N Hart

Description overdue on 10/27/2014

• Latin name: Hartil-H
• ATC code: C09BA05
• Active substance: Ramipril (Ramiprilum), hydrochlorothiazide (Hydrochlorothiazidum)
• Manufacturer: Egis (Hungary)

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• Composition
• Product form
• Pharmacological action
• Pharmacodynamics and pharmacokinetics
• Indications
• Contraindications
• Side effects
• Instructions for use Hart H (method and dosage)
• Overdose
• Cooperation
• Terms of sale
• Storage conditions
• Shelf life
• Reviews
• Price, where to buy

Composition

Active substances Charter H - ramipril   and hydrochlorothiazide .

As additional components are provided: lactose monohydrate, crospovidone, sodium fumarate, hypromellose, MCC.

Product form

The medicine is available in tablets.

Pharmacological action

The drug belongs to ACE inhibitors   and diuretics .

Pharmacodynamics and pharmacokinetics

Hart H characterized diuretic   and antihypertensive effect .

Ramipril   inhibits ACE catalyzes the biotransformation of angiotensin I to angiotensin II .   as well as active splitting at azodilatatora bradykinin . This causes vasodilation and reducing emissions aldosterone . Stimulation actions bradykinin   It activates the cardioprotective effects and protects the endothelium.

In addition, the use of H Hart provokes a marked reduction peripheral arterial resistance .

BP reduced without compensatory increased heart rate. Action ramipril markedly after 60-120 minutes after a single application. The maximal effect of the drug is achieved in about 4-5 hours. The antihypertensive effect of the drug lasts less than a day. When long-term therapy the maximum effect ramipril   noticeable after 2-4 weeks and lasts for two years. Completion of the course taking the medicine does not cause a rapid increase in blood pressure.

Hydrochlorothiazide   It is a thiazide diuretic. Reception of the active substance in high doses results in excretion of sodium and prolonged course reduces the excretion of calcium.

The antihypertensive effect is accompanied by changes in sodium balance, renal vascular resistance, reduction of extracellular fluid and plasma, as well as reactions to Angiotensin II   and norepinephrine .

The excretion of electrolytes and water begins at about 120 minutes after oral application, the maximum effect - after about 4-5 hours. It lasts up to 12 hours. The antihypertensive effect hydrochlorothiazide   noticeable 3-4 days after initiation of therapy and lasts about a week after its completion.

In the long course of blood pressure reduction seen with lower doses than is necessary for the diuretic effect. It is accompanied by some acceleration glomerular filtration rate As well as increased activity Renin   in plasma and renal vascular resistance channel.

Ramipril   characterized by a rapid absorption from the digestive tract. Its maximum plasma concentration is reached in an hour. This active substance is biotransformed principally in the liver to form metabolites . For example,   ramiprilata . It is about 6-fold more potent ramipril . Its maximum plasma concentration is reached after about 3 hours. Among known metabolites that are less active, are formed diketopiperazine ether   and diketopiperazine acid .

Ramipril   Associated with the blood of 77%, and ramiprilat   - By 56%. On average, the equilibrium concentration of the drug at the rate achieved in the blood plasma on the fourth day.

About 60% ramipril   excreted in the urine mainly as metabolites . The rest of the amount - with the feces.

After oral use 70% hydrochlorothiazide   absorbed in the duodenum and upper intestine empty. Maximum plasma concentration is reached after at least 1, 5 hours. The degree of association with the plasma protein - 40%.

This active substance excreted mainly via the kidneys as a result canalicular excretion. Half-life - 5-15 hours. Therapeutic effect of doses normally noticeable after 120 minutes after the application of the maximum - about 3 hours.

Indications

Hart used in H hypertension .

Contraindications

Do not take this tool at:

• hypersensitivity to its components, as well as other ACE inhibitors   and thiazide diuretics ;
• hereditary / idiopathic angioedema ;
• serious disturbances in the kidneys;
• anurii ;
• Applications of extracorporeal therapy, in which the blood contact with negatively charged surfaces;
• angioedema   due to ACE inhibitors   at history ;
• renal artery stenosis ;
• severe violations of the liver;
• cholestasis ;
• hepatic encephalopathy ;
• clinically significant electrolyte imbalance.

Side effects

Upon receipt of Hart H may receive the following adverse reactions:

• nervous system and sense organs - dizziness . asthenia . headache ;
• SSA and the circulatory system - hypotension . syncope . myocardial infarction , Pain in the chest, angina . heart failure . vertigo ;
• urinary system - renal dysfunction, oliguria . proteinuria . swelling ;
• Gastrointestinal - nausea, diarrhea Vomiting;
• respiratory system - infections of the upper respiratory tract, cough;
• allergy - hives . erythema multiforme . angioedema , skin rash, photosensitization ;
• Other - increasing levels of nitrogen urea   and creatinine Weight reduction, arthralgia . myalgia . hyperkalemia Level change   bilirubin   and glucose, anaphylactoid   reaction arthritis . fever , Changes in enzyme activity and concentration of uric acid.

