Amprylan tablets instructions for use
Amprilan is an antihypertensive agent belonging to the group of angiotensin converting enzyme (ACE) inhibitors. It has a vasodilating effect, lowers blood pressure. The drug is effective in the treatment of chronic heart failure. After myocardial infarction, the use of Amprilan reduces the risk of sudden death, prevents the development of chronic heart failure. Reduces the likelihood of nephropathy.
Release form and composition
The main active component of the drug Amprilan - ramipril.
Contained in the tablets auxiliary components: croscarmellose sodium; pregelatinized starch; sodium fumarate; sodium bicarbonate, lactose monohydrate, dyes.
Available dosages: 1.25 mg, 2.5 mg, 5 mg and 10 mg ramipril in one tablet.
Amprylan is produced in tablets (7 or 10 tablets in a blister) of oval shape with a flat surface and a facet. The color of the tablets differs depending on the dosage of the drug: white or almost white (1.25 mg and 10 mg each), light yellow (2.5 mg each), pink with patches (5 mg each),
Pharmacodynamics. Amprylan - a long-acting ACE inhibitor. Angiotensin-converting enzyme accelerates the conversion of angiotensin II from angiotensin I, which is identical to the kinase, an enzyme that accelerates the breakdown of bradykinin. As a result of the blockade of ACP Amprilan, the concentration of angiotensin II decreases, the activity of renin in the blood plasma increases, the effect of bradykinin and the production of aldosterone increase, which leads to an increase in the content of potassium in the blood.
Amprilan has an antihypertensive and hemodynamic effect due to the expansion of blood vessels and a decrease in their total peripheral resistance. In this case, the heart rate does not change. A decrease in pressure after a single dose of Amprilan is noted in 1–2 hours, in 3–6 hours the therapeutic effect reaches its maximum and lasts for 24 hours.
With long-term drug treatment, left ventricular hypertrophy is reduced, with no negative effects on the heart function.
Pharmacokinetics. The active substance is rapidly absorbed from the digestive tract (speed does not depend on food intake). An hour after application, the maximum concentration of the active substance in the blood is reached. With plasma proteins binds up to 73% ramipril.
The drug is broken down in the liver, forming the active metabolite ramiprilat (the activity of the latter is 6 times greater than the activity of ramipril itself) and the inactive compound diketopiperazine. The maximum concentration of ramiprilat in the blood is detected 2–4 hours after the use of the agent, a steady and constant therapeutic concentration - on the 4th day of treatment. About 56% of ramiprilat binds to plasma proteins.
Up to 60% of ramipril and ramiprilat are excreted by the kidneys in the form of metabolites, less than 2% of ramipril is removed from the body unchanged. The half-life of ramiprilat is from 13 to 17 hours, ramipril - 5 hours.
If kidney function is impaired, the rate of excretion of ramipril and metabolites decreases. In patients with hepatic impairment, the process of converting ramipril to ramiprilat has been delayed, and the content of ramipril in the blood serum is increased.
Indications for use
In accordance with the instructions indications for use Amprilan are:
- chronic heart failure;
- in complex maintenance treatment after myocardial infarction;
- arterial hypertension;
- diabetic nephropathy;
- nephropathy due to chronic diffuse kidney disease;
- acute violation of arterial peripheral circulation (arterial occlusion);
- prevention of stroke, heart attack and reduction of mortality from cardiovascular pathologies;
- after coronary bypass surgery.
According to the instructions, the drug is contraindicated in the following pathologies and conditions:
- transferred angioedema (idiopathic, resulting from the use of ACE inhibitors, hereditary);
- renal failure;
- previous kidney transplantation;
- mitral or aortic stenosis;
- bilateral renal artery stenosis or stenosis of one renal artery in the presence of only one kidney;
- cardiomyopathy (inflammation of the muscle tissue of the heart);
- heart defects;
- low pressure;
- hyperaldosteronism (excessive aldosterone synthesis);
- age under 18;
- pregnancy and lactation.
Dosing and Administration
Tablets are taken orally, regardless of the meal, do not chew, drink a sufficient amount of liquid.
The dosage of the drug is chosen by the doctor individually for each patient, taking into account the indications, the tolerability of the drug, associated diseases and the age of the patient. When selecting the dose, blood pressure is always taken into account. The maximum allowable dosage of the drug for all types of pathologies is 10 mg per day. The course of treatment is usually long, also set by the doctor.
For hypertension, the initial recommended dosage is 2.5 mg once a day. If necessary, the dose in 7-14 days can be doubled.
In chronic heart failure, the initial recommended dose of the drug is 1.25 mg (can be doubled in 1-2 weeks).
