Ramimed combo

Ramimed Combi is a drug that affects the cardiovascular system, specifically the renin-angiotensin system, and is a combined ACE inhibitor.

The active ingredients of the drug are ramipril and hydrochlorothiazide.

Produced by the Icelandic pharmaceutical company Actavis Ltd.

The drug is sold in pharmacies upon presentation of a prescription, therefore the drug is prescribed only by a specialist if there are clear indications for its use.

Indications Ramimed combo

Ramimed combi is used:

• in hypertensive conditions;
• in chronic heart failure;
• during the rehabilitation period of post-infarction and post-stroke conditions;
• in case of nephropathy, regardless of its connection with diabetes.

Release form

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

Available in 10 tablets per blister, 30 tablets per cardboard package.

Pharmacodynamics

A medication for stabilizing high blood pressure that inhibits ACE. Suppresses ACE, which causes relaxation of the vascular walls and a decrease in blood pressure. As a result of ACE inhibition, the activity of renin is stimulated - a component of the renin-angiotensin system, which returns blood pressure to normal.

In cases of severe nephropathy (with or without diabetes mellitus), Ramimed Combi slows down the progression of renal disorders. In patients at risk of kidney damage, the severity of albuminuria is reduced.

Ramimed combi has virtually no effect on blood circulation in the renal system and the rate of urine formation (UP).

Patients with high blood pressure experience a decrease in blood pressure regardless of changes in body position. In the majority of patients, a decrease in blood pressure begins within 1-2 hours after taking the pill.

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

Stable blood pressure readings are established after about a month of continuous use of Ramimed Combi. Long-term use of the drug does not cause drug dependence and does not affect the degree of the drug's effect.

Abrupt discontinuation of Ramimed Combi does not lead to a simultaneous increase in blood pressure readings.

Pharmacokinetics

Ramimed combi is used when the use of each component of the drug separately does not bring the desired effect. The complex drug has a more pronounced effect and is well absorbed when taken orally. Food consumed at the same time does not affect the absorption and assimilation of the drug. Metabolism occurs to a greater extent in the liver, where active and inactive intermediate metabolic products are formed. The active product of metabolism is ramiprilat. Its activity is more than 5 times greater than the activity of the active substance of the drug ramipril.

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

Hydrochlorothiazide becomes bioavailable by approximately 70%. Its maximum amount 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 one lasts 2 hours, and the final one – approximately 10 hours. Up to 75% of the dose consumed leaves the body with urine unchanged.

In case of renal dysfunction, the active component ramipril tends to accumulate inside the body.

When liver function is impaired, there is a failure in the process of transforming the active component into ramiprilat.

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

Dosing and administration

Ramimed combi is taken orally, regardless of meal time. The tablet is swallowed without chewing or crushing. If necessary, it can be divided into 2 parts.

For high blood pressure, Ramimed Combi is started 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 appropriate, the amount of the drug used can be increased to 5 mg/25 mg. The maximum daily dosage of the drug is 5 mg/25 mg.

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

For the treatment of post-infarction conditions, Ramimed Combi is prescribed from the 4th-5th day after the infarction, provided that the patient's hemodynamics are stable. The dosage is selected by the doctor strictly individually.

In case of insufficient renal function, with creatinine clearance of 50 ml per minute, Ramimed Combi is taken in a standard dosage. If clearance is ≤50 ml per minute, the drug is prescribed at 1.25 mg (half a tablet of 2.5 mg / 12.5 mg) once a day.

Use Ramimed combo during pregnancy

Ramimed Combi is not used during pregnancy or breastfeeding.

Contraindications

Before use, carefully study the list of contraindications to taking the drug:

• tendency to allergic reactions to the active ingredients or any of the additional components of the drug;
• allergic hypersensitivity to other drugs that inhibit ACE, as well as to thiazides or sulfonamide-based drugs;
• previous history of Quincke's edema;
• narrowing of the lumen of the renal arterial vessels, kidney transplant;
• aortic spasm, mitral stenosis;
• cardiac muscle hypertrophy;
• primary increased production of aldosterone;
• insufficient liver function;
• carrying out hemofiltration.

The medicine is not prescribed to women during pregnancy and breastfeeding, as well as to children.

Ramimed Combi is contraindicated in severe forms of cardiac insufficiency, orthostatic imbalance, exacerbation of coronary heart disease, severe cardiac arrhythmias, and pulmonary heart disease.

Side effects Ramimed combo

What are the possible side effects of Ramimed Combi:

• decreased blood pressure (including critical), myocardial ischemia, chest pain, heart rhythm disturbances, tachycardia;
• anemia, decreased platelet count in the blood, inflammation of the vascular walls;
• dyspepsia, bowel disorders, epigastric pain, inflammation of the digestive tract, liver dysfunction, cholestasis;
• headaches, memory and sleep disorders, sensitivity disorders in the extremities, hand tremors, hearing and visual impairments;
• dry cough, inflammatory processes in the nasal sinuses, nasopharynx, bronchi and trachea;
• deterioration of the urinary system, swelling, decrease in daily urine volume, appearance of protein in the urine;
• allergic dermatoses, hypersensitivity to ultraviolet radiation;
• weight loss, joint and muscle pain, fever, etc.

Overdose

Overdose may manifest itself as a critical drop in blood pressure, up to a state of shock. In some cases, an imbalance in water-salt metabolism and kidney dysfunction occur.

To help with an overdose, general measures are used to detoxify the body: wash the stomach, give an enterosorbent drug (for example, activated carbon). Physiological solution and catecholamines are administered intravenously.

Interactions with other drugs

The combined use of drugs aimed at lowering blood pressure, as well as diuretics, opium-based analgesics, and anesthetics may enhance the hypotensive properties of Ramimed Combi.

The combined use of non-steroidal anti-inflammatory drugs (aspirin, ibuprofen, etc.), sympathomimetic agents and foods rich in table salt may reduce the effect of Ramimed combi.

The simultaneous combination of potassium-containing drugs, potassium-sparing diuretics and Ramimed combi may result in a significant increase in the level of potassium in the blood.

Simultaneous use of Ramimed Combi with lithium-containing drugs may provoke an increase in the lithium content in the bloodstream. Taking these drugs is possible only under constant monitoring of the amount of lithium in the blood.

The combined use of Ramimed Combi with drugs for the treatment of diabetes mellitus may enhance the degree of hypoglycemic effect and increase the risk of hypoglycemia.

Concomitant use of cytostatics, immunosuppressants, and allopurinol can provoke the development of leukopenia.

Concomitant administration with methyldopa may result in hemolysis.

Using Ramimed Combi together with alcohol potentiates the effect of the latter.

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Storage conditions

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

Ramimed Combi must be stored in its original packaging, in a place specially designated for medicines, where children have limited access.

Shelf life

The expiration date is indicated on the packaging of the medicine and is no more than 2 years from the date of manufacture. If the expiration date has expired, it is recommended to dispose of the medicine.