Hartil

Hartil is a drug that belongs to the group of ACE inhibitors. active active substance of the drug is ramipril.

The main substance of the drug has an effect on the ACE, which circulates in the blood and is found in the tissues. This agent inhibits the action of ACE, resulting in an antihypertensive effect without compensatory enhancement Heart rate, angiotensin II and aldosterone levels decrease, and plasma renin activity increases.

The action of the drug begins 60-120 minutes after oral administration. The maximum concentration is observed after 4-5 hours and remains within 24 hours. Thus, with a regular intake, a high concentration of the active substance is maintained constantly. In patients with heart failure and liver function problems, the content of ramipril in the blood is higher.

Clinical and pharmacological group

ACE inhibitor.

Terms of sale from pharmacies

Can buyby prescription.

Price

How much does Hartil cost in pharmacies? The average price is at the level of510 rubles.

Composition and form of release

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This product is available in the form of tablets intended for oral use. Each blister contains 7 tablets.

The drug as an active ingredient contains ramipril.

Additional components: sodium stearyl fumarate, pregelatinized starch 1500, iron oxide yellow, sodium bicarbonate, lactose monohydrate sodium croscarmellose. In addition, 5 mg tablets have iron oxide red in their composition.

Pharmacological effect

Ramipril is a representative of ACE inhibitors (angiotensin-converting effect). Due to the suppression of ACE, it exhibits an antihypertensive effect. The drug acts on the ACE of not only blood but also tissues, as well as the vascular wall.

Hartil reduces pressure in the capillaries of the lungs, improves cardiac output, dilates blood vessels and helps reduce blood pressure. The hypotensive effect occurs an hour or two after the preparation, but most fully effect is observed after three to six hours and lasts a whole day. The use of Hartil by the course allows obtaining a stable normalization of pressure after three to four weeks of application.

With chronic nephropathy, the drug eliminates the progression of renal impairment and helps to avoid kidney failure.

In the case of preventive reception in patients with heart disease, vessels with diabetes mellitus, smokers patients, ramipril effectively reduces the risk of stroke, myocardial infarction, cardiovascular disorders. By slowing the progression of heart failure, this drug reduces the number of deaths in this group of patients. In patients with infarction, the drug narrows the necrosis zone and prevents the development of repeated myocardial infarctions.

When taking over six months, Hartil effectively copes even with the state of pulmonary hypertension, characteristic patients with various defects of the structure of the heart (whether they are innate or acquired).

Indications for use

According to the instructions to Hartil, the drug should be taken as a medicine in the following types of diseases:

with arterial hypertension;
with chronic heart failure;
with heart failure, which occurred after acute myocardial infarction in patients with stable hemodynamics;
with nephropathy of the diabetic type, chronic diffuse kidney diseases.

Medical reviews of Hartil recommend the drug as a means to reduce the risk of developing myocardial infarction, coronary death, or stroke in patients with IHD, including those suffering aortocoronary bypass, myocardial infarction, percutaneous transluminal coronary angioplasty.

Contraindications

The drug has a number of contraindications to use, so before starting taking Hartil tablets, you should carefully read the attached instructions. Tablets can not be taken orally in the presence of one or more of the following conditions:

severe violations of liver function;
age to 18 years (this is due to the lack of experience in the use of the drug and the unproven safety of Hartil);
arterial hypotension;
pregnancy and the period of breastfeeding;
angioedema in a history of medications;
severe renal failure;
individual intolerance of the drug components.

Relative contraindications are (the drug can be taken only under the supervision of a doctor and in the least effective dosage):

disturbance of water-electrolyte balance in the blood;
a decrease in the volume of circulating blood;
oppression of bone marrow hematopoiesis;
mitral stenosis or aortic stenosis;
arterial hypertension caused by malignant neoplasms on vessels or kidneys;
unstable angina;
diabetes;
terminal stage of chronic heart failure;
disturbances of the heart rhythm by ventricular type;
patients older than 65 years.

