Description overdue on 10/18/2014
- Latin name: Hartil-D
- ATC code: C09BA05
- Active substance: Hydrochlorothiazide (Hydrochlorothiazidum), ramipril (Ramiprilum)
- Manufacturer: Egis (Hungary)
- Composition
- Product form
- Pharmacological action
- Pharmacodynamics and pharmacokinetics
- Indications
- Contraindications
- Side effects
- Instructions for use Hart-D (Method and Dosage)
- Overdose
- Cooperation
- Terms of sale
- Storage conditions
- Shelf life
- Reviews
- Price, where to buy
Composition
The active ingredients of the drug - ramipril and hydrochlorothiazide .
Additional components: lactose monohydrate . crospovidone . sodium fumarate . Valium . MCC .
Product form
The drug is sold in tablets.
Pharmacological action
Hart-D is antihypertensive drug which also has diuretic action. Antihypertensive action of active substances medications complements the each other's, at the same time ramipril decreases gipokaliemichesky effect hydrochlorothiazide .
Pharmacodynamics and pharmacokinetics
Active components of the tool are used for high blood pressure.
Ramiprilata (active metabolite of ramipril ) Inhibits ACE . In addition, it reduces the overshoot aldosterone . Ramipril also causes a decrease in peripheral vascular resistance .
In most cases antihypertensive noticeable effect in 1-2 hours. It persists for days. The maximum degree of action achieved after 3-6 hours. When long-term therapy the maximal effect is usually noticeable after about 3 weeks. For long-term course of treatment that is supported for 2 years.
Hydrochlorothiazide represents thiazide diuretic . The possible nature of it antihypertensive action includes changing the balance of sodium and renal vascular resistance and a decrease in the level of extracellular fluid and plasma reactions Angiotensin II and norepinephrine .
The maximum effect is seen after 3-6 hours and lasts up to 12 hours. Antihypertensive effect is achieved after 3-4 days of treatment and continues week after the completion of the course. When decrease in long-term therapy Blood Pressure It is achieved by use of lower doses than needed to diuretic effect. Reduction Blood Pressure accompanied by a slight increase in speed glomerular filtration rate Are active Renin in plasma blood, and also Renal vascular resistance channel . When used hydrochlorothiazide in high dosages decreased plasma volume and speed glomerular filtration rate . mean arterial pressure and renal blood flow. When long-term therapy in small doses, the volume of blood plasma, systemic vascular resistance and Mean arterial pressure remain relatively low, while the speed glomerular filtration rate and minute volume returned to previous levels.
Indications
The medicine should be taken at hypertension as belonging to of combined treatment.
Contraindications
This tool is not recommended to use at:
- cholestasis ;
- angioedema at history And hereditary / idiopathic;
- significant problems with kidney function;
- anurii ;
- primary aldosteronism ;
- hemodialysis ;
- intolerance galactose ;
- hereditary deficiency Lactase or malabsorption glucose-galactose ;
- breastfeeding ;
- pregnancy ;
- childhood;
- significant violations of the liver;
- hypotension ;
- condition after kidney transplantation;
- intolerance to the drug components.
With caution Hart-D appoint at aortic and mitral stenosis , Systemic connective tissue diseases, severe coronary and cerebral arteries, decompensated "pulmonary heart" serious ventricular arrhythmias, inhibition of bone marrow hematopoiesis, bilateral renal artery stenosis . gout . hyponatremia . hypercalcemia . renal failure . cirrhosis , Unstable angina , Chronic Heart Failure (fourth stage), decreasing BCC . diabetes , Old age, hypertrophic obstructive cardiomyopathy . hyperkalemia . artery stenosis of a solitary kidney . hypokalemia . CHD . hepatic insufficiency .
Side effects
While taking the drug at the beginning of treatment and after dose increase may appear expressed hypotension . There may be symptoms such as dizziness , Blurred vision, weakness, fainting. In addition, it is informed about individual cases, of dynamical breaking of cerebral circulation, tachycardia . arrhythmias . myocardial infarction , Palpitations, severe hypertension . angina and shock. During use ACE inhibitors at hypotension possible bleeding in the brain and ischemic stroke .
