Proviron hair loss, prevents the conversion of angiotensin I to angiotensin II without a compensatory increase.Aldosterone production reduces the total peripheral vascular resistance, pulmonary capillary wedge pressure, pulmonary vascular resistance, does not change in glomerular filtration rate, increases coronary blood flow. With long-term use of the drug decreases myocardial hypertrophy in patients with arterial hypertension, the incidence of arrhythmias during reperfusion reduced myocardial; It improves blood circulation isheminizirovannogo infarction. Cardioprotective effect due to the influence on prostaglandin synthesis, induction of nitric oxide in endothelial cells. The drug reduces platelet aggregation. Starting hypotensive action – 1.5 hours after oral administration, the maximum effect – in 5-9 hours duration – 24 hours. There is no drug withdrawal syndrome. proviron hair loss. Thiazide diuretics, the diuretic effect of which is associated with impaired reabsorption of sodium, chlorine, potassium, magnesium, water in the distal nephron; delayed excretion of calcium, uric acid. It has antihypertensive properties; hypotensive action develops due to the expansion of the arterioles.The antihypertensive effect occurs within 3-4 days, but may need 3-4 weeks to achieve the optimal therapeutic effect. Ramipril and proviron hair loss have additive effects. Ramipril reduces the loss of potassium ions, caused by the reception of proviron hair loss.
. Pharmacokinetics The pharmacokinetics of ramipril and proviron hair loss while receiving no different from that in their separate appointment
Absorption of ramipril is an average of 50 – 60%. Food does not affect the extent of absorption but reduces its speed, the time to maximum concentration – 2 4 hour.
After oral administration, absorption of proviron hair loss is 60-80%. The maximum concentration of proviron hair loss in the blood is achieved in 1-5 hours after ingestion. Contact ramipril with plasma proteins is 73%, ramiprilata – 56%. Communicating with proviron hair loss plasma proteins – 64%. The half-life (T 1/2) to ramipril – 5D h; phase distribution and elimination decrease in serum concentration of ramiprilat occurs T1 / 2 – 4-5 days. T1 / 2 is increased in renal failure.
The volume of distribution of ramipril – 90 L, ramiprilat – 500 l. Ramipril metabolism occurs primarily in the liver to form the active metabolite ramiprilat, which inhibits ACE 6 times more potent than ramipril and diketoshsherazina inactive metabolite which then glyukuroniziruyutsya. The drug is excreted mainly as metabolites, kidney – 60%, intestine – 40%. proviron hair loss is not metabolized and is rapidly excreted by the kidneys. The half-life is 5 – 15 hours.
Hypertension (in patients who have shown combination therapy).
Hypersensitivity to ramipril or any other ingredient of the drug or other ACE inhibitors, angioneurotic edema history, including related to previous treatment with ACE inhibitors, hemodynamically significant bilateral renal artery stenosis, stenosis of the artery only kidney condition after kidney transplantation, hemodialysis, renal insufficiency (creatinine clearance less than 30 ml / min.), hemodynamically significant aortic or mitral stenosis (risk of excessive reduction of blood pressure followed by impaired renal function), hypertrophic obstructive cardiomyopathy, primary hyperaldosteronism, pregnancy and lactation, age 18 years (effectiveness and security is not installed). Precautions: severe coronary and cerebral arteries (risk reduction of blood flow in the excessive decrease in blood pressure), unstable angina, severe ventricular arrhythmias, congestive heart failure stage IV, decompensated “pulmonary heart”, renal and / or hepatic impairment , hyperkalemia, hyponatremia (including background diuretics and diet restriction of salt intake), a condition associated with decreased blood volume (including diarrhea, vomiting), systemic connective tissue diseases, including scleroderma, and systemic lupus erythematosus, diseases requiring the appointment of corticosteroids (glucocorticoids) and immunosuppressants (no clinical experience), diabetes, inhibition of bone marrow hematopoiesis, old age.proviron hair loss Hypersensitivity to the drug or other sulfonamides history, gout, diabetes mellitus (severe) chronic renal failure (clearance creatinine less than 20-30 mL / min, anuria), severe hepatic insufficiency, refractory hypokalemia, hypercalcemia, hyponatremia, pregnancy, lactation, age up to 3 years (the solid dosage form). Precautions: hypokalemia, hyponatremia, giperkaltsiemiya, coronary heart disease, liver failure, cirrhosis, asthma history, advanced age.
