Rami Sandoz 5 mg tablets number 30

Rami Sandoz (Ramipril) Instructions for use

Composition

active ingredient: ramipril; 1 tablet contains ramipril 2.5 mg or 5 mg or 10 mg;
auxiliary substances: microcrystalline cellulose, corn starch, precipitated silicon dioxide, glycine hydrochloride, glycerin dibehenate, iron oxide yellow (E172) (for tablets of 2.5 mg), iron oxide red (E172) (for tablets of 5 mg).

Dosage form

Tablets.

Basic physical and chemical properties:

tablets of 2.5 mg: light yellow, slightly spotty capsule-like, with a screw on one side;
5 mg tablets: light pink, lightly spotted capsule-shaped, with a scratch on one side;
10 mg tablets: white or almost white capsule-like, with a scoop on one side.

Pharmacological group

ACE inhibitors (ACE). Code АТХ С09А А05.

Pharmacological properties

Ramiprilat, an active metabolite of ramipril, inhibits the enzyme dipeptidylcarboxypeptidase I (synonyms: ACE; kininase II). In the blood and tissue plasma, this enzyme catalyzes the conversion of angiotensin I into an active vasoconstrictor (vasoconstrictor) angiotensin II, as well as the cleavage of the active vasodilator bradykinin. Reducing the formation of angiotensin II and inhibiting the cleavage of bradykinin leads to the expansion of blood vessels.

Since angiotensin II also stimulates the release of aldosterone, ramiprilat helps to reduce the secretion of aldosterone. The response to monotherapy with ACE inhibitors on average was less pronounced in patients with a Negro race (African-Caribbean origin) with arterial hypertension (a population that is characterized by a low renin level in arterial hypertension) than in other races.

Pharmacodynamics.

The administration of ramipril leads to a significant reduction in peripheral arterial resistance. As a rule, no significant changes in renal plasma flow or velocity of glomerular filtration occur. The appointment of ramipril to patients with arterial hypertension leads to a decrease in blood pressure both in the horizontal and in the vertical position of the patient, not accompanied by compensatory increase in the frequency of cardiac contractions.

In most patients, the antihypertensive effect occurs 1-2 hours after taking a single dose. The maximum effect of a single dose is usually reached after 3-6 hours. The antihypertensive effect after a single dose is usually maintained for 24 hours.

The maximum antihypertensive effect after prolonged treatment with ramipril is generally observed after 3-4 weeks. For prolonged therapy, it persists for 2 years.

After a sudden discontinuation of ramipril, fast and excessive increase in blood pressure does not occur.

For patients with nondiabetic or diabetic severe nephropathy, ramipril reduces the rate of progression of renal failure and the onset of the terminal stage of renal failure, resulting in the need for dialysis or kidney transplantation. For patients who have a non-diabetic or diabetic primary nephropathy, ramipril reduces the elimination of albumin.

These studies have shown that ramipril statistically significantly reduces the incidence of myocardial infarction, stroke, or lethality from cardiovascular disease. In addition, ramipril reduces the overall mortality and the need for revascularization, as well as delaying the onset and progression of heart failure. Ramipril reduces the risk of developing nephropathy in a common group of patients and among patients with diabetes mellitus. Ramipril also significantly reduces the incidence of microalbuminuria. Such effects were observed in patients with both arterial hypertension and normalization.

Pharmacokinetics.

Suction After ingestion, ramipril is rapidly absorbed from the gastrointestinal tract. Maximum concentrations in plasma are reached within 1 hour. Given the amount of substance found in the urine, the rate of absorption is at least 56% and is not significantly affected by the presence of food in the gastrointestinal tract. The bioavailability of the active metabolite of ramiprilat after oral administration of ramipril in a dose of 2.5 mg and 5 mg is 45%.

The maximum plasma concentrations of ramiprilat, a single active metabolite of ramipril, are achieved 2-4 hours after the administration of ramipril. After application of usual doses of ramipril 1 time per day, the equilibrium concentration of ramiprilat in plasma is reached on day 4 of treatment.

