Ramipril

When ATH:
C09AA05

Characteristic.

The white crystalline powder, soluble in polar organic solvents and aqueous buffer solutions.

Pharmacological action.
Gipotenzivnoe, vazodilatirtee, kardioprotektivnoe, natriuretic.

Application.

Arterial hypertension, heart failure, post-MI (in clinically stable condition).

Contraindications.

Hypersensitivity, gipotenziya, severe renal insufficiency, severe hyperkalemia, pregnancy, lactation.

Restrictions apply.

Assessment of the risk-benefit ratio in the following cases: angioedema in history, severe autoimmune disease (systemic lupus erythematosus, scleroderma, and other systemic collagen), bone marrow suppression (leukopenia, thrombocytopenia), coronary insufficiency or cerebral circulation, atherosclerosis of the lower extremities, aortic, mytralnыy stenosis or others. obstructive changes, impede the outflow of blood from the heart, bilateral renal artery stenosis or stenosis of the artery to a solitary kidney, the transplanted kidney, hepatitis, chronic obstructive pulmonary disease, diabetes, severe renal insufficiency (serum creatinine above 300 µmol/l or 3,5 mg / dL) and hyperkalemia (higher 5,5 mmol / l), hyponatremia or restriction of sodium in the diet, carrying out dialysis treatments, general anesthesia and surgical procedures, dehydration, children's (Safety and efficacy have not determined) and old age.

Pregnancy and breast-feeding.

Contraindicated in pregnancy.

Category actions result in FDA - C (I trimester). (The study of reproduction in animals has revealed adverse effects on the fetus, and adequate and well-controlled studies in pregnant women have not held, However, the potential benefits, associated with drugs in pregnant, may justify its use, in spite of the possible risk.)

Category actions result in FDA - D (II and III trimesters).

At the time of treatment should stop breastfeeding.

Side effects.

Cardio-vascular system and blood (hematopoiesis, hemostasis): gipotenziya (10,7%), incl. postural (2,2%), angina (2,9%), syncope (2,1%), heart failure (2%), myocardial infarction (1,7%), vertigo (1,5%), chest pain (1,1%), less than 1% - Arrhythmia, heartbeat, gemoliticheskaya anemia, mielodeprescia, pancytopenia, thrombocytopenia, eozinofilija, agranulocytosis; vasculitis.

From the digestive tract: nausea (2,2%), vomiting (1,6%), diarrhea (1,1%), less than 1% -dry mouth or increased salivation, anorexia, dyspepsia, dysphagia, constipation, abdominal pain, gastroenteritis, pancreatitis, hepatitis, abnormal liver function (cholestatic jaundice, fulminant hepatic necrosis with fatal outcome), changes in the level of transaminases.

From the nervous system and sensory organs: dizziness (4,1%), headache (1,2%), asthenia (0,3%), less than 1% -cerebrovascular, amnesia, drowsiness, convulsions, depression, somnipathy, neuralgia, neuropathy, paraesthesia, tremor, diminished hearing, blurred vision.

From the respiratory system: nonproductive cough (7,6%), upper respiratory tract infection, less than 1% - Dyspnoea, pharyngitis, sinusitis, rhinitis, traheobronhit, laringit, bronchospasm.

With the genitourinary system: impairment of renal function (1,2%), less than 1% -proteinuria, oligurija, swelling; impotence.

For the skin: hives, prurigo, rash, erythema multiforme, photosensitivity.

Other: less than 1% -reducing body weight, anaphylactoid reactions, increased BUN and creatinine, angioedema (0,3%), arthralgia / arthritis, myalgia, fever, increasing titer of antinuclear antibodies, hyperkalemia, changes in the activity of enzymes, bilirubin, Uric acid, Glucose.

Cooperation.

Effects strengthen antihypertensives, including beta-blockers, incl. with significant systemic absorption of ophthalmic forms, diuretics, opioid analgesics, for narcosis, alcohol, weaken - estrogens, NSAIDs, sympathomimetic. Potentiates the hypoglycemic effect of oral antidiabetic drugs, the inhibitory effect of alcohol on the central nervous system. Reduces the secondary hyperaldosteronism and hypokalemia, caused by diuretics. Increases plasma levels of digoxin and lithium (toxicity increases). Potassium-sparing diuretics, cyclosporine, kalisodergaszczye medicines and supplements, salt substitutes, milk with a low salt content increase the risk of hyperkalemia. Funds, providing mielodepressivnoe action, increase the risk of neutropenia and / or fatal agranulocytosis.

Overdose.

Symptoms: severe hypotension, cerebrovascular accident, angioedema, myocardial infarction, thromboembolic complications.

Treatment: dose reduction or complete removal of the drug; gastric lavage, Transfer the patient to a horizontal position, introduce measures to increase BCC (isotonic sodium chloride solution, transfusions, etc.. blood liquids), simptomaticheskaya therapy: epinephrine (n / a or I /), gidrokortizon (I /), antihistamines.

Dosing and Administration.

Inside, hypertension -initial dose is 2,5 mg 1 once a day, with long-term therapy-2.5-20 mg/day in the reception 1-2. In heart failure in postinfarctne period in the initial dose of 2,5 mg 2 once a day; in case of failure — on 5 mg 2 once a day, When expressed hypotension or on the background of diuretics is on 1,25 mg 2 once a day. In renal insufficiency (clubockova filtering less than 40 mL/min and creatinine levels more 0,22 mmol / l) starting dose is 1/4 ordinary with a gradual increase to 5 mg / day (no more).

Precautions.

Treatment is carried out under regular medical supervision. Before treatment (for 1 Sun) earlier antigipertenzivnuu therapy, incl. diuretic should repeal (If you cannot cancel diuretics should be reduced dose and adjust vodno-elektrolitny balance). In patients with malignant hypertension dose gradually increase over the, every 24 no, under the supervision of ad to achieve maximum effect. During treatment requires monitoring of blood pressure, continuous monitoring of peripheral blood (before treatment, the first 3-6 months of treatment and at periodic intervals thereafter until 1 year, especially in patients with an increased risk of neutropenia), protein levels, Plasma potassium, BUN, creatinine, renal function, body weight, diet. In developing the patient giponatriemii and dehydration is a correction mode (decreasing doses). In developing holetsaticescoy jaundice and progressirovanii fulminantny liver necrosis treatment ceased. Avoid hemodialysis through high capacity membranes poliakrilonitritmetallilsulfata (например АN69), gemofilytratsii or LDL apheresis (may develop anaphylaxis or anaphylactoid reactions). It will be appreciated, that when using ramiprila in patients with autoimmune diseases and syndromes, increased risk of neutropenia. Giposensibilizatsionnaya therapy may increase the risk of anaphylactic reactions. It is recommended that the use of alcohol during treatment. Be wary of during the drivers of vehicles and people, skills relate to the high concentration of attention.

Cooperation