Olmesartan medoxomil/hydrochlorothiazide 20 mg/25 mg film-coated tablets

• 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, pharmacist or nurse. This includes any possible side effects not listed in this leaflet. See section 4.

1. What Olmesartan medoxomil/hydrochlorothiazide is and what it is used for
2. What you need to know before you take Olmesartan medoxomil/hydrochlorothiazide
3. How to take Olmesartan medoxomil/hydrochlorothiazide
4. Possible side effects
5. How to store Olmesartan medoxomil/hydrochlorothiazide
6. Contents of the pack and other information

• if you are allergic to olmesartan medoxomil or hydrochlorothiazide, or any of the other ingredients of this medicine (listed in section 6) or substances similar to hydrochlorothiazide (sulfonamides)
• if you are more than 3 months pregnant (It is also better to avoid Olmesartan medoxomil/hydrochlorothiazide in early pregnancy – see pregnancy section)
• if you have severe kidney problems
• if you have diabetes or impaired kidney function and you are treated with a blood pressure lowering medicine containing aliskiren
• if you suffer from low potassium, low sodium, high calcium or high uric acid levels in the blood (with symptoms of gout or kidney stones) that do not get better when treated
• if you suffer from severe liver problems or yellowing of the skin and eyes (jaundice) or problems with drainage of the bile from the gallbladder (biliary obstruction e.g. gallstones)

If you think any of these apply to you, or you are unsure, do not take the tablets. Talk to your doctor first and follow the advice given.

Talk to your doctor before using Olmesartan medoxomil/hydrochlorothiazide.

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

• an ACE-inhibitor (for example enalapril, lisinopril, ramipril), in particular if you have diabetes-related kidney problems.
• aliskiren

Your doctor may check your kidney function, blood pressure, and the amount of electrolytes (e.g. potassium) in your blood at regular intervals.

See also information under the heading “Do not take Olmesartan medoxomil/hydrochlorothiazide”.

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

• Mild to moderate kidney problems or if you have had a recent kidney transplant
• Liver diseases
• Heart failure or problems with your heart valves or heart muscles
• Vomiting (being sick) or diarrhoea which is severe or it goes on for several days
• Treatment with high doses of water tablets (diuretics) or if you are on a low salt diet
• Problems with your adrenal glands (e.g. primary aldosteronism)
• Diabetes
• Lupus erythematosus (an autoimmune disease)
• Allergies or asthma
• If you have had skin cancer or if you develop an unexpected skin lesion during the treatment. Treatment with hydrochlorothiazide, particularly long term use with high doses, may increase the risk of some types of skin and lip cancer (non-melanoma skin cancer). Protect your skin from sun exposure and UV rays while taking Olmesartan medoxomil/hydrochlorothiazide
• If you experienced breathing or lung problems (including inflammation or fluid in the lungs) following hydrochlorothiazide intake in the past. If you develop any severe shortness of breath or difficulty breathing after taking Olmesartan medoxomil/hydrochlorothiazide, seek medical attention immediately.

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

• diarrhoea that is severe, persistent and causes substantial weight loss. Your doctor may evaluate your symptoms and decide on how to continue your blood pressure medication.
• decrease in vision or eye pain. These could be symptoms of fluid accumulation in the vascular layer of the eye (choroidal effusion) or an increase of pressure in your eye and can happen within hours to weeks of taking Olmesartan medoxomil/hydrochlorothiazide. This can lead to permanent vision impairment, if not treated.

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

Olmesartan medoxomil/hydrochlorothiazide may cause a rise in blood fat levels and uric acid levels (the cause of gout – painful swelling of the joints). Your doctor will probably want to do a blood test from time to time to check these.

It may change the levels of certain chemicals in your blood called electrolytes. Your doctor will probably want to do a blood test from time to time to check these. Signs of electrolyte changes are: thirst, dryness of the mouth, muscle pain or cramps, tired muscles, low blood pressure (hypotension), feeling weak, sluggish, tired, sleepy or restless, nausea, vomiting, less need to pass urine, a rapid heart rate. Tell your doctor if you notice these symptoms.