In rare cases it is possible: changes in the level transaminases . hemolytic anemia . arrhythmia . pancytopenia . eosinophilia . vasculitis , Palpitations, mielodeprescia . thrombocytopenia . agranulocytosis , Dry mouth, dyspepsia . constipation . gastroenteritis . hepatitis . dysphagia , abdominal pain, pancreatitis . cerebrovascular   violations depression , Abnormal liver function,   drowsiness . neuralgia . paresthesia , Hearing loss, amnesia , Seizures, sleep disorders . neuropathy . tremor , Blurred vision, dyspnea . sinusitis . tracheobronchitis . bronchospasm . pharyngitis . rhinitis . laryngitis .

Instructions for use Hart H (method and dosage)

The tablets are administered orally. As a general rule, appoint one tablet once a day (preferably in the morning). Instructions for use H Hart recommends swallow the tablets whole, without chewing, while drinking the right amount of liquid. Eating does not affect the action of the drug.

The dosage for each patient must choose a doctor. The starting dose may be increased, if necessary, every three weeks. Typically, during the early course designate two 5 mg ramipril   and 12 mg of 5 hydrochlorothiazide . This is the usual maintenance dose. Some patients also appoint 5 mg ramipril and 25 mg hydrochlorothiazide . This maximum daily dosage, it should not be exceeded. Only in some cases, after consultation with the physician can be increased to 10 and 50 mg ramipril   and hydrochlorothiazide respectively.

For the elderly and those with impaired renal function has to be considered by the dosage should be as low as possible.

Overdose

Known symptoms of overdose: urinary retention, excessive peripheral vasodilatation . arrhythmia , Confusion, shock, bradycardia . renal failure . coma . paresis Reinforced diuresis Expressed hypotension . tachycardia , Seizures, electrolyte imbalance, paralytic ileus . seizures . When hyperplasia   prostate hydrochlorothiazide   at doses higher than normal, can cause urinary retention.

As the therapy is conducted in the first 30 minutes of such common activities as taking sodium sulfate and adsorbents , Gastric lavage. Furthermore, prescribed application 0 9% sodium chloride, Angiotensin II . catecholamines . artificial pacemaker .

If angioedema subcutaneously administered 0, 3-0, 5 ml epinephrine or slow intravenous adrenaline . Then it is shown intravenous glucocorticoids . Also recommended for use antihistamines   medicines and H2 receptor antagonists .

Cooperation

Antihypertensive . Opioid analgesics . Estrogens . diuretics And preparations for anesthesia   increase the hypotensive effect of H. Hart

Nonsteroidal anti-inflammatory medications and kitchen salt reduces its effectiveness. If necessary, such a combination with the drug the patient H Hart to control.

Cyclosporine Milk, additives and drugs with potassium potassium-sparing diuretics As well as salt substitutes may result in the interaction with the drug to hyperkalemia .

Drugs that trigger bone marrow suppression, increase the likelihood of neutropenia   and agranulocytosis end .

Combination with drugs, which include lithium, results in an increase in their concentration in the blood.

In addition, Hart H may increase hypoglycemic   action insulin   and derivatives sulfonylureas As well as a depressing effect   ethanol   and toxic effects salicylates   CNS.

Interaction with Allopurinol . immunosuppressants . cytostatics   and Procainamide   increases the likelihood of leukopenia .

Terms of sale

The drug is sold only by prescription.

Storage conditions

Keep the tool should be out of the reach of small children. The optimum temperature is not higher than 25 ° C.

Shelf life

Store this medication should be no longer than three years from the date of manufacture indicated on the package. It does not use it after this time.

Reviews

The opinion of patients about this vehicle, usually positive. However, there are also comments about his lack of efficacy or occurrence of side effects. In this case you should immediately consult your doctor for a dose adjustment or purpose other treatment.

Generally, if the drug used in accordance with the assigned specialist, negative results do not occur. In any deterioration during therapy Hart H should consult with your doctor.

Price, where to buy

This tool is sold in Ukrainian pharmacies. The average price of pellets, which contain 5 and 25 mg of ramipril and hydrochlorothiazide, respectively - 130 hryvnia. The average cost of tablets 2, 5 and 12, 5 mg ramipril and hydrochlorothiazide, respectively - 95 hryvnia.

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