RAMIPRIL

Indications & Dose:

Adult

Hypertension:

Initially 1.25 mg daily, increased at intervals of 1-2 weeks; usual range 2.5-5 mg once daily; max. 10 mg daily. Note. Discontinue diuretic for 2-3 days before and resume later if required; patients with renal impairment or congestive heart failure require initiation under close medical supervision in hospital; close medical supervision is also required for patients with hepatic impairment.

In CHF

Starting dose 1.5mg once daily. Increase gradually at intervals of 2-3 weeks to 5-10mg/day.

Prophylaxis after myocardial infarction (started in hospital 3 to 10 days after infarction), initially 2.5 mg twice daily, increased after 2 days to 5 mg twice daily; maintenance 2.5-5 mg twice daily.

Note: If initial 2.5 mg dose not tolerated, give 1.25 mg twice daily for 2 days before increasing to 2.5 mg twice daily or tolerated.

Children

Not recommended.

Contraindications:

Bilateral renal artery stenosis, hypersensitivity.

Side Effects:

CNS: Anxiety, dizziness, headache, insomnia, paresthesia

CV: Angina, hypotension, palpitations, postural hypotension, syncope (especially with 1st dose)

GI: Abdominal pain, constipation, impaired taste sensation, nausea, pancreatitis, vomiting

GU: Decreased libido, impotence, renal insufficienc

HEME: Agranulocytosis, neutropenia, thrombocytopenia

METAB: Hyperkalemia, hyponatrernia, hyperglycemia

MS: Arihralgia, arthritis, myalgia

RESP: Asthma, bronchitis, cough, dyspnea, sinusitis

SKIN: Angioedema, flushing, rash, sweating

Cautions:

Precautions:

Renal insufficiency (<30 ml/ min) hypotension (CHF, elderly, volume depletion— diuretics, dialysis, cirrhosis) aortic stenosis, hyperkalemia (potassium supplements, potassium-sparing diuretics, renal disease, diabetes), neutropenia (autoimmune diseases, collagen vascular, febrile illness, immunosuppressant drug therapy), proteinuria, renal artery stenosis, surgery/ anesthesia ( hypotension, correctable with fluids 

Interaction:

Drugs

Allopurinol: Predisposition to hypersensitivity reactions

A adrenergic Mockers: Exaggerated 1st dose hypotensive response

Aspirin: Reduced hemodynamic effects; Less likely with nonacetyIated salicylates

Azathioprine: Increased myelosuppression

Cyclosporine: Renal insufficiency

Insulin: Enhanced hypoglycemic response

Iron (parenteral): Increased risk of systemic reaction

Lithium: Increased risk of serious lithium toxicity

Loop diuretics: Initiation of ACE inhibitor therapy may cause hypotension and renal insufficiency

NSAIDs: Inhibition of the antihypertensive response to ACE inhibitors

Potassium, potassium-sparring diuretics: Increased risk for hyperkalemia

Trimethoprim: Additive risk of hyperkalemia, especially in patient predisposed to renal insufficiency

Warnings:

Adverse Effects:

Lactations:

AC inhibitors can cause fetal and neonatal morbidity and death when administered to pregnant women ; when pregnancy is detected, discontinue ACE inhibitors as soon as possible

Special Precautions:

Counselling:

Side Effects Or Adverse Reactions:

Patient And Carer Advice: