Trinomia 40 mg hard capsules *
Pharmacy Only: Prescription

Updated on 29 November 2022

File name

63860de055f8d.pdf

Reasons for updating

  • Change to section 6.4 - Special precautions for storage

Legal category:Product subject to medical prescription which may be renewed (B)

Free text change information supplied by the pharmaceutical company

Shelf Life Updated from 2-3 years

Updated on 05 September 2022

File name

631602aae5b36.pdf

Reasons for updating

  • Change to section 6.4 - Special precautions for storage
  • Change to section 10 - Date of revision of the text

Legal category:Product subject to medical prescription which may be renewed (B)

Free text change information supplied by the pharmaceutical company

Section 6.4 - Storage conditions updated

Section 10 - Date of revision updated

Updated on 05 September 2022

File name

631602545124c.pdf

Reasons for updating

  • Change to section 5 - how to store or dispose
  • Change to section 6 - date of revision

Free text change information supplied by the pharmaceutical company

Section 5 - Storage conditions updated

Section 6 - Date of revision updated

Updated on 08 July 2021

File name

1.3.1_SmPC-AA40R_IE-v.15a_clean_1625755281.pdf

Reasons for updating

  • Change to section 4.4 - Special warnings and precautions for use
  • Change to Section 4.8 – Undesirable effects - how to report a side effect
  • Change to section 5.1 - Pharmacodynamic properties
  • Change to section 6.1 - List of excipients
  • Change to section 10 - Date of revision of the text

Legal category:Product subject to medical prescription which may be renewed (B)

Free text change information supplied by the pharmaceutical company

Section 4.4 - minor update by including the word excipients as a header before excipient warnings 

Section 4.8 - HPRA AE reporting details updated

Section 5.1 - Info regarding Peadiatric population moved to end of section 5.1

Section 6.1 - E numbers added

Section 10 - Revision date updated 

Updated on 08 July 2021

File name

1.3.1_PIL-AA40R_IE-v.15a_clean_1625755160.pdf

Reasons for updating

  • Change to section 4 - how to report a side effect
  • Change to section 6 - what the product contains
  • Change to section 6 - date of revision

Free text change information supplied by the pharmaceutical company

Section 4 - HPRA reporting details updated

Section 6 - headings added and E numbers added 

Section 6 - Revision date updated 

Updated on 19 March 2020

File name

1.3.1_SmPC-AA40R_IE-v.13a_clean 11-3-20_1584628691.pdf

Reasons for updating

  • Change to section 4.5 - Interaction with other medicinal products and other forms of interaction

Legal category:Product subject to medical prescription which may be renewed (B)

Free text change information supplied by the pharmaceutical company

New interaction added for metamizole:

4.5       Interaction with other medicinal products and other forms of interaction

Acetylsalicylic acid: pharmacodynamic & pharmacokinetic interactions:

- Effect of co-administered medicinal products on Acetylsalicylic acid

Metamizole: Metamizole may reduce the effect of acetylsalicylic acid on platelet aggregation, when taken concomitantly. Therefore, this combination should be used with caution in patients taking low dose aspirin for cardioprotection.

Updated on 19 March 2020

File name

1.3.1_PIL-AA40R_IE-v.13a_clean 11-3-20_1584628606.pdf

Reasons for updating

  • Change to section 2 - interactions with other medicines, food or drink

Free text change information supplied by the pharmaceutical company

New interaction added for metamizole:

2.  What you need to know before you take Trinomia

Other medicines and Trinomia

Please tell your doctor if you are taking any of the following medicines that can make acetylsalicylic acid work less well:

  • Metamizole: Metamizole (substance to decrease pain and fever) may reduce the effect of acetylsalicylic acid on platelet aggregation (blood cells sticking together and forming a blood clot), when taken concomitantly. Therefore, this combination should be used with caution in patients taking low dose aspirin for cardioprotection.

Updated on 04 February 2020

File name

1.3.1_PIL-AA40R_IE-v.12a_clean 4-11-19_1580825737.pdf

Reasons for updating

  • Change to section 4 - possible side effects
  • Change to section 6 - date of revision

Free text change information supplied by the pharmaceutical company

Section 4 Possible side-effects is updated

Updated on 30 October 2019

File name

ie_PIL_clean 40 mg v.12a 10-10-19_1572438809.pdf

Reasons for updating

  • Change to section 2 - what you need to know - contraindications
  • Change to section 4 - possible side effects
  • Change to section 6 - date of revision

Updated on 30 October 2019

File name

ie_SmPC_v.13a clean 40 mg approved 10-10-19_1572438769.pdf

Reasons for updating

  • Change to section 4.2 - Posology and method of administration
  • Change to section 4.3 - Contraindications
  • Change to section 4.4 - Special warnings and precautions for use
  • Change to section 4.5 - Interaction with other medicinal products and other forms of interaction
  • Change to Section 4.8 – Undesirable effects - how to report a side effect
  • Change to section 5.2 - Pharmacokinetic properties
  • Change to section 10 - Date of revision of the text

Legal category:Product subject to medical prescription which may be renewed (B)

Free text change information supplied by the pharmaceutical company

The following sections are updated:

4.2       Posology and method of administration

New information added:

Co-administration with other medicines

In patients taking hepatitis C antiviral agents elbasvir/grazoprevir concomitantly with atorvastatin, the dose of atorvastatin should not exceed 20 mg/day (see sections 4.4 and 4.5).

4.3       Contraindications

New contra-indications:

- Patients treated with the hepatitis C antivirals glecaprevir/pibrentasvir

- Concomitant use with sacubitril/valsartan therapy. Trinomia must not be initiated earlier than 36 hours after the last dose of sacubitril/valsartan (see also sections 4.4 and 4.5).

4.4       Special warnings and precautions for use

Warning on ACE inhibitors and hyperkalaemia added (replacing previous warning on hyperkalaemia):

  • Serum potassium: ACE inhibitors can cause hyperkalemia because they inhibit the release of aldosterone. The effect is usually not significant in patients with normal renal function. However, in patients with impaired renal function and/or in patients taking potassium supplements (including salt substitutes), potassiumsparing diuretics, trimethoprim or co-trimoxazole also known as trimethoprim/sulfamethoxazole and especially aldosterone antagonists or angiotensin-receptor blockers, hyperkalemia can occur. Potassium-sparing diuretics and angiotensin-receptor blockers should be used with caution in patients receiving ACE inhibitors, and serum potassium and renal function should be monitored (see section 4.5). Other situations that may increase the risk of hyperkalaemia are: age >70 years, uncontrolled diabetes mellitus, dehydration, acute cardiac decompensation or metabolic acidosis.

Increased risk of rhabdomyolysis warning – updated:

Tipranavir/ritonavir and antivirals for the treatment of hepatitis C (HCV) (boceprevir, telaprevir, elvasvir/grazoprevir) added.

Angioedema - additional warnings added:

Concomitant use of ACE inhibitors with sacubitril/valsartan is contraindicated due to the increased risk of angioedema. Treatment with sacubitril/valsartan must not be initiated earlier than 36 hours after the last dose of Trimomia. Treatment with Trinomia must not be initiated earlier than 36 hours after the last dose of sacubitril/valsartan (see sections 4.3 and 4.5).

Concomitant use of ACE inhibitors with racecadotril, mTOR inhibitors (e.g. sirolimus, everolimus, temsirolimus) and vildagliptin may lead to an increased risk of angioedema (e.g. swelling of the airways or tongue, with or without respiratory impairment) (see section 4.5). Caution should be used when starting racecadotril, mTOR inhibitors (e.g. sirolimus, everolimus, temsirolimus) and vildagliptin in a patient already taking an ACE inhibitor.

4.5       Interaction with other medicinal products and other forms of interaction

Atorvastatin: pharmacodynamic & pharmacokinetic interactions

- Effect of co-administered medicinal products on atorvastatin

Updated information:

Atorvastatin is metabolised by cytochrome P450 3A4 (CYP3A4) and is a substrate of the hepatic transporters, organic anion-transporting polypeptide 1B1 (OATP1B1) and 1B3 (OATP1B3) transporter. Metabolites of atorvastatin are substrates of OATP1B1. Atorvastatin is also identified as a substrate of the multi-drug resistance protein 1 (MDR1) and breast cancer resistance protein (BCRP), which may limit the intestinal absorption and biliary clearance of atorvastatin (see section 5.2).

