Ramipril tablets 5mg №10×3

Name:
Ramipril. Release form Tablets. Dosage 5 mg. Pack quantity: 30 pcs. ProducerAmantismed Ltd. INN ramipril. FTGApf blocker.
Description:
Tablets of white or almost white color, flat-cylindrical, with a chamfer and a risk on one side (dosage 5 mg and 10 mg); light yellow tablets, flat-cylindrical, with a chamfer and a risk on one side, blotches of a darker color are allowed (dosage 2.5 mg). The risk is intended only for breaking the tablet in order to facilitate swallowing, and not for dividing into equal doses. Composition One tablet with a dosage of 2.5 mg contains: active substance: ramipril – 2.5 mg; excipients: sodium bicarbonate, pregelatinized corn starch, sodium croscarmellose, sodium stearyl fumarate, lactose monohydrate, yellow iron oxide (E172); one tablet with a dosage of 5 mg contains: active substance: ramipril – 5 mg; excipients: sodium bicarbonate, pregelatinized corn starch, sodium croscarmellose, sodium stearyl fumarate, lactose monohydrate; one tablet with a dosage of 10 mg contains: active substance: ramipril – 10 mg; excipients: sodium bicarbonate, pregelatinized corn starch, sodium croscarmellose, sodium stearyl fumarate, lactose monohydrate. Pharmacotherapeutic group Means that affect the renin-angiotensin system. ACE inhibitors. ATC code: C09AA05. Pharmacological action Ramiprilat, the active metabolite of ramipril, is a long-acting angiotensin-converting enzyme (ACE) inhibitor. In plasma and tissues, ACE catalyzes the conversion of angiotensin I to angiotensin II (an active vasoconstrictor) and the breakdown of the active vasodilator bradykinin. A decrease in the formation of angiotensin II and an increase in bradykinin activity leads to vasodilation and contributes to the cardioprotective and endothelial protective effects of ramipril. Angiotensin II stimulates the release of aldosterone, in connection with this, ramipril causes a decrease in aldosterone secretion. Hypotensive effect Taking ramipril causes a pronounced decrease in peripheral arterial resistance. Changes in renal blood flow and glomerular filtration rate are usually not observed. Reception of ramipril causes in hypertensive patients a decrease in blood pressure in the “lying” and “standing” positions without a compensatory increase in heart rate. In most patients, a noticeable hypotensive effect occurs 1-2 hours after ingestion of a single dose. The maximum effect of a single dose is achieved 3-6 hours after ingestion. The hypotensive effect of a single dose usually lasts for 24 hours. The maximum hypotensive effect with continuous treatment with ramipril usually occurs after 3-4 weeks. It has been shown that the hypotensive effect of long-term therapy persists for 2 years. Abrupt discontinuation of ramipril does not cause a rapid and excessive rebound increase in blood pressure. Indications for use Treatment of arterial hypertension: to lower blood pressure, both in monotherapy and in combination with other antihypertensive drugs Prevention of potentially fatal cardiovascular complications (see section “Method of application and dosage”): reduction in the number of cardiovascular complications ( myocardial infarction, stroke, and death) in patients with: manifestations of atherothrombotic cardiovascular disease (presence of coronary heart disease or stroke in anamnesis, obliterating diseases of the arteries of the lower extremities) or diabetes mellitus and with at least one cardiovascular risk factor Secondary prevention in patients with acute myocardial infarction: reduced risk of death, starting from the acute phase of myocardial infarction, in patients with clinical signs of heart failure when prescribed 48 hours after the onset of the disease Treatment of glomerular kidney disease: the initial stage of diabetic nephropathy, manifested by the presence of microalbuminuria severe diabetic nephropathy with the presence of macroproteinuria in patients with at least one risk factor for cardiovascular disease severe non-diabetic nephropathy with macroproteinuria ≥ 3 g / day Treatment of heart failure with clinical manifestations. Method of application and dosageFor oral administration. It is recommended to take every day at the same time. Ramipril can be taken with or without food as bioavailability is independent of food intake. Ramipril must be taken with sufficient liquid. Do not chew or crush tablets