Entresto - patient leaflet, side effects, dosage

B. PACKAGE LEAFLET

Package leaflet: Information for the patient

Entresto 24 mg/26 mg film-coated tablets

Entresto 49 mg/51 mg film-coated tablets

Entresto 97 mg/103 mg film-coated tablets

sacubitril/val­sartan

Read all of this leaflet carefully before you start taking this medicine because it contains important information for you.

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

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

• – This medicine has been prescribed for you only. Do not pass it on to others. It may harm them,

even if their signs of illness are the same as yours.

• – If you get any side effects, talk to your doctor or pharmacist. This includes any possible side

effects not listed in this leaflet. See section 4.

What is in this leaflet

• 1. What Entresto is and what it is used for

• 2. What you need to know before you take Entresto

• 3. How to take Entresto

• 4. Possible side effects

• 5. How to store Entresto

• 6. Contents of the pack and other information

1. What Entresto is and what it is used for

Entresto is a medicine containing an angiotensin receptor neprilysin inhibitor. It delivers two active substances, sacubitril and valsartan.

Entresto is used to treat a type of long-term heart failure in adults.

This type of heart failure occurs when the heart is weak and cannot pump enough blood to the lungs and the rest of the body. The most common symptoms of heart failure are breathlessness, fatigue, tiredness and ankle swelling.

2. What you need to know before you take Entresto

Do not take Entresto

• if you are allergic to sacubitril, valsartan or any of the other ingredients of this medicine (listed

in section 6).

• if you are taking another type of medicine called an angiotensin converting enzyme (ACE)

inhibitor (for example enalapril, lisinopril or ramipril). ACE inhibitors are used to treat high blood pressure or heart failure. If you have been taking an ACE inhibitor, wait for 36 hours after taking the last dose before you start to take Entresto (see “Other medicines and Entresto”).

• if you or a member of your family have ever had a reaction called angioedema (swelling of the

face, lips, tongue and/or throat, difficulties in breathing) when taking an ACE inhibitor or an angiotensin receptor blocker (ARB) (such as valsartan, telmisartan or irbesartan).

• if you have diabetes or impaired kidney function and you are being treated with a blood pressure

lowering medicine containing aliskiren (see “Other medicines and Entresto”).

• if you have severe liver disease.
• if you are more than 3 months pregnant (it is also better to avoid this medicine in early

pregnancy, see “Pregnancy and breast-feeding”).

If any of the above applies to you, do not take Entresto and talk to your doctor.

Warnings and precautions

Talk to your doctor, pharmacist or nurse before or when taking Entresto:

• if you are being treated with an angiotensin receptor blocker (ARB) or aliskiren (see “Do not

take Entresto”).

• if you have ever had angioedema (see “Do not take Entresto” and section 4 “Possible side

effects”).

• if you have low blood pressure or are taking any other medicines that reduce your blood

pressure (for example, a diuretic) or are suffering from vomiting or diarrhoea, especially if you are aged 65 years or more, or if you have kidney disease and low blood pressure.

• if you have severe kidney disease.
• if you are suffering from dehydration.
• if your kidney artery has narrowed.
• if you have liver disease.
• if you experience hallucinations, paranoia or changes in sleeping pattern.

Your doctor may check the amount of potassium in your blood at regular intervals during Entresto treatment.

If any of the above applies to you, tell your doctor, pharmacist or nurse before you take Entresto.

Children and adolescents

Do not give this medicine to children (aged below 18 years) because it has not been studied in this age group.

Other medicines and Entresto

Tell your doctor, pharmacist or nurse if you are taking, have recently taken or might take any other medicines. It may be necessary to change the dose, to take other precautions, or even to stop taking one of the medicines. This is particularly important for the following medicines:

• ACE inhibitors. Do not take Entresto with ACE inhibitors. If you have been taking an ACE

inhibitor, wait 36 hours after taking the last dose of the ACE inhibitor before starting to take Entresto (see “Do not take Entresto”). If you stop taking Entresto, wait 36 hours after taking your last dose of Entresto before starting an ACE inhibitor.

• other medicines used to treat heart failure or lower blood pressure, such as angiotensin receptor

blockers or aliskiren (see “Do not take Entresto”).

• some medicines known as statins that are used to lower high cholesterol levels (for example

atorvastatin).

• sildenafil, a medicine used to treat erectile dysfunction or lung hypertension.
• medicines that increase the amount of potassium in the blood. These include potassium

supplements, salt substitutes containing potassium, potassium-sparing medicines and heparin.

• painkillers of the type called non-steroidal anti-inflammatory medicines (NSAIDs) or selective cyclooxygenase-2 (Cox-2) inhibitors. If you are taking one of these, your doctor may want to check your kidney function when starting or adjusting treatment (see “Warnings and precautions”).
• lithium, a medicine used to treat some types of psychiatric illness.
• furosemide, a medicine belonging to the type known as diuretics, which are used to increase the

amount of urine you produce.

