Ezeact is indicated for the treatment of essential hypertension in adults.

Posology
The recommended starting dose is 40 mg once daily. The dose may be increased to a maximum of
80 mg once daily for patients whose blood pressure is not adequately controlled at the lower dose.
Near-maximal antihypertensive effect is evident at 2 weeks, with maximal effects attained by
4 weeks.
If blood pressure is not adequately controlled with Ezeact alone, additional blood pressure reduction
can be achieved when this treatment is coadministered with other antihypertensive medicinal products, including diuretics (such as chlorthalidone and hydrochlorothiazide) and calcium
channel blockers (see sections 4.3, 4.4, 4.5 and 5.1).
Special populations
Elderly (65 years and over)
No initial dose adjustment with Ezeact is necessary in elderly patients (see section 5.2), although
consideration can be given to 20 mg as a starting dose in the very elderly (≥ 75 years), who may be at
risk of hypotension.
Renal impairment
Caution should be exercised in hypertensive patients with severe renal impairment and end stage renal
disease as there is no experience of use of Ezeact in these patients (see sections 4.4 and 5.2).
Hemodialysis does not remove azilsartan from the systemic circulation.
No dose adjustment is required in patients with mild or moderate renal impairment.
Hepatic impairment
Ezeact has not been studied in patients with severe hepatic impairment and therefore its use is not
recommended in this patient group (see sections 4.4 and 5.2).
As there is limited experience of use of Ezeact in patients with mild to moderate hepatic impairment
close monitoring is recommended and consideration should be given to 20 mg as a starting dose (see
section 5.2).
Intravascular volume depletion
For patients with possible depletion of intravascular volume or salt depletion (e.g. patients with
vomiting, diarrhoea or taking high doses of diuretics), Ezeact should be initiated under close medical
supervision and consideration can be given to 20 mg as a starting dose (see section 4.4)

Black population
No dose adjustment is required in the black population, although smaller reductions in blood pressure
are observed compared with a non-black population (see section 5.1). This generally has been true for
other angiotensin II receptor (AT1) antagonists and angiotensin-converting enzyme inhibitors.
Consequently, uptitration of Ezeact and concomitant therapy may be needed more frequently for
blood pressure control in black patients.
Paediatric population
The safety and efficacy of Ezeact in children and adolescents aged 0 to < 18 years have not yet been
established.
No data are available.
Method of administration
Ezeact is for oral use and may be taken with or without food (see section 5.2).

- Hypersensitivity to the active substance or to any of the excipients listed in section 6.1. - Second and third trimester of pregnancy (see sections 4.4 and 4.6). - The concomitant use of Ezeact with aliskiren-containing products is contraindicated in patients with diabetes mellitus or renal impairment (GFR < 60 mL/min/1.73m2) (see sections 4.5 and 5.1).

Activated renin-angiotensin-aldosterone system (RAAS)
In patients whose vascular tone and renal function depend predominantly on the activity of the RAAS
(e.g. patients with congestive heart failure, severe renal impairment or renal artery stenosis), treatment with medicinal products that affect this system, such as angiotensin-converting enzyme (ACE)
inhibitors and angiotensin II receptor antagonists, has been associated with acute hypotension,
azotaemia, oliguria or, rarely, acute renal failure. The possibility of similar effects cannot be excluded
with Ezeact.
Caution should be exercised in hypertensive patients with severe renal impairment, congestive heart
failure or renal artery stenosis, as there is no experience of use of Ezeact in these patients (see
sections 4.2 and 5.2).
Excessive blood pressure decreases in patients with ischaemic cardiomyopathy or ischaemic
cerebrovascular disease could result in a myocardial infarction or stroke.
Dual blockade of the RAAS
There is evidence that the concomitant use of ACE-inhibitors, angiotensin II receptor blockers or
aliskiren increases the risk of hypotension, hyperkalaemia and decreased renal function (including
acute renal failure). Dual blockade of RAAS through the combined use of ACE-inhibitors,
angiotensin II receptor blockers or aliskiren is therefore not recommended (see sections 4.5 and 5.1).
If dual blockade therapy is considered absolutely necessary, this should only occur under specialist
supervision and subject to frequent close monitoring of renal function, electrolytes and blood
pressure.
ACE-inhibitors and angiotensin II receptor blockers should not be used concomitantly in patients with
diabetic nephropathy.
Kidney transplantation
There is currently no experience on the use of Ezeact in patients who have recently undergone kidney
transplantation.
Hepatic impairment

