Nebilet 5mg Tablets

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

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

• if you are allergic to nebivolol or any of the other ingredients of this medicine (listed in section 6).
• if you have one or more of the following disorders:
  • low blood pressure
  • serious circulation problems in the arms or legs
  • very slow heartbeat (less than 60 beats per minute)
  • certain other serious heart rhythm problems (e.g. 2^nd and 3^rd degree atrioventricular block, heart conduction disorders).
  • heart failure, which has just occurred or which has recently become worse, or you are receiving treatment for circulatory shock due to acute heart failure by intravenous drip feed to help your heart work
  • asthma or wheezing (now or in the past)
  • untreated phaeochromocytoma, a tumour located on top of the kidneys (in the adrenal glands)
  • liver function disorder
  • a metabolic disorder (metabolic acidosis), for example, diabetic ketoacidosis.

Talk to your doctor or pharmacist before taking Nebilet.

Inform your doctor if you have or develop one of the following problems:

• abnormally slow heartbeat
• a type of chest pain due to spontaneously occurring heart cramp called Prinzmetal angina
• untreated chronic heart failure
• 1^st degree heart block (a kind of light heart conduction disorder that affects heart rhythm)
• poor circulation in the arms or legs, e.g. Raynaud’s disease or syndrome, cramp-like pains when walking
• prolonged breathing problems
• diabetes: This medicine has no effect on blood sugar, but it could conceal the warning signs of a low sugar level (e.g. palpitations, fast heartbeat) and could increase the risk of severe hypoglycaemia when used with certain type of antidiabetic drugs called sulfonylureas (e.g. gliquidone, gliclazide, glibenclamide, glipizide, glimepiride or tolbutamide).
• overactive thyroid gland: This medicine may mask the signs of an abnormally fast heart rate due to this condition
• allergy: This medicine may intensify your reaction to pollen or other substances you are allergic to
• psoriasis (a skin disease - scaly pink patches) or if you have ever had psoriasis
• if you have to have surgery, always inform your anaesthetist that you are on Nebilet before being anaesthetised.

If you have serious kidney problems do not take Nebilet for heart failure and tell your doctor.

You will be regularly monitored at the beginning of your treatment for chronic heart failure by an experienced physician (see section 3).

This treatment should not be stopped abruptly unless clearly indicated and evaluated by your doctor (see section 3).

Because of the lack of data on the use of the product in children and adolescents, Nebilet is not recommended for use in them.

Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines.

Always tell your doctor if you are using or receiving any of the following medicines in addition to Nebilet:

• Medicines for controlling the blood pressure or medicines for heart problems (such as amiodarone, amlodipine, cibenzoline, clonidine, digoxin, diltiazem, disopyramide, felodipine, flecainide, guanfacin, hydroquinidine, lacidipine, lidocaine, methyldopa, mexiletine, moxonidine, nicardipine, nifedipine, nimodipine, nitrendipine, propafenone, quinidine, rilmenidine, verapamil).
• Sedatives and therapies for psychosis (a mental illness) e.g. barbiturates (also used for epilepsy), phenothiazine (also used for vomiting and nausea) and thioridazine.
• Medicines for depression e.g. amitriptyline, paroxetine, fluoxetine.
• Medicines used for anaesthesia during an operation.
• Medicines for asthma, blocked nose or certain eye disorders such as glaucoma (increased pressure in the eye) or dilation (widening) of the pupil.
• Baclofen (an antispasmodic drug); Amifostine (a protective medicine used during cancer treatment)
• Medicines for diabetes such as insulin or oral antidiabetic drugs

All these drugs as well as nebivolol may influence the blood pressure and/or heart function.

• Medicines for treating excessive stomach acid or ulcers (antacid drug): you should take Nebilet during a meal and the antacid drug between meals.

Please refer to section 3.

Beta-blockers, including nebivolol, can affect pregnancy and may harm the unborn baby. They can reduce blood flow to the placenta, which may lead to slower growth, miscarriage, premature birth or death of the foetus during pregnancy. Nebilet should not be used during pregnancy, unless clearly necessary.

If nebivolol is required during pregnancy, close monitoring is required. After birth, your baby needs to be monitored for signs of low blood sugar (hypoglycaemia) and slow heart rate (bradycardia), which can occur within the first three days of life.

Mothers receiving Nebilet should not breastfeed.

