Pharmacological properties

Pharmacodynamics. ramiprilat, the active metabolite of medicament of a ramipril, suppresses enzyme to a dipeptidilkarboksipeptidaz (synonyms: apf, kininaza of ii). in blood plasma and fabrics this enzyme catalyzes conversion of angiotensin i in active vasoconstrictive substance ii angiotensin and also disintegration of an active vazodilatator of bradykinin. reduction of forming of ii angiotensin and oppression of disintegration of bradykinin lead to a vazodilatation.

As angiotensin II also stimulates with

release of Aldosteronum, ramiprilat promotes reduction of secretion of Aldosteronum.

Purpose of a ramipril causes significant decrease in peripheric resistance of arteries. Generally, there are no significant changes of a renal plazmotok and glomerular filtration rate. Purpose of a ramipril to patients with AG leads to decrease in the ABP level in horizontal and vertical provisions, without compensatory increase in ChSS.

At most of patients the antihypertensive effect after single dose occurs in 1–2 h after oral administration of drug. The maximum effect after single dose is usually reached in 3–6 h after oral administration. The antihypertensive effect remains during 24 h. The maximum antihypertensive effect at long-term treatment ramiprily in general becomes obvious in 3–4 weeks. It is shown that the antihypertensive effect keeps at long therapy within 2 years. The sudden termination of reception of a ramipril does not lead to fast and excessive ricochet increase in the ABP.

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In addition to usual therapy by diuretics and, if necessary, cardiac glycosides, it was shown that ramiprit it is effective at patients from the II-IV functional class NYHA. Drug renders favorable effects on a warm hemodynamics (pressure decrease of filling of the left and right ventricles, OPSS, increase in warm emission and improvement of cardiac index). It also reduces neuroendocrinal activation.

Pharmacokinetics. Absorption. After oral administration ramiprit quickly it is absorbed from a GIT: peak concentration in blood plasma are reached for 1 h. On the basis of removal with urine the extent of absorption makes not less than 56%, and for it significantly existence of food in a GIT does not influence. The bioavailability of an active metabolite after oral administration ramiprit 2.5 and 5 mg in a dose is 45%.

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Peak concentration in blood plasma of the ramiprilat, an active metabolite of a ramipril, are reached in 2–4 h after administration of drug.

equilibrium concentration of medicine in blood plasma is reached by

In the conditions of application of usual doses (1 time a day) for the 4th day of use of drug.

Distribution. Linking of a ramipril with blood proteins makes about 73%, and the ramiprilat — 56%.

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

Removal. Excretion of metabolites mainly renal. Decrease in concentration of the ramiprilat in blood plasma happens in several phases. Considering powerful, saturated linking with APF and slow dissociation with enzyme, ramiprilat it is characterized the elimination prolonged by a terminal phase at very low concentration in blood plasma.

After reception of reusable doses of a ramipril of T _½ depending on a dose is made by 13-17 h for doses of 5-10 mg and longer — for lower doses (1.25-2.5 mg). The distinction is caused by saturable ability of enzyme concerning binding of the ramiprilat.

ramiprit

At reception of a single oral dose and its metabolites are not defined in breast milk. At reusable use the effect is unknown.

Renal excretion of the ramiprilat decreases at patients with a renal failure, and the renal clearance of the ramiprilat is in proportion connected with clearance of creatinine. It leads to increase in concentration of the ramiprilat in blood plasma which decrease more slowly, than at persons with normal function of kidneys.

metabolism of a ramipril to the ramiprilat is slowed down by

At patients with an abnormal liver function that is caused by reduced activity of hepatic esterases, and the level of a ramipril in blood plasma at them was increased. Peak concentration of the ramiprilat at these patients, however, did not differ from those at persons with normal function of a liver.

Indication

Lecheniye ag.

Prevention of cardiovascular pathologies: decrease in cardiovascular incidence, lethality at patients with:

• profound cardiovascular disease of aterotrombotichesky genesis (existence in the anamnesis of an ischemic heart disease or stroke, or pathology of peripheral vessels);
• diabetes which have at least 1 factor of cardiovascular risk (see. Pharmacological PROPERTIES).