Intended use for pregnancy and lactation

Acceptance of Hartil at different periods of pregnancy is contraindicated. In the course of experimental studies it was found that the active substance of the drug penetrates through the placental barrier and is capable of causing deformation of the skull, anomalies in the development of the brain, oppression of the bone marrow.

The use of the drug in the period of breastfeeding is contraindicated, since Hartil can be excreted in breast milk and enters in the body of the child, causing him to dysfunction of the respiratory system, a sharp drop in blood pressure. If you need therapy with a lactating mother, stop lactation.

Dosage and route of administration

As indicated in the instructions for use of the tablet, Hartil should be taken orally, swallowing whole, without chewing, with a large amount of liquid (about 1 cup). Tablets can be taken regardless of the time of ingestion. Tablets can be divided in half, breaking down the risk.

The dose is set individually, taking into account the therapeutic effect and tolerability.

With arterial hypertension, the recommended initial dose is 2.5 mg 1 time / day. Depending on the therapeutic effect, the dose can be increased by doubling the daily dose every 2-3 weeks. The standard maintenance dose is 2.5-5 mg / day. The maximum daily dose is 10 mg.
For treatment after myocardial infarction, it is recommended to start taking the drug 3-10 days after an acute myocardial infarction. The recommended initial dose, depending on the condition of the patient and the time elapsed after acute myocardial infarction, is 2.5 mg 2 times / day. Depending on the therapeutic effect, the initial dose can be doubled to 5 mg 2 times / day. The maximum daily dose is 10 mg. When intolerance of the drug should reduce the dose.
In chronic heart failure, the recommended initial dose is 1.25 mg 1 time / day. Depending on the therapeutic effect, the dose can be increased by doubling the daily dose every 2-3 weeks. If you need to use the drug in a dose of more than 2.5 mg, this dose can be taken immediately or divided into 2 divided doses. The maximum daily dose is 10 mg.
Prevention of myocardial infarction, stroke or death from cardiovascular disorders: the recommended initial dose is 2.5 mg 1 time / day. Depending on the tolerability of the drug, after 1 week of taking the dose should be increased by half compared with the initial dose. This dose should be doubled again after 3 weeks of admission. The recommended maintenance dose is 10 mg 1 time / day.
With nondiabetic or diabetic nephropathy, the recommended initial dose is 1.25 mg 1 time / day daily. Depending on the therapeutic effect, the dose can be increased by doubling the daily dose every 2-3 weeks. If you need more than 2.5 mg of the drug, this dose can be taken immediately or divided into 2 divided doses. The recommended maximum daily dose is 5 mg.

In elderly patients taking diuretics, and / or with heart failure, as well as for violations of the function liver or kidney dose should be set by individual selection, depending on the patient's response to treatment.

Patients with renal failure require a correction of the dosing regimen. With a moderate impairment of kidney function (QC from 20 to 50 ml / min based on 1.73 m2 of the body surface), the initial dose is usually 1.25 mg 1 time / day. The maximum daily dose is 5 mg.

If the SC is not measured, it can be calculated from the serum creatinine level using the Cockcroft formula.

For women: the result of the calculation should be multiplied by 0.85.

In case of violations of the liver function, a reduced or increased effect of Hartil, therefore at the early stages of treatment of this category of patients careful medical supervision is required. The maximum daily dose in such cases is 2.5 mg.

In patients receiving diuretic therapy, because of the risk of a significant reduction in blood pressure, consideration should be given to the possibility of temporary cancellation or at least reduce the dose of diuretics in at least 2-3 days (or longer, depending on the duration of the action of diuretics) before the start of Hartil. For patients who previously received diuretics, usually the initial dose is 1.25 mg.

Adverse Reactions

Adverse reactions with the use of this drug can be as follows:

allergies - rash, hives, photosensitivity, itching, conjunctivitis;
respiratory system - "dry" cough, shortness of breath, rhinitis, bronchitis, bronchospasm, rhinorrhea, sinusitis;
genitourinary system - the severity of symptoms of proteinuria, a decrease in the volume of urine, kidney failure;
sensory organs - impaired sense of smell, sight and other sensory organs, tinnitus, vestibular disturbances;
hematopoiesis - anemia, thrombocytopenia, neutropenia, pancytopenia, a decrease in the number of erythrocytes, leukocytopenia, decrease in the concentration of hemoglobin and hematocrit, agranulocytosis, hemolytic anemia, bone marrow suppression;
laboratory indicators - hypercreatininaemia, hyperkalemia, increased activity of "hepatic" transaminases, hyperbilirubinemia, increased urea nitrogen levels, hyponatremia;
SSS - orthostatic hypotension, lowering blood pressure, tachycardia. With excessive decrease in blood pressure, cerebral ischemia and myocardial ischemia may occur;
CNS - drowsiness, headache, weakness, nervous excitability, anxiety, muscle spasm, paresthesia, dizziness, tremor, changes in mood;
digestive system - nausea, diarrhea, pain in the epigastric region, thirst, stomatitis, pancreatitis, vomiting, constipation, dry mouth, blunting appetite, hypersensitivity or inflammation of the mucous membrane of the cheeks;
other - convulsions, hyperthermia, alopecia, increased sweating.

In rare cases, it is also possible: arrhythmia, impaired blood supply to organs due to narrowing of blood vessels, hepatitis, liver problems with the appearance of hepatic insufficiency, cholestatic jaundice, Quincke's edema, arthralgia, multiform exudative erythema, pemphigus, onycholysis, myositis, eosinophilia, exfoliative dermatitis, Lyell's syndrome, serositis, vasculitis, myalgia, arthritis, an increase in the antinuclear factor titer.

Overdose

Overdose Hartil is extremely dangerous for humans.

Lowering the pressure can cause a slowdown in the rhythm of the heart, a shock state, the patient has a water-salt imbalance, the kidneys begin to work poorly.

When these symptoms are manifested, the patient is laid with raised legs and injected with drugs that raise blood pressure.

special instructions

Before you start using the drug, read the special instructions:

During treatment with Hartil, regular medical supervision is necessary.
In case of excessive decrease in blood pressure, the patient should be laid, raise his legs; it may also be necessary to administer fluid and other measures.
Experience with ramipril in children with severe renal insufficiency (CC <20 ml / min / 1.73 m2 body surface) and during dialysis - is limited.
Impaired renal function can be identified by elevated levels of urea and serum creatinine, especially if the patient takes diuretics.
After taking the first dose, as well as increasing the dose of the diuretic and / or Hartil, patients should stay for 8 hours under observation of a physician in order to avoid the development of an uncontrolled hypotensive reaction; a multiple measurement of blood pressure is recommended.
If possible, adjust the dehydration, hypovolemia, reduce the number of red blood cells before starting the drug. If these disorders are severe, taking ramipril should not begin or continue until measures are taken to prevent excessive fall in blood pressure and impaired renal function.
Due to a decrease in the synthesis of angiotensin II and the secretion of aldosterone in the serum, a decrease in the sodium level and an increase in the level of potassium are possible. Hyperkalemia is more common in patients with impaired renal function (eg, with diabetic nephropathy) or with simultaneous admission with potassium-sparing diuretics.
Changes in blood are more likely in patients with impaired renal function and concomitant connective tissue disease (eg, SLE and scleroderma), as well as in the case of using other means that affect the hematopoietic and immune systems.
The serum sodium level should also be monitored regularly in patients taking diuretics concomitantly with Hartil. It should also regularly check the number of white blood cells to avoid the development of leukopenia. Control should be more frequent at the beginning of therapy and in patients belonging to any risk group.
There are reports of life-threatening anaphylactoid reactions, sometimes turning into shock, in hemodialysis patients using membranes with high hydraulic permeability (for example, from polyacrylonitrile) with simultaneous administration of ACE inhibitors. Anaphylactoid reactions were also observed in patients subjected to LDL apheresis with absorption of dextran sulfate.
When desensitizing therapy is conducted to reduce the allergic reaction to insect bites (eg, bees and wasps) during the intake of inhibitors ACE can occur a severe, life-threatening anaphylactoid reaction (a fall in blood pressure, a violation of breathing, vomiting, skin reactions). Therefore, ACE inhibitors should not be given to patients receiving desensitizing therapy.
Careful observation is required for patients with renal vascular disease (eg, clinically insignificant stenosis of the renal artery or hemodynamically significant stenosis of the artery the only kidney), renal dysfunction, with a marked decrease in blood pressure, mainly in patients with heart failure, and also after kidney transplantation.
When lactase deficiency, galactosemia, or glucose / lactose absorption disorder should be considered, each tablet The drug Hartil contains the following amounts of lactose: tablets of 5 mg - 96.47 mg, tablets of 10 mg - 193.2 mg.

