Ramipril

Medpreparat refer to synthetic cardiovascular drugs, aimed at regulating blood pressure. This effect is achieved through the action of the active component of ramipril on the renin-angiotensin system.

Ramipril is produced by the German pharmaceutical company Höchst AG.

Medication Ramipril is dispensed in the pharmacy network only if prescription is confirmed by the doctor.

[1], [2], [3], [4], [5], [6],

Indications Ramipril

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

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

Indication for prescription Ramipril is considered preventive therapy of strokes and heart attacks, as well as deaths due to cardiovascular pathology. The drug can be prescribed for CHD, diseases of the peripheral vascular system, hypertension, high cholesterol in the blood, a low content of high-density lipoproteins.

[7], [8], [9], [10]

Release form

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

The active component of the drug is ramipril.

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

Pharmacodynamics

Ramipril is a medicinal product designed to normalize blood pressure. Belongs to the group of medications that inhibit the angiotensin-converting enzyme. The key component is ramipril, which, entering the bloodstream, undergoes transformation to the active substance of ramiprilate.

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

In the treatment of ramipril in patients there is a decrease in the degree of resistance of the vascular walls, relaxation of the walls of the vessels, which leads to a confident decrease in blood pressure without increasing the burden on the heart. In addition, the drug is able to reduce the load on the heart muscle, thereby beneficially affecting the patients' well-being, especially during post-infarction and post-stroke states.

Lowering blood pressure is observed after 60-120 minutes after the use of ramipril and lasts throughout the day. The maximum effectiveness occurs after 14-20 days of continuous treatment. The drug does not need to be canceled gradually: withdrawal syndrome is not observed.

[15], [16], [17], [18]

Pharmacokinetics

The basic metabolic processes with the drug occur in the liver, resulting in the formation of ramiprilate. Ramipril is converted to the ether of diketopiperazine.

Ramiprilate becomes bioavailable when ingested and can be about 45%. The substance is quickly absorbed in the digestive system (at least 56% of the amount received). The degree of absorption is not dependent on simultaneous ingestion. The peak plasma content can be observed 60 minutes after the drug is used.

The half-life is also 60 minutes.

Limit level of ramiprilata in the circulatory system is found 120-240 minutes after the dose.

The final stage of excretion of the drug is long enough: after a single use of the drug at a dosage of 2.5 mg or more, the organism returns to its basal state after four days. With the course therapy, the half-life can be from 13 to 17 hours.

The relationship between the active component and its metabolite with plasma proteins can be 70-56%.

The pharmacokinetic picture of ramipril is not dependent on the age of the patient. There is no accumulation in the body.

[19], [20], [21],

Dosing and administration

The medication is used for internal reception. It is not recommended to chew and grind tablets.

The daily dosage is divided into one, less often by two doses. You can eat tablets before or after eating. The duration of the course of therapy and dosage is selected by the attending physician.

To treat the increase in blood pressure take 2.5 mg of ramipril per day. If the dynamics of normalization of pressure is insufficient, then after 14-20 days the dosage is corrected and increased twofold. The optimal steady-state dosage of the drug may 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 stabilization of pressure indicators, it is allowed to use additional medications, such as diuretics and calcium antagonists.

In case of a lack of cardiac activity, Ramipril is taken in the amount of 1,25 mg per day. If the resulting therapeutic effect is insufficient, the dosage can be doubled every 7-14 days. The limiting 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 times 2.5 mg per reception. It is necessary to monitor the patient's condition and, if necessary, revise the dose in one direction or the other. Increase the dosage is carried out gradually, every three days. The peak dosage is 10 mg per day.

In severe course of heart failure, medication is used with caution, starting from a possibly small dosage.

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

Patients with nephropathy (related or not associated with diabetes) take 1.25 mg of the drug per day. It is not recommended the use of such patients more than 5 mg of ramipril per day.

An elderly patient with a disorder of renal function (with creatinine clearance of 20-50 ml per minute) takes ramipril at a test dosage of 1.25 mg per day. The limiting dose for such patients can not be more than 5 mg per day.

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

Do not initially take high doses of patients with persistent hypertension, disorders of water-salt metabolism, pathologies of peripheral circulation.

Patients who undergo 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. 

[25], [26], [27]

Use Ramipril during pregnancy

The medicine is not prescribed to women during the bearing of the child. Moreover, before prescribing the drug, the doctor should make sure that the patient does not have a pregnancy. During the course of treatment, patients are recommended to use contraceptives.