• nitroglycerine, a medicine used to treat angina pectoris.
• some types of antibiotics (rifamycin group), ciclosporin (used to prevent rejection of

transplanted organs) or antivirals such as ritonavir (used to treat HIV/AIDS).

• metformin, a medicine used to treat diabetes.

If any of the above applies to you, tell your doctor or pharmacist before you take Entresto.

Pregnancy and breastfeeding

Pregnancy

You must tell your doctor if you think that you are (or might become) pregnant. Your doctor will normally advise you to stop taking this medicine before you become pregnant or as soon as you know you are pregnant, and will advise you to take another medicine instead of Entresto.

This medicine is not recommended in early pregnancy, and must not be taken when more than 3 months pregnant, as it may cause serious harm to your baby if it is used after the third month of pregnancy.

Breast-feeding

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

Driving and using machines

Before you drive a vehicle, use tools or operate machines, or carry out other activities that require concentration, make sure you know how Entresto affects you. If you feel dizzy or very tired while taking this medicine, do not drive a vehicle, cycle or use any tools or machines.

3. How to take Entresto

Always take this medicine exactly as your doctor or pharmacist has told you. Check with your doctor or pharmacist if you are not sure.

You will usually start by taking 24 mg/26 mg or 49 mg/51 mg twice a day (one tablet in the morning and one tablet in the evening). Your doctor will decide your exact starting dose based on which medicines you have been taking previously. Your doctor will then adjust the dose depending on how you respond to the treatment until the best dose for you is found.

The usual recommended target dose is 97 mg/103 mg twice a day (one tablet in the morning and one tablet in the evening).

Patients taking Entresto can develop low blood pressure (dizziness, light-headedness), a high level of potassium in the blood (which would be detected when your doctor performed a blood test) or decreased kidney function. If this happens, your doctor may reduce the dose of any other medicine you are taking, temporarily reduce your Entresto dose, or stop your Entresto treatment completely.

Swallow the tablets with a glass of water. You can take Entresto with or without food. Splitting or crushing of the tablets is not recommended.

If you take more Entresto than you should

If you have accidentally taken too many Entresto tablets, or if someone else has taken your tablets, contact your doctor immediately. If you experience severe dizziness and/or fainting, tell your doctor as quickly as possible and lie down.

If you forget to take Entresto

It is advisable to take your medicine at the same time each day. However, if you forget to take a dose, you should simply take the next one at the scheduled time. Do not take a double dose to make up for a forgotten tablet.

If you stop taking Entresto

Stopping your treatment with Entresto may cause your condition to get worse. Do not stop taking your medicine unless your doctor tells you to.

If you have any further questions on the use of this medicine, ask your doctor or pharmacist.

4. Possible side effects

Like all medicines, this medicine can cause side effects, although not everybody gets them.

Some side effects may be serious.

• Stop taking Entresto and seek immediate medical attention if you notice any swelling of the

face, lips, tongue and/or throat, which may cause difficulties in breathing or swallowing. These may be signs of angioedema (an uncommon side effect which may affect up to 1 in 100 people).

Other possible side effects:

If any of the side effects listed below becomes severe, tell your doctor or pharmacist.

Very common (may affect more than 1 in 10 people)

• low blood pressure (dizziness, light-headedness)
• high level of potassium in the blood (shown in a blood test)
• decreased renal function (renal impairment)

Common (may affect up to 1 in 10 people)

• cough
• dizziness
• diarrhoea
• low level of red blood cells (shown in a blood test)
• tiredness
• (acute) renal failure (severe kidney disorder)
• low level of potassium in the blood (shown in a blood test)
• headache
• fainting
• weakness
• feeling sick (nausea)
• low blood pressure (dizziness, light-headedness) when switching from sitting or lying to

standing position

• gastritis (stomach pain, nausea)
• spinning sensation
• low level of sugar in the blood (shown in a blood test)

Uncommon (may affect up to 1 in 100 people)

• allergic reaction with rash and itching
• dizziness when switching from sitting to standing position

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

• hallucinations
• changes in sleeping pattern

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

• paranoia

Reporting of side effects

If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via the national reporting system listed in Appendix V. By reporting side effects you can help provide more information on the safety of this medicine.

5. How to store Entresto

Keep this medicine out of the sight and reach of children.

Do not use this medicine after the expiry date which is stated on the carton and blister after EXP. The expiry date refers to the last day of that month.

This medicine does not require any special temperature storage conditions.

Store in the original package in order to protect from moisture.

Do not use this medicine if you notice that the pack is damaged or shows signs of tampering.

Do not throw away any medicines via wastewater. Ask your pharmacist how to throw away medicines you no longer use. These measures will help protect the environment.

