(ra mi' pril)
P / L - Contraindicated in pregnancy and lactation
WARNING: FETAL TOXICITY
RECENT MAJOR CHANGES of Ramipril brand with U.S. FDA:
See Brand Manufacturer's Prescribing Information for relevant sections.
|Indication(s) & Dosage||
Ramipril is an angiotensin converting enzyme (ACE) inhibitor indicated for the treatment of hypertension, to lower blood pressure. Lowering blood pressure reduces the risk of fatal and nonfatal cardiovascular events, primarily strokes and myocardial infarctions. It may be used alone or in combination with thiazide diuretics.
In patients 55 years or older at high risk of developing a major cardiovascular event, Ramipril is indicated to reduce the risk of myocardial infarction, stroke, or death from cardiovascular causes.
Adult:Initially, 1.25 mg orally once daily. Max dose: 10 mg daily. Doses â‰¥2.5 mg may be given in 2 divided doses.
Max Dosage:10 mg daily in 1-2 divided doses.
Post myocardial infarction
Adult:Initially, 2.5 mg orally bid increased after 2 days to 5 mg bid. Start treatment 3-10 days after infarction. Usual dose: 2.5-5 mg bid.
Prophylaxis of cardiovascular events in high-risk patients
Adult:Initially, 2.5 mg orally once daily increased to 5 mg once daily after 1 wk if tolerated. Maintenance: 10 mg once daily after a further 3 wk.
Special Populations:Reduce dose in patients with .
|Administration||May be taken with or without food.
|May lead to severe hypotension. Normal saline infusion may be used for treatment.|
Angioedema related to previous treatment with an ACE inhibitor or a history of hereditary or idiopathic angioedema. Do not co-administer aliskiren with ALTACE in patients with diabetes.Hypersensitivity, bilateral renal artery stenosis, or a single kidney with unilateral renal artery stenosis. Aortic stenosis or outflow tract obstruction. Pregnancy and lactation.
|Warning & Precautions||
ACE inhibitor use has been associated with the following:
*mTOR: mammalian Target of Rapamycin is a serine/threonine kinase, which belongs to phosphatidylinositol-3 kinase (PI3K) related kinases (PIKKs) family. It regulates cellular metabolism, growth and proliferation and therefore is a target for the development of a number of mTOR inhibitors.
|Adverse Drug Reaction(s)||
The most common adverse reactions in patients with hypertension included headache, dizziness, fatigue and cough. Among others there may be nausea, vomiting, diarrhoea & abdominal pain. Rarely symptomatic hypotension. Angioneurotic oedema of face, lips, tongue, glottis and larynx, syncope, renal impairment, hypersensitivity reactions.Potentially Fatal: Severe hypotension and renal failure, angioedema.
|Drug Interactions||NSAIDs may increase risk of deterioration of renal function.
Potentially Fatal:Concomitant admin of diuretics may lead to serious hypotension. Severe hyperkalaemia may result when used with potassium-sparing diuretics, potasisum supplements and drugs that cause hyperkalaemia. May increase serum lithium concentration.
|Pregnancy Category (FDA)||Category D: There is positive evidence of human foetal risk, but the benefits from use in pregnant women may be acceptable despite the risk (e.g., if the drug is needed in a life-threatening situation or for a serious disease for which safer drugs cannot be used or are ineffective).|
|Pharmacology||Ramipril is an ACE inhibitor which is metabolised into the active metabolite ramiprilat. It competitively inhibits angiotensin-converting enzyme (ACE) from converting angiotensin I to angiotensin II resulting in increased plasma renin activity and reduced aldosterone secretion. It also increases bradykinin levels. By these mechanisms, ramipril produces a hypotensive effect and a beneficial effect in CHF.
Absorption:50-60% is absorbed from the GI tract (oral); peak plasma concentrations after 2-4 hr (ramiprilat).
Metabolism:Hepatic: Converted to ramiprilat.
Excretion:Via urine (60% of the dose), via faeces (remaining dose); 13-17 hr (elimination half-life), may be prolonged in renal impairment.
|ATC Classification||C09AA05 - ramipril; Belongs to the class of ACE inhibitors. Used in the treatment of cardiovascular disease.|
|Brand Name||Manufacturer/Marketer||Composition||Dosage Form||Pack Size & Price|
|ACECARD 1.25||Healthcare Pharmacuticals Ltd.||Ramipril BP 1.25 mg||Tablet||30's MRP 90 Tk|
|ACECARD 2.5||Healthcare Pharmacuticals Ltd.||Ramipril BP 2.5mg||Tablet||30's MRP 150 Tk|
|ACECARD 5||Healthcare Pharmacuticals Ltd.||Ramipril BP 5mg||Tablet||30's MRP 240 Tk|
|MYPRIL||Eskayef Bangladesh Ltd||Ramipril BP 2.5mg & 5mg||Tablet||40's MRP: 200.00 & 320.00|
|PIRAMIL||Sandoz/Novartis||Ramipril BP 2.5mg & 5mg||Tablet||2.5mg x 28's: MRP 168.00 IP 5mg x 28's: MRP 252.00 IP|
|PRICARD||The White Horse Pharma||Ramipril BP 2.5mg, 5mg||Tablet||2.5mg x 50's, 5mg x 30's: 200.00 & 240.00 MRP|
|PRIMACE 1.25||Beximco Pharmaceuticals Ltd||Ramipril BP 1.25mg||Capsule||30's: 75.00 MRP|
|PRIMACE 10||Beximco Pharmaceuticals Ltd||Ramipril BP 10mg||Capsule||1's: 12.00 MRP|
|PRIMACE 2.5||Beximco Pharmaceuticals Ltd||Ramipril BP 2.5mg||Capsule||30's: 150.00 MRP|
|PRIMACE 2.5 TABLET||Beximco Pharmaceuticals Ltd||Ramipril BP 2.5mg||Tablet||30's: 150.00 MRP|
|PRIMACE 5||Beximco Pharmaceuticals Ltd||Ramipril BP 5mg||Capsule||30's: 240.00 MRP|
|PRIMACE 5 TABLET||Beximco Pharmaceuticals Ltd||Ramipril 5mg||Tablet||30's: 240.00 MRP|
|PROTACE||Unimed & Unihealth Manufacturers Ltd.||Ramipril BP 2.5mg & 5mg||Tablet||30's each: 150.00 & 240.00 MRP|
|R-PIL||Biopharma Laboratories Ltd||Ramipril BP 1.25, 2.5 & 5mg||Tablet||30's each: 90.30, 150.60 & 240.90 MRP|
|RACARD||Pacific Pharmaceuticals Ltd.||Ramipril BP 1.25, 2.5 & 5mg||Tablet||30's each: 75.00, 138.00 & 240.00 MRP|
|RAMACE||Opsonin Pharma Limited||Ramipril BP 1.25, 2.5 & 5mg||Tablet||1.25mg x 50's, 2.5mgx 30's, 5mg x 30's: 125.00, 150.00 & 240.00 MRP|
|RAMICARD||Drug International Ltd||Ramipril BP 2.5mg, 5mg||Tablet||2.5mg x 50's, 5mg x 50's: 150.00 & 350.00 MRP|
|RAMIL||Popular Pharmaceuticals Ltd.||Ramipril BP 1.25, 2.5, 5 & 10mg||Tablet||1.25 & 5mg x50's: 125 & 401.50, 2.5 & 10mg x30's: 251 & 360.00 MRP|
|RAMILOK||Aristopharma Ltd.||Ramipril BP 2.5mg, 5mg||Tablet||2.5mg x 50's, 5mg x 30's: 250.00 & 240.00 MRP|
|RAMIPRESS||Silva Pharmaceuticals Limited||Ramipril BP 1.25, 2.5 & 5mg||Tablet||30's each: 75.28 & 150.57 & 240.90 MRP|
|RAMIPRO||General Pharmaceuticals Ltd||Ramipril BP 2.5mg, 5mg||Tablet||2.5mg x 50's, 5mg x 30's: 151.00 & 240.90 MRP|
|RAMORIL||Incepta Pharmaceuticals Limited||Ramipril BP 1.25, 2.5, 5.0 & 10mg||Tablet||1.25, 2.5 & 5mg x50's: 125, 250 & 400.00 MRP; 10mg x30's: 360.00 MRP|
|RAMPRIL||Rangs Pharmaceuticals Ltd.||Ramipril BP 2.5mg, 5mg||Tablet||30's each:120.00 & 180.00 MRP|
|RIPRIL 1.25||Square Pharmaceuticals Ltd.||Ramipril 1.25mg||Tablet||3x10's: 75.60 MRP|
|RIPRIL 2.5||Square Pharmaceuticals Ltd.||Ramipril 2.5mg||Tablet||3x10's: 150.90 MRP|
|RIPRIL 5||Square Pharmaceuticals Ltd.||Ramipril 5mg||Tablet||3x10's: 241.80 MRP|
|TRITACE||Sanofi||Ramipril BP 2.5mg, 5mg & 10mg||Tablet||28's each: 241.92, 354.20 & 505.96 MRP|
|UNIPRIL||The Acme Laboratories Ltd.||Ramipril BP 2.5mg, 5mg||Tablet||30's each: 150.30 & 241.20 MRP|
|Do not take ramipril if you are pregnant. If you become pregnant while taking ramipril, call your doctor immediately. Ramipril may harm the fetus.|
Why is this medication prescribed?
Ramipril is used alone or in combination with other medications to treat high blood pressure. It is also used to reduce the risk of heart attack and stroke in patients at risk for these problems and to improve survival in patients with heart failure after a heart attack. Ramipril is in a class of medications called angiotensin-converting enzyme (ACE) inhibitors. It works by decreasing certain chemicals that tighten the blood vessels, so blood flows more smoothly and the heart can pump blood more efficiently.
How should this medicine be used?
Ramipril may come as a tablet or capsule to take by mouth. It is usually taken once or twice a day with or without food. To help you remember to take ramipril, take it around the same time every day. Follow the directions on your prescription carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take ramipril exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.
Swallow the capsule whole, or open the capsule and sprinkle the contents on a small amount of applesauce (about 4 oz.) or in 4 oz. (about 120 mL) of water or apple juice. Eat or drink the entire mixture. This mixture can be prepared in advance and stored for 24 hours at room temperature or 48 hours in the refrigerator.
Your doctor will probably start you on a low dose of ramipril and gradually increase your dose.
Ramipril controls high blood pressure and heart failure but does not cure them. Continue to take ramipril even if you feel well. Do not stop taking ramipril without talking to your doctor.
Other uses for this medicine
This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.
What special precautions should I follow?
Before taking ramipril,
- tell your doctor and pharmacist if you are allergic to ramipril, benazepril, captopril, enalapril, fosinopril (Monopril), lisinopril, moexipril, perindopril (Coversyl), quinapril, trandolapril or any other medications.
- tell your doctor if you have diabetes (high blood sugar) and you are taking aliskiren (Tekturna). Your doctor will probably tell you not to take ramipril if you have diabetes and you are also taking aliskiren.
- tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking. Be sure to mention any of the following: aspirin and other nonsteroidal anti-inflammatory medications (NSAIDs) such as indomethacin; diuretics ('water pills'); lithium; and potassium supplements. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
- tell your doctor if you have or have ever had heart, liver, or kidney disease; lupus; scleroderma; diabetes; or angioedema, a condition that causes difficulty swallowing or breathing and painful swelling of the the face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs.
- tell your doctor if you plan to become pregnant or are breast-feeding.
- if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking ramipril.
- you should know that diarrhea, vomiting, not drinking enough fluids, and sweating a lot can cause a drop in blood pressure, which may cause light-headedness and fainting.
What special dietary instructions should I follow?
Talk to your doctor before using salt substitutes containing potassium. If your doctor prescribes a low-salt or low-sodium diet, follow these directions carefully.
What should I do if I forget a dose?
Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular regular dosing schedule. Do not take a double dose to make up for a missed one.
What side effects can this medication cause?
Ramipril may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:
Some side effects can be serious. The following symptoms are uncommon, but if you experience any of them, call your doctor immediately:
swelling of the face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs
difficulty breathing or swallowing
yellowing of the skin or eyes
fever, sore throat, chills, and other signs of infection
Ramipril may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.
What should I know about storage and disposal of this medication?
Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.
In case of emergency/overdose
In case of overdose, consult your Doctor. If the victim has collapsed or is not breathing, consult local medical emergency services.
Symptoms of overdose may include:
This medication may cause other side effects. Consult your doctor if you have any unusual problems while taking this.
What other information should I know?
Keep all appointments with your doctor and the laboratory. Your doctor will order certain lab tests to check your response to this medicine.
Do not let anyone else use your medication. If you still have symptoms and need further treatment, consult your doctor.
It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.
This information is provided for reference only and not a replacement for and should only be used in conjunction with full consultation with a registered medical practitioner. It may not contain all the available information you require and cannot substitute professional medical care, nor does it take into account all individual circumstances. Although great effort has been made to ensure content accuracy, mph-bd shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise.
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