Ramil

A remedy directly affecting the renin-angiotensin system, Ramil, refers to ACE-inhibiting drugs with the active ingredient Ramipril.

Ramil is produced by the Indian pharmaceutical company Kadila Heltker Ltd. 

Ramil can be appointed only by a doctor, so he is released by pharmacies only when presenting a prescription.

Indications Ramil

 Ramil can be used:

• with an increase in blood pressure, for independent or combined treatment of high blood pressure, in combination with diuretics and calcium channel blockers;
• with congestive heart failure, with the possibility of combination with other (diuretic) drugs;
• in case of cardiac insufficiency, which is a consequence of a heart attack;
• with postinfarction;
• with nephropathy associated with or unrelated to diabetes mellitus;
• to prevent the risk of heart attack, stroke or death as a result of cardiovascular pathology, especially with obvious IHD, diseases of the distal vessels, diabetes mellitus;
• at the risk of cardiovascular diseases as a result of high blood pressure, increased amount of cholesterol in the blood, a low amount of high-density lipoproteins.

[1], [2],

Release form

Ramil is produced in tablet form, 15 tablets each in blister pack. The cardboard box contains two cell packs.

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

The auxiliary components are hydroxypropyl methylcellulose, pregelatinized starch, MCC, sodium stearyl fumarate, iron oxide (E 172).

Pharmacodynamics

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

Ramil has an antihypertensive effect that does not depend on the position of the patient's body, without provoking a compensatory increase in heart rate. Stabilizes the pressure regardless of the content of renin in the bloodstream.

In the majority of patients, the pressure stabilizes within 1-2 hours after the use of tablets. The maximum effect can be observed after 3-6 hours: it lasts throughout the day. The peak level of pressure stabilization can be achieved after 20-30 days from the beginning of treatment with the drug. The stabilizing effect is stable and can persist with a prolonged course of treatment (about 2 years). A sharp cessation of treatment can not provoke a sudden increase in blood pressure.

Ramipril does not have a significant effect on the renal blood flow, only sometimes its insignificant increase is observed. Also, Ramil does not affect the rate of glomerular filtration. The pronounced form of nephropathy (with or without diabetes) can be accompanied by impairment of renal function: Ramil inhibits these negative processes in the kidneys. In patients with the existing danger of nephropathy of different genesis, the drug lowers the degree of albuminuria.

[3]

Pharmacokinetics

Ramil is well absorbed when taken orally. Simultaneous use of food in no way worsens the absorption of the drug.

The metabolism of the drug occurs in the liver, where active and inactive exchange products are formed. The active product of ramipril metabolism is the so-called ramiprilate, which exhibits activity six times that of the original component.

The peak content of the active metabolite in the blood can be observed after 2 to 4 hours after the use of the tablet. The distribution volume is determined in 500 liters. The association with plasma proteins is estimated at about 56%. The half-life is 13 to 17 hours. About 40% leaves the body with fecal masses, 60% - through the urinary system.

In patients of senile age, the pharmacokinetic properties of the drug do not undergo significant changes.

With insufficient kidney function, the active component of the drug is able to accumulate in the body.

With insufficient liver function, the transformation of the active component of the drug into a final product of ramiprilate metabolism deteriorates. 

[4], [5], [6], [7], [8]

Dosing and administration

Ramil is consumed orally, regardless of the time of ingestion. The tablet should be swallowed without chewing or grinding, with plenty of liquid. It is allowed to divide the tablet in half.

At high blood pressure take 2.5 mg of medicine per day at one time, preferably in the morning. If an increase in dosage is required, then it is carried out gradually, for 2 or 3 weeks to 5 mg. The maximum permissible daily dosage is up to 10 mg. The prescribed amount of the drug in some cases can be divided into two doses per day.

With chronic heart failure, initially 1.25 mg of medication per day is taken. In some cases, an increase in dosage may be required, which is achieved by doubling the dose for 7-14 days. Daily intake can be divided into 2 times.

In the post-infarction period, Ramil is appointed no earlier than three days after the infarction, provided stable hemodynamics and the absence of signs of ischemia in the patient. The optimal initial dosage is 2.5 mg twice daily. If the tablets are poorly tolerated by the patient, a reduction in the initial dose to 1.25 mg twice daily is allowed. Further, the amount of the drug is gradually increased, bringing to a stabilizing dose of 5 mg twice a day. The maximum daily amount of the drug is 10 mg.

