Amprilan tabs 5mg #30

Instruction for Amprilan

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Amprilan is a drug with a vasodilating, hypotensive effect.

Release form and composition

Dosage form of release - tablets: flat, oval, chamfered, almost white or white (1.25 / 10 mg each), light yellow (2.5 mg each), pink with visible blotches (5 mg each) color (each 10 pcs. In blisters, in a cardboard box of 3, 6 or 9 blisters; 7 pcs. In blisters, in a cardboard box of 2, 4, 8, 12 or 14 blisters; each box also contains instructions for the use of Amprilan).
Composition of 1 tablet:
    Active ingredient: ramipril - 1.25, 2.5, 5 or 10 mg;
    Additional components (1.25 / 2.5 / 5/10 mg): sodium stearyl fumarate - 1/2 / 1.3 / 2.6 mg, sodium bicarbonate - 1.25 / 2.5 / 5/10 mg, sodium croscarmellose - 2/4 / 2.6 / 5.2 mg, lactose monohydrate - 79.5 / 155/94 / 193.2 mg, pregelatinized starch - 15/30 / 19.5 / 39 mg, mixture of dyes "PB 22886 yellow "(lactose monohydrate, yellow dye iron oxide (E172)) - 0/4/0/0 mg, mixture of dyes" PB 24899 pink "(lactose monohydrate, red dye iron oxide (E172), yellow dye iron oxide (E172) ) - 0/0 / 2.6 / 0 mg.

Pharmacodynamics

Ramipril acts as an active ingredient in Amprilan. Pharmacological activity is manifested by its metabolite - ramiprilat (kininase II, dipeptidylcarboxydipeptidase I), which is metabolized by hepatic enzymes. It is a long-acting angiotensin-converting enzyme (ACE) inhibitor. In blood plasma and tissues, ACE is a catalyst for the biotransformation of angiotensin I into angiotensin II (which has a vasoconstrictor effect) and the breakdown of bradykinin (which has a vasodilating effect). In this regard, oral administration of ramipril reduces the formation of angiotensin II and the accumulation of bradykinin. The result of this pharmacological action is vasodilation and a decrease in blood pressure (BP). At the same time, an increase in the activity of the kallikrein-kinin system, caused by ramipril in blood plasma and tissues, with the subsequent activation of the prostaglandin system, as well as an increase in the synthesis of prostaglandins that stimulate the synthesis of nitric oxide (NO) in endotheliocytes, causes its regulating effect on the heart muscle and heart function in the whole.
Since angiotensin II has a stimulating effect on the production of aldosterone, therapy with ramipril leads to a decrease in the secretion of the latter and an increase in the serum potassium concentration in the blood. With a decrease in the concentration of angiotensin II in the blood plasma, its inhibitory effect on the secretion of renin in the form of negative feedback is eliminated, which leads to an increase in the activity of renin in the blood plasma.
It is assumed that the development of certain negative side reactions (for example, dry cough) is associated with an increase in the activity of bradykinin.
With arterial hypertension, ramipril therapy leads to a decrease in blood pressure both in the supine position and standing, which is not accompanied by a compensatory increase in the heart rate (HR). Amprilan significantly reduces total peripheral vascular resistance (OPSR), almost without affecting renal blood flow and glomerular filtration rate. The antihypertensive effect of Amprilan begins to manifest itself 1-2 hours after oral administration of a single dose, reaches its maximum value in the interval from 3 to 6 hours, and retains its effect for 24 hours. As a result of a course intake, the antihypertensive effect may gradually increase. By 3-4 weeks of regular therapy, the effect usually stabilizes and lasts for an extended period of time. With a sudden discontinuation of Amprilan, there is no rapid and significant increase in blood pressure, since there is no withdrawal syndrome. Ramipril in patients with arterial hypertension delays the development and progression of hypertrophic cardiomyopathy and vascular wall hypertrophy.
In chronic heart failure (CHF), ramipril lowers the systemic vascular resistance, thereby reducing the afterload on the heart, and increases the capacity of the venous bed, reduces the filling pressure of the left ventricle (LV), respectively, reducing the preload on the heart. Patients experience an increase in cardiac output and LVEF (LVEF), and exercise tolerance is improved.
In patients with diabetic / non-diabetic nephropathy, ramipril reduces the rate of progression and postpones the onset of end-stage renal failure. This reduces the need for hemodialysis or kidney transplantation. In the early stages of diabetic / nondiabetic nephropathy, the incidence of albuminuria decreases. Adding Amprilan to the standard therapy of patients with an increased risk of developing cardiovascular pathologies due to vascular lesions [history of obliterating peripheral arterial diseases, stroke, diagnosed coronary heart disease (IHD)] or diabetes mellitus aggravated by such risk factors (at least one of them), such as arterial hypertension, microalbuminuria, smoking, an increase in the level of total cholesterol (TC), a decrease in the content of high-density lipoprotein cholesterol (HDL-C), reduces the incidence of stroke, myocardial infarction and mortality from cardiovascular causes. Also, ramipril reduces the overall mortality rate and the need for revascularization, slows down the onset / progression of CHF.
Among patients with heart failure, the clinical manifestations of which develop in the first days (from the 2nd to the 9th day) of acute myocardial infarction, started within 3-10 days from the moment of heart muscle injury, the use of ramipril by 27% reduces the mortality of patients , by 30% - the risk of sudden death, by 23% - the likelihood of developing heart failure to a severe degree III – IV functional class according to NYHA classification or resistant to therapy, by 26% - the likelihood of subsequent hospitalization due to heart failure.
In diabetes mellitus with arterial hypertension and with normal blood pressure, as well as in the general population of patients, ramipril reduces the risk of developing nephropathy and microalbuminuria.

