Drugs List

Therapeutic Indications

Uses

Essential hypertension when stabilised on same ingreds.in same proportions

Contraindications

Children under 18 years
Within 36 hours of discontinuing a sacubitril containing product
Breastfeeding
Cardiogenic shock
Galactosaemia
Haemodialysis with high flux membranes
Haemodynamic instability
Haemodynamically significant valvular heart disease
Hereditary angioneurotic oedema
History of cerebrovascular accident
Hypotension
Idiopathic angioneurotic oedema
Left ventricular outflow obstruction
Pregnancy
Renal artery stenosis
Renal impairment - creatinine clearance below 20ml/minute
Second degree atrioventricular block
Severe aortic stenosis
Severe hepatic impairment
Third degree atrioventricular block
Uncontrolled congestive cardiac failure
Unstable angina
Within 1 month of a myocardial infarction

Precautions and Warnings

Desensitisation therapy
Immunosuppression
Major surgery
Aortic stenosis
Atherosclerosis
Cardiac failure
Cerebral ischaemia
Cerebrovascular insufficiency
Collagen vascular disease
Diabetes mellitus
Glucose-galactose malabsorption syndrome
Hepatic disorder
Hyperkalaemia
Hypertrophic obstructive cardiomyopathy
Hyponatraemia
Hypovolaemia
Ischaemic heart disease
Lactose intolerance
Mitral stenosis
Peripheral vascular disease
Renal dialysis
Renal impairment - creatinine clearance 20-60ml/minute
Renovascular disorder
Severe left ventricular failure

Anaesthetist should be made aware patient is taking this medication
Anaphylactoid reactions possible with haemofiltration or LDL apheresis
Anaphylactoid reactions possible with highly permeable dialysis membranes
Anaphylaxis possible with concomitant hyposensitisation to wasp/bee venom
Advise ability to drive/operate machinery may be affected by side effects
Afro-Caribbean or black patients may show reduced response
Exclude renovascular disorder before treatment
Contains lactose
Evaluate renal function before and during treatment
Exclude pregnancy prior to initiation of treatment
Monitor serum electrolytes before and during treatment
Consider monitoring white blood cell counts in collagen vascular disease
Monitor antidiabetic drug treatment
Monitor blood pressure
Monitor patients with renovascular disease
Higher incidence of angioedema in black patients
Increased risk of hyperkalaemia with K+ suppl. and K+ sparing diuretic
Increased risk of hypotension with diuretics and other antihypertensives
Patient to report nausea, vomiting or situations leading to salt/water loss
Advise patient to seek advice at first indications of pregnancy
Discontinue if cardiogenic shock develops
Discontinue if ischaemic pain occurs shortly after starting therapy
Discontinue if jaundice or other evidence of hepatic impairment occurs
Discontinue if persistent or symptomatic hypotension occurs
Discontinue immediately if angioedema involves face/oropharynx/larynx
Advise patient not to take NSAIDs unless advised by clinician
Hypotensive effects may be potentiated by alcohol
Advise on problems of salt substitutes/high intake of potassium-rich food
Advise patient Seville (sour) orange products may increase plasma level
Grapefruit prod increase dihydropyridine Ca channel blocker bioavailability
Female: Ensure adequate contraception during treatment

Caution when administering felodipine with ramipril to these patients. Only administer if the patient is stable and with careful titration of the dose using felodipine and ramipril as separate products. Patient can then be switched to the fixed combination product if appropriate. Hypertensive patients without cardiac and renal impairment may also experience hypotension, especially patients with hypovolaemia due to diuretic therapy, salt restriction, diarrhoea or vomiting.

Patients at risk from an undesirably pronounced reduction in blood pressure (e.g. those with cerebrovascular or coronary impairment) should be treated with ramipril and felodipine as separate products. If satisfactory and stable blood pressure control is achieved with the individual doses equivalent to the combined felodipine with ramipril preparations, the patients may be switched to the combination.

Pregnancy and Lactation

Pregnancy

Felodipine with ramipril is contraindicated in pregnancy.

Ramipril
Unless treatment with ramipril is considered essential, patients planning pregnancy should be changed to alternative anti-hypertensive treatment with an established safety profile in pregnancy. Guidelines published from NICE recommend that women with chronic hypertension on ACE inhibitors are informed that there is a risk of congenital abnormalities if the drugs are taken during pregnancy and other antihypertensive treatments for management their condition should be discussed if they are planning pregnancy.

