Package leaflet: Information for the patient

Atacand 4 mg tablets Atacand 8 mg tablets Atacand 16 mg tablets Atacand 32 mg tablets

candesartan cilexetil

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. This includes any possible side effects not listed in this leaflet.

What is in this leaflet:

1.    What Atacand is and what it is used for

2.    What you need to know before you take Atacand

3.    How to take Atacand

4.    Possible side effects

5.    How to store Atacand

6.    Contents of the pack and other information

1.    What Atacand is and what it is used for

The name of your medicine is Atacand. The active ingredient is candesartan cilexetil. This belongs to a group of medicines called angiotensin II receptor antagonists. It works by making your blood vessels relax and widen. This helps to lower your blood pressure. It also makes it easier for your heart to pump blood to all parts of your body.

Atacand can be used to:

•    treat high blood pressure (hypertension) in adult patients and in children and adolescents aged 6 to <18 years.

•    treat adult heart failure patients with reduced heart muscle function when Angiotensin Converting Enzyme (ACE) inhibitors cannot be used or in addition to ACE-inhibitors when symptoms persist despite treatment and mineralocorticoid receptor antagonists (MRA) cannot be used (ACE-inhibitors and MRAs are medicines used to treat heart failure).

2.    What you need to know before you take Atacand Do not take Atacand:

•    if you are allergic to candesartan cilexetil or any of the other ingredients of this medicine (listed in section 6).

•    if you are more than 3 months pregnant (it is also better to avoid Atacand in early pregnancy - see pregnancy section).

if you have severe liver disease or biliary obstruction (a problem with the drainage of the bile from the gall bladder).

•    if the patient is a child under 1 year of age.

•    if you have diabetes or impaired kidney function and you are treated with a blood pressure lowering medicine containing aliskiren.

If you are not sure if any of these apply to you, talk to your doctor or pharmacist before taking Atacand.

Warnings and precautions

Talk to your doctor before taking Atacand:

•    if you have heart, liver or kidney problems, or are on dialysis.

•    if you have recently had a kidney transplant.

•    if you are vomiting, have recently had severe vomiting, or have diarrhoea.

•    if you have a disease of the adrenal gland called Conn’s syndrome (also called primary hyperaldosteronism).

•    if you have low blood pressure.

•    if you have ever had a stroke.

•    you must tell your doctor if you think you are (or might become) pregnant. Atacand 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).

•    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.

•    if you are taking an ACE-inhibitor together with a medicine which belongs to the class of medicines known as mineralocorticoid receptor antagonists (MRA). These medicines are for the treatment of heart failure (see “Other medicines and Atacand”).

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 Atacand”.

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

If you are going to have an operation, tell your doctor or dentist that you are taking Atacand. This is because Atacand, when combined with some anaesthetics, may cause an excessive drop in blood pressure.

Children and adolescents

Atacand has been studied in children. For more information, talk to your doctor. Atacand must not be given to children under 1 year of age due to the potential risk to the developing kidneys.

Other medicines and Atacand

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

Atacand can affect the way some other medicines work and some medicines can have an

effect on Atacand. If you are using certain medicines, your doctor may need to do blood tests

from time to time.

In particular, tell your doctor if you are using any of the following medicines as your doctor

may need to change your dose and/or take other precautions:

•    Other medicines to help lower your blood pressure, including beta-blockers, diazoxide and ACE inhibitors such as enalapril, captopril, lisinopril or ramipril.

•    Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen, diclofenac, celecoxib or etoricoxib (medicines to relieve pain and inflammation).

•    Acetylsalicylic acid (if you are taking more than 3 g each day) (medicine to relieve pain and inflammation).

•    Potassium supplements or salt substitutes containing potassium (medicines that increase the amount of potassium in your blood).

•    Heparin (a medicine for thinning the blood).

•    Co-trimoxazole (an antibiotic medicine) also known as trimethoprim/sulfamethoxazole.

•    Water tablets (diuretics).

•    Lithium (a medicine for mental health problems).

•    If you are taking an ACE-inhibitor or aliskiren (see also information under the headings “Do not take Atacand” and “Warnings and precautions”).

•    If you are being treated with an ACE-inhibitor together with certain other medicines to treat your heart failure, which are known as mineralocorticoid receptor antagonists (MRA) (for example: spironolactone, eplerenone).

Atacand with food and drink and alcohol

•    You can take Atacand with or without food.

•    When you are prescribed Atacand, discuss with your doctor before drinking alcohol. Alcohol may make you feel faint or dizzy.

Pregnancy and breast-feeding

Breast-feeding

Tell your doctor if you are breast-feeding or about to start breast-feeding. Atacand is not recommended for mothers who are breast-feeding, and your doctor may choose another treatment for you if you wish to breast-feed, especially if your baby is newborn, or was born prematurely.

Driving and using machines

Some people may feel tired or dizzy when taking Atacand. If this happens to you, do not drive or use any tools or machines.

Atacand contains lactose. Lactose is 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 medicine.

3. How to take Atacand

Always take this medicine exactly as your doctor has told you. Check with your doctor or pharmacist if you are not sure. It is important to keep taking Atacand every day.

You can take Atacand with or without food.

Swallow the tablet with a drink of water.

Try to take the tablet at the same time each day. This will help you to remember to take it. High blood pressure:

•    The recommended dose of Atacand is 8 mg once a day. Your doctor may increase this dose to 16 mg once a day and further up to 32 mg once a day depending on blood pressure response.

•    In some patients, such as those with liver problems, kidney problems or those who recently have lost body fluids, e.g. through vomiting or diarrhoea or by using water tablets, the doctor may prescribe a lower starting dose.