CYP3A4 inhibitors:

Some antivirals used in the treatment of HCV (e.g. elbasvir/grazoprevir)

Amended wording: In cases where co-administration of these medicinal products with atorvastatin cannot be avoided lower starting and maximum doses of atorvastatin should be considered and appropriate clinical monitoring of the patient is recommended (see Table 1).

Transport inhibitors

Amended wording: If concomitant administration cannot be avoided, a dose reduction and clinical monitoring for efficacy is recommended (see Table 1).

Table 1: Effect of co-administered medicinal products on the pharmacokinetics of atorvastatin amended to add Glecaprevir / Pibrentasvir and Elbasvir / Grazoprevir.

Ramipril: pharmacodynamic & pharmacokinetic interactions

Interaction added:

- Medicines increasing the risk of angioedema: Concomitant use of ACE inhibitors with sacubitril/valsartan is contraindicated as this increases the risk of angioedema (see section 4.3 and 4.4).

Precautions for use

Wording amended and/or added:

- Potassium sparing diuretics, potassium supplements or potassium-containing salt substitutes: Although serum potassium usually remains within normal limits, hyperkalaemia may occur in some patients treated with ramipril. Potassium sparing diuretics (e.g. spironolactone, triamterene, or amiloride), potassium supplements, or potassium-containing salt substitutes may lead to significant increases in serum potassium. Care should also be taken when ramipril is co-administered with other agents that increase serum potassium, such as trimethoprim and cotrimoxazole (trimethoprim/sulfamethoxazole) as trimethoprim is known to act as a potassium-sparing diuretic like amiloride. Therefore, the combination of ramipril with the above-mentioned drugs is not recommended. If concomitant use is indicated, they should be used with caution and with frequent monitoring of serum potassium.

- Heparin: Hyperkalaemia may occur during concomitant use of ACE inhibitors with heparin. Monitoring of serum potassium is recommended.

- Medicines increasing the risk of angioedema: Concomitant use of ACE inhibitors with racecadotril, mTOR inhibitors (e.g. sirolimus, everolimus, temsirolimus) and vildagliptin may lead to an increased risk for angioedema (see section 4.4).

- Ciclosoporin: Hyperkalaemia may occur during concomitant use of ACE inhibitors with ciclosporin. Monitoring of serum potassium is recommended.

4.8       Undesirable effects

Muscle rupture added (rare)

Lupus-like syndrome added (very rare)

5.2       Pharmacokinetic properties

Atorvastatin

Elimination – additional information added:

Atorvastatin is a substrate of the hepatic transporters, organic anion-transporting polypeptide 1B1 (OATP1B1) and 1B3 (OATP1B3) transporter. Metabolites of atorvastatin are substrates of OATP1B1. Atorvastatin is also identified as a substrate of the efflux transporters multi-drug resistance protein 1 (MDR1) and breast cancer resistance protein (BCRP), which may limit the intestinal absorption and biliary clearance of atorvastatin.

Updated on 06 June 2019

File name

1.3.1_PIL_IE clean 10-5-19_1559817373.pdf

Reasons for updating

  • Change to section 4 - possible side effects
  • Change to section 6 - what the product contains
  • Change to section 6 - date of revision

Updated on 06 June 2019

File name

1.3.1_SmPC_IE-clean 10-5-19_1559817208.pdf

Reasons for updating

  • Change due to harmonisation of SPC

Legal category:Product subject to medical prescription which may be renewed (B)

Free text change information supplied by the pharmaceutical company

The SmPCs wording is updated to correct formatting errors and to align to the 20 mg strengths.

Updated on 06 June 2018

File name

IE_spc_Trinomia_40mg_30_6_17.docx

Reasons for updating

  • New SPC for new product

Legal category:Product subject to medical prescription which may be renewed (B)

Updated on 04 May 2018

File name

ie_pl_40_mg_approved_30_6_17.pdf

Reasons for updating

  • New PIL for new product