Pregnancy and lactation
The drug is contraindicated in pregnancy. When pregnancy occurs the drug should be discontinued immediately. If necessary, the appointment during lactation should stop breastfeeding.
Dosing and Administration
Inside. Dose picked individually. The daily dose for adults – 1 tablet per day Amprilana ND.
If any of the functions of mild or moderate renal (creatinine clearance 30 mL / min, serum creatinine of about 3 mg / dL or 265 umol / L.), We recommend the usual dose of the drug. When creatinine clearance less than 30 ml / min is not recommended to use the drug.
The duration of treatment is not limited.
Cardio-vascular system: decrease in blood pressure, orthostatic hypotension, Orthostatic hypotension, tachycardia, rarely – arrhythmias, palpitations, aggravation of Raynaud’s syndrome. Excessive decrease in blood pressure, mainly in patients with coronary heart disease and clinically significant narrowing of the vessels of the brain may develop myocardial ischemia (angina, myocardial infarction) and cerebral ischemia (possibly dynamic cerebrovascular krovoborascheniya or stroke). From the urogenital system: the development or strengthening of the symptoms of kidney failure, proteinuria, oliguria, interstitsialny nephritis, nephrotic syndrome, decrease in urine volume, gynecomastia, reduced potency, libido. On the part of the central nervous system: dizziness, headache, weakness, drowsiness, peripheral neuropathy (paresthesia), nervous irritability, anxiety, tremors, muscle spasms, mood disorders, apathy, when used in high doses – insomnia, anxiety, depression, ataxia, confusion, fainting. From the senses:vestibular disorders, taste disturbances (eg metallic taste) smell, hearing and vision, blepharitis, dry conjunctiva, lacrimation, tinnitus. From the digestive system: nausea, vomiting, diarrhea or constipation, epigastric pain, intestinal obstruction, flatulence, pancreatitis, hepatitis, cholestatic jaundice, cholecystitis (with nalichyan cholelithiasis), abnormal liver function with the development of liver failure, melena, ileus, dry mouth, thirst, loss of appetite, stomatitis, glossitis, inflammation of the salivary glands. The respiratory system: the “dry” cough, bronchospasm, dyspnea, rhinorrhea, rhinitis , sinusitis, pharyngitis, hoarseness, bronchitis, interstitial pneumonia, pulmonary embolism, pulmonary infarction, pulmonary edema. Allergic reactions: skin rash, itching, hives, conjunctivitis, photosensitization, angioneurotic edema of the face, extremities, lips, tongue, pharynx, and / or larynx, exfoliative dermatitis, erythema multiforme exudative (including syndrome
Stevens-Johnson), toxic epidermal necrolysis (Lyell’s syndrome), pemphigus, serositis, onycholysis, vasculitis, myositis, muscular weakness, mialtiya, arthralgia, arthritis, eosinophilia. Other: spasms, alopecia, herpes zoster, hyperthermia, sweating. Laboratory tests : hypercreatininemia, increased BUN, increased activity of “liver” enzymes, hyperbilirubinemia, hyperkalemia, hyponatremia, anemia, decreased hemoglobin concentration and hematocrit, neutropenia, thrombocytopenia, agronulotsitoz, pancytopenia, haemolytic anemia, the appearance of antinuclear antibodies. Effect on the fetus:dysfunction fruit, lower blood pressure (BP) of the fetus and newborn, renal dysfunction, hyperkalemia, hypoplasia of the skull bones, oligohydramnios, limb contractures, skull deformity, hypoplasia of the lungs. proviron hair loss From the water-electrolyte and acid-base balance: possible hypokalemia development and hypochloremic alkalosis (dry mouth, increased thirst, heart rhythm disturbances, mood changes and mental, cramps or muscle aches, nausea, vomiting, weakness; when gipohloremichesky alkalosis may develop hepatic encephalopathy or hepatic coma), hyponatremia (confusion, seizures, lethargy, slowing of thought processes, fatigue, irritability), hypomagnesemia (arrhythmias). From the system hematopoiesis’, agranulocytosis, thrombocytopenia, hemolytic and aplastic anemia, leykotsitopeniya, eosinophilia, neutropenia, pancytopenia. cardio-vascular system: arrhythmia, orthostatic hypotension, tachycardia. digestive system: cholecystitis, pancreatitis, jaundice, diarrhea, sialadenitis, constipation, anorexia, epigastric pain. On the part of metabolism: hypercholesterolemia, hypertriglyceridemia, hyperglycemia, glycosuria, hyperuricemia, giperkalyschemiya, exacerbation of gout.On the part of the central nervous system: depression, sleep disturbances, anxiety, paresthesia, confusion, dizziness. From the senses: xanthopsia, blurred vision. From the urogenital system: impaired renal function, reduced potency, interstitial nephritis. Allergic reactions: skin rash, urticaria, purpura, necrotizing vasculitis, Stevens-Johnson syndrome, respiratory distress syndrome (pneumonia, non-cardiogenic pulmonary edema), toxic epidermal necrolysis, photosensitivity; anaphylactic reactions (up to life-threatening anaphylactic shock). Other, pyrexia, weakness.