Ezeact has not been studied in patients with severe hepatic impairment and therefore its use is not
recommended in this patient group (see sections 4.2 and 5.2).
Hypotension in volume- and /or salt-depleted patients
In patients with marked volume- and/or salt-depletion (e.g. patients with vomiting, diarrhoea or taking
high doses of diuretics) symptomatic hypotension could occur after initiation of treatment with
Ezeact. Hypovolemia should be corrected prior to administration of Ezeact, or the treatment should
start under close medical supervision, and consideration can be given to a starting dose of 20 mg.
Primary hyperaldosteronism
Patients with primary hyperaldosteronism generally will not respond to antihypertensive medicinal
products acting through inhibition of the RAAS. Therefore, the use of Ezeact is not recommended in
these patients.
Hyperkalaemia
Based on experience with the use of other medicinal products that affect the RAAS, concomitant use
of Ezeact with potassium-sparing diuretics, potassium supplements, salt substitutes containing
potassium, or other medicinal products that may increase potassium levels (e.g. heparin) may lead to
increases in serum potassium in hypertensive patients (see section 4.5). In the elderly, in patients with
renal insufficiency, in diabetic patients and/or in patients with other co-morbidities, the risk of
hyperkalaemia, which may be fatal, is increased. Monitoring of potassium should be undertaken as
appropriate.
Aortic and mitral valve stenosis, obstructive hypertrophic cardiomyopathy
Special caution is indicated in patients suffering from aortic or mitral valve stenosis, or hypertrophic
obstructive cardiomyopathy (HOCM).

Pregnancy
Angiotensin II receptor antagonists should not be initiated during pregnancy. Unless continued
angiotensin II receptor antagonist therapy is considered essential, patients planning pregnancy should
be changed to alternative antihypertensive treatments which have an established safety profile for use
in pregnancy. When pregnancy is diagnosed, treatment with angiotensin II receptor antagonists should
be stopped immediately, and, if appropriate, alternative therapy should be started (see sections 4.3
and 4.6).
Lithium
As with other angiotensin II receptor antagonists the combination of lithium and Ezeact is not
recommended (see section 4.5).

Concomitant use not recommended
Lithium
Reversible increases in serum lithium concentrations and toxicity have been reported during
concurrent use of lithium and angiotensin-converting enzyme inhibitors. A similar effect may occur
with angiotensin II receptor antagonists. Due to the lack of experience with concomitant use of
azilsartan medoxomil and lithium, this combination is not recommended. If the combination proves
necessary, careful monitoring of serum lithium levels is recommended.
Caution required with concomitant use
Non-steroidal anti-inflammatory drugs (NSAIDs), including selective COX-2 inhibitors,
acetylsalicylic acid > 3 g/day), and non-selective NSAIDs
When angiotensin II receptor antagonists are administered simultaneously with NSAIDs (i.e. selective
COX-2 inhibitors, acetylsalicylic acid (> 3 g/day) and non-selective NSAIDs), attenuation of the
antihypertensive effect may occur. Furthermore, concomitant use of angiotensin II receptor
antagonists and NSAIDs may lead to an increased risk of worsening of renal function and an increase
in serum potassium. Therefore, adequate hydration and monitoring of renal function at the beginning
of the treatment are recommended.
Potassium-sparing diuretics, potassium supplements, salt substitutes containing potassium and other
substances that may increase potassium levels
Concomitant use of potassium-sparing diuretics, potassium supplements, salt substitutes containing
potassium, or other medicinal products (e.g. heparin) may increase potassium levels. Monitoring of
serum potassium should be undertaken as appropriate (see section 4.4).
Additional information

Clinical trial data has shown that dual blockade of the RAAS through the combined use of
ACE-inhibitors, angiotensin II receptor blockers or aliskiren is associated with a higher frequency of
adverse events such as hypotension, hyperkalaemia and decreased renal function (including acute
renal failure) compared to the use of a single RAAS-acting agent (see sections 4.3, 4.4 and 5.1).
No clinically significant interactions have been reported in studies of azilsartan medoxomil or
azilsartan given with amlodipine, antacids, chlortalidone, digoxin, fluconazole, glyburide,
ketoconazole, metformin, and warfarin.
Azilsartan medoxomil is rapidly hydrolysed to the active moiety azilsartan by esterases in the
gastrointestinal tract and/or during drug absorption (see section 5.2). In vitro studies indicated that
interactions based on esterase inhibition are unlikely.

