Adalat Retard 20mg
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ADALAT® RETARD 20MG
(nifedipine)
Your medicine is available using the name Adalat Retard 20mg but will be referred to as Adalat throughout this leaflet. Other strength '10mg' is also available.
Read all of this leaflet carefully before you start taking this medicine.
■ Keep this leaflet. You may need to read it again.
■ If you have more 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 gets serious, or if you notice any side effects not listed in this leaflet, please tell your doctor or pharmacist.
In this leaflet
1. What Adalat is
2. Before you take Adalat
3. How you take Adalat
4. Possible side effects
5. How to store Adalat
6. Further information
1. What Adalat is
Adalat contains nifedipine, which belongs to a group of medicines called calcium antagonists.
Adalat is used to treat high blood pressure or angina (chest pain).
For high blood pressure: Adalat works by relaxing and expanding the blood vessels. This makes the blood flow more easily and lowers blood pressure. Lower blood pressure reduces the strain on your heart.
For angina: Adalat works by relaxing and expanding the arteries supplying the heart. This allows more blood and oxygen to reach the heart and decreases the strain on it. Your angina attacks will be less severe and less frequent if there is less strain on the heart.
2. Before you take Adalat
Do not take Adalat:
■ If you have had a heart attack within the last month.
■ If you get a sudden angina attack. Adalat will not help relieve symptoms of angina quickly.
■ If you have unstable angina.
■ If you are allergic to the active ingredient (nifedipine), to any other similar medicines (known as dihydropyridines) or to any of the other ingredients. The ingredients of Adalat are listed in section 6.
■ If you are pregnant.
■ If you are breastfeeding. If you need to take Adalat, you should stop breastfeeding before you start to take this medicine.
■ If you are taking rifampicin, an antibiotic.
■ If you have been told that you have a narrowing of the
aortic heart valve (stenosis).
■ If you have ever had a collapse caused by a heart problem (cardiogenic shock), during which you became breathless, pale and had a cold sweat and dry mouth.
■ If your blood pressure continues to rise despite treatment (malignant hypertension).
■ If you have been told to avoid lactose, that you have a hereditary condition called Lapp lactase deficiency or glucose-galactose malabsorption.
Tell your doctor and do not take Adalat if any of these apply to you.
Your doctor will take special care:
■ If you have low blood pressure and you were prescribed Adalat for your angina. Your blood pressure may be decreased further by this treatment.
■ If you have a heart condition where your heart cannot cope with increased strain (poor cardiac reserve).
■ If you are a diabetic. The treatment for your diabetes may need to be adjusted. If you have any questions about this, ask your doctor.
■ If you are on kidney dialysis. If you have a very high blood pressure and a low blood volume, you might experience a sudden drop in blood pressure when you take Adalat.
■ If your liver is not working properly. Your doctor may need to do some blood tests. You may also be given a lower dose of Adalat.
■ Talk to your doctor before you take Adalat if any of these apply to you.
Tell your doctor:
■ If your chest pain (angina) gets worse (comes on more often or more severely) over a matter of hours or days. You may be advised not to take Adalat.
■ If you have chest pains after taking your first dose of Adalat. Your doctor may wish to change your treatment.
■ If you notice increased breathlessness.
■ If you notice swelling of the ankles.
Tell your doctor before you take the next dose if any of these apply to you.
Also tell your doctor:
■ If you are giving a urine sample. Adalat may interfere with the results of certain urine tests.
■ If you are a man who has been unable to father a child by in vitro fertilisation. Drugs like Adalat have been shown to impair sperm function.
Other medicines and Adalat
Tell your doctor about any other medicines that you are taking, or took recently. This includes any products you bought without a prescription.
Some medicines may affect the way Adalat works. Tell your doctor if you are taking:
■ Other medicines to treat high blood pressure.
■ Rifampicin (an antibiotic).
■ Cimetidine (to treat stomach ulcers).
■ Digoxin, diltiazem, quinidine or beta-blockers (to treat heart conditions).
■ Quinupristin/dalfopristin (a combination antibiotic).
■ Phenytoin, carbamazepine or valproic acid (to treat epilepsy).
