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BIFENICO 30 MG/12.5 MG FILM-COATED TABLETS

Active substance(s): HYDROCHLOROTHIAZIDE / ZOFENOPRIL CALCIUM

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PACKAGE LEAFLET: INFORMATION FOR THE USER

Bifenico 30mg /12.5 mg film-coated tablets
(Zofenopril Calcium / Hydrochlorothiazide)

Read all of this leaflet carefully before you start taking this medicine because it contains important
information for you.
- Keep this leaflet. You may need to read it again.
- If you have any further questions, ask your doctor or pharmacist.
- This medicine has been prescribed for you. Do not pass it on to others. It may harm them, even if their
signs of illness are the same as yours.
- If you get any side effects talk to your doctor or pharmacist. This includes any possible side effects not
listed in this leaflet. See section 4.
What is in this leaflet:
1. What Bifenico is and what it is used for
2. What you need to know before you take Bifenico3. How to take Bifenico
4. Possible side effects
5. How to store Bifenico
6. Content of the pack and other information
1. WHAT BIFENICO IS AND WHAT IT IS USED FOR
Bifenico contains zofenopril calcium 30 mg and hydrochlorothiazide 12.5 mg as the active ingredients.
• Zofenopril calcium is a cardiovascular drug which belongs to a group of blood pressure lowering
medicines called angiotensin converting enzyme (ACE) inhibitors.
• Hydrochlorothiazide is a diuretic, that acts by increasing the amount of urine you produce.
Bifenico is used to treat mild to moderate high blood pressure (hypertension), when this is not adequately
controlled by taking zofenopril alone.
2. WHAT YOU NEED TO KNOW BEFORE YOU TAKE BIFENICO
Do Not take Bifenico if you:
• are more than 3 months pregnant (It is also better to avoid Bifenico in early pregnancy - see “pregnancy
section”).
• are allergic (hypersensitive) to zofenopril or to hydrochlorothiazide or to any of the ingredients in the
product (see Section 6 ‘What Bifenico contains’ and end of Section 2 ‘Bifenico contains lactose’)
• are allergic (hypersensitive) to other sulphonamide-derived substances (like hydrochlorothiazide, which
is a sulphonamide-derived drug)
• have had any previous allergic reaction to any other ACE inhibitor such as captopril or enalapril
• have a history of severe swelling and itching around the face, nose and throat (angioneurotic oedema)
associated with previous ACE inhibitor therapy, or if you suffer from hereditary/idiopathic angioneurotic
oedema (rapid swelling of the skin, tissues, digestive tract and other organs)
• suffer from severe liver or kidney problems
• suffer from narrowing of the arteries to the kidneys
• have diabetes or impaired kidney function and you are treated with a blood pressure lowering medicine
containing aliskiren
Warnings and precautions
Talk to your doctor before taking Bifenico if you:
• have liver or kidney problems

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have high blood pressure that is caused by a kidney problem or by narrowing of the artery leading to the
kidney (renovascular hypertension)
have recently had a kidney transplant
are undergoing dialysis
are on LDL apheresis (a procedure similar to kidney dialysis that clears your blood of harmful
cholesterol)
have abnormally high levels of the hormone aldosterone in your blood (primary aldosteronism)
have a narrowing of the heart valve (aortic stenosis) or thickening of the heart walls (hypertrophic
cardiomyopathy)
suffer or have suffered from psoriasis (skin disease characterised by scaly pink patches)
are receiving desensitization treatment (‘allergy injections’) for insect stings
have lupus erythematosus (a disorder of the immune system, your body’s defence system)
if you tend to have low blood potassium, and especially if you suffer from prolonged QT syndrome (a
kind of ECG abnormality) or you are taking digitalis (to help your heart pump)
have diabetes
if you have angina or disorders affecting the brain, since low blood pressure can lead to a heart attack or
stroke.
are taking any of the following medicines used to treat high blood pressure:
- an “angiotensin II receptor blocker” (ARBs) (also known as sartans - for example valsartan,
telmisartan, irbesartan, etc.), in particular if you have diabetes-related kidney problems.
- aliskiren

Your doctor may check your kidney function, blood pressure, and the amount of electrolytes (e.g. potassium)
in your blood at regular intervals.
See also information under the heading “Do not take Bifenico’’
The hydrochlorothiazide in Bifenico may cause your skin to be oversensitive to sunlight or artificial UV
light. Stop taking Bifenico and tell your doctor if you get a rash, itchy spots or sensitive skin during
treatment (see also Section 4).
Anti-dope test: Bifenico could cause a positive anti-dope test.