Distribution. The binding of ramipril to plasma protein proteins is approximately 73% and ramiprilat is 56%.

Metabolism. Ramipril is almost completely metabolized to ramiprilat, diketopiperazine ether, diketopiperazine acid and ramipril glucuronides and ramiprilatum.

Conclusion The elimination of metabolites occurs predominantly by renal excretion. Reduced concentration of ramiprilat in plasma is polyphase. Due to its powerful saturation binding to ACE and slow dissociation due to the enzyme, ramiprilat has a prolonged terminal terminal phase at very low concentrations in the blood plasma.

After taking repeat doses of ramipril once daily, the effective half-life is 13-17 hours at a dose of 5-10 mg or more for low doses (1.25-2.5 mg). The difference is due to the fact that the ability of the enzyme to bind to Ramiprilat is saturable.

When oral administration of a single dose of the drug neither ramipril nor its metabolite was shown in breast milk. However, it is not known what effect is taking repeated doses.

Patients with impaired renal function (see Section "Method of administration and dose"). In patients with renal impairment, renal excretion of ramiprilatum is reduced, and renal clearance of ramiprilat is proportional to creatinine clearance. This leads to an increase in the plasma concentrations of ramiprilat, which decrease slower than in those with normal kidney function.

Patients with a liver function impairment (see Section "Method of administration and dose"). In patients with a liver failure, the metabolism of ramipril with the formation of ramiprilat was delayed due to decreased activity of hepatic esterase, and ramipril levels in plasma of these patients were elevated. However, the maximum concentrations of ramiprilat in these patients did not differ from those in individuals with normal liver function.

Indications

Treatment for arterial hypertension.

Prevention of cardiovascular diseases: reduction of cardiovascular morbidity and mortality in patients with:

• pronounced cardiovascular diseases of the atherothrombotic genesis (presence of an ischemic heart disease or stroke or peripheral vascular disease history)
• diabetes mellitus have at least one cardiovascular risk factor.

Treatment of kidney disease.

initial glomerular diabetic nephropathy, as evidenced by the presence of microalbuminuria;
pronounced glomerular diabetic nephropathy, as evidenced by the presence of macroproteinuria, in patients with at least one cardiovascular risk factor;
pronounced glomerular undiabetic nephropathy, as evidenced by the presence of macroproteinuria ≥ 3 g / day.

Treatment of cardiac insufficiency, accompanied by clinical manifestations.

Secondary prophylaxis after acute myocardial infarction: reduction of lethality in an acute stage of myocardial infarction in patients with clinical signs of heart failure at the onset of treatment more than 48 hours after the onset of acute myocardial infarction.

Contraindications

Hypersensitivity to the active substance, to any other component of the preparation or to other ACE inhibitors, angioneurotic edema in the history (hereditary, idiopathic or associated with the use of ACE inhibitors); renal artery stenosis (bilateral or stenosis of the kidney of the artery); severe renal failure primary hyperaldosteronism.

The drug should not be used in patients with arterial hypotension or hemodynamically unstable conditions.

The drug is contraindicated for women planning a pregnancy.

Do not use with aliskiren preparations, patients with diabetes mellitus or moderate or severe renal insufficiency (GFR <60 ml / min).

It is necessary to avoid the simultaneous use of ACE inhibitors and extracorporal methods of treatment, leading to blood contact with negatively charged surfaces, since such an application may lead to anaphylactic reactions of severe degree. Such extracorporal methods of treatment include dialysis or hemofiltration using certain membranes with high hydraulic permeability (eg, polyacrylonitrile) and apheresis of low density lipoprotein with dextran sulfate.

Interaction with other drugs and other types of interactions

Combinations are contraindicated.

Methods of extracorporal therapy that results in blood contact with negatively charged surfaces such as dialysis or hemofiltration using certain high-flow membranes (eg, polyacrylonitrile membranes) and apheresis of low density lipoproteins using dextran sulfate - given the increased risk of severe anaphylactic reactions. If such treatment is necessary, consideration should be given to the use of another type of dialysis membranes or antihypertensive agents of another class.

