Ramil 5

Ramipril belongs to a group of medicines known as angiotensin converting enzyme (ACE) inhibitors. It is widely used to treat high blood pressure and heart failure and may be prescribed after a heart attack. It also lowers the chances of having a heart attack or stroke. Ramipril can be prescribed either alone or in combination with other medicines. It may be taken empty stomach or with a meal. This medicine should be taken at the same time each day to get the maximum benefit. It is important to continue taking it regularly even if you feel well or even if your blood pressure is controlled. Most people with high blood pressure do not feel any symptoms, but if you stop taking this medicine, your condition could get worse. This is a widely used medicine and is considered safe for long-