Among diseases that can significantly reduce life expectancy and affect its quality, arterial hypertension stands alone. It develops gradually and gradually affects the blood vessels, brain, kidneys and myocardium. At the initial stages, it is difficult for the patient to recognize the disease, because it manifests itself practically without complaints.
Later, they appear, and the patient notes that his blood pressure is much higher than normal. This situation requires the beginning of pharmacological therapy, which is possible with the use of 5 classes of drugs. And “Ramipril” is the most perfect of them, guaranteeing the result with monotherapy or as part of a combined multicomponent treatment.
Systemic characteristics of the drug
"Ramipril", analogues of the drug, as well as complex drugs are antihypertensive agents. Ramipril itself is an active substance that is found in many drugs. It is an ACE inhibitor that can block the enzyme and lower blood pressure. It allows you to significantly improve the prognosis of the course of the disease in the elderly.
Clinical studies have shown that ramiprilat, the active metabolite of Ramipril, inhibits the angiotensin converting enzyme much more strongly. Because of this, Ramipril, analogues and complex preparations are the means of choice for difficultly controlled hypertension.
Analogs
Since the drug is able to strongly block ACE and helps to control high blood pressure, Ramipril has many analogues. All of them are successfully used in the treatment of hypertension. Moreover, the original ramipril is the drug "Tritace". All the rest are his generics, the effectiveness of which must be compared with him. The admission to sale must be confirmed by bioequivalence to the Tritace drug.
At the moment, the list of analogues is as follows: Amprilan, Vazolong, Dilaprel, Korpril, Pyramil, Ramepress, Ramigamma, Ramicardia, Tritace, Hartil. Ramipril is also produced by Russian companies TathimpharmPreparaty, Biokom and Severnaya Zvezda. The products of the latter are called Ramipril SZ.
Standard dosages and complex preparations
The antihypertensive drug Ramipril is easy to dose and take. Its activity allows you to distinguish three standard dosages of the drug. These are 2.5 mg, 10 and 5 mg. Tablets of this mass are taken twice a day. There are also complex medicines containing ramipril and hydrochlorothiazide: Amprilan ND, Amprilan NL, Vazolong N, Remazid, Triapin, Tritace Plus, Hartil D, Egypt. Here, the amount of ramipril ranges from 2.5 mg to 10, and the dose of hydrochlorothiazide is from 12.5 to 25 mg in one tablet.
The second category of complex drugs is a combination of Ramipril and a calcium antagonist, Amlodipine. An example of a medicine is Egipress, which is available in two standard dosages: 10 mg ramipril and 5 mg amlodipine, and also at a dose of 10/10 mg. In addition to this combination, there is another type of drug containing the ACE inhibitor Ramipril and the calcium antagonist Felodipine. This is Triapin, which contains 2.5 mg of ramipril and 2.5 mg of felodipine.
Directions for use
In addition to the recommendations of the doctor, the patient should take into account the instructions for use. It contains information about the indications, side effects, dosage and administration regimens, contraindications and precautions. The instructions for use attached to the Ramipril preparation explain the need for refusing alcohol during the treatment of hypertension.
Indications
Ramipril, analogues of the drug and generic Tritace are indicated for:
- essential hypertension ;
- as part of complex multiclass therapy of chronic heart failure;
- diabetic and other nephropathy at the clinical or subclinical stage, not associated with renal artery stenosis ;
- with symptomatic arterial hypertension;
- for the prevention of myocardial infarction, mortality reduction in patients with cardiac diseases, as well as for the treatment of hypertension with a high total cardiovascular risk.
The main indication is arterial hypertension. This is the most common disease of middle and old age, requiring correction. Also, the drug "Ramipril" or another ACE inhibitor should be prescribed to patients in the first 2-9 days from the acute period of myocardial infarction. The dose of the drug should be as tolerated as possible even when the patient is not sick with hypertension. This is due to the powerful cardioprotective effects of ACE inhibitors.