Pharmacokinetics

Ramipril after oral administration of Amprilan is rapidly absorbed from the gastrointestinal tract (gastrointestinal tract) at a level of 50-60%. Simultaneous intake with food slows down its absorption, but does not affect the amount of substance that has entered the bloodstream. As a result of intensive presystemic biotransformation / activation of ramipril, mainly in the liver by hydrolysis, ramiprilat (an active metabolite; 6 times more active than ramipril in relation to ACE inhibition) and diketopiperazine (a metabolite that does not have pharmacological activity) are formed. Further, diketopiperazine is conjugated with glucuronic acid, and ramiprilat is glucuronid and metabolized to diketopiperazic acid.
The bioavailability of ramipril depends on the dose taken orally and varies from 15% (for 2.5 mg) to 28% (for 5 mg). The bioavailability of ramiprilat after oral administration of 2.5 mg and 5 mg of ramipril is ~ 45% of this indicator obtained after intravenous administration of the same doses.
After taking the drug inside, the maximum plasma concentration of ramipril is reached after 1 hour, ramiprilat - after 2-4 hours. The decrease in the level of ramiprilat in plasma occurs in several stages: the stage of distribution and excretion with T1 / 2 (half-life) ~ 3 hours, an intermediate stage with T1 / 2 ~ 15 hours and the final stage with a very low content of ramiprilat in the blood plasma and T1 / 2 ~ 4-5 days, which is due to the slow release of ramiprilat from a strong bond with ACE receptors. Despite this duration of the final phase, a single dose of 2.5 mg or more of ramipril orally per day allows reaching an equilibrium plasma concentration of ramiprilat after 4 days of taking the drug. With the course of taking Amprilan, effective T1 / 2 depends on the dose and varies from 13 to 17 hours.
With blood plasma proteins, ramipril binds at approximately 73%, ramiprilat - 56%.
After oral administration of ramipril labeled with a radioactive isotope, at a dose of 10 mg, up to 39% of radioactivity is excreted through the intestines, about 60% is excreted by the kidneys. In patients with drainage of the bile ducts, as a result of taking 5 mg of ramipril orally by the kidneys and through the intestines, almost the same amounts of ramipril and its metabolites are secreted during the first 24 hours after administration.
Approximately 80–90% of the ingested substance in urine and bile was identified as ramiprilat and its metabolites. Ramipril glucuronide and diketopiperazine account for ~ 10–20% of the total dose, and unmetabolized ramipril accounts for ~ 2%.
In preclinical studies on animals, it was found that ramipril passes into breast milk.
In patients with impaired renal function with creatinine clearance (CC) less than 60 ml / min, the elimination of ramiprilat and its metabolites slows down. This leads to an increase in their plasma concentration and a slower decrease in comparison with patients with normal renal function.
Taking high doses of ramipril (10 mg) with impaired liver function leads to a decrease in the first-pass metabolism of ramipril and a slower excretion of its active metabolite.
In healthy volunteers and in patients with arterial hypertension as a result of two-week therapy with Amprilan at a dosage of 5 mg per day, no clinically significant cumulation of ramipril and ramiprilat was observed. After a similar two-week course in patients with CHF, there was a 1.5-1.8-fold increase in the level of ramiprilat in the blood plasma and the area under the concentration-time curve (AUC).
Pharmacokinetic characteristics of ramipril and ramiprilat in elderly healthy volunteers aged 65–75 years do not differ significantly from those in young healthy volunteers.

Indications for use

    Chronic heart failure, including arising within 2-9 days after myocardial infarction (simultaneously with other drugs);
    Arterial hypertension;
    Diabetic nephropathy and non-diabetic nephropathy in chronic diffuse kidney disease (clinical / preclinical stages), including chronic glomerulonephritis with severe proteinuria;
    Reducing the likelihood of developing stroke, myocardial infarction and cardiovascular mortality with high cardiovascular risk, including patients with confirmed coronary artery disease (with / without a history of myocardial infarction), patients after undergoing percutaneous transluminal coronary angioplasty, coronary artery bypass grafting, with stroke in anamnesis, occlusive lesions of the peripheral arteries.

Contraindications

Absolute:
    A history of angioedema (idiopathic / hereditary / associated with previous therapy with angiotensin-converting enzyme inhibitors);
    Bilateral renal artery stenosis (hemodynamically significant);
    Primary hyperaldosteronism;
    Hemodialysis;
    Conditions after kidney transplantation;
    Stenosis of an artery of a solitary kidney;
    Aortic / mitral stenosis (hemodynamically significant; there is a possibility of an excessive decrease in blood pressure (BP), followed by impaired renal function);
    Severe arterial hypotension (with blood pressure less than 90 mm Hg);
    Unstable hemodynamics;
    Renal failure (with creatinine clearance <20 ml / min);
    Decompensated chronic heart failure;
    Hypertrophic obstructive cardiomyopathy;
    Combined use with glucocorticosteroids, non-steroidal anti-inflammatory drugs, cytostatics and / or immunomodulators in the treatment of nephropathy;
    Galactose intolerance / glucose-galactose malabsorption syndrome / lactase deficiency;
    Age up to 18 years (the safety profile for this age group of patients has not been studied);
    Pregnancy and lactation period;
    Hypersensitivity to the components of Amprilan or other angiotensin-converting enzyme inhibitors.
Relative (Amprilan is prescribed with caution in the presence of the following diseases / conditions):
    Ventricular rhythm disturbances in severe course;
    Severe lesions of the cerebral / coronary arteries (there is a danger of a decrease in blood flow with an excessive decrease in blood pressure);
    Conditions occurring with a decrease in circulating blood volume (including diarrhea, vomiting);
    Diabetes;
    Hyperkalemia / hyponatremia (including those arising from the use of diuretics and adherence to a diet with limited consumption of table salt);
    Malignant arterial hypertension;
    Systemic connective tissue diseases;
    Unstable angina;
    Mitral / aortic stenosis;
    Chronic heart failure (NYHA functional class IV);
    Oppression of bone marrow hematopoiesis;
    Decompensated cor pulmonale;
    Hepatic / renal impairment;
    Combined desensitizing therapy with allergens (eg, hymenoptera venom);
    Conditions before the apheresis procedure with low density lipoproteins;
    Hemodialysis with high-flow polyacrylonitrile membranes (there is a possibility of anaphylactoid reactions);
    Elderly age.

Instructions for use: method and dosage

Amprilan tablets should be taken orally, without chewing, with a sufficient amount of liquid. Food intake does not affect the effectiveness of the drug.
The course of treatment is long, determined individually by a specialist. Also, the doctor selects the dose of Amprilan, it depends on the effectiveness of therapy and the tolerability of the drug.
The recommended scheme for taking Amprilan tablets:
    Arterial hypertension: initial dose - 2.5 mg in 1 dose. With a break of 7-14 days, the dose may be doubled. The average maintenance daily dose is 2.5-5 mg, the maximum is 10 mg. With the previous intake of diuretics, it is necessary to cancel them or reduce the dose not less than 3 days before the appointment of Amprilan;
    Chronic heart failure: initial dose - 1.25 mg in 1 dose. With a break of 7-14 days, the dose may be doubled. The average maximum dose is 10 mg per day. With the previous intake of large doses of diuretics, it is necessary to reduce their dose before the appointment of Amprilan;
    Heart failure that has arisen within 2-9 days after acute myocardial infarction: the initial dose is 5 mg in 2 divided doses (one 2.5 mg tablet should be taken in the morning, the second in the evening). With poor tolerance of Amprilan (excessive decrease in blood pressure), a single dose should be reduced by 2 times while maintaining the frequency of taking the drug. Subsequently, depending on the patient's reaction, the dose can be increased again to the previous level with a break of 1-3 days. Later, the daily dose can be taken in 1 dose. The maximum dose is 10 mg per day. If the daily dose of 5 mg is poorly tolerated, therapy should be canceled;
    Diabetic nephropathy and nephropathy in chronic diffuse kidney disease: initial dose - 1.25 mg in 1 dose. The dose can be gradually increased to 5 mg per day (it is recommended to double it every 14 days);
    Reducing the risk of stroke, myocardial infarction and cardiovascular mortality: the initial dose is 2.5 mg in 1 dose. The dose of Amprilan should be gradually increased to 10 mg (it is recommended to double it after 7 days, then after another 14-21 days).
Recommendations for taking the drug by individual groups of patients:
    Patients with functional disorders of the liver: initial daily dose - 1.25 mg in 1 dose, maximum - 2.5 mg in 1 dose;
    Patients with functional impairment of the kidneys (with creatinine clearance less than 30 ml / min): initial daily dose - 1.25 mg, maximum - 5 mg;
    Elderly patients (over 65 years old) taking diuretics: the dose is selected individually based on the blood pressure level with careful monitoring of the condition.

Side effects

Possible adverse reactions during the period of taking Amprilan (> 1/10 - very often;> 1 / 100- <1/10 - often;> 1 / 1000- <1/100 - infrequently;> 1/10 000- <1/1000 - rarely; <1/10 000, taking into account single messages - very rarely):
    Respiratory system: often - unproductive dry cough, aggravated by lying down and at night (in most cases observed in women and nonsmoking patients), bronchitis, sinusitis, shortness of breath; rarely - pharyngitis, nasal congestion, bronchospasm (including deterioration in bronchial asthma);
    Nervous system: often - headache, weakness; rarely - depression, dizziness, increased fatigue, anxiety, nervousness, imbalance, tremor, confusion, sleep disorders, motor restlessness; very rarely - paresthesias, parosmia, ischemic stroke, transient ischemic attacks, impaired concentration, cerebral ischemia;
    Cardiovascular system: often - a pronounced decrease in blood pressure (usually at the beginning of the course, with the appointment of a diuretic or increasing the dose), syncope, orthostatic hypotension; rarely - a feeling of palpitations, peripheral edema, arrhythmia, angina pectoris; very rarely - myocardial infarction / ischemia, Raynaud's syndrome, increased circulatory disorders with stenosing vascular lesions, vasculitis, flushing of the face, tachycardia;
    Urogenital system: rarely - decreased libido, transient impotence, an increase in the amount of excreted urine, functional renal impairment up to acute renal failure, an increase in the concentration of creatinine / urea, an increase in pre-existing proteinuria; very rarely - gynecomastia;
    Musculoskeletal system: often - muscle cramps, myalgia; rarely - arthralgia;
    Digestive system: often - inflammation of the mucous membrane of the gastrointestinal tract, a feeling of discomfort in the abdomen, indigestion, nausea, diarrhea, dyspepsia, vomiting; rarely - an increase in the concentration of bilirubin / activity of liver enzymes, acute liver failure, cholestatic jaundice, hepatocellular lesions, cholestatic hepatitis, abdominal pain, dryness of the oral mucosa, constipation, gastritis, pancreatitis (including in extremely rare cases with fatal outcome), intestinal angioedema, anorexia, decreased appetite; very rarely - aphthous stomatitis, glossitis;
    Skin: often - maculopapular skin rash; rarely - an increase in sweating (with a decrease in blood pressure), itching; very rarely - pemphigus, maculopapular erythema and exanthema, erythema multiforme, toxic epidermal necrolysis, Stevens-Johnson syndrome, alopecia, psoriasiform, lichenoid and pemphigoid lesions of the mucous membranes / skin, worsening of the course of psoriasis; very rarely - photosensitivity, urticaria, exfoliative dermatitis, onycholysis;
    Sense organs: rarely - conjunctivitis, visual disturbances (including blurred vision), hearing impairment, taste / smell disorders (including metallic taste, temporary / partial loss of taste);
    Laboratory indicators: rarely - hyperkalemia, neutropenia / hypoglobinemia, thrombocytopenia and erythropenia with a moderate (in some cases severe) course, increased activity of pancreatic enzymes; very rarely - hyponatremia, proteinuria (although, as a rule, angiotensin-converting enzyme inhibitors reduce the previous proteinuria) or an increase in urine output (in combination with worsening heart function), hemolytic anemia, bone marrow depression, pancytopenia, agranulocytosis;
    Allergic reactions: very rarely - angioneurotic syndrome involving the mucous membrane of the eyes, lips, tongue, pharynx and larynx, anaphylactoid / anaphylactic reactions (insect poisons), increased concentration of antinuclear bodies;
    Others: rarely - hyperthermia; very rarely - fever.

