RAMIHEXAL 30 tablets 5mg. / 25 mg
RamiHEXAL is an ACE inhibitor (angiotensin converting enzyme) - medicine that lowers blood pressure, reduces the workload of the heart and protects the organs from damage.
What is RamiHEXAL tablets?
The product is used in:
- Essential hypertension
- Improving the prognosis of mild to moderate heart failure (NYHA II-Ill) after miokardden infarction (3-10 days)
When you should not take RamiHEXAL tablets?
RamiHEXAL shall not apply to:
- Hypersensitivity (allergy) to ramipril, an ACE inhibitor or any of the excipients
- Tendency to swelling of tissues (angioedema, also as a result of previous treatment with ACE inhibitors)
- Narrowing of the renal arteries (bilateral renal artery stenosis or unilateral - in patients with one kidney)
- A significant narrowing of the heart valves of the left ventricle (severe stenosis of the aortic or mitral valve) or difficult function of the left ventricle (hypertrophic obstructive cardiomyopathy)
- After kidney transplant
- Increased concentration of the hormone aldosterone in the blood
- Pregnancy and lactation
- Dialysis with some Membranes (polyacrylonitrile membranes)
- Purification of some of the blood lipids (LDL-apheresis)
- Slimming treatment of allergic reactions (desensitisation therapy), eg. against insect venom
Reported life-threatening hypersensitivity reactions in hemodialysis or hemofiltration (eg. With polyacrylonitrile membranes as "AN 69").
Similar effects were observed in LDL-apheresis and desensitization terapiya.RamiHEXAL should not be used in mild to moderate heart failure after myocardial infarction in:
- Permanently low blood pressure (hypotension: systolic blood pressure below 90 mmHg)
- Significant fall in blood pressure when changing from a lying to standing position (orthostatic) - severe heart failure (NYHA IV)
- The emergence or worsening of pain or tightness in the sternum due to impaired blood supply (angina pectoris)
- Threatening ventricular arrhythmias
- Enlarged right side of the heart (cor pulmonale)
What special precautions are necessary when using RamiHEXAL tablets?
Significant fall in blood pressure with symptoms (symptomatic hypotension) in the treatment of high blood pressure in some patients may nablyuvava significant fall in blood Pressure with symptoms, which also leads to oplakvaniya.Tova is rarely seen in patients with uncomplicated hypertension, but PAD deficit of liquids, eg. prior treatment with water pills medicines, dietary salt restriction, dialysis, diarrhea or vomiting, high blood pressure (renin-dependent hypertension). If you suffer from heart failure with or without associated renal failure there is an increased risk of symptomatic hopotoniya, especially in patients with severe heart failure as a result of the use of high doses of some 'water products (loop diuretics), decreased sodium concentration or renal function violation. If you are at high risk of symptomatic hypotension, you should be under careful medical supervision at the start of therapy and adjusting dozite.Pri drop in blood pressure patient should be placed in the supine position and promptly informed doctor, as you may the need for transfusion of fluids or other merki.Ako suffer from heart failure with normal or low blood pressure, a risk of further reduction in blood pressure during treatment with RamiHEXAL. This effect is predictable and is not a cause for discontinuation of therapy. If hypotension becomes symptomatic, the doctor may reduce or discontinue therapy RamiHEXAL.Ponizheno blood pressure after acute myocardial infarction In patients received with acute myocardial infarction who are at risk of deterioration after treatment with a vasodilator products not should be initiated treatment with ramipril. These are patients with a systolic blood pressure of 100 mm Hg or less, or patients with shock due to heart failure. During the first days after infarction, the dose should be reduced if the systolic blood pressure of 120 mm Hg or less; Maintaining dosage should be reduced to 5 mg or temporarily to 2.5 mg, if the systolic blood pressure was 100 mm Hg or less. If low blood pressure continues (systolic blood pressure below 90 mm Hg for more than 1 hour) administration of ramipril should be discontinued Constriction of the heart valves (aortic or mitral valve) or impaired function of the left ventricle (hypertrophic cardiomyopathy) As with other ACE inhibitors, RamiHEXAL should be used with caution in patients with mitral valve stenosis and obstruction of the outflow of the left ventricle such as aortic stenosis or hypertrophic cardiomyopathy.
Impaired renal function (creatinine the clearance below 50 ml / min), the dose should be adjusted at the beginning of treatment. Some blood parameters (potassium and creatinine) should be monitored at regular intervals.