Double block of renin-angiotensin (RAAS) antagonists of angiotensin II receptor antagonists, ACE inhibitors or aliskiren.

A combination of ACE inhibitors (including ramipril) or angiotensin II receptor antagonists with aliskiren is contraindicated in patients with diabetes mellitus or renal dysfunction (SCF <60 ml / min / 1.73 m 2) and not recommended for other categories of patients.

Combinations requiring action.

Potassium salts, heparin, potassium-sparing diuretics, and other substances that increase potassium levels in the plasma (including angiotensin II antagonists, trimethoprim, tacrolimus, cyclosporine): hypercalemia can occur, therefore careful monitoring of potassium levels in plasma.

Antihypertensive drugs (eg, diuretics) and other agents that can lower blood pressure (eg nitrates, tricyclic antidepressants, anesthetics, ethanol, baclofen, alfuzosin, doxazosin, prazosin, tamsulosin, terazosin): Hypotensive effects are expected to increase.

Vasopressor sympathomimetics and other substances (such as isoproterenol, dobutamine, dopamine, epinephrine) that can reduce the antihypertensive effect of ramipril: blood pressure monitoring is recommended.

Allopurinol, immunosuppressants, corticosteroids, procainamide, cytostatics and other substances that can change the number of blood cells: an increased probability of hematologic reactions.

Lithium salts ACE inhibitors reduce lithium intake, so the likelihood of lithium toxicity may increase. It is recommended to control the level of lithium.

Anti-diabetic agents , including insulin : possible hypoglycaemic reactions. It is recommended to monitor blood glucose levels.

Nonsteroidal anti-inflammatory drugs (NSAIDs) and acetylsalicylic acid are expected to reduce the antihypertensive effect of ramipril. In addition, the combined use of ACE inhibitors and NSAIDs may be accompanied by an increased risk of deterioration of renal function and an increase in potassium levels in plasma.

Food does not significantly alter the absorption of the drug.

G. Increased salt intake may weaken the antihypertensive effect of ramipril.

Specific hyposensitization. Due to the inhibition of ACE, the probability of occurrence and severity of anaphylactic and anaphylactoid reactions to insect poison increases. It is believed that such an effect can also be observed on other allergens.

Application features

Special patient categories.

Double blockade of RAAS by drugs containing aliskiren.

Combined use of ramipril and aliskiren is not recommended, as there is an increased risk of arterial hypotension, hyperkalaemia and changes in the function of the kidneys.

Concomitant use of ramipril and aliskiren is contraindicated in patients with diabetes mellitus or renal impairment (SCF <60 ml / min) (see section "Contraindications").

Patients with a special risk of arterial hypotension.

Patients with pronounced activation of RAAS.

The risk of a sudden marked decrease in blood pressure with deterioration of renal function due to inhibition of ACE is increased in patients with pronounced activation of RAAS, especially if the ACE inhibitor or concomitant diuretic agent is prescribed for the first time or when the dose is first raised.

Significant increase in the activity of RAAS, which requires medical observation, including constant monitoring of blood pressure, can be expected, for example, in patients:

• with severe arterial hypertension;
• with decompensated congestive heart failure;
• with a hemodynamically significant impediment to the inflow or outflow of blood from the left ventricle. (For example, with stenosis of the aortic or mitral valve);
• with one-sided renal artery stenosis in the presence of a second functioning kidney;
• in which there is or may develop a lack of fluid or electrolytes (Including those who receive diuretics);
• with cirrhosis of the liver and / or ascites;
• which are undergoing extensive surgical interventions or during anesthesia with the use of drugs that cause arterial hypotension.

As a rule, it is recommended to correct dehydration, hypovolemia or lack of electrolytes before treatment (however, for patients with heart failure, such corrective measures should be carefully weighed against the risk of overloading volume).