Overdose

Symptoms of Amprilan overdose are: bradycardia, marked decrease in blood pressure, shock, acute renal failure, imbalance in water and electrolyte balance, stupor.
For the treatment of mild cases of overdose, it is recommended to wash the stomach, then give the patient adsorbents and sodium picosulfate (preferably no later than half an hour after taking Amprilan inside). In the case of a pronounced decrease in blood pressure, catecholamines, α1-adrenergic agonists (dopamine, norepinephrine) and angiotensin II antagonists (angiotensinamide) are administered intravenously. The patient should be placed on his back, on a surface with a low headboard. If necessary, the BCC can be replenished by infusion of 0.9% sodium chloride solution. For the treatment of bradycardia, a temporary artificial pacemaker may be required. Careful monitoring of blood pressure, renal function and serum potassium is required.
The effectiveness of hemodialysis with an overdose of ramipril has not been established.

Special instructions

Before the appointment of Amprilan, it is necessary to assess the functional state of the kidneys. Monitoring of renal function should be carefully carried out after kidney transplantation, in case of impaired renal function, heart failure, stenosis of an artery of a single kidney, or bilateral stenosis of the renal arteries.
In some cases, when using Amprilan, it is possible to develop cholestatic jaundice, with the progression of which fulminant necrosis of the liver occurs, sometimes with a fatal outcome. If there is a significant increase in the activity of hepatic transaminases or jaundice, the drug should be canceled.
Symptomatic arterial hypotension against the background of uncomplicated arterial hypertension after taking the first dose of Amprilan rarely develops. The likelihood of arterial hypotension increases with the following diseases / conditions:
    Chronic heart failure in severe course (recommended starting dose - 1.25 mg);
    Combined use with diuretics (the recommended initial dose is 1.25 mg; if possible, the dose of the diuretic should be reduced or canceled in advance);
    A high risk of developing hypovolemia associated with insufficient fluid intake, diarrhea, vomiting or excessive sweating in conditions of insufficient compensation for the loss of fluid and salt (before starting therapy, it is recommended to adjust the volume of circulating blood, in cases where these conditions become clinically significant, Amprilan may be taken started / continued under medical supervision at a minimum dose of 1.25 mg).
When left ventricular outflow tract obstruction and mitral / aortic stenosis are present, therapy should be administered with caution.
With normal renal function, in cases where other complications are absent, neutropenia develops rarely and is transient (disappears after Amprilan is discontinued).
Against the background of connective tissue diseases and combined use with procainamide, allopurinol, immunosuppressive therapy, especially with existing impaired renal function, Amprilan should be used with great caution (due to the risk of severe infections that are not amenable to intensive antibiotic therapy). Periodic monitoring of leukocytes in the blood is recommended. If you experience any symptoms of infectious diseases (in the form of a sore throat, fever), you should immediately consult a specialist.
During the period of therapy, hyperkalemia may develop. The main risk factors include: advanced age, renal failure, diabetes mellitus, some concomitant conditions (decreased blood volume, metabolic acidosis, decompensated acute heart failure), combined use with potassium-sparing diuretics (eplerenone, spironolactone, amiloride, triamterene), potassium preparations or potassium-containing substitutes for table salt, other drugs that increase the plasma potassium content (for example, heparin). Hyperkalemia can lead to significant irregularities in heart rhythm, in some cases fatal.
The combined use of Amprilan with potassium-sparing diuretics, as well as potassium preparations and potassium-containing substitutes for table salt is not recommended.
Taking the drug should be interrupted 12 hours before the start of the surgical operation, warning the anesthesiologist about taking Amprilan (general anesthesia can lead to a pronounced decrease in blood pressure, especially when using drugs with hypotensive action).
In the event of a dry cough, you need to remember that it may be associated with the ongoing therapy (it passes after the abolition of Amprilan).
In patients with a tendency to develop allergic reactions against the background of the desensitization procedure, Amprilan is prescribed with caution (the development of prolonged, life-threatening anaphylactoid reactions is possible; in order to avoid their occurrence, at least a day before the desensitization procedure, Amprilan should be canceled). Also, in order to prevent anaphylactoid reaction, the drug is canceled before each apheresis procedure with low-density lipoproteins using high-flow membranes.
Anaphylactoid reactions were observed during hemodialysis with high-flow membranes during therapy with Amprilan. In this regard, it is recommended to use a different type of membrane or the use of an antihypertensive drug of another pharmacotherapeutic group.