It is also likely the following adverse reactions:
- Metabolism - hyperglycemia Increase the level of acid, hypokalemia . gout . hyperkalemia . hypomagnesemia . hypercalcemia . hyponatremia . hyperchloremia ;
- nervous system - apathy , Nervousness, headache , Fatigue, feeling of weakness, drowsiness ;
- organs of vision - conjunctivitis . blepharitis ;
- cardiovascular system - a significant reduction Blood Pressure . edema ankles;
- respiratory system - the appearance of dry cough, bronchitis ;
- digestive system - nausea, vomiting, feeling of abdominal pain, dyspepsia , Cramps epigastric . constipation , Blunting appetite, thirst, diarrhea ;
- skin - hives . photosensitization . itch ;
- urinary system - proteinuria ;
- reproductive system - decreased libido.
In rare cases:
- circulatory system and lymph - reduction of hematocrit and Hemoglobin . thrombocytopenia . eosinophilia . leukopenia . pancytopenia . agranulocytosis . hemolytic anemia (in case of shortage glucose-6-phosphate dehydrogenase );
- metabolism and nutrition - the wrong water-electrolyte balance, metabolic alkalosis . chloropenia , Increase content triglycerides in blood serum and savorotocna amylase . hypercholesterolemia , Decompensation Diabetes ;
- nervous system - anxiety, impaired balance, smell, paresthesia ;
- organs of vision - transient myopia;
- hearing - ringing in the ears;
- cardiovascular system - dynamic stroke, fainting, thromboembolic complications . vasculitis . thrombosis , Worsening Raynaud's disease Diseases of veins, embolism ;
- respiratory system - shortness of breath, rhinitis . glossitis , Allergic interstitial pneumonia . sinusitis . pharyngitis . bronchospasm . angioedema , pulmonary edema;
- digestive organs - bowel obstruction, dry mouth, taste disturbance, sialadenitis , Vomiting, inflammation of the mucous membranes, pancreatolysis ;
- liver - an increase in activity bilirubin and liver enzymes, cholestatic jaundice . cholecystitis . hepatitis . necrosis liver;
- integuments - systemic lupus erythematosus . erythema multiforme , Flushing, peripheral edema, increased sweating, Lyell's syndrome , Worsening psoriasis . Stevens-Johnson syndrome . allergic reactions . alopecia . onycholysis ;
- musculoskeletal system and connective tissue - muscle spasm, arthralgia . arthritis . myalgia , Muscle weakness, paralysis ;
- urinary system - the deterioration of kidney function, dehydration, increased residual nitrogen serum creatinine . nephrotic syndrome , Acute renal failure . oliguria . interstitial nephritis ;
- reproductive system - impotence ;
- Other - anaphylactic reaction.
Angioedema in most cases, patients receive blacks. In addition, there is a small group angioedema Face and oropharyngeal area due to the use of ACE inhibitors .
When pronounced side effects of skin should consult with a specialist.
Medical surveillance is indicated for jaundice and magnification activity liver enzymes .
Instructions for use Hart-D (Method and Dosage)
The drug is intended for single use in the morning with plenty of fluids. Instructions for use D Hart reported that eating does not affect its operation. Tablets should not be cut into pieces.
Take this remedy should be only after the doctor will choose the dosage and pattern of use. Usually, to begin a course assigned - 2 5 mg ramipril and 12 mg of 5 hydrochlorothiazide . Maintenance dose is the same or twice, respectively, for each active substance. The dose is increased as necessary with a minimum interval of 3 weeks. The recommended maximum daily dose - 5 mg ramipril and 25 mg hydrochlorothiazide .
For older people, as well as for those who are in violation of the kidneys and liver, the dose of each component are selected individually to go to the combined tool Hart-D. The dose must be minimal.
