Libracor

Package leaflet: Information for the user

Libracor1.25 mg film-coated tablets

Libracor2.5 mg film-coated tablets

Libracor3.75 mg film-coated tablets

Libracor 5 mg film-coated tablets

Libracor7.5 mg film-coated tablets

Libracor10 mg film-coated tablets

Bisoprolol fumarate

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 your 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 Libracor is and what it is used for

2. What you need to know before you take Libracor

3. How to take Libracor

4. Possible side effects

5. How to store Libracor

6. Contents of the pack and other information

1. WhatLibracor is and what it is used for

The active substance in Libracor is bisoprolol. Bisoprolol belongs to a group of medicines called beta-blockers. These medicines work by affecting the body`s response to some nerve impulses, especially in the heart. As a result, bisoprolol slows down the heart rate and makes the heart more efficient at pumping blood around the body.

Heart failure occurs when the heart muscle is weak and unable to pump enough blood to supply the body's needs. Libracor is used to treat stable chronic heart failure.

It is used in combination with other medicines suitable for this condition (such as ACE-inhibitors, diuretics, and heart glycosides).

2. What you need to know before you take Libracor

Do not take Libracor

Do not take Libracor if one of the following conditions applies to you:

allergy (hypersensitivity) to bisoprolol or to any of the other ingredients (see section 6 ‘What Libracor contains’)
severe asthma
severe blood circulation problems in your limbs (such as Raynaud’s syndrome), which may cause your fingers and toes to tingle or turn pale or blue
untreated phaeochromocytoma, which is a rare tumour of the adrenal gland
metabolic acidosis, which is a condition when there is too much acid in the blood.

Do not take Libracor if you have one of the following heart problems:

acute heart failure
worsening heart failure requiring injection of medicines into a vein, that increase the force of contraction of the heart
slow heart rate
low blood pressure
certain heart conditions causing a very slow heart rate or irregular heartbeat
cardiogenic shock, which is an acute serious heart condition causing low blood pressure and circulatory failure.

Warnings and precautions

If you have any of the following conditions tell your doctor before taking Libracor; he or she may want to take special care(for example give additional treatment or perform more frequent checks):

diabetes
strict fasting
certain heart diseases such as disturbances in heart rhythm, or severe chest pain at rest (Prinzmetal’s angina)
kidney or liver problems
less severe blood circulation problems in your limbs
chronic lung disease or less severe asthma
history of a scaly skin rash (psoriasis)
tumour of the adrenal gland (phaeochromocytoma)
thyroid disorder.

In addition, tell your doctor if you are going to have:

desensitization therapy (for example for the prevention of hay fever), because Libracor may make it more likely that you experience an allergic reaction, or such reaction may be more severe
anaesthesia (for example for surgery), because Libracor may influence how your body reacts to this situation.

If you have chronic lung disease or less severe asthma please inform your doctor immediately if you start to experience new difficulties in breathing, cough, wheezing after exercise, etc. when using Libracor.

Children and adolescents

Libracor is not recommended for use in children or adolescents.

Other medicines and Libracor

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

Do not take the following medicines with Libracor without special advice from your doctor:

certain medicines used to treat irregular or abnormal heartbeat (Class I antiarrhythmic medicines such as quinidine, disopyramide, lidocaine, phenytoin; flecainide, propafenone)
certain medicines used to treat high blood pressure, angina pectoris or irregular heartbeat (calcium antagonists such as verapamil and diltiazem)
certain medicines used to treat high blood pressure such as clonidine, methyldopa, moxonodine, rilmenidine. However, do not stop taking these medicines without checking with your doctor first.

Check with your doctor before taking the following medicines with Libracor; your doctor may need to check your condition more frequently:

certain medicines used to treat high blood pressure or angina pectoris (dihydropyridine-type calcium antagonists such as felodipine and amlodipine)
certain medicines used to treat irregular or abnormal heartbeat (Class III antiarrhythmic medicines such as amiodarone)
beta-blockers applied locally (such as timolol eye drops for glaucoma treatment)
certain medicines used to treat for example Alzheimer’s disease or glaucoma (parasympathomimetics such as tacrine or carbachol) or medicines that are used to treat acute heart problems (sympathomimetics such as isoprenaline and dobutamine)
antidiabetic medicines including insulin
anaesthetic agents (for example during surgery)
digitalis, used to treat heart failure
non-steroidal anti-inflammatory medicines (NSAIDs) used to treat arthritis, pain or inflammation (for example ibuprofen or diclofenac)
any medicine, which can lower blood pressure as a desired or undesired effect such as antihypertensives, certain medicines for depression (tricyclic antidepressants such as imipramine or amitriptyline), certain medicines used to treat epilepsy or during anaesthesia (barbiturates such as phenobarbital), or certain medicines to treat mental illness characterized by a loss of contact with reality (phenothiazines such as levomepromazine)
mefloquine, used for prevention or treatment of malaria
depression treatment medicines called monoamine oxidase inhibitors (except MAO-B inhibitors) such as moclobemide.

