Serious adverse effect 
Fetal Toxicity
- When pregnancy is detected, discontinue Lotevan as soon as possible.
- Drugs that act directly on the renin-angiotensin system can cause injury and death to the developing fetus.

1. What Lotevan is and what it is used for 
Lotevan tablets contain two substances called amlodipine and valsartan. Both of these substances help to control high blood pressure.
- Amlodipine belongs to a group of substances called “calcium channel blockers”. Amlodipine stops calcium from moving into the blood vessel wall which stops the blood vessels from tightening.
- Valsartan belongs to a group of substances called “angiotensin-II receptor antagonists”.
Angiotensin II is produced by the body and makes the blood vessels tighten, thus increasing the blood pressure. Valsartan works by blocking the effect of angiotensin II.
This means that both of these substances help to stop the blood vessels tightening. As a result, the blood vessels relax and blood pressure is lowered.
Lotevan is used to treat high blood pressure in adults whose blood pressure is not controlled enough with either amlodipine or valsartan on its own.

2. Before you take Lotevan
Do not take Lotevan
- If you are allergic to amlodipine or to any other calcium channel blockers. This may involve itching, reddening of the skin or difficulty in breathing.
- If you are allergic to valsartan or any of the other ingredients of this medicine.
- If you think you may be allergic, talk to your doctor before taking Lotevan.
- If you have severe liver problems or bile problems such as biliary cirrhosis or cholestasis.
- If you are more than 3 months pregnant. It is also better to avoid Lotevan in early pregnancy.
- If you have severe low blood pressure (hypotension).
- If you have narrowing of the aortic valve (aortic stenosis) or cardiogenic shock (a condition where your heart is unable to supply enough blood to the body).
- If you suffer from heart failure after a heart attack.
- If you have diabetes or impaired kidney function and you are treated with a blood pressure lowering medicine containing aliskiren.
If any of the above applies to you, do not take Lotevan and talk to your doctor.
Warnings and precautions
Talk to your doctor before taking Lotevan:
- If you have been sick (vomiting or diarrhea).
- If you have liver or kidney problems.
- If you have had a kidney transplant or if you had been told that you have a narrowing of your kidney arteries.
- If you have a condition affecting the renal glands called “primary hyperaldosteronism”.
- If you have had heart failure or have experienced a heart attack. Follow your doctor’s instructions for the starting dose carefully. Your doctor may also check your kidney function.
- If your doctor has told you that you have a narrowing of the valves in your heart (called “aortic or mitral stenosis”) or that the thickness of your heart muscle is abnormally increased (called “obstructive hypertrophic cardiomyopathy”).
- If you have experienced swelling, particularly of the face and throat, while taking other medicines (including angiotensin converting enzyme inhibitors). If you get these symptoms, stop taking Lotevan and contact your doctor straight away. You should never take Lotevan again.
- If you are being treated with a type of medicine used to treat high blood pressure called ACE inhibitors (for example enalapril, lisinopril, ramipril) in particular if you have diabetes-related kidney problems or aliskiren.
Your doctor may check your kidney function, blood pressure, and the amount of electrolytes (e.g. potassium) in your blood at regular intervals.
If any of these apply to you, tell your doctor before taking Lotevan.
Children and adolescents
The use of Lotevan in children and adolescents is not recommended (aged below 18 years old).
Taking other medicines
Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines. Your doctor may need to change the dose or take other precautions.
In some cases you may have to stop taking one of the medicines.
This applies especially to the medicines listed below:
- ACE inhibitors or aliskiren.
- Diuretics (a type of medicine also called “water tablets” which increases the amount of urine you produce).
- Lithium (a medicine used to treat some types of depression).
- Potassium-sparing diuretics, potassium supplements, salt substitutes containing potassium and other substances that may increase potassium levels.
- Certain types of painkillers called non-steroidal anti-inflammatory medicines (NSAIDs) or selective cyclooxygenase-2 inhibitors (COX-2 inhibitors). Your doctor may also check your kidney function.
- Anticonvulsant agents (e.g. carbamazepine, phenobarbital, phenytoin, fosphenytoin, primidone).
- St. John’s wort.
- Nitroglycerin and other nitrates, or other substances called “vasodilators”.
- Medicines used for HIV/AIDS (e.g. ritonavir, indinavir, nelfinavir).
- Medicines used to treat fungal infections (e.g. ketoconazole, itraconazole).
- Medicines used to treat bacterial infections (such as rifampicin, erythromycin, clarithromycin, talithromycin).
- Verapamil, diltiazem (heart medicines).
- Simvastatin (a medicine used to control high cholesterol levels).
- Dantrolene (infusion for severe body temperature abnormalities).
- Medicines used to protect against transplant rejection (ciclosporin).
Taking Lotevan with food and drink
Grapefruit and grapefruit juice should not be consumed by people who are taking Lotevan. This is because grapefruit and grapefruit juice can lead to an increase in the blood levels of the active substance amlodipine, which can cause an unpredictable increase in the blood pressure lowering effect of Lotevan.
Pregnancy and breast-feeding
Pregnancy: You must tell your doctor if you think you are (or might become) pregnant. Your doctor will normally advise you to stop taking Lotevan before you become pregnant or as soon as you know you are pregnant and will advise you to take another medicine instead of Lotevan. Lotevan is not recommended in early pregnancy (first 3 months), and must not be taken when more than 3 months pregnant, as it may cause serious harm to your baby if used after the third month of pregnancy.
Breast-feeding: Tell your doctor if you are breast-feeding or about to start breast-feeding. Amlodipine has been shown to pass into breast milk in small amounts Lotevan 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. Ask your doctor or pharmacist for advice before taking any medicine.
Driving and using machines
This medicine may make you feel dizzy. This can affect how well you can concentrate. So, if you are not sure how this medicine will affect you, do not drive, use machinery, or do other activities that you need to concentrate on