As with any medicine which reduces blood pressure, an excessive drop in blood pressure in patients with blood flow disturbances of the heart or brain could lead to a heart attack or stroke. Your doctor will therefore check your blood pressure carefully.

If you are due to have tests for parathyroid function, you should stop taking Olmesartan medoxomil/hydrochlorothiazide before these tests are carried out.

If you are a sports person, this medicine could change the results of an anti-dope test to make it positive.

You must tell your doctor if you think that you are (or might become) pregnant. Olmesartan medoxomil/hydrochlorothiazide 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).

Talk to your doctor if you experience abdominal pain, nausea, vomiting or diarrhoea after taking Olmesartan medoxomil/hydrochlorothiazide. Your doctor will decide on further treatment. Do not stop taking Olmesartan medoxomil/hydrochlorothiazide on your own.

Olmesartan medoxomil/hydrochlorothiazide is not recommended for children and adolescents under the age of 18.

Tell your doctor or pharmacist if you are using, have recently used or might use any other medicines.

In particular, tell your doctor or pharmacist about any of the following:

• Other blood pressure lowering medicines (anti-hypertensives), as the effect of Olmesartan medoxomil/hydrochlorothiazide can be increased.
  Your doctor may need to change your dose and/or to take other precautions:
  If you are taking an ACE-inhibitor or aliskiren (see also information under the headings “Do not take Olmesartan medoxomil/hydrochlorothiazide” and “Warnings and precautions”).
• Medicines which may alter the levels of potassium in your blood if used at the same time as Olmesartan medoxomil/hydrochlorothiazide. These include:
  • potassium supplements (as well as salt substitutes containing potassium)
  • water tablets (diuretics)
  • heparin (for thinning the blood)
  • laxatives
  • steroids
  • adrenocorticotrophic hormone (ACTH)
  • carbenoxolone (a medicine used to treat mouth and stomach ulcers)
  • penicillin G sodium (also called benzylpenicillin sodium, an antibiotic)
  • certain pain killers such as aspirin or salicylates
• Lithium (a medicine used to treat mood swings and some types of depression) used at the same time as Olmesartan medoxomil/hydrochlorothiazide may increase the toxicity of lithium. If you have to take lithium, your doctor will measure your lithium blood levels.
• Non-steroidal anti-inflammatory (NSAIDs) medicines (medicines used to relieve pain, swelling and other symptoms of inflammation, including arthritis) used at the same time as Olmesartan medoxomil/hydrochlorothiazide may increase the risk of kidney failure and the effect of Olmesartan medoxomil/hydrochlorothiazide can be decreased by NSAIDs.
• Sleeping tablets, sedatives and anti-depressant medicines, as using these medicines together with Olmesartan medoxomil/hydrochlorothiazide may cause a sudden drop in blood pressure when standing up.
• Certain medicines such as baclofen and tubocurarine, used to relax muscles.
• Amifostine and some other drugs used to treat cancers, such as cyclophosphamide or methotrexate.
• Colestyramine and colestipol, medicines for lowering blood fat levels.
• Colesevelam hydrochloride, a drug that lowers the level of cholesterol in your blood, as the effect of Olmesartan medoxomil/hydrochlorothiazide may be decreased. Your doctor may advise you to take Olmesartan medoxomil/hydrochlorothiazide at least 4 hours before colesevelam hydrochloride.
• Anticholinergic agents, such as atropine and biperiden.
• Drugs such as thioridazine, chlorpromazine, levomepromazine, trifluoperazine, cyamemazine, sulpiride, amisulpride, pimozide, sultopride, tiapride, droperidol or haloperidol, used to treat certain psychiatric disorders.
• Certain medicines such as quinidine, hydroquinidine, disopyramide, amiodarone, sotalol or digitalis, used to treat heart problems.
• Medicines such as mizolastine, pentamidine, terfenadine, dofetilide, ibutilide or erythromycin injections, which may change the heart rhythm.
• Oral anti-diabetic medicines, such as metformin, or insulin, used to lower blood sugar.
• Beta-blockers and diazoxide, medicines used to treat high blood pressure or low blood sugar, respectively, as Olmesartan medoxomil/hydrochlorothiazide can enhance their blood-sugar-increasing effect.
• Methyldopa, a medicine used to treat high blood pressure.
• Medicines such as noradrenaline, used to increase blood pressure and slow heart rate.
• Diphemanil, used to treat a slow heartbeat or reduce sweating.
• Medicines such as probenecid, sulfinpyrazone and allopurinol, used to treat gout.
• Calcium supplements.
• Amantadine, an anti-viral drug.
• Ciclosporin, a medicine used to stop rejection of organ transplants.
• Certain antibiotics called tetracyclines or sparfloxacin.
• Amphotericin, a medicine used to treat fungal infections.
• Certain antacids, used to treat too much stomach acid, such as aluminium magnesium hydroxide, as the effect of Olmesartan medoxomil/hydrochlorothiazide can be slightly decreased.
• Cisapride, used to increase food movement in the stomach and gut.
• Halofantrine, used for malaria.

