Ramipril

pills should be swallowed whole, not liquid, squeezed with a large amount of liquid (approximately 1 cup). pills can be taken regardless of meal times. The dosage should be set for each patient individually, taking into account the therapeutic effect and tolerability.
Arterial hypertension: the recommended initial dose is 2.5 mg once a day (1 tablet of Hartil 2.5 mg daily). Depending on the therapeutic effect, the dose can be increased by doubling the daily dose every 2-3 weeks. The usual maintenance dose is 2.5-5 mg per day (1 tablet Hartil 2.5 mg or 1 tablet 5 mg). The maximum daily dose should not exceed 10 mg.
Chronic heart failure: the recommended initial dose is 1.25 mg once a day (1 tablet of Hartil 1.25 mg daily). Depending on the therapeutic effect, the dose can be increased by doubling the daily dose every 2-3 weeks. If necessary, receiving more than 2.5 mg of the drug, this dose can be taken immediately or divided into 2 doses. The maximum daily dose should not exceed 10 mg.
Treatment after myocardial infarction: taking the drug is recommended to start at 3 - 10 days after acute myocardial infarction. The recommended initial dose, depending on the condition of the patient and the time elapsed after an acute myocardial infarction, is 2.5 mg 2 times a day (2 pills of Hartil 1.25 mg or 1 tablet of Hartil 2.5 mg) 2 times a day. Depending on the therapeutic effect, the initial dose can be doubled to 5 mg (2 pills of Hartil 2.5 mg or 1 tablet of Hartil 5 mg) 2 times a day. The maximum daily dose should not exceed 10 mg. In case of intolerance of the drug should reduce the dose.
Non-diabetic or diabetic nephropathy: the recommended initial dose is 1.25 mg 1 time per day (1 tablet of Chartyl 1.25 mg daily). Depending on the therapeutic effect, the dose can be increased by doubling the daily dose every 2-3 weeks. If necessary, taking more than 2.5 mg of the drug, this dose can be taken immediately or divided into two doses. The recommended maximum daily dose is 5 mg.
Prevention of myocardial infarction, stroke or death from cardiovascular disorders: the recommended initial dose is 2.5 mg once a day. Depending on the tolerability of the drug, after one week of the dose should be doubled compared with the initial. This dose should be doubled again after 3 weeks of administration. The recommended maintenance dose is 10 mg once a day.
Special patient groups
Elderly patients: the use of ramipril in elderly patients taking diuretics and / or heart failure, as well as impaired liver or kidney function, requires special attention. The dosage should be set by individual selection of doses depending on the response to the drug.
Patients with renal insufficiency: with moderate renal impairment (creatinine clearance from 20 to 50 ml / min per 1.73 m2 of body surface), the initial dose is usually 1.25 mg 1 time per day (one tablet Hartil 1.25 per day). The maximum daily dose should not exceed 5 mg.
If creatinine clearance is not measured, it can be calculated from the serum creatinine level using the Cockroft equation:
For men: creatinine clearance (ml / min) = [body weight in kg x (140 - age) / 72 x serum creatinine (mg / dL)].
For women: the result of the calculation using the above equation is multiplied by 0.85.
Liver dysfunction: if there is an impaired liver function, a reduced or increased effect on the use of the drug Hartil can be observed equally often; therefore, in the early stages of treatment, patients with liver dysfunction need careful medical observation. The maximum daily dose in such cases should not exceed 2.5 mg.
In patients receiving diuretic therapy, due to the risk of a significant reduction in blood pressure (BP), the possibility of temporary cancellation or at least a reduction in the dose of diuretics should be considered, not less than 2-3 days (or longer, depending on the duration of the diuretics) before starting the drug Hartil. For patients who have previously received diuretics, the initial dose is usually 1.25 mg.

During treatment with the drug Hartil requires regular medical supervision.
After taking the first dose, as well as increasing the dose of diuretic and / or Hartil, patients should be under the supervision of a physician for 8 hours in order to avoid the development of an uncontrolled hypotensive reaction; multiple blood pressure measurement is recommended.
If possible, you should adjust the dehydration, hypovolemia, reducing the number of red blood cells before taking the drug. If these disorders are severe, taking ramipril should not be started or continued until measures are taken to prevent an excessive drop in blood pressure and impaired renal function.
Careful observation is required for patients with damage to the renal vessels (for example, clinically insignificant stenosis of the renal artery or hemodynamically significant stenosis of the artery of a single kidney), impaired renal function, with a marked decrease in blood pressure, mainly in patients with heart failure, and after kidney transplantation.
Impaired renal function can be detected by elevated levels of urea and serum creatinine, especially if the patient is taking diuretics.
Due to the decrease in the synthesis of angiotensin II and the secretion of aldosterone in the serum, a decrease in the level of sodium and an increase in the level of potassium are possible. Hyperkalemia is more common in patients with impaired renal function (for example, in diabetic nephropathy) or when taken simultaneously with potassium-sparing diuretics.
In the case of an excessive decrease in blood pressure of the patient should be laid, lift the legs; fluids and other measures may also be required.
Blood changes are more likely in patients with impaired renal function and concomitant connective tissue disease (for example, SLE and scleroderma), as well as in the case of using other drugs that affect the hematopoietic and immune systems.
Serum sodium levels should also be regularly monitored in patients taking diuretics at the same time as Hartil. You should also regularly check the number of leukocytes in order to avoid the development of leukopenia. Monitoring should be more frequent at the start of therapy and in patients belonging to any risk group.
There are reports of life-threatening anaphylactoid reactions, sometimes turning into shock, in patients on hemodialysis using membranes with high hydraulic permeability (for example, from polyacrylonitrile) with simultaneous administration of ACE inhibitors. Anaphylactoid reactions have also been observed in patients who have undergone LDL apheresis with absorption of dextran sulfate.
When desensitizing therapy is used to reduce an allergic reaction to insect bites (for example, bees and wasps), a severe, life-threatening anaphylactoid reaction (drop in blood pressure, impaired breathing, vomiting, skin reactions) can occur while taking ACE inhibitors. Therefore, ACE inhibitors should not be given to patients receiving desensitization therapy.
In case of lactase deficiency, galactosemia or glucose / lactose absorption disorder syndrome, it should be noted that each tablet of Hartil contains the following amounts of lactose: 2.5 mg pills - 158.8 mg, 5 mg pills - 96.47 mg, 10 mg pills - 193.2 mg.
Use in Pediatrics
Experience with ramipril in children with severe renal failure (CCInfluence on ability to drive motor transport and control mechanisms
At the beginning of treatment, a decrease in blood pressure may affect the ability to concentrate.In this case, patients are advised to refrain from driving vehicles and practicing potentially hazardous activities that require increased concentration and psychomotor speed. In the future, the degree of limitation is determined for each patient individually.

Symptoms: a marked decrease in blood pressure, bradycardia, shock, impaired water and electrolyte balance, acute renal failure.
Treatment: in the case of a light overdose - gastric lavage, the introduction of adsorbents and sodium sulfate (preferably within 30 minutes after ingestion).
In acute overdose: control and support of vital functions in the ICU; with a decrease in blood pressure - the introduction of catecholamines and angiotensin II. The patient should be laid on his back with an elevated position of the legs, to introduce additional amounts of fluid and sodium.
It is not known whether ramipril excretion accelerated diuresis, hemofiltration and correction of urine pH. This should be considered when considering the possibility of hemodialysis and hemofiltration.