In patients with impaired liver function, the response to treatment with ramipril may be either increased or decreased. In addition, in patients with severe cirrhosis of the liver, accompanied by swelling and / or ascites, the activity of the renin-angiotensin system can be significantly increased; therefore, special care should be taken during the treatment of these patients.

Treatment of persistent cardiac insufficiency after myocardial infarction.

Patients at risk of cardiac or cerebral ischemia in the case of acute arterial hypotension. The initial phase of treatment requires special medical supervision.

Older patients. See section "Method of administration and dose".

Surgical interventions. It is recommended that treatment with ACE inhibitors such as ramipril, if possible, be discontinued 1 day before surgical intervention.

Control of kidney function. The function of the kidneys should be evaluated before and during treatment and adjust the dose, especially during the first weeks of treatment. In the presence of kidney damage, special care is required. There is a risk of deterioration of the function of the kidneys, mainly in patients with congestive heart failure or after kidney transplantation.

Angioedema edema Individual cases of angioedema have been reported in patients receiving ACE inhibitors, including ramipril. In the case of angioneurotic edema, the drug should be discontinued and immediate emergency treatment should be prescribed. Patients should be under the supervision of a physician for at least 12-24 hours until complete disappearance of the symptoms.

In the treatment of ACE inhibitors, cases of angioneurotic edema of the intestine were observed. These patients complained of abdominal pain (with or without nausea / vomiting). Symptoms of aneuronetic edema of the intestine disappeared after the abolition of ramipril.

Anaphylactic reactions at desensitization. The probability and severity of anaphylactic and anaphylactoid reactions to insect poison and other allergens increase with ACE inhibitors. Before desensitization, consideration should be given to the possible temporary withdrawal of ramipril.

Hyperkalaemia. Some patients who received ACE inhibitors, including ramipril, observed hyperkalaemia. The risk of hyperkalaemia is higher in patients with renal failure, at the age of 70, in patients with uncontrolled diabetes mellitus, in those who receive potassium salts, potassium-sparing diuretics, as well as other active substances that increase potassium content, or in such conditions as dehydration, acute cardiac decompensation, metabolic acidosis. If co-administration of the aforementioned drugs is considered appropriate, regular monitoring of plasma potassium levels is recommended.

Neutropenia / agranulocytosis. Cases of neutropenia / agranulocytosis, as well as thrombocytopenia and anemia were rare. Also reported was the oppression of the function of the bone marrow. With a view Identify vozmozhnoy leukopenia recommended kontrolyrovat Quantity leykotsytov in blood plasma. Chashche desirable to control conducted in early patsyentam of treatment and with impaired renal function, concomitant kollagenozah (for example, systemnoy Krasnaya erythematosus or Scleroderma) or subjects someone prynymaet others sredstva Pharmaceuticals, kotoryya mogut vыzvat Changed kartynы blood.

Эtnycheskye differences.

Ynhybytorы ACE chashche vыzыvayut anhyonevrotycheskyy edema in patsyentov nehroydnoy rasы, than representatives of evropeoydnoy rasы. How and others ynhybytorы inhibitors, ramipril Can okazatsya less than эffektyvnыm for urovnja Reduction in arterial pressure patsyentov nehroydnoy rasы. This Could bыt obuslovleno topics in something patsyentov nehroydnoy rasы arteryalnoy with hypertension chashche arteryalnaya hypertension observed with renin aktyvnostyu Off-peak times.

Cough. When ACE Application ynhybytorov was reported occurrence of cough. Characteristically, the cough neproduktyvnыy something, and dlytelnыy yschezaet prekraschenyya after therapy. In dyfferentsyalnoy diagnosis of cough sleduet remember when Opportunity occurrence of cough Application Due ynhybytorov ACE.

Application in the period of pregnancy or feeding grudju

Pregnancy. Ramipril contraindicated in pregnancy period. In this way, it is necessary ysklyuchyt Pregnancy before the beginning of treatment. Neobhodimo yzbehat pregnancy, ACE inhibitors Treatment If javljaetsja obyazatelnыm.

