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نشرة الممارس الصحي نشرة معلومات المريض بالعربية نشرة معلومات المريض بالانجليزية صور الدواء بيانات الدواء
  SFDA PIL (Patient Information Leaflet (PIL) are under review by Saudi Food and Drug Authority)

Verquvo contains the active substance vericiguat, which is a type of heart medicine called soluble guanylate cyclase stimulator.

Verquvo is used to treat adults with long-term heart failure who recently have had an increase in heart failure symptoms. Therefore, you may have gone to hospital and/or received a medicine (diuretic) given in a vein to help you pass more urine than usual.

Heart failure is when your heart is weak and cannot pump enough blood to your body. Some common symptoms of heart failure are shortness of breath, tiredness, or swelling caused by a build-up of fluid.


Do not take Verquvo if you are

·     allergic to vericiguat or any of the other ingredients of this medicine (listed in section 6),

·     taking any medicine that contains another soluble guanylate cyclase stimulator, e.g. riociguat used to treat high blood pressure in lungs.

If any of the above applies to you, talk to your doctor first and do not take this medicine.

 

Warnings and precautions

Talk to your doctor or pharmacist before taking Verquvo if you have

·     low blood pressure with symptoms like dizziness or light-headedness,

·     severe kidney problems or are on dialysis,

·     severe liver problems.

 

Children and adolescents

Do not give this medicine to children and adolescents aged under 18 years because it has not been studied yet in this age group.

 

Other medicines and Verquvo

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

·     belong to the group of soluble guanylate cyclase stimulators (e.g. riociguat). Do not take Verquvo when taking these medicines. See “Do not take Verquvo”.

·     treat high blood pressure in the lungs, or medicines to achieve or maintain an erection, called PDE5 inhibitors (e.g. sildenafil, tadalafil, vardenafil). The use of these medicines is not recommended when taking Verquvo.

·     treat heart disease including chest pain, called nitrates (e.g. isosorbide mononitrate).

 

Pregnancy and breast-feeding

If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, ask your doctor or pharmacist for advice before taking this medicine.

Pregnancy

Verquvo should not be used during pregnancy, as it is not known if it harms the unborn baby. If there is a chance that you could become pregnant, talk to your doctor about reliable forms of contraception.

Breast-feeding

It is not known if Verquvo passes into your breast milk and could harm your baby. Your doctor will decide with you whether breast-feeding or Verquvo therapy should be stopped.

 

Driving and using machines

If you feel dizzy while taking this medicine, do not drive a vehicle, cycle or use any machines.

 

Verquvo contains lactose and sodium

This medicine contains lactose. If you have been told by your doctor that you have an intolerance to some sugars, contact your doctor before taking this medicine.

This medicine contains less than 1 mmol sodium (23 mg) per tablet, that is to say essentially “sodium- free”.


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

The recommended starting dose is 1 tablet of 2.5 mg once daily. Your doctor will then adjust the dose depending on how well the treatment is tolerated. Typically, your doctor will increase the dose after about

2 weeks to 1 tablet of 5 mg once daily and after about another 2 weeks up to the maximum target dose of 1 tablet of 10 mg once daily.

If you have low blood pressure while taking Verquvo, this can make you feel dizzy and light-headed and your doctor may temporarily reduce your Verquvo dose or interrupt your treatment with Verquvo.

Take one tablet at the same time each day with food. If you cannot swallow the tablet, you may crush Verquvo and mix it with water. Take this mixture immediately.

 

If you take more Verquvo than you should

Contact your doctor immediately if you take more Verquvo than you should and you get any side effects listed in section 4. The most likely effect would be a lowering of your blood pressure which can make you feel dizzy and light-headed.

 

If you forget to take Verquvo

Take the missed tablet as soon as you remember on the same day of the missed dose. Do not take a double dose to make up for a forgotten tablet.

 

If you stop taking Verquvo

Do not stop taking this medicine without speaking with your doctor first. If you stop taking this medicine, your condition may worsen.

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


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

The possible side effects are:

 

Very common (may affect more than 1 in 10 people)

·     low blood pressure (hypotension)

 

Common (may affect up to 1 in 10 people)

·     low number of red blood cells (anaemia), which can cause pale skin, weakness or breathlessness

·     dizziness

·     headache

·     nausea and vomiting

·     indigestion (dyspepsia)

·     heartburn (gastro-oesophageal reflux disease)

 

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. By reporting side effects, you can help provide more information on the safety of this medicine.

 

To report any side effect(s):

Saudi Arabia:

The National Pharmacovigilance Centre (NPC).

SFDA Call Center: 19999

E-mail: npc.drug@sfda.gov.sa

Website: https://ade.sfda.gov.sa

Egypt:

Egyptian Pharmaceutical Vigilance Centre

Tel.: +20 -225354100  Ext.:1303

Email:

pv.followup@edaegypt.gov.eg

United Arab Emirates (UAE):

Pharmacovigilance & Medical Device section

Tel: 80011111 / +971 42301000 

Email: pv@mohap.gov.ae

Website: www.mohap.gov.ae

P.O.Box 1853 Dubai

Jordan:

Tel: +962-6-5632000

JFDA email : jpc@jfda.jo

JFDA website: www.jfda.jo

http://primaryreporting.who-umc.org/JO

Kuwait:

Hotline: 1810005

Email: health@moh.gov.kw

Website: www.moh.gov.kw/kdfc/

P.O.Box: 5 Safat, 13001 Kuwait

Oman:

Tel: +968 - 2444 1999

Fax: +968 - 24602287

Email: pharma-vigil@moh.gov.om

Website: www.moh.gov.om

Other Countries:

Please contact the relevant competent authority

 

 

 


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 and on each blister or bottle after “EXP”. The expiry date refers to the last day of that month.

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.


What Verquvo contains

·     The active substance is vericiguat. Each film-coated tablet contains 2.5 mg, 5 mg or 10 mg vericiguat.

·     The other ingredients are:

Tablet core: Microcrystalline cellulose, croscarmellose sodium, hypromellose 2910, lactose monohydrate, magnesium stearate, sodium laurilsulfate (see section 2 “Verquvo contains lactose and sodium”).

Film-coat: Hypromellose 2910, talc, titanium dioxide (E 171),

iron oxide red (E 172) (Verquvo 5 mg only),

iron oxide yellow (E 172) (Verquvo 10 mg only).


