Ramil

A drug that directly affects the renin-angiotensin system – Ramil – is a drug that inhibits ACE, with the active ingredient Ramipril.

Ramil is manufactured by the Indian pharmaceutical company Cadila Healthcare Ltd.

Ramil can only be prescribed by a doctor, therefore it is sold in pharmacies only upon presentation of a prescription.

Indications Ramil

Ramil can be used:

• for high blood pressure, for independent or combined treatment of high blood pressure, in combination with diuretics and calcium channel blockers;
• for congestive heart failure, with the possibility of combination with other (diuretic) drugs;
• in case of cardiac insufficiency, which is a consequence of a previous heart attack;
• in post-infarction condition;
• in case of diabetes-related or unrelated nephropathy;
• to prevent the risk of heart attack, stroke or death as a result of cardiovascular pathology, especially in cases of obvious coronary heart disease, distal vascular diseases, and diabetes mellitus;
• in case of risk of cardiovascular diseases as a result of high blood pressure, high blood cholesterol, low high-density lipoproteins.

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Release form

Ramil is produced in tablet form, 15 tablets in a blister pack. The cardboard box contains two blister packs.

The active component of the drug is ramipril. One tablet may contain 2.5 mg, 5 mg or 10 mg of ramipril.

The auxiliary components are hydroxypropyl methylcellulose, pregelatinized starch, MCC, sodium stearyl fumarate, iron oxide (E 172).

Pharmacodynamics

The active component ramipril is able to inhibit the action of ACE. Ramil is able to suppress the production of angiotensin II, eliminate vasoconstriction, stimulate the production of aldosterone. It activates the action of renin in blood plasma, inhibits the metabolic processes of bradykinin.

Ramil has a hypotensive effect that does not depend on the patient's body position, without causing a compensatory increase in heart rate. It stabilizes blood pressure regardless of the renin content in the bloodstream.

In most patients, the pressure stabilizes within 1-2 hours after taking the tablets. The maximum effect can be observed after 3-6 hours: it lasts for 24 hours. The peak level of pressure stabilization can be achieved after 20-30 days from the start of treatment with the drug. The stabilizing effect is stable and can be maintained during a long course of treatment (about 2 years). Abrupt cessation of treatment cannot provoke a sudden increase in blood pressure.

Ramipril does not have a significant effect on renal blood flow, only sometimes a slight increase is observed. Also, Ramil does not affect the glomerular filtration rate. A pronounced form of nephropathy (with or without diabetes) can be accompanied by deterioration of renal function: Ramil inhibits these negative processes in the kidneys. In patients with an existing risk of nephropathy of various origins, the drug reduces the degree of albuminuria.

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Pharmacokinetics

Ramil is well absorbed when taken orally. Simultaneous consumption of food does not impair the absorption of the drug in any way.

The drug is metabolized in the liver, where active and inactive metabolic products are formed. The active metabolic product of ramipril is the so-called ramiprilat, which exhibits activity six times greater than that of the original component.

The peak content of the active metabolite in the blood can be observed 2 to 4 hours after taking the tablet. The distribution volume is determined to be 500 l. The connection with plasma proteins is estimated at approximately 56%. The half-life is 13 to 17 hours. About 40% leaves the body with feces, 60% through the urinary system.

In elderly patients, the pharmacokinetic properties of the drug do not undergo significant changes.

If kidney function is insufficient, the active component of the drug can accumulate in the body.

In case of insufficient liver function, the transformation of the active component of the drug into the final metabolic product ramiprilat is impaired.

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Dosing and administration

Ramil is taken orally, regardless of meal time. The tablet should be swallowed without chewing or crushing, with plenty of liquid. It is permissible to divide the tablet in half.

For high blood pressure, take 2.5 mg of the medicine per day in one dose, preferably in the morning. If an increase in dosage is required, it is carried out gradually, over 2 or 3 weeks up to 5 mg. The maximum permissible daily dosage is up to 10 mg. In some cases, the prescribed amount of medicine can be divided into two doses per day.

In chronic heart failure, initially take 1.25 mg of the drug per day. In some cases, it may be necessary to increase the dosage, which is achieved by doubling the dose over 7-14 days. The daily dose can be divided into 2 times.