Lecheniye of diseases of kidneys:

• an initial glomerular diabetic nephropathy to which presence of a microalbuminuria testifies;
• expressed glomerular diabetic nephropathy to which presence of a macroproteinuria, at patients with at least 1 factor of cardiovascular risk (testifies see. Pharmacological PROPERTIES);
• expressed glomerular not diabetic nephropathy to which presence of a macroproteinuria of ≥3 g/days (testifies see. Pharmacological PROPERTIES).

Lecheniye of the heart failure which is followed by clinical manifestations.

Secondary prevention after the postponed acute myocardial infarction: reduction of lethality during the acute stage of a myocardial infarction at patients with clinical signs of heart failure at an initiation of treatment more than in 48 h after developing of an acute myocardial infarction.

Use

Drug for oral administration. accept hartit every day at the same time. the medicament can be taken to, in time or after a meal as meal does not affect its bioavailability. it is necessary to swallow of tablets whole, washing down with water. they cannot be chewed or crushed.

Patients who apply diuretics. In an initiation of treatment the arterial hypotension which development is more probable at patients who at the same time accept diuretics can arise the medicament Hartil. In similar cases it is recommended to show care as at these patients the decrease in OCK and/or amount of electrolytes is possible.

use of diuretic in 2–3 days prior to the Hartil medicament treatment Is desirable to stop

if it is possible (see. Special INSTRUCTIONS).

therapy by the medicament Hartil should begin with

At patients with AG which cannot cancel diuretic with a dose 1.25 mg. It is necessary to control carefully function of kidneys and level of potassium in blood. Further medicament dosing Hartil should be adjusted depending on the AD target level.

AG. The dose should be selected individually, depending on features of a condition of the patient (see. Special INSTRUCTIONS) and results of control measurements of the ABP. Hartil it is possible to apply as monotherapy or in a combination with other classes of antihypertensive medicines.

Initial dose. The Hartil medicament treatment should be begun gradually, starting with recommended an initial dose of 2.5 mg/days

At patients with considerable activation the system renin-angiotensin-aldosteronovoy (SRAA) after reception of an initial dose can arise considerable decrease in the ABP. For such patients the recommended initial dose makes 1.25 mg, and their treatment needs to be begun under control (see. Special INSTRUCTIONS).

Titration of a dose and maintenance dose. A dose it is possible to double each 2–4 weeks before achievement of the AD target level; the maximum dose of the medicament Hartil makes 10 mg/days. 1 time a day is recommended to take the drug.

Prevention of cardiovascular diseases

Initial dose. The recommended initial dose of the medicament Hartil makes 2.5 mg of 1 times a day.

Titration of a dose and maintenance dose. Depending on individual tolerance of medicament the dose should be raised gradually. It is recommended to double a dose in 1–2 weeks of treatment, and then through 2–3 weeks — to raise it to a target maintenance dose of 10 mg of 1 times in days (also see information given above concerning medicament dosing for patients who receive diuretics).

Treatment of a disease of kidneys

At patients with diabetes and a microalbuminuria

Initial dose. The recommended initial dose of the medicament Hartil makes 1.25 mg in the corresponding dosage of 1 times a day.

Titration of a dose and maintenance dose. Depending on individual tolerance of medicament at further treatment the dose should be raised. In 2 weeks of treatment about 2.5 mg are recommended to double a single daily dose, and then — up to 5 mg in 2 weeks of treatment.

Patients with diabetes and not less than 1 factor of cardiovascular risk

Initial dose. The recommended initial dose of the medicament Hartil makes 2.5 mg of 1 times a day.

Titration of a dose and maintenance dose. Depending on individual tolerance of medicament at further treatment the dose should be raised. In 1–2 weeks of therapy about 5 mg are recommended to double a dose of the medicament Hartil, and then — up to 10 mg in 2–3 weeks of treatment. The target daily dose makes 10 mg.

Patients with not diabetic nephropathy to which presence of a macroproteinuria of ≥3 g/days

Initial dose testifies. The recommended initial dose of the medicament Hartil makes 1.25 mg (in the corresponding dosage) 1 time a day.

Titration of a dose and maintenance dose. Depending on individual shipping the patient of medicament at further treatment the dose should be raised. In 2 weeks of treatment about 2.5 mg, and then up to 5 mg in 2 weeks of therapy are recommended to double a single daily dose.

Heart failure with clinical manifestations

Initial dose. For patients whose condition was stabilized after treatment by diuretics the recommended dose makes 1.25 mg/days

Titration of a dose and a maintenance dose. A dose of the medicament Hartil it is necessary to titrate by doubling each 1–2 weeks before achievement of the maximum daily dose 10 mg. It is desirable to distribute a dose on 2 receptions.

Secondary prevention after the postponed acute myocardial infarction in the presence of heart failure

Initial dose. In 48 h after developing of a myocardial infarction to patients whose condition clinically and hemodynamically steadily, it is necessary to appoint an initial dose of 2.5 mg 2 times a day for 3 days. If the initial dose of 2.5 mg is transferred badly, then it is necessary to apply up to 1.25 mg (in the corresponding dosage) 2 times a day within 2 days with the subsequent increase to 2.5 mg and 5 mg 2 times a day. If it is impossible to raise a dose to 2.5 mg 2 times a day, treatment should be cancelled (see information which is also given above concerning medicament dosing for patients who receive diuretics).

Titration of a dose and maintenance dose. Further the daily dose should be raised by doubling at an interval of 1–3 days to achievement of a target maintenance dose 5 mg 2 times a day. When it is possible, the maintenance dose should be divided into 2 receptions.

If cannot raise a dose to 2.5 mg 2 times a day, therapy should be cancelled. Experience of treatment of patients with heavy heart failure (the IV functional class on classification of NYHA) right after a myocardial infarction is still not enough. If nevertheless the decision on treatment of such patients with this medicament is made, it is recommended to begin therapy with a dose of 1.25 mg (in the corresponding dosage) 1 time a day and any its increase to carry out with extreme care.

Special categories of patients

Patients with a renal failure. The daily dose for patients with a renal failure depends on an indicator of clearance of creatinine (see. Pharmacological PROPERTIES):

if the clearance of creatinine of ≥60 ml/min., need for correction of an initial dose (2.5 mg/days) is not present

• , and the maximum daily dose makes 10 mg;
if the clearance of creatinine of 30-60 ml/min., need for correction of an initial dose (2.5 mg/days) is not present
• , and the maximum daily dose makes 5 mg;
• if the clearance of creatinine of 10-30 ml/min., an initial dose is 1.25 mg in the corresponding dosage in day, and the maximum daily dose — 5 mg;
• patients about AG which are on a hemodialysis: at a hemodialysis ramiprit it is removed slightly; the initial dose makes 1.25 mg (in the corresponding dosage), the maximum daily dose — 5 mg; the medicament should be taken in several hours after holding a session of a hemodialysis.

Patients with an abnormal liver function (see. Pharmacological PROPERTIES). The Hartil medicament treatment of patients with abnormal liver functions should be begun under careful medical observation, and the maximum daily dose in such cases has to make 2.5 mg.

Patients of advanced age. The initial dose has to be lower, and further titration of a dose should be carried out more gradually, considering a high probability of emergence of undesirable effects, especially at patients of senile age and patients with an asthenia. In such cases appoint the minimum initial dose — ramiprit 1.25 mg (in the corresponding dosage).

Contraindication

Hypersensitivity to active agent or any other component of medicament or other inhibitors apf. a Quincke's disease in the anamnesis (hereditary, idiopathic or before postponed against the background of use of inhibitors apf or antagonists of receptors of angiotensin іі) a .znachitelny bilateral renal artery stenosis or a renal artery stenosis of the only functioning kidney.

Period of pregnancy or if the woman plans pregnancy (see. Special INSTRUCTIONS).

Ramipril should not be applied at patients with arterial hypotension or hemodynamically unstable states.

Simultaneous use with the medicaments containing aliskiren at patients with diabetes or with a moderate or heavy renal failure (clearance of creatinine of 60 ml/min.). It is necessary to avoid simultaneous use of APF inhibitors and extracorporal methods of treatment which lead to contact of blood with negatively charged surfaces as their use can lead to anaphylactic reactions of heavy degree. Extracorporal methods of treatment include dialysis or haemo filtration with use of certain membranes with high hydraulic permeability (for example polyacrylonitrile), aferez LDL using a sulfate dextran.