before taking. This drug does not provide a dosage of 1.25 mg, when prescribing ramipril at a dose of 1.25 mg, it is necessary to use a drug from another manufacturer. If you take a larger than usual dose of ramipril, you should contact your doctor or go to the nearest hospital immediately. At the same time, you cannot drive a vehicle on your own, it is recommended to invite someone from the environment as an escort or call an ambulance team. In order for the doctor to quickly determine the cause, you need to take the package of the medication you have taken with you. If a dose is missed, simply take the next dose at its usual time. Do not take a double dose to make up for a forgotten one. Adults Patients treated with diuretics Starting ramipril may be accompanied by hypotension; this is more common in patients treated with diuretics. The lack of salts and fluids in the body is subject to preliminary correction before the start of treatment with ramipril, diuretics should be limited or discontinued, no later than 2-3 days in advance (see section “Precautions”) Treatment of patients who have not canceled diuretics should be start with the smallest single dose of 1.25 mg ramipril. It is necessary to monitor kidney function and the content of potassium in the blood serum. The subsequent dose of ramipril should be adjusted according to the target blood pressure level. Treatment of arterial hypertension The dosage is calculated depending on the expected therapeutic effect and the tolerability of ramipril by the patient in each case (see section “Precautions”). Ramipril can be used both as monotherapy and in combination with other classes of drugs for the treatment of hypertension. Initial dose Treatment with ramipril should be started with an initial dose of 2.5 mg daily. In patients with a highly activated renin-angiotensin-aldesterone system, a significant decrease in blood pressure may follow the initial dose. For such patients, the recommended starting dose is 1.25 mg and treatment should be started under medical supervision (see Precautions section). Individual maintenance dose titration The dose may be doubled at 2-4 week intervals to achieve the target blood pressure level. The maximum daily dose is 10 mg. The daily dose is taken once a day. Prevention of Potentially Fatal Cardiovascular Complications Initial Dose The recommended initial dose is 2.5 mg once daily. Titration of individual maintenance dose The dose is gradually increased depending on the patient’s tolerance to ramipril. It is recommended to double the dose after 1-2 weeks of treatment, and after the next 2-3 weeks – to increase the maintenance dose to 10 mg of ramipril daily. See also dosing in patients previously treated with diuretics. Secondary prophylaxis in patients with acute myocardial infarction with clinical signs of heart failure Initial dose After 48 hours following myocardial infarction in clinically and hemodynamically stable patients, the recommended initial dose is 2.5 mg twice a day for three days. If the initial dose of 2.5 mg is not tolerated by the patient, 1.25 mg twice daily for 2 days should be given before increasing the dose to 2.5 mg and 5 mg twice daily. If the dose cannot be increased to 2.5 mg twice daily, treatment should be discontinued. See also dosing in patients previously treated with diuretics. Titration and individual maintenance dose The daily dose is sequentially increased by doubling it at intervals of 1-3 days until a maintenance dose of 5 mg twice a day is reached. The maintenance daily dose is recommended to be divided into 2 doses. The maximum daily dose is 10 mg. If a decision is made to treat a patient with severe (NYHA grade IV) chronic heart failure after myocardial infarction with ramipril, it is recommended to start with a dose of 1.25 mg 1 time per day. The dose should be increased with extreme caution. Treatment of kidney disease In patients with diabetes and microalbuminuria Initial dose The recommended initial dose is 1.25 mg once daily. Titration of individual maintenance dose The dose is increased sequentially depending on the patient’s tolerance to ramipril. It is recommended to double the daily dose to 2.5 mg after 2 weeks of treatment, and then to 5 mg after the next 2 weeks. In patients with diabetes and at least one cardiovascular risk factor Initial dose The recommended initial dose is 2.5 mg once