Olmesartan medoxomil/hydrochlorothiazide can be taken with or without food.

Take care when drinking alcohol while you are taking Olmesartan medoxomil/hydrochlorothiazide, as some people feel faint or dizzy. If this happens to you, do not drink any alcohol, including wine, beer or alcopops.

As with other similar drugs the blood pressure lowering effect of Olmesartan medoxomil/hydrochlorothiazide is somewhat less in black patients.

Pregnancy

You must tell your doctor if you think you are (or might become) pregnant. Your doctor will normally advise you to stop taking Olmesartan medoxomil/hydrochlorothiazide before you become pregnant or as soon as you know you are pregnant and will advise you to take another medicine instead of Olmesartan medoxomil/hydrochlorothiazide. Olmesartan medoxomil/hydrochlorothiazide 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 it is used after the third month of pregnancy.

Breast-feeding

Tell your doctor if you are breast-feeding or about to start breast-feeding. Olmesartan medoxomil/hydrochlorothiazide is not recommended for mothers who are breast-feeding, and your doctor may choose another treatment for you if you wish to breast-feed.

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.

You may feel sleepy or dizzy while being treated for your high blood pressure. If this happens, do not drive or use machines until the symptoms wear off. Ask your doctor for advice.

This medicine contains lactose (a type of sugar). If you have been told by your doctor that you have an intolerance to some sugars, contact your doctor before taking this medicinal product.

If you take more tablets than you should, or if a child accidentally swallows one or more, go to your doctor or nearest accident and emergency department immediately and take your medicine pack with you.

If you forget to take a dose, take your normal dose on the following day as usual. Do not take a double dose to make up for a forgotten dose.

It is important to continue to take Olmesartan medoxomil/hydrochlorothiazide unless your doctor tells you to stop.

If these side effects occur, they are often mild and you do not need to stop your treatment.

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

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

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

Fluttering of the heartbeat (palpitations), rash, eczema, vertigo, cough, indigestion, abdominal pain, nausea, vomiting, diarrhoea, muscle cramps and muscular pain, pain in joints, arms and legs, back pain, erection difficulties in men, blood in urine.

Some changes in blood test results have also been seen uncommonly and include:

Rise in blood fat levels, rise in blood urea or uric acid, rise in creatinine, rise or decrease in blood potassium levels, rise in blood calcium levels, rise in blood sugar, increase in levels of liver function. Your doctor will know about these from a blood test and will tell you if you need to do anything.

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

Feeling unwell, disturbances in consciousness, skin lumps (wheals), acute kidney failure.

Some changes in blood test results have also been seen in rare cases and include:

Rise in blood urea nitrogen, decrease in haemoglobin and haematocrit values. Your doctor will know about these from a blood test and will tell you if you need to do anything.

Olmesartan medoxomil:

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

Bronchitis, cough, runny or stuffy nose, sore throat, abdominal pain, indigestion, diarrhoea, nausea, gastroenteritis, pain in the joints or bones, back pain, blood in urine, urinary tract infection, flu-like symptoms, pain.

Some changes in blood test results have also been seen commonly and include:

Rise in blood fat levels, rise in blood urea or uric acid, increase in levels of liver and muscle function.

