Ramimed combi

Ramide Combi refers to drugs that affect the cardiovascular system, specifically the renin-angiotensin system, and is a combined ACE inhibitor.

The active ingredients of the medication are ramipril and hydrochlorothiazide.

Produced by the Icelandic pharmaceutical company Aktavis Ltd.

The medication is dispensed in pharmacies upon presentation of a prescription, so the appointment of the drug is performed only by a specialist with clear indications for its use. 

Indications Ramimed combi

 Ramieded combi is used:

• with hypertensive state;
• in chronic course of heart failure;
• during the rehabilitation of postinfarction and post-stroke states;
• with nephropathy, regardless of its association with diabetes.

Release form

The medicine is produced in tablet form. The content of ingredients per tablet: ramipril 2.5 or 5 mg, hydrochlorothiazide 12.5 mg or 25 mg, respectively. Additional components are sodium bicarbonate, croscarmellose sodium, pregelatinized starch, sodium stearyl, lactose.

It is produced on 10 tablets in a blister pack, 30 pcs. Each. In a cardboard box.

Pharmacodynamics

 Medication for stabilization of the raised pressure, inhibiting ACE. Suppresses ACE, which causes relaxation of the vascular walls and lowering blood pressure. As a result of inhibition of ACE, the activity of renin, a component of the renin-angiotensin system, is stimulated, which returns normal blood pressure.

With a pronounced degree of nephropathy (against diabetes mellitus or without it) Ramemed combi slows down the progression of renal disorders. In patients with a risk of kidney damage, the severity of albuminuria decreases.

Ramide compound has practically no effect on the blood circulation in the kidney system and the rate of the process of urination (CF).

In patients with high blood pressure, a decrease in blood pressure is noted regardless of changes in body position. In the main number of patients, a decrease in pressure begins already 1-2 hours after the use of the tablet.

The maximum effect can be observed after three to six hours: it continues throughout the day.

Steady blood pressure indicators are established after about a month of constant intake of Ramide Combi. Long-term use of the drug does not cause drug dependence and does not affect the degree of drug exposure.

Rapid cancellation of Ramide Combi does not lead to a simultaneous increase in pressure indicators.

Pharmacokinetics

Rami-combination is used when the use of each component of the drug alone does not bring the desired effect. The complex preparation has a more pronounced effect and is well absorbed when used internally. At the same time, the food used does not affect the absorption and absorption of the medication. Metabolism occurs more in the liver, where active and inactive intermediate products of metabolism are formed. The active product of metabolism is ramiprilate. Its activity is more than 5 times greater than that of the active substance of the ramipril preparation.

The peak concentration of the active component in the bloodstream is observed after a period of time from 2 to 4 hours after ingestion. The connection with plasma proteins can be about 56%. The half-life is 13-17 hours from the use of a repeated dosage of Ramide Combi. Most of the active ingredient leaves the body through the urinary system, about 40% - with the feces.

Hydrochlorothiazide becomes bioavailable by approximately 70%. Its limiting number is observed after one and a half to three hours. The connection with plasma proteins is from 40 to 70%. The exit from the plasma occurs in two stages: the initial lasts 2 hours, and the final one - about 10 hours. Up to 75% of the dose used leaves the body with urine in an unchanged state.

In disorders of renal function, the active ingredient ramipril tends to accumulate inside the body.

If there is a violation of the liver function, a failure occurs during the transformation of the active ingredient into ramiprilate.

The patient's age does not affect the pharmacokinetic properties of the drug.

Dosing and administration

Ramide Combi is taken orally, regardless of the time of ingestion. The tablet is swallowed without chewing or grinding. If necessary, it can be divided into 2 parts.

With high blood pressure, Ramide Combi starts with 2.5 mg / 12.5 mg once a day. As a rule, the same dosage is used for further therapy with the possibility of increasing it after 3 weeks. If the doctor deems it advisable, the amount of the drug used can be increased to 5 mg / 25 mg. Limit dosage of the drug per day - 5 mg / 25 mg.

In chronic course of heart failure, treatment is started with 1.25 mg (half a tablet 2.5 mg / 12.5 mg) Ramide Combi per day. The doctor monitors the patient and, if necessary, increases the amount of the drug for 7-14 days.