daily. Titration of individual maintenance dose The dose is increased sequentially depending on the patient’s tolerance to ramipril. It is recommended to double the daily dose to 5 mg after 2 weeks of treatment, and then to 10 mg after the next 2-3 weeks. The maximum daily dose is 10 mg. In patients with non-diabetic nephropathy with macroproteinuria ≥ 3 g/day Initial dose The recommended initial dose is 1.25 mg once daily. Titration of individual maintenance dose The dose is increased sequentially depending on the patient’s tolerance to ramipril. It is recommended to double the daily dose to 2.5 mg after 2 weeks of treatment, and then to 5 mg after the next 2 weeks. Treatment of symptomatic heart failure Initial dose For patients receiving diuretic therapy, the recommended initial dose is 1.25 mg once daily. Individual maintenance dose titration It is recommended that the dose of ramipril be doubled every two weeks up to a maximum daily dose of 10 mg. It is preferable to divide the daily dose into 2 doses. Special categories of patients Treatment of patients with impaired renal function Daily dose for patients with impaired renal function is prescribed taking into account creatinine clearance if creatinine clearance> 60 ml / min, there is no need to adjust the initial dose (2.5 mg daily), the maximum daily dose is 10 mg ; if creatinine clearance is in the range of 30-60 ml / min, there is no need to adjust the initial dose (2.5 mg daily), the maximum daily dose is 5 mg; if creatinine clearance is in the range of 10-30 ml / min, the initial dose is 1.25 mg daily, and the maximum daily dose is 5 mg; in patients with hypertension undergoing hemodialysis: ramipril is poorly dialyzed; the initial dose is 1.25 mg daily and the maximum daily dose is 5 mg; ramipril must be taken a few hours after hemodialysis. Patients with impaired liver function Treatment of such patients should be carried out with extreme caution and only under medical supervision. The maximum allowable daily dose in such cases is 2.5 mg of ramipril. Elderly patients Initial doses should be lower and their administration should be more gradual due to the increased risk of adverse reactions, especially in elderly and debilitated patients. The recommended starting daily dose is 1.25 mg ramipril. Pediatric population Ramipril is not recommended for use in children and adolescents under 18 years of age due to insufficient relevant data on the safety and efficacy of ramipril. Side effect The frequency of development of adverse reactions is given in the following gradation: very often (≥ 1/10); often (≥ 1/100, < 1/10); infrequently (≥ 1/1000, < 1/100); rarely (≥ 1/10000, < 1/1000); very rarely (< 1/10000); unknown (according to the available data, it is not possible to determine the frequency of occurrence). Cardiac disorders: infrequently: myocardial ischemia, including angina pectoris or myocardial infarction, tachycardia, arrhythmia, palpitations, peripheral edema; Vascular disorders: often: excessive decrease in blood pressure (BP), impaired orthostatic regulation of vascular tone (orthostatic hypotension), syncope; infrequently: "tides" of blood to the skin of the face; rarely: the occurrence or intensification of circulatory disorders against the background of stenosing vascular lesions, vasculitis; frequency unknown: Raynaud's syndrome; Blood and lymphatic system disorders: infrequently: eosinophilia; rarely: leukopenia, including neutropenia and agranulocytosis, a decrease in the number of red blood cells, a decrease in hemoglobin, thrombocytopenia; frequency unknown: oppression of bone marrow hematopoiesis, pancytopenia, hemolytic anemia; Nervous system disorders: often: headache, dizziness; infrequently: vertigo, paresthesia, ageusia (loss of taste), dysgeusia (taste disorder); rarely: tremor, imbalance; frequency unknown: cerebral ischemia, including ischemic stroke and transient cerebrovascular accident, impaired psychomotor reactions, burning sensation, parosmia (impaired odor perception); On the part of the organ of vision: infrequently: visual disturbances, including blurred images; rarely: conjunctivitis; Hearing disorders: rarely: hearing loss, tinnitus; Respiratory, chest and mediastinal disorders: often: dry, non-productive cough, bronchitis, sinusitis, dyspnea; infrequently: bronchospasm, including exacerbation of asthma, nasal congestion; Gastrointestinal