Before starting treatment with Pyramus ® is necessary to eliminate hypovolemia and hyponatremia. In patients previously treated with diuretics, you must cancel them or reduce their dose for 2-3 days before you start taking the drug nandrolone phenylpropionate profile ® . In this case, you should carefully monitor the condition of patients with chronic heart failure due to the possibility of their decompensation, with increased blood volume.
After the first dose, as well as by increasing the dose of the diuretic and / or peers drug ® patients should be within 8 h under medical supervision because of the possibility of orthostatic hypotension.
Transient hypotension is not a contraindication to continue treatment with Pyramus ®, since the reduction of the volume of circulating blood and normalization of blood pressure receiving these doses usually does not cause symptomatic hypotension.
In the case of the re-emergence of severe arterial hypotension should reduce the dose or stop the drug. Patients with malignant hypertension or concomitant heart failure, especially in the acute phase of myocardial infarction, should start treatment only in a hospital.
Patients with chronic heart failure receiving Pyramus drug ® may lead to the development of significant decrease in blood pressure, which in some cases accompanied by oliguria or azotemia and rarely development of acute renal failure.
in patients with increased activity of the RAAS, taking the drug for the first time or at high doses should regularly monitor the blood pressure and renal function, especially at the beginning of treatment, since these patients have an increased risk of excessive reduction of blood pressure and renal function impairment as a result of ACE suppression.
caution should be exercised when treating elderly patients as they may be particularly sensitive to ACE inhibitors.
caution should be exercised as during physical exertion and / or hot weather because of the risk of increased sweating and dehydration with the development of arterial hypotension due to reduced circulating blood volume and to reduce the sodium content in the blood.
Before and during treatment with nandrolone phenylpropionate profile® should regularly monitor kidney function (creatinine, urea), the content of potassium in the blood plasma, blood count, hemoglobin, liver function tests.
With the development of cholestatic jaundice or marked increase in the activity of “liver” transaminases should stop taking ACE inhibitors.
Group risk for hyperkalemia consists of patients with renal insufficiency, diabetes mellitus, and also taking potassium-sparing diuretics, potassium supplements or kalisodergaszczye substitutes edible salt and drugs that improve the content of potassium in the blood serum (eg heparin).
in patients with an increased risk of neutropenia (with impaired renal function, systemic connective tissue diseases) in the appointment of the drug Pyramus ® is necessary to monitor blood count 1 time per month during the first 3-6 months of therapy, as well as the first sign of infection. In identifying neutropenia (neutrophil counts less than 2000 / l) treatment with ACE inhibitors should be discontinued.
In rare cases, treatment with ACE inhibitors, including ramipril, marked angioneurotic edema of the face, extremities, lips, tongue, throat, and / or throat. When the swelling that can occur suddenly at any time during treatment, you should immediately stop taking the drug, take emergency medical assistance measures and to ensure close monitoring of the patient until complete and sustained disappearance of symptoms.
Patients treated with ACE inhibitors, there have been cases of intestinal angioedema which is manifested by abdominal pain with nausea and vomiting or without, in some cases, both observed and angioneurotic edema of the face. When a patient during treatment with an ACE inhibitor the above symptoms should be in the differential diagnosis to consider and opportunity to develop their intestinal angioedema.
The use of ACE inhibitors, including ramipril, in patients undergoing surgery with general anesthesia, may lead to the development of hypotension.
It is recommended to stop taking Pyramus drug ® one day before surgery.
You should avoid the use of some high-strength membrane with negatively charged surface (eg, nitron polyacrylic membrane), for example, for urgent hemodialysis or hemofiltration combined with an ACE inhibitor (because of the possibility of anaphylactoid responses in patients). In rare cases, apheresis low-density lipoprotein (LDL) cholesterol with dextran sulfate and simultaneous administration of ACE inhibitors may develop anaphylactoid reactions.
Therefore, this method should not be used in patients receiving ACE inhibitors.
Antihypertensive agents that inhibit the RAAS, are usually not effective in the treatment of patients with primary hyperaldosteronism, therefore the use of ramipril in these cases is not recommended.
As with other ACE inhibitors, is contraindicated concomitant use of nandrolone phenylpropionate profile 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).
The simultaneous use of medicines containing aliskiren, or angiotensin II receptor antagonists, leading to a dual blockade of the RAAS is not recommended due to the risk of excessive reduction of blood pressure, the development of hyperkalemia and worsening renal function compared with monotherapy.
Concomitant use with angiotensin II receptor antagonists in patients with diabetic nephropathy patients is contraindicated (see. “Contraindications”).
Effects on ability to drive vehicles, machinery
Data about the negative effects of the drug Pyramus ® at recommended doses on the ability to drive traffic sredsva or using machinery not. However, because of the likelihood of side effects such as lowering blood pressure and drowsiness, it is recommended to refrain from activities potentially hazardous activities that require high concentration and psychomotor speed reactions, including vehicle control, especially after receiving the initial dose, switching to another nandrolone phenylpropionate profile drug , simultaneous reception of diuretics and alcohol.