Expiration date: 05/2025

The composition and form of issue:

Capsules. 1 capsule contains ramipril 2.5, 5 or 10 mg

excipients: lactose — 143 mg (dosage 2.5 mg), 140,5 mg (dosage 5 mg) and 135.5 mg (dosage 10 mg) silicon dioxide colloidal (Aerosil) is 3 mg of calcium stearate 1.5 mg 

capsule shell: gelatin titanium dioxide dye iron oxide yellow (for the dosages of 2.5 and 5 mg) 

in a contour acheikova packing 10 PCs. in cardboard pack 1, 2, 3, 5 or 6 packages or contour acheikova packing 14 PCs. in cardboard pack 1, 2 or 4 packs.

Description pharmaceutical form:

Capsules 2.5 mg: hard gelatin capsules No. 3 with white lid and yellow.

Capsules 5 mg: hard gelatin capsules No. 3 with case and cover yellow.

Capsules 10 mg: hard gelatin capsules No. 3 with case and cover white.

The contents of the capsules: powder or compacted mass of white or almost white, falling apart when pressed with a glass rod.

Pharmacokinetics:

After oral ramipril is rapidly absorbed from the gastrointestinal tract (50-60%). Food intake slows the absorption but does not affect the completeness of absorption.

In the liver is metabolized to the active metabolite — ramiprilat (6 times actively inhibits ACE than ramipril) and inactive metabolites — diketopiperazines ether, diketopiperazines acids and glucuronides (ramipril and ramiprilat). All metabolites formed, except ramiprilat, pharmacological activity have not. Linking blood plasma proteins for the ramipril is 73% and of ramiprilat is 56%.

After taking the inside ramipril Cmax ramipril and ramiprilat are reached in 1 and 2-4 h, respectively.

The bioavailability of ramipril after ingestion of 2.5–5 mg 15-28% for ramiprilat — 45%. After daily administration of 5 mg/day stable concentration of ramiprilat in plasma are achieved by the 4th day. T1/2 ramiprila — 5.1 CH in the phase of distribution and elimination of a low concentration of ramiprilat in the blood serum occurs with a T1/2 — 3 hours, followed by a transitional phase with a T1/2 — 15 hours and a long terminal phase with very low concentrations of ramiprilat in plasma and T1/2 — 4-5 days. T1/2 is increased in chronic renal failure. Vd ramipril — 90 l, ramiprilat — 500 l.

In animal studies it was shown that ramipril is excreted in breast milk.

Excreted by the kidneys — 60%, through the intestines — 40% (mainly as metabolites). When violation of the kidney excretion ramiprila and its metabolites is slowed in proportion to the reduction in creatinine clearance if abnormal liver function slows down the conversion to ramiprilat in heart failure the concentration of ramiprilat increased 1.5–1.8 times.

In healthy volunteers elderly (65-76 years), the pharmacokinetics of ramipril and ramiprilat did not significantly differ from that in young healthy volunteers.

Description pharmacological action:

Ramipril inhibits the enzyme that blocks the conversion of angiotensin I to angiotensin II, resulting in (regardless of the renin activity of blood plasma) develops hypotensive effect (with the patient supine and standing) without a compensatory increase in heart rate. Reduces the production of aldosterone.

Decreases in systemic vascular resistance or afterload, pulmonary capillary pressure (preload), the resistance in the pulmonary vessels increases the minute volume of blood and tolerance to stress. Long-term use promotes regression of myocardial hypertrophy in patients with arterial hypertension. Reduces the incidence of arrhythmias during reperfusion improves blood flow to the ischemic myocardium prevents changes of the vascular endothelium caused by vysokochastotnogo diet.

Increases coronary and renal blood flow.

A start of antihypertensive action through 1.5 h after oral administration, the maximum effect — after 5-9 h, duration — 24 h. no withdrawal syndrome.

In patients with heart failure, which developed in the first days of acute myocardial infarction (2-9 days), while taking ramipril, 3 to 10 days of acute myocardial infarction, reduced the risk of mortality (27%), the risk of sudden death (30%), the risk of progression of chronic heart failure to severe (III–IV functional class NYHA classification)/resistant to therapy (27%), the likelihood of subsequent hospitalization due to heart failure (26%).

In diabetic and non-diabetic nephropathy receiving ramipril slows the rate of progression of renal failure and time of occurrence of end-stage renal failure and thereby reduces the need for dialysis or kidney transplantation. In the early stages of diabetic or non-diabetic nephropathy ramipril reduces the severity of albuminuria.