Pregnancy
The use of angiotensin II receptor antagonists is not recommended during the first trimester of
pregnancy (see section 4.4).
The use of angiotensin II receptor antagonists is contraindicated during the second and third trimester
of pregnancy (see sections 4.3 and 4.4).
There are no data from the use of azilsartan medoxomil in pregnant women. Studies in animals have
shown reproductive toxicity (see section 5.3).
Epidemiological evidence regarding the risk of teratogenicity following exposure to angiotensin
converting enzyme inhibitors during the first trimester of pregnancy has not been conclusive;
however, a small increase in risk cannot be excluded. Whilst there are no controlled epidemiological
data on the risk with angiotensin II receptor antagonists, similar risks may exist for this class of
medicinal products. Unless continued angiotensin II receptor antagonist therapy is considered
essential, patients planning pregnancy should be changed to alternative anti-hypertensive treatments
which have an established safety profile for use in pregnancy. When pregnancy is diagnosed,
treatment with angiotensin II receptor antagonists should be stopped immediately and, if appropriate,
alternative therapy should be started.
Exposure to angiotensin II receptor antagonist therapy during the second and third trimesters is known
to induce human fetotoxicity (decreased renal function, oligohydramnios, skull ossification
retardation) and neonatal toxicity (renal failure, hypotension, hyperkalaemia) (see section 5.3).
Should exposure to angiotensin II receptor antagonists have occurred from the second trimester of
pregnancy, ultrasound check of renal function and skull is recommended.

Infants whose mothers have taken Angiotensin II receptor antagonists should be closely observed for
hypotension (see sections 4.3 and 4.4).
Breast-feeding
Because no information is available regarding the use of azilsartan medoxomil during breastfeeding,
Ezeact is not recommended and alternative treatments with better established safety profiles during
breastfeeding are preferable, especially while breast-feeding a newborn or preterm infant.
Fertility
No data are available on the effect of azilsartan medoxomil on human fertility. Nonclinical studies
demonstrated that azilsartan did not appear to affect male or female fertility in the rat (see
section 5.3).

Azilsartan medoxomil has no or negligible influence on the ability to drive and use machines.
However it should be taken into account that occasionally dizziness or tiredness may occur.

Summary of the safety profile
Ezeact at doses of 20, 40 or 80 mg has been evaluated for safety in clinical studies in patients treated
for up to 56 weeks. In these clinical studies, adverse reactions associated with treatment with Ezeact
were mostly mild or moderate, with an overall incidence similar to placebo. The most common
adverse reaction was dizziness. The incidence of adverse reactions with this treatment was not affected by gender, age, or race. Adverse reactions were reported at a similar frequency for the Ezeact
20 mg dose as with the 40 and 80 mg doses in one placebo controlled study.
Tabulated list of adverse reactions
Adverse reactions based on pooled data (40 and 80 mg doses) are listed below according to system
organ class and preferred terms. These are ranked by frequency, using the following convention: 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); very rare (< 1/10,000), including isolated reports. Within each
frequency grouping, adverse reactions are presented in order of decreasing seriousness.

System organ class                                                                 Frequency                                        Adverse reaction
Nervous system disorders                                                    Common                                                Dizziness
Vascular disorders                                                                 Uncommon                                           Hypotension
Gastrointestinal disorders                                                    Common                                                  Diarrhoea
                                                                                                 Uncommon                                                Nausea

Skin and subcutaneous tissue
disorders                                                                                 Uncommon                                           Rash, pruritus
                                                                                                         Rare                                                   Angioedema
 
Musculoskeletal and
connective tissue disorders                                                  Uncommon                                         Muscle spasms
General disorders and
administration site conditions                                           Uncommon                                             Fatigue
Peripheral oedema
Investigations                                                                        Common                                                 Blood creatine phosphokinase increased
                                                                                                Uncommon                                                Blood creatinine increased
                                                                                                                                                                  Blood uric acid increased / Hyperuricemia

 