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.

This medicine may cause dizziness or fatigue. If affected, do not drive or operate machinery.

This product contains lactose. If you have been told by your doctor that you have an intolerance to some sugars, contact your doctor before taking this medicine.

This medicine contains less than 1 mmol sodium (23 mg) per tablet, that is to say essentially ‘sodium-free’.

• The usual dose is 1 tablet per day. The dose should be taken preferably at the same time of the day.
• Elderly patients and patients with a kidney disorder will usually start with ½ (half) tablet daily.
• The therapeutic effect on blood pressure becomes evident after 1-2 weeks of treatment. Occasionally, the optimal effect is reached only after 4 weeks.

• Your treatment will be started and closely supervised by an experienced physician.
• Your doctor will start your treatment with ¼ (quarter) tablet per day. This may be increased after 1-2 weeks to ½ (half) tablet per day, then to 1 tablet per day and then to 2 tablets per day until the correct dose is reached for you. Your doctor will prescribe the dose that is right for you at each step and you should closely follow his/her instructions.
• The maximum recommended dose is 2 tablets (10mg) a day.
• You will need to be under the close supervision for 2 hours by an experienced physician when you start treatment and every time your dose is increased
• Your doctor may reduce your dose if necessary
• You should not stop treatment abruptly as this can make your heart failure worse.
• Patients with serious kidney problems should not take this medicine.
• Take your medicine once daily, preferably at about the same time of day.

If you have been told by your doctor to take ¼ (quarter) or ½ (half) tablet daily, please refer to the instructions below on how to break Nebilet 5 mg cross-scored tablets.

• Place the tablets onto a flat, hard surface (e.g. a table or worktop), with the cross score facing up.
• Break the tablet by pushing it with the index fingers of both hands placed along one breakmark (Diagrams 1 and 2).
• Tablet quarters are obtained by breaking the halves in the same way (Diagrams 3 and 4).

• Your doctor may decide to combine Nebilet tablets with other medicines to treat your condition.
• Do not use in children or adolescents.

If you accidentally take an overdose of this medicine, tell your doctor or pharmacist immediately. The most frequent symptoms and signs of a Nebilet overdose are very slow heart beat (bradycardia), low blood pressure with possible fainting (hypotension), breathlessness such as in asthma (bronchospasm), and acute heart failure.

You can take activated charcoal (which is available at your pharmacy) while you wait for the arrival of the doctor.

If you forget a dose of Nebilet, but remember a little later on that you should have taken it, take that day’s dose as usual. However, if a long delay has occurred (e.g. several hours), so that the next due dose is near, skip the forgotten dose and take the next, scheduled, normal dose at the usual time. Do not take a double dose. Repeated skipping, however, should be avoided.

You should always consult with your doctor before stopping Nebilet treatment, whether you are taking it for high blood pressure or chronic heart failure.

You should not stop Nebilet treatment abruptly as this can temporarily make your heart failure worse. If it is necessary to stop Nebilet treatment for chronic heart failure, the daily dose should be decreased gradually, by halving the dose, at weekly intervals.

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 Yellow Card Scheme. Website: www.mhra.gov.uk/yellowcard. By reporting side effects you can help provide more information on the safety of this medicine.

• The active substance is nebivolol. Each tablet contains 5 mg nebivolol (as nebivolol hydrochloride): 2.5 mg of d-nebivolol and 2.5 mg of l-nebivolol.
• The other ingredients are: lactose monohydrate, polysorbate 80 (E433), hypromellose (E464), maize starch, croscarmellose sodium (E468), microcrystalline cellulose (E460), silica colloidal anhydrous (E551), magnesium stearate (E470b).

Nebilet is available as white, round, cross-scored tablets in packs of 7, 14, 28, 30, 50, 56, 90, 100, 500 tablets. Tablets are provided in blister packs (PVC/aluminium blister).

(Not all pack sizes may be marketed)

Marketing Authorisation Holder

Manufacturer

Or

Or

Marketed by

A. Menarini Farmaceutica Internazionale SRL

This medicine is authorised in the Member States of the European Economic Area and in the United Kingdom (Northern Ireland)under the following names:

Austria: Nomexor

Greece: Hypoloc

Ireland: Nebilet

Italy: Lobivon

Spain: Silostar

The Netherlands: Hypoloc

United Kingdom (Northern Ireland): Nebilet