Indications:

• hypertension
  
• chronic heart failure (in combination therapy, particularly in combination with diuretics)
  
• heart failure, which developed during the first few days (from 2nd to 9th day) after acute myocardial infarction
  
• diabetic or non-diabetic nephropathy (preclinical and symptomatic stages), including with severe proteinuria, especially when combined with hypertension.
  

Contraindications:

• hypersensitivity to ramipril, other ACE inhibitors or to any component of the drug
  
• angioedema (hereditary or idiopathic, and after taking ACE inhibitors) in history, the risk of rapid development of angioedema
  
• hemodynamically significant renal artery stenosis (bilateral or unilateral in the case of a solitary kidney)
  
• hypotension (SBP <90 mm Hg. Hg), or condition with unstable hemodynamics
  
• hemodynamically significant stenosis of the aortic or mitral valve, or hypertrophic obstructive cardiomyopathy
  
• primary hyperaldosteronism
  
• expressed kidney failure (Cl creatinine <20 ml/min when the body surface area of 1.73 m2)
  
• hemodialysis
  
• pregnancy
  
• lactation
  
• nephropathy, the treatment of which is corticosteroids, NSAIDs, immunosuppressants, and/or other cytotoxic agents (see "Interactions")
  
• chronic cardiac insufficiency of the decompensation (clinical experience is insufficient)
  
• the age of 18 years (efficacy and safety not established)
  
• LDL apheresis using dextran sulfate (risk of development of hypersensitivity reactions)
  
• hyposensitization therapy in the hypersensitivity reactions to poison insects such as bees, wasps
  
• lactase deficiency, lactose intolerance, glucose-galactose malabsorption.
  

Additional contraindications to use of the drug Delapril in the acute phase of myocardial infarction:

• severe chronic heart failure (III–IV functional class NYHA classification)
  
• unstable angina
  
• life-threatening ventricular arrhythmias
  
• pulmonary heart.
  

With caution:

• a condition in which excessive reduction of blood pressure is especially dangerous (in atherosclerotic lesions of coronary and cerebral arteries)
  
• conditions associated with increased activity of the RAAS, in which the inhibition of ACE has a risk of a sharp decline in blood pressure with deterioration of renal function (severe hypertension, especially malignant hypertension, congestive heart failure, especially severe or for which you take other drugs with hypotensive hemodynamically significant unilateral renal artery stenosis in the presence of both kidneys prior to the administration of diuretics disorders of water and electrolyte balance as a result of insufficient fluid intake and salt, diarrhea, vomiting, sweating)
  
• infringements of function of a liver (lack of experience in the application: might as strengthening and weakening effects of ramipril in the presence in patients of liver cirrhosis with ascites and edema may be a significant activation of the RAAS, see above "the state, accompanied by increased activity of the RAAS")
  
• the human kidney (Cl creatinine >20 ml/min when the body surface area of 1.73 m2) because of the risk of hyperkalemia and leukopenia
  
• condition after kidney transplantation
  
• systemic connective tissue diseases, including systemic lupus erythematosus, scleroderma, concomitant therapy mielotoksicnae drugs that can cause changes in the peripheral blood (possible inhibition of bone marrow hematopoiesis, the development of neutropenia or agranulocytosis)
  
• diabetes mellitus (risk of hyperkalemia)
  
• older age (risk increase gipotenzivnogo action)
  
• hyperkalemia.
  

Application of pregnancy and breast-feeding:

Delapril should not be used during pregnancy. Therefore, before beginning treatment to verify the absence of pregnancy.

If the patient becomes pregnant during treatment, you need to replace drug therapy Diepraam to other therapy. Otherwise there is a risk of damage to the fetus, especially during the first trimester of pregnancy.

If Diepraam treatment is necessary during lactation, breastfeeding should be discontinued.

Side effects:

Listed below are undesirable effects are given in the description complies with the following gradations of their frequency of occurrence: very often — &ge10% often — &ge1–<10% infrequently — &ge0,1–<1% rare — &ge0,01–<0,1% very rare <0,01%, including individual messages, the frequency is unknown — according to the available data set the frequency of occurrence is not possible.