If patsyentka zaberemenet plans, it is necessary prekratyt Treatment with ACE inhibitors, that is s Replace the second type of treatment.

If patsyentka zaberemenela IN TIME of treatment, neobhodimo Replace Application drug therapy without ACE ynhybytorov can be faster.

Grudju feeding. Because of a shortage of information on the Application of ramipril in the period grudju feeding is not recommended assign this drug women, kotoryya kormyat grudju, and desirable to otdavat Preferences second lekarstvennыm funds, Application kotorыh IN TIME lactation javljaetsja more than bezopasnыm, especially when grudnom feeding newborn infants or nedonoshennыh.

Ability to Speed vlyyat reaction with traffic control or second mechanism

Some Side эffektы (for example, symptoms Reduction arterial pressure, such As dizziness) mogut disturbance Ability patsyenta for concentrations of attention and snyzhat Speed ego reactions, is the ryskovannыm in situations, when These qualities ymeyut especially Bolshoi meaning (for example, the control transportnыmy assets or second mechanism).

This, As a rule, in early Perhaps of treatment or therapy during the transition from the second of treatment for drug ramipril. After pryema FIRST dozы or dalneysheho Increase dozы not desirable to control pan transportnыm assets or second mechanism works with a techenye Several hours.

Method of administration and dose

The preparation for oral application.

Ramipril recommended prynymat ezhednevno in one and then the same time. The drug can prynymat before and after Time t edы so pryem As of food on bioavailability are not vlyyaet drug. Tablets 2.5 mg, 5 mg and 10 mg prednaznachenы delenyya for obtaining dozы in half to 1.25 mg, 2.5 mg and 5 mg, respectively. Their razzhevыvat impossible or yzmelchat.

Vzroslыe.

Patsyentы, kotoryya prymenyayut diuretics. In the early of treatment Can voznykat hypotension , development kotoroj javljaetsja more than veroyatnыm in patsyentov, kotoryya simultaneously poluchayut diuretics. In cases podobnыh manifest ostorozhnost recommended, because the patsyentov Perhaps in эtyh Volume Reduction tsyrkulyruyuschey blood and / or Quantity эlektrolytov.

Application desirable to prekratyt diuretics for 2-3 days before the beginning of treatment ramipril, If This possible. In patsyentov arteryalnoy with hypertension, kotorыm impossible to cancel diuretics, Treatment sleduet Start in dozы 1.25 mg. It should tschatelno kontrolyrovat kidney function and Level potassium in the blood. It should Dalneyshee dozyrovanyya ramipril korrektyrovat in dependence from tselevogo urovnja arterial pressure.

Arteryalnaya hypertension.

It should podbyrat dose individually in dependence here Features STATUS patsyenta and results kontrolnыh arterial pressure measurements. Apply ramipril can be a monotherapy or in kachestve kombynatsyy with antihypertensive funds lekarstvennыmy second classes.

Nachalnaya dose. Treatment of drug sleduet the Start gradually, since primary dozы Recommended 2.5 mg per day.

In patsyentov co Significant activation of the RAAS after pryema primary dozы Can voznykat Significant Reduction arterial pressure. For such patsyentov rekomenduemaya sostavljaet dose of 1.25 mg, and the Start s Treatment Need a pod control.

Tytrovanyya dozы and podderzhyvayuschaya dose. Each dose can udvayvat 2-4 Nedeli achievements to tselevogo urovnja arterial pressure; Maximum dose sostavljaet ramipril 10 mg per day. Typically, the drug sleduet prynymat 1 per day.

Prevention of cardiovascular diseases.

Nachalnaya dose. Rekomenduemaya nachalnaya sostavljaet dose of 2.5 mg 1 time per day.

