Aceril 5Tablet

Generic

Ramipril

Indications

Ramipril is suitable for the following conditions:

• hypertension; low blood pressure, as single drug therapy or in combination with other antihypertensive drugs.
• Congestive heart failure; it can also be combined with diuretics.
• treats patients who show clinical symptoms of congestive heart failure in the first days after an acute myocardial infarction.
• Treatment of obvious non-diabetic or diabetic glomeruli or early stage renal disease.
• Reduce the risk of myocardial infarction, stroke or cardiovascular death in patients with increased cardiovascular risk, such as obvious coronary artery disease (with or without a history of myocardial infarction), history of stroke, history of peripheral vascular disease or accompanied by al at least one other heart disease Diabetes due to vascular risk factors (microalbuminuria, high blood pressure, high levels of total cholesterol, low levels of high-density lipoprotein cholesterol, smoking).

Pharmacology

Ramipril is an angiotensin converting enzyme (ACE) inhibitor, which prevents the conversion of angiotensin I to the vasoconstrictor chemical angiotensin II after hydrolysis to ramiprilat. As a result, ramipril inhibits ACE, resulting in lower plasma angiotensin II levels, lower vasopressor activity, and lower aldosterone secretion. Ramipril's antihypertensive effect is thus achieved. It can also help with heart failure management and lowering the risk of stroke, myocardial infarction, and mortality from cardiovascular events. It has a lengthy half-life and is well tolerated, thus it can be used for long-term treatment.

Dosage & Administration

Dosage of Ramipril must be adjusted according to the patient tolerance and response.

Hypertension: For the management of hypertension in adults not receiving a diuretic, the usual initial dose of Ramipril is 1.25-2.5 mg once daily. Dosage generally is adjusted no more rapidly than at 2 week intervals. The usual maintenance dosage in adults is 2.5-20 mg daily given as a single dose or in 2 divided doses daily. If BP is not controlled with Ramipril alone, a diuretic may be added.

Congestive heart failure after myocardial infarction: In this case, Ramipril therapy may be initiated as early as 2 days after myocardial infarction. An initial dose of 2.5 mg twice daily is recommended, but if hypotension occurs, dose should be reduced to 1.25 mg twice daily. Therapy is then titrated to a target daily dose of 5 mg twice daily.

Prevention of major cardiovascular events: In this case, the recommended dose is 2.5 mg once daily for the first week of therapy and 5 mg once daily for the following 3 weeks; dosage then may be increased, as tolerated, to a maintenance dosage of 10 mg once daily.

Dosage in renal impairment:

• For patients with hypertension and renal impairment: The recommended initial dose is 1.25 mg Ramipril once daily. Subsequent dosage should be titrated according to individual tolerance and BP response, up to a maximum of 5 mg daily.
• For patients with heart failure and renal impairment: The recommended dose is 1.25 mg once daily. The dose may be increased to 1.25 mg twice daily and up to a maximum dose of 2.5 mg twice daily depending upon clinical response and tolerability.

Ramipril tablets have to be swallowed with sufficient amounts of liquid. The tablets must not be chewed or crushed. Absorption of Ramipril is not significantly affected by food. Ramipril may, therefore, be taken before, during or after a meal.

Interaction

Concurrent use with diuretics might cause significant hypotension and, in the case of potassium sparing diuretics, hazardous hyperkalemia. Lithium concomitant medication may result in a higher serum lithium content. Reduced blood pressure can impair one's ability to drive and operate machines, which can be aggravated by drinking. NSAIDs may diminish Ramipril's antihypertensive efficacy and cause renal function to deteriorate.

Contraindications

Ramipril

• should not be used in patients who are allergic to ramipril, any other ACE inhibitor, or any of the excipients in ramipril.
• Patients with a history of angioedema.
• is used simultaneously with sacubitril/valsartan treatment. Do not take ramipril Cinfa until sacubitril/valsartan is cleared from your body. If you switch from ramipril to sacubitril/valsartan, please do not start taking sacubitril/valsartan until ramipril is cleared from your body.
• Patients with hemodynamic-related renal artery stenosis, bilateral or unilateral single kidney.
• In patients with hypotension or hemodynamic instability.
• Aliskiren-containing drugs are used in patients with diabetes or moderate to severe renal impairment (creatinine clearance <60 ml / min). Application of
• and angiotensin II receptor antagonist (AIIRA) in patients with diabetic nephropathy.
• During pregnancy.

Simultaneous use of ACE inhibitors and extracorporeal treatments that cause blood to come into contact with negatively charged surfaces should be avoided because such use can cause severe allergic-like reactions. Such extracorporeal treatments include the use of certain high-fluidity membranes (such as polyacrylonitrile) for dialysis or hemofiltration, and the use of dextran sulfate for low-density lipoprotein separation.

Side Effects

Ramipril is well tolerated by the majority of people. Side symptoms such as dizziness, headache, fatigue, and asthenia are prevalent. Symptomatic hypotension, cough, nausea, vomiting, diarrhoea, rash, urticaria, oliguria, anxiety, and amnesia are some of the less common adverse effects. Rare cases of angioneurotic oedema, allergic responses, and hyperkalemia have been documented.

Pregnancy & Lactation

Ramipril should not be used when pregnant. As a result, pregnancy must be ruled out before beginning treatment. In circumstances where ACE inhibitor medication is required, pregnancy should be avoided. If the patient wants to become pregnant, ACE inhibitors must be stopped and replaced with a different type of medication. If the patient falls pregnant while taking Ramipril, the medication must be changed as soon as feasible with an ACE inhibitor-free therapy regimen. There is a danger of injury to the fetus if this is not done. Ramipril should not be taken when nursing.

Precautions & Warnings

Ramipril should be used with caution in patients with impaired renal function, hyperkalaemia, hypotension, and impaired hepatic function.

Therapeutic Class

Angiotensin-converting enzyme (ACE) inhibitors

Storage Conditions

Store at 30° or below, protect from light. Keep out of the reach of children. Do not use later than the date of expiry. To be dispensed only on the prescription of a registered physician.

Pharmaceutical Name

Ibn Sina Pharmaceuticals Ltd.