In patients with heart failure, hypotension following the initiation of treatment may lead to severe renal impairment. Has been reported acute renal nedostatachnost.Stesnenie renal artery (bilateral or unilateral in the case of a kidney) in some patients with bilateral renal artery stenosis or unilateral constriction in a single functioning kidney, which were treated with ACE inhibitors, was observed reversibly increases in serum creatinine and blood urea. This is especially true for patients with renal insufficiency. For high blood pressure and renal vascular disease are at increased risk of a sharp drop in blood pressure and deterioration of renal function. In these patients, treatment should be initiated with low doses under medical supervision and careful adjustment of dosage. Since 'water treatment products (diuretics) may increase the risk of hypotension (low blood pressure), the intake of these products should be discontinued and to monitor renal function during the first weeks of treatment with RamiHEXAL.
Hypertension and renal vascular disease
In some patients with hypertension (high blood pressure) and hidden pre-existing renal vascular disease is a mild and transient increase in serum creatinine and BUN, especially when remipril was administered concomitantly with a diuretic. This occurs more frequently in patients with preexisting renal impairment.
May be necessary to dose reduction and / or discontinuation of diuretik.Ostar myocardial miokardaPri patients with acute myocardial infarction and renal dysfunction (serum creatinine above 177 mol / I and / or proteinuria exceeding 500 mg / 24 h) did not December should be initiated RamiHEXAL. If an impairment of renal function during treatment with RamiHEXAL® (serum creatinine above 265 mol / I or double the values before treatment), physicians should consider discontinuation of ramipril.Povishena concentration of the hormone aldosterone in the blood These patients most generally do not respond to products that lower blood pressure (such RamiHEXAL®) with an effect on the renin-angiotensin sistema.Babrechna transplant performed recently no data on the use of RamiHEXAL in patients with a recent kidney transplantation. RamiHEXAL should not be used in these patients.
Hemodialysis with some membranes (high flux dialysis membranes)
In these cases may arise hypersensitivity reactions. Patients should be used in December another type of dialysis membrane or a different class of products, lowering blood pressure.
Swelling of tissues (angioedema)
Rarely reported swelling of tissues (angioedema), affecting the face, extremities, lips, tongue, glottis and / or larynx during treatment with RamiHEXAL and other products of this class. This can be observed at any time during treatment. In these cases, you should immediately discontinue treatment and seek medical attention as needed to appropriate treatment and follow-up. You should be under medical supervision until complete resolution of symptoms. Even with swelling of the tongue without difficulty breathing require prolonged observation since treatment with drugs that affect the symptoms may not be enough. Very rarely, fatalities have been reported due to angioedema involving the larynx and glottis. Patients with swelling of the tongue, glottis or larynx have airway obstruction, especially those with operation of the airways in history. In these cases should immediately implement emergency therapy. This may include the administration of adrenaline and / or maintaining a free airway. The patient should be under close medical supervision until symptoms have resolved. ACE inhibitors cause a higher rate of angioedema in black patients compared to patients of other races. Patients with a history of angioedema unrelated to ACE inhibitors were at increased risk of angioedema during therapy with ACE inhibitors.
During LDL-apheresis (apheresis low density lipoproteins) with dextran sulfate may be seen (in some cases, life-threatening) hypersensitivity reactions. These reactions were avoided by temporarily interrupting therapy RamiHEXAL before each afereza.Desensibilizatsiya (weight loss treatment of hypersensitivity reactions, eg. Against insect venom) In these cases have been observed hypersensitivity reactions. In some patients, these reactions can be avoided by temporarily interrupting therapy with ACE inhibitors, but reappear in careless repeated-dose produkt.Tezhko hepatic dysfunction Rarely ACE inhibitors have been associated with a syndrome that starts as jaundice (cholestatic jaundice) and progresses to severe liver disease (hepatic necrosis) and (sometimes) death. The mechanism of this syndrome is unknown. Patients receiving ACE inhibitors who develop jaundice or marked elevations of hepatic enzymes should discontinue the ACE inhibitor and consult a doctor for further medical nablyudenie.Promeni blood count (neutropenia or agranulocytosis) During the reception ACE inhibitors can be observed changes in the number of certain white blood kretki (neutropenia or agranulocytosis), low platelet count (thrombocytopenia) and anemia. In patients with normal renal function and no complications are rarely observed neutropenia. Neutropenia and agranulocytosis are reversible after discontinuation ACE inhibitor. RamiHEXAL should be used with caution in patients with diseases of the blood vessels (collagen vascular) during treatment with medicines that suppress the immune system (immunosuppressants), treatment with allopurinol or procainamide, or a combination of these factors, especially in advance existing renal impairment. Some patients developed serious infections, which in rare cases did not respond to intensive antibiotic terapiya.Poradi Therefore, the physician should periodically monitor the number of blood cells in these patients. Please tell your doctor about any signs of infection.
Administration of ACE inhibitors such as RamiHEXAL can be observed cough that is nonproductive, persistent and resolves after discontinuation of therapy. Cough caused by ACE inhibitors should be considered as part of the differential diagnoza.Operatsiya or anesteziyaPri patients undergoing major surgery or during anesthesia with products that lower blood pressure, RamiHEXAL can strengthen lowering blood pressure (hypotension). For this reason, before the big 'surgery, tell the anesthesiologist about taking RamiHEXAL Such hypotension may be korigirana.RamiHEXAL, as with other ACE inhibitors, may have less effect of lowering blood pressure in black patients, probably due to the widespread condition with decreased concentrations of renin in hypertensive patients than rasa.Povishena potassium kravtaPri in some patients treated with ACE inhibitoi including RamiHEXAL, experiencing an increase of potassium in the blood. The risk is increased in patients with impaired renal function, diabetes or patients co-administered potassium-sparing diuretics (water products), potassium supplements or potassium-containing salt substitutes or other medicinal products that increase the concentration of potassium in the blood (eg. Heparin) . If necessary concomitant use of these products, it is recommended regular monitoring of serum potassium in the blood.
DiabetPri the patients with diabetes treated with drugs to lower blood sugar (antidiabetics) or insulin should be carefully monitored blood glucose during the first month of treatment with RamiHEXAL.
The combination of lithium and RamiHEXAL not recommended. dialysis
Application of RamiHEXAL not recommended for patients on dialysis, because of lack of experience.
What other products influence the effect of RamiHEXAL tablets or can be influenced by the product?
Please tell your doctor or pharmacist if you are taking other medicines or have recently taken, even those without medical predpisanie.RamiHEXAL® can further strengthen increase potassium levels in the blood, if you take potassium salts or other products that may increase potassium levels . These are some otvodnyavatsi products (potassium-sparing diuretics such as spironolactone, triamterene or amiloride), potassium products or substitutes containing potassium sol.Drugi products having blood pressure lowering effect (eg. Nitrates, tricyclic antidepressants, sedatives and anesthetics [hypnotics drugs, anesthetics]), may further reduce blood pressure. Lithium-containing medicines can be taken simultaneously with RamiHEXAL only under close monitoring serum lithium concentrations to avoid the increased risk of toxic effects of lithium on the heart and nerves. Certain anti-inflammatory drugs (NSAIDs such as indomethacin, acetylsalicylic acid) can reduce the effect of lowering blood pressure RamiHEXAL®, leading to deterioration of renal function and increased potassium levels after prolonged use. These effects are usually reversible. Especially in patients with impaired renal function, eg. in elderly patients or dehydration can vaznnikne acute renal failure.
Increased risk of blood dyscrasias have in concomitant treatment with allopurinol, procainamide or medicines that suppress the immune response (cytotoxic agents, immunosuppressants, systemic corticosteroids) .Efektat lowering blood pressure RamiHEXAL can be reduced by concomitant administration of products pressor (sympathomimetic). Concomitant administration of ACE inhibitors and antidiabetic medicines (insulin, used to lower blood sugar by mouth) may enhance the effect of lowering blood sugar and lower LVEF below normal (hypoglycemia). (Recommended especially careful medical supervision at the start of therapy.) Please note that these data refer to products taken recently.
What foods and drinks you should avoid?
Drinking alcohol may increase the effect of lowering blood pressure RamiHEXAL®. You should not drink alcohol during treatment with RamiHEXAL®.Povishenata use of salt can reduce the effect of RamiHEXAL®.
What must comply children and adults in the application of RamiHEXAL tablets?
Application of RamiHEXAL not recommended for children due to lack of experience.
What special precautions should be taken during pregnancy and lactation?
RamiHEXAL should not be used during pregnancy. Before starting treatment with RamiHEXAL tell your doctor if you are pregnant or planning a pregnancy. If you are planning pregnancy, treatment must be replaced with another suitable lechenie.Ako pregnancy is detected during treatment with RamiHEXAL, please tell your lekar.Ramipril, the active substance of RamiHEXAL, passes into breast milk of animals. Since it is not known whether ramipril passes into breast milk in humans and whether it causes side effects in the breast-fed child, you should not take RamiHEXAL during lactation.
If your doctor determines the need for treatment during lactation, it should be discontinued.
What to be aware when driving, operating machinery or insecure (eg. Climbing stairs)?