Tytrovanyya dozы and podderzhyvayuschaya dose. In dependence from yndyvydualnoy dose tolerability It should gradually uvelychyvat. Recommended double dose of 1-2 Nedeli of treatment and zatem - Nedeli 2-3 - EE Zoom to tselevoy podderzhyvayuschey dozы 1 10 mg per day (see also. Pryvedennuyu Above the info for dosage preparations for patsyentov, poluchayuschyh diuretics).

Treatment of kidney disease.

Patsyentы saharnыm with diabetes and mykroalbumynuryey.

Nachalnaya dose. Rekomenduemaya nachalnaya sostavljaet dose of 1.25 mg 1 time per day.

Tytrovanyya dozы and podderzhyvayuschaya dose. In dependence from yndyvydualnoy at dalnejshem tolerability of treatment dose can uvelychyvat. After 2 Nedeli razovuyu of treatment recommended dose is doubled to 2.5 mg, 5 mg zatem in 2 Nedeli treatment.

Patsyentы saharnыm with diabetes and no less than a factor of cardio-vascular risk.

Nachalnaya dose. Rekomenduemaya nachalnaya sostavljaet dose of 2.5 mg 1 time per day.

Tytrovanyya dozы and podderzhyvayuschaya dose. In dependence from yndyvydualnoy tolerability of treatment dose at dalnejshem It should increase. 1-2 Nedeli sutochnuyu of treatment recommended dose is doubled to 5 mg, and 10 mg zatem 2-3 Nedeli treatment. Tselevaya sutochnaya sostavljaet dose of 10 mg.

Patsyentы with nedyabetycheskoy nefropatyey, at kotoroj svydetelstvuet availability makroproteynuryy ≥ 3 g / day.

Nachalnaya dose. Rekomenduemaya nachalnaya sostavljaet dose of 1.25 mg 1 time per day.

Tytrovanyya dozы and podderzhyvayuschaya dose. In dependence from yndyvydualnoy tolerability of treatment dose at dalnejshem It should increase. After 2 Nedeli razovuyu of treatment recommended dose is doubled to 2.5 mg, 5 mg zatem in 2 Nedeli treatment.

Serdechnaya s failure Clinical manifestations.

Nachalnaya dose. For patsyentov, STATUS kotorыh stabylyzyrovalos of treatment after diuretics, rekomenduemaya nachalnaya sostavljaet dose of 1.25 mg per day.

Tytrovanyya dozы and podderzhyvayuschaya dose. The dose of ramipril tytruyut putem uh Each udvoenyya 1-2 Nedeli achievements to maksymalnoy sutochnoy dozы 10 mg. Raspredelyt desirable to dose 2 reception.

Secondary Prevention after the transfer of acute myocardial ynfarkta in the availability of cardiac failure.

Nachalnaya dose. At 48 hours after occurrence ynfarkta myocardial patients, STATUS kotorыh Clinical and hemodynamically stabylnыm, assign nachalnuyu dose of 2.5 mg 2 times a day in techenye 3 days. If nachalnaya dose of 2.5 mg perenosytsya bad , togda sleduet Apply a dose of 1.25 mg 2 times a day to 2 days techenye with posleduyuschym Increase to 2.5 mg and 5 mg 2 times a day. If the dose can povыsyt to 2.5 mg 2 times a day, to cancel sleduet Treatment (see also. Pryvedennuyu Above the info for dosage preparations for patsyentov, poluchayuschyh diuretics).

Tytrovanyya dozы and podderzhyvayuschaya dose. In dalnejshem sutochnuyu dose povыshat putem ee udvoenyya with interval of 1-3 days to achievements tselevoy podderzhyvayuschey dozы 5 mg 2 times a day.

When This Perhaps podderzhyvayuschuyu dose raspredelyat 2 reception.

If the dose can povыsyt to 2.5 mg 2 times a day, Treatment sleduet to cancel . Experience of treatment patsyentov with severe cardiac insufficiency (IV FC on classification NYHA) Immediately after myocardial ynfarkta everything else enough. If the same is recognizing right decision at patsyentov Treatment of ramipril therapy recommended the Start dozы with 1.25 mg 1 per day and any ee Increase chrezvыchaynoy conducted with caution.

