Ramipril pills 10mg №30

Composition

1 pill contains:

Active substance: ramipril - 10 mg;

Excipients:lactose monohydrate 143.5 mg, Magnesium stearate 1.5 mg.

Dosage and administration

Tablets must be swallowed whole (do not chew), and drink plenty of water (1/2 cup) of water, regardless of the meal (that is, pills can be taken both before and during or after meals). The dose is selected depending on the therapeutic effect and tolerability of the drug by the patient. Treatment with Ramipril-SZ is usually long, and its duration in each particular case is determined by the doctor. Unless otherwise prescribed, the following dosing regimens are recommended for normal kidney and liver function.
With essential hypertension
Usually the initial dose is 2.5 mg 1 time per day in the morning. If, when taking the drug in this dose for 3 weeks or more, it is not possible to normalize blood pressure, then the dose may be increased to 5 mg of Ramipril per day. With insufficient effectiveness of the dose of 5 mg in 2-3 weeks, it can be doubled to the maximum recommended daily dose of 10 mg per day. As an alternative to increasing the dose to 10 mg per day with insufficient hypotensive efficacy of a daily dose of 5 mg, other antihypertensive drugs, in particular diuretics or “slow” Calcium channel blockers, can be added to the treatment.
In chronic heart failure  
Recommended initial dose: 1.25 mg 1 time per day (1/2 pill 2.5 mg). Depending on the patient's response to therapy, the dose may increase. It is recommended to double the dose at intervals of 1-2 weeks.If a daily dose of 2.5 mg or more is required, it can be given once a day or divided into 2 doses. The maximum recommended daily dose is 10 mg.
With diabetic or non-diabetic nephropathy
Recommended initial dose: 1.25 mg 1 time per day (1/2 pill 2.5 mg). The dose may be increased to 5 mg once a day. In these conditions, doses higher than 5 mg once a day have not been studied enough in controlled clinical trials.
To reduce the risk of myocardial infarction, stroke or cardiovascular mortality in patients with high cardiovascular risk
The recommended initial dose: 2.5 mg 1 time per day. Depending on the patient's tolerance of the drug, the dose can be gradually increased. It is recommended to double the dose after 1 week of treatment, and in the next 3 weeks of treatment to increase it to the usual maintenance dose of 10 mg 1 time per day. Doses in excess of 10 mg are not well understood in controlled clinical trials. The use of the drug in patients with QA less than 0.6 ml / sec has not been studied enough.
In heart failure that developed during the first few days (from 2nd to 9th day) after acute myocardial infarction 
The recommended initial dose is 5 mg per day, divided into two single doses of 2.5 mg, which are taken one in the morning and the second in the evening. If the patient does not tolerate this initial dose (there is an excessive decrease in blood pressure), then it is recommended that he give 1.25 mg 2 times a day for two days (1/2 pill 2.5 mg). Then, depending on the response of the patient, the dose may be increased.It is recommended that the dose with its increase doubled with an interval of 1-3 days. Later, the total daily dose, which was initially divided into two doses, can be given once. The maximum recommended dose is 10 mg. Currently, the experience of treating patients with severe heart failure (III-IV functional class according to the NYHA classification), which arose immediately after an acute myocardial infarction, is insufficient. If such patients decide on treatment with Ramipril-SZ, it is recommended that treatment should be started with the lowest possible dose - 1.25 mg once a day (1/2 pill 2.5 mg) and special care should be exercised at every increase. doses.

Since the cardiovascular system and blood (hematopoiesis, hemostasis): hypotension (10.7%), incl. postural (2.2%), stenocardia (2.9%), syncope (2.1%), heart failure (2%), myocardial infarction (1.7%), vertigo (1.5%), pain in chest (1.1%), less than 1% - arrhythmia, palpitations, hemolytic anemia, myelodepression, pancytopenia, thrombocytopenia, eosinophilia, agranulocytosis; vasculitis

On the part of 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 necrosis of the liver with a 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 disorders, amnesia, drowsiness, convulsions, depression, sleep disorder, neuralgia, neuropathy, paresthesia, tremor, hearing loss, blurred vision.

