Hartil tablets 5mg, No. 28

arterial hypertension;

chronic heart failure;

chronic heart failure after acute myocardial infarction in patients with stable hemodynamics;

diabetic nephropathy and chronic diffuse kidney disease (nondiabetic nephropathy);

reducing the risk of developing myocardial infarction, stroke or 'coronary death' in patients with coronary artery disease, including patients after myocardial infarction, percutaneous transluminal coronary angioplasty, coronary artery bypass grafting.

Inside, without chewing, drinking plenty of liquid (about 1 glass), regardless of the time of the meal.

The dosage should be set for each patient individually, taking into account the therapeutic effect and tolerability. The tablets can be split in half, breaking at risk.

Arterial hypertension. The recommended initial dose is 2.5 mg once a day (1 tablet daily. HartilЃ 2.5 mg). Depending on the therapeutic effect, the dose can be increased by doubling the daily dose every 2-3 weeks. The usual maintenance dose is 2.5Ц5 mg per day (1 tablet HartilЃ 2.5 mg or 1 tablet 5 mg). The maximum daily dose should not exceed 10 mg.

CHF. The recommended initial dose is 1.25 mg once a day (1/2 table. HartilЃ 2.5 mg daily). Depending on the therapeutic effect, the dose can be increased by doubling the daily dose every 2-3 weeks. If you need to take more than 2.5 mg of the drug, this dose can be taken immediately or divided into 2 doses. The maximum daily dose should not exceed 10 mg.

Treatment after myocardial infarction. It is recommended to start taking the drug on the 3-10th day after acute myocardial infarction. The recommended initial dose, depending on the patient's condition and the time elapsed after acute myocardial infarction, is 2.5 mg 2 times a day (1 tab. HartilaЃ 2.5 mg 2 times a day). Depending on the therapeutic effect, the initial dose can be doubled to 5 mg (2 tablets HartilaЃ 2.5 mg or 1 tablet HartilaЃ 5 mg) 2 times a day. The maximum daily dose should not exceed 10 mg. If the drug is intolerant, the dose should be reduced.

Non-diabetic or diabetic nephropathy. The recommended initial dose is 1.25 mg 1 time per day (1/2 tab. HartilЃ 2.5 mg daily). Depending on the therapeutic effect, the dose can be increased by doubling the daily dose every 2-3 weeks. If you need to take more than 2.5 mg of the drug, this dose can be taken immediately or divided into two doses. The recommended maximum daily dose is 5 mg.

Prevention of myocardial infarction, stroke or death from cardiovascular disorders. The recommended starting dose is 2.5 mg once a day. Depending on the tolerability of the drug, after 1 week of administration, the dose should be doubled compared to the initial one. This dose should be doubled again after 3 weeks of administration. The recommended maintenance dose is 10 mg once a day.

Special patient groups

Elderly patients. The use of ramipril in elderly patients taking diuretics and / or with heart failure, as well as impaired liver or kidney function, requires special attention. The dosage should be set by individual selection of doses depending on the response to the drug.

Patients with renal insufficiency. With moderate renal impairment (Cl creatinine from 20 to 50 ml / min per 1.73 m2 of body surface area), the initial dose is usually 1.25 mg 1 time per day (1/2 tab.HartilЃ 2.5 mg per day). The maximum daily dose should not exceed 5 mg.

If creatinine clearance is not measured, it can be calculated from the serum creatinine level using the Cockroft equation:

For men: creatinine clearance, ml / min = (body weight, kg Ј (140? Age) / 72 Ј serum creatinine, mg / dl).

For women: multiply the result of the above equation by 0.85.

Liver dysfunction. With impaired liver function, a reduced or increased effect on taking the drug HartilЃ can equally often be observed, therefore, in the early stages of treatment, patients with impaired liver function need careful medical supervision. The maximum daily dose in such cases should not exceed 2.5 mg.

In patients receiving diuretic therapy, due to the risk of a significant decrease in blood pressure, the possibility of temporary withdrawal or at least a decrease in the dose of diuretics should be considered, at least 2-3 days (or longer, depending on the duration of the action of diuretics) before starting the drug HartilЃ. For patients who have previously received diuretics, the usual starting dose is 1.25 mg.

hypersensitivity to ramipril or any other component of the drug;

history of angioedema, incl. and associated with prior therapy with ACE inhibitors;

hemodynamically significant bilateral renal artery stenosis or stenosis of an artery of a single kidney;

arterial hypotension or unstable hemodynamics;

pregnancy;

lactation period;

primary hyperaldosteronism;

renal failure (Cl creatinine <20 ml / min).

With care: hemodynamically significant aortic or mitral stenosis (risk of excessive decrease in blood pressure followed by impaired renal function); severe primary malignant arterial hypertension; severe damage to the coronary and cerebral arteries (risk of decreased blood flow with an excessive decrease in blood pressure); unstable angina pectoris, severe ventricular arrhythmias, end-stage CHF, decompensated cor pulmonale; diseases requiring the appointment of corticosteroids and immunosuppressants (lack of clinical experience), incl. systemic connective tissue diseases; severe renal and / or hepatic impairment; hyperkalemia, hyponatremia (including against the background of diuretics and diet with restriction of Na + intake); initial or severe manifestations of fluid and electrolyte deficiency; conditions accompanied by a decrease in BCC (incl.diarrhea, vomiting); diabetes; oppression of bone marrow hematopoiesis; condition after kidney transplant; elderly age; age up to 18 years (efficacy and safety have not been established).