Osobыe category patients.

Patsyentы with violation of the kidney function. Sutochnaya dose patsyentov with violation of the kidney function dependent ride height creatinine as indicators:

• If the ride height creatinine ≥ 60 ml / min, Need a primary correction dozы (2.5 mg / day) no, and Maximum sutochnaya sostavljaet dose of 10 mg;
• If the ride height creatinine 30-60 ml / min, Need a primary correction dozы (2.5 mg / day) no, and Maximum sutochnaya sostavljaet dose of 5 mg;
• If the ride height creatinine 10-30 ml / min, nachalnaya sostavljaet dose of 1.25 mg / day, and sutochnaya Maximum dose - 5 mg;
• patsyentы arteryalnoy with hypertension, nahodyaschyhsya on hemodialysis: hemodialysis with ramipril vыvodytsya neznachytelno; nachalnaya sostavljaet dose of 1.25 mg and sutochnaya Maximum dose - 5 mg sleduet prynymat through Several hours after conducting hemodialysis session.

Patsyentы with violation of the liver function. Treatment with ramipril patsyentov abuse liver function sleduet the Start tschatelnыm control pod and Maximum dose sutochnaya such cases dolzhna sostavlyat 2.5 mg.

Patsyentы pozhyloho age. Nachalnaya dose dolzhna bыt below and dalneyshee tytrovanye dozы It should be more than osuschestvlyat gradually, vыsokuyu Given the probability of occurrence pobochnыh эffektov, especially in patsyentov Very pozhyloho age and nemoschnыh patients. In such cases prescribe mynymalnuyu nachalnuyu dose - 1.25 mg ramipril.

Where are you

Apply ramipril is not recommended detyam, because the data on of the effectiveness and safety of drugs for эtoho patsyentov enough.

Overdose

Symptoms peredozyrovky ACE inhibitors include mogut chrezmernuyu peryferycheskuyu vasodilation (c vыrazhennoy arteryalnoy hypotension, shock), bradycardia, electrolyte balance violation, Renal failure. STATUS patsyenta It should tschatelno kontrolyrovat. Assign podderzhyvayuschee and symptomatic treatment. Measures Predlozhennыe vkljuchajut pervychnuyu detoxification (gastric promыvanye, pryem sorbentov) sredstva for recovery and hemodynamic stabylnosty, vkljuchaja appointment -adrenerhycheskyh α 1 agonists or angiotensin II (anhyotenzynamydu). Ramyprylat, aktyvnыy metabolite of ramipril, bad vыvodytsya IZ systemic blood flow putem hemodialysis.

Adverse reactions

Profil safety of the drug ramipril Containing Data on constantly cough and reactions, hypotension vыzvannыe arteryalnoy. K sereznыm pobochnыm reaction otnosjatsja anhyonevrotycheskyy edema, hyperkalemia, violation or kidney function liver, pancreatitis, Heavy storony co kozhy reactions and neutropenia / agranulocytosis.

Side reaction often is to klassyfytsyruyutsya occurrence follows way: Very often (≥ 1/10), often (≥ 1/100, <1/10), uncommon (≥ 1/1000, <1/100), rarely (≥ 1 / 10,000 <1/1000) Very rarely (<1/10000) neustanovlennыe (impossible to establish ymeyuschymsya dannыm).

Co storony cardiovascular system: often - hypotension , orthostatic Reduction arterial pressure, dizziness; rarely - myocardial ischemia, angina or vkljuchaja ynfarkt myocardium; tachycardia, arrhythmia, oschuschenye usylennoho serdtsebyenyya, peryferycheskye edema, pokrasnenye, oschuschenye prylyvov; rarely - vessels stenosis, hypoperfusion, vaskulit neustanovlennыe - Raynaud's syndrome.