Your blood pressure may get too low with Bifenico, especially after the first dose (this is more likely
if you have also been taking diuretics, are dehydrated or a low-salt diet, or if you have sickness or
diarrhea). If this happens, tell your doctor immediately and then lie down on your back (see also
Section 4).

If you are having an operation, tell your anaesthetist that you are taking Bifenico before being
anaesthetised. This will help him/her to control your blood pressure and heart rate during the procedure.
You must tell your doctor if you think you are (or might become) pregnant. Bifenico is not recommended in
early pregnancy, and must not be taken if you are more than 3 months pregnant, as it may cause serious harm
to your baby if used at that stage (see pregnancy section)
Children and adolescents
Do not give this medicine to children and adolescents under the age of 18 years because it is unlikely to be
safe.
Other medicines and Bifenico
Tell your doctor if you are taking, have recently taken or might take any other medicines.
In particular, tell your doctor if you are taking:
• medicines that increase blood potassium levels (e.g. trimethoprim, potassium supplements, potassiumsparing diuretics such as spironolactone, triamterene, amiloride), , potassium-containing salt substitutes

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other medicines that affect the levels of blood chemicals (AdrenoCorticoTropic Hormone - ACTH - used
to stimulate the production of some hormones by the body, amphotericin B injections, carbenoxolone,
stimulant laxatives)
lithium (used to treat mood disorders)
anaesthetics
narcotic drugs (such as morphine)
antipsychotic drugs (used to treat schizophrenia and similar illnesses)
antidepressants of the tricyclic type, e.g. amitriptyline and clomipramine
other high blood pressure medicines and vasodilators (including, beta-blockers alpha-blockers and
diuretics, such as hydrochlorothiazide, furosemide, torasemide)
Your doctor may need to change your dose and/or to take other precautions:
If you are taking an angiotensin II receptor blocker (ARB) or aliskiren (see also information under the
headings “Do not take Bifenico” and “Warnings and precautions”)
nitroglycerine and other nitrates used for chest pain (angina)
antacids including cimetidine (used to treat heartburn and stomach ulcers)
cyclosporin (used after organ transplants) and other immunosuppressant drugs (medicines that suppress
your body’s immune defences)
medicines for gout (e.g. probenecid, sulfinpyrazone and allopurinol)
insulin or oral anti-diabetic medicines
cytostatic agents (used to treat cancer or diseases which affect the body’s immune defences)
corticosteroids (powerful anti-inflammatory drugs)
procainamide (used to control an irregular heart beat)
nonsteroidal anti-inflammatory drugs (NSAIDs, such as aspirin or ibuprofen)
sympathomimetic drugs (medicines that act on the nervous system, including some used to treat asthma
or hay fever and pressor amines, e.g. adrenalin)
calcium salts
digitalis (used to help the heart pump)
cholestyramine and colestipol resins (used to lower cholesterol)
medicines used to relax muscles (e.g. tubocurarine)
amantadine (an antiviral medicine).

Bifenico with food, drink and alcohol
Bifenico can be taken with food or on an empty stomach, but always with some water.
To ease swallowing, you may break the tablet in two and swallow one half right after the other.
Alcohol increases the hypotensive (lowering of blood pressure) effect of Bifenico; ask your doctor for further
advice on drinking alcohol whilst on this medication.
Pregnancy and breast-feeding
Pregnancy
If you are pregnant, if you think you may be pregnant or are planning to have a baby, ask your doctor for
advice before taking this medicine. Your doctor will normally advise you to stop taking Bifenico before you
become pregnant or as soon as you know you are pregnant and will advise you to take another medicine
instead of Bifenico.
Bifenico is not recommended in early pregnancy, 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.
Breastfeeding
If you are breast-feeding or about to start breast-feeding ask your doctor for advice before taking this
medicine. Bifenico 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.
Driving and using machines
This medicine may cause dizziness or tiredness. If this happens to you, do not drive or operate machinery.

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Bifenico contains lactose
This product contains lactose - if you know you have an intolerance to some sugars, contact your doctor
before taking this medicine.

