Ramipril - instructions for use, reviews, analogs and formulations (tablets 2.5 mg, 5 mg, 10 mg NW) of a drug for the treatment of hypertension and pressure reduction in adults, children and pregnancy. Composition

In this article, you can read the instructions for using the drug Ramipril. There are reviews of visitors to the site - consumers of this medication, as well as opinions of specialists on the use of Ramipril in their practice. A big request is to actively add their feedback on the drug: the medicine helped or did not help get rid of the disease, which were observed complications and side effects, possibly not declared by the manufacturer in the annotation. Analogues of ramipril in the presence of existing structural analogues. Use to treat hypertension and reduce blood pressure in adults, children, as well as during pregnancy and lactation. Composition of the preparation.

Ramipril - ACE inhibitor.It is a prodrug, from which the active metabolite ramiprilate is formed in the body. It is believed that the mechanism of antihypertensive action is associated with competitive inhibition of ACE activity, which leads to a decrease in the rate of conversion of angiotensin 1 into angiotensin 2, which is a potent vasoconstrictor. As a result of a decrease in the concentration of angiotensin 2, a secondary increase in plasma renin activity occurs due to elimination of negative feedback during the release of renin and a direct decrease in aldosterone secretion. Due to the vasodilator effect reduces OPSS (afterload), wedging pressure in the pulmonary capillaries (preload) and resistance in the pulmonary vessels; increases the minute volume of the heart and tolerance to the load.

In patients with signs of chronic heart failure after myocardial infarction, ramipril reduces the risk of sudden death, the progression of heart failure to severe / resistant failure, and reduces the number of hospitalizations for heart failure.

It is known that ramipril significantly reduces the incidence of myocardial infarction,stroke and cardiovascular death in patients with increased cardiovascular risk due to vascular disease (CHD, stroke or peripheral vascular disease) or diabetes mellitus, which have at least one additional risk factor (microalbuminuria, hypertension, increased total cholesterol, low level of HDL, smoking). Reduces the overall mortality and need for revascularization procedures, slows the onset and progression of chronic heart failure. As in patients with diabetes mellitus, and without it, ramipril significantly reduces the existing microalbuminuria and the risk of developing nephropathy. These effects are observed in patients with both elevated and normal BP.

The hypotensive effect of ramipril develops after about 1-2 hours, reaches a maximum within 3-6 hours, lasts at least 24 hours.

Composition

Ramipril + excipients.

Pharmacokinetics

When ingested absorption is 50-60%, food does not affect the degree of absorption, but slows absorption. In the liver, it is metabolized to form an active metabolite of ramiprilate (6 times more active inhibits ACE than ramipril), inactive diketopiperazine, and glucuronize.All metabolites formed, with the exception of ramiprilate, have no pharmacological activity. Binding to plasma proteins for ramipril - 73%, ramiprilata - 56%. Bioavailability after oral administration of 2.5-5 mg of ramipril - 15-28%; for ramiprilate - 45%. After a daily intake of ramipril at a dose of 5 mg per day, the steady concentration of ramiprilate in plasma is reached by day 4. The kidneys excrete 60%, through the intestines - 40% (mainly in the form of metabolites). If renal function is impaired, excretion of ramipril and its metabolites slows in proportion to the decrease in QC; when the liver function is impaired, the conversion into ramiprilat is slowed down; with heart failure, the concentration of ramiprilate increases 1.5-1.8 times.

Indications

• arterial hypertension;
• chronic heart failure;
• heart failure, developed in the first few days after an acute myocardial infarction;
• diabetic and nondiabetic nephropathy;
• reduction in the risk of myocardial infarction, stroke and cardiovascular mortality in patients with high cardiovascular risk, including patients with confirmed CHD (with or without a history of heart attack)who underwent percutaneous transluminal coronary angioplasty, coronary artery bypass graft, with a history of stroke and patients with occlusive lesions of peripheral arteries.

Forms of release

Tablets 2.5 mg, 5 mg and 10 mg.

Instructions for use and dosage

Is taken internally. The initial dose is 1.25-2.5 mg 1-2 times a day. If necessary, a gradual increase in the dose is possible. The maintenance dose is set individually, depending on the indications for use and the effectiveness of the treatment.