disorders: often: inflammatory reactions in the stomach and intestines, digestive disorders, discomfort in the abdomen, dyspepsia, diarrhea, nausea, vomiting; infrequently: pancreatitis, including fatal cases (cases of fatal pancreatitis when taking ACE inhibitors were extremely rare), increased activity of pancreatic enzymes, intestinal angioedema, abdominal pain, gastritis, constipation, dryness of the oral mucosa; rarely: glossitis; frequency unknown: aphthous stomatitis; On the part of the kidneys and urinary system: infrequently: impaired renal function, including acute renal failure, increased existing proteinuria, increased concentrations of urea and creatinine in the blood; Skin and subcutaneous tissue disorders: often: skin rash; infrequently: angioedema, including fatal (laryngeal edema can cause airway obstruction, leading to death), pruritus, hyperhidrosis (excessive sweating); rarely: exfoliative dermatitis, urticaria, onycholysis; very rarely: photosensitivity reactions; frequency unknown: toxic epidermal necrolysis, Stevens-Johnson syndrome, erythema multiforme, pemphigus, worsening of psoriasis, psoriasis-like dermatitis, pemphigoid or lichenoid (lichen-like) exanthema or enanthema, alopecia; Musculoskeletal and connective tissue disorders: often: muscle cramps, myalgia; infrequently: arthralgia; Metabolic and nutritional disorders: often: an increase in the concentration of potassium in the blood; infrequently: anorexia, loss of appetite; frequency unknown: decrease in the concentration of sodium in the blood; General disorders: often: chest pain, feeling tired; infrequently: fever; rarely: asthenia; Immune system disorders: frequency unknown: anaphylactic or anaphylactoid reactions (with ACE inhibition, the number of anaphylactic or anaphylactoid reactions to insect venom increases), an increase in the concentration of antinuclear antibodies; Liver disorders: infrequently: an increase in the activity of "liver" enzymes and the concentration of conjugated bilirubin in the blood plasma; rarely: cholestatic jaundice, hepatocellular lesions; frequency unknown: acute liver failure, cholestatic or cytolytic hepatitis (there was a single fatal outcome); Reproductive system and mammary gland disorders: infrequently: transient impotence due to erectile dysfunction, decreased libido; frequency unknown: gynecomastia; Endocrine system disorders: frequency unknown: syndrome of inappropriate secretion of antidiuretic hormone; Mental disorders: infrequently: depressed mood, anxiety, nervousness, restlessness, sleep disturbance, including drowsiness; rarely: confusion; frequency unknown: impaired attention. Children The nature and severity of adverse reactions of ramipril are similar to those in adult patients, the frequency of the following adverse reactions is higher in the pediatric population: tachycardia, nasal congestion and rhinitis: often in children and infrequently in adults; conjunctivitis: often in children and rarely in adults; tremor and urticaria: uncommon in children and rare in adults. However: The overall safety profile of ramipril in children is not significantly different from that in adults. In the event of adverse reactions, as indicated in the instructions for use, or any others, you should contact your doctor. Contraindications - hypersensitivity to ramipril and other components of the drug or other ACE inhibitors; patients with a history of angioedema (hereditary, idiopathic, or due to taking an ACE inhibitor or an angiotensin II receptor antagonist (ARA II)); extracorporeal treatment methods, during which it has blood contact with negatively charged surfaces (see the section "Interaction with other drugs and other types of interaction"); established stenosis of the renal artery (bilateral, in the case of one kidney - unilateral); 2nd and 3rd trimester of pregnancy; ramipril should not be taken in patients with low blood pressure or hemodynamically unstable condition; simultaneous use with aliskiren in patients with diabetes mellitus or moderate / severe renal insufficiency (glomerular filtration rate (GFR) < 60 ml / min); simultaneous use with ARA II in patients with diabetic nephropathy. Overdose Symptoms of intoxication Symptoms associated with an overdose of ACE inhibitors may include: increased peripheral vasodilation (accompanied by hypotension, shock), bradycardia, electrolyte imbalance, renal failure. Treatment Patients should be monitored closely and treatment should be determined by the nature and timing of the drug and the type and severity of symptoms. In addition to general measures aimed at removing ramipril from the body (for example, gastric lavage, administration of adsorbents) and measures to restore hemodynamic stability, the use of alpha-1-adrenergic agonists or angiotensin II may be required. Ramiprilat, the active metabolite of ramipril, is almost never dialyzed. PrecautionsDouble blockade of the renin-angiotensin-aldosterone system (RAAS) Dual blockade of the renin-angiotensin-aldosterone system is associated with an increased risk of hypotension, hyperkalemia and renal dysfunction (including acute renal failure) compared with monotherapy. Dual blockade of the RAAS with an ACE inhibitor, ARA II, or aliskiren cannot be recommended for any patient, especially those with diabetic nephropathy. In some cases, when the combined use of ACE inhibitors and ARA II is absolutely indicated, careful supervision of a specialist and mandatory monitoring of kidney function, water and electrolyte balance, and blood pressure are necessary. This refers to the use of candesartan or valsartan as add-on therapy to an ACE inhibitor in patients with chronic heart failure. Conducting a double blockade of the RAAS under the close supervision of a specialist and mandatory monitoring of kidney function, water and electrolyte balance and blood pressure is possible in patients with chronic heart failure with intolerance to aldosterone antagonists (spironolactone), who have persistent symptoms of chronic heart failure, despite other measures. adequate therapy. The use of ramipril in combination with angiotensin II receptor antagonists is contraindicated in patients with diabetic nephropathy. Special Patients Pregnancy ACE inhibitors such as ramipril or ARA II should not be used during pregnancy. If the patient is planning pregnancy, before continuing therapy with an ACE inhibitor/ARA II, it is necessary to select another treatment for hypertension with a more reliable safety profile for pregnancy. If pregnancy is detected during treatment with ACE inhibitors / ARA II, you should immediately stop taking ramipril and start therapy with drugs of other classes (see sections "Contraindications" and "Side Effects"). Patients at increased risk of hypotension Patients with increased activity of the renin-angiotensin-aldosterone system Patients with increased activity of the RAAS are at risk of a sharp drop in blood pressure and deterioration of kidney function during ACE inhibition, especially at the beginning of treatment or when the dose of an ACE inhibitor or co-administered is first increased diuretics. Possible manifestations of increased activity of the RAAS must be taken into account, carrying out constant medical supervision, including monitoring of blood pressure, in cases, for example: patients with severe hypertension; patients with decompensated congestive heart failure; patients with clinically significant hemodynamic disorders (inflow or outflow) in the left ventricle (for example, aortic stenosis, mitral stenosis); patients with unilateral renal artery stenosis with a second functional kidney; patients with electrolyte and / or fluid deficiency (including patients previously treated with diuretics); patients with liver cirrhosis and/or ascites; patients undergoing major surgery or during anesthesia with hypotensive agents. Correction of dehydration, hypovolemia, or electrolyte deficiency is recommended prior to initiation of treatment (in patients with heart failure, such corrective actions should be assessed against the risk of overvolume). Transient or permanent heart failure after myocardial infarction Patients at risk of cardiac or cerebral ischemia due to acute hypotension The initial stages of treatment require special medical supervision. Elderly patients (see section "Method of application and dosage"). Surgery It is recommended to stop treatment with ACE inhibitors (including ramipril), if possible the day before surgery. Monitoring of renal function Renal function should be monitored before the appointment of ramipril. Monitoring of renal function is recommended, in particular, in the first weeks of treatment, especially in patients with renal insufficiency (see section "Method of application and dosage"). Possible