3. HOW TO TAKE BIFENICO
Always take Bifenico exactly as your doctor has told you. Check with your doctor if you are not sure.
The recommended dose of Bifenico is one tablet per day.
Bifenico may be taken with food or on an empty stomach. The tablet is best taken with some water.
Use in children and adolescents
This medicine is not recommended for use in children and adolescents under the age of 18 years..
If you are over 65 and suffer from an impaired kidney function, Bifenico may not be suitable for you (see
also Section 2 – ’Warnings and precautions’)
If you take more Bifenico than you should
If you accidentally take too many tablets, contact your doctor or nearest hospital immediately (taking any
remaining tablets, the carton or this leaflet with you if possible).
The most frequent symptoms and signs of an overdose are low blood pressure with fainting (hypotension),
very slow heart beat (bradycardia), changes in blood chemicals (electrolytes), kidney dysfunction, excessive
urination with consequent dehydration, nausea and somnolence, muscle spasms, heart rhythm disturbances
(especially if you are also taking digitalis or medicines for heart rhythm problems).
If you forget to take Bifenico
If you miss a dose, take the next dose as soon as you remember. However if your next dose is nearly due,
skip the forgotten dose and take the next scheduled normal dose at the usual time. Do not take a double dose
to make up for a forgotten tablet.
If you stop taking Bifenico
Always consult your doctor before stopping Bifenico treatment.
If you have any further questions on the use of this product, ask your doctor or pharmacist.
4. POSSIBLE SIDE EFFECTS
Like all medicines, Bifenico can cause side effects, although not everybody gets them.
The following side effects have been reported in clinical trials with Bifenico:
Common side effects (affecting less than 1 person in every 10 treated):
• dizziness
• headache
• cough.
Less common side effects (affecting less than 1 person in every 100 treated):
• infection
• bronchitis
• sore throat
• increase in blood cholesterol and/or other lipids, increased blood glucose, potassium, uric acid,
creatinine and liver enzymes
• decrease in blood potassium

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insomnia
somnolence, fainting, muscle tightness (hypertonia)
angina, heart attack, atrial fibrillation, palpitations
flushing, low blood pressure, high blood pressure
nausea, indigestion, gastritis, inflammation of the gums, dry mouth, stomach pain
rapid-onset swelling, especially of the lips, cheeks, eyelids, tongue, palate, voice box (larynx), with
possible sudden difficulty breathing (angioneurotic edema). If you have any of these, it means that
you have a serious allergy for Bifenico. You may require urgent medical intervention, or you may
need to be hospitalized
skin disease characterised by scaly pink patches (psoriasis), acne, dry skin, itching, hives
back pain
increased urine (polyuria)
general weakness (asthenia), flu like symptoms, peripheral swelling (usually around the ankles)
impotence

The following side effects were not reported in clinical trials with Bifenico, but they have been reported with
zofenopril calcium and/or other ACE inhibitors, so they may also occur with the use of Bifenico:
















Tiredness (fatigue). Severe low blood pressure at the start of treatment or when the dosage is
increased, with dizziness, impaired vision, fainting; low blood pressure on standing.
Chest pain, muscle aches and/or cramps.
Impaired consciousness, sudden dizziness, suddenly impaired vision or weakness and/or loss of
sense of touch on one side of the body (transient ischaemic attack or stroke).
Reduced kidney function, changes in the amount of daily urine, presence of proteins in the urine
(proteinuria).
Vomiting, diarrhoea, constipation.
Allergic skin reaction with peeling, redness, loosening and blistering of the skin (toxic
epidermal necrolysis), worsening of psoriasis, hair loss (alopecia).
Increased sweating.
Mood changes, depression, sleep disorders.
Altered skin sensations such as burning, prickling, or tingling (paraesthesia).
Disorders of balance, confusion, ringing in the ears (tinnitus), taste disturbances, blurred vision.
Difficulty in breathing, narrowing of the airways in the lung (bronchospasm), sinusitis, runny or
stuffy nose (rhinitis), inflammation of the tongue (glossitis).
Yellowing of the skin (jaundice), inflammation of the liver or pancreas (hepatitis, pancreatitis),
bowel obstruction (ileus).
Changes in blood tests, such as red blood cell, white blood cell or platelet count or a reduction
in all kinds of blood cells (pancytopenia): Contact your doctor if you find that you bruise
easily or develop an unexplained sore throat or fever.
Increased blood levels of bilirubin, increased blood urea.
Anaemia due to rupture of red blood cells (haemolytic anaemia), which may occur if you suffer
from G6PD (glucose-6-phosphate dehydrogenase) deficiency.

