Angeliq Film-Coated Tablets
S0580-RM-PIL-17.06.2016 (PAGE 1 OF 3)
PATIENT INFORMATION LEAFLET
Angeliq® film-coated tablets
(estradiol + drospirenone)
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 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. This includes any possible side effects not listed in this leaflet. See section 4.
What is in this leaflet
1. What Angeliq is and what it is used for
2. What you need to know before you take Angeliq
Medical history and regular check-ups Do not take Angeliq Warnings and precautions HRT and cancer
Effects of HRT on your heart or circulation
Other conditions
Other medicines and Angeliq
Laboratory tests
Pregnancy and breast-feeding
Driving or using machines
Angeliq contains lactose
3. How to take Angeliq About the pack
When to start
If you take more Angeliq than you should If you forget to take Angeliq If you stop taking Angeliq If you need to have surgery
4. Possible side effects
5. How to store Angeliq
6. Contents of the pack and other information
1. WHAT ANGELIQ IS AND WHAT IT IS USED FOR
Angeliq is a Hormone Replacement Therapy (HRT). It contains two types of female hormone, an oestrogen and a progestogen. Angeliq is used in postmenopausal women with at least 12 months (1 year) since their last natural period.
What Angeliq is used for
Relief of symptoms occurring after menopause
During the menopause, the amount of the oestrogen produced by a woman's body drops. This can cause symptoms such as hot face, neck and chest (“hot flushes”). Angeliq alleviates these symptoms after menopause. You will only be prescribed Angeliq if your symptoms seriously hinder your daily life.
Prevention of osteoporosis
After the menopause, some women may develop fragile bones (osteoporosis). You should discuss all available options with your doctor.
If you are at an increased risk of fractures due to osteoporosis and other medicines are not suitable for you, you can use Angeliq to prevent osteoporosis after menopause.
2. WHAT YOU NEED TO KNOW BEFORE YOU TAKE ANGELIQ
Medical history and regular check-ups
The use of HRT carries risks which need to be considered when deciding whether to start taking it, or whether to carry on taking it.
The experience in treating women with a premature menopause (due to ovarian failure or surgery) is limited. If you have a premature menopause the risks of using HRT may be different. Please talk to your doctor.
Before you start (or restart) HRT, your doctor will ask about your own and your family's medical history. Your doctor may decide to perform a physical examination. This may include an examination of your breasts and/or an internal examination, if necessary.
Once you have started on Angeliq, you should see your doctor for regular check-ups (at least once a year). At these check-ups, discuss with your doctor the benefits and risks of continuing with Angeliq.
Be sure to:
> go for regular breast screening and cervical smear tests.
> regularly check your breasts for any changes such as dimpling of the skin, changes in the nipple, or any lumps you can see or feel.
Do not take Angeliq
if any of the following applies to you. If you are not sure about any of the points below, talk to your doctor before taking Angeliq.
Do not take Angeliq
• if you have or have ever had breast cancer, or if you are suspected of having it
• if you have cancer which is sensitive to oestrogens, such as cancer of the womb lining (endometrium) or if you are suspected of having it
• if you have any unexplained vaginal bleeding
• if you have excessive thickening of the womb lining (endometrial hyperplasia) that is not being treated
• if you have or have ever had a blood clot in a vein (thrombosis) such as in the legs (deep venous thrombosis) or the lungs (pulmonary embolism)
• if you have a blood clotting disorder (such as protein C, protein S, or antithrombin deficiency)
• If you have or recently have had a disease caused by blood clots in the arteries, such as a heart attack, stroke or angina
• if you have or have ever had a liver disease and your liver function tests have not yet returned to normal
• if you have a rare blood problem called “Porphyria” which is passed down in families (inherited)
• if you have severe kidney disease or acute kidney failure
• if you are allergic (hypersensitive) to oestrogens, progestogens or any of the other ingredients of Angeliq (listed in section 6)
• if you have any reason to believe that you either are, or may be, pregnant, or if you are producing milk (lactating) and breast-feeding. (See also the 'Pregnancy and breast-feeding' section of this leaflet)
> If any of the above conditions appear for the first time while taking Angeliq, stop taking it at once and consult your doctor immediately.
Warnings and precautions
Talk to your doctor or pharmacist before taking Angeliq. Tell your doctor if you have ever had any of the following problems, before you start the treatment, as these may return or become worse during treatment with Angeliq. If so, you should see your doctor more often for check-ups:
• fibroids inside your womb
• growth of womb lining outside your womb (endometriosis) or a history of excessive growth of the womb lining (endometrial hyperplasia)
• increased risk of developing blood clots (see "Blood clots in a vein (thrombosis)")
• increased risk of getting an oestrogen-sensitive cancer (such as a mother, sister or grandmother who has had breast cancer)
• high blood pressure
• a liver disorder, such as benign liver tumour
• diabetes
• gallstones
• migraine or severe headaches
• a disease of the immune system that affects many organs of the body (systemic lupus erythematosus, SLE)
• epilepsy
• asthma
• a disease affecting the eardrum and hearing (otosclerosis)
• a very high level of fat in your blood (triglycerides)
• fluid retention due to cardiac or kidney problems
Stop taking Angeliq and see a doctor immediately
If you notice any of the following when taking HRT:
• any of the conditions mentioned in the ‘DO NOT take Angeliq' section
• yellowing of your skin or the whites of your eyes (jaundice). These may be signs of a liver disease
• a large rise in your blood pressure (symptoms may be headache, tiredness, dizziness)
• migraine-like headaches which happen for the first time
• if you become pregnant
• if you notice signs of a blood clot, such as
- painful swelling and redness of the legs
- sudden chest pain
- difficulty breathing
For more information see ‘Blood clots in a vein (thrombosis)'
Note: Angeliq is not a contraceptive. If it is less than 12 months since your last menstrual period or you are under 50 years old, you may still need to use additional contraception to prevent pregnancy. Speak to your doctor for advice.
HRT and cancer
Excessive thickening of the lining of the womb (endometrial hyperplasia) and cancer of the lining of the womb (endometrial cancer)
Taking oestrogen-only HRT will increase the risk of excessive thickening of the lining of the womb (endometrial hyperplasia) and cancer of the lining of the womb (endometrial cancer).
The progestogen in Angeliq protects you from this extra risk.
Irregular bleeding
You may have irregular bleeding or drops of blood (spotting) during the first 3-6 months of taking Angeliq. However, if the irregular bleeding:
• carries on for more than the first 6 months
• starts after you have been taking Angeliq for more than 6 months
• carries on after you have stopped taking Angeliq > See your doctor as soon as possible.
Breast cancer
Women who have breast cancer, or have had breast cancer in the past, should not take HRT.
Evidence suggests that taking combined oestrogen-progestogen and possibly also oestrogen-only HRT increases the risk of breast cancer. The extra risk depends on how long you take HRT. The additional risk becomes clear within a few years. However, it returns to normal within a few years (at most 5) after stopping treatment.
Your risk of breast cancer is also higher:
• if you have a close relative (mother, sister or grandmother) who has had breast cancer
• if you are seriously overweight
Compare
Looking at women aged 50 to 79 who are not taking HRT, on
average, 9 to 17 in 1000 will be diagnosed with breast cancer over a 5-year period.
For women aged 50 to 79 who are taking oestrogen-progestogen HRT over 5 years, there will be 13 to 23 cases in 1000 users (i.e. an extra 4 to 6 cases).
Regularly check your breasts. See your doctor, if you notice any changes in your breast, such as:
• dimpling or sinking of the skin
• changes in the nipple
• any lumps you can see or feel
Additionally, you are advised to join mammography screening programs when offered to you. For mammogram screening, it is important that you inform the nurse/healthcare professional who is actually taking the x-ray that you use HRT, as this medication may increase the density of your breasts which may affect the outcome of the mammogram. Where the density of the breast is increased, mammography may not detect all lumps.
Ovarian cancer
Ovarian cancer (cancer of the ovaries) is rare. It can be difficult to diagnose, because there are often no obvious signs of the disease. A slightly increased risk of ovarian cancer has been reported in women taking HRT for at least 5 to 10 years.
Women aged 50 to 69 who are not taking HRT, on average about 2 women in 1000 will be diagnosed with ovarian cancer over a 5-year period. For women who have been taking HRT for 5 years, there will be between 2 and 3 cases per 1000 users (i.e. up to 1 extra case).
Effects of HRT on your heart or circulation Blood clots in a vein (thrombosis)
The risk of blood clots in the veins (also called deep vein thrombosis, or DVT) is about 1.3 to 3-times higher in HRT users than non-users, especially during the first year of taking it.
Blood clots can be serious if one travels to the lungs it can cause chest pain, breathlessness, fainting or even death. This condition is called pulmonary embolism or PE.
DVT and PE are examples of a condition called venous thromboembolism, or VTE.