In the post-infarction period, Ramil is prescribed no earlier than three days after the infarction, provided that the hemodynamics are stable and there are no signs of ischemia in the patient. The optimal initial dosage is 2.5 mg twice a day. If the tablets are poorly tolerated by the patient, then the initial dose can be reduced to 1.25 mg twice a day. Then the amount of the drug is gradually increased, bringing it to a stabilizing dose of 5 mg twice a day. The maximum daily amount of the drug is 10 mg.

If kidney function is insufficient, the dosage of Ramil is adjusted at the discretion of the doctor.

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Use Ramil during pregnancy

Ramil is not used during pregnancy and breastfeeding. Before prescribing the drug, the doctor must make sure that the patient is not pregnant.

During the entire course of therapy, reliable methods of contraception should be used. If pregnancy occurs, the course of treatment with the drug should be stopped immediately, or this drug should be replaced with another one approved for use during pregnancy.

Contraindications

What are the possible contraindications to the use of Ramil:

• a tendency to allergic reactions in response to the active component of a drug or another auxiliary component;
• previous allergy to ACE inhibitor drugs;
• narrowing of the lumen of the renal arteries (one or two);
• complicated and severe kidney pathologies (with creatinine clearance less than 30 ml per minute);
• recovery period after kidney transplant surgery;
• primary form of hyperaldosteronism;
• pregnancy and breastfeeding period;
• undergoing hemodialysis procedures;
• insufficient liver function.

Ramil is not used to treat pediatric patients.

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Side effects Ramil

Side effects of Ramil can affect various organs and systems of the body.

Cardiovascular system: decreased blood pressure, attacks of short-term loss of consciousness, cardiac insufficiency, dizziness, chest pain, heart rhythm disturbances.

Hematopoietic organs: anemia, decreased number of platelets, neutrophils and eosinophils in the blood, inflammatory changes in the walls of blood vessels, pancytopenia.

Gastrointestinal tract: dyspeptic symptoms, dysfunction of the salivary glands, weight loss, difficulty swallowing, bowel disorders, inflammatory diseases of the digestive organs, liver dysfunction (inflammation, cholestasis, jaundice).

Respiratory system: dry cough, inflammatory processes in the upper respiratory tract.

Nervous system: headaches, asthenic condition, vestibular disorders, memory and sleep disorders, seizures, depression, tremors and numbness of the extremities, hearing and vision impairment.

Urinary system: renal dysfunction, protein in urine, dysuric disorders, peripheral edema.

Skin and mucous membranes: allergic rashes, redness, increased sensitivity to ultraviolet radiation.

Other side effects include muscle and/or joint pain, increased levels of urea and creatinine in the blood, and increased titers of antinuclear antibodies.

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Overdose

Signs of an overdose of Ramil may include:

• excessive decrease in blood pressure;
• state of shock;
• electrolyte imbalance;
• renal failure (ARF).

Measures in case of overdose: gastric lavage and rinsing, use of sorbents, if necessary – intravenous infusions of saline, catecholamines, angiotensin II.

If the heart rate slows down steadily, an artificial pacemaker (pacemaker) can be used.

If Quincke's edema occurs, an urgent injection of adrenaline (subcutaneously or intravenously) is administered, followed by intravenous administration of glucocorticoid drugs, antihistamines, and H²-receptor antagonists.

Hemodialysis in case of Ramil overdose is ineffective, therefore its use is inappropriate.

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Interactions with other drugs

The combined use of Ramil and other hypotensive, diuretic, opium-based painkillers (narcotic analgesics), anesthetic drugs, tricyclic antidepressants and antipsychotic drugs can provoke an increase in the hypotensive effect of the drug.

Combined use with non-steroidal anti-inflammatory drugs, estrogen-containing drugs, sympathomimetics, as well as drugs containing table salt, can reduce the hypotensive effect of Ramil.

Combined use with potassium-based medications may help increase the amount of potassium in the bloodstream.

You should not combine the use of Ramil and lithium-based medications, as this can provoke an increase in the toxic effects of lithium-containing drugs.

Combined use with antidiabetic drugs (including insulin) can provoke an increased decrease in blood glucose levels, even to the point of hypoglycemia.

Combined use with allopurinol, cytostatics, immunosuppressants, and corticosteroid hormones increases the risk of developing leukopenia.

Ramil and its active ingredient ramipril enhance the effects of alcoholic beverages.

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Storage conditions

It is recommended to store the medicine in a dry, dark place, in the original packaging, out of reach of children. Temperature indicators should not exceed +25°C.

Shelf life

Shelf life is up to 3 years, subject to the storage conditions of the medicine.