6. Contents of the pack and other information

What Entresto contains

• The active substances are sacubitril and valsartan.

o Each 24 mg/26 mg film-coated tablet contains 24.3 mg sacubitril and 25.7 mg valsartan (as sacubitril valsartan sodium salt complex).

o Each 49 mg/51 mg film-coated tablet contains 48.6 mg sacubitril and 51.4 mg valsartan (as sacubitril valsartan sodium salt complex).

o Each 97 mg/103 mg film-coated tablet contains 97.2 mg sacubitril and 102.8 mg valsartan (as sacubitril valsartan sodium salt complex).

• The other ingredients in the tablet core are microcrystalline cellulose, low-substituted

hydroxypropyl­cellulose, crospovidone, magnesium stearate, talc and silica colloidal anhydrous.

• The 24 mg/26 mg and the 97 mg/103 mg tablet coatings contain hypromellose, titanium dioxide

(E171), Macrogol (4000), talc, iron oxide red (E172) and iron oxide black (E172).

• The 49 mg/51 mg tablet coating contains hypromellose, titanium dioxide (E171), Macrogol

What Entresto looks like and contents of the pack

Entresto 24 mg/26 mg film-coated tablets are violet-white oval tablets with “NVR” on one side and “LZ” on the other side. Approximate tablet dimensions 13.1 mm x 5.2 mm.

Entresto 49 mg/51 mg film-coated tablets are pale yellow oval tablets with “NVR” on one side and “L1” on the other side. Approximate tablet dimensions 13.1 mm x 5.2 mm

Entresto 97 mg/103 mg film-coated tablets are light pink oval tablets with “NVR” on one side and “L11” on the other side. Approximate tablet dimensions 15.1 mm x 6.0 mm.

The tablets are supplied in packs containing 14, 20, 28, 56, 168 or 196 tablets and in multipacks comprising 7 cartons, each containing 28 tablets. The 49 mg/51 mg and 97 mg/103 mg tablets are also supplied in multipacks comprising 3 cartons, each containing 56 tablets.

Not all pack sizes may be marketed.

Marketing Authorisation Holder

Novartis Europharm Limited

Vista Building

Elm Park, Merrion Road

Dublin 4

Ireland

Manufacturer

Novartis Farma S.p.A

Via Provinciale Schito 131

80058 Torre Annunziata (NA)

Italy

Novartis Pharma GmbH

Roonstrasse 25

90429 Nuremberg

Germany

LEK farmacevtska družba d. d., Poslovna enota PROIZVODNJA LENDAVA

Trimlini 2D

Lendava, 9220

Slovenia

For any information about this medicine, please contact the local representative of the Marketing Authorisation Holder:

België/Belgiqu­e/Belgien Novartis Pharma N.V. Tél/Tel: +32 2 246 16 11	Lietuva SIA Novartis Baltics Lietuvos filialas Tel: +370 5 269 16 50
Efc^rapufl Novartis Bulgaria EOOD Ten: +359 2 489 98 28	Luxembourg/Lu­xemburg Novartis Pharma N.V. Tél/Tel: +32 2 246 16 11
Česká republika Novartis s.r.o. Tel: +420 225 775 111	Magyarorszag Novartis Hungaria Kft. Tel.: +36 1 457 65 00
Danmark Novartis Healthcare A/S Tlf: +45 39 16 84 00	Malta Novartis Pharma Services Inc. Tel: +356 2122 2872
Deutschland Novartis Pharma GmbH Tel: +49 911 273 0	Nederland Novartis Pharma B.V. Tel: +31 88 04 52 111
Eesti SIA Novartis Baltics Eesti filiaal Tel: +372 66 30 810	Norge Novartis Norge AS Tlf: +47 23 05 20 00
EXÀàôa Novartis (Hellas) A.E.B.E. TnX: +30 210 281 17 12	Österreich Novartis Pharma GmbH Tel: +43 1 86 6570
España Novartis Farmacéutica, S.A. Tel: +34 93 306 42 00	Polska Novartis Poland Sp. z o.o. Tel.: +48 22 375 4888
France Novartis Pharma S.A.S. Tél: +33 1 55 47 66 00	Portugal Novartis Farma – Produtos Farmacêuticos, S.A. Tel: +351 21 000 8600
Hrvatska Novartis Hrvatska d.o.o. Tel. +385 1 6274 220	România Novartis Pharma Services Romania SRL Tel: +40 21 31299 01
Ireland Novartis Ireland Limited Tel: +353 1 260 12 55	Slovenija Novartis Pharma Services Inc. Tel: +386 1 300 75 50

This leaflet was last revised in

Other sources of information

Detailed information on this medicine is available on the European Medicines Agency web site: http: //www.ema. europa. eu

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