3. How to take Lotevan
Always take this medicine exactly as your doctor has told you. Check with your doctor if you are not sure. This will help you get the best results and lower the risk of side effects.
The usual dose of Lotevan is one tablet per day.
- It is advisable to take your medicine at the same time each day.
- Swallow the tablets with a glass of water.
- You can take Lotevan with or without food. Do not take 
- Lotevan with grapefruit or grapefruit juice.
Depending on how you respond to the treatment, your doctor may suggest a higher or lower dose.
Do not exceed the prescribed dose.
Lotevan and older people (age 65 years or over)
Your doctor should exercise caution when increasing your dose. If you have any further questions on the use of this medicine, ask your doctor or pharmacist.
If you take more Lotevan than you should
If you have taken too many tablets of Lotevan, or if someone else has taken your tablets, consult a doctor immediately.
If you forget to take Lotevan
If you forget to take this medicine, take it as soon as you remember. Then take your next dose at its usual time. However, if it is almost time for your next dose, skip the dose you missed. Do not take a double dose to make up for a forgotten tablet.
If you stop taking Lotevan
Stopping your treatment with Lotevan may cause your disease to get worse. Do not stop taking your medicine unless your doctor tells you to.

4. Possible side effects
Like all medicines, this medicine can cause side effects, although not everybody gets them.
Some side effects can be serious and need immediate medical attention:
A few patients have experienced these serious side effects (may affect up to 1 in 1,000 people). If any of the following happen, tell your doctor straight away:
Allergic reaction with symptoms such as rash, itching, swelling of face or lips or tongue, difficulty breathing, low blood pressure (feeling of faintness, light-headedness).
Other possible side effects of Lotevan:
Common (may affect up to 1 in 10 people): Influenza (flu), blocked nose, sore throat and discomfort when swallowing, headache, swelling of arms, hands, legs, ankles or feet, tiredness, asthenia (weakness), redness and warm feeling of the face and/or neck.
Uncommon (may affect up to 1 in 100 people): Dizziness, nausea and abdominal pain, dry mouth, drowsiness, tingling or numbness of the hands or feet, vertigo, fast heart beat including palpitations, dizziness on standing up, cough, diarrhea, constipation, skin rash, redness of the skin, joint swelling, back pain, pain in joints.
Rare (may affect up to 1 in 1,000 people): Feeling anxious, ringing in the ears (tinnitus), fainting, passing more urine than normal or feeling more of an urge to pass urine, inability to get or maintain an erection, sensation of heaviness, low blood pressure with symptoms such as dizziness, light-headedness, excessive sweating, skin rash all over your body, itching, muscle spasm.
If any of these affect you severely, tell your doctor.
Side effects reported with amlodipine or valsartan alone and either not observed with Lotevan or observed with a higher frequency than with Lotevan:
Amlodipine
Consult a doctor immediately if you experience any of the following very rare, severe side effects after taking this medicine:
- Sudden wheeziness, chest pain, shortness of breath or difficulty in breathing.
- Swelling of eyelids, face or lips.
- Swelling of the tongue and throat which causes great difficulty breathing.
- Severe skin reactions including intense skin rash, hives, reddening of the skin over your whole body, severe itching, blistering, peeling and swelling of the skin, inflammation of the mucous membranes (Stevens-Johnson Syndrome, toxic epidermal necrolysis) or other allergic reactions.
- Heart attack, abnormal heart beat.
- Inflamed pancreas, which may cause severe abdominal and back pain accompanied with feeling of being very unwell.
The following side effects have been reported. If any of these cause you problems or if they last for more than one week, you should contact your doctor.
Common (may affect up to 1 in 10 people): Dizziness, sleepiness, palpitations (awareness of your heart beat), flushing, ankle swelling (oedema), abdominal pain, feeling sick (nausea).
Uncommon (may affect up to 1 in 100 people): Mood changes, anxiety, depression, sleeplessness, trembling, taste abnormalities, fainting, loss of pain sensation, visual disturbances, visual impairment, ringing in the ears, low blood pressure, sneezing/runny nose caused by inflammation of the lining of the nose (rhinitis), indigestion, vomiting (being sick), hair loss, increased sweating, itchy skin, skin discolouration; disorder in passing urine, increased need to urinate at night, increased number of times of passing urine, inability to obtain an erection, discomfort or enlargement of the breasts in men, pain, feeling unwell, muscle pain, muscle cramps; weight increase or decrease.
Rare (may affect up to 1 in 1,000 people): Confusion.
Very rare (may affect up to 1 in 10,000 people): Decreased number of white blood cells, decrease in blood platelets which may result in unusual brusing or easy bleeding (red blood cell damage), excess sugar in blood (hyperglycaemia), swelling of the gums, abdominal bloating (gastritis), abnormal liver function, inflammation of the liver (hepatitis), yellowing of the skin (jaundice), liver enzyme increase which may have an effect on some medical tests, increased muscle tension, inflammation of blood vessels often with skin rash, sensitivity to light, disorders combining rigidity, tremor and/or movement disorders.
Valsartan
Not known (frequency cannot be estimated from the available data): Decrease in red blood cells, fever, sore throat or mouth sores due to infections, spontaneous bleeding or bruising, high level of potassium in the blood, abnormal liver test results, decreased renal functions and severely decreased renal functions, swelling mainly of the face and the throat, muscle pain, rash, purplish-red spots, fever, itching, allergic reaction, blistering skin (sign of a condition called dermatitis bullous).
If you experience any of these, tell your doctor straight away.
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

5. How to store Lotevan
Keep out of reach of children.
Store below 30°C.
Do not use beyond the expiry date or if the product shows any sign of deterioration