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

Quick allergic reactions that may affect the whole body and may cause breathing problems as well as a rapid fall of blood pressure that may even lead to fainting (anaphylactic reactions), swelling of the face, angina (pain or uncomfortable feeling in the chest; known as angina pectoris), feeling unwell, allergic skin rash, itching, exanthema (skin eruption), skin lumps (wheals).

Some changes in blood test results have also been seen uncommonly and include:

Reduced numbers of a type of blood cell, known as platelets (thrombocytopenia).

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

Impaired kidney function, lack of energy.

Some changes in blood test results have also been seen rarely and include:

Increase in blood potassium.

Intestinal angioedema: a swelling in the gut presenting with symptoms like abdominal pain, nausea, vomiting and diarrhea.

Hydrochlorothiazide:

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

Changes in blood results including: Increase in blood fat and uric acid levels.

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

Feeling confused, abdominal pain, stomach upset, bloated feeling, diarrhoea, nausea, vomiting, constipation, excretion of glucose into the urine.

Some changes in blood results have also been seen and include:

Increase in blood creatinine, urea, calcium and sugar levels, decrease in blood chloride, potassium, magnesium and sodium levels. Increase of serum amylase (hyperamylasaemia).

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

Decreased or loss of appetite, severe difficulty breathing, anaphylactic skin reactions (hypersensitivity reactions), worsening of pre-existing myopia, erythema, skin reactions to light, itching, purplish spots or patches on the skin due to small haemorrhages (purpura), skin lumps (wheals).

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

Swollen and sore salivary glands, decreased number of white blood cells, decreased number of blood platelets, anaemia, bone marrow damage, restlessness, feeling ‘down’ or depressed, problems sleeping, feeling un-interested (apathy), tingling and numbness, fits (convulsions), objects you look at appearing yellow, blurred vision, dry eyes, irregular heartbeat, inflammation of the blood vessels, blood clots (thrombosis or embolism), inflammation of the lung, fluid accumulation in the lungs, inflammation of the pancreas, jaundice, infection in the gall bladder, symptoms of lupus erythematosus such as rash, joint pains and cold hands and fingers, allergic skin reactions, peeling and blistering of the skin, non-infectious inflammation of the kidney (interstitial nephritis), fever, muscle weakness (sometimes causing impaired movement).

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

Electrolyte disturbance leading to an abnormally depleted level of chloride in the blood (hypochloraemic alkalosis), blockage in the gut (paralytic ileus).

Acute respiratory distress (signs include severe shortness of breath, fever, weakness, and confusion).

Not known (frequency cannot be estimated from the available data):

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

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

If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via the Yellow Card Scheme at http://www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store. By reporting side effects you can help provide more information on the safety of this medicine.

The active substances are:

Olmesartan medoxomil/hydrochlorothiazide 20 mg/12.5 mg: Each film-coated tablet contains 20 mg olmesartan medoxomil and 12.5 mg hydrochlorothiazide.

Olmesartan medoxomil/hydrochlorothiazide 20 mg/25 mg: Each film-coated tablet contains 20 mg olmesartan medoxomil and 25 mg hydrochlorothiazide.

The other ingredients are:

Lactose monohydrate*, cellulose, microcrystalline, low substituted hydroxypropyl cellulose, hydroxypropyl cellulose, stearic acid, hypromellose 2910 (E464), talc (E553b), titanium dioxide (E171), iron oxide yellow (E172) and iron oxide red (E172).

* See ‘Olmesartan medoxomil/hydrochlorothiazide contains lactose’ section above

Olmesartan medoxomil/hydrochlorothiazide 20/12.5 mg: Light orange, round, film-coated, biconvex tablets, debossed with “MO” on one side, and “8” on other side.

Olmesartan medoxomil/hydrochlorothiazide 20/25 mg: Pink, round, film-coated, biconvex tablets, debossed with “MO” on one side, and “12” on other side.

They are available in packs of 10, 14, 28, 30, 56, 84, 90, 98 and 10 x 28 film-coated tablets and in packs with perforated unit dose blisters of 10, 28, 50 and 500 film-coated tablets.

Not all pack sizes may be marketed.