Influence on the ability to drive vehicles and complex mechanisms

Due to the likelihood of developing such disorders as confusion, drowsiness, dizziness, patients during the period of taking Amprilan should be careful when performing potentially hazardous types of work that require quick psychomotor reactions and high concentration.

Application during pregnancy and lactation

Amprilan is contraindicated for use during pregnancy. Ramipril can have a teratogenic effect on the fetus (hyperkalemia, impaired renal function, hypoplasia of the bones of the skull, hypoplasia of the lungs, etc.). Before starting the use of Amprilan in women of childbearing age, it is required to exclude pregnancy. If pregnancy is diagnosed during therapy, the drug should be discontinued as soon as possible.
If treatment with Amprilan is necessary during lactation, breastfeeding should be discontinued.

Pediatric use

In pediatric practice, Amprilan is contraindicated for the treatment of children and adolescents under 18 years of age.

With impaired renal function

    Contraindicated: severe renal dysfunction (CC <20 ml / min), hemodynamically significant renal artery stenosis (bilateral or unilateral in the case of a single kidney), the period after kidney transplantation;
    Use with caution: moderate renal dysfunction (CC 20-50 ml / min). It is recommended to start treatment with a daily dose of 1.25 mg, the maximum dose should not exceed 5 mg / day.

For violations of liver function

Amprilan is taken with caution in liver failure, since the response of blood pressure to ramipril can be enhanced by reducing the rate of excretion of ramipril or weakened by reducing the metabolic rate of inactive ramipril to active ramipril. At the beginning of therapy, careful medical monitoring is carried out. The maximum dose should not exceed 2.5 mg / day.

Use in the elderly

Elderly patients are advised to take Amprilan with caution. Treatment should be started with a daily dose of 1.25 mg.

Drug interactions

With the combined use of Amprilan with certain drugs / substances, the following effects may develop:
    Vasopressor sympathomimetics (norepinephrine, epinephrine): a decrease in the antihypertensive effect (with combined use, blood pressure must be carefully monitored);
    Lithium preparations: development of a reversible increase in serum lithium concentration;
    Ethanol: increased inhibitory effect on the central nervous system;
    Non-steroidal anti-inflammatory drugs (non-selective COX inhibitors, for example, acetylsalicylic acid in anti-inflammatory doses): a decrease in the hypotensive effect of Amprilan, an increase in the likelihood of functional renal impairment, an increase in serum potassium in case of already existing renal dysfunction;
    Thiazide diuretics: an increase in the concentration of lithium and the likelihood of its toxic effects;
    Antipsychotics (neuroleptics), tricyclic antidepressants: increased antihypertensive action and increased risk of orthostatic hypotension (additive effect);
    Immunosuppressants, cytostatic agents, procainamide, allopurinol, glucocorticosteroids (with systemic use): increased likelihood of leukopenia;
    Glucocorticosteroids, tetracosactide: decrease in antihypertensive action (due to fluid retention);
    Potassium preparations, potassium-sparing diuretics, potassium-containing substitutes for table salt: development of interaction (the combination is not recommended; regular monitoring of plasma potassium and ECG parameters is required);
    Some of the drugs used in general anesthesia are: increased antihypertensive action;
    Oral hypoglycemic agents, insulin (in diabetes mellitus): increased hypoglycemic effect, increased glucose tolerance (correction of their doses may be required);
    Gold preparation (intravenous administration of sodium aurothiomalate): the development of nitrate-like reactions (in the form of nausea, vomiting, hyperemia of the skin of the face, a pronounced decrease in blood pressure).

Terms and conditions of storage

Store in a dry place out of reach of children at temperatures up to 25 ° C.
Shelf life of tablets:
    1.25 mg - 2 years;
    2.5 / 5/10 mg - 3 years.

Reviews

According to reviews, Amprilan is an effective fast-acting drug for normalizing blood pressure. Some patients consider it to be one of the best antihypertensive drugs to be taken regularly.
Warn that with prolonged use, it can cause a dry cough. Other side effects are rarely mentioned. The cost is called relatively low.

Terms of sell

You can buy Amprilan without a prescription.