• Verquvo 2.5 mg film-coated tablets (tablets) are round, biconvex and white with a diameter of 7 mm, marked with “2.5” on one side and “VC” on the other side. • Verquvo 5 mg film-coated tablets (tablets) are round, biconvex and brown-red with a diameter of 7 mm, marked with “5” on one side and “VC” on the other side. • Verquvo 10 mg film-coated tablets (tablets) are round, biconvex and yellow-orange with a diameter of 9 mm, marked with “10” on one side and “VC” on the other side. Verquvo is available • in blisters in cartons of 14 (14’s blister), 28 (14’s blister x 2) or 98 film-coated tablets • in perforated unit dose blisters in cartons of 10 × 1 or 100 × 1 film-coated tablets • in bottles of 100 film-coated tablets Not all pack sizes may be marketed.

Marketing Authorisation Holder

Bayer AG

51368 Leverkusen Germany

 

Manufacturer

Bayer AG

Kaiser-Wilhelm-Allee

51368 Leverkusen Germany


07/2021
  نشرة الدواء تحت مراجعة الهيئة العامة للغذاء والدواء (اقرأ هذه النشرة بعناية قبل البدء في استخدام هذا المنتج لأنه يحتوي على معلومات مهمة لك)

يحتوي ڤيركوڤو على المادة الفعالة ڤيريسيجوات و هو نوع من أدوية علاج امراض القلب و يسمى مُحفِّز جوانيلات سيكلاز القابل للذوبان

يستخدم ڤيركوڤو لعلاج البالغين الذين لديهم قصور القلب طويل الأمد و عانوا من زيادة في أعراض قصور القلب. لذلك، ربما تكون قد ذهبت إلى المستشفى و / أو تلقيت دواء (مدر للبول) يُعطى في الوريد لمساعدتك على إخراج المزيد من البول أكثر من المعتاد.

يحدث قصور القلب عندما يكون قلبك ضعيفًا ولا يستطيع ضخ الدم الكافي لجسمك. بعض الأعراض الشائعة لقصور القلب هي ضيق التنفس، التعب أو التورم الناجم عن تراكم السوائل.

لا تتناول ڤيركوڤو إذا كنت:

·     تعاني من حساسية من ڤيريسيجوات أو أي من المكونات الأخرى لهذا الدواء (المدرجة في الجزء رقم 6)،

·     تتناول أي دواء يحتوي على مُحفِّز جوانيلات سيكلاز قابل للذوبان آخر، على سبيل المثال ريوسيجوات المستخدم لعلاج ارتفاع ضغط الدم في الرئة.

إذا انطبق عليك أي مما سبق، تحدث إلى طبيبك المعالج أولاً ولا تتناول هذا الدواء.

 

تحذيرات و احتياطات

تحدث إلى طبيبك المعالج أو الصيدلي قبل تناول ڤيركوڤو إذا كنت تعاني من:

·     انخفاض ضغط الدم مع أعراض مثل الدوخة أو إحساس مزعج بالدوار

·     مشاكل حادة في الكلى أو تخضع للغسيل الكلوي،

·     مشاكل كبد شديدة.

 

الأطفال والمراهقون

لا تعطي هذا الدواء للأطفال والمراهقين الذين تقل أعمارهم عن 18 عاماً لأنه لم يتم دراسة الفعالية والأمان بعد على هذه الفئة العمرية.

 

الأدوية الأخرى و ڤيركوڤو

أخبر طبيبك المعالج أو الصيدلي إذا كنت تتناول، تناولت حديثاً أو قد تتناول أي أدوية أخرى، خاصة الأدوية التي:

·     تنتمي للمجموعة الدوائية التي تسمى مُحفِّز جوانيلات سيكلاز قابل للذوبان (مثال لذلك الريوسيجوات). لا تتناول ڤيركوڤو عندما تتناول هذه الأدوية. انظر الى التعليمات المذكورة في الجزء «لا تتناول ڤيركوڤو إذا كنت».

·     تعالج ارتفاع ضغط الدم في الرئة، أو الأدوية لتحقيق أو المحافظة على الانتصاب، تسمى مثبطات PDE5 (فسفوديستيراز النوع الخامس) (مثل سيلدينافيل، تادالافيل، فاردينافيل). لا ينصح باستخدام هذه الأدوية عند تناول ڤيركوڤو.

·     تعالج أمراض القلب بما في ذلك آلام الصدر، التي تسمى النيترات (مثل إيزوسوربيد أحادي النيترات).

 

الحمل و الرضاعة الطبيعية

إذا كنت حاملاً أو مرضعة، أو تعتقدين أنك حامل أو تخططين لإنجاب طفل، اسألي طبيبك أو الصيدلي للحصول على المشورة قبل تناول هذا الدواء.

الحمل

لا يجب تناول ڤيركوڤو أثناء فترة الحمل، لأنه من غير المعروف ما إذا كان سيؤذي الجنين. إذا كان هناك احتمال أن تصبحي حاملاً، فتحدثي مع طبيبك المعالج حول الأشكال الموثوقة لمنع الحمل.

الرضاعة الطبيعية

من غير المعروف ما إذا كان ينتقل ڤيركوڤو إلى حليب الثدي وقد يؤذي طفلك. سوف يقرر طبيبك معك ما إذا كان يجب إيقاف الرضاعة الطبيعية أو العلاج بڤيركوڤو.

 

القيادة واستخدام الآلات

إذا شعرت بدوار أثناء تناول هذا الدواء، فلا يجوز قيادة السيارة أو ركوب الدراجة أو استخدام أي آلات.

 

يحتوي ڤيركوڤو على اللاكتوز والصوديوم

هذا الدواء يحتوي على اللاكتوز. إذا أخبرك طبيبك أن لديك عدم المقدرة على تحمل بعض السكريات، فاتصل بطبيبك المعالج قبل تناول هذا الدواء.

يحتوي هذا الدواء على أقل من 1 مليمول صوديوم (23 مجم) لكل قرص، وهذا يعني بشكل أساسي «خالٍ من الصوديوم».

https://localhost:44358/Dashboard

احرص دائماً على تناول هذا الدواء تماماً كما أخبرك طبيبك المعالج. استشر طبيبك أو الصيدلي إذا كنت غير متأكد.