■ Cisapride (to treat reduced movements of the gullet and stomach).
■ Magnesium sulphate injections during pregnancy (may cause a severe fall in blood pressure).
■ Erythromycin (an antibiotic).
■ Ketoconazole, itraconazole or fluconazole (anti-fungal
medicines).
■ Indinavir, nelfinavir, ritonavir, saquinavir or amprenavir (to treat HIV).
■ Fluoxetine or nefazodone (to treat depression).
■ Tacrolimus (to prevent the rejection of transplanted organs).
■ Phenobarbital (usually used to treat insomnia or anxiety).
Food and drink with Adalat
You can take Adalat either with or without food.
Do not drink grapefruit juice or eat grapefruit while taking Adalat.
Do not start taking Adalat within 3 days of drinking grapefruit juice or eating grapefruit. Tell your doctor if you have had grapefruit or grapefruit juice in this time. Also, do not drink grapefruit juice or eat grapefruit whilst taking Adalat. Grapefruit juice is known to increase the blood levels of the active ingredient, nifedipine. This effect can last for at least 3 days.
Pregnancy and breast-feeding
If you are pregnant, think you might be pregnant or are planning a family, tell your doctor before taking Adalat.
You may be able to use Adalat, but only after special consideration and agreement by your doctor.
Do not take Adalat if you are breast-feeding.
If you need to take Adalat, you should stop breast-feeding before you start taking the tablets.
Driving and using machines
Adalat may make you feel dizzy, faint, extremely tired or have visual disturbances. Do not drive or operate machinery if you are affected in this way.
This may be more likely when you first start treatment, if you change tablets, or if you have drunk alcohol.
3. How to take Adalat
Take the tablets as prescribed by your doctor.
■ To start with, you may be given a lower strength (10mg) tablet called Adalat 10mg. This allows your doctor to monitor how you are responding so that the best long-term dose can be identified.
■ The usual maintenance dose of Adalat (20mg strength) is 1 tablet, every 12 hours (i.e. twice per day), but your doctor may increase or decrease the dose depending on how well your blood pressure or angina is being controlled. The maximum dose is 2 tablets (40mg) every 12 hours.
■ Lower doses may be prescribed for elderly patients.
■ If you have problems with your liver you are likely to be given Adalat 10mg, at least to begin with.
■ Swallow the tablets whole with a little water.
■ Continue to take the tablets for as long as your doctor has told you to.
Do not take them with grapefruit juice.
You can take Adalat either with or without food.
Use in children: Adalat is not recommended for use in children and adolescents below 18 years of age, because there are only limited data on the safety and efficacy in this population.
If you take too many tablets
Get medical help immediately. If possible, take your tablets or the box with you to show the doctor.
Taking too many tablets may cause your blood pressure to become too low and your heartbeats to speed up or slow down. It may also lead to an increase in your blood sugar level or an increase in the acidity of your blood, swelling in the lungs, low blood oxygen levels and disturbances in consciousness, possibly leading to unconsciousness.
If you forget to take the tablets
Take your normal dose immediately and continue taking your tablets as prescribed, waiting 12 hours before taking your next dose.
Do not take a double dose to make up for the missed dose.
4. Possible side effects
Like all medicines, Adalat can have side effects, although not everybody gets them.
Serious side effects
If you notice:
■ Severe, sudden generalised allergic reaction including very rarely life-threatening shock (e.g. difficulty in breathing, drop of blood pressure, fast pulse), swelling (including potentially life-threatening swelling of the airway)
■ other allergic reactions causing swelling under the skin (possibly severe and including swelling of the larynx that may result in a life-threatening outcome)
■ fast heart beat (tachycardia)
■ shortness of breath or difficulty breathing
■ mild to moderate allergic reactions
■ itching (possibly severe), a rash or hives
Contact your doctor immediately and do not take the next dose as these may be the first signs of allergic reaction which may become severe.
If you develop:
■ a skin reaction or blistering/peeling of the skin and/or mucosal reactions (in the mouth/nose or at the penis/vagina) (Toxic Epidermal Necrolysis)
Contact your doctor immediately before you continue treatment as these may be signs of a severe reaction.