For the treatment of postinfarction conditions, Ramide Combi is prescribed from 4-5 days after the infarction, provided the patient's hemodynamics is stable. Dosage is selected by the doctor especially individually.

If the kidneys are not working properly, when creatinine clearance is 50 ml per minute, Ramide Combi is taken in a standard dosage. If the clearance is ≤50 ml per minute, then the drug is prescribed at 1.25 mg (half the tablet 2.5 mg / 12.5 mg) once a day. 

Use Ramimed combi during pregnancy

Ramide Combi is not used during pregnancy, but also during breastfeeding.

Contraindications

Before using, carefully study the list of contraindications for taking the drug:

• propensity to allergic reaction to active ingredients or any of the additional components of the drug;
• allergic hypersensitivity to other ACE inhibitory drugs, as well as to thiazides or sulfonamide preparations;
• previously swollen Quincke;
• narrowing of the lumen of the arterial vessels of the kidneys, kidney transplant;
• aortic spasm, mitral stenosis;
• hypertrophy of the heart muscle;
• primary increased production of aldosterone;
• insufficient liver function;
• carrying out hemofiltration.

 The medicine is not prescribed to women during the period of gestation and breastfeeding, and also to children.

Ramyed Combi is contraindicated in severe form of heart failure, with orthostatic imbalance, with exacerbation of coronary artery disease, severe heart rhythm disturbances, pulmonary heart disease.

Side effects Ramimed combi

How can side effects of Ramide Combi manifest itself:

• lowering blood pressure (including critical), myocardial ischemia, chest pain, heart rhythm disturbances, tachycardia;
• anemia, a decrease in the number of platelets in the blood, inflammation of the vascular walls;
• dyspepsia, stool disorders, epigastric pain, inflammation of the digestive tract, impaired hepatic function, cholestasis;
• pain in the head, memory and sleep disturbances, sensitivity disorders of limbs, the appearance of trembling in the hands, the violation of auditory and visual functions;
• dry cough, inflammatory processes in the nasal sinuses, nasopharynx, bronchi and trachea;
• deterioration of the urinary system, swelling, a decrease in the daily volume of urine, the appearance of protein in the urine;
• allergic dermatoses, hypersensitivity to ultraviolet radiation;
• weight loss, pain in joints and muscles, fever, etc.

Overdose

Overdose can be manifested by a critical reduction in pressure, up to a shock state. In some cases there is an imbalance of water-salt metabolism, a disorder of kidney function.

As an aid in overdosing, general measures for detoxifying the body are used: they wash the stomach, give an enterosorbent preparation (for example, activated charcoal). Intravenously inject saline, catecholamines.

Interactions with other drugs

Joint intake of drugs aimed at lowering blood pressure, as well as diuretics, analgesics based on opium, drugs for anesthesia can enhance the antihypertensive property of Ramide Combi.

Joint use of non-steroidal anti-inflammatory drugs (aspirin, ibuprofen, etc.), sympathomimetic drugs and salt-rich foods can lower the effect of Ramide Combi.

Simultaneous combination of potassium-containing medicines, potassium-sparing diuretics and Ramieded combi is possible a marked increase in the level of potassium in the blood.

Simultaneous use of Ramideed combi with lithium-containing medicines can provoke an increase in the content of lithium in the bloodstream. Reception of these drugs is possible only under the constant control of the amount of lithium in the blood.

The joint administration of Ramideed combi with preparations for the treatment of diabetes mellitus may increase the degree of hypoglycemic action and increase the risk of hypoglycemia.

Simultaneous reception of cytostatics, immunosuppressants, allopurinol can provoke the occurrence of leukopenia.

Simultaneous reception with methyldofoy can lead to hemolysis.

The use of Ramideed combi together with alcohol potentiates the effect of the latter.

[1], [2]

Storage conditions

Storage is recommended at temperatures up to + 30 ° C. The medicine should not be frozen or exposed to direct ultraviolet radiation.

Ramide Combi must be stored in factory packaging, in a specially designated place for medicines, where children's access is limited. 

Shelf life

Shelf life is indicated on the package with medication and is no more than 2 years from the date of manufacture. If the expiration date is finished, the medicine should be disposed of.