الجرعة الموصي بها في بداية العلاج هي قرص واحد 2,5 مجم مرة واحدة يوميًا. سيقوم طبيبك بعد ذلك بتعديل الجرعة اعتمادًا على مدى تحملك للعلاج. عادة، سيزيد طبيبك المعالج الجرعة بعد أسبوعين تقريباً إلى قرص واحد 5 مجم مرة واحدة يومياً وبعد حوالي أسبوعين آخرين سيزيد طبيبك المعالج الجرعة حتى أقصى جرعة مستهدفة والتي تبلغ قرص واحد 10 مجم مرة واحدة يومياً.

إذا كنت تعاني من انخفاض في ضغط الدم أثناء تناول ڤيركوڤو، فقد يجعلك ذلك تشعر بدوخة وإحساس مزعج بالدوار وفي هذه الحالة قد يقوم طبيبك بتقليل جرعة ڤيركوڤو مؤقتاً أو وقف علاجك بڤيركوڤو.

تناول قرصاً واحداً في نفس الوقت كل يوم مع الطعام. إذا لم تكن قادراً على ابتلاع القرص، يمكنك سحق قرص ڤيركوڤو وخلطه بالماء. تناول هذا الخليط على الفور.

 

إذا تناولت ڤيركوڤو أكثر مما ينبغي

اتصل بطبيبك على الفور إذا تناولت ڤيركوڤو أكثر مما ينبغي و تعرضت لأي آثار جانبية مدرجة في الجزء رقم 4. من المرجح أن يكون التأثير هو انخفاض ضغط الدم مما قد يجعلك تشعر بدوخة وإحساس مزعج بالدوار

 

إذا نسيت تناول ڤيركوڤو

تناول القرص الذي تم نسيانه بمجرد أن تتذكر في نفس اليوم من الجرعة المنسية. لا تتناول جرعة مضاعفة لتعويض قرص منسي.

 

إذا توقفت عن تناول ڤيركوڤو

لا تتوقف عن تناول هذا الدواء دون التكلم مع طبيبك المعالج أولاً. إذا توقفت عن تناول هذا الدواء، فقد تتفاقم حالتك.

إذا كان لديك أي أسئلة أخرى حول تناول هذا الدواء، اسأل طبيبك المعالج أو الصيدلي.

مثل جميع الأدوية، يمكن أن يسبب هذا الدواء آثار جانبية، على الرغم من أنها لا تحدث للجميع.

الآثار الجانبية المحتملة هي:

شائع جداً (قد يحدث لدى أكثر من 1 من كل 10 أشخاص)

·     انخفاض ضغط الدم 

 

شائع (قد يحدث لدى 1 من كل 10 أشخاص)

·     انخفاض عدد خلايا الدم الحمراء (فقر الدم) التي يمكن ان تسبب شحوب الجلد، ضعف أو ضيق التنفس

·     دوخة

·     صداع

·     قئ وغثيان

·     عسر الهضم (سوء الهضم)

·     حرقة المعدة (مرض الارتداد المعدي المريئي)

 

الإبلاغ عن الآثار الجانبية

إذا تم إصابتك بأي آثار جانبية، تحدث مع طبيبك المعالج أو الصيدلي. يتضمن ذلك أي آثار جانبية محتملة غير مدرجة في هذه النشرة. من خلال الإبلاغ عن الآثار الجانبية، يمكنك المساعدة في تقديم مزيد من المعلومات عن سلامة وأمان هذا الدواء.

للإبلاغ عن الأعراض الجانبية:

السعودية:

المركز الوطني للتيقظ الدوائي

مركز اتصال الهيئة العامة للغذاء والدواء: 19999

البريد الالكتروني: npc.drug@sfda.gov.sa

الموقع الالكتروني: https://ade.sfda.gov.sa

مصر:

مركز اليقظة الصيدلية المصري

هاتف: 225354100 - 20+    تحويلة: 1303

البريد الالكتروني:

pv.followup@edaegypt.gov.eg

الإمارات العربية المتحدة:

قسم التيقظ الدوائي والأجهزة الطبية

هاتف: 80011111 / 42301000 – 971+

البريد الاكتروني: pv@mohap.gov.ae

الموقع الالكتروني: www.mohap.gov.ae

ص.ب. 1853 دبي

الأردن:

هاتف: 5632000-6-962+

البريد الالكتروني: jpc@jfda.jo

الموقع الالكتروني: www.jfda.jo

http://primaryreporting.who-umc.org/JO

الكويت:

الخط الساخن: 1810005

البريد الاكتروني: health@moh.gov.kw

الموقع الالكتروني: /www.moh.gov.kw/kdfc

ص.ب: 5 صفاة، 13001 الكويت

سلطنة عمان:

هاتف: 24441999 – 968+

فاكس: 24602287 – 968+

البريد الالكتروني: pharma-vigil@moh.gov.om

الموقع الالكتروني: www.moh.gov.om

بلدان أخرى:

يرجى الاتصال بالسلطة المختصة ذات الصلة.

احتفظ بهذا الدواء بعيداً عن أعين ومتناول أيدي الأطفال.

لا تستخدم هذا الدواء بعد تاريخ انتهاء الصلاحية المكتوب على العلبة الكرتون وعلي شريط أو زجاجة بعد كلمة «EXP». يشير تاريخ انتهاء الصلاحية إلى آخر يوم في ذلك الشهر.

لا يحفظ في درجة حرارة أعلى من 30 درجة مئوية.

لا تتخلص من أي أدوية عن طريق مياه الصرف الصحي أو عن طريق النفايات المنزلية. اسأل الصيدلي عن كيفية التخلص من الأدوية التي لم تعد تستخدمها. سوف تساعد هذه التدابير في حماية البيئة.

ماذا يحتوي ڤيركوڤو

·     المادة الفعالة هي ڤيريسيجوات. يحتوي كل قرص مغلف على 2,5 مجم، 5 مجم أو 10 مجم ڤيريسيجوات.

·     المكونات الأخرى هي:

لب القرص: سليلوز دقيق التبلور، كروس كارميلوز الصوديوم، هيبروميلوز 2910، مونوهيدرات اللاكتوز، ستيرات المغنيسيوم، لوريلسلفات الصوديوم (انظر الجزء رقم 2 « يحتوي ڤيركوڤو على اللاكتوز والصوديوم»).