Description of selected adverse reactions
When Ezeact was coadministered with chlorthalidone, the frequencies of blood creatinine
increased and hypotension were increased from uncommon to common.
When Ezeact was coadministered with amlodipine, the frequency of peripheral oedema was increased
from uncommon to common, but was lower than amlodipine alone.
Investigations
Serum creatinine
The incidence of elevations in serum creatinine following treatment with Ezeact was similar to placebo
in the randomised placebo-controlled monotherapy studies. Coadministration of Ezeact with diuretics,
such as chlortalidone, resulted in a greater incidence of creatinine elevations, an observation consistent
with that of other angiotensin II receptor antagonists and angiotensin converting enzyme inhibitors.
The elevations in serum creatinine during coadminstiration of Ezeact with diuretics were associated
with larger blood pressure reductions compared with a single medicinal product. Many of these
elevations were transient or nonprogressive while subjects continued to receive treatment. Following
discontinuation of treatment, the majority of the elevations that had not resolved during treatment were
reversible, with the creatinine levels of most subjects returning to baseline or near- baseline values.
Uric acid
Small mean increases of serum uric acid were observed with Ezeact (10.8 μmol/l) compared with
placebo (4.3 μmol/l).

Hemoglobin and hematocrit
Small decreases in hemoglobin and hematocrit (mean decreases of approximately 3 g/l and 1 volume
percent, respectively) were observed in placebo-controlled monotherapy studies. This effect is also
seen with other inhibitors of the RAAS.

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 National Pharmacovigilance
and Drug Safety Centre (NPC) listed below:

• Saudi Arabia:
The National Pharmacovigilance and Drug Safety Centre (NPC)
Fax: +966-11-205-7662
Call NPC at +966-11-2038222
Exts: 2317-2356-2353-2354-2334-2340.
Toll free phone:
8002490000
E-mail: npc.drug@sfda.gov.sa
Website:www.sfda.gov.sa/npc

Symptoms
Based on pharmacological considerations, the main manifestation of an overdose is likely to be
symptomatic hypotension and dizziness. During controlled clinical studies in healthy subjects,
once daily doses up to 320 mg of azilsartan medoxomil were administered for 7 days and were
well tolerated.
Management
If symptomatic hypotension should occur, supportive treatment should be instituted and vital
signs monitored.
Azilsartan is not removed by dialysis.

Pharmacotherapeutic group: Agents acting on the renin-angiotensin system, angiotensin II
antagonists, plain, ATC Code: C09CA09
Mechanism of action
Azilsartan medoxomil is an orally active prodrug that is rapidly converted to the active moiety,
azilsartan, which selectively antagonises the effects of angiotensin II by blocking its binding to the
AT1 receptor in multiple tissues (see section 5.2). Angiotensin II is the principal pressor agent of the
RAAS, with effects that include vasoconstriction, stimulation of synthesis and release of
aldosterone, cardiac stimulation, and renal reabsorption of sodium.
Blockade of the AT1 receptor inhibits the negative regulatory feedback of angiotensin II on renin
secretion, but the resulting increases in plasma renin activity and angiotensin II circulating levels
do not overcome the antihypertensive effect of azilsartan.
Essential hypertension
In seven double blind controlled studies, a total of 5,941 patients (3,672 given Ezeact, 801 given
placebo, and 1,468 given active comparator) were evaluated. Overall, 51% of patients were male
and 26% were 65 years or older (5% ≥ 75 years); 67% were white and 19% were black.
Ezeact was compared with placebo and active comparators in two 6 week randomised, double blind
studies. Blood pressure reductions compared with placebo based on 24 hour mean blood pressure by
ambulatory blood pressure monitoring (ABPM) and clinic blood pressure measurements at trough
are shown in the table below for both studies. Additionally, Ezeact 80 mg resulted in significantly
greater reductions in SBP than the highest approved doses of olmesartan medoxomil and valsartan.

headache and dyslipidemia. For Ezeact, olmesartan medoxomil and valsartan, respectively
dizziness was observed at an incidence of 3.0%, 3.3% and 1.8%; headache at 4.8%, 5.5% and
7.6% and dyslipidemia at 3.5%, 2.4% and 1.1%.
In active-comparator studies with either valsartan or ramipril, the blood-pressure-lowering effect
with Ezeact was sustained during long-term treatment. Ezeact had a lower incidence of cough
(1.2%) compared with ramipril (8.2%).
The antihypertensive effect of azilsartan medoxomil occurred within the first 2 weeks of dosing with
the full effect achieved by 4 weeks. The blood pressure lowering effect of azilsartan medoxomil was
also maintained throughout the 24 hour dosing interval. The placebo-corrected trough-to-peak ratios
for SBP and DBP were approximately 80% or higher.
Rebound hypertension was not observed following abrupt cessation of Ezeact therapy after 6
months of treatment.
No overall differences in safety and effectiveness were observed between elderly patients and
younger patients, but greater sensitivity to blood pressure lowering effects in some elderly
individuals cannot
be ruled out (see section 4.2). As with other angiotensin II receptor antagonists and angiotensin
converting enzyme inhibitors the antihypertensive effect was lower in black patients (usually a
low- renin population).