Epidemiology of the risk of teratogenicity following exposure in the first trimester in human has not be conclusive, however, the MHRA recommends that a risk can not be excluded. The MHRA states that the use of ACE inhibitors in late pregnancy has been associated with adverse effects on the kidney and other congenital anomalies, therefore ACE inhibitors should not be used at any stage during of pregnancy unless absolutely necessary and only then after the potential risks and benefits have been discussed with the patient. Briggs (2011) comments that ramipril and other ACE inhibitors appear to be human teratogens when used in the second and third trimester, producing foetal hypocalvaria and renal defects. ACE inhibitor therapy exposure during the second and third trimester is known to induce human foetotoxicity (decreased renal function, oligohydramnios, skull ossification retardation). Anuria-associated oligohydramnios may produce pulmonary hypoplasia, limb contractures, persistent patent ductus arteriosus, craniofacial deformation and neonatal death. Interuterine growth retardation, prematurity and severe neonatal hypotension may also been seen.

Should exposure to ramipril have occurred from the first trimester, an ultrasound check of renal function and skull is recommended. Newborns whose mothers have taken an ACE inhibitor during pregnancy should be closely observed for hypotension, oliguria and hyperkalaemia. Schaefer (2007) states that accidental exposure does not require invasive diagnosis procedures or termination of pregnancy but if there has been long term exposure to ACE inhibitor then it is recommended to monitor for oligohydramnios and foetal growth via an ultrasound.

Felodipine
Studies on pregnant women exposed to calcium channel blockers have revealed no adverse effects. However, nifedipine or verapamil, are the best studied calcium antagonists during pregnancy and are the preferred first-line drugs of choice in this group for the treatment of hypertension (Schaefer, 2007).

If exposure to felodipine has occurred during the first trimester Schaefer (2007) recommends a detailed ultrasound diagnosis. Exposure to a calcium antagonist during pregnancy is not considered to be an indication for invasive diagnostic procedures or termination of pregnancy.

Felodipine is teratogenic in rabbits, producing digital abnormalities in a dose dependent manner within the range of 0.4 to 4 times the maximum recommended human dose. Reproductive studies in rabbits showed dose-related reversible enlargement of the mammary glands of the parent animal. Rats exposed to 4 times the maximum recommended human dose exhibited delayed parturition with difficult labour and an increased incidence of foetal and post natal deaths (Briggs, 2011).

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Felodipine with ramipril is contraindicated in breastfeeding.

Ramipril
There is insufficient data on ramipril in breastfeeding. Animal studies have indicated that ramiprilat is transferred into milk in concentrations about one third of those found in serum, but animal studies are always high and do not correlate with humans. The MHRA states that ACE inhibitors have a small molecular size so transfer into human breast milk is possible. With the exception of captopril, the active metabolites of ACE inhibitors have long estimated half lives; however these metabolites are poorly absorbed orally.

Advice on LactMed, via TOXNET, suggests as no information is available on the use of ramipril during breastfeeding, an alternate drug may be preferred, especially whilst nursing a newborn or preterm infant. Schaefer (2007) advises that nursing mothers who are accidentally exposed to ramipril do not need to stop breastfeeding but therapy should be changed.

Felodipine
Felodipine has been detected in breast milk, but it is unknown whether it has harmful effects on the newborn.

Hale (2014) suggests that the use of felodipine should be avoided because the numerous studies on other calcium channel blockers makes them a more informed choice.