طبقة التغليف: هيبروميلوز 2910، التلك، ثاني أكسيد التيتانيوم (E 171)،

أكسيد الحديد الأحمر (E 172) (فقط لدى ڤيركوڤو 5 مجم)،

أكسيد الحديد الأصفر (E 172) (فقط لدى ڤيركوڤو 10 مجم)،

كيف يبدو ڤيركوڤو وما هي محتويات العبوة

·     أقراص ڤيركوڤو 2,5 مجم المغلفة (أقراص) مستديرة، محدبة من الجانبين لونها أبيض بقطر 7 مم، بها علامة “2.5” من جانب وعلامة “VC” على الجانب الآخر.

·     أقراص ڤيركوڤو 5 مجم المغلفة (أقراص) مستديرة، محدبة من الجانبين لونها لون الأحمر البني بقطر 7 مم، بها علامة “5” من جانب وعلامة “VC” على الجانب الآخر.

·     أقراص ڤيركوڤو 10 مجم المغلفة (أقراص) مستديرة، محدبة من الجانبين لونها لون اصفر برتقالي بقطر 9 مم، بها علامة “10” من جانب وعلامة “VC” على الجانب الآخر.

 

ڤيركوڤو متوفر في العبوات الآتية:

·     داخل شرائط في علب كرتون بها 14 (شريط به 14)، 28 (شريط به 14 × 2) أو 98 قرص مغلف

·     داخل شرائط مثقبة لجرعة واحدة معبئة في علب كرتون عبوة 10 × 1 أو 100 × 1 قرص مغلف

·     داخل زجاجات عبوة 100 قرص مغلف

قد لا يتم تسويق جميع أحجام العبوات.

صاحب ترخيص التسويق

باير ايه جي

51368 ليفركوزن ألمانيا

 

المُصَنِّع

باير ايه جي

قيصر – ويلهلم – آلي

51368 ليفركوزن ألمانيا

07/2021
 Read this leaflet carefully before you start using this product as it contains important information for you

Verquvo 2.5 mg film-coated tablets Verquvo 5 mg film-coated tablets Verquvo 10 mg film-coated tablets

Verquvo 2.5 mg film-coated tablets Each film-coated tablet contains 2.5 mg vericiguat. Excipient with known effect Each film-coated tablet contains 58.14 mg lactose (as monohydrate), see section 4.4. Verquvo 5 mg film-coated tablets Each film-coated tablet contains 5 mg vericiguat. Excipient with known effect Each film-coated tablet contains 55.59 mg lactose (as monohydrate), see section 4.4. Verquvo 10 mg film-coated tablets Each film-coated tablet contains 10 mg vericiguat. Excipient with known effect Each film-coated tablet contains 111.15 mg lactose (as monohydrate), see section 4.4. For the full list of excipients, see section 6.1.

Film-coated tablet (tablet) Verquvo 2.5 mg film-coated tablets Round, biconvex, white film-coated tablet with a diameter of 7 mm, marked with “2.5” on one side and “VC” on the other side. Verquvo 5 mg film-coated tablets Round, biconvex, brown-red film-coated tablet with a diameter of 7 mm, marked with “5” on one side and “VC” on the other side. Verquvo 10 mg film-coated tablets Round, biconvex, yellow-orange film-coated tablet with a diameter of 9 mm, marked with “10” on one side and “VC” on the other side.

Verquvo is indicated for the treatment of symptomatic chronic heart failure in adult patients with reduced ejection fraction who are stabilised after a recent decompensation event requiring IV therapy (see section 5.1).


Posology

 

Vericiguat is administered in conjunction with other heart failure therapies.

 

Before starting vericiguat, care should be taken to optimise volume status and diuretic therapy to stabilise patients after the decompensation event, particularly in patients with very high NT-proBNP levels (see section 5.1).

 

The recommended starting dose is 2.5 mg vericiguat once daily. The dose should be doubled approximately every 2 weeks to reach the target maintenance dose of 10 mg once daily, as tolerated by the patient.

 

If patients experience tolerability issues (symptomatic hypotension or systolic blood pressure [SBP] less than 90 mmHg), temporary down-titration or discontinuation of vericiguat is recommended (see section 4.4).

 

Treatment should not be initiated in patients with SBP <100 mmHg (see section 4.4).

 

Missed dose

If a dose is missed, it should be taken as soon as the patient remembers on the same day of the missed dose. Patients should not take two doses of vericiguat on the same day.

 

Special populations

 

Elderly

No dose adjustment is required for elderly patients (see sections 5.1 and 5.2).

 

Renal impairment

No dose adjustment is required in patients with estimated glomerular filtration rate (eGFR)

>15 mL/min/1.73 m2 (without dialysis). Treatment with vericiguat is not recommended in patients with eGFR <15 mL/min/1.73 m2 at treatment initiation or on dialysis (see sections 4.4 and 5.2).

 

Hepatic impairment

No dose adjustment is required in patients with mild or moderate hepatic impairment. Treatment with vericiguat is not recommended in patients with severe hepatic impairment (see sections 4.4 and 5.2).

 

Paediatric population

The safety and efficacy of vericiguat in children and adolescents aged below 18 years have not yet been established. No clinical data are available. Undesirable effects were observed on growing bone in non-clinical studies (see section 5.3).

 

Method of administration

 

For oral use. Verquvo should be taken with food (see section 5.2).

 

Crushed tablets

For patients who are unable to swallow whole tablets, Verquvo may be crushed and mixed with water immediately before administration (see section 5.2).


- Hypersensitivity to the active substance or to any of the excipients listed in section 6.1. - Concomitant use of other soluble guanylate cyclase (sGC) stimulators, such as riociguat (see section 4.5).

Symptomatic hypotension

 

Vericiguat may cause symptomatic hypotension (see section 4.8). Patients with SBP less than 100 mmHg or symptomatic hypotension at treatment initiation were not studied.

The potential for symptomatic hypotension should be considered in patients with hypovolaemia, severe left ventricular outflow obstruction, resting hypotension, autonomic dysfunction, history of hypotension, or concomitant treatment with antihypertensives or organic nitrates (see section 4.5). If patients experience tolerability issues (symptomatic hypotension or SBP less than 90 mmHg), temporary down-titration or discontinuation of vericiguat is recommended (see section 4.2).