In the presence of insufficient work of the kidneys, Ramil dosage is corrected at the discretion of the doctor.

[11], [12], [13], [14]

Use Ramil during pregnancy

Ramil is not used in the period of gestation and breastfeeding. Before appointing the drug, the doctor must make sure that the patient is not pregnant.

Throughout the course of therapy, reliable methods of contraception should be used. At the onset of pregnancy, the course of treatment with the drug should be stopped immediately, or the drug should be replaced with another drug approved during pregnancy. 

Contraindications

What can be contraindications to the use of Ramil:

• propensity to allergic reactions in response to the action of the active component of the drug, or other auxiliary component;
• an earlier allergy to ACE inhibitor drugs;
• narrowing of the lumen of the renal arteries (one or two);
• complicated and severe kidney pathology (with creatinine clearance less than 30 ml per minute);
• recovery period after a kidney transplant;
• the primary form of hyperaldosteronism;
• pregnancy and the period of breastfeeding;
• hemodialysis procedures;
• insufficient function of the liver.

Ramil is not used to treat patients of childhood.

[9]

Side effects Ramil

Side effects of Ramil can affect various organs and systems of the body.

Cardiovascular system: lowering of blood pressure, fits of short-term loss of consciousness, insufficiency of cardiac activity, dizziness, chest pains, heart rhythm disturbances.

Hemopoietic organs: anemia, a decrease in the number of platelets, neutrophils and eosinophils in the blood, inflammatory changes in the walls of blood vessels, pancytopenia.

Gastrointestinal tract: dyspeptic phenomena, salivary gland dysfunction, emaciation, swallowing difficulties, stool disorders, inflammatory diseases of the digestive system, liver dysfunction (inflammation, cholestasis, jaundice).

Respiratory organs: dry cough, inflammatory processes in the upper respiratory tract.

Nervous system: pain in the head, asthenic condition, disorders of the vestibular apparatus, memory and sleep disorders, seizures, depressive state, trembling and numbness of the limbs, deterioration of hearing and vision.

Urinary system: renal dysfunction, the appearance of protein in the urine, dysuric disorders, peripheral puffiness.

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

Among other side effects, muscle and joint pain, increased urea and creatinine in the blood, an increase in the titer of antinuclear antibodies are also noted.

[10]

Overdose

Symptoms of an overdose of Ramil may include:

• excessive lowering of blood pressure;
• state of shock;
• disturbance of electrolyte metabolism;
• disturbance of the kidneys (OPN).

Activities with overdose: cleaning and washing the stomach, the use of sorbents, if necessary - intravenous infusions of saline, catecholamines, angiotensin II.

With a steady slowing of the heart rate, you can use an artificial pacemaker (pacemaker).

With the appearance of edema Quincke - an urgent injection of epinephrine (sc or IV), then - iv injection of glucocorticoid drugs, antihistamines, antagonists of H 2 -receptors.

Hemodialysis with an overdose of Ramil is ineffective, therefore its use is inexpedient.

[15], [16]

Interactions with other drugs

The combination of Ramil and other antihypertensive drugs, diuretics, anesthetics based on opium (narcotic analgesics), anesthetics, tricyclic antidepressants and antipsychotics can provoke an increase in the hypotensive effect of the medication.

Combination with non-steroidal anti-inflammatory drugs, estrogen-containing drugs, sympathomimetics, as well as with preparations containing salt, can reduce the hypotensive effect of Ramil.

A combination with potassium-based medications can increase the amount of potassium in the bloodstream.

Do not combine Ramil and lithium-based drugs, as this can provoke an increase in the toxic effects of lithium-containing drugs.

A combination with diabetes mellitus (including that of insulin) can trigger an increased lowering of blood glucose levels up to hypoglycemia.

Combination with allopurinol, cytostatics, immunosuppressants, corticosteroid hormones increases the risk of developing leukopenia.

Ramil and its active ingredient ramipril enhances the effect of alcoholic beverages.

[17], [18]

Storage conditions

It is recommended to keep the drug in a dry, dark place, in the factory packaging, in the area of inaccessibility for children. The temperature should not exceed + 25 ° C.

Shelf life

Shelf life - up to 3 years, subject to the storage conditions of the medicinal product.