Coadministration of Ezeact 40 and 80 mg with a calcium channel blocker (amlodipine) or a
thiazide- type diuretic (chlortalidone) resulted in additional blood pressure reductions compared
with the other antihypertensive alone. Dose dependent adverse events including dizziness,

hypotension and serum creatinine elevations were more frequent with diuretic coadministration
compared with Ezeact alone, while hypokalemia was less frequent compared with diuretic alone.
Beneficial effects of Ezeact on mortality and cardiovascular morbidity and target organ damage
are currently unknown.
Effect on cardiac repolarisation
A thorough QT/QTc study was conducted to assess the potential of azilsartan medoxomil to prolong
the QT/QTc interval in healthy subjects. There was no evidence of QT/QTc prolongation at a dose of
320 mg of azilsartan medoxomil.
Additional information
Two large randomised, controlled trials (ONTARGET (ONgoing Telmisartan Alone and in
combination with Ramipril Global Endpoint Trial) and VA NEPHRON-D (The Veterans Affairs
Nephropathy in Diabetes)) have examined the use of the combination of an ACE-inhibitor with an
angiotensin II receptor blocker.
ONTARGET was a study conducted in patients with a history of cardiovascular or cerebrovascular
disease, or type 2 diabetes mellitus accompanied by evidence of end-organ damage.
VA NEPHRON-D was a study in patients with type 2 diabetes mellitus and diabetic nephropathy.
These studies have shown no significant beneficial effect on renal and/or cardiovascular outcomes
and mortality, while an increased risk of hyperkalaemia, acute kidney injury and/or hypotension as
compared to monotherapy was observed. Given their similar pharmacodynamic properties, these
results are also relevant for other ACE-inhibitors and angiotensin II receptor blockers.

ACE inhibitors and angiotensin II receptor blockers should therefore not be used concomitantly in
patients with diabetic nephropathy.
ALTITUDE (Aliskiren Trial in Type 2 Diabetes Using Cardiovascular and Renal Disease Endpoints)
was a study designed to test the benefit of adding aliskiren to a standard therapy of an ACE inhibitor
or an angiotensin II receptor blocker in patients with type 2 diabetes mellitus and chronic kidney
disease, cardiovascular disease, or both. The study was terminated early because of an increased risk
of adverse outcomes. Cardiovascular death and stroke were both numerically more frequent in the
aliskiren group than in the placebo group and adverse events and serious adverse events of interest
(hyperkalaemia, hypotension and renal dysfunction) were more frequently reported in the aliskiren
group than in the placebo group.
Paediatric population
The European Medicines Agency has deferred the obligation to submit the results of studies with
Ezeact in one or more subsets of the paediatric population in hypertension (see section 4.2 for
information on paediatric use).

Following oral administration, azilsartan medoxomil is rapidly hydrolyzed to the active moiety
azilsartan in the gastrointestinal tract and/or during absorption. Based on in vitro studies,
carboxymethylenebutenolidase is involved in the hydrolysis in the intestine and liver. In addition,
plasma esterases are involved in the hydrolysis of azilsartan medoxomil to azilsartan.
Absorption
The estimated absolute oral bioavailability of azilsartan medoxomil based on plasma levels of
azilsartan is approximately 60%. After oral administration of azilsartan medoxomil, peak plasma
concentrations (Cmax) of azilsartan are reached within 1.5 to 3 hours. Food does not affect the
bioavailability of azilsartan (see section 4.2).
Distribution