Concomitant use of vericiguat and PDE5 inhibitors, such as sildenafil, has not been studied in patients with heart failure and is therefore not recommended due to the potential increased risk for symptomatic hypotension (see section 4.5).

 

Renal impairment

 

Patients with eGFR <15 mL/min/1.73 m2 at treatment initiation or on dialysis have not been studied, therefore treatment with vericiguat is not recommended in these patients (see sections 4.2 and 5.2).

 

Hepatic impairment

 

Patients with severe hepatic impairment have not been studied, therefore treatment with vericiguat is not recommended in these patients (see sections 4.2 and 5.2).

 

Excipients

 

Lactose

This medicinal product contains lactose. Patients with rare hereditary problems of galactose intolerance, total lactase deficiency or glucose-galactose malabsorption should not take this medicinal product.

 

Sodium

This medicinal product contains less than 1 mmol sodium (23 mg) per dose, that is to say essentially “sodium-free”.


Pharmacodynamic interactions

 

Vericiguat co-administration with haemodynamic active substances did not result in a more than additive effect (see sections 4.4 and 5.1). In addition, vericiguat reduced systolic blood pressure by approximately 1 to 2 mmHg when co-administered with other medicinal products used in patients with heart failure (see section 4.8).

 

Other soluble guanylate cyclase (sGC) stimulators

Verquvo is contraindicated in patients with concomitant use of other soluble guanylate cyclase (sGC) stimulators, such as riociguat (see section 4.3).

 

PDE5 inhibitors

Addition of single doses of sildenafil (25, 50, or 100 mg) to multiple doses of vericiguat (10 mg) once daily in healthy subjects was associated with additional seated blood pressure (BP) reduction of less than or equal to 5.4 mmHg (systolic/diastolic BP, mean arterial pressure [MAP]) compared to administration of vericiguat alone. No dose-dependent trend was observed with the different sildenafil doses.

Co-administration was not associated with a clinically relevant effect on the exposure (AUC and Cmax) of either medicinal product.

Concomitant use of vericiguat and PDE5 inhibitors, such as sildenafil, has not been studied in patients with heart failure and is therefore not recommended due to the potential increased risk for symptomatic hypotension (see section 4.4).

 

Acetylsalicylic acid

Administration of a single dose of vericiguat (15 mg) in healthy subjects did not alter the effect of acetylsalicylic acid (500 mg) on bleeding time or platelet aggregation. Bleeding time or platelet aggregation did not change under treatment with vericiguat (15 mg) alone.

Co-administration of acetylsalicylic acid was not associated with a clinically relevant effect on the exposure (AUC and Cmax) of vericiguat.

 

Warfarin

Administration of multiple doses of vericiguat (10 mg) once daily in healthy subjects did not alter the effect of a single dose of warfarin (25 mg) on prothrombin time and the activities of Factors II, VII, and X.

Co-administration was not associated with a clinically relevant effect on the exposure (AUC and Cmax) of either medicinal product.

 

Combination of sacubitril/valsartan

Addition of multiple doses of vericiguat (2.5 mg) to multiple doses of sacubitril/valsartan (97/103 mg) in healthy subjects had no additional effect on seated blood pressure compared to administration of sacubitril/valsartan alone.

Co-administration was not associated with a clinically relevant effect on the exposure (AUC and Cmax) of either medicinal product.

 

Organic nitrates

Co-administration of multiple doses of vericiguat increased to 10 mg once daily did not significantly alter the seated blood pressure effects of short- and long-acting nitrates (nitroglycerin spray and isosorbide mononitrate [ISMN]) in patients with coronary artery disease. In patients with heart failure, concomitant use of short-acting nitrates was well tolerated. There is limited experience with concomitant use of vericiguat and long-acting nitrates in patients with heart failure (see section 4.4).

 

Pharmacokinetic interactions

 

Vericiguat is eliminated via multiple routes in humans. The dominant route is glucuronidation via UGT1A9 and UGT1A1, and vericiguat does not affect the pharmacokinetics of other medicinal products (see section 5.2).

 

UGT1A9/1A1 inhibitors

Vericiguat is metabolised by UGT1A9 and UGT1A1. Inhibitors of these UGTs may result in increased exposure of vericiguat.

No clinically meaningful effect on vericiguat exposure was observed when vericiguat was co- administered with mefenamic acid (weak to moderate UGT1A9 inhibitor).

As strong inhibition of UGT1A9 or combined UGT1A9/1A1 has not been tested in clinical drug-drug interaction studies due to the lack of available inhibitors, the clinical consequences of co- administration with these medicinal products are currently unknown.

 

Concomitant use with medicinal products that increase gastric pH

Co-treatment with medicinal products that increase gastric pH, such as proton pump inhibitors (omeprazole), H2-receptor antagonists or antacids (aluminium hydroxide/magnesium hydroxide) did not affect vericiguat exposure when vericiguat was taken as directed with food in heart failure patients (see section 4.2).

 

No significant interactions

Concomitant administration of medicinal products affecting one or more of vericiguat´s elimination pathways does not have a clinically relevant effect on the pharmacokinetics of vericiguat.

No clinically meaningful effect on vericiguat exposure was observed when vericiguat was

co-administered with ketoconazole (multi-pathway CYP and transporter inhibitor), or rifampicin (multi-pathway UGT, CYP and transporter inducer).

No clinically meaningful effect on midazolam (CYP3A substrate) or digoxin (P-gp substrate) exposure was observed when vericiguat was co-administered with these medicinal products.

 


Pregnancy

There are no data from the use of vericiguat in pregnant women. Studies in animals have shown reproductive toxicity in presence of maternal toxicity (see section 5.3). As a precautionary measure, vericiguat should not be used during pregnancy and in women of childbearing potential not using contraception.

 

Breast-feeding

There is no information regarding the presence of vericiguat in human milk, the effects on the breastfed infant, or the effects on milk production. Vericiguat is present in the milk of lactating rats. A risk to the breastfed child cannot be excluded.

A decision must be made whether to discontinue breast-feeding or to discontinue or abstain from vericiguat therapy, taking into account the benefit of breast-feeding for the child and the benefit of therapy for the woman.

 

Fertility

There are no data available on the effect of vericiguat on human fertility. In a study with male and female rats, vericiguat showed no impairment of fertility (see section 5.3).