For heart failure that occurs 2–9 days after acute myocardial infarction, it is recommended to take 5 mg of Amprilan per day - 2, 5 mg in the morning and evening. If during treatment, the pressure is greatly reduced, the dosage is halved (1.25 mg twice a day). After 3 days, the dose is increased again. If taking the drug at a dose of 2.5 mg twice a day is again poorly tolerated by the patient, treatment with Amprilan should be canceled.
Nephropathy (with diffuse pathologies of the kidneys and diabetic). The recommended starting dose is 1.25 mg per day. Every 14 days, the dosage is doubled to a maintenance dose of 5 mg per day.
Prevention of heart failure after myocardial infarction. At the initial stage of the therapeutic course, Amprlan 2.5 mg per tablet per day is prescribed. After a week, the dosage is increased to 5 mg per day, and after 2–3 weeks to a maintenance dose of 10 mg once a day.
In case of arterial occlusion and after coronary artery bypass surgery, Amprilan is taken 2.5 mg once a day for 7 days. Then, for 2-3 weeks, the drug is taken in 5 mg per day, after its dosage is doubled to 10 mg per day.
The drug is well tolerated. But there is the likelihood of side effects from various body systems.
Since the cardiovascular system:
- pronounced lowering of blood pressure, especially in the initial stages of treatment, with complex use with diuretics or with increasing doses (often);
- development of arrhythmias, angina pectoris, peripheral edema (rarely);
- circulatory disorders, tachycardia , vasculitis , increased circulatory disorders, ischemia and myocardial infarction (extremely rare).
From the nervous system:
- weakness and headache (often);
- nervousness and fatigue, depression, confusion and impairment of consciousness, dizziness, anxiety, sleep disorder (rare);
- reduced ability to concentrate, impaired perception of odors, cerebral ischemia, ischemic stroke (extremely rare).
From the excretory system:
- functional disorders of the kidneys, renal failure, increased proteinuria, increased urea (rare);
- gynecomastia (very rare).
On the part of the respiratory tract:
- dry cough, worse at night and lying down, sinusitis, bronchitis (often);
- pharyngitis , bronchospasm, exacerbation of bronchial asthma (rarely).
From the skin:
- skin rash (often);
- pruritus, increased sweating (rarely);
- erythema, exacerbation of psoriasis, alopecia, urticaria , dermatitis, photosensitivity (extremely rare).
From the digestive system:
- inflammation of the mucous membrane of the digestive tract, discomfort in the area of epigastria, indigestion, nausea, vomiting, diarrhea (often);
- increased bilirubin concentration and liver enzyme activity, cholestatic jaundice and hepatitis, liver failure, gastritis , pancreatitis , dryness of the oral mucosa (rarely);
- glossitis, stomatitis, anorexia, angioedema (extremely rare).
From the musculoskeletal system:
- myalgia and muscle cramps (often);
- arthralgia (rare).
With an overdose of the drug is noted:
- marked lowering of blood pressure;
- bradycardia (slow heart rate);
- acute renal failure;
- violation of water and electrolyte metabolism;
In case of overdose in mild cases, gastric lavage, the introduction of sodium sulfate (for 30 minutes after applying a high dose of amprlan), the use of sorbents. With a pronounced decrease in pressure, the introduction of catecholamines, angiotensin II, alpha-1-adrenomimetics intravenously is required.
- For patients with functional disorders of the kidneys, the initial dose of Amprilan should be 1.25 mg, and the maximum daily dosage should be 5 mg.
- For patients with hepatic insufficiency, the initial dose is 1.25 mg, the maximum daily dose is 2.5 mg.
- If Amprilan is prescribed to patients taking diuretics, it is necessary to cancel or reduce the dosage of diuretic drugs. Also requires constant monitoring of the status of these patients, especially elderly patients (over 65 years).
- Amprilan is taken with caution in patients with systemic diseases of the connective tissue, diabetes, unstable angina.
- The drug has a negative effect on the fetus (hypoplasia of the lungs and skull bones, hyperkalemia, impaired kidney function) and is contraindicated in pregnant women. Before discharge Amprilana women of childbearing age, it is important to exclude pregnancy.
- When taking Amprilan during lactation, breast feeding should be canceled.
Terms and conditions of storage
The drug should be stored at a temperature not exceeding 25 ° C, protected from moisture and sunlight, inaccessible to children place. The shelf life of Amprilan tablets is 3 years. After the date indicated on the package, the drug can not be taken.
Structural analogues of Amprilan (drugs with the same active substance) are:
Price for Amprylan
Amprylan tablets 1.25 mg, 30 pcs. - from 165 rubles.
Amprylan 2.5 mg tablets, 30 pcs. - from 217 rubles.
Amprylan tablets 5 mg, 30 pcs. - from 283 rubles.
Amprylan tablets 10 mg, 30 pcs. - from 345 rubles.