Schaefer (2007) concludes that diltiazem, nifedipine and verapamil are the calcium antagonists of choice during breastfeeding. Individual doses of felodipine do not require limitation of breastfeeding, but therapy should be changed.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Aggravation of existing asthma
Agranulocytosis
Alopecia
Alterations in pancreatic enzymes
Anaemia
Angina
Angioedema
Anxiety
Arthralgia
Bone marrow depression
Bronchitis
Bronchospasm
Cardiac arrhythmias
Cardiogenic shock
Cholestatic jaundice
Confusion
Conjunctivitis
Cough
Decreased appetite
Delayed reactions
Depressed mood
Dizziness
Drowsiness
Dry mouth
Dyspnoea
Eosinophilia
Erythema multiforme
Exacerbation of psoriasis
Exanthema
Fatigue
Fever
Flushing
Gastritis-like pain
GI disorders
Gingival hyperplasia
Gingivitis
Glossitis
Gynaecomastia
Haemolytic anaemia
Headache
Hearing disturbances
Hepatic failure
Hepatitis
Hyperglycaemia
Hyperkalaemia
Hypersensitivity reactions
Hyponatraemia
Hypotension
Ileus
Impaired renal function
Increase in antinuclear antibodies (ANA)
Increased urinary frequency
Increases in hepatic enzymes
Ischaemic stroke
Leucocytosis
Light-headedness
Muscle cramps
Myalgia
Myocardial infarction
Myocardial ischaemia
Myositis
Nausea
Nervousness
Onycholysis
Orthostatic hypotension
Palpitations
Pancreatitis
Pancytopenia
Paraesthesia
Pemphigus
Peripheral oedema
Photosensitivity
Pruritus
Rash
Raynaud's phenomenon
Reduced platelet count
Restlessness
Rhinitis
Serositis
Sexual dysfunction
Sinusitis
Sleep disturbances
Smelling disturbances
Somnolence
Stevens-Johnson syndrome
Stomatitis
Sweating
Syncope
Tachycardia
Taste disturbances
Tinnitus
Toxic epidermal necrolysis
Transient ischaemic attack
Tremor
Urticaria
Vasculitis
Visual disturbances
Weakness
White blood cell count decreased

Presentation

Modified release tablets containing felodipine and ramipril

Drugs List

Therapeutic Indications

Uses

Essential hypertension when stabilised on same ingreds.in same proportions

Dosage

Adults

Elderly

Patients with Renal Impairment

Patients with Hepatic Impairment

Contraindications

Children under 18 years
Within 36 hours of discontinuing a sacubitril containing product
Breastfeeding
Cardiogenic shock
Galactosaemia
Haemodialysis with high flux membranes
Haemodynamic instability
Haemodynamically significant valvular heart disease
Hereditary angioneurotic oedema
History of cerebrovascular accident
Hypotension
Idiopathic angioneurotic oedema
Left ventricular outflow obstruction
Pregnancy
Renal artery stenosis
Renal impairment - creatinine clearance below 20ml/minute
Second degree atrioventricular block
Severe aortic stenosis
Severe hepatic impairment
Third degree atrioventricular block
Uncontrolled congestive cardiac failure
Unstable angina
Within 1 month of a myocardial infarction

Precautions and Warnings

Desensitisation therapy
Immunosuppression
Major surgery
Aortic stenosis
Atherosclerosis
Cardiac failure
Cerebral ischaemia
Cerebrovascular insufficiency
Collagen vascular disease
Diabetes mellitus
Glucose-galactose malabsorption syndrome
Hepatic disorder
Hyperkalaemia
Hypertrophic obstructive cardiomyopathy
Hyponatraemia
Hypovolaemia
Ischaemic heart disease
Lactose intolerance
Mitral stenosis
Peripheral vascular disease
Renal dialysis
Renal impairment - creatinine clearance 20-60ml/minute
Renovascular disorder
Severe left ventricular failure

Anaesthetist should be made aware patient is taking this medication
Anaphylactoid reactions possible with haemofiltration or LDL apheresis
Anaphylactoid reactions possible with highly permeable dialysis membranes
Anaphylaxis possible with concomitant hyposensitisation to wasp/bee venom
Advise ability to drive/operate machinery may be affected by side effects
Afro-Caribbean or black patients may show reduced response
Exclude renovascular disorder before treatment
Contains lactose
Evaluate renal function before and during treatment
Exclude pregnancy prior to initiation of treatment
Monitor serum electrolytes before and during treatment
Consider monitoring white blood cell counts in collagen vascular disease
Monitor antidiabetic drug treatment
Monitor blood pressure
Monitor patients with renovascular disease
Higher incidence of angioedema in black patients
Increased risk of hyperkalaemia with K+ suppl. and K+ sparing diuretic
Increased risk of hypotension with diuretics and other antihypertensives
Patient to report nausea, vomiting or situations leading to salt/water loss
Advise patient to seek advice at first indications of pregnancy
Discontinue if cardiogenic shock develops
Discontinue if ischaemic pain occurs shortly after starting therapy
Discontinue if jaundice or other evidence of hepatic impairment occurs
Discontinue if persistent or symptomatic hypotension occurs
Discontinue immediately if angioedema involves face/oropharynx/larynx
Advise patient not to take NSAIDs unless advised by clinician
Hypotensive effects may be potentiated by alcohol
Advise on problems of salt substitutes/high intake of potassium-rich food
Advise patient Seville (sour) orange products may increase plasma level
Grapefruit prod increase dihydropyridine Ca channel blocker bioavailability
Female: Ensure adequate contraception during treatment

Caution when administering felodipine with ramipril to these patients. Only administer if the patient is stable and with careful titration of the dose using felodipine and ramipril as separate products. Patient can then be switched to the fixed combination product if appropriate. Hypertensive patients without cardiac and renal impairment may also experience hypotension, especially patients with hypovolaemia due to diuretic therapy, salt restriction, diarrhoea or vomiting.

Patients at risk from an undesirably pronounced reduction in blood pressure (e.g. those with cerebrovascular or coronary impairment) should be treated with ramipril and felodipine as separate products. If satisfactory and stable blood pressure control is achieved with the individual doses equivalent to the combined felodipine with ramipril preparations, the patients may be switched to the combination.

Pregnancy and Lactation

Pregnancy

Felodipine with ramipril is contraindicated in pregnancy.

Ramipril
Unless treatment with ramipril is considered essential, patients planning pregnancy should be changed to alternative anti-hypertensive treatment with an established safety profile in pregnancy. Guidelines published from NICE recommend that women with chronic hypertension on ACE inhibitors are informed that there is a risk of congenital abnormalities if the drugs are taken during pregnancy and other antihypertensive treatments for management their condition should be discussed if they are planning pregnancy.

Epidemiology of the risk of teratogenicity following exposure in the first trimester in human has not be conclusive, however, the MHRA recommends that a risk can not be excluded. The MHRA states that the use of ACE inhibitors in late pregnancy has been associated with adverse effects on the kidney and other congenital anomalies, therefore ACE inhibitors should not be used at any stage during of pregnancy unless absolutely necessary and only then after the potential risks and benefits have been discussed with the patient. Briggs (2011) comments that ramipril and other ACE inhibitors appear to be human teratogens when used in the second and third trimester, producing foetal hypocalvaria and renal defects. ACE inhibitor therapy exposure during the second and third trimester is known to induce human foetotoxicity (decreased renal function, oligohydramnios, skull ossification retardation). Anuria-associated oligohydramnios may produce pulmonary hypoplasia, limb contractures, persistent patent ductus arteriosus, craniofacial deformation and neonatal death. Interuterine growth retardation, prematurity and severe neonatal hypotension may also been seen.

Should exposure to ramipril have occurred from the first trimester, an ultrasound check of renal function and skull is recommended. Newborns whose mothers have taken an ACE inhibitor during pregnancy should be closely observed for hypotension, oliguria and hyperkalaemia. Schaefer (2007) states that accidental exposure does not require invasive diagnosis procedures or termination of pregnancy but if there has been long term exposure to ACE inhibitor then it is recommended to monitor for oligohydramnios and foetal growth via an ultrasound.

Felodipine
Studies on pregnant women exposed to calcium channel blockers have revealed no adverse effects. However, nifedipine or verapamil, are the best studied calcium antagonists during pregnancy and are the preferred first-line drugs of choice in this group for the treatment of hypertension (Schaefer, 2007).

If exposure to felodipine has occurred during the first trimester Schaefer (2007) recommends a detailed ultrasound diagnosis. Exposure to a calcium antagonist during pregnancy is not considered to be an indication for invasive diagnostic procedures or termination of pregnancy.

Felodipine is teratogenic in rabbits, producing digital abnormalities in a dose dependent manner within the range of 0.4 to 4 times the maximum recommended human dose. Reproductive studies in rabbits showed dose-related reversible enlargement of the mammary glands of the parent animal. Rats exposed to 4 times the maximum recommended human dose exhibited delayed parturition with difficult labour and an increased incidence of foetal and post natal deaths (Briggs, 2011).

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Felodipine with ramipril is contraindicated in breastfeeding.

Ramipril
There is insufficient data on ramipril in breastfeeding. Animal studies have indicated that ramiprilat is transferred into milk in concentrations about one third of those found in serum, but animal studies are always high and do not correlate with humans. The MHRA states that ACE inhibitors have a small molecular size so transfer into human breast milk is possible. With the exception of captopril, the active metabolites of ACE inhibitors have long estimated half lives; however these metabolites are poorly absorbed orally.

Advice on LactMed, via TOXNET, suggests as no information is available on the use of ramipril during breastfeeding, an alternate drug may be preferred, especially whilst nursing a newborn or preterm infant. Schaefer (2007) advises that nursing mothers who are accidentally exposed to ramipril do not need to stop breastfeeding but therapy should be changed.

Felodipine
Felodipine has been detected in breast milk, but it is unknown whether it has harmful effects on the newborn.

Hale (2014) suggests that the use of felodipine should be avoided because the numerous studies on other calcium channel blockers makes them a more informed choice.

Schaefer (2007) concludes that diltiazem, nifedipine and verapamil are the calcium antagonists of choice during breastfeeding. Individual doses of felodipine do not require limitation of breastfeeding, but therapy should be changed.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Aggravation of existing asthma
Agranulocytosis
Alopecia
Alterations in pancreatic enzymes
Anaemia
Angina
Angioedema
Anxiety
Arthralgia
Bone marrow depression
Bronchitis
Bronchospasm
Cardiac arrhythmias
Cardiogenic shock
Cholestatic jaundice
Confusion
Conjunctivitis
Cough
Decreased appetite
Delayed reactions
Depressed mood
Dizziness
Drowsiness
Dry mouth
Dyspnoea
Eosinophilia
Erythema multiforme
Exacerbation of psoriasis
Exanthema
Fatigue
Fever
Flushing
Gastritis-like pain
GI disorders
Gingival hyperplasia
Gingivitis
Glossitis
Gynaecomastia
Haemolytic anaemia
Headache
Hearing disturbances
Hepatic failure
Hepatitis
Hyperglycaemia
Hyperkalaemia
Hypersensitivity reactions
Hyponatraemia
Hypotension
Ileus
Impaired renal function
Increase in antinuclear antibodies (ANA)
Increased urinary frequency
Increases in hepatic enzymes
Ischaemic stroke
Leucocytosis
Light-headedness
Muscle cramps
Myalgia
Myocardial infarction
Myocardial ischaemia
Myositis
Nausea
Nervousness
Onycholysis
Orthostatic hypotension
Palpitations
Pancreatitis
Pancytopenia
Paraesthesia
Pemphigus
Peripheral oedema
Photosensitivity
Pruritus
Rash
Raynaud's phenomenon
Reduced platelet count
Restlessness
Rhinitis
Serositis
Sexual dysfunction
Sinusitis
Sleep disturbances
Smelling disturbances
Somnolence
Stevens-Johnson syndrome
Stomatitis
Sweating
Syncope
Tachycardia
Taste disturbances
Tinnitus
Toxic epidermal necrolysis
Transient ischaemic attack
Tremor
Urticaria
Vasculitis
Visual disturbances
Weakness
White blood cell count decreased

Overdosage

It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

The following number will direct the caller to the relevant local centre (0844) 892 0111

Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Further Information

Last Full Review Date: April 2015.

Reference Sources

Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 2nd edition (2007) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.

Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 9th edition (2011) ed. Briggs, G., Freeman, R. and Yaffe, S. Lippincott Williams & Wilkins, Philadelphia.

Evaluations of Drug Interactions (EDI), The Standard For Drug Interactions, Volume 2 (2008) ed. Zucchero, M.A., Hogan, M.J. and Sommer, C.D. First DataBank, Inc.

Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press Accessed on 13 April 2015.

Martindale: The Complete Drug Reference (online) London: Brayfield A (ed). Pharmaceutical Press Accessed on 13 April 2015.

Medications and Mothers' Milk, Sixteenth Edition (2014) Hale, T and Rowe, H, Hale Publishing, Plano, Texas.

Summary of Product Characteristics: Triapin 2.5mg/2.5mg prolonged release tablets. Sanofi. Revised February 2015.
Summary of Product Characteristics: Triapin 5mg/5mg prolonged release tablets. Sanofi. Revised February 2015.

US National Library of Medicine. Toxicology Data Network. Drugs and Lactation Database (LactMed).
Available at: https://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT
Felodipine Last revised: 10 March 2015
Last accessed: 13 April 2015

US National Library of Medicine. Toxicology Data Network. Drugs and Lactation Database (LactMed).
Available at: https://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT
Ramipril Last revised: 10 March 2015
Last accessed: 13 April 2015