If a woman is planning a pregnancy, or she has already started, it is necessary to cancel the treatment of ramipril, or to switch to another approved drug.

The active component of ramipril can be found in breast milk, so when prescribing the breastfeeding should be stopped.

Contraindications

Ramipril is not indicated for use in the following cases:

• with a tendency to allergic reactions to any ingredient of the drug, as well as to drugs that inhibit the angiotensin-converting enzyme;
• with lactase deficiency and the state of glucose-galactose malabsorption;
• with angioedema in the past;
• with a narrowing of the arteries of the kidneys, with an imbalance of hemodynamics, with a tendency to lowered blood pressure;
• with hyperaldosteronism (primary origin);
• during pregnancy and lactation;
• for treatment of children under 18;
• with severe kidney disease.

 The drug is administered cautiously and under the supervision of a doctor under the following conditions:

• hypertensive crisis;
• complicated ischemic heart disease;
• disturbance of water-salt metabolism;
• narrowing of the aorta;
• narrowing of the mitral valve;
• hypertrophic cardiomyopathy;
• severe liver dysfunction;
• disorder of coronary and cerebral circulation;
• collagenoses;
• decompensation of cardiac activity;
• elderly age.

[22]

Side effects Ramipril

 In the treatment of possible development of some side effects:

• excessive lowering of blood pressure;
• ischemia of the heart muscle, disturbances of the heart rhythm, edema of the extremities, inflammatory reactions in the vascular wall, vasospasms;
• renal function impairment, arthritis, increased diuresis, the appearance of protein in the urine, an elevated level of creatinine and urea in the blood;
• dry irritating cough, inflammation of the bronchi, nasal sinuses, bronchospasm, asthma relapse;
• inflammatory processes of the oral mucosa, throat, digestive tract;
• dyspeptic phenomena, disorders of stool, disorders of taste and olfactory sensations, liver dysfunction;
• pain in the head, visual and auditory pathologies, anxiety, sleep disorders, vestibular disorders, trembling in the limbs, inflammation of the conjunctiva of the eye, cerebral circulation and psychomotor reactions, worsening concentration of attention;
• allergic reactions (rashes, itching of the skin, puffiness);
• excessive sweating, increased sensitivity to ultraviolet rays, exacerbation of skin diseases, allopecia;
• cramps and pain in the muscles or joints;
• metabolic disorders, weight loss, loss of appetite;
• in the blood eosinophilia, anemia, neutropenia, agranulocytosis, a drop in the level of hemoglobin and platelets;
• chest pain, fatigue, apathy;
• lowering of sexual desire, erectile dysfunction;
• swelling of the mammary glands (gynecomastia).

[23], [24]

Overdose

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

A special drug that neutralizes the action of ramipril does not exist. When using large doses of Ramipril, the stomach cavity is washed, after which sorbents (activated charcoal) are prescribed. When the water-salt metabolism is disturbed and the volume of circulating blood is reduced by a droplet, infusion solutions are added to replenish the fluid in the body.

With excessive lowering of blood pressure, cardiotonic hypertensive drugs (dopamine, reserpine) can be prescribed.

It is not necessary to use hemodialysis or forced diuresis in case of an overdose, because of their questionable effectiveness in this issue.

[28], [29], [30], [31]

Interactions with other drugs

Therapeutic effects Ramipril may become more pronounced when combined with other pressure-reducing drugs, such as diuretics, antidepressants of the tricyclic structure, and anesthetics.

With the simultaneous treatment of ramipril and diuretics, there is a need to monitor the sodium level in the blood.

Sympathomimetics with vasoconstrictive properties when combined with ramipril reduce the effect of the latter. With the joint use of these drugs, it is important to monitor the blood pressure readings.

The probability of occurrence of a hematologic reaction with combined administration of ramipril and immunosuppressants, cytostatics, glucocorticosteroids increases.

It is not recommended to use Ramipril and lithium-containing drugs, in view of the increased toxicity of the latter.

When using ramipril and antidiabetic drugs, you need to monitor blood sugar levels.

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Storage conditions

It is recommended to keep the medicine in dark places with a temperature of no more than + 25 ° C, outside the children's access zone.

List B.

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Shelf life

 Shelf life is indicated on the package to the preparation and is 36 months from the date of release. 

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