member of your family has had a similar reaction.

•    if you have severe liver or kidney problems (ask your doctor if you have any doubt).

•    If you are more than 3 months pregnant. (It is also better to avoid Captopril Tablets in early pregnancy - see pregnancy section.).

Captopril Tablets should not be given to children and adolescents

(< 18 years).

Take special care with Captopril Tablets

•    if you suffer from excessive vomiting or diarrhoea.

•    if you are on a low-salt diet and you use salt substitutes or supplements containing potassium.

•    if you have any liver or kidney problems (ask your doctor if you have any doubt).

•    if you know that you have reduced blood circulation in the heart muscle or a narrowing of the aorta (aortic stenosis) or the renal artery (renal artery stenosis).

•    if you have had shock following heart failure (cardiogenic shock).

•    if you suffer from diabetes.

Captopril Tablets may influence the effect of insulin or other anti-diabetic medicines. Please ask your doctor for advice.

•    if you are using dialysis.

There have been some reports of allergic-type reactions when people using medicinal products such as Captopril Tablets undergo dialysis with certain dialysis membranes [so called High-flux-Haemodialysis-Membranes or low density lipoprotein (LDL)-apheresis with dextran sulphate absorption]. Tell your doctor before your next dialysis treatment.

•    if you are to have desensitisation treatment for wasp or bee stings.

There have been some reports of allergic-type reactions when people using medicinal products such as Captopril Tablets have such desensitisation treatment. Tell your doctor before your treatment.

•    if you suffer from lupus or lupus-like disorders.

You must tell your doctor if you think you are (or might become) pregnant. Captopril Tablets are not recommended in early pregnancy, and must not be taken if you are more than 3 months pregnant, as it may cause serious harm to your baby if used at that stage (see pregnancy section).

Medicinal products containing lithium should not be taken with Captopril Tablets without close monitoring by your doctor.

If you develop one of the following, contact your doctor immediately:

•    swelling of the arms, legs, ankles, face, lips, tongue and/or throat with difficulty swallowing or breathing,

•    any sign of infection (such as sore throat or fever) not readily responding to the usual treatment,

•    severe dizziness or fainting,

•    severe abdominal pain,

•    unusually fast or irregular heart beat,

•    jaundice (yellow skin/eyes),

•    any sudden, unexplained rash or burning, red or peeling skin.

Please inform following persons that you take Captopril Tablets:

•    the medical staff, especially the anaesthetist (if you are having an operation) if you are hospitalised.

•    your dentist before you have an anaesthetic for a dental procedure.

If you are taking Captopril Tablets for the first time you may feel lightheaded or dizzy for a short time and it may help to sit or lie down. This is unlikely to happen when you are taking the tablets regularly. If you are worried, contact your doctor.

Note:

The hydrochlorothiazide contained in this medicine could produce a positive result in a doping test.

Taking Captopril Tablets with other medicinal products

Please tell your doctor or pharmacist if you are taking or have recently taken any other medicinal products, including medicinal products obtained without a prescription. These include medicines for a cold, cough, hay fever or sinus problems as these may increase your blood pressure.

•    some pain-killers which are also called 'anti inflammatories'

(e.g. indomethacin, ibuprofen),

•    lithium (for the treatment of mental disorders),

•    carbenoxolone (for the treatment of gastrointestinal ulcers),

•    corticosteroids, corticotrophin (ACTH),

•    some laxatives,

•    injections of an antifungal (amphotericin),

•    muscle relaxants (given at the time of surgery),

•    cholestyramine resin, colestipol (for lowering blood cholesterol),

•    allopurinol (for the treatment of gout),

•    procainamide and digoxin or other cardiac glycosides (treatment for irregular pulse),

•    cytostatic or immunosuppressive agents (e.g. azathioprine and cyclophosphamide),

•    calcium salts,

•    potassium supplements or salt substitutes containing potassium, diuretics (water tablets, in particular those so called potassium sparing), other drugs which can increase potassium in your body (such as heparin),

•    drugs that reduce blood pressure by widening of the blood vessels (e.g. minoxidil),

•    carbamazepine (for the treatment of epilepsy)

•    drugs used in diabetes (insulin and oral antidiabetics such as sulphonyl ureas),

•    drugs used to treat psychotic conditions and some antidepressants,

•    or any other treatment for high blood pressure.

