Contraindicated in combination
Application of some high-strength membrane with negatively charged surface (eg, polyacryl-nitrile membrane) during hemodialysis or hemofiltration, the use of dextran sulfate in low-density lipoprotein apheresis may entail the risk of severe anaphylactic reactions; if durabolin the patient is necessary to carry out these procedures, it is necessary to use other types of membranes (in the case of plasmapheresis, and hemofiltration) or transfer of the patient to treatment with other antihypertensive agents.
As in the case with other ACE inhibitors are contraindicated combined use of ramipril with aliskiren and aliskirensoderzhaschimi drugs in patients with diabetes mellitus or moderate to severe renal insufficiency (creatinine clearance less than 60 mL / min / 1.73 m²).
Concomitant use with other ACE inhibitors increases the risk of renal failure (including acute renal failure), hyperkalemia.
The simultaneous use of the drug and the antagonists angiotensin II receptor antagonists in patients with diabetic nephropathy is contraindicated and not recommended in other patients. Combinations that should be used with caution Concomitant use with potassium salts, potassium-sparing diuretics (eg, amiloride, triamterene, spironolactone), as well as drugs, contributes to the potassium content serum(including trimethoprim, tacrolimus, cyclosporine, receptor antagonists of angiotensin II) may lead to an increase of potassium in blood serum (requires regular monitoring of potassium in blood serum).Antihypertensive agents (alfuzosin, doxazosin, prazosin, tamsulosin, terazosin), baclofen , diuretics, nitrates, tricyclic antidepressants, antipsychotics, hypnotics, narcotic analgesics, for general and local anesthesia increase the antihypertensive effect of ramipril. vasopressor sympathomimetics and other drugs that cause antihypertensive durabolin effect (eg isoproterenol, dobutamine, dopamine, epinephrine) reduce the antihypertensive effect of ramipril , this requires regular monitoring of blood pressure. Concomitant use with allopurinol, procainamide, cytostatics, immunosuppressants, corticosteroids (corticosteroids and mineralokortikosteroidami) and other agents that may affect the hematologic indices, increases the risk of leukopenia.
The simultaneous use of ramipril with corticosteroids is not recommended. salts lithium lead to increased concentration of lithium in blood serum and increased cardio and neurotoxic effects of lithium. Ramipril hypoglycemic effect enhances hypoglycemic agents (insulin, hypoglycemic agents for oral use (sulfonylurea derivatives)) until the development of hypoglycemia. . Necessary to monitor the concentration of glucose vildagliptin leads to increased incidence of angioedema.Simultaneous use of ramipril mTOR (mammalian Target of Rapamycin – rapamycin target in mammalian cells), for example, with temsirolimus, may lead to increased incidence of angioedema. Combinations to be take into account the non-steroidal anti-inflammatory drugs (NSAIDs) (eg, acetylsalicylic acid (more than 3 g / day), cyclooxygenase-2 (COX- 2 )) may reduce the antihypertensive effect of ramipril and cause renal failure, sometimes leading to the development of renal failure . Heparin may increase serum potassium. Sodium chloride may weaken the effect of ramipril. Do not use ethanol during treatment with ramipril (enhanced inhibitory effect of ethanol on the central nervous system (CNS)). Estrogens weaken durabolin antihypertensive effect (fluid retention). desensitizing therapy hypersensitivity to insect poisons.ACE inhibitors including ramipril, increase the likelihood of severe anaphylactic or anaphylactoid reactions to insect venoms.