•    Some black patients may have a reduced response to this type of medicine, when given as the only treatment, and these patients may need a higher dose.

Use in children and adolescents with high blood pressure:

Children 6 to <18 years of age:

The recommended starting dose is 4 mg once daily.

For patients weighing < 50 kg: In some patients whose blood pressure is not adequately controlled, your doctor may decide the dose needs to be increased to a maximum of 8 mg once daily.

For patients weighing > 50 kg: In some patients whose blood pressure is not adequately controlled, your doctor may decide the dose needs to be increased to 8 mg once daily and to 16 mg once daily.

Heart failure in adults:

•    The recommended starting dose of Atacand is 4 mg once a day. Your doctor may increase your dose by doubling the dose at intervals of at least 2 weeks up to 32 mg once a day. Atacand can be taken together with other medicines for heart failure, and your doctor will decide which treatment is suitable for you.

If you take more Atacand than you should

If you take more Atacand than prescribed by your doctor, contact a doctor or pharmacist immediately for advice.

If you forget to take Atacand

Do not take a double dose to make up for a forgotten tablet. Just take the next dose as normal. If you stop taking Atacand

If you stop taking Atacand, your blood pressure may increase again. Therefore do not stop taking Atacand without first talking to your doctor.

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. It is important that you are aware of what these side effects may be.

Stop taking Atacand and seek medical help immediately if you have any of the following allergic reactions:

•    difficulties in breathing, with or without swelling of the face, lips, tongue and/or throat

•    swelling of the face, lips, tongue and/or throat, which may cause difficulties in swallowing

•    severe itching of the skin (with raised lumps)

Atacand may cause a reduction in the number of white blood cells. Your resistance to infection may be decreased and you may notice tiredness, an infection or a fever. If this happens contact your doctor. Your doctor may occasionally do blood tests to check whether Atacand has had any effect on your blood (agranulocytosis).

Other possible side effects include:

Common (affects 1 to 10 users in 100)

•    Feeling dizzy/spinning sensation.

•    Headache.

•    Respiratory infection.

•    Low blood pressure. This may make you feel faint or dizzy.

•    Changes in blood test results:

- An increased amount of potassium in your blood, especially if you already have kidney problems or heart failure. If this is severe you may notice tiredness, weakness, irregular heart beat or pins and needles.

•    Effects on how your kidneys work, especially if you already have kidney problems or heart failure. In very rare cases, kidney failure may occur.

Very rare (affects less than 1 user in 10,000)

•    Swelling of the face, lips, tongue and/or throat.

•    A reduction in your red or white blood cells. You may notice tiredness, an infection or a fever.

•    Skin rash, lumpy rash (hives).

•    Itching.

•    Back pain, pain in joints and muscles.

•    Changes in how your liver is working, including inflammation of the liver (hepatitis). You may notice tiredness, yellowing of your skin and the whites of your eyes and flulike symptoms.

•    Nausea.

•    Changes in blood test results:

- A reduced amount of sodium in your blood. If this is severe then you may notice weakness, lack of energy, or muscle cramps.

•    Cough.

In children treated for high blood pressure, side effects appear to be similar to those seen in adults, but they happen more often. Sore throat is a very common side effect in children but not reported in adults and runny nose, fever and increased heart rate are common in children but not reported in adults.

Reporting of side effects

If you get any side effects, talk to your doctor. 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.

5. How to store Atacand

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, blister pack or bottle. The expiry date refers to the last day of that month.

•    This medicinal product does not require any special temperature storage conditions.

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

6.    Contents of the pack and other information

What Atacand contains

•    The active ingredient is candesartan cilexetil. The tablets contain 4 mg, 8 mg, 16 mg or 32 mg of candesartan cilexetil.

•    The other ingredients are carmellose calcium, hydroxypropyl cellulose, lactose monohydrate, magnesium stearate, maize starch and macrogol. The 8 mg, 16 mg and 32 mg tablets also contain iron oxide (E172).

What Atacand looks like and contents of the pack

•    4 mg tablets are white, round tablets with a score and marked A/CF on one side and 004 on the other.

•    8 mg tablets are light pink, round tablets with a score and marked A/CG on one side and 008 on the other.

•    16 mg tablets are pink, round tablets with a score and marked A/CH on one side and 016 on the other.

•    32 mg tablets are pink, round tablets with a score and marked A/CL on one side and 032 on the other.

The tablet can be divided into equal doses by breaking along the score line.

The tablets come in a plastic bottle containing 100 or 250 tablets or a blister pack containing

7,    14, 15, 15x1, 20, 28, 30, 30x1, 50, 50x1, 56, 90, 98, 98x1, 100 or 300 tablets.

Not all pack sizes may be marketed in every country.

Marketing Authorisation Holder and Manufacturer

Atacand is released onto the market by AstraZeneca UK Limited, Silk Road Business Park,

Macclesfield, Cheshire, SK10 2NA, United Kingdom. The Marketing Authorisations are held

by AstraZeneca UK Limited, 600 Capability Green, Luton, LU1 3LU, UK.

Manufacturer: AstraZeneca AB, AstraZeneca Sweden, Gartunavagen, S-151 85, Sodertalje,

Sweden.

This medicinal product is authorised in the Member States of the EEA under the following names:

Member State	Name
Austria, Belgium, Bulgaria, Cyprus, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Ireland, Latvia, Lithuania, Luxembourg, Malta, The Netherlands, Norway, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden, UK	Atacand
Italy	Ratacand
This leaflet was last revised in December 2015 © AstraZeneca 2015 Atacand is a trademark of the AstraZeneca group of companies. CV 15 0083a ^7hJceday

Candesartan cilexetil is manufactured under the licence from Takeda Pharmaceutical Company Limited.