Vericiguat has minor influence on the ability to drive or use machines. When driving vehicles or operating machines it should be taken into account that dizziness may occur occasionally.


Summary of the safety profile

 

The most frequently reported adverse reaction under treatment with vericiguat was hypotension (16.4%).

 

Tabulated list of adverse reactions

 

The safety of vericiguat was evaluated in a phase III study (VICTORIA) which included a total of 2,519 patients treated with vericiguat (up to 10 mg once daily) (see section 5.1). The mean duration of vericiguat exposure was 1 year and the maximum duration was 2.6 years.

 

The adverse reactions reported with vericiguat obtained from clinical studies are listed in the table below by MedDRA system organ class and by frequency. Frequencies are defined as very common (≥1/10), common (≥1/100 to <1/10), uncommon (≥1/1,000 to <1/100), rare (≥1/10,000 to <1/1,000), and very rare (<1/10,000).

 

Table 1: Adverse reactions

 

MedDRA

system organ class

Very common

Common

Blood and lymphatic system disorders

 

Anaemia

Nervous system disorders

 

Dizziness Headache

Vascular disorders

Hypotension

 

Gastrointestinal disorders

 

Nausea Dyspepsia Vomiting

Gastro-oesophageal reflux disease

 

Description of selected adverse reactions

 

Hypotension

Over the course of the VICTORIA study, the mean reduction in systolic blood pressure was approximately 1 to 2 mmHg greater in patients who received vericiguat compared with placebo. In VICTORIA, hypotension was reported in 16.4% of vericiguat-treated patients compared with 14.9% of placebo-treated patients. This includes also orthostatic hypotension that was reported in 1.3% of vericiguat-treated patients compared with 1.0% of placebo-treated patients. Symptomatic hypotension was reported in 9.1% of vericiguat-treated and 7.9% of placebo-treated patients, and was considered as a serious adverse event in 1.2% of vericiguat-treated patients and 1.5% of placebo-treated patients (see section 4.4).

 

Reporting of suspected adverse reactions

 

Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via the national reporting system listed in Appendix V.


Overdose of vericiguat may lead to hypotension. If necessary, symptomatic treatment should be provided. The medicinal product is unlikely to be removed by haemodialysis due to high protein binding.


Pharmacotherapeutic group: Cardiac therapy, other vasodilators used in cardiac diseases, ATC code: C01DX22

 

Mechanism of action

 

Vericiguat is a stimulator of soluble guanylate cyclase (sGC). Heart failure is associated with impaired synthesis of nitric oxide (NO) and decreased activity of its receptor, sGC. Deficiency in sGC-derived cyclic guanosine monophosphate (cGMP) contributes to myocardial and vascular dysfunction.

Vericiguat restores the relative deficiency in the NO-sGC-cGMP signalling pathway by directly stimulating sGC, independently of and synergistically with NO, to augment the levels of intracellular cGMP, which may improve both myocardial and vascular function.

 

Pharmacodynamic effects

 

The pharmacodynamic effects of vericiguat are consistent with the mode of action of a sGC stimulator resulting in smooth muscle relaxation and vasodilation.

 

In a 12-week placebo-controlled dose-finding study (SOCRATES-REDUCED) in patients with heart failure, vericiguat demonstrated a dose-dependent reduction in NT-proBNP, a biomarker in heart failure, compared to placebo when added to standard of care. In VICTORIA, the estimated reduction from baseline NT-proBNP at week 32 was greater in patients who received vericiguat compared with placebo (see clinical efficacy and safety).

 

Cardiac electrophysiology

In a dedicated QT study in patients with stable coronary artery disease, administration of 10 mg of vericiguat at steady state did not prolong the QT interval to a clinically relevant extent, i.e. the maximum mean prolongation of the QTcF interval did not exceed 6 ms (upper bound of the 90% CI

<10 ms).

 

Clinical efficacy and safety

 

The safety and efficacy of vericiguat were evaluated in a randomised, parallel-group, placebo- controlled, double-blind, event-driven, multi-centre trial (VICTORIA) comparing vericiguat and placebo in 5,050 adult patients with symptomatic chronic heart failure (NYHA class II–IV) and left ventricular ejection fraction (LVEF) less than 45% following a worsening heart failure (HF) event. A worsening chronic HF event was defined as heart failure hospitalisation within 6 months before randomisation or use of outpatient IV diuretics for heart failure within 3 months before randomisation.

 

Patients were treated up to the target maintenance dose of vericiguat 10 mg once daily or matching placebo in combination with other HF therapies. Therapy was initiated at 2.5 mg vericiguat once daily and increased in approximately 2 week intervals to 5 mg once daily and then 10 mg once daily, as tolerated. After approximately 1 year, 89% of vericiguat-treated patients and 91% of placebo-treated patients received the 10 mg target dose in addition to other HF therapies.

 

The primary endpoint was the time to first event of the composite of cardiovascular (CV) death or hospitalisation for HF. The median follow-up for the primary endpoint was 11 months. Patients on vericiguat were treated for a mean duration of 1 year and up to 2.6 years.

 

The mean age of the studied population was 67 years, a total of 1,596 (63%) patients treated with vericiguat were 65 years and older, and 783 (31%) patients treated with vericiguat were 75 years and older. At randomisation, 58.9% of patients were NYHA Class II, 39.7% were NYHA Class III, and 1.3% were NYHA Class IV. The mean LVEF was 28.9%, approximately half of all patients had an LVEF <30%, and 14.3% of patients had an LVEF between 40% and 45%. The most frequently reported medical history conditions other than HF included hypertension (79%), coronary artery disease (58%), hyperlipidaemia (57%), diabetes mellitus (47%), atrial fibrillation (45%), and myocardial infarction (42%). At randomisation, the mean eGFR was 62 mL/min/1.73 m2 (88% of patients >30 mL/min/1.73 m2; 10% of patients ≤30 mL/min/1.73 m2). 67% of the patients in VICTORIA were enrolled within 3 months of a HF hospitalisation; 17% were enrolled within 3 to

6 months of HF hospitalisation and 16% were enrolled within 3 months of outpatient treatment with IV diuretics. The median NT-proBNP level was 2,816 pg/mL at randomisation.

