Ravel SR tablets: instructions for use, price and reviews

Pharmacodynamics and pharmacokinetics

Pharmacodynamics

It has an unexpressed saluretic (removal of salts) and diuretic effect. Suppresses the absorption of sodium in the renal tubules, this leads to the excretion of chlorine and sodium in the urine and increased diuresis . Slightly increases the excretion of potassium and magnesium. Reduces the tone of the muscles of the arteries, reduces peripheral vascular resistance and generally has a vasodilating effect. The antihypertensive effect occurs in doses that do not cause a pronounced diuretic effect. blood pressure reduction in high doses. After taking the tablet, the maximum effect is observed after 24 hours. Reduces left ventricular hypertrophy.

Pharmacokinetics

Rapidly absorbed into the gastrointestinal tract . There is a slowdown in absorption after eating. The maximum concentration in plasma is determined after 12 hours. 79% protein bound. The half-life is 14-24 hours. After repeated administration, no accumulation is observed. Metabolized in the liver. 70% is excreted by the kidneys and 20% in feces. In renal failure, the pharmacokinetics remain virtually unchanged.

Rawel® sr

Combinations not recommended

When used simultaneously with lithium preparations, it is possible to increase the concentration of lithium ions in the blood plasma due to a decrease in its excretion from the body, accompanied by the appearance of signs of overdose (nephrotoxic effect), as well as when following a salt-free diet (reduced excretion of lithium ions by the kidneys).

Combinations requiring special attention

Simultaneous use with any of the drugs that can cause heart rhythm disturbances of the “pirouette” type, incl. class IA antiarrhythmics (quinidine, hydroquinidine, disopyramide), class III antiarrhythmics (amiodarone, dofetilide, ibutilide, bretylium tosylate), sotalol, some antipsychotics: phenothiazines (chlorpromazine, cyamemazine, levomepromazine, thioridazine, trifluoperazine), benzamides (amisulpride, sulpiride , sultopride, tiapride), butyrophenones (droperidol, haloperidol), as well as bepridil, cisapride, difemanil, erythromycin (iv), halofantrine, mizolastine, pentamidine, sparfloxacin, moxifloxacin, vincamine (iv), astemizole, especially against the background hypokalemia increases the risk of ventricular arrhythmias. Before starting combination therapy with Ravel® SR and the above drugs, the potassium content in the blood plasma should be monitored and, if necessary, adjusted. It is recommended to monitor the patient’s clinical condition, as well as the content of plasma electrolytes and ECG. In patients with hypokalemia, it is necessary to use drugs that do not provoke the development of arrhythmias.

With the simultaneous administration of NSAIDs (with systemic use), including selective COX-2 inhibitors, high doses of salicylic acid (3 g/day or more), the antihypertensive effect of indapamide may be reduced and acute renal failure may develop in dehydrated patients (due to a decrease in glomerular filtration rate). At the beginning of indapamide therapy, it is necessary to restore water and electrolyte balance and monitor renal function.

ACE inhibitors in patients with hyponatremia (especially in patients with renal artery stenosis) increase the risk of developing arterial hypotension and/or acute renal failure. Patients with hypertension and possibly hyponatremia due to diuretics should:

- stop taking the drug 3 days before starting therapy with ACE inhibitors and switch to therapy with potassium-sparing diuretics;

- or start therapy with ACE inhibitors with low doses, followed by a gradual increase in dose if necessary. During the first week of therapy with ACE inhibitors, it is recommended to monitor plasma creatinine concentrations.

When taking drugs that can cause hypokalemia with indapamide, incl. amphotericin B (iv), gluco- and mineralocorticoids (when administered systemically), tetracosactide, laxatives that stimulate intestinal motility, the risk of developing hypokalemia increases (additive effect). If necessary, the content of potassium ions in the blood plasma should be monitored and adjusted.

Simultaneous therapy with baclofen enhances the antihypertensive effect of indapamide.

Hypokalemia caused by indapamide increases the toxic effect of cardiac glycosides (glycoside intoxication). With the simultaneous use of indapamide and cardiac glycosides, the content of potassium ions in the blood plasma, ECG parameters should be monitored, and, if necessary, therapy should be adjusted.

