Ramiexsal

Ramygexal is referred to drugs that affect the cardiovascular system - the renin-angiotensin system - a monocomponent ACE inhibitor.

The active component of the medication is Ramipril.

Produced by the German pharmaceutical company Salutas Pharma GmbH.

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

Indications Ramiexsal

Ramygexal is used:

• with hypertension;
• in chronic course of heart failure;
• in the rehabilitation period of postinfarction and post-insult conditions;
• with nephropathy associated with diabetes.

[1], [2]

Release form

The medicine is produced in tablet form. Content per tablet: ramipril 2.5 or 5 mg. Additional components are sodium hydrogencarbonate, MCC, hypromelose, pregelatinized starch, sodium stearyl. 

Pharmacodynamics

The agent for stabilization of the raised pressure, inhibiting ACE. Suppresses ACE, which causes relaxation of the vascular walls and lowering blood pressure. As a consequence of the inhibition of ACE, the activity of renin, a component of the renin-angiotensin system, is stimulated, which normalizes blood pressure.

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

Ramiexal has practically no effect on the blood circulation in the kidneys and the rate of the process of urination (CF).

Patients with high blood pressure note a decrease in blood pressure, 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 action can be observed after 3 to 6 hours: it continues throughout the day.

Persistent blood pressure indicators are established after about a month of constant use of Ramygexal.

Long-term use of the drug does not cause dependence and does not affect the degree of drug exposure.

The abrupt elimination of Ramygexal does not lead to a simultaneous increase in the pressure indices.

[3], [4], [5],

Pharmacokinetics

Ramiexal is well absorbed when used internally. At the same time, the food taken does not affect the absorption and absorption of the medicine. 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 2 to 4 hours after ingestion. The connection with plasma proteins can be about 56%. The half-life is 14-16 hours from the use of the repeated dosage of Ramygexal. Most of the active ingredient leaves the body through the urinary system, about 40% - with the feces.

In disorders of renal function, the active component tends to accumulate within 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.

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Dosing and administration

Ramygexal 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, Ramihexal is started with 2.5 mg once a day. Typically, the same dosage is used for further therapy. If the doctor finds it advisable, the amount of the drug used can be increased for 14-20 days to 5 mg. Limit dosage of the drug per day - 10 mg. Sometimes the reception of Ramygexal is combined with diuretics.

In chronic course of heart failure, treatment is started with 1.25 mg of Ramyexal per day. The doctor monitors the patient and, if necessary, increases the amount of the drug for 7-14 days.

For the treatment of post-infarction states, Ramygesal 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, Ramihexal is taken in a standard dosage. If the clearance is ≤50 ml per minute, then the drug is prescribed at 1.25 mg once a day. Maximum - 5 mg once a day.

[11]

Use Ramiexsal during pregnancy

Ramiexal is not used during pregnancy, but also breastfeeding.

Contraindications

Before use, carefully read the list of contraindications for taking medication:

• propensity to allergy to the active or any of the additional components of the drug;
• allergic sensitivity to other drugs that inhibit ACE;
• 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;
• conducting hemodialysis.

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

Ramygexal is contraindicated in severe form of cardiac insufficiency, with orthostatic imbalance, with exacerbation of coronary heart disease, severe heart rhythm disturbances, pulmonary heart disease.

[7], [8], [9],

Side effects Ramiexsal

What can be the side effects of Ramygexal:

• lowering of blood pressure (including critical pressure), myocardial ischemia, retrosternal 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 disorders, sensitivity disorders of limbs, trembling in the hands, impairment of auditory and visual functions;
• dry cough, inflammatory processes in the nasal sinuses, nasopharynx, bronchi and trachea;
• deterioration of the kidneys, puffiness, a decrease in the daily volume of urine, protein in the urine;
• allergic dermatoses, sensitivity to ultraviolet radiation;
• weight loss, pain in joints and muscles, fever, etc.

[10]

Overdose

Overdose Ramygexal can be expressed in a critical drop in pressure, up to a shock state. In some cases there is an imbalance of electrolyte metabolism, a disorder in the work of the kidneys.

As an aid in overdose, general measures are used to detoxify the body: wash the stomach, give a sorbent preparation (for example, activated charcoal). Intravenously inject saline, catecholamines.

The use of hemodialysis with an overdose of Ramygexal is inappropriate.

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Interactions with other drugs

Combined use of drugs aimed at lowering blood pressure, as well as diuretics, analgesics based on opium, drugs for anesthesia can enhance the antihypertensive property of Ramygexal.

 The combined use of non-steroidal anti-inflammatory drugs (aspirin, ibuprofen, etc.), sympathomimetic agents and salt-rich foods can lower the effect of Ramygexal.

Simultaneous use of potassium-containing drugs, potassium-sparing diuretics and Ramiexal is possible a marked increase in potassium levels in the bloodstream.

Simultaneous use of Ramygexal with lithium-containing drugs can provoke an increase in the level 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 combination of Ramihexal with drugs for diabetes can increase the degree of hypoglycemic action.

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

The use of Ramygexal together with alcohol potentiates the effect of the latter.

[13]

Storage conditions

Storage of Ramygexal is recommended at temperatures up to + 25 ° C. The medicine should not be frozen or exposed to direct ultraviolet radiation.

Ramihexal must be stored in factory packaging, in a specially designated place, where children's access is limited. 

Shelf life

Shelf life Ramiexal is indicated on the package with the preparation and is no more than 2 years from the date of manufacture. If the expiration date is finished, it is recommended to discard the drug.