Overdose
When using the drug in doses in excess of the possible: urinary retention, a significant reduction Blood Pressure , Seizures, arrhythmia , A state of shock, intestinal obstruction, electrolyte imbalance, coma . paresis . bradycardia . renal failure .
Driving therapy begging individually. As general measures may be assigned gastric lavage, sodium sulfate and activated carbon. Also, supportive therapy is applied.
Ramipril It is removed from the of the organism by means dialysis .
With a significant reduction Blood Pressure carried reconstitution fluid volume with saline. If this did not give the desired result may intravenous Angiotensin II . catecholamines . It is important to watch out for BCC . KHS . diuresis , Electrolytes, and level of glucose in the blood. When expressed bradycardia pacemaker installed. With hypokalemia to restore normal potassium levels.
If life-threatening angioedema the following measures:
- subcutaneous administration to 0, 5 mg epinephrine or slow intravenous injection adrenaline controlled ECG and Blood Pressure ;
- introduction antihistamines drugs;
- intravenous or intramuscular injection glucocorticoids ;
- adrenaline can be supplemented C₁-inactivator If the patient has its drawback.
Cooperation
The combination ramipril and diuretics may exacerbate antihypertensive effect. Furthermore, a significant reduction is possible Blood Pressure . So it is desirable to avoid such combination.
Antihypertensive the effect may be enhanced when taking ramipril simultaneously with organic nitrates or vasodilators . Furthermore, it is attenuated by the use of NSAIDs . These agents can also result in combination with ramipril to impaired renal function. In rare cases renal failure . The risk of developing it increases with simultaneous admission to the Hart-D Allopurinol (may appear leukopenia ) And Cyclosporine . Last resort, as well as Lovastatin and Trimethoprim can cause and hyperkalemia . Leukopenia also developed by combining with Hart-D Procainamide . immunosuppressants and cytostatics .
Cooperation ramipril with lithium increases the lithium level in blood serum, it is possible to develop toxic effects. This combination is not recommended, but if it inevitably requires monitoring of the patient. Lithium intoxication can be amplified at the use of thiazide diuretics .
Hypotension amplified by reacting ramipril with some anesthetics . antipsychotic and means tricyclic antidepressants .
It should also monitor the patient in combination with the Hart-D simpatomimetikami . A by reaction with hypoglycemic funds may increase their action until the appearance hypoglycemia . This is especially is possible when the beginning of therapy and at infringements of in the work of of kidneys.
The combination dialysis from ACE inhibitors It is contraindicated, as it may lead to anaphylactoid reactions.
Hydrochlorothiazide interacting with Amphotericin B . GCS , Laxatives, Carbenoxolone or Corticotropin It can lead to electrolyte imbalance. And when combined with calcium salts is likely to occur hypercalcemia With heart glycosides - digitalis intoxication and hypokalemia , from Sotalol - arrhythmia , from salicylates - Strengthening their toxic effects on the CNS.
Absorption hydrochlorothiazide decreases under the influence kolestiraminovyh resins and Colestipol . Therefore, between them is necessary to make the reception period of one to several hours.
This active substance Hart-D also enhances the effect of non-depolarizing muscle relaxants .
Besides that, antihypertensive reduced drug effect in combination with sodium chloride.
Terms of sale
Hart-D is released only by prescription.
Storage conditions
The medicine should be stored at temperatures up to 25 ° C.
Shelf life
Use this tool should be no longer than three years from the date printed on the package.
Reviews of Hart-D
Reviews of Hart-D show the effectiveness of this drug. Its effect is noticeable from the beginning of the course. Some patients, however, require the adjustment of dosages as possible excessive reduction in blood pressure. That's why the given means should be applied only under the control specialist. If you take it according to the doctor's recommendation, it effectively helps with hypertension .
Price, where to buy
The cost of this agent in tablets of 2, 5 mg of ramipril and 12 mg of 5 hydrochlorothiazide - About 300 rubles. Price tablets, in which 5 mg ramipril and 25 mg hydrochlorothiazide - About 400 rubles.
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