Pregnancy and breast-feeding Pregnancy

You must tell your doctor if you think you are (or might become) pregnant. Your doctor will normally advise you to stop taking Captopril Tablets before you become pregnant or as soon as you know you are pregnant and will advise you to take another medicine instead of Captopril Tablets. Captopril Tablets are not recommended during pregnancy, and must not be taken when more than 3 months pregnant, as it may cause serious harm to your baby if used after the third month of pregnancy.

Breastfeeding

Tell your doctor if you are breast-feeding or about to start breastfeeding. Captopril Tablets are not recommended for mothers who are breast-feeding.

Driving and using machines

Caution is necessary when driving or operating machinery if side effects occur such as light-headedness, dizziness or tiredness. This applies in particular at the start of the treatment, when the dosage is changed or if you have had any alcohol.

Important information about some of the ingredients of Captopril Tablets

Lactose (lactose monohydrate)

Captopril Tablets contain lactose monohydrate (see “Further information”). If you have been told by your doctor that you have an intolerance to some sugars (e.g. lactose), contact your doctor before taking this medicine.

3 How to take Captopril Tablets

Always take Captopril Tablets exactly as your doctor has told you. You should ask your doctor or pharmacist if you are not sure how to take these tablets.

Your doctor has prescribed Captopril Tablets since previous treatment for high blood pressure did not provide appropriate blood pressure reduction. Your doctor will inform you how to switch from the previous treatment to Captopril Tablets.

The usual dose is 1 tablet Captopril Tablets a day (corresponding to 50 mg captopril and 25 mg hydrochlorothiazide). The maximum daily dose of 1 tablet Captopril Tablets should not be exceeded.

Method of administration

Captopril Tablets are for oral use only.

The tablets should be swallowed with a sufficient amount of fluid (e.g. one glass of water). You can take Captopril Tablets with or without food. You should try to take your daily dose at about the same time each day, preferably in the morning. It is important that you continue to take Captopril Tablets until your doctor tells you otherwise.

Special populations: If you suffer from moderate kidney disease, diabetes, or if you have less salt or water in your body, your doctor may prescribe a lower dose of Captopril Tablets for you, such as % tablet Captopril Tablets (corresponding to 25 mg captopril and 12.5 mg hydrochlorothiazide).

Elderly patients: your doctor may prescribe a lower dose of Captopril Tablets for you, such as % tablet Captopril Tablets (corresponding to 25 mg captopril and 12.5 mg hydrochlorothiazide).

If you have the impression that the effect of Captopril Tablets are too strong or too weak, talk to your doctor or pharmacist.

If you take more Captopril Tablets than you should

If you have accidentally taken too many tablets, or a child has swallowed some, contact your doctor or pharmacist immediately. Take the empty container and any remaining tablets with you.

If you take more than you should you may experience the following: passing water more frequently, a change in the levels of some components in your blood, a large drop in your blood pressure, a reduced awareness of yourself or your surrounding (which includes coma), fits, a weakness in the muscles, an irregular or slower heartbeat or reduced kidney function.

If another person has taken too many tablets and has fainted, lay the person down and rest the person's feet higher than the person's head.

If you forget to take Captopril Tablets

If you accidentally miss a daily dose, just take the next dose as prescribed. Do not take a double dose to make up for the missed tablet.

If you have any further questions about the use of this medicinal product, ask your doctor or pharmacist.

4 Possible side effects

Like all medicinal products, Captopril Tablets can cause side effects, although not everybody gets them.

Stop taking Captopril Tablets and seek medical attention immediately if you experience any of the following:

•    swelling of the arms, legs, ankles, face, lips, tongue and/or throat with difficulty in swallowing or breathing, sore throat or fever,

•    severe dizziness or fainting,

•    severe abdominal pain,

• unusually fast or irregular heart beat,

• jaundice (yellow skin/eyes),

•    sudden unexplained skin reactions such as rash, burning, red or peeling skin.

Below you will find separated side effects presented in order of decreasing seriousness that were observed with captopril and/or other ACE inhibitors and side effects that were observed with hydrochlorothiazide.

Following side effects were commonly observed (occurring in more than 1 in 100 but fewer than 1 in 10 patients) that may occur with captopril and other ACE inhibitors:

•    sleep disorders,

•    taste impairment, dizziness,

•    dry, irritating (non-productive) cough, breathing problems,

•    nausea, vomiting, gastric irritations, abdominal pain, diarrhoea, constipation, dry mouth,

•    skin problems such as itchiness and rash, hair loss.