You are more likely to get a blood clot in your veins as you get older and if any of the following applies to you. Inform your doctor if any of these situations apply to you:
• you are unable to walk for a long time because of major surgery, injury or illness (see also sections 3, If you need to have surgery)
• you are seriously overweight (BMI >30kg/m2)
• you have any blood clotting problem that needs long-term treatment with a medicine used to prevent blood clots such as warfarin
• if any of your close relatives has ever had a blood clot in the leg, lung or another organ
• you have had one or more miscarriages
• you have systemic lupus erythematosus (SLE)
• you have cancer
For signs of a blood clot, see “Stop taking Angeliq and see a doctor immediately”.
Compare
Looking at women in their 50s who are not taking HRT, on average, over a 5-year period, 4 to 7 in 1000 would be expected to get a blood clot in a vein.
For women in their 50s who are taking oestrogen-progestogen HRT, for over 5 years, there will be 9 - 12 cases in 1000 (i.e. an extra 5 cases)._
Heart disease (heart attack)
There is no evidence that HRT will prevent a heart attack.
HRT is not recommended for women who have heart disease, or have had heart disease recently. If you have ever had heart disease, talk to your doctor to see if you should be taking HRT.
Women over the age of 60 years who use oestrogen-progestogen HRT are slightly more likely to develop heart disease than those not taking any HRT.
Studies with one type of HRT (containing conjugated oestrogen plus the progestogen MPA) have shown that women may be slightly more likely to get heart disease during the first year of taking the medication. For other types of HRT, the risk is likely to be similar, although this is not yet certain._
If you get:
• a pain in your chest that spreads to your arm or neck
> See a doctor as soon as possible and do not take any more
HRT until your doctor says you can. This pain could be a sign of heart disease.
Stroke
The risk of getting a stroke is about 1.5-times higher in HRT users than in non-users. The number of extra cases of stroke due to HRT use will increase with age.
Other things that can increase the risk of stroke include:
• getting older
• high blood pressure
• smoking
• drinking too much alcohol
• an irregular heartbeat
If you are worried about any of these things, or if you have had a stroke in the past, talk to your doctor to see if you should take HRT.
Compare
Looking at women in their 50s who are not taking HRT, on average, 8 in 1000 would be expected to have a stroke over a 5-year period.
For women in their 50s who are taking HRT, there will be 11 cases in 1000 users, over 5 years (i.e. an extra 3 cases)._
If you get:
• unexplained migraine-type headaches, with or without disturbed vision.
• weakness, numbness, or paralysis of the face, arm, or leg
• dizziness, loss of balance or coordination
> See a doctor as soon as possible and do not take any more
HRT until your doctor says you can. These headaches may be an early warning sign of a stroke.
Other conditions
• HRT will not prevent memory loss. There is some evidence of a higher risk of memory loss in women who start using HRT after the age of 65. Speak to your doctor for advice.
• If you have heart or kidney problems, your doctor should examine you carefully as oestrogens may cause fluid retention resulting in swelling.
• If you have pre-existing elevated triglycerides (a type of blood fat) your doctor should monitor you closely during oestrogen replacement therapy or HRT. Rare cases of large increases of plasma triglycerides (hypertriglyceridemia) leading to inflammation of the pancreas (pancreatitis) have been reported with oestrogen replacement therapy.
• If you have a kidney disorder and have high serum potassium levels, particularly if you are taking ACE inhibitors, angiotensin II antagonists and non-steroidal anti-inflammatory agents, your doctor may check the potassium levels in your blood during the first month of treatment.
• If you have high blood pressure, treatment with Angeliq may decrease it. Angeliq should not be used to treat high blood pressure.
• If you have a tendency to develop blotchy brown patches (chloasma) on the face you should avoid exposure to the sun or ultraviolet light whilst using Angeliq.
Other medicines and Angeliq
Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines. Some medicines may interfere with the effect of Angeliq. This might lead to irregular bleeding. This applies to the following medicines.
• medicines for epilepsy (such as. phenobarbital, phenytoin, carbamazepine)
• medicines for tuberculosis (such as rifampicin, rifabutin)
• medicines for HIV infection (such as nevirapine, efavirenz, nelfinavir and ritonavir) and Hepatitis C Virus infections
• medicines for inflammation or pain (such as aspirin and other non-steriodal anti-inflammatory drugs (NSAIDS)
• medicines for certain types of heart disease or high blood pressure (ACE inhibitors or angiotensin II receptor antagonists, verapamil, diltiazem). If you are having treatment for high blood pressure and take Angeliq there may be an additional decrease in blood pressure.