Combinations of drugs requiring attention

Concomitant use with potassium-sparing diuretics (amiloride, spironolactone, triamterene) is advisable in some patients, but the possibility of developing hypokalemia cannot be excluded. Hyperkalemia may develop against the background of diabetes mellitus or renal failure. It is necessary to monitor the content of potassium ions in the blood plasma, ECG indicators, and, if necessary, adjust therapy.

Metformin increases the risk of developing lactic acidosis, because It is possible to develop renal failure while taking diuretics, especially loop diuretics. Metformin should not be taken if the plasma creatinine concentration is more than 15 mg/l (135 µmol/l) in men and 12 mg/l (110 µmol/l) in women.

The simultaneous use of large doses of iodine-containing contrast agents against the background of hypovolemia and diuretics increases the risk of developing acute renal failure. It is recommended to restore the water and electrolyte balance of the blood before using the drugs.

Tricyclic antidepressants (imipramine-like) and antipsychotics increase the hypotensive effect and the risk of developing orthostatic hypotension (additive effect).

Preparations containing calcium salts increase the risk of developing hypercalcemia due to decreased excretion of calcium ions by the kidneys.

Cyclosporine and tacrolimus increase the risk of increasing plasma creatinine concentrations without changing the concentration of circulating cyclosporine.

GCS, tetracosactide (when used systemically) reduce the hypotensive effect of indapamide (retention of sodium ions and fluid).

Contraindications

simultaneous administration of drugs that prolong the QT interval ;
increased sensitivity;
severe renal failure ;
persons under 18 years of age;
hypokalemia;
hepatic encephalopathy.

Use with caution for diabetes mellitus , impaired renal and liver function, hyperparathyroidism , hyperuricemia , and increased QT .

Side effects of the drug Ravel SR

Hypokalemia may develop. In clinical studies, hypokalemia after 4–6 weeks of treatment with indapamide was observed in 10% of patients (plasma potassium level ≤3.4 mmol/L) and 4% of patients (plasma potassium level ≤3.2 mmol/L). After 12 weeks, the average decrease in plasma potassium concentration was 0.23 mmol/L. Hyponatremia with hypovolemia is possible, which can lead to dehydration and orthostatic hypotension; Due to the concomitant loss of chloride, compensatory metabolic alkalosis may develop. The development of hyperuricemia and hyperglycemia is possible, so the drug should be prescribed with caution to patients with diabetes mellitus or gout. Hypercalcemia, thrombocytopenia, leukopenia, agranulocytosis, bone marrow aplasia and hemolytic anemia are observed in isolated cases. Patients with liver failure may develop hepatic encephalopathy. Allergic reactions (maculopapular rash, purpura) occur mainly in patients with a tendency to hypersensitivity reactions. Possible exacerbation of systemic lupus erythematosus. Dizziness, headache, paresthesia, increased fatigue, constipation and dry mouth, nausea are rarely noted. In rare cases, pancreatitis may develop.

Side effects

orthostatic hypotension , palpitations, arrhythmia ;
headache , nervousness, dizziness ;
constipation ( diarrhea ), nausea, dyspepsia , abdominal pain;
nocturia , urinary tract infections, polyuria ;
itching, urticaria , rash, hemorrhagic vasculitis ;
cough, sinusitis , pharyngitis ;
hypercalcemia , hypochloremia , hyperuricemia , hyperglycemia , hyponatremia .

Overdose

An overdose is manifested by nausea, vomiting, convulsions , decreased blood pressure , dizziness , lethargy, polyuria , turning into anuria . Blood tests show hyponatremia and hypokalemia . sorbents are taken . specific antidote . In the hospital, water and electrolyte metabolism is restored.

Interaction

When taken with lithium drugs, its concentration increases and symptoms of overdose appear. The likelihood of cardiac dysfunction occurs when taken with astemizole , erythromycin , bepridine , pentamidine , halofantrine , terfenadine , sultopride , quinidine , disopyramide , hydroquinidine , bretylium , amiodarone , sotalol . The following factors contribute to this: hypokalemia , prolongation of the QT interval and bradycardia . The risk of renal failure appears with the simultaneous administration of non-steroidal drugs and high doses of salicylates .

of hypokalemia increases significantly when taken with amphotericin B , cardiac glycosides , glucocorticosteroids , and laxatives. Neuroleptics , baclofen , tricyclic antidepressants , ACE inhibitors cause increased hypotensive effect and orthostatic hypotension . Dehydration of the body is observed when used with contrast agents containing iodine. Taking calcium salts leads to an increase in its concentration in the blood. Use with other diuretics causes the development of hypokalemia .

Ravel SR, 1.5 mg, extended-release film-coated tablets, 20 pcs.

Combinations not recommended

When used simultaneously with lithium preparations

it is possible to increase the concentration of lithium ions in the blood plasma due to a decrease in its excretion from the body by the kidneys, accompanied by the appearance of signs of overdose (nephrotoxic effect), as well as when following a salt-free diet (decreased excretion of lithium ions by the kidneys).

Combinations requiring special attention

1. Drugs that can cause heart rhythm disturbances of the “pirouette” type: class IA antiarrhythmics (quinidine, hydroquinidine, disopyramide), class III antiarrhythmics (amiodarone, dofetilide, ibutilide, bretylium tosylate), sotalol, some neuroleptics: phenothiazines (chlorpromazine , cyamemazine, levomepromazine, thioridazine, trifluoperazine), benzamides (amisulpride, sulpiride, sultopride, tiapride), butyrophenones (droperidol, haloperidol), others (bepridil, cisapride, difemanil, erythromycin (iv), halofantrine, mizolastine, pentamidine, sparfloxacin , moxifloxacin, vincamine (iv), astemizole.

Concomitant use with any of these drugs, especially against the background of hypokalemia, increases the risk of ventricular arrhythmias. Before starting combination therapy with Ravel® CP and the above drugs, the potassium content in the blood plasma should be monitored and, if necessary, adjusted. Recommended: monitoring the patient’s clinical condition, as well as the content of electrolytes in the blood plasma and ECG. In patients with hypokalemia, it is necessary to use drugs that do not provoke the development of arrhythmias.

2. With simultaneous administration of NSAIDs (for systemic use), including selective COX-2 inhibitors, high doses of salicylic acid (3 g/day or more)

Possible: reduction in the antihypertensive effect of indapamide, development of acute renal failure in dehydrated patients (due to a decrease in glomerular filtration rate). At the beginning of indapamide therapy, it is necessary to restore water and electrolyte balance and monitor renal function.

3. ACE inhibitors

in patients with hyponatremia (especially in patients with renal artery stenosis) increase the risk of developing arterial hypotension and/or acute renal failure. Patients with hypertension and possibly hyponatremia due to diuretics should:

- stop taking the drug 3 days before starting therapy with ACE inhibitors and switch to therapy with potassium-sparing diuretics;

4. Other drugs that can cause hypokalemia:

— amphotericin B (iv);

- gluco- and mineralocorticosteroids (if administered systemically)

(see also information in the section “Drug combinations requiring attention”);

- tetracosactide

(see also information in the section “Drug combinations requiring attention”);

- laxatives that stimulate intestinal motility.

When taken simultaneously with indapamide, the above drugs increase the risk of developing hypokalemia (additive effect).

If necessary, the content of potassium ions in the blood plasma should be monitored and adjusted.

5. Simultaneous therapy with baclofen

enhances the antihypertensive effect of indapamide.

6. Cardiac glycosides:

hypokalemia increases the toxic effect of cardiac glycosides (glycoside intoxication). With the simultaneous use of indapamide and cardiac glycosides, the content of potassium ions in the blood plasma, ECG parameters should be monitored and, if necessary, therapy should be adjusted.

Combinations of drugs requiring attention

1. Simultaneous use with potassium-sparing diuretics (amiloride, spironolactone, triamterene)

appropriate in some patients, but the possibility of hypokalemia cannot be excluded. Hyperkalemia may develop against the background of diabetes mellitus or renal failure. It is necessary to monitor the content of potassium ions in the blood plasma, ECG parameters and, if necessary, adjust therapy.

2. Metformin

increases the risk of developing lactic acidosis, because It is possible to develop renal failure while taking diuretics, especially loop diuretics. Metformin should not be taken if the plasma creatinine concentration is more than 15 mg/l (135 µmol/l) in men and 12 mg/l (110 µmol/l) in women.

3. Simultaneous use of large doses of iodinated contrast agents

against the background of hypovolemia and taking diuretics increases the risk of developing acute renal failure. It is recommended to restore the water and electrolyte balance of the blood before using the drugs.

4. Tricyclic antidepressants (imipramine-like) and antipsychotics

increase the hypotensive effect and the risk of developing orthostatic hypotension (additive effect).

5. Preparations containing calcium salts

increase the risk of developing hypercalcemia due to decreased excretion of calcium ions by the kidneys.

6. Cyclosporine, tacrolimus

- the risk of increasing the concentration of creatinine in the blood plasma without changing the concentration of circulating cyclosporine.

7. GCS, tetracosactide (for systemic use)

reduce the hypotensive effect (retention of sodium ions and fluid).

Analogues of Ravel SR

Level 4 ATC code matches:
Chlorthalidone

Klopamide

Indapamide

Arifon

Indap

Arifon , Indap , Indapamide , Ionic , Lorvas , Pamid .

Reviews about Ravel SR

extended-release tablets is that they ensure a constant required level of indapamide in the blood to achieve a therapeutic effect. Sustained release is important for sustained antihypertensive effect in hypertension .

However, there are not many reviews about the drug, since in case of severe arterial hypertension it is not used as monotherapy, but is prescribed in combination with antihypertensive drugs of other groups. Considering that this is a diuretic (by the way, with medium potency), while taking it you need to include foods rich in potassium in your diet. In addition, studies have proven that long-term use of Ravel SR together with an ACE inhibitor ( Enap ) improves the lipid spectrum ( TC and LDL cholesterol ).

While taking this drug, there is also a decrease in glucose , which is important when prescribing it to patients with diabetes mellitus . It was noted that treatment with it improves vascular elasticity, which was assessed by pulse wave speed.

“...Effective, convenient to take once a day.”
“... Ravel SR helps my mother well; her blood pressure is not very high.”

The patients did not report any side effects.

Special instructions for the use of the drug Ravel SR

In patients with impaired liver function, thiazide diuretics can cause the development of encephalopathy. In this case, the diuretic should be discontinued immediately. Long-term use of diuretics can cause the development of hyponatremia. The concentration of sodium in the blood plasma must be determined before the start of treatment and at regular intervals during the treatment period. In elderly people and patients with liver cirrhosis, determination of sodium concentration in blood plasma should be carried out more often. In patients with malnutrition, when taking several drugs simultaneously, in the elderly, patients with liver cirrhosis and ascites, coronary artery disease and heart failure, patients with an increased QT on the ECG, it is necessary to prevent the development of hypokalemia (≤3.4 mmol/l ). In these patients, hypokalemia increases the cardiotoxicity of digitalis preparations and the risk of developing arrhythmias. Hypokalemia contributes to the development of dangerous arrhythmias, in particular polymorphic ventricular tachycardia of the pirouette type. These patients should have their plasma potassium levels monitored more frequently. Thiazide and thiazide-like diuretics may reduce urinary calcium excretion and cause mild transient hypercalcemia. Persistent hypercalcemia may be due to the presence of hyperparathyroidism. Therefore, diuretic treatment should be discontinued until parathyroid function is assessed. In patients with diabetes, it is important to control blood glucose levels, especially if there is hypokalemia. Patients with hyperuricemia may experience gout attacks. Thiazide and thiazide-like diuretics are most effective when renal function is normal or slightly impaired (plasma creatinine level in adults ≤25 mg/l or 220 µmol/l). Hypovolemia that occurs at the beginning of diuretic use due to loss of water and sodium can cause a decrease in glomerular filtration. This may lead to increased levels of urea and creatinine in the blood plasma. In patients with normal renal function, such transient functional renal failure resolves without any consequences, but in patients with pre-treatment renal insufficiency, the condition may worsen. Ravel SR may cause a positive reaction during doping control in athletes taking this drug. The drug should not be prescribed during pregnancy, as this may cause placental ischemia and impair fetal development. During the treatment period, it is recommended to stop breastfeeding.

Price for Ravel SR, where to buy

You can buy the drug at any pharmacy. The cost of 30 tablets ranges from 170-211 rubles.

Online pharmacies in RussiaRussia
Online pharmacies in KazakhstanKazakhstan

LuxPharma* special offer

Ravel SR 1.5 mg tab.
No. 30 1690 rub. order