Side effect

• arterial hypotension;
• pain in the chest;
• tachycardia;
• dizziness;
• weakness;
• headache;
• sleep disturbance, mood;
• diarrhea, constipation;
• loss of appetite;
• stomatitis;
• stomach ache;
• pancreatitis;
• cholestatic jaundice;
• dry cough;
• bronchitis;
• sinusitis;
• proteinuria;
• increase in the concentration of creatinine and urea in the blood (mainly in patients with impaired renal function);
• neutropenia, agranulocytosis, thrombocytopenia, anemia;
• skin rash;
• angioedema and other hypersensitivity reactions;
• muscle spasms;
• impotence;
• alopecia.

Contraindications

• marked violations of kidney and liver function;
• bilateral stenosis of the renal arteries or stenosis of the artery of a single kidney;
• condition after kidney transplantation;
• primary hyperaldosteronism;
• hyperkalemia;
• stenosis of the aortic aorta;
• pregnancy;
• lactation (breastfeeding);
• children and adolescents under 18;
• increased sensitivity to ramipril and other ACE inhibitors.

Application in pregnancy and lactation

Ramipril is contraindicated in pregnancy and lactation (breastfeeding).

Use in children

Contraindicated in children and adolescents under 18 years.

special instructions

In patients with concomitant renal dysfunction, doses are individually selected in accordance with the values ​​of CK. Before starting treatment, all patients need to conduct a study of kidney function. In the process of treatment with ramipril, kidney function, electrolyte blood composition, hepatic enzymes level in the blood, as well as peripheral blood patterns are regularly monitored (especially in patients with diffuse connective tissue diseases, in patients receiving immunosuppressants, allopurinol).Patients who have a deficiency of fluid and / or sodium before treatment should be corrected water-electrolyte disorders. During treatment with ramipril, hemodialysis can not be performed using polyacrylonitrile membranes (the risk of anaphylactic reactions is increased).

Drug Interactions

With simultaneous use of potassium-sparing diuretics (including spironolactone, triamterene, amiloride), potassium drugs, salts and supplements to food substitutes containing potassium may develop hyperkalemia (particularly in patients with impaired renal function), as ACE inhibitors reduce the content of aldosterone, which leads to a delay in potassium in the body against the background of the limitation of the excretion of potassium or its additional intake into the body.

While the use of nonsteroidal anti-inflammatory drugs (NSAIDs) may decrease the antihypertensive effect of ramipril, impaired kidney function.

When used simultaneously with "loop" or thiazide diuretics, the antihypertensive effect is enhanced. Pronounced arterial hypotension, especially after taking the first dose of a diuretic, appears to be due to hypovolemia,which leads to transient strengthening of the hypotensive effect of ramipril. There is a risk of hypokalemia. Increased risk of impaired renal function.

With simultaneous use with drugs that have an antihypertensive effect, it is possible to intensify the hypotensive effect.

When used simultaneously with insulin, hypoglycemic agents, sulfonylurea derivatives, metformin, hypoglycemia may develop.

With simultaneous use with allopurinol, cytostatics, immunosuppressants, procainamide, an increased risk of developing leukopenia is possible.

With the simultaneous use of lithium carbonate, an increase in the concentration of lithium in the blood serum is possible.

Analogues of the drug Ramipril

Structural analogs for the active substance:

• Amprilan;
• Vazolong;
• Dilaprel;
• Korpril;
• Pyrimil;
• Ramepress;
• Ramigamma;
• Ramicardium;
• Ramipril SZ;
• Tritace;
• Hartil.

Analogues on the curative effect (means for the treatment of hypertension):

• Adelphan Ezidrex;
• Akkupro;
• Amlodipine;
• Amprilan;
• Anaprilin;
• Atenolol;
• Berlipril;
• Betalk;
• Bisoprolol;
• Wales H;
• Verapamil;
• Veroshpiron;
• Hypothiazide;
• Diltiazem;
• Diroton;
• Euroramipril;
• Euroramipril H;
• The Zocardis;
• Indap;
• Indapamide;
• Captopril;
• Carvedilol;
• Clopheline;
• Concor;
• Corvitol;
• Cordaflex;
• Cordipine;
• Corinfar;
• Lysinopril;
• Lozap;
• Losartan;
• Lorist;
• Metoprolol;
• Non-ticket;
• Nifedipine;
• Noliprel;
• Noliprel forte;
• Norvasc;
• Obsidan;
• Prestan;
• Prestarium;
• Raunatin;
• Renitek;
• Spironolactone;
• Stamlo;
• Physiotherapy;
• Fosicard;
• Furosemide;
• Egilok;
• Equator;
• Exforge;
• Enalapril;
• Enam;
• Enap;
• Enap H;
• Enziks;
• Estecor.

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