The volume of distribution of azilsartan is approximately 16 litres. Azilsartan is highly bound to
plasma proteins (> 99%), mainly serum albumin. Protein binding is constant at azilsartan plasma
concentrations well above the range achieved with recommended doses.
Biotransformation
Azilsartan is metabolised to two primary metabolites. The major metabolite in plasma is formed by
O- dealkylation, referred to as metabolite M-II, and the minor metabolite is formed by
decarboxylation, referred to as metabolite M-I. Systemic exposures to the major and minor
metabolites in humans were approximately 50% and less than 1% that of azilsartan, respectively. M-I
and M-II do not contribute
to the pharmacologic activity of azilsartan medoxomil. The major enzyme responsible for
azilsartan metabolism is CYP2C9.
Elimination
Following an oral dose of 14C-labelled azilsartan medoxomil, approximately 55% of radioactivity
was recovered in faeces and approximately 42% in urine, with 15% of the dose excreted in urine as
azilsartan. The elimination half-life of azilsartan is approximately 11 hours and renal clearance is
approximately 2.3 ml/min. Steady-state levels of azilsartan are achieved within 5 days and no
accumulation in plasma occurs with repeated once-daily dosing.

Linearity/non-linearity
Dose proportionality in exposure was established for azilsartan in the azilsartan medoxomil
dose range of 20 mg to 320 mg after single or multiple dosing.
Characteristics in specific groups of patients
Paediatric population
The pharmacokinetics of azilsartan have not been studied in children under 18 years of age.
Older people
Pharmacokinetics of azilsartan do not differ significantly between young (age range 18-45 years)
and elderly (age range 65-85 years) patients.
Renal impairment
In patients with mild, moderate, and severe renal impairment azilsartan total exposure (AUC) was
+30%, +25% and +95% increased. No increase (+5%) was observed in end-stage renal disease
patients who were dialysed. However, there is no clinical experience in patients with severe renal
impairment or end stage renal disease (see section 4.2). Hemodialysis does not remove azilsartan
from the systemic circulation.
Hepatic impairment
Administration of Ezeact for up to 5 days in subjects with mild (Child-Pugh A) or moderate
(Child-Pugh B) hepatic impairment resulted in slight increase in azilsartan exposure (AUC
increased by 1.3 to 1.6 fold, see section 4.2). Ezeact has not been studied in patients with severe
hepatic impairment.

Gender
Pharmacokinetics of azilsartan do not differ significantly between males and females. No
dose adjustment is necessary based on gender.
Race
Pharmacokinetics of azilsartan do not differ significantly between black and white populations.
No dose adjustment is necessary based on race.

In preclinical safety studies, azilsartan medoxomil and M-II, the major human metabolite,
were examined for repeated-dose toxicity, reproduction toxicity, mutagenicity and
carcinogenicity.
In the repeated-dose toxicity studies, doses producing exposure comparable to that in the
clinical therapeutic range caused reduced red cell parameters, changes in the kidney and renal
haemodynamics, as well as increased serum potassium in normotensive animals. These effects, which
were prevented by oral saline supplementation, do not have clinical significance in treatment of
hypertension.
In rats and dogs, increased plasma renin activity and hypertrophy/hyperplasia of the renal
juxtaglomerular cells were observed. These changes, also a class effect of angiotensin converting
enzyme inhibitors and other angiotensin II receptor antagonists, do not appear to have clinical
significance.
Azilsartan and M-II crossed the placenta and were found in the fetuses of pregnant rats and were
excreted into the milk of lactating rats. In the reproduction toxicity studies, there were no effects on
male or female fertility. There is no evidence of a teratogenic effect, but animal studies indicated
some hazardous potential to the postnatal development of the offspring such as lower body weight, a
slight delay in physical development (delayed incisor eruption, pinna detachment, eye opening), and
higher mortality.
Azilsartan and M-II showed no evidence of mutagenicity and relevant clastogenic activity in in vitro
studies and no evidence of carcinogenicity in rats and mice.

Mannitol (E 421)
Fumaric acid (E297)
Sodium hydroxide
Hydroxypropylcellulose (E 463)
Croscarmellose sodium
Microcrystalline cellulose (E 460)
Magnesium stearate (E 572)

Not applicable.

3 years.

Do not store above 30 °C. Store in the original package in order to protect from
light and moisture. Keep out of the reach and sight of children.
Do not use Ezeact after the expiry date which is stated on the carton after EXP. The
expiry date refers to the last day of the month.

Aluminum blisters integrated with desiccant.
Pack sizes: One blister pack contains either 7 tablets or 14 tablets or 15 tablets.
14, 28, 30, 56, 90 or 98 tablets. Not all pack sizes may be marketed.

No special requirements.

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