 

At baseline, more than 99% of patients were treated with other HF therapies which included beta blockers (93%), angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARB) (73%), mineralocorticoid receptor antagonists (MRA) (70%), a combination of an angiotensin receptor and neprilysin inhibitor (ARNI) (15%), ivabradine (6%), implantable cardiac defibrillators (28%), and biventricular pacemakers (15%). 91% of patients were treated with 2 or more HF medicinal products (beta blocker, any renin-angiotensin system [RAS] inhibitor, or MRA) and 60% of patients were treated with all 3. 3% of patients were on a sodium glucose co-transporter 2 (SGLT2) inhibitor.

 

Vericiguat was superior to placebo in reducing the risk of CV death or HF hospitalisation based on a time-to-event analysis. Over the course of the study, the annualised absolute risk reduction (ARR) was 4.2% with vericiguat compared with placebo. Therefore, 24 patients would need to be treated over an average of 1 year to prevent 1 primary endpoint event. The treatment effect reflected a reduction in the risk of CV death, HF hospitalisation, all-cause mortality or HF hospitalisation and total number of HF hospitalisation (see table 2 and figure 1).

 

Table 2: Treatment effect for the primary composite endpoint, its components, and the secondary endpoints

 

 

Vericiguat N=2,526

Placebo N=2,524

Treatment comparison

n (%)

[Annual %1]

n (%)

[Annual %1]

Hazard Ratio (95% CI)2 [Annualised ARR %]4

Primary endpoint

Composite of CV death or

897 (35.5)

972 (38.5)

0.90 (0.82, 0.98)

HF hospitalisation5

[33.6]

[37.8]

p = 0.0193

 

 

 

[4.2]

CV death

206 (8.2)

225 (8.9)

 

HF hospitalisation

691 (27.4)

747 (29.6)

 

Secondary endpoints

CV death

414 (16.4)

441 (17.5)

0.93 (0.81, 1.06)

 

[12.9]

[13.9]

 

HF hospitalisation

691 (27.4)

747 (29.6)

0.90 (0.81, 1.00)

 

[25.9]

[29.1]

 

Composite of all-cause mortality or HF hospitalisation5

957 (37.9)

[35.9]

1,032 (40.9)

[40.1]

0.90 (0.83, 0.98)

Total number of

HF hospitalisations (first and recurrent)

1,223

[38.3]

1,336

[42.4]

0.91 (0.84, 0.99)6

1 Total patients with an event per 100 patient years at risk.

2 Hazard ratio (vericiguat over placebo) and confidence interval from a Cox proportional hazards model.

3 From the log-rank test. p-value applies to HR only and not annualised ARR.

4 Annualised absolute risk reduction, calculated as difference (placebo-vericiguat) in annual %. 5 For patients with multiple events, only the first event contributing to the composite endpoint is counted.

6 Hazard ratio (vericiguat over placebo) and confidence interval from an Andersen-Gill model. N=Number of patients in Intent-to-treat (ITT) population; n=Number of patients with an event.

 

Figure 1: Kaplan-Meier curve for the primary composite endpoint: time to first occurrence of CV death or HF hospitalisation

 

A wide range of demographic characteristics, baseline disease characteristics and baseline concomitant medicinal products were examined for their influence on outcomes. The results of the primary composite endpoint were generally consistent across subgroups. Results of select pre-specified subgroup analyses are shown in figure 2.

 

 

Figure 2: Primary composite endpoint (time to first occurrence of CV death or HF hospitalisation) - select subgroups of the pre-specified analyses

 

 

Patients with very high NT-proBNP may not be fully stabilised and require further optimisation of volume status and diuretic therapy (see sections 4.1 and 4.2).

 

Paediatric population

The European Medicines Agency has deferred the obligation to submit the results of studies with Verquvo in one or more subsets of the paediatric population in the treatment of left ventricular failure (see section 4.2 for information on paediatric use).

 


General introduction

 

Vericiguat shows time-independent pharmacokinetics with low to moderate variability when administered with food. Pharmacokinetics are dose proportional in healthy volunteers and slightly less than dose proportional in heart failure patients. Vericiguat accumulates in plasma up to 155-171% and reaches pharmacokinetic steady state after approximately 6 days. The mean steady-state population pharmacokinetic parameters of vericiguat in heart failure patients are summarised in table 3. Steady- state exposure is estimated to be about 20% higher in heart failure patients when compared to healthy volunteers.

 

Table 3: Population pharmacokinetic model based steady-state geometric mean (CV%) plasma pharmacokinetic (PK) parameters of 2.5 mg, 5 mg, or 10 mg vericiguat in heart failure patients (N=2,321)

 

PK Parameters

2.5 mg

5 mg

10 mg

Cmax (µg/L)

120 (29.0)

201 (29.0)

350 (29.0)

AUC (µg•h/L)

2,300 (33.9)

3,850 (33.9)

6,680 (33.9)

 

Absorption

 

The absolute bioavailability of vericiguat is high (93%) when taken with food. Bioavailability (AUC) and peak plasma levels (Cmax) of vericiguat administered orally as a crushed tablet in water are comparable to that of a whole tablet (see section 4.2).

 

Effect of food

Administration of vericiguat with a high-fat, high-calorie meal increases Tmax from about 1 hour (fasted) to about 4 hours (fed), reduces PK variability, and increases vericiguat exposure by 19% (AUC) and 9% (Cmax) for the 5 mg tablet and by 44% (AUC) and 41% (Cmax) for the 10 mg tablet as compared with the fasted state. Similar results were obtained when vericiguat was administered with a low-fat, high-carbohydrate meal. Therefore, Verquvo should be taken with food (see section 4.2).

 

Distribution

 

The mean steady-state volume of distribution of vericiguat in healthy subjects is approximately 44 L. Plasma protein binding of vericiguat is about 98%, with serum albumin being the main binding component. Plasma protein binding of vericiguat is not altered by renal or hepatic impairment.

 

Biotransformation

 

Glucuronidation is the major biotransformation pathway of vericiguat to form an N-glucuronide, which is pharmacologically inactive and the major drug-related component in plasma, accounting for 72% of the total drug-related AUC, with the parent vericiguat accounting for 28% of the total drug- related AUC. N-glucuronidation is catalysed predominantly by UGT1A9, as well as UGT1A1.

CYP-mediated metabolism is a minor clearance pathway (<5%).

