Public Assessment Report Decentralised Procedure …

1 Public Assessment Report Decentralised Procedure CANDESARTAN CILEXETIL 8MG, 16MG AND 32MG. TABLETS. CANDESARTAN CILEXETIL. UK/H/ 3930 , 4698 & 4699/001-3/DC. UK Licence No: PL 00289/1176-8, 1535-7 & 1540-2. TEVA UK LIMITED. PAR Candesartan Cilexetil 8 mg, 16 mg and 32 mg Tablets UK/H/ 3930 , 4698 & 4699/001-3/DC. LAY SUMMARY. On 3rd November 2011, the MHRA granted Teva UK Limited Marketing Authorisations (licences) for Candesartan cilexetil 8 mg, 16 mg and 32 mg Tablets. Candesartan cilexetil 8 mg, 16 mg and 32 mg Tablets contain the active ingredient, candesartan cilexetil. Candesartan cilexetil belongs to a group of medicines called Angiotensin II receptor antagonists.

2 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. Candesartan cilexetil 8 mg, 16 mg and 32 mg Tablets are used for: Treating high blood pressure (hypertension) in adult patients. Treating adult heart failure patients with reduced heart muscle function in addition to Angiotensin Converting Enzyme (ACE) inhibitors or when ACE inhibitors cannot be used (ACE inhibitors are a group of medicines used to treat heart failure). No new or unexpected safety concerns arose from these applications and it was, therefore, judged that the benefits of taking Candesartan cilexetil 8 mg, 16 mg and 32 mg Tablets outweigh the risks; hence these Marketing Authorisations have been granted.

3 2. PAR Candesartan Cilexetil 8 mg, 16 mg and 32 mg Tablets UK/H/ 3930 , 4698 & 4699/001-3/DC. TABLE OF CONTENTS. Module 1: Information about initial Procedure Page 4. Module 2: Summary of Product Characteristics Page 6. Module 3: Product Information Leaflets Page 96. Module 4: Labelling Page 102. Module 5: Scientific Discussion Page 105. 1 Introduction 2 Quality aspects 3 Non-clinical aspects 4 Clinical aspects 5 Overall conclusions Module 6: Steps taken after initial Procedure Not applicable 3. PAR Candesartan Cilexetil 8 mg, 16 mg and 32 mg Tablets UK/H/ 3930 , 4698 & 4699/001-3/DC. Module 1.

4 Product Name Candesartan cilexetil 8 mg Tablets Candesartan cilexetil 16 mg Tablets Candesartan cilexetil 32 mg Tablets Type of Application Generic application, Article Active Substance Candesartan cilexetil Form Tablets Strength 8 mg 16 mg 32 mg MA Holder Teva UK Limited Brampton Road Hampden Park Eastbourne BN22 9AG. United Kingdom Reference Member State (RMS) United Kingdom (UK). Concerned Member States (CMS) UK/H/ 3930 /001-2/DC: Belgium (BE), Germany (DE), Denmark (DK), Estonia (EE), Greece (EL), Spain (ES), Finland (FI), France (FR), Hungary (HU), Ireland (IE), Italy (IT), Luxembourg (LU), Latvia (LV), the Netherlands (NL), Norway (NO), Poland (PL), Portugal (PT), Romania (RO), Sweden (SE), the Slovak Republic (SK).

5 UK/H/ 3930 /003/DC: Belgium (BE), Germany (DE), Denmark (DK), Estonia (EE), Greece (EL), Spain (ES), Finland (FI), France (FR), Hungary (HU), Ireland (IE), Italy (IT), Luxembourg (LU), the Netherlands (NL), Norway (NO), Poland (PL), Portugal (PT), Romania (RO), Sweden (SE), the Slovak Republic (SK). UK/H/4698/001-3/DC: Austria (AT), Germany (DE), Spain (ES), France (FR), Portugal (PT), Slovenia (SI). UK/H/4699/001-3/DC: Germany (DE), Spain (ES), France (FR). 4. PAR Candesartan Cilexetil 8 mg, 16 mg and 32 mg Tablets UK/H/ 3930 , 4698 & 4699/001-3/DC. Procedure Number UK/H/ 3930 /001-3/DC.

6 UK/H/4698/001-3/DC. UK/H/4699/001-3/DC. End of Procedure Day 205: 16th September 2011. 5. PAR Candesartan Cilexetil 8 mg, 16 mg and 32 mg Tablets UK/H/ 3930 , 4698 & 4699/001-3/DC. Module 2. Summary of Product Characteristics 1 NAME OF THE MEDICINAL PRODUCT. Candesartan cilexetil 8 mg Tablets 2 QUALITATIVE AND QUANTITATIVE COMPOSITION. Each tablet contains 8 mg candesartan cilexetil. Excipients: Lactose: mg lactose monohydrate / 8 mg tablet For a full list of excipients, see section 3 PHARMACEUTICAL FORM. Tablet. Pink, capsule shaped tablet, mm in length and mm in width, scored on both sides.

7 Both sides of the tablet is debossed with the number " 8 | C ". The tablet can be divided into equal halves 4 CLINICAL PARTICULARS. Therapeutic indications Candesartan cilexetil is indicated for the: Treatment of essential hypertension in adults. Treatment of adult patients with heart failure and impaired left ventricular systolic function (left ventricular ejection fraction 40%) as add-on therapy to Angiotensin Converting Enzyme (ACE). inhibitors or when ACE inhibitors are not tolerated (see section ). Posology and method of administration Posology in Hypertension The recommended initial dose and usual maintenance dose of Candesartan cilexetil is 8 mg once daily.

8 Most of the antihypertensive effect is attained within 4 weeks. In some patients whose blood pressure is not adequately controlled, the dose can be increased to 16 mg once daily and to a maximum of 32. mg once daily. Therapy should be adjusted according to blood pressure response. Candesartan cilexetil may also be administered with other antihypertensive agents. Addition of hydrochlorothiazide has been shown to have an additive antihypertensive effect with various doses of Candesartan cilexetil. Elderly population No initial dose adjustment is necessary in elderly patients. Patients with intravascular volume depletion An initial dose of 4 mg may be considered in patients at risk for hypotension, such as patients with possible volume depletion (see section ).

9 Patients with renal impairment The starting dose is 4 mg in patients with renal impairment, including patients on haemodialysis. The dose should be titrated according to response. There is limited experience in patients with very severe or endstage renal impairment (Clcreatinine < 15 ml/min) (see section ). Patients with hepatic impairment An initial dose of 4 mg once daily is recommended in patients with mild to moderate hepatic impairment. The dose may be adjusted according to response. Candesartan cilexetil is contraindicated in patients with severe hepatic impairment and/or cholestasis (see sections and ).

10 Black patients The antihypertensive effect of candesartan is less pronounced in black patients than in non-black patients. Consequently, uptitration of Candesartan cilexetil and concomitant therapy may be more frequently needed for blood pressure control in black patients than in non-black patients (see section ). 6. PAR Candesartan Cilexetil 8 mg, 16 mg and 32 mg Tablets UK/H/ 3930 , 4698 & 4699/001-3/DC. Posology in Heart Failure The usual recommended initial dose of Candesartan cilexetil is 4 mg once daily. Up-titration to the target dose of 32 mg once daily (maximum dose) or the highest tolerated dose is done by doubling the dose at intervals of at least 2 weeks (see section ).