Contraindications
The drug "Ramipril SZ" should not be used if there is a history of angioedema for any analogue of the drug, as well as any allergic reaction that developed on its administration. Appointment in the presence of hemodynamically significant stenosis of arteries on both sides is contraindicated. If the stenosis is unilateral and both kidneys function normally in the patient, then the appointment is allowed with caution and under the supervision of GFR.
The drug "Ramipril" (5 mg or offered in any other dosage) is not used for hypotension below 90 mm RT. Art. Also, the drug should not be used for hemodynamically significant stenosis of the aortic or mitral valve, for obstructive hypertrophic cardiomyopathy, primary hyperaldosteronism, chronic renal failure with a creatinine clearance index (GFR) of less than 20 ml / min.
The instructions for use attached to the Ramipril preparation (there are no analogues of this documentation) contain an indication of the impossibility of using the drug during pregnancy and lactation. It is also unacceptable to use the medicine for children. Under 18 years of age, clinical experience is inadequate and cannot confirm safety.
Dosage regimens
The main dosage form of Ramipril is tablets. In capsules, it is less common. In this case, the recommended initial dose is 1.25 mg. The smallest dosage of the drug is 2.5 mg, which forces it to be divided in two. Having a line on the tablet makes this easy.
With any form of hypertension, the initial dose is 1.25 mg once a day. Then, with good tolerance, the dose gradually doubles. Dose titration is performed until the blood pressure indicator has stabilized. The criterion for the effective treatment of hypertension is persistent blood pressure, which rarely rises at rest.
Precautionary measures
The drug should be taken under pressure control, especially for the first time. It is important that systolic blood pressure is reduced not lower than 90 mm. Hg. Art. If blood pressure falls below this level, it is recommended that you seek help from medical staff. In order to prevent blood pressure drops, it is not recommended to use Ramipril together with nitrates, class I antiarrhythmics (Procainamide) and alpha-1 blockers (Alfuzosin, Tamsulozin).
The drug should be taken regularly and preferably at the same time. This allows you to adapt the renin-angiotensin-aldosterone system, which regulates blood pressure. Also, do not skip taking medications, which can be expressed by severe hypertensive crises. A sharp refusal to take can cause strokes, the risks of which increase during this period.
Patient reviews about the drug
Tritace and its generics are high-quality drugs that control blood pressure well. To date, this drug is the most powerful antihypertensive drug. Thanks to this, patient reviews about him are generally positive. They characterize it as a reliable and powerful drug that controls blood pressure well. Especially important are the reviews of those patients who have previously taken other drugs in this group.
Patients noted a small number of adverse reactions associated with toxicity. A high degree of affinity for ACE, as well as a small dose of the drug neutralize a number of metabolic effects that are potentially undesirable with constant use. It is important that the number of crises amid the constant use of Ramipril is significantly reduced. However, their complete exclusion is not possible with monotherapy.
Reviews of doctors about the drug
Hypertension statistics are depressing. It confirms the importance of this disease for modern medicine. It is also important that pathology significantly reduces life expectancy. Hypertension develops due to overproduction of renin, which increases the amount of blood angiotensin. Inhibition of this enzyme leads to a decrease in pressure. This is necessary to prevent sclerosis of the vessel wall and the appearance of formidable complications of hypertension.
As retrospective clinical studies show, many atrial fibrillations and cases of coronary heart disease develop after the patient has already had hypertension for some time. Therefore, the importance of her treatment is huge. And more importantly, it is possible to eliminate the ailment thanks to the ACE inhibitors. Among them, Ramipril is by far the most powerful and effective.
Reviews of doctors about him prove its advantages. The drug is convenient to use, has few adverse reactions and is quite effective. However, despite these qualities, it may not be enough to treat severe hypertension. This is almost 40-50% of clinical cases.
Their treatment requires a combination regimen consisting of an ACE inhibitor, a diuretic, a calcium antagonist, and sometimes a beta blocker. As an inhibitor of angiotensin - converting enzyme , Ramipril is well suited. Therefore, it can always take its place in the treatment of hypertension, when it is permissible. Although many patients consider it a relatively high cost for a disadvantage.