 

The potential effect of UGT-related genetic polymorphism has not been investigated given the low-to- moderate inter-individual variability of vericiguat (see table 3). Titration of vericiguat mitigates the clinical impact of potential changes in exposure (see section 4.2).

 

Elimination

 

Vericiguat is a low-clearance drug (1.6 L/h in healthy subjects). The half-life is about 20 hours in healthy subjects and 30 hours in heart failure patients. Following oral administration of

[14C]-vericiguat to healthy subjects, approximately 53% of the dose was excreted in urine (primarily as

 

the N-glucuronide), and 45% of the dose was excreted in faeces (primarily as vericiguat, likely due to excretion of the N-glucuronide into bile followed by hydrolysis back to vericiguat by intestinal microflora).

 

Special populations

 

Renal impairment

In patients with heart failure with mild, moderate, and severe renal impairment not requiring dialysis, the mean exposure (AUC) of vericiguat was increased by 5%, 13%, and 20% respectively, compared to patients with normal renal function. These differences in exposure are not considered clinically relevant. The pharmacokinetics of vericiguat have not been studied in patients with eGFR <15 mL/min/1.73 m2 at treatment initiation or on dialysis (see sections 4.2 and 4.4).

 

In a dedicated clinical pharmacology study, otherwise healthy participants with mild, moderate, and severe renal impairment, had 8%, 73%, and 143% respectively, higher mean vericiguat exposure (unbound AUC normalised for body weight) after a single dose compared to healthy controls.

 

The apparent discrepancy of the effect of renal impairment on vericiguat exposure between the dedicated clinical pharmacology study and the analysis in patients with heart failure may be attributed to differences in study design and size.

 

Hepatic impairment

No relevant increase in exposure (unbound AUC) was observed for subjects with mild hepatic impairment (Child-Pugh A) with mean exposure to vericiguat 21% higher compared to healthy subjects with normal hepatic function. In subjects with moderate hepatic impairment (Child-Pugh B), mean exposure to vericiguat was approximately 47% higher compared to their healthy subjects with normal hepatic function. The pharmacokinetics of vericiguat have not been studied in patients with severe hepatic impairment (Child-Pugh C) (see sections 4.2 and 4.4).

 

Effects of age, body weight, gender, ethnicity, race and baseline NT-proBNP

Based on an integrated population pharmacokinetic analysis of vericiguat in patients with heart failure, age (23-98 years), body weight, gender, ethnicity, race and baseline NT-proBNP do not have a clinically meaningful effect on the pharmacokinetics of vericiguat (see section 5.1).

 

Paediatric population

No studies with vericiguat have been performed yet in paediatric patients.

 

In vitro assessment of medicinal product interactions

 

Vericiguat is a substrate for UGT1A9, as well as UGT1A1 (see section 4.5). In vitro studies indicate that vericiguat and its N-glucuronide are neither inhibitors of major CYP isoforms (CYP1A2, 2B6, 2C8, 2C9, 2C19, 2D6 and 3A4) or UGT isoforms (UGT1A1, 1A4, 1A6, 1A9, 2B4, and 2B7), nor

inducers of CYP1A2, 2B6 and 3A4, at clinically relevant concentrations.

 

Vericiguat is a substrate of P-glycoprotein (P-gp) and breast cancer resistance protein (BCRP) transporters and is not a substrate of organic cation transporter (OCT1) or organic anion transporting polypeptides (OATP1B1, OATP1B3). Vericiguat and its N-glucuronide are not inhibitors of drug transporters, including P-gp, BCRP, BSEP, OATP1B1/1B3, OAT1, OAT3, OCT1, OCT2, MATE1, and MATE2K, at clinically relevant concentrations.

 

Overall, these data indicate that the administration of vericiguat is unlikely to affect the pharmacokinetics of concurrently administered medicinal products that are substrates of these enzymes or transporters.


Non-clinical data reveal no special hazard for humans based on conventional studies of safety pharmacology, repeated dose toxicity, genotoxicity, carcinogenic potential, and male and female fertility.

 

In repeat-dose toxicity studies, the toxicological profile was characterised by effects secondary to exaggerated pharmacodynamics. Secondary to smooth muscle relaxation haemodynamic and gastrointestinal effects were noted in all species investigated.

In adolescent rapidly-growing rats, reversible bone effects consisting of hypertrophy of growth plate and hyperostosis and remodelling of metaphyseal and diaphyseal bone were seen. These effects were not observed after chronic administration of vericiguat to adult rats and almost full-grown dogs.

 

A study in pregnant rats showed that vericiguat is transferred to the foetus through the placenta. Developmental toxicity studies in rats with vericiguat administered orally during organogenesis showed no developmental toxicity up to at least 21 times the human exposure (based on unbound AUC) at the maximum recommended human dose (MRHD) of 10 mg. In rabbits, late abortions and resorptions were observed, at maternally toxic doses at ≥6 times the human exposure at the MRHD. In a pre-/postnatal toxicity study in rats, at maternal toxic doses decreased pup body weight gain resulting in a slight delay in incisor eruption and a slight delay in vaginal opening was observed at approximately ≥21 times the human exposure at the MRHD. An increased incidence of stillbirths and decreased pup survival and a delay in balano-preputial separation were observed at 49 times the human exposure at the MRHD.


Tablet core

Microcrystalline cellulose

Croscarmellose sodium

Hypromellose 2910

Lactose monohydrate

Magnesium stearate

Sodium laurilsulfate

 

Film-coat

Hypromellose 2910 Talc

Titanium dioxide (E 171)

Iron oxide red (E 172) (Verquvo 5 mg only)

Iron oxide yellow (E 172) (Verquvo 10 mg only)


Not applicable.


3 Years

Do not store above 30°C


PVC/PVDC/Aluminium foil blisters in cartons of 14, 28 or 98 film-coated tablets or perforated unit dose blisters in cartons of 10 × 1 or 100 × 1 film-coated tablets.

PP/Aluminium foil blisters in cartons of 14, 28 or 98 film-coated tablets or perforated unit dose blisters in cartons of 10 × 1 or 100 × 1 film-coated tablets.

HDPE bottles with a PP screw cap containing 100 film-coated tablets.

Not all pack sizes may be marketed.


Any unused medicinal product or waste material should be disposed of in accordance with local requirements.


Bayer AG 51368 Leverkusen Germany

07/2021
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