Generic
Hydrochlorothiazide + Ramipril
9 brands available in the market
At a glance
Hydrochlorothiazide + Ramipril combination is used for the treatment of mild to moderate hypertension in patients for whom combination therapy is appropriate.
Description
Hydrochlorothiazide + Ramipril is a combination medicine that helps control high blood pressure. Ramipril is an angiotensin-converting enzyme (ACE) inhibitor that reduces stress on the heart and relaxes blood vessels, allowing blood to flow more smoothly. Hydrochlorothiazide is a diuretic that removes extra water and electrolytes from the body. This combination is effective for treating hypertension and helps reduce the risk of future heart attacks and strokes. It is best taken in the morning with breakfast.
Indications
- Mild to moderate hypertension (high blood pressure) - in patients for whom combination therapy is appropriate
Therapeutic class
Combined antihypertensive preparations
Pharmacological class
ACE Inhibitor + Thiazide Diuretic
Pharmacology
Ramipril is an ACE inhibitor that after hydrolysis to ramiprilat, blocks the conversion of angiotensin I to the vasoconstrictor angiotensin II, decreasing plasma angiotensin II, vasopressor activity and aldosterone secretion. Hydrochlorothiazide inhibits Na+/Cl- reabsorption in the distal convoluted tubule, increasing sodium and chloride excretion, which reduces plasma volume and activates the renin-aldosterone system.
Mechanism of action
Ramipril inhibits ACE to prevent angiotensin II formation and relax blood vessels; Hydrochlorothiazide lowers blood pressure by removing excess water through distal tubule sodium reabsorption inhibition.
Dosage
Adult Dose (Oral):
- Initial: Ramipril 2.5 mg + HCTZ 12.5 mg (1 tablet) once daily
- May increase to max 4 tablets daily if needed
- Renal Impairment: CrCl 60-30 mL/min: Start with Ramipril 1.25 mg; may increase to 2.5 mg; then switch to combination
Hepatic Impairment: Caution is advised
Administration
Take this medicine in the dose and duration as advised by your doctor; swallow the whole tablet; may be taken with or without food; better to take at a fixed time; take in the morning with breakfast to avoid nighttime urination.
Missed dose
If you miss a dose, take it as soon as possible; if it is almost time for your next dose, skip the missed dose and follow regular schedule; do not double the dose.
Side effects
Common Side Effects:
- Nausea
- Indigestion
- Taste change
- Diarrhea
- Stomach pain
- Headache
- Dizziness
- Weakness
- Cough
- Decreased blood pressure
Ramipril: Persistent dry cough, angioedema, rash, pancreatitis, sinusitis, rhinitis, dizziness, fatigue, taste disturbance, bronchospasm, photosensitivity
Hydrochlorothiazide: Tachycardia, serum sickness, weight loss, maculopapular rash, acidosis
Precautions & warnings
Precautions:
- Hydrochlorothiazide + Ramipril may decrease alertness, affect vision or make you feel sleepy and dizzy; do not drive if these symptoms occur
- Take in the morning with breakfast to avoid getting up at night to urinate
- Inform doctor about any cough or throat irritation that doesn't go away
- May cause dehydration; drink plenty of fluids; inform doctor if extreme thirst, muscle weakness or very dry mouth develops
- May cause dizziness or sleepiness; get up slowly when rising from a sitting or lying position
- Regular monitoring of kidney function and electrolytes (especially potassium) is important
- Caution in hypertension, hypotension, surgery/anesthesia and hepatic impairment
Contraindications
Contraindications:
- Anuria
- Hypersensitivity
- History of angioedema
- Bilateral or unilateral renal artery stenosis
- Mitral stenosis, aortic stenosis
- Low blood pressure (hypotensive patients)
- Clinically relevant electrolyte disturbances (hypokalemia, hyponatremia, hypercalcemia)
Drug interactions
Drug Interactions:
- Alcohol, Barbiturates, Narcotics: May potentiate orthostatic hypotension
- Antidiabetic drugs: Dosage adjustment may be required
- Other antihypertensives: Additive effect
- Potassium-sparing diuretics: May cause severe hyperkalemia
- Lithium: May increase serum lithium concentration
- NSAIDs: May reduce antihypertensive effect and cause deterioration of renal function
- Cholestyramine & Colestipol: Reduced absorption
Food interactions
Food Interactions: Hydrochlorothiazide + Ramipril may cause excessive drowsiness with alcohol.
Use in pregnancy
Use in Pregnancy: Unsafe during pregnancy; ACE inhibitor exposure in mid or late pregnancy associated with oligohydramnios and neonatal hypotension with anuria or renal failure; avoid during pregnancy.
Use in lactation
Use in Lactation: Ramipril should not be used during lactation; thiazides appear in breast milk.
Pediatric use
Safety and efficacy not established in pediatric patients.
Geriatric use
Dose selection for elderly patients should be cautious, usually starting at the lower end of the dosing range.
Renal / hepatic impairment
Renal Impairment: CrCl 60-30 mL/min: Start with Ramipril 1.25 mg; may increase to 2.5 mg; then switch to combination; contraindicated in severe renal impairment.
Hepatic Impairment: Caution is advised.
Overdose effects
Overdose: Ramipril: Hypotension; treat with normal saline infusion. Hydrochlorothiazide: Electrolyte depletion (hypokalemia, hypochloremia) and dehydration; hypokalemia with digitalis may accentuate cardiac arrhythmias; symptomatic treatment.
Storage conditions
Store in a cool and dry place, protected from light.
Chemical structure
Hydrochlorothiazide + Ramipril