From the CCC: often — excessive decrease in blood pressure, orthostatic hypotension, syncope, chest pain rarely, myocardial ischemia, including the development of angina or myocardial infarction, tachycardia, arrhythmia (new or increasing), palpitations, peripheral edema, flushing to the face, rarely — the development or strengthening of circulatory disorders on the background of stenotic vascular lesions, vasculitis frequency not known — the Raynaud's syndrome.

With the genitourinary system: rare — violation of the kidney, including acute renal failure, increasing the amount of urine, strengthening the existing proteinuria, increase of urea and creatinine in the blood, transient impotence due to erectile dysfunction, decreased libido frequency unknown — gynecomastia.

CNS: frequently — headache, feeling of lightness in head, fatigue rarely dizziness, depressed mood, anxiety, irritability, restlessness, sleep disturbance, including drowsiness, rarely — tremor, impaired balance, confusion, asthenia frequency is unknown cerebral ischemia including ischemic stroke and transient disorders of cerebral circulation, disturbance of psychomotor reactions, paresthesia (burning sensation), parosmia (impaired sense of smell), impaired attention, depression.

From the sensory organs: rare — visual disturbances, including blurred vision, ageusia (loss of taste sensitivity), dysgeusia (violation of taste sensitivity) rare — conjunctivitis, hearing impairment, noise in the ears.

From the side of musculoskeletal system: often — muscle cramps, myalgia rare — arthralgia.

From the digestive system: often — inflammatory response in the stomach and intestines, indigestion, a feeling of discomfort in the abdomen, indigestion, diarrhea, nausea, vomiting, rarely pancreatitis, including and fatalities, increased activity of pancreatic enzymes in the blood plasma, intestinal angioedema, abdominal pain, gastritis, constipation, dry mucous membranes of the mouth, increased liver enzymes and concentration of conjugated bilirubin in plasma, anorexia, loss of appetite rarely — glossitis, cholestatic jaundice, hepatocellular lesions frequency unknown — aphthous stomatitis, acute liver failure, cholestatic or cytolytic hepatitis (fatal outcome has been observed very rarely).

The respiratory system: often — dry cough (increasing at night in the supine position), sinusitis, bronchitis, shortness of breath, rarely bronchospasm, including worsening of bronchial asthma, nasal congestion.

With the skin: often — skin rash, in particular maculate-papular rare — angioedema, including and fatal (edema of the larynx may cause airway obstruction, leading to death), pruritus, hyperhidrosis (excessive sweating), rarely — exfoliative dermatitis, urticaria, onycholysis rarely — photosensitivity reaction frequency unknown — toxic epidermal necrolysis, Stevens-Johnson syndrome, erythema multiforme, pemphigus, worsening of psoriasis, psoriasiform dermatitis, lichenoid or pemphigoid (michaelina) rash or enanthema, alopecia, anaphylactic or anaphylactoid reactions (the inhibition of ACE increases the number of anaphylactic or anaphylactoid reactions to insect venoms), increasing the concentration of antinuclear antibodies.

Organs of hematopoiesis: rarely — eosinophilia, rarely — leukopenia, including neutropenia and agranulocytosis, a decrease in the number of erythrocytes in peripheral blood, decrease in hemoglobin concentration, thrombocytopenia frequency is unknown — inhibition of bone marrow hematopoiesis, pancytopenia, hemolytic anemia.

Other: rarely — hyperthermia.

The laboratory parameters: often — increased content of potassium in the blood unknown frequency — reduction of sodium in the blood. Reported cases of hypoglycemia in patients with diabetes who took insulin and oral hypoglycemic drugs.

Drug interactions:

Contraindicated in combination

The use of some high-flow membranes with negatively charged surface (e.g. polyacrylnitrile membrane) during hemodialysis or hemofiltration, the use of dextran sulfate in apherese LDL.

The risk of severe anaphylactic reactions.

Deprecated combination

With potassium salts, potassium-sparing diuretics (e.g. amiloride, triamterene, spironolactone).

Perhaps a more pronounced increase in the content of potassium in the blood serum (in case of simultaneous use requires regular monitoring of potassium in the blood serum).

Combinations that should be used with caution

With antihypertensive drugs (especially diuretics) and other drugs that reduce blood pressure (nitrates, tricyclic antidepressants), — potentiation of hypotensive effect in combination with diuretics should monitor the sodium content in the blood serum.

With hypnotics, narcotic analgesics and painkillers — increased hypotensive action.

With a vasopressor sympathomimetics (epinephrine) — decrease the hypotensive effect of ramipril requires regular monitoring AD.

With allopurinol, procainamide, cytostatics, immunosuppressants, systemic corticosteroids and other drugs that may affect hematological parameters, — combined use increases the risk of leukopenia.

With lithium salts — increased serum lithium and increased cardio and neurotoxic effect of lithium.

With hypoglycemic agents for oral administration (sulfonylureas, biguanides), insulin — a decrease in insulin resistance under the influence of ramipril may increase hypoglycemic effect of these drugs until the development of hypoglycemia.

Combinations to be taken into account

NSAIDs (indomethacin, acetylsalicylic acid) may weaken the effect of ramipril, increase the risk of renal dysfunction and improve the potassium content in the blood serum.

With heparin may increase the amount of potassium in the blood serum.

With sodium chloride — the weakening of the hypotensive effect of ramipril and less effective treatment of the symptoms of chronic heart failure.

With ethanol — increased symptoms of vasodilation. Ramipril may potentiate the adverse effects of ethanol on the body.

With estrogen — attenuation of the hypotensive effect of ramipril (fluid retention).

Desensitizing therapy in case of hypersensitivity to poisons insect ACE inhibitors, including ramipril, increase the likelihood of developing severe anaphylactic or anaphylactoid reactions to insect venoms.

Method of application and dose:

Inside, swallowing it whole and drinking plenty (1/2 Cup) of water, regardless of meals (i.e. capsules can be taken both before and during or after eating). The dose is adjusted depending on therapeutic effect and tolerability of patients.

Hypertension

Initial dose 2.5 mg once daily, in the morning. If when taking the drug at this dose for 3 weeks or more, you cannot normalize a AD, then the dose may be increased to 5 mg/day of the drug Delapril. The lack of effectiveness of a dose of 5 mg after 2-3 weeks she could still be doubled to the maximum recommended daily dose of 10 mg/day.

Alternatively, increasing the dose to 10 mg/day in case of insufficient antihypertensive effect of a daily dose of 5 mg may be added to the treatment of other antihypertensive agents, particularly diuretics or CCB.

Chronic heart failure

Initial dose — 1.25 mg/day (the drug use ramipril to another dosage form: tablet 2.5 mg with valium). Depending on the patient's response to ongoing therapy, the dose can be increased. It is recommended to double it, at intervals of 1-2 weeks. Doses of 2.5 mg or more taken as a single dose or divided into 2 doses. The maximum daily dose — 10 mg.

In heart failure, which developed during the first few days (from 2nd to 9th day) after acute myocardial infarction

The initial dose is 5 mg divided into 2 doses, 2.5 mg morning and evening.

If the patient does not tolerate this initial dosage (there is no excessive decrease in blood pressure), he recommended for two days to give 1.25 mg 2 times a day (in this case, you can use the drug ramipril in the other dosage form: tablets 2.5 mg with valium).

Then, depending on patient response, the dose may be increased. It is recommended that the dose increase has doubled with an interval of 1-3 days. Later, the total daily dose, initially divided into 2 doses, can be used only once.

The maximum recommended dose of 10 mg.

Currently, the experience of treatment of patients with severe chronic heart failure (III–IV functional class NYHA classification), arising directly following acute myocardial infarction, is insufficient.

If in such patients the decision on carrying out of treatment Delapril, it is recommended that treatment is started with the lowest possible dose is 1.25 mg 1 times per day (in this case, you can use the drug ramipril in the other dosage form: tablets 2.5 mg with valium) and special caution should be observed at each increasing dose.

In diabetic or non-diabetic nephropathy

Initial dose — 1.25 mg (ramipril drug in a different dosage form: tablet 2.5 mg with valium) 1 time per day. The dose may be increased to 5 mg 1 time per day.

The maximum daily dose of 5 mg.

The use of the drug Delapril in certain group of patients

Patients with impaired renal function

When Cl creatinine from 50 to 20 ml/min per 1.73 m2 of body surface, the initial daily dose is usually 1.25 mg (in this case, you can use the drug ramipril in the other dosage form: tablets 2.5 mg with valium). The maximum allowable daily dose of 5 mg.

Patients with incompletely corrected fluid loss and electrolytes, patients with severe hypertension, and patients for whom excessive BP reduction is some risk (for example in severe atherosclerotic lesions of the coronary and cerebral arteries)

The initial dose is reduced to 1.25 mg/day (in this case, you can use the drug ramipril in the other dosage form: tablets 2.5 mg with valium).

Patients with previous therapy dioretikami

You need the ability to cancel diuretics for 2-3 days (depending on the duration of action of the diuretic) before starting treatment with the drug Delapril or at least to reduce the dose of diuretics taken. The treatment of such patients should start with the lowest dose, equal to 1.25 mg of ramipril (in this case, you can use the drug ramipril in the other dosage form: tablets 2.5 mg with valium) taken 1 time daily in the morning. After the first dose and every time after increasing the dose of ramipril and (or) loop diuretics patients should be under medical observation for at least 8 hours in order to avoid uncontrolled hypotensive reaction.

Elderly patients (over 65 years)

The initial dose is reduced to 1.25 mg/day (in this case, you can use the drug ramipril in the other dosage form: tablets 2.5 mg with valium).

Patients with impaired liver function

Reaction AD on the drug Delapril can grow (by slowing down the excretion of ramiprilat) or fall (by slowing down the conversion of inactive to active ramipril ramiprilat). Therefore, at the beginning of treatment requires careful medical supervision. Maximum daily dose of 2.5 mg.

Overdose:

Symptoms: excessive peripheral vasodilation with the development of expressed lower AD, shock, bradycardia, fluid and electrolyte disorders, acute renal failure, stupor.

Treatment: gastric lavage, appointment of adsorbents, sodium sulfate (preferably within 30 min after administration).

When expressed lower AD — fill the BCC, the recovery of water and electrolyte balance of the blood, in/with the introduction of catecholamines, angiotensin II, with bradycardia — the installation of an artificial pacemaker. In case of overdose it is necessary to monitor serum concentrations of creatinine and electrolytes. Hemodialysis is ineffective.

Special instructions:

Treatment Diepraam is usually long, its duration in each particular case is determined by the doctor. It also requires regular medical monitoring, particularly in patients with impaired liver function and kidney.

Before beginning treatment drug Delapril necessary to correct hyponatremia and hypovolemia. In patients previously taking diuretics, you need to cancel or at least reduce the dose for 2-3 days before starting this drug Delapril (in this case, should carefully monitor the condition of patients with chronic heart failure in connection with the possibility of developing their decompensation due to the increase in BCC).

After taking the first dose and with increasing dose and/or dose of diuretics (especially loop) it is necessary to provide careful medical monitoring of the patient for at least 8 h for the timely adoption of appropriate measures in case of excessive loss AD.

If the drug Delapril applied for the first time or in high doses in patients with increased activity of the RAAS, then they should carefully monitor AD, especially in early treatment, because these patients have an increased risk of excessive loss AD (see "Contraindications", "carefully").

In malignant hypertension and heart failure, especially in the acute phase of myocardial infarction, treatment with drug Delapril should be started only in a hospital.

In patients with chronic heart failure taking the drug can lead to the development of expressed lower AD, which in some cases is accompanied by oliguria or azotemia and rarely with acute renal failure.

Caution should be exercised when treating elderly patients because they may be particularly sensitive to ACE inhibitors, in the initial phase of treatment is recommended to monitor indicators of kidney function (see also "Method of application and dosage").

In patients for whom blood pressure reduction may present some risk (for example patients with atherosclerotic narrowing of the coronary or cerebral arteries), the treatment should start under strict medical supervision.

Care should be taken during exercise and/or hot weather because of the risk of excessive perspiration and dehydration with the development of hypotension due to reduction of BCC and reduce the concentration of sodium in the blood.

During drug treatment Delapril not recommended to drink alcohol.

Transient hypotension is not a contraindication to continue treatment after stabilization AD. In the case of repeated development of arterial expressed hypotension should reduce the dose or stop the drug.

In patients treated with ACE inhibitors, there have been cases of angioedema face, extremities, lips, tongue, pharynx or larynx. If you experience swelling of the face (lips, eyelids), or language, or violation of swallowing or breathing, the patient should immediately stop taking the drug.

Angioedema, localized in the region of the tongue, pharynx or larynx (possible symptoms: impaired swallowing or breathing), may be life-threatening and requires urgent measures for its relief: p/to the introduction of 0.3–0.5 mg or/in the drip of 0.1 mg of epinephrine (under the control of blood pressure, heart rate and ECG) with the subsequent use of corticosteroids (in/in, in/m in) is also recommended in/with the introduction of antihistamines (histamine H1- and H2-receptors), and in the case of deficiency of inactivators of the enzyme C1 esterase is possible to consider the need to introduce in addition to epinephrine inhibitors of the enzyme C1 esterase. The patient should be hospitalized, and monitoring should continue until complete relief of symptoms, but not less than 24 hours.

In patients treated with ACE inhibitors, there have been cases of intestinal angioedema, which is manifested by abdominal pain with nausea and vomiting, or without them in some instances was observed and angioedema of the face. The appearance of the patient on the background of treatment with ACE inhibitors, the above symptoms should be in the differential diagnosis consider the possibility of the development of their intestinal angioedema.

Treatment is aimed at desensitization to poison insects (bees, wasps), and concomitant use of ACE inhibitors can trigger anaphylactic and anaphylactoid reactions (e.g. decrease in blood pressure, shortness of breath, vomiting, allergic skin reaction) which can sometimes be life-threatening. On the background of treatment with ACE inhibitors hypersensitivity reactions to insect venom (such as bees, wasps) are developing faster and are heavier. If necessary to carry out desensitization to poison insects, the ACE inhibitor should be substituted with the relevant drug of another class.

With the use of ACE inhibitors has been described life-threatening, rapidly developing anaphylactoid reactions, sometimes until the development of shock during hemodialysis or plasmafiltration with the use of certain high-flow membranes (e.g. polyacrylonitrile membrane) (see also the instructions of the manufacturers of the membranes). You must avoid joint use of the drug Delapril and such membranes, for example for urgent dialysis or hemofiltration. In this case, preferably, the use of other membranes or exclusion receiving ACE inhibitors. Similar responses were observed when afereze engineers using dextran sulfate. Therefore, this method should not be used in patients receiving ACE inhibitors.

In patients with impaired liver function reaction to drug treatment Diaprel can be either enhanced or weakened. In addition, patients with severe liver cirrhosis with oedema and/or ascites may be a significant activation of the RAAS, therefore, in the treatment of these patients should be observed with special care (see also "Method of application and dosage").

Before surgery (including dentistry) must notify an anesthesiologist on the use of ACE inhibitors.

It is recommended to closely monitor newborns who were exposed in-utero to ACE inhibitors, to detect arterial hypotension, oliguria and hyperkalemia. If oliguria is necessary to maintenance of blood pressure and renal perfusion through the introduction of appropriate fluids and vasoconstrictor. In newborns there is a risk of oliguria and neurological disorders may because of declining renal and cerebral blood flow due to lower AD, the called ACE inhibitors.

Monitoring of laboratory parameters before and during drug treatment Delapril (up to 1 times per month in the first 3-6 months of treatment)

In the treatment of ACE inhibitors in the first weeks of treatment and subsequently recommended to monitor renal function. Particularly careful monitoring is required for patients with acute and chronic heart failure, impaired kidney function, after kidney transplantation, patients with renovascular disease, including patients with hemodynamically significant unilateral renal artery stenosis in the presence of two kidneys (in such patients, even a slight increase in the concentration of serum creatinine can be an indicator of loss of kidney function).

Is recommended regular monitoring of potassium in blood serum. Particularly careful monitoring of the content of potassium in the blood serum required for patients with impaired renal function, significant violations of water-electrolyte balance, chronic heart failure.

It is recommended to monitor indicators of the General analysis of blood to detect possible radiation. More regular monitoring is recommended at the beginning of treatment and in patients with impaired renal function and in patients with connective tissue diseases or in patients receiving other drugs at the same time, able to change picture peripheral blood (see "Interactions"). Control the number of cells required for early detection of leukopenia, which is especially important in patients with an increased risk of its development, and at the first sign of infection. The detection of neutropenia (neutrophil count <2000/µl) require discontinuation of treatment with ACE inhibitors.

With the appearance of symptoms caused by radiation (e.g. fever, swollen lymph nodes, tonsillitis), urgently needed to be monitored picture peripheral blood. In case of occurrence of signs of bleeding (tiny petechiae, reddish-brown rash on the skin and mucous membranes) is necessary to control the number of platelets in peripheral blood.

If jaundice or significant increases in liver enzymes drug treatment Delapril should stop and provide medical monitoring of the patient.

Effects on ability to drive or to perform work requiring high speed physical and mental reactions. During the period of drug treatment Delapril should refrain from activities potentially hazardous activities, require high concentration and speed of psychomotor reactions, including