Ramipril

The drug is classified as a synthetic cardiovascular agent aimed at regulating blood pressure. This effect is achieved due to the effect of the active component ramipril on the renin-angiotensin system.

Ramipril is produced by the German pharmaceutical company Hoechst AG.

The drug Ramipril is sold in pharmacies only with a doctor's prescription.

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Indications Ramipril

Ramipril can be prescribed as an independent drug or in combination with other medications aimed at stabilizing blood pressure and improving cardiac function (mainly in the post-infarction and post-stroke period).

The drug is recommended for use in the treatment regimen for patients with nephropathy (diabetic or other etiology).

The indication for prescribing Ramipril is considered to be preventive therapy of strokes and heart attacks, as well as fatal outcomes due to cardiovascular pathology. The drug can be prescribed for coronary heart disease, diseases of the peripheral vascular system, hypertension, high cholesterol in the blood, low high-density lipoproteins.

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Release form

The medicine is produced in tablet form. One cardboard package contains a blister, including 28 tablets.

The active component of the drug is ramipril.

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Pharmacodynamics

Ramipril is a drug intended to normalize blood pressure. It belongs to a group of drugs that inhibit angiotensin-converting enzyme. The key component is ramipril, which, when it enters the bloodstream, undergoes transformation to the active substance ramiprilat.

The active component has the ability to inhibit angiotensin-converting enzyme, which entails a decrease in the amount of angiotensin II in the blood serum and a decrease in aldosterone production. Among other things, the action of renin in the blood is activated and the breakdown of bradykinin is slowed down.

During treatment with Ramipril, patients experience a decrease in the degree of vascular wall resistance, relaxation of the vessel walls, which leads to a confident decrease in blood pressure without increasing the load on the heart. In addition, the drug is able to reduce the load on the heart muscle, thereby having a beneficial effect on the well-being of patients, especially during post-infarction and post-stroke conditions.

A decrease in blood pressure is observed already 60-120 minutes after taking Ramipril and lasts for 24 hours. Maximum effectiveness occurs after 14-20 days of continuous treatment. The drug does not have to be discontinued gradually: there is no withdrawal syndrome.

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Pharmacokinetics

The main metabolic processes with the drug occur in the liver, resulting in the formation of ramiprilat. Ramipril is converted into the ether substance diketopiperazine.

Ramiprilat becomes bioavailable when taken orally and can be approximately 45%. The substance is quickly absorbed in the digestive system (at least 56% of the amount received). The degree of absorption is independent of simultaneous food intake. Peak plasma levels can be observed 60 minutes after taking the drug.

The half-life is also 60 minutes.

The peak level of ramiprilat in the circulatory system is detected 120-240 minutes after taking the dose.

The final stage of drug elimination is quite long: after a single use of the drug in a dosage of 2.5 mg or more, the body returns to the basic state after four days. With a course of therapy, the half-life can be from 13 to 17 hours.

The binding of the active ingredient and its metabolite to plasma proteins can be 70-56%.

The pharmacokinetic picture of Ramipril is independent of the patient's age. No accumulation in the body occurs.

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Dosing and administration

The medicine is used for internal use. It is not recommended to chew or crush the tablets.

The daily dosage is divided into one, less often into two doses. Tablets can be taken both before and after meals. The duration of the course of therapy and the dosage are selected by the attending physician.

To treat high blood pressure, take 2.5 mg of Ramipril per day. If the dynamics of pressure normalization are insufficient, then after 14-20 days the dosage is adjusted and doubled. The optimal stationary dosage of the drug can be 2.5-5 mg per day. The peak amount of the drug is 10 mg per day. In order to speed up the process of stabilizing pressure indicators, it is allowed to use additional medications, such as diuretics and calcium antagonists.

In case of cardiac insufficiency, Ramipril is taken in the amount of 1.25 mg per day. If the obtained therapeutic effect is insufficient, the dosage can be doubled every 7-14 days. The maximum dosage is 10 mg per day.

In the post-infarction period, the recommended dosage is 5 mg per day. This dosage can be divided into two doses of 2.5 mg per dose. The patient's condition should be monitored and, if necessary, the dosage should be revised in one direction or another. The dosage should be increased gradually, every three days. The peak dosage is 10 mg per day.

In severe cases of heart failure, the drug is used with caution, starting with the lowest possible dosage.

To prevent possible heart attack, stroke or death due to cardiovascular complications, Ramipril is taken 2.5 mg in the morning and evening. After a week from the start of therapy, the dosage can be gradually increased.

Patients with nephropathy (diabetic or non-diabetic) take 1.25 mg of the drug per day. It is not recommended for such patients to use more than 5 mg of Ramipril per day.

Elderly patients with impaired renal function (with creatinine clearance of 20-50 ml per minute) take Ramipril in a test dose of 1.25 mg per day. The maximum dose for such patients cannot exceed 5 mg per day.

Patients with insufficient liver function take the drug at 1.25 mg per day. The maximum permissible dosage for such patients is 2.5 mg per day.

Patients with persistent hypertension, water-salt metabolism disorders, and peripheral circulatory pathologies should not take high doses initially.

Patients undergoing hemodialysis should take the drug in an amount of 1.25 mg per day. The dose is taken 2-4 hours after the end of the procedure.

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Use Ramipril during pregnancy

The drug is not prescribed to women during pregnancy. Moreover, before prescribing the drug, the doctor must make sure that the patient is not pregnant. During the course of treatment, patients are recommended to use contraceptives.

If a woman is planning a pregnancy or has already become pregnant, treatment with Ramipril should be discontinued or another approved drug should be switched to.

The active ingredient Ramipril can be found in breast milk, so breastfeeding should be discontinued when the drug is prescribed.

Contraindications

Ramipril is not indicated for use in the following cases:

• if you are prone to allergic reactions to any ingredient of the drug, as well as to drugs that inhibit angiotensin-converting enzyme;
• in case of lactase deficiency and glucose-galactose malabsorption;
• with a history of angioedema;
• in case of narrowing of the renal artery, in case of hemodynamic imbalance, in case of a tendency to low blood pressure;
• in hyperaldosteronism (primary origin);
• during pregnancy and breastfeeding;
• for the treatment of children under 18 years of age;
• in severe kidney diseases.

The drug is prescribed with caution and under the supervision of a physician in the following conditions:

• hypertensive crisis;
• complicated ischemic heart disease;
• water-salt metabolism disorder;
• aortic stenosis;
• mitral valve stenosis;
• hypertrophic cardiomyopathy;
• severe liver dysfunction;
• coronary and cerebral circulation disorder;
• collagenoses;
• decompensation of cardiac activity;
• old age.

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Side effects Ramipril

During treatment, some side effects may develop:

• excessive decrease in blood pressure;
• ischemia of the heart muscle, heart rhythm disturbances, swelling of the extremities, inflammatory reactions in the vascular wall, vascular spasms;
• renal dysfunction, acute renal failure, increased diuresis, the appearance of protein in the urine, increased levels of creatinine and urea in the blood;
• dry irritating cough, inflammation of the bronchi, nasal sinuses, bronchospasm, asthmatic relapses;
• inflammatory processes of the mucous membrane of the mouth, throat, digestive tract;
• dyspeptic phenomena, bowel disorders, disturbances of taste and smell, liver dysfunction;
• headaches, visual and auditory pathologies, anxiety, sleep disorders, vestibular disorders, tremors in the limbs, inflammation of the conjunctiva of the eye, cerebrovascular accidents and psychomotor reactions, deterioration of concentration;
• allergic reactions (rashes, itchy skin, swelling);
• excessive sweating, increased sensitivity to ultraviolet rays, exacerbation of skin diseases, alopecia;
• cramps and pain in muscles or joints;
• metabolic disorders, weight loss, loss of appetite;
• in the blood there is eosinophilia, anemia, neutropenia, agranulocytosis, a drop in hemoglobin and platelet levels;
• chest pain, increased fatigue, apathy;
• decreased sexual desire, erectile dysfunction;
• swelling of the mammary glands (gynecomastia).

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Overdose

Taking large amounts of Ramipril can cause excessive vasodilation, which will cause a sharp drop in blood pressure, even to the point of collapse. In addition, taking too much of the drug can cause a slowdown in heart rate, deterioration in kidney function, and a disorder of water-salt metabolism.

There is no special drug that neutralizes the effect of ramipril. When using large doses of Ramipril, gastric lavage is performed, after which sorbents (activated carbon) are prescribed. In case of water-salt metabolism disorder and a decrease in the volume of circulating blood, infusion solutions are administered by drip to replenish fluid in the body.

In case of excessive decrease in blood pressure, cardiotonic hypertensive agents (dopamine, reserpine) may be prescribed.

There is no need to use hemodialysis or forced diuresis in case of overdose, due to their questionable effectiveness in this problem.

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Interactions with other drugs

The therapeutic effect of Ramipril may be increased when used in combination with other drugs that lower blood pressure, such as diuretics, tricyclic antidepressants, and anesthetics.

When treating Ramipril with diuretics, there is a need to monitor the sodium level in the blood.

Sympathomimetics with vasoconstrictor properties when used together with Ramipril reduce the effect of the latter. When taking the listed drugs together, it is important to monitor blood pressure readings.

The likelihood of a hematological reaction increases with the combined use of Ramipril and immunosuppressants, cytostatics, and glucocorticosteroids.

It is not recommended to use Ramipril and lithium-containing agents due to the increased toxicity of the latter.

When using Ramipril and antidiabetic drugs, it is necessary to monitor blood sugar levels.

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Storage conditions

It is recommended to store the medicine in dark places with a temperature of no more than +25°C, out of reach of children.

List B.

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Shelf life

The shelf life is indicated on the packaging of the drug and is 36 months from the date of manufacture.

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