Less serious side effects
Apart from the side effects listed above, these are the other side effects of Adalat, starting with the more common ones:
Common side effects
(These may affect up to 1 in 10 people)
■ headache
■ flushing
■ general feeling of being unwell
■ constipation
■ swelling, particularly of the ankles and legs
Uncommon side effects
(These may affect up to 1 in 100 people)
■ stomach pain (abdominal pain)
■ unspecific pain
■ chills
■ low blood pressure when standing up (symptoms include fainting, dizziness, light headedness, occasional palpitations, blurred vision and sometimes confusion)
■ fainting
■ irregular heartbeat (palpitations)
■ dry mouth
■ indigestion or upset stomach
■ wind (flatulence)
■ feeling sick (nausea)
■ muscle cramps
■ joint swelling
■ sleep disorders
■ anxiety or nervousness
■ reddening of the skin
■ nose bleeds
■ nasal congestion
■ sensation of spinning or whirling motion (vertigo)
■ migraine
■ dizziness
■ trembling
■ increase in the need to pass water (urinate)
■ painful or difficult urination
■ inability to achieve or maintain an erection (impotence)
■ blurred vision
■ temporary increase in certain liver enzymes
Rare side effects
(These may affect up to 1 in 1,000 people)
■ pins and needles
■ inflammation of the gums, tender or swollen gums, bleeding gums
Other side effects
(Frequency unknown)
■ vomiting
■ a reduction in the number of white blood cells (leucopenia)
■ a more severe decrease in a specific class of white blood cell (agranulocytosis)
■ increased blood sugar (hyperglycaemia)
■ decreased skin sensitivity (hypoaesthesia)
■ drowsiness (somnolence)
■ eye pain
■ chest pain (angina pectoris)
■ heartburn or indigestion (gastroesophageal sphincter
insufficiency)
■ yellowing of the whites of the eyes or skin (jaundice)
■ sensitivity to light (photosensitivity allergic reaction)
■ small, raised areas of bleeding in the skin (palpable purpura)
■ joint pain
■ muscle pain
All of these symptoms usually go away when treatment with Adalat is stopped.
If you get side effects
Tell your doctor if any side effect gets serious, or if you
get any effects not listed in this leaflet.
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 Yellow Card Scheme at: www.mhra.gov.uk/yellowcard. By reporting side effects, you can help provide more information on the safety of this medicine.
5. How to store Adalat
■ Store in the original container. The tablets should be protected from strong light, so only remove the tablet from the container or blister strip when you are about to take it.
■ KEEP OUT OF THE SIGHT AND REACH OF CHILDREN.
■ Do not use tablets after the expiry date which is marked on both the outer carton and on each blister strip of tablets.
The expiry date refers to the last date of the month.
■ If you find you have tablets after their expiry date, return them to your local pharmacist (chemist) who will dispose of them properly. 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 tablets become discoloured or show any signs of deterioration, you should seek the advice of your pharmacist.
6. Further information
What Adalat contains
Each tablet contains 20mg of the active ingredient nifedipine.
Adalat also contain microcrystalline cellulose, polysorbate 80, hypromellose, lactose, maize starch, macrogol 4000 and magnesium stearate. Titanium dioxide (E171) and red iron oxide (E172) are included as colouring agents.
The active ingredient, nifedipine, is one of a group of medicines called calcium antagonists. These relax and expand blood vessels.
What Adalat looks like and contents of the pack
Adalat are grey-pink, circular film-coated tablets engraved with A/20 on one side and the Bayer symbol on the reverse.
Your medicine comes in blister packs of 56 and 60 tablets.
Manufacturer
Manufactured by: Bayer Pharma AG, Leverkusen, Germany.
Procured from within the EU and repackaged by: Doncaster Pharmaceuticals Group Ltd., Kirk Sandall, Doncaster, DN3 1QR.
Product Licence holder: Landmark Pharma Ltd., 7 Regents Drive, Prudhoe, Northumberland, NE42 6PX.
PL No: 21828/0117 POM
Leaflet revision date: 20.02.14
Adalat® is a registered trademark of Bayer Aktiengesellschaft.
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