• Herbal remedies containing St. John’s wort (Hypericum perforatum)
• medicines for treatment of fungal infections (such as itraconazole, voriconazole, fluconazole)
• medicines for treatment of bacterial infections (such as clarithromycin, erythromycin)
• grapefruit juice
> Please tell your doctor or pharmacist if you are taking or have recently taken any other medicines including medicines obtained without a prescription, herbal medicines or other natural products.
Laboratory tests
If you need a blood test, tell your doctor or the laboratory staff that you are taking Angeliq, because this medicine can affect the results of some tests.
Pregnancy and breast-feeding Angeliq is for use in post-menopausal women.
If you become pregnant, stop taking Angeliq immediately and contact your doctor.
Driving or using machines
There is nothing to suggest that the use of Angeliq affects driving or use of machines.
Angeliq contains lactose
Angeliq contains lactose (a type of sugar). If you have intolerance to some sugars, check with your doctor before taking Angeliq.
3. HOW TO TAKE ANGELIQ
Do not start taking Angeliq until at least 12 months after your last natural period.
About the pack
This pack is designed to help you remember to take your medicine. Each tablet is placed in a section marked with the day of the week on which it should be taken. The arrows between tablets show the order in which they must be taken. Your doctor may tell you when to start (see "when to start" for further information).
On the day you start, take your first tablet from the top row of tablets marked with the correct day. For instance, if you start on a Tuesday, press out the tablet from the blister marked 'Ma'.
The translation for the days of the week are as below:
|
Lu |
= Mon |
|
Ma |
= Tue |
|
Mi |
= Wed |
|
Jo |
= Thu |
|
Vi |
= Fri |
|
Sb |
= Sat |
|
Du |
= Sun |
Take one tablet each day, following the directions of the arrows, until you have finished all 28 tablets in the pack. When you have finished each memo strip, start the next memo strip on the following day. Do not leave a break between memo strips.
It is best to take your tablet at the same time each day. You can take Angeliq with or without food. The tablet should be swallowed whole with a glass of water or milk.
When to start
If you have been taking other HRT preparations: carry on until you have finished your current pack and have taken all the tablets for that month. Take your first Angeliq tablet the next day. Do not leave a break between your old tablets and the Angeliq tablets.
If this is your first HRT treatment: you can start your Angeliq tablets any day.
If you take more Angeliq than you should
If you have taken too many Angeliq tablets by mistake, you may feel sick, vomit or have some menstruation-like bleeding. No specific treatment is necessary but you should consult your doctor or pharmacist if you are worried.
If you forget to take Angeliq
If you forget to take a tablet at your usual time and you are less than 24 hours late, take it as soon as possible. Take the next tablet at the usual time.
If you are more than 24 hours late, leave the forgotten tablet in the pack. Continue to take the rest of the tablets at the usual time every day.
If you forget to take your tablet for several days you may experience irregular bleeding.
If you stop taking Angeliq
You may begin to feel the usual symptoms of the menopause again, which may include hot flushes, trouble sleeping, nervousness, dizziness or vaginal dryness. Consult your doctor or pharmacist if you want to stop taking Angeliq tablets. If you have any further questions on the use of this medicine, ask your doctor or pharmacist.
If you need to have surgery
If you are going to have surgery, tell the surgeon that you are taking Angeliq. You may need to stop taking Angeliq about 4 to 6 weeks before the operation to reduce the risk of a blood clot (see section 2, “Blood clots in a vein (thrombosis)”). Ask your doctor when you can start taking Angeliq again.
4. POSSIBLE SIDE EFFECTS
Like all medicines, Angeliq can cause side effects, although not everybody gets them.
If any of the side effects gets serious, or if you notice any side effects not listed in this booklet, please tell your doctor or pharmacist. The following diseases are reported more often in women using HRT compared to women not using HRT:
Serious side effects
• breast cancer
• abnormal growth or cancer of the lining of the womb (endometrial hyperplasia or cancer)
• ovarian cancer
• blood clots in the veins of the leg or the lungs (venous thromboembolism)
• heart disease
• stroke
• probable memory loss if HRT is started over the age of 65
For more information about these side effects see Section 2.