At the beginning of treatment, a decrease in blood pressure can affect the ability to concentrate. In this case, patients are advised to refrain from driving vehicles and practicing potentially dangerous Activities that require increased concentration and speed of psychomotor reactions. In the future, the degree of restriction is determined for each patient individually.

Compatibility with other drugs

When using the drug, it is necessary to take into account the interaction with other drugs:

Ramipril can enhance the action of ethanol.
NSAIDs and sodium salts reduce the effectiveness of ACE inhibitors.
It is not recommended simultaneous administration with ramipril of potassium salts and potassium-sparing diuretics, heparin because of the risk of developing hyperkalemia.
When used simultaneously with other antihypertensive drugs (including diuretics) or other drugs that have an antihypertensive effect (for example, nitrates, tricyclic antidepressants and anesthetics), it is possible to increase the antihypertensive effect.
With simultaneous use with lithium preparations, an increase in the concentration of lithium in serum is observed, which leads to an increased risk of cardio- and nephrotoxicity.
With simultaneous application of Hartil with allopurinol, corticosteroids, procainamide, cytostatics and other substances that cause blood changes, increases the risk of violations from the hematopoiesis system.
With simultaneous application of Hartil with hypoglycemic drugs (insulin or sulfonylurea derivatives), an excessive decrease in blood glucose levels is possible. This phenomenon may be due to the fact that ACE inhibitors can increase the sensitivity of tissues to insulin.

Reviews

We offer to read reviews of people who used Hartil:

Svetlana. My mom is retired, suffering from hypertension. Constantly drinks tablets from pressure. Now she began taking 5 mg of Hartil. This drug perfectly normalizes the pressure. Did not notice any side events. Has been drinking for more than three years, we do not increase the dose. The drug, however, bitter, but nothing. And although the drug is expensive for us, but it is very effective.
Natalia. A terrible drug! Took it 4 months, appointed a paid cardiologist, developed a very strong dry cough, swelling on his legs, shortness of breath, why he was appointed at all, if from him only suffering. The little fool drank it until she read the side effects, realized that it was from him. Now the doctor prescribed another drug for blood
Zinaida. I recently suddenly began to feel badly myself - it became hard for me to walk on the steps, I do not tolerate weather changes, my head is spinning and it hurts. The doctor diagnosed me - hypertension. I began to drink Hartil, and I am still satisfied with it. The price is also acceptable from him. So he helped me out. And to put experiments and check other drugs I will not even

Analogues

Structural analogs for the active substance:

Amprilan;
Vazolong;
Dilaprel;
Korpril;
Pyrimil;
Ramepress;
Ramigamma;
Ramicardium;
Ramipril;
Tritace;
Hartil D.

Before buying an analogue, consult your doctor.

Shelf life and storage conditions

Tablets are stored at a temperature of less than 25 ° C (must be hidden from children). Shelf life of 1.25 mg is 1.5 years, tablets with a higher dosage (2.5 mg - 10 mg) - two years.