Ramicard 2.5 mg (Tablet)

Title

• Ramicard Tablets 2.5mg

Categories

• Hypertension Medication
• Heart Failure Medication

Description

• Ramicard is an angiotensin converting enzyme (ACE) inhibitor indicated for the management of hypertension, congestive heart failure, and for reducing the risk of stroke, myocardial infarction, and death from cardiovascular events. It is also used for the treatment of non-diabetic or diabetic overt glomerular or incipient nephropathy.

Dosage Instructions

• Initial dose of 1.25-2.5 mg once daily for hypertension, which can be adjusted up to 20 mg daily. For congestive heart failure after myocardial infarction, the initial dose is 2.5 mg twice daily, titrated to a target daily dose of 5 mg twice daily. Prevention of major cardiovascular events requires 2.5 mg once daily for the first week, then 5 mg once daily for the following 3 weeks, with a possibility of increasing to 10 mg once daily.

Administration Method

• Tablets must be swallowed with sufficient liquid, not chewed or crushed. Can be taken before, during, or after a meal. Absorption is not significantly affected by food.

Interaction Warnings

• Concomitant use with diuretics may lead to serious hypotension and hyperkalemia, while NSAIDs may reduce the antihypertensive effect and cause deterioration of renal function. Concomitant therapy with lithium may increase serum lithium concentration.

Contraindications

• Hypersensitivity to ramipril or any other ACE inhibitor, history of angioedema, concomitant use with sacubitril/valsartan therapy, haemodynamically relevant renal artery stenosis, hypotensive or haemodynamically unstable states, aliskiren-containing medicines in patients with diabetes or moderate to severe renal impairment, and angiotensin II receptor antagonists (AIIRAs) in patients with diabetic nephropathy. Additionally, contraindicated during pregnancy.

Side Effects

• Commonly reported side effects include dizziness, headache, fatigue, and asthenia. Less frequent side effects include symptomatic hypotension, cough, nausea, vomiting, diarrhea, rash, urticaria, oliguria, anxiety, and amnesia. Rare cases of angioneurotic edema, anaphylactic reactions, and hyperkalemia have also been reported.

Pregnancy & Lactation Warnings

• Ramipril is contraindicated during pregnancy and not recommended during breastfeeding. Pregnancy must be excluded before starting treatment, and if the patient intends to become pregnant, treatment with ACE inhibitors must be discontinued.

Precautions & Warnings

• Use with caution in patients with impaired renal function, hyperkalemia, hypotension, and impaired hepatic function.

Special Population Usage

• Elderly patients may require a reduced initial dose. Patients with hepatic or renal impairment should be closely monitored, with specific dosage recommendations based on their condition. Patients pretreated with a diuretic may require appropriate adjustments.

Overdose Effects

• Overdosage may cause excessive peripheral vasodilatation, marked hypotension, shock, bradycardia, electrolyte disturbances, and renal failure. Management may include detoxification methods like gastric lavage, administration of adsorbents, sodium sulfate, and consideration of alpha-adrenergic agonists or angiotensin II administration.

Therapeutic Class

• Angiotensin-converting enzyme (ACE) inhibitors

Storage Conditions

• Store at 30°C or below, protect from light, and keep out of the reach of children. Do not use after the expiry date.

Indications

• Treatment of hypertension, congestive heart failure, patients who have demonstrated clinical signs of congestive heart failure after an acute myocardial infarction, non-diabetic or diabetic overt glomerular or incipient nephropathy, and reduction in the risk of myocardial infarction, stroke, or cardiovascular death in patients with increased cardiovascular risk.

Pharmacology

• An ACE inhibitor that blocks the conversion of angiotensin I to angiotensin II, resulting in decreased plasma angiotensin II, decreased vasopressor activity, and decreased aldosterone secretion. Exhibits antihypertensive, heart failure management, and risk reduction activities.

Dosage in Renal Impairment

• Recommended initial dose of 1.25 mg once daily for hypertension and renal impairment. For heart failure and renal impairment, the recommended dose is 1.25 mg once daily, with a possibility of increasing to 1.25 mg twice daily and up to a maximum of 2.5 mg twice daily depending upon clinical response and tolerability.

Drug Interactions

• Interactions with diuretics may lead to serious hypotension and dangerous hyperkalemia, while concomitant therapy with lithium may increase serum lithium concentration. Reduced blood pressure due to Ramicard may affect the ability to drive and operate machinery, exacerbated by alcohol consumption. NSAIDs may reduce the antihypertensive effect and cause deterioration of renal function.

Elderly Usage

• Elderly patients may require a reduced initial dose of 1.25 mg Ramicard daily.

Hepatic Impairment Usage

• Treatment in patients with hepatic impairment must be initiated under close medical supervision, with a maximum permitted daily dose of 2.5 mg Ramicard.

Renal Impairment Usage

• For patients with creatinine clearance between 50 and 20 ml/min per 1.73 m2 body surface area, the initial daily dose is generally 1.25 mg Ramicard, with a maximum permitted daily dose of 5 mg Ramicard.

Patients Pretreated with a Diuretic

• Consideration must be given to discontinuing the diuretic for at least 2 to 3 days, or at least reducing the diuretic dose, before starting treatment with Ramicard. The initial daily dose in patients previously treated with a diuretic is generally 1.25 mg Ramicard.

Overdose Symptoms

• Overdosage may cause excessive peripheral vasodilatation, marked hypotension, shock, bradycardia, electrolyte disturbances, and renal failure.

Overdose Management

• Primary detoxification may include methods like gastric lavage, administration of adsorbents, and sodium sulfate. Hypotension management may involve the administration of alpha-adrenergic agonists or angiotensin II.

Side Effects List

• Dizziness
• Headache
• Fatigue
• Asthenia
• Symptomatic hypotension
• Cough
• Nausea
• Vomiting
• Diarrhea
• Rash
• Urticaria
• Oliguria
• Anxiety
• Amnesia
• Angioneurotic edema
• Anaphylactic reactions
• Hyperkalemia

Contraindications List

• Hypersensitivity to ramipril or any other ACE inhibitor
• History of angioedema
• Concomitant use with sacubitril/valsartan therapy
• Haemodynamically relevant renal artery stenosis
• Hypotensive or haemodynamically unstable states
• Concomitant use with aliskiren-containing medicines in patients with diabetes or moderate to severe renal impairment
• Concomitant use with angiotensin II receptor antagonists (AIIRAs) in patients with diabetic nephropathy
• During pregnancy

Interaction Types

• Diuretics
• Lithium
• Blood Pressure
• NSAIDs
• Alcohol
• Extracorporeal Treatments

Special Population Types

• Elderly
• Hepatic impairment
• Renal impairment
• Patients pretreated with a diuretic

Overdose Effects Management

• Detoxification methods
• Hypotension management

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