The following is a list of side effects that have been linked to the use of Angeliq:
Most frequent side effects:
• breakthrough bleeding at unexpected times (see also section 2 "HRT and cancer/ Excessive thickening of the lining of the womb (endometrial hyperplasia) and cancer of the lining of the womb (endometrial cancer)")
• breast tenderness
• breast pains
These side effects occur during the first few months of treatment with Angeliq. They are usually temporary and normally disappear with continued treatment. If they do not, contact your doctor.
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Common side effects (affecting between 1 and 10 in every 100 patients):
• depression, mood changes, nervousness
• headache
• stomach ache, nausea, stomach enlargement
• non-cancerous breast tumour (benign breast neoplasm), swollen breasts
• increase in size of uterine fibroids
• non-cancerous growth of cells at the neck of the wom b (benign cervical growth)
• irregularities in your menstrual period
• vaginal discharge
• loss of energy, localised swelling.
Uncommon side effects (affecting between 1 and 10 in every 1000 patients):
• weight increase or decrease, loss or increase of appetite for food, increase blood fats
• sleep problems, anxiety, decrease in sex drive
• burning or pricking sensation, decreased concentration, dizziness
• eye problems, visual disturbances (such as dry eyes or blurred vision)
• palpitations
• blood clot, venous thrombosis (leg pain), high blood pressure, migraine, inflammation of the veins, varicose veins
• breathlessness
• stomach disorder, diarrhoea, constipation, vomiting, dry mouth, wind, altered sense of taste
• altered liver enzymes (will show up in blood tests)
• skin problems, acne, hair loss, itchy skin, rash, excessive hair or hair problems
• backache, pains in hands and feet, joint pain, muscle cramps
• urinary tract disorders and infections
• thickening of the lining of the womb, thrush, vaginal dryness and itchiness or burning of the vagina.
• lumpy breast (fibrocystic breast), disorders of the ovaries, cervix and uterus, pelvic pain
• generalised fluid retention, chest pain, feeling generally unwell, increase in sweating
• non-cancerous tumour of the womb (benign uterine neoplasm)
Rare side effects (affecting between 1 and 10 in every 10,000 patients):
• anaemia
• giddiness (vertigo)
• ringing in the ears (tinnitus)
• gall stones (cholelithiasis)
• muscle pain (myalgia)
• inflammation of the fallopian tubes (salpingitis)
• milky discharge from the nipples (galactorrhoea)
• chills
The following side effects have occurred in clinical trials of women with high blood pressure:
• high potassium levels (hyperkalaemia)
• heart failure, enlargement of the heart, heart flutter, effects on heart rhythm
• increase in blood aldosterone
The following side effects have been reported with other HRTs:
• gall bladder disease
• various skin disorders:
• discoloration of the skin especially of the face or neck known as “pregnancy patches” (chloasma)
• painful reddish skin nodules (erythema nodosum)
• rash with target-shaped reddening or sores (erythema multiforme)
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.
Reporting of side effects
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: 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 ANGELIQ
• Keep out of the sight and reach of children.
• Do not take Angeliq after the expiry date which is printed on the pack after "EXP". The expiry date refers to the last day of that month.
• There are no special storage instructions.
• Medicines should not be disposed of via wastewater or household waste. Ask your pharmacist how to dispose medicines no longer required. These measures will help to protect the environment.
• If the tablets become discoloured or show any signs of deterioration, you should seek the advice of your pharmacist.
6. CONTENTS OF THE PACK AND OTHER INFORMATION What Angeliq contains
The active substances are estradiol and drospirenone.
Each film-coated tablet contains 1 mg estradiol (as estradiol hemihydrate) and 2 mg drospirenone.
The other ingredients are:
Tablet core: lactose monohydrate, maize starch, modified starch, povidone 25000, magnesium stearate;
Tablet film: hypromellose, macrogol 6000, talc, titanium dioxide (E171) and red ferric oxide (E172).
What Angeliq looks like and contents of the pack
Medium red, round tablets with convex faces, one side embossed with the letters “DL” in a regular hexagon and plain on the other side.
They are available in calendar blister packs of 1 or 3 blisters each with 28 tablets.
Manufacturer
Bayer Pharma AG
Mullerstrape 178, 13353 Berlin, Germany
Procured from within the EU and repackaged by: Amimed Direct Ltd, Hendon London, NW9 6AQ.
Product Licence holder: Sam Pharma Ltd, Unit 20 Garrick Industrial Estate, Irving Way, Hendon, London, NW9 6AQ.
POM
PL 33902/0580
Leaflet revision date: 17/06/2016
Angeliq® is a registered trademark of Bayer Intellectual Property GmbH.
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