risk of impaired renal function, especially in patients with congestive heart failure or after kidney transplantation. Angioedema Cases of angioedema have been reported in patients treated with ACE inhibitors, including ramipril (see section "Side Effects"). The risk of angioedema may be increased in patients taking concomitant medications such as vildagliptin or mTOR inhibitors (target of rapamycin in cells) eg temsirolimus, everolimus, sirolimus. If angioedema occurs during treatment, ramipril should be discontinued immediately. Emergency treatment must be started immediately. The patient should be observed for at least 12-24 hours and discharged only after the disappearance of all symptoms. A case of angioedema of the intestine has been reported in patients treated with ACE inhibitors, including ramipril (see section "Side Effects"). Patients had abdominal pain (sometimes accompanied by nausea and vomiting). Anaphylactic reactions during sensitization The likelihood and severity of anaphylactic and anaphylactoid reactions to insect venom is increased by ACE inhibitors. It is assumed that a similar effect may also occur when interacting with other allergens. Temporary discontinuation of ramipril should be considered prior to the onset of sensitization. Hyperkalemia Hyperkalemia has been observed in some patients treated with ACE inhibitors, including ramipril. Patients at risk of developing hyperkalemia include patients with renal insufficiency; aged > 70 years; uncontrolled diabetes mellitus; using potassium salts, potassium-sparing diuretics or other substances that increase the content of potassium in the plasma; as well as conditions such as dehydration, acute cardiac decompensation, metabolic acidosis. During simultaneous treatment with these drugs, strict monitoring of serum potassium concentration is necessary (see section “Interaction with other medicinal products and other forms of interaction”). Hyponatremia In some patients treated with ramipril, there was a syndrome of inappropriate secretion of antidiuretic hormone (ADH) with subsequent development of hyponatremia. It is recommended to regularly monitor serum sodium levels in the elderly and in other patients who are at risk of developing hyponatremia. Neutropenia/agranulocytosis Neutropenia/agranulocytosis, as well as thrombocytopenia and anemia, are rare, and bone marrow depression has also been reported. It is recommended to monitor the number of leukocytes to prevent possible leukopenia. More detailed monitoring is recommended at the initial stages of treatment and in patients with impaired renal function, with concomitant collagenosis (lupus erythematosus or scleroderma), treated with other drugs that may affect the blood picture (see sections “Interaction with other drugs and other types of interaction” and “Side effects”). Ethnic differences The risk of angioedema with ACE inhibitors is more likely in black patients than in white patients. The overall response to ACE inhibitor monotherapy is lower in black (Afro-Caribbean) patients with hypertension (low renin population) than in white patients. Cough Cough has been reported during treatment with ACE inhibitors. The cough is unproductive, persistent and disappears after discontinuation of therapy. When making a differential diagnosis of cough in a patient, the possibility of its association with ACE inhibitors should be taken into account. Pregnancy and lactation Pregnancy Breast-feeding The use of ramipril during breast-feeding is not recommended, and alternative treatment with a better established safety profile during breast-feeding is preferred, especially when feeding a newborn or premature baby. Influence on the ability to drive vehicles or other potentially dangerous mechanisms Some undesirable effects (hypotension, dizziness) may reduce the reaction and concentration of the patient, which may affect his ability to drive a car and mechanisms. This is most likely at the start of treatment, during dose increases, drug changes, and interactions with alcohol. It is not recommended to drive a car or operate machinery within a few hours after taking the first dose or increasing the dose. Interactions with other drugs and other forms of interaction Contraindicated combinations Extracorporeal treatment in which there is contact of blood with negatively charged surfaces, such as dialysis or hemofiltration