Ramizes 10 Farmak treatment for hypertension, congestive heart failure (3 blisters x 10 tablets)

Ramipril has a selective effect on the RAA (Renin-Angiotensin-Aldosterone) system: Ramipril increases plasma renin activity and reduces angiotensin II and Aldosterone plasma concentrations. Therefore, the mechanism of lowering blood pressure effects of RamIPril is due to ACE inhibitors reducing the speed of Angiotensin I into angiotensin II, a strong vasoconstrator.

Therefore the drug reduces peripheral artery resistance causing hypotension. Reducing Angiotensin II concentration causes reduction in aldosteron secretion, resulting in increased sodium discharge and discharge, and slightly increasing serum potassium.

Besides, Ramipril as well as angiotensin enzyme inhibitors can also affect the Kallikrein-oilin system (reducing decomposition leading to increased Bradykinin levels) and increasing the synthesis of prostaglandin is also factors that reduce blood pressure.

RamIPril's heart failure treatment effects by reducing the burden due to reducing peripheral vascular resistance, reducing the burden of burden due to reducing pulmonary capillary pressure and pulmonary resistance, improving cardiac supply and tolerance of exertion.

Currently on the market there are 12 ACE inhibitors. Usually these drugs differ in pharmacokinetics and treatment effectiveness. The drugs all have the same enzyme that converts angiotensin I to angiotensin II the same and have similar indications, side effects and contraindications. However, the important thing is to choose the type and dosage to suit the patient to ensure the quality of life for the patient.

Ramipril is a long -lasting ACE inhibitor. In vitro, Ramiprilat work stronger than captopril and enalapril. Ramipril has been well tested in Hope (Heart Outeome Preventative Evaluation) on: Early clinical heart failure after myocardial infarction, kidney protection and cardiovascular prophylaxis.

pharmacokinetics

After drinking at least 50 - 60% of the dose is absorbed, food does not affect the level but may slow down the absorption speed.

Ramipril is metabolized in the liver into RamIPrilate which is active metabolites, other metabolites are not active.

RamIPrilat's peak plasma concentration 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 has a plasma protein about 56%.

Ramipril is eliminated through the kidneys in the form of ramIPrilat, other metabolites and constant forms.

About 40% of the dose is found in feces, due to the excretion of the bile and even due to the absorption.

Half life accumulates Ramiprilat after taking multiple doses of Ramipril at a dose of 5 - 10 mg effectively is 13 to 17 hours, but it will last much longer when taking the dose of 1.25 - 5 mg daily. This difference is related to the last half of the long life combined with the saturation process with ACE.

RamIPrilat's clearance decreases in patients with renal failure.

When experiencing side effects of the drug, it is necessary to stop using and notify the doctor or go to the nearest medical facility for timely treatment.

Precautions when using

Effects 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 dehydration due to prolonged use of diuretics, due to a reduced salt diet, due to hemolysis, diarrhea or vomiting. Need salt and/or water before starting treatment with RamIPril.

Strong hypotension may occur in patients with congestion heart failure (whether or not with renal failure), causing urinary discharge and/or hyper nitrogen, 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

Neutral leukemia, grain leukemia, anemia, leukopenia, thrombocytopenia, all bloody hypoglycemia may occur in patients with ACE inhibitors, especially in patients with renal insufficiency (especially in patients and also with glue -like diseases such as systemic erythema or sclerosis).

It should be noted to closely monitor leukocytes in these patients, especially if there is kidney failure.

Effects on the liver

ACE inhibitors can cause (rare) jaundice caused by biliary obstruction, progressing into a liver necrotic outbreak that is at risk of life -threatening. Patients who are taking ACE inhibitors (next to RamIPril), if there is no manifestation of jaundice or increases the liver enzyme clearly, it is necessary to stop the drug and take appropriate management measures.

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 face edema, tongue, subject, it is necessary to stop Ramipril immediately and proceed with appropriate therapies (for example: use epinephrin).

Evaluation in the intestine, often showing signs of abdominal pain (with or without vomiting/vomiting), diagnosis 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 the intestine in patients with abdominal pain during treatment with enzyme inhibitors.

Effects on the kidneys

Renin-Anotensin-Aldosteron (RAA) systems can inhibit renal and even (dangerous) 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 blood failure).

impaired renal function, manifestation of temporary hyperuremia (bun) and serum creatinine may be encountered when using ACE inhibitors, especially in patients with hypertension with one or both sides, patients who have had kidney failure before, patients are using simultaneously with diuretics. Kidney function usually recovers after stopping the drug.

Need 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 ...).

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may have persistent coughs, 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 ability to drive and operate machinery

Caution because the drug can cause dizziness, dizziness, headache.

Pregnancy

Using angiotensin transferred enzyme inhibitors in the middle and last three months of pregnancy can cause influence, even fetal death and infants. The transferred enzyme inhibitors may 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 period

There is no detection of Ramipril and its metabolites in breast milk after the mother used a single dose of 10 mg of Ramipril. However, there is no research on the concentration of drugs in milk after multiple dosage.

Due to the risk of serious complications for breastfeeding, women who use Ramipril should not breastfeed.

Medicinal interaction

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

Steroid anti -inflammatory drugs: Pharmacological interaction, reducing kidney function and increasing potassium concentration in serum.

Medications that increase the concentration of potassium in serum: Pharmacological interaction, causing a combination effect to increase potassium.

Hypoglycemic drugs (for example, insulin or sulfonylurea conductors): can lead to excessive hypoglycemic concentration (hypoglycemic reaction).

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