An overdose of
Symptoms: marked reduction of blood pressure, bradycardia, shock, disruption of water and electrolyte balance, acute renal failure, stupor, dry mouth, weakness, drowsiness, Treatment: the patient to give a horizontal position with raised legs, in mild cases of overdose – gastric lavage, introduction of adsorbents and sodium sulfate (preferably to take measures during the first 30 minutes after dosing). By reducing blood pressure (BP) – intravenous catecholamines, angiotensin A; bradycardia – the use of pacemakers. The drug is not displayed during hemodialysis. proviron hair loss Symptoms: hypokalemia (weakness, paralysis, constipation, arrhythmia), somnolence, decreased blood pressure. Treatment: infusion of electrolyte solutions; compensation of the deficit of K + (K + prescriptions and potassium-sparing diuretics).
Interactions with other drugs Ramipril
Do dampening effect of ethanol on the central nervous system. Receiving salts with food may reduce the hypotensive effect ramiprila.Pri simultaneous use of ramipril and other means of reducing blood pressure (e.g. diuretics, nitrates, tricyclic antidepressants, agents for general anesthesia) leads to increased antihypertensive effect of ramipril. The simultaneous appointment of ramipril and potassium medications or potassium-sparing diuretics can cause hyperkalemia. Vasopressor sympathomimetics (epinephrine, norepinephrine) may reduce the antihypertensive effect of ramipril, in this regard, while the treatment should be carefully monitored blood pressure. The simultaneous appointment of ramipril and allopurinol, immunosuppressants, corticosteroids, procainamide, cytostatics increases the likelihood of changes in peripheral blood picture (risk of leucopenia).
Co-administration of ramipril and lithium preparations leads to a decrease in lithium excretion, it is necessary to monitor the concentration of lithium in blood serum – the risk of toxic effects.
Inhibitors of ACE are or sulfonylureas), which in some cases can cause hypoglycemia, therefore the blood sugar level must be carefully controlled, particularly at the beginning of a joint application.Simultaneous use of ramipril and nonsteroidal anti-inflammatory drugs (NGGOTS) (e.g., acetylsalicylic acid and indomethacin) It may weaken hypotensive effect of ramipril. In addition, the simultaneous use may cause hyperkalemia and increase the risk of renal dysfunction. The simultaneous use of heparin and ramipril may cause giperkaliemii.Anafilakticheskie and anaphylactoid reactions to the venom of stinging insects (and possibly other allergens) are more pronounced during treatment with ACE inhibitors.
proviron hair loss
With simultaneous use of digitalis glycosides with thiazide diuretics increases the probability of toxic effects of glycosides (including ventricular irritability) due to a possible development of hypokalemia and hypomagnesemia.
Drugs that bind to intensive blood supply (indirect anticoagulants, clofibrate, NSAIDs) increase the diuretic effect of proviron hair loss. The hypotensive effect of proviron hair loss reinforce vasodilators, beta-blockers, barbiturates, phenothiazines, tricyclic antidepressants, ethanol. proviron hair loss increases the neurotoxicity salicylates, reduces the effect of oral hypoglycemic agents, norepinephrine, epinephrine and protivopodagricakih drugs enhances cardiotoxic and neurotoxic effect of lithium preparations, the effect of peripheral muscle relaxants, reduces excretion of quinidine. At the same time taking methyldopa may develop hemolysis.
