Ramifix 2.5 Savi treatment for hypertension, congestive heart failure, diabetes kidney disease (30 tablets)

Pharmacokinetics

absorption

After drinking, at least 50 - 60% of the dose is absorbed, the food does not affect the level but may slow down the absorption speed. Ramiprilat's peak in plasma is achieved after drinking about 2-4 hours. After taking 1 dose, the drug started to work within 1 to 2 hours, achieved a maximum effect of 4 - 6.5 hours and lasted about 24 hours. However, in order for the drug to fully promote the effectiveness of treatment, it is necessary to use the drug for a few weeks. RamIPrilate distribution with plasma proteins is about 56%.

Metabolism - Elimination

Ramipril is converted in the liver into RamIPrilate - active metabolites, other metabolites are inactivated. Ramiprilat, other metabolites and constant forms are excreted through the kidneys. About 40% of the dose is found in the feces, due to the excretion of the bile and even the part is not absorbed. Half -life Ramiprilat accumulated effectively after using multiple doses of Ramipril at a dose of 5 - 10 mg is 13 to 17 hours, but it will last much longer when using the dose of 1.25 - 5 mg daily; This difference is involved in the last half of the long life combined with the saturation process with ACE. The clearance of RamIPrilate decreases in patients with renal failure.

When encountering angiography in the tongue, bar or larynx should stop immediately and allow patients to be hospitalized, use epinephrin injected subcutaneously (or intravenously - rarely need), use diphenhydramin hydrochloride and hydrocortison intravenous. When an angioedema is encountered in the face or in the mucosa of the oral, lips, usually just stopped the drug, rarely need to take other supportive treatments, which can use antihistamines to reduce symptoms.

Handling some other ADRs, see more caution.

Caution when using

The effect on the heart

As well as other ACE inhibitors, Ramipril rarely causes hypotension in hypertension patients with no complications. However, the symptoms of hypotension can still occur, especially in patients with salt loss and/or severe tears due to prolonged diuretic use, due to a diet, due to hemolysis, diarrhea or vomiting. Salt and/or water should be compensated before starting treatment with RamIPril. Strong hypotension may occur in patients with congested heart failure (with or not accompanied by kidney failure), causing urinary discharge and/or hyper nitror, ​​even acute renal failure and/or death (rare). In patients with congestive heart failure, it is necessary to closely monitor patients for at least 2 weeks when starting with Ramipril or diuretics and when adjusting the dose one of two drugs.

Hematology effects

neutropenia, granulocytosis, anemia, leukopenia, thrombocytopenia, all bloody hypoglycemia may occur in patients with ACE inhibitors, especially in patients with renal impairment (especially in patients and also with glue -like diseases such as systemic erythema or sclerosis). It should be noted to closely monitor leukemia in these patients, especially if there is kidney failure.

Sensitive reaction

Sensitive reactions such as anaphylaxis and angioed reactions are serious reactions, at risk of life -threatening. The veins at the head and neck are related to the edema of the tongue, the bar or the larynx can cause obstruction of the airway. If you see wheezing in the larynx or facial edema, tongue, bar, it is necessary to stop Ramipril immediately and proceed with appropriate therapies (such as using epinephrin). The angioedema in the intestine, often shows signs of abdominal pain (with or without vomiting/nausea), diagnosed by CT scan or abdominal ultrasound. These symptoms are usually over after stopping the transferred enzyme inhibitors. It should be noted that the diagnosis of the angioedema in patients with abdominal pain showing on treatment with enzyme inhibitors.

Effects on the kidneys

Renin-Anotensin-Aldosteron (RAA) systems can inhibit renal and even (rare) impaired (rare) impairment that cause kidney failure and/or death in sensitive patients (for example, kidney function patients depend heavily on RAA activity such as severe patients with severe overarching heart failure). Impaired renal function, manifested by temporary hyperur with urea (Bun: Blood Urea Nitrogen) va Creatinin serum may be encountered when using ACE inhibitors, especially in patients with hypertension with narrowed kidney artery narrowed one or both sides, patients who have previously had kidney failure, patients are using simultaneously with diuretic drugs. Kidney function usually recovers after stopping the drug. It is necessary to monitor the patient's kidney function closely in the first few weeks of treatment and periodic treatment.

affect blood potassium

may experience hyperkalemia, especially in patients with renal impairment or diabetes, patients are taking drugs that increase the concentration of serum potassium (diuretic reducing potassium, supplementing potassium, potassium -containing drugs ...).

Causes cough

may have persistent cough, usually after stopping the drug.

surgery/use of anesthesia

Hematuria drops may occur in patients with ACE inhibitors that require surgery or during anesthesia with drugs at risk of hypotension. Can handle hypotension on these patients by compensation.

The effect of the drug on the ability to drive and operate machinery

Depending on the individual case, there may be symptoms of hypotension. Some side effects (for example, some symptoms of hypotension such as dizziness, dizziness) may reduce the ability to focus and flexibility of the patient. Therefore, when treated with any antihypertensive drugs, it may affect the ability to drive or operate machinery, especially at the beginning of treatment, or when transferred from other drug products or during the use of the drug again drink alcohol.

Using drugs for women during pregnancy and lactation

Case of pregnancy

Using Angiotensin enzyme inhibitors in the middle and last three months of pregnancy can affect, even causing pregnancy and infants. Enzyme inhibitors can also increase the risk of serious birth defects when used in the first 3 months of pregnancy. Therefore, it is necessary to stop Ramipril as soon as possible after being pregnant.

Breastfeeding case

No Ramipril detects and its metabolites in breast milk after the mother used a single dose of 10 mg of Ramipril. However, there is no study on the concentration of drugs in milk after dosage. Due to the risk of serious complications for breastfeeding, women use Ramipril should not breastfeed.

Interactive drug

Diuretics: Interaction according to both pharmacokinetic and pharmacokinetic mechanisms, causing hypotension.

Hydropherellation: The potential for hidden blood pressure must be predicted when RamIPril is simultaneously used with antihypertensive drugs (such as diuretics) and other substances that can reduce blood pressure (such as nitrat, three -ring anti -depressive drugs, oral alcohol, Baclofen, Alfuzosin, Doxazosin, Prazosin, Taysulosin, Terazosin).

Non -steroid anti -inflammatory drugs: Pharmacological interaction, reducing kidney function and increasing blood potassium concentration.

Medications increase the concentration of potassium: pharmacological interaction, causing a combination effect that increases potassium.

lithium: pharmacokinetic interaction, increasing the concentration and clinical toxicity of lithium.

Extracorporeal treatments: Extracorporeal treatments, leading to blood -charged blood surfaces such as dialysis or dialysis with high -flow darkening membranes that can increase the risk of hypersensitivity reactions that are life -threatening.

The drug contains Aliskiren: The use of ACE inhibitors, Angiotensin II or Aliskiren receptor blockers shows that it is associated with an increase in side effects such as hypotension, hyperkalemia and reducing kidney function (including acute renal failure) compared to the use of drugs acting on individual RAA systems.

Passion sympathetic drugs can reduce the hypotension effect of RamIPril.

Diabetes treatment: Ace inhibitors can increase the effect of lowering blood glucose in patients with diabetes. Need to monitor blood sugar.

Mechanical inhibitors (Mechanistic Target of Rapamycin) or DPP-4 (Dipeptidyl peptidase 4) (eg Temsirolimus): There may be an increase in angioed risk in patients with medication simultaneously with MTor inhibitors (Temsirolimus, Everolimus, Sirolimus) or Vildagliptin.