Following uncommon side effects were observed (occurring in more than 1 in 1000 but fewer than 1 in 100 patients) that may occur with captopril and other ACE inhibitors:

•    heart problems such as an unusually fast or irregular heart beat, chest pain (angina), feeling your heartbeat,

•    low blood pressure, impaired circulation in the fingers (Raynaud's syndrome), flushing or pale skin,

•    swellings of the hands, face, lips or tongue,

•    chest pain, tiredness, feeling unwell.

Following rare side effects were observed (occurring in less than 1 in 1000 but more than 1 in 10.000 patients) that may occur with captopril and other ACE inhibitors:

•    loss of appetite (anorexia),

•    drowsiness, headache, an abnormal sensation on your skin such as a burning or prickle,

•    mouth problems such as sore mouth and mouth ulcers,

•    allergic reaction in the gut causing severe abdominal pain (intestinal angioedema),

•    kidney problems, increased or decreased urination.

Following very rare side effects were observed (occurring in 1 or less in 10.000 patients including isolated reports) that may occur with captopril and other ACE inhibitors:

•    side effects affecting the blood and its components such as:

•    anaemia (reduced red blood cell count that may cause decrease in performance and tiredness),

•    lack of certain types of white blood cells which may cause infection, sore throat, fever or bleeding (neutropenia, agranulocytosis, pancytopenia),

•    a reduced ability of the blood to clot (thrombocytopenia) which may cause bleeding or bruising

•    confusion, depression,

•    stroke, fainting,

•    blurred vision,

•    heart attack,

•    chest problems (including:

•    difficulty in breathing or wheezing,

•    a blocked or runny nose, a type of pneumonia, caused by changes in the blood or a condition which causes cough, fever, shortness of breath and wheezing,

•    swollen tongue, stomach ulcers, pancreatitis (inflammation of the pancreas which may cause a stomach ache),

•    impaired liver function, including jaundice which causes the skin and eyes to turn yellow, and inflammation of the liver (hepatitis),

•    severe skin reactions such as:

•    allergic reactions which cause the skin to itch and turn red (urticaria),

•    a severe rash all over the body (Stevens-Johnson syndrome),

•    an allergic rash which causes pink-red patches which may have clear centres (erythema multiforme),

•    sensitivity of the skin to light,

•    a reddening of the skin (erythroderma),

•    a series of skin reactions which can cause fluid-filled patches to form (pemphigoid reactions),

•    a condition causing the skin to scale or peel (exfoliative dermatitis),

•    pains in the muscles and joints,

•    kidney problems,

•    impotence, swelling of the breasts in men,

•    fever,

•    changes in laboratory test values.

Following side effects that were observed with hydrochlorothiazide,

the second active substance contained in Captopril Tablets include:

•    swollen salivary glands,

•    side effects affecting the blood and its components which may cause:

•    decrease in performance,

•    tiredness

•    infection,

•    sore throat or fever due to a lack of white blood cells,

•    a reduced ability for the blood to clot which may cause bleeding or bruising

•    loss of appetite (anorexia), sugar in the urine, abnormal changes in your blood components such as sugar, uric acid (gout), sodium, potassium, high levels of cholesterol and other lipids in the blood,

•    restlessness, depression, sleep disturbances,

•    pins and needles, light-headedness,

•    problems with the eyes and vision such as 'yellow vision' and blurred vision,

•    dizziness,

•    low blood pressure, heart problems such as an irregular heart beat,

•    circulation problems such as inflammed blood vessels including those in the skin and other organs (necrotising angiitis),

•    lung and breathing problems such as respiratory distress,

•    gastric irritation, diarrhoea, constipation, pancreatitis,

•    jaundice which causes the skin and eyes to turn yellow,

•    severe skin reactions such as:

•    sensitivity of the skin to light,

•    rash,

•    a condition that causes a characteristic red, blotchy, butterflyshaped rash over the cheeks and nose (lupus and lupus-like reactions),

•    allergic reactions which cause the skin to itch and turn red (urticaria),

•    an over-reaction of the body's natural defence system (hypersensitivity reactions),

•    muscle spasm,

•    kidney problems,

•    fever, weakness.

If any of the side effects become severe, or if you notice any side

effects not listed in this leaflet, please tell your doctor or pharmacist.

S553 LEAFLET captopril 20121011