The following side effects were not reported in clinical trials with Bifenico, but they have been reported with
hydrochlorothiazide, so they may also occur with the use of Bifenico:








Impaired production of new blood cells by the bone marrow (bone marrow failure).
Fever, whole-body allergic reaction (anaphylactic reaction).
Altered levels of body fluids (dehydration) and blood chemicals (electrolytes), gout, diabetes,
metabolic alkalosis.
Apathy, nervousness, restlessness.
Convulsions, depressed level of consciousness, coma, paresis.
Yellow vision (xanthopsia), worsening of myopia, decreased lacrimation.
Vertigo (spinning sensation).

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Heart rhythm disturbances (arrhythmias), changes in the electrocardiogram.
Formation of blood clots in veins (thrombosis) and embolism, circulatory collapse (shock).
Respiratory distress, lung inflammation (pneumonitis), formation of fibrous tissue in the lungs
(interstitial lung disease), fluid accumulation in the lung (pulmonary oedema).
Thirst, lack of appetite (anorexia), absence of bowel movements (ileus paralytic), excessive gas
in the stomach, inflammation of the glands that produce saliva (sialoadenitis), increased blood
amylase (a pancreatic enzyme, hyperamylasaemia), inflammation of the gall bladder
(cholecystitis).
Purple spots/blotches on the skin (purpura), increased sensitivity of your skin to sunlight, rash
(especially facial) and/or patchy redness that can cause scarring (cutaneous lupus
erythematosus), inflammation of blood vessels with consequent death of tissue (vasculitis
necrotising).
Acute kidney failure (with reduced urine production and build-up of fluid and wastes in your
body), inflammation of the connective tissue within the kidneys (interstitial nephritis), sugar in
the urine.

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. You can also report side effects directly via the Yellow Card Scheme at
www.mhra.gov.uk/yellowcard. By reporting side effects you can help provide more information on the
safety of this medicine.
5. HOW TO STORE BIFENICO
Keep this medicine out of the sight and reach of children.
Do not store above 30°C
Do not take Bifenico after the expiry date (‘EXP’) which is stated on the box and blister pack.
Always keep the tablets in their original packaging.
Do not throw away any medicines via wastewater. Ask your pharmacist how to throw away medicines you
no longer use. These measures will help to protect the environment.
6 . CONTENT OF THE PACK AND OTHER INFORMATION
What Bifenico contains The active substances are zofenopril calcium 30mg and

hydrochlorothiazide 12.5 mg.
The other ingredients are the following:
- Tablet Core: Microcrystalline cellulose, lactose monohydrate, maize starch, hypromellose, silica
colloidal anhydrous, magnesium stearate
- Film Coat: Opadry Pink 02B24436 (hypromellose, titanium dioxide (E 171), macrogol 400, iron
oxide red (E 172), macrogol 6000
(see end of Section 2 ‘Bifenico contains lactose’).
What Bifenico looks like and contents of the pack
Bifenico 30mg/12.5mg tablets are pastel-red, round, slightly bi-convex film-coated tablets with a score line
on one side. The score line is to facilitate breaking for ease of swallowing and not to divide into equal doses.
The tablets are available in packs of 14, 28, 30, 50, 56, 90 or 100 tablets.
Not all pack sizes may be marketed.
Marketing Authorisation Holder
Menarini International Operations Luxembourg S.A.
1, Avenue de la Gare L-1611, Luxembourg.
Manufacturer
A. MENARINI Manufacturing Logistics and Services Srl

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Campo di Pile, L'Aquila, Italy.
Menarini –Von Heyden GmbH
Leipziger Strasse 7-13,
01097 – Dresden (Germany).
This medicinal product is authorised in the Member States of the EEA under the following names:
Italy: Zantipride
United Kingdom: Bifenico
This leaflet was last revised in 09/2014.

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Source: Medicines and Healthcare Products Regulatory Agency

Disclaimer: Every effort has been made to ensure that the information provided here is accurate, up-to-date and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. This information has been compiled for use by healthcare practitioners and consumers in the United States. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate that the drug or combination is safe, effective or appropriate for any given patient. If you have questions about the substances you are taking, check with your doctor, nurse or pharmacist.

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