with high-flow membranes (for example, polyacrylonitrile) and low-density lipoprotein (LDL) apheresis with using dextran sulfate should not be used during treatment with ramipril, as this may lead to anaphylactoid reactions (see section “Contraindications”). If such treatment is needed, other types of filtration membranes and other (non-ACE inhibitor) classes of antihypertensive agents are used. Dual blockade of the renin-angiotensin-aldosterone system Based on the available data, dual blockade of the RAAS with an ACE inhibitor, ARA II, or aliskiren cannot be recommended in any patient, especially in patients with diabetic nephropathy. In patients with diabetes mellitus or moderate / severe renal insufficiency (GFR < 60 ml / min / 1.73 m2), the simultaneous use of aliskiren with an ACE inhibitor or ARA II is contraindicated. In some cases, when the combined use of ACE inhibitors and ARA II is absolutely indicated, careful observation of a specialist and mandatory monitoring of kidney function, water and electrolyte balance, and blood pressure are necessary. The use of ramipril in combination with an angiotensin II receptor antagonist is contraindicated in patients with diabetic nephropathy and is not recommended in other patients. Non-recommended combinations of potassium salts, heparin, potassium-sparing diuretics and other substances that increase the concentration of potassium in the plasma (for example, ARA II, trimethoprim, tacrolimus, cyclosporine, spironolactone): a more pronounced increase in the concentration of potassium in the blood serum (hyperkalemia), sometimes severe. During concomitant treatment with these medicinal products, strict monitoring of serum potassium concentrations is necessary. Precautions in the use of antihypertensive agents (diuretics) and other substances that can lower blood pressure (for example, nitrates, tricyclic antidepressants, anesthetics, alcohol, baclofen, alfuzosin, doxazosin, prazosin, tamsulosin, terazosin): increased hypotensive effect of ramipril. The potential risk of hypotension must be excluded (see section "Method of application and dosage"); vasopressive sympathomimetics and other substances (eg, isoproterenol, dobutamine, dopamine, adrenaline): possible weakening of the hypotensive effect of ramipril (careful monitoring of blood pressure is recommended); allopurinol, procainamide, cytostatics, immunosuppressants, systemic corticosteroids and other drugs that affect the blood picture: the likelihood of hematological reactions increases (see section "Precautions"); lithium salts: ACE inhibitors can cause an increase in serum lithium concentration, resulting in increased cardiotoxicity and lithium neurotoxicity (regular monitoring of serum lithium levels is required); antidiabetic agents, including insulin: hypoglycemic reactions may occur. Particularly careful monitoring of blood sugar levels is recommended; vildagliptin: there has been an increase in angioedema in patients taking ACE inhibitors and vildagliptin; non-steroidal anti-inflammatory drugs, painkillers and acetylsalicylic acid: it is possible to weaken the hypotensive effect of ramipril; possible increased risk of impaired renal function and increased serum potassium concentration; mTOR inhibitors or vildagliptin: The risk of angioedema may be increased in patients taking concomitant medications such as vildagliptin or mTOR inhibitors (such as temsirolimus, everolimus, sirolimus); neutral endopeptidase inhibitors: A potential increased risk of angioedema has been reported with the combined use of ACE inhibitors with neutral endopeptidase inhibitors, such as racecadotril and sacubitril/valsartan; desensitizing therapy: The likelihood and severity of anaphylactic and anaphylactoid reactions to insect venom increases with ACE inhibitors. It is assumed that a similar effect may also occur when interacting with other allergens. Storage conditions In a place protected from moisture and light at a temperature not exceeding 25 ° C. Keep out of the reach of children. Shelf life 2 years. Do not use after the expiry date stated on the package. Upakovka10 tablets in a blister pack of PVC film and aluminum foil. Three blister packs together with instructions for medical use in a cardboard pack. Conditions for dispensing from pharmacies By prescription. Buy Ramipril tablets 5 mg No. 10x3 Price for Ramipril tablets 5 mg No. 10x3