On the part of the respiratory system: nonproductive cough (7.6%), infections of the upper respiratory tract, less than 1% - dyspnea, pharyngitis, sinusitis, rhinitis, tracheobronchitis, laryngitis, bronchospasm.

From the genitourinary system: impaired renal function (1.2%), less than 1% - proteinuria, oliguria, edema; impotence.

From the skin: urticaria, prurigo, rash, erythema multiforme, photosensitivity.

Other: less than 1% - weight loss, anaphylactoid reactions, increased urea nitrogen and creatinine, angioedema (0.3%), arthralgia / arthritis, myalgia, fever, increased antinuclear antibody titer, hyperkalemia, changes in enzyme activity, bilirubin concentration, uric acid, glucose.

Drug interactions

Contraindications
- The use of some high-flow membranes with a negatively charged surface (for example, polyacrylonitrile membranes) during hemodialysis or hemofiltration; the use of dextran sulfate in the apheresis of low density lipoproteins The risk of developing severe Anaphylactic reactions.
Not recommended combinations 
- With potassium salts, potassium-sparing diuretics (for example, amiloride,triamterenom, spironolactone) Perhaps a more pronounced increase in the content of potassium in the blood serum (with simultaneous use, careful control of the content of potassium in the blood serum is required).
Combinations that should be used with caution
- With antihypertensive drugs (especially diuretics) and other drugs that reduce blood pressure (nitrates, tricyclic antidepressants) Potentiation of the hypotensive effect; when combined with diuretics, serum sodium should be monitored.
- With sleeping pills, narcotic and non-narcotic analgesics Perhaps a more pronounced decrease in blood pressure;
- With vasopressor sympathomimetics (epinephrine) Reduction of the hypotensive effect of ramipril, careful control of blood pressure is required.
- With Allopurinol, procainamide, cytostatics, immunosuppressants, systemic glucocorticosteroids and other drugs that may affect hematological parameters. Combined use increases the risk of leukopenia.
- With lithium salts Increase in serum lithium concentration and enhance the cardio - and neurotoxic effects of lithium.
- With oral hypoglycemic agents (sulfonylurea derivatives, biguanides), insulin In connection with a decrease in insulin resistance under the influence of ramipril, the hypoglycemic effect of these drugs may increase, up to the development of hypoglycemia.Combinations to be taken into account 
- With nonsteroidal anti-inflammatory drugs (indomethacin, acetylsalicylic acid) It is possible to weaken the effect of ramipril, increase the risk of renal dysfunction and increase serum potassium.
- With Heparin It is possible to increase the content of potassium in the blood serum.
- With sodium chloride. Weakening of the hypotensive effect of ramipril and less effective treatment of the symptoms of chronic heart failure.
- With ethanol. Enhanced vasodilation. Ramipril may increase the adverse effects of ethanol on the body.
- With estrogens Weakening of the hypotensive effect of ramipril (fluid retention).
- Desensitization therapy in case of hypersensitivity to the poisons of insects ACE inhibitors, including ramipril, increase the likelihood of severe anaphylactic or anaphylactoid reactions to insect poisons. With the simultaneous use of ACE inhibitors and gold preparations (sodium aurothiomalate) for intravenous administration, a symptom complex has been described, including facial flushing, nausea, vomiting, and arterial hypotension.

Symptoms: excessive peripheral vasodilation with the development of a pronounced decrease in blood pressure, shock; bradycardia, water and electrolyte disorders, acute renal failure, stupor.

Treatment: gastric lavage, taking adsorbents, sodium sulfate (if possible during the first 30 minutes).In the case of a pronounced decrease in blood pressure, the introduction of alpha1-adrenergic agonists (norepinephrine, dopamine) can be added to the therapy to replenish the circulating blood volume and restore electrolyte balance. In the case of bradycardia refractory to a drug treatment, it may be necessary to install a temporary artificial pacemaker. In case of overdose, it is necessary to monitor serum concentrations of creatinine and electrolytes.

In dry, the dark place at a temperature of no higher than 25 ^aboutC. Keep out of the reach of children.