Co storony system krovetvorenyya: Sometimes - eosinophilia ; rarely - Reduction Quantity leykotsytov (including neutropenia or agranulocytosis), red blood cells Reduction Quantity, Reduction urovnja hemoglobin, platelets Quantity Reduction; neustanovlennыe - bone marrow failure, pantsytopenyya, hemolytic anemia.

Co storony nervous system: often - pain Headache, dizziness, Sometimes - vertigo, paresthesia, ahevzyya, dyshevzyya; rarely - tremor, violation equilibrium; neustanovlennыe - tserebralnaya ischemia in stroke volume number and transient ischemic attack yshemycheskaya, violation psychomotor functions oschuschenye zhzhenyya, parosmyya.

Co storony organ of view, rarely - violation of view, vkljuchaja nechetkost of view; rarely - conjunctivitis.

Co storony organs of hearing and labyrynta: rarely - violation hearing noise in the ears.

Co storony dыhatelnoy system: often - neproduktyvnыy razdrazhayuschyy cough, bronchitis, sinusitis, odыshka; rarely - bronchospasm in volume including exacerbations bronhyalnoy astmы, nasal congestion.

Co storony pyschevarytelnoho tract: often - inflammatory phenomena in the gastrointestinal Truckee, disorders pyschevarenyya discomfort in vivo, indigestion, diarrhea, nausea, vomiting rarely - pancreatitis (in rarely cases was reported at letalnыh consequences in the Application ynhybytorov ACE) Increase urovnja enzymes podzheludochnoy gland, small intestine anhyonevrotycheskyy edema, pain in the upper part of the abdomen, vkljuchaja gastritis, constipation, dry t RTU rarely - hlossyt; neustanovlennыe - stomatitis.

Co storony urinary system: rarely - violation kidney function, vkljuchaja ostruyu pochechnuyu failure Increase Quantity urine, uhudshenye techenyya fonovoy proteinuria, Increase urovnja mochevynы and creatinine in the blood.

Co storony kozhy and podkozhnыh tissue, often - in particular sыp makulopapuleznыe; rarely - anhyonevrotycheskyy edema in Very ysklyuchytelnыh cases - violation prohodymosty dыhatelnыh tracks Due anhyonevrotycheskoho edema, kotoryya Can ymet letalnыy outcomes; itching, Hyperhidrosis; rarely - эksfolyatyvnыy dermatitis krapyvnytsa, onyholyz; Very rarely - fotochuvstvytelnosty reaction; neustanovlennыe - toxic epidermal nekrolyz, Stevens-Johnson syndrome, multyformnaya эrytema, pemphigus, exacerbations techenyya psoriasis, psoriatic dermatitis, rash pemfyhoydnaya or lyhenoydnaya or эnantema, alopetsyya.

Co-dvyhatelnoho storony locomotor apparatus, often - mыshechnыe spazmы, myalgia rarely - arthralgia.

Endocrine disorders: unidentified - syndrome of inappropriate ADH secretion.

Metabolic disturbances: often - increased potassium levels in the blood rarely - anorexia, decreased appetite unidentified - decreased sodium levels in the blood.

General disorders: often - chest pain, increased fatigue; sometimes - pyrexia; rarely - asthenia.

From the immune system: unidentified - anaphylactic and anaphylactoid reactions, increased levels of antinuclear antibodies.

Hepatobiliary system: rarely - elevation of hepatic enzymes and / or bilirubin conjugates rarely - cholestatic jaundice, damage to the liver cells; unidentified - acute liver failure, cholestatic or cytolytic hepatitis (in very exceptional cases - with fatal outcome).

From the side of the reproductive function: sometimes - transient erectile impotence, decrease in libido not established - gynecomastia.

Mental disorders: rarely - malaise, anxiety, nervousness, anxiety, sleep disorders, including drowsiness is rarely - a state of confusion in consciousness; unidentified - disturbance of attention.

Shelf life

2 years

Storage conditions

Store at a temperature no higher than 25 ° in the original packaging. Keep out of the reach of children.

Packaging

10 tablets in a blister, 3 (10 × 3) blister in a cardboard box.

Vacation category

By recipe