Cholestyramine reduces absorption of proviron hair loss.
proviron hair loss reduces the effect of oral contraceptives.
At the beginning of treatment it is necessary to assess renal function. It is necessary to carefully monitor renal function during treatment with ramipril, especially in patients with impaired renal function, a renal vascular lesions (eg, clinically insignificant renal artery stenosis or hemodynamically significant stenosis of the artery to a solitary kidney); heart failure.
The risk of hypersensitivity and allergic like (anaphylactoid) reactions is increased in patients receiving both ACE inhibitors and undergoing hemodialysis using dialysis membrane AN69. Similar reactions have been identified in low density lipoprotein apheresis using dextran sulfate therefore use of this method should be avoided in the treatment of ACE inhibitors.
During treatment with ramipril in patients with impaired renal function, especially in the simultaneous treatment with diuretics, may increase blood urea and serum creatinine. In this case, treatment should continue with lower doses of ramipril or cancel product. In patients with impaired renal function and increased risk of hyperkalemia.
In patients with impaired liver function due to the reduction in activity of “liver” enzymes can be slowed metabolism of ramipril and formation of the active metabolite. In this regard, the treatment of such patients should be initiated only under close medical supervision.
Caution should be exercised in the appointment of ramipril in patients who are on malosolevoy or salt-free diet (increased risk of arterial hypotension). In patients with a decreased volume of circulating blood (as a result of diuretic therapy), during dialysis, diarrhea and vomiting may develop symptomatic hypotension.
Transient hypotension is not a contraindication to further treatment after stabilization of blood pressure. should reduce the dose or stop the drug in case of recurrence of severe hypotension. In patients undergoing major surgery or receiving other agents causing hypotension during general anesthesia, ramipril can cause the formation of angiotensin II blockade due to compensatory renin release. If the doctor connects the development of arterial hypotension with the above mechanism, hypotension can be adjusted to increase the volume of blood plasma.
In rare cases during treatment with ACE inhibitors observed agranulocytosis, erythropenia, thrombocytopenia. hemoglobinemia or bone marrow suppression. At
the beginning and during treatment is necessary to control the number of white blood cells to detect possible neutropenia / agranulocytosis. More frequent monitoring is recommended in
patients with renal insufficiency, with connective tissue diseases (eg., Systemic lupus erythematosus or scleroderma), and in patients taking concomitant
medications that affect the blood (see. Interaction with other medicinal products). Blood counts should be performed as in the event of clinical priznakovneytropenii / agranulocytosis and increased bleeding.
In patients with hypertension in the treatment of ramipril rarely marked increase in the level of potassium in the blood serum. The risk of hyperkalemia is increased in patients with chronic heart failure, while the treatment of potassium-sparing diuretics (spironolactone, amiloride, triamterene) and potassium appointment drugs. When using ACE inhibitors during desensitizing treatment for wasp or bee venom may arise anaphylactoid reactions (eg, hypotension, dyspnea, vomiting, skin rash), which can be life-threatening. hypersensitivity reactions may occur with insect bites (eg bee or wasps). When the need for a desensitizing treatment with bee or wasp venom is necessary to cancel ACE inhibitors and continue treatment with suitable drugs from other groups.
proviron hair loss
For the prevention of deficiency of K + and Mg2 + is prescribed a diet with a high content of these salts, potassium-sparing diuretics, salts of K + and Mg2 +. A regular control of the content of potassium in the plasma glucose, uric acid, creatinine and lipids.
The effect on the ability to drive the vehicle and the mechanisms
In the period of treatment must be careful when driving, as well as during activities potentially hazardous activities that require high concentration and psychomotor speed reactions,
The tablets of ramipril 5 mg and 25 mg of proviron hair loss. At 7 or 10 tablets per blister.
Blister on 7 Tablets: 2.4, 8.12, or 14 blisters in a carton box together with instructions for use.
Blister of 10 tablets: 3, 6 or 9 blisters in a carton box together with instructions for use. gen shi labs