Ramipril & Hydrochlorothiazide
Therapeutic Class: Cardiovascular (Combined antihypertensive preparations)
Indications:
Ramipril & Hydrochlorothiazide 2.5 & Ramoril 5 is indicated for the treatment of hypertension.
Ramipril & Hydrochlorothiazide 2.5 & Ramoril 5 is indicated for the treatment of hypertension.
Presentation:
Ramipril & Hydrochlorothiazide 2.5: Each tablet contains Ramipril BP 2.5 mg and Hydrochlorothiazide BP 12.5 mg
Ramipril & Hydrochlorothiazide 5 : Each tablet contains Ramipril BP 5 mg and Hydrochlorothiazide BP 25 mg
Description:
Ramipril & Hydrochlorothiazide is an angiotensin-converting enzyme (ACE) inhibitor, which after hydrolysis to ramiprilat, blocks the conversion of angiotensin I to the vasoconstrictor substance, angiotensin II. So, inhibition of ACE by ramipril results in decreased plasma angiotensin II, which leads to decreased vasopressor activity and decreased aldosterone secretion. Thus Ramipril & Hydrochlorothiazide exerts its antihypertensive activity. It is also effective in the management of heart failure and reduction of the risk of stroke, myocardial infarction and death from cardiovascular events. It is long-acting and well-tolerated; so, can be used in long term therapy.
Hydrochlorothiazide is a thiazide diuretic. Thiazides affect the renal tubular mechanisms of electrolyte reabsorption, directly increasing the excretion of sodium and chloride in approximately equivalent amounts. Indirectly, the diuretic action of Hydrochlorothiazide reduces plasma volume, with consequent increases in plasma renin activity, increases in aldosterone secretion, increases in urinary potassium loss, and decreases in serum potassium. The renin-aldosterone link is mediated by angiotensin II, so co-administration of anangiotensin converting enzyme (ACE) inhibitor tends to reverse the potassium loss associated with these diuretics.
Dosage & Administration:
A patient whose blood pressure is not adequately controlled with Ramipril (or another ACE inhibitor) alone or with Hydrochlorothiazide (or another thiazide diuretic) alone may be switched to combination therapy with Ramipril & Hydrochlorothiazide 2.5 or Ramipril & Hydrochlorothiazide 5. The usual starting dose of Ramipril & Hydrochlorothiazide 2.5 or Ramipril & Hydrochlorothiazide 5 is one tablet once daily. If necessary, the dose may be increased to two tablets of Ramipril & Hydrochlorothiazide 2.5 or Ramipril & Hydrochlorothiazide 5 once daily.
Dosage in renal impairment: In patients with a creatinine clearance between 60 and 30 ml/min, treatment should be initiated with Ramipril 1.25 mg monotherapy. If blood pressure is not adequately controlled, the dose of Ramipril & Hydrochlorothiazide may be increased to 2.5 mg. If blood pressure is still not controlled, the patient may be switched to one tablet of Ramipril & Hydrochlorothiazide 2.5 once daily. Dosage may be titrated upward to Ramipril & Hydrochlorothiazide 5 until blood pressure is controlled.
Side Effects:
This drug is generally well tolerated. dizziness, headache, fatigue and asthenia are commonly reported side effects. Other side-effects occurring less frequently include symptomatic hypotension, cough, nausea, vomiting, diarrhoea, rash, urticaria, oliguria, anxiety, amnesia etc. Angioneurotic edema, anaphylactic reactions and hyperkalemia have also been reported rarely.
Precautions:
Ramipril & Hydrochlorothiazide 2.5 or Ramipril & Hydrochlorothiazide 5 should be used with caution in patients with impaired renal function, hyperkalemia, hypotension, surgery/anaesthesia and impaired hepatic function.
Use in Pregnancy & Lactation:
Pregnancy: Not recommended
Nursing mother: Not recommended
Overdose:
Ramipril: Limited data on human overdosage are available. The most likely clinical manifestations would be symptoms attributable to hypotension. Because the hypotensive effect of Ramipril is achieved through vasodilation and effective hypovolemia, it is reasonable to treat Ramipril overdosage by infusion of normal saline solution.
Hydrochlorothiazide: The most common signs and symptoms observed are those caused by electrolyte depletion (hypokalemia, hypochloremia, and dehydration resulting from excessive diuresis. If digitalis has also been administered, hypokalemia may accentuate cardiac arrhythmias. The degree to which Hydrochlorothiazide is removed by hemodialysis has not been established.
Storage:
Store in a cool and dry place, protected from light.
A patient whose blood pressure is not adequately controlled with Ramipril (or another ACE inhibitor) alone or with Hydrochlorothiazide (or another thiazide diuretic) alone may be switched to combination therapy with Ramipril & Hydrochlorothiazide 2.5 or Ramipril & Hydrochlorothiazide 5. The usual starting dose of Ramipril & Hydrochlorothiazide 2.5 or Ramipril & Hydrochlorothiazide 5 is one tablet once daily. If necessary, the dose may be increased to two tablets of Ramipril & Hydrochlorothiazide 2.5 or Ramipril & Hydrochlorothiazide 5 once daily.
Dosage in renal impairment: In patients with a creatinine clearance between 60 and 30 ml/min, treatment should be initiated with Ramipril 1.25 mg monotherapy. If blood pressure is not adequately controlled, the dose of Ramipril & Hydrochlorothiazide may be increased to 2.5 mg. If blood pressure is still not controlled, the patient may be switched to one tablet of Ramipril & Hydrochlorothiazide 2.5 once daily. Dosage may be titrated upward to Ramipril & Hydrochlorothiazide 5 until blood pressure is controlled.
Side Effects:
This drug is generally well tolerated. dizziness, headache, fatigue and asthenia are commonly reported side effects. Other side-effects occurring less frequently include symptomatic hypotension, cough, nausea, vomiting, diarrhoea, rash, urticaria, oliguria, anxiety, amnesia etc. Angioneurotic edema, anaphylactic reactions and hyperkalemia have also been reported rarely.
Precautions:
Ramipril & Hydrochlorothiazide 2.5 or Ramipril & Hydrochlorothiazide 5 should be used with caution in patients with impaired renal function, hyperkalemia, hypotension, surgery/anaesthesia and impaired hepatic function.
Use in Pregnancy & Lactation:
Pregnancy: Not recommended
Nursing mother: Not recommended
Overdose:
Ramipril: Limited data on human overdosage are available. The most likely clinical manifestations would be symptoms attributable to hypotension. Because the hypotensive effect of Ramipril is achieved through vasodilation and effective hypovolemia, it is reasonable to treat Ramipril overdosage by infusion of normal saline solution.
Hydrochlorothiazide: The most common signs and symptoms observed are those caused by electrolyte depletion (hypokalemia, hypochloremia, and dehydration resulting from excessive diuresis. If digitalis has also been administered, hypokalemia may accentuate cardiac arrhythmias. The degree to which Hydrochlorothiazide is removed by hemodialysis has not been established.
Store in a cool and dry place, protected from light.
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