Pregnancy and breast-feeding

Pregnancy

There is a risk that use of Libracor during pregnancy may harm the baby. If you are pregnant or planning to become pregnant, tell your doctor. He or she will decide whether you can take Libracor during pregnancy.

Breast-feeding

It is not known whether bisoprolol passes into human breast milk. Therefore, breastfeeding is not recommended during therapy with Libracor.

Driving and using machines

Your ability to drive or use machinery may be affected depending on how well you tolerate the medicine. Please be especially cautious at the start of treatment, when the dose is increased or the medication is changed, as well as in combination with alcohol.

3. How to take Libracor

Always take this medicine exactly as your doctor has told you. Check with your doctor or pharmacist if you are not sure.

Treatment with Libracor requires regular monitoring by your doctor. This is particularly necessary at the start of treatment, during dose increase, and when you stop treatment.

Take the tablet with some water in the morning, with or without food. Do not crush or chew the tablet.

The scored tablets can be divided into two equal doses.

Treatment with Libracor is usually long-term.

Adults including the elderly

Treatment with bisoprolol must be started at a low dose and increased gradually.

Your doctor will decide how to increase the dose, and this will normally be done in the following way:

1.25 mg bisoprolol once daily for one week
2.5 mg bisoprolol once daily for one week
3.75 mg bisoprolol once daily for one week
5 mg bisoprolol once daily for four weeks
7.5 mg bisoprolol once daily for four weeks
10 mg bisoprolol once daily for maintenance (on-going) therapy.

The maximum recommended daily dose is 10 mg bisoprolol.

Depending on how well you tolerate the medicine, your doctor may also decide to lengthen the time between dose increases. If your condition gets worse or you no longer tolerate the drug, it may be necessary to reduce the dose again or to interrupt treatment. In some patients a maintenance dose lower than 10 mg bisoprolol may be sufficient.

Your doctor will tell you what to do.

If you have to stop treatment entirely, your doctor will usually advise you to reduce the dose gradually, as otherwise your condition may become worse.

If you take more Libracor than you should

If you have taken more Libracor tablets than you should, tell your doctor immediately. Your doctor will decide what measures are necessary.

Symptoms of an overdose may include slowed heart rate, severe difficulty in breathing feeling dizzy, or trembling (due to decreased blood sugar).

If you forget to take Libracor

Do not take a double dose to make up for a forgotten dose. Take your usual dose the next morning.

If you stop taking Libracor

Never stop taking Libracor unless on your doctor’s advice. Otherwise your condition could become much worse.

If you have any further questions on the use of this product, ask your doctor or pharmacist.

4. Possibleside effects

Like all medicines, this medicine can cause side effects, although not everybody gets them.

To prevent serious reactions, speak to a doctor immediately if a side effect is severe, occurred suddenly or gets worse rapidly.

The most serious side effects are related to the heart function:

slowing of heart rate (may affect more than 1 in 10 people)
worsening of heart failure (may affect up to 1 in 10 people)
slow or irregular heartbeat (may affect up to 1 in 100 people)

If you feel dizzy or weak, or have breathing difficulties please contact your doctor as soon as possible.

Further side effects are listed below according to how frequently they may occur:

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

tiredness, feeling weak, dizziness, headache
feeling of coldness or numbness in hands or feet
low blood pressure
stomach or intestine problems such as nausea, vomiting, diarrhoea, or constipation.

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

sleep disturbances
depression
dizziness when standing up
breathing problems in patients with asthma or chronic lung disease
muscle weakness, muscle cramps.

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

hearing problems
allergic runny nose
reduced tear flow
inflammation of the liver which can cause yellowing of the skin or whites of the eyes
certain blood test results for liver function or fat levels differing from normal
allergy-like reactions such as itching, flush, rash
impaired erection
nightmares, hallucinations.
fainting

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

irritation and redness of the eye (conjunctivitis)
hair loss
appearance or worsening of scaly skin rash (psoriasis); psoriasis-like rash.

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 the side effects directly via the national reporting system listed in Appendix V*. By reporting side effects you can help provide more information on the safety of this medicine.

5. HowtostoreLibracor

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 blister and the carton after EXP. The expiry date refers to the last date of that month.

Libracor1.25 mg film-coated tablets:

Libracor2.5 mg film-coated tablets:

Libracor3.75 mg film-coated tablets:

Do not store above 25°C.

Libracor 5 mg film-coated tablets:

Libracor7.5 mg film-coated tablets:

Libracor10 mg film-coated tablets:

Do not store above 30°C.

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

6. Contents of the pack and other information

What Libracor contains

Libracor 1.25 mg film-coated tablets

The active substance is bisoprolol fumarate. Each film-coated tablet contains 1.25 mg.
The other ingredients are:

Tablet core: Silica, colloidal anhydrous; magnesium stearate; crospovidone; pregelatinised maize starch; maize starch; microcrystalline cellulose; calcium hydrogen phosphate (anhydrous).

Film coating: dimethicone; talc; macrogol 400; titanium dioxide (E171); hypromellose.

Libracor 2.5 mg film-coated tablets

The active substance is bisoprolol fumarate. Each film-coated tablet contains 2.5 mg.
The other ingredients are: