Ramira

A medicinal product with an effect on the renin-angiotensin system – Ramira – is classified as an ACE inhibitor with the active ingredient ramipril.

Ramira is produced by the Icelandic pharmaceutical company Actavis AT or the Maltese company Actavis Ltd.

Indications Ramira

The medicine is recommended for use:

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

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Release form

Ramira is produced in tablet form, the tablets are in a blister cell package. The cardboard box contains three or nine cell packages.

• 1.25 mg – 30 pcs. (3 x 10 pcs.);
• 1.25 mg – 90 pcs. (9 x 10 pcs.);
• 10 mg – 30 pcs. (3 x 10 pcs.;
• 10 mg – 90 pcs. (9 x 10 pcs.;
• 2.5 mg – 30 pcs. (3 x 10 pcs.);
• 2.5 mg – 90 pcs. (9 x 10 pcs.);
• 5 mg – 30 pcs. (3 x 10 pcs.;
• 5 mg – 90 pcs. (9 x 10 pcs.).

The active component of the drug is ramipril. One tablet may contain 1.25 mg, 2.5 mg, 5 mg or 10 mg of ramipril.

The auxiliary components are sodium bicarbonate, pregelatinized starch, lactose, sodium croscarmellose, sodium stearyl fumarate. The tablets may also contain a pigmented mixture of yellow or pink color.

Pharmacodynamics

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

Ramira has a hypotensive effect that does not depend on the patient's body position and does not lead to a compensatory increase in heart rate. It stabilizes blood pressure regardless of the renin content in the circulatory system.

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 therapy (about 2 years). Abrupt cessation of treatment is not capable of causing a sudden increase in blood pressure.

Ramipril does not have a significant effect on renal blood circulation, only sometimes its slight acceleration is observed. Also, the drug does not affect the rate of glomerular filtration. A pronounced form of nephropathy (with or without diabetes) can be accompanied by deterioration of renal function: Ramira inhibits the development of these pathological 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

Ramira is easily absorbed when taken orally. Simultaneous consumption of food does not impair the absorption of the medicine 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 the effect of the original component.

The peak content of the active metabolite in the blood can be observed after a period of time from 2 to 4 hours after taking the tablet. The distribution volume is determined to be 500 l. The connection with the protein component of plasma is estimated at approximately 56%. The half-life is from 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

Ramira is to be 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 state, Ramira 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.

In case of insufficient renal function, the dosage of Ramir is adjusted at the discretion of the attending physician.

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Use Ramira during pregnancy

Ramira 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. In case of pregnancy, the course of treatment with the drug should be stopped immediately, or this drug should be replaced with another one, permitted during pregnancy.

Contraindications

In what cases should the drug be avoided:

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

Ramira is not used to treat pediatric patients.

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Side effects Ramira

Side effects of Ramir 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: signs of 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: attacks of 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.

Kidney and urinary system: renal dysfunction, protein in urine, dysuric disorders, peripheral edema.

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

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

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Overdose

Signs of consuming large amounts of Ramir are:

• excessive decrease in blood pressure;
• state of shock;
• electrolyte imbalances;
• renal dysfunction (ARD).

Overdose first aid measures: gastric lavage and rinsing, use of sorbents, if necessary – intravenous infusions of saline, catecholamines, angiotensin II.

If the heart rate slows progressively, 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 is not very effective in case of Ramir overdose, so its use is not advisable.

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Interactions with other drugs

The combined use of Ramir 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.

Concomitant use with non-steroidal anti-inflammatory drugs, estrogen-containing drugs, sympathomimetics, as well as drugs containing table salt, may reduce the hypotensive effect of Ramir.

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

You should not combine the use of Ramir 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.

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

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

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Storage conditions

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

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Shelf life

Shelf life:

• for tablets with a dosage of 2.5 mg, 5 mg and 10 mg – up to 2 years;
• for tablets with a dosage of 1.25 mg - up to one and a half years, subject to the storage conditions of the drug.

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