Side effects

Information on safety of medicament hartit

contains data on constant cough and the reactions caused by arterial hypotension. the Quincke's disease, a hyperpotassemia, an abnormal liver function or kidneys, pancreatitis, heavy reactions belong to serious side effects from skin, a neutropenia/agranulocytosis.

from a cardiovascular system: myocardium ischemia, including stenocardia or a myocardial infarction; tachycardia; arrhythmia; feeling of the strengthened heartbeat; peripheral hypostases.

from the system of a hemopoiesis and lymphatic system: eosinophilia; reduction of quantity of leukocytes (including a neutropenia or an agranulocytosis), reduction of quantity of erythrocytes, decrease in level of hemoglobin, reduction of quantity of thrombocytes; insufficiency of marrow; pancytopenia, hemolytic anemia.

from nervous system: headache, dizziness, tremor, balance disturbance, cerebral ischemia, including ischemic stroke and tranzitorny ischemic attack; disturbance of psychomotor functions; burning, dysgeusia, ageusia; parosmiya; vertigo; paresthesias.

from organs of sight: a disorder of vision, including illegibility of sight; conjunctivitis.

from organs of hearing and balance: hearing disorder, sonitus.

Respiratory, thoracic and mediastinal disturbances: the unproductive irritating cough, bronchitis, sinusitis, short wind, a bronchospasm, including exacerbation of asthma; congestion of a nose.

from digestive system: the inflammatory phenomena in a GIT, digestion disturbances, discomfort in a stomach, dyspepsia, diarrhea, nausea, vomiting, pancreatitis (in isolated cases it was reported about lethal consequences at use of APF inhibitors), increase in level of enzymes of a pancreas, a Quincke's disease of a small intestine, pain in an upper part of a stomach, including gastritis, a constipation, dryness in a mouth; glossitis; aphthous stomatitis.

from kidneys and an urinary system: a renal failure, including OPN, increase in an uropoiesis, deterioration in a course of a background proteinuria, increase in level of urea in blood; increase in level of creatinine in blood.

from skin and its derivatives: rash, in particular makulopapulezny; Quincke's disease; in very exceptional cases — disturbance of passability of airways owing to a Quincke's disease which can have a lethal outcome; itching, hyperhidrosis; exfoliative dermatitis, small tortoiseshell, onycholysis; reaction of photosensitivity; a toxic epidermal necrolysis, Stephens's syndrome — Johnson, a multiformny erythema, a pempigus, aggravation of a course of psoriasis: psoriasis dermatitis, pemfigoidny or lichenoid dieback or enantema, alopecia.

from a musculoskeletal system and connective tissue: muscular spasms, myalgia, arthralgia.

from an endocrine system: syndrome of inadequate secretion of antidiuretic hormone.

Metabolic and alimentary disturbances: increase in level of potassium in blood; anorexia, a loss of appetite, decrease in level of sodium in blood.

from vessels: arterial hypotension, orthostatic decrease in the ABP, syncope; inflows; stenosis of vessels, hypoperfusion, vasculitis, Reynaud's phenomenon.

General state: stethalgia, fatigue; pyrexia; asthenia.

from the immune system: anaphylactic and anaphylactoid reactions, increase in level of antinuclear antibodies.

from a gepatobiliarny system: increase in level of liver enzymes and/or the conjugated bilirubin; cholestatic jaundice, damage of hepatic cells; an acute liver failure, cholestatic or cytolytic hepatitis (in very exceptional cases — with a lethal outcome).

from a reproductive system and mammary glands: tranzitorny erectile dysfunction, decrease in a libido; gynecomastia.

Mental disorders: decrease in mood, uneasiness, nervousness, concern, sleep disorders, including drowsiness; condition of confusion of consciousness; disturbances of attention.

Special instructions

Special categories of patients

Double blockade of RAAS by means of the medicines containing aliskiren

Double blockade of RAAS by the combined use of the medicament Hartil and an aliskiren is not recommended to

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as at the same time there is an increased risk of developing arterial hypotension, a hyperpotassemia and emergence of changes of function of kidneys.

At patients with diabetes or renal failures (glomerular filtration rate of 60 ml/min.) the combined use of the medicament Hartil and an aliskiren contraindicated (see CONTRAINDICATIONS).

Patients who have an extra risk of developing of arterial hypotension

Patients with the significant activation of RAAS. The risk of sudden decrease in the ABP with deterioration in function of kidneys owing to oppression of APF increases at patients with the significant activation of RAAS, especially if APF inhibitor or the accompanying diuretic medicine are appointed for the first time or at the first increase in a dose.

Significant activation of RAAS is expected by

, and the medical control including monitoring of the ABP is necessary at such states:

• heavy AG;
• dekompensirovanny stagnant heart failure;
• hemodynamically significant obstacle to inflow or outflow of blood from a left ventricle (for example stenosis of the aortal or mitral valve);
• a unilateral renal artery stenosis with the second functioning kidney;
• disturbance of water and electrolytic balance or a possibility of its development (including accepting diuretics);
• cirrhosis and/or ascites;
• when performing extensive surgical interventions or during anesthesia the medicines causing arterial hypotension.

Is recommended to adjust dehydration, a hypovolemia or deficiency of electrolytes before an initiation of treatment (at patients with heart failure such correction needs to be weighed carefully, considering risk of development of a volume overload).

At patients with abnormal liver functions the response to the Hartil medicament treatment can be either strengthened, or reduced. Besides, at patients with heavy cirrhosis which is followed by hypostases and/or ascites the activity of RAAS can be essential raised; therefore during treatment of these patients it is necessary to show extra care.

Tranzitornaya or persistent heart failure after a myocardial infarction

Patients with risk of cardiac or cerebral ischemia in case of acute arterial hypotension. The initial phase of treatment demands special medical control.

Patients of advanced age. See USE.

Surgical interventions. It is recommended to stop treatment by APF inhibitors, such as ramiprit if it is possible, for 1 days before surgical intervention.

Control of function of kidneys. Function of kidneys needs to be estimated to and during treatment and to korrigirovat a dose, especially in the first weeks of therapy. In the presence of a renal failure especially careful monitoring is necessary (see USE). There is a risk of deterioration in function of kidneys, generally at patients with stagnant heart failure or after renal transplantation.

Quincke's disease. At the patients receiving APF inhibitors, including ramiprit, it was reported about development of a Quincke's disease (see. Side EFFECTS). In case of a Quincke's disease the administration of medicament Hartil needs to be stopped and to immediately appoint emergency treatment. Patients have to be under observation for not less than 12-24 h and can be written out after full elimination of symptoms.

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At the patients treated by APF inhibitors, including Hartil, observed cases of a Quincke's disease of intestines (see. Side EFFECTS). These patients complained of an abdominal pain (with or without nausea/vomiting).

Anaphylactic reactions during desensitization. Probability and weight of anaphylactic and anaphylactoid reactions to poison of insects and other allergens increase at intake of APF inhibitors. Before desensitization it is necessary to consider a question of the temporary termination of administration of medicament Hartil.

Hyperpotassemia. At some patients receiving APF inhibitors, including Hartil, the hyperpotassemia was noted. The risk of emergence of a hyperpotassemia above at persons with a renal failure is aged more senior than 70 years, at patients with uncontrollable diabetes, at receiving potassium salts, kaliysberegayushchy diuretics and also other active agents which increase potassium content, or at such states as dehydration, a sharp warm decompensation, a metabolic acidosis. If simultaneous use of the listed medicaments is considered expedient, recommend regular monitoring of level of potassium in blood plasma (see INTERACTIONS).

Neutropenia/agranulocytosis. Cases of a neutropenia/agranulocytosis and also thrombocytopenia and anemia revealed seldom. Reported also about a possibility of oppression of marrow. Recommend to control quantity of leukocytes for identification of a possible leukopenia. Frequent monitoring in an initial phase of treatment at patients with a renal failure, with the accompanying collagenoses (system lupus erythematosus or a scleroderma) is recommended or at use by patients of other medicaments who can cause changes of a picture of blood (see INTERACTIONS, SIDE EFFECTS).

Ethnic differences. APF inhibitors cause a Quincke's disease in patients of negroid race more often, than in representatives of other races. Equally as at use of other APF inhibitors, ramiprit it can be less effective for decrease in the ABP level at patients of negroid race in comparison with representatives of other races. It can be caused by the fact that at patients of negroid race with AG AG with low activity of renin develops more often.

Cough. At use of APF inhibitors it was reported about cases of developing of cough. It is characteristic that cough is unproductive, long and passes after the therapy termination. The possibility of appearance of the cough caused by APF inhibitors has to be considered at implementation of differential diagnosis of cough.

Patients with such rare hereditary diseases as intolerance of a galactose, deficiency of Lappa lactase and disturbance of absorption of glucose galactose, should not use this drug.

Period of pregnancy and feeding by a breast. Pregnancy. Drug should not be used by the pregnant women or women planning pregnancy. If during treatment the pregnancy is confirmed by medicine, its use needs to be stopped and replaced immediately with other medicament allowed for use for pregnant women.

If the patient became pregnant during treatment, use of the medicament Hartil needs to be replaced with therapy without APF inhibitors as soon as possible.

Feeding by a breast. Because of the shortage of information on use of a ramipril during feeding by a breast (see. Pharmacological PROPERTIES) this medicament during this period is not recommended to appoint and it is desirable to give preference to other medicines which use during a lactation is safer, especially during breastfeeding of newborn or premature babies.

Children. Hartil do not apply at children, considering lack of data on efficiency and safety.

Ability to influence speed of response at control of vehicles or other mechanisms. Some side effects (for example symptoms of decrease in the ABP, such as dizziness) can affect ability of the patient to concentrate attention and to speed of response, especially in an initiation of treatment or upon transition from use of other drugs.

After reception of the 1st dose or its further increase it is undesirable to p to run vehicles or to work with other mechanisms for several hours.

Interaction

Contraindicated combinations. extracorporal methods of treatment which lead to contact of blood with negatively charged surfaces, such as dialysis or haemo filtration with use of certain high-line membranes (for example polyacrylonitrile) and also aferez LDL using a sulfate dextran owing to the increased risk of development of heavy anaphylactoid reactions (see contraindications). in need of such treatment it is necessary to consider a question of use of other type of a dialysis membrane or other class of antihypertensive drugs.

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Combined use of the medicament Hartil with the medicines containing aliskiren is contraindicated to patients with diabetes or moderately heavy renal failures and is not recommended to other categories of patients (see CONTRAINDICATIONS and SPECIAL INSTRUCTIONS).

Combination, demanding precautionary measures. The potassium salts, heparin, kaliysberegayushchy diuretics and other active agents increasing potassium level in blood plasma (including antagonists of angiotensin ІІ, Trimethoprimum, takrolimus, cyclosporine): there can be a hyperpotassemia therefore continuous monitoring of level of potassium in blood plasma is necessary.

Antihypertensive medicaments (for example diuretics) and other medicines which can lower the arterial blood pressure (for example nitrates, tricyclic antidepressants, anesthetics, ethanol, Baclofenum, alfuzozin, docsazozin, Prazozinum, tamsulozin, terazozin): it is necessary to expect increase in risk of developing of arterial hypotension (see. Special INSTRUCTIONS).

Angiotonic sympathomimetics and other substances (for example Isoproterenolum, Dobutaminum, a dopamine, epinephrine) which can reduce antihypertensive effect of the medicament Hartil: careful control of the ABP is recommended.

Allopyrinolum, immunosuppressants, GKS, procaineamide, cytostatics and other substances which can affect quantity of blood cells: the increased probability of hematologic reactions (see. Special INSTRUCTIONS).

Salt of lithium: APF inhibitors can reduce lithium excretion and therefore the probability of toxicity of medicaments of lithium can increase. Recommend to control lithium level in blood plasma.

Antidiabetic means, including insulin: hypoglycemic reactions are possible. Control of level of glucose in blood is recommended.

NPVP and acetylsalicylic acid: the expected decrease in antihypertensive effect of the medicament Hartil. Moreover, simultaneous use of APF and NPVP inhibitors can be followed by the increased risk of deterioration in function of kidneys and increase in level of potassium in blood.

Salt. The increased level of the use of salt can reduce antihypertensive effect of drug.

Specific desensitization. Owing to inhibition of APF the probability emergence of heavy anaphylactic and anaphylactoid reactions to poison of insects increases. It is considered that such effect can be also observed and concerning other allergens.

Overdose

Symptoms of overdose of inhibitors apf can include an excessive peripheral vazodilatation (with the profound arterial hypotension, shock), bradycardia, electrolytic disturbances, a renal failure. the condition of the patient should be controlled carefully. perform the symptomatic and supporting treatment. the proposed measures include primary detoxication (gastric lavage, reception of sorbents) and restoration of hemodynamic stability, including prescribing of agonists α1-адренорецепторов or ii angiotensin (Angiotensinamidum). ramiprilat, the active metabolite of a ramipril, is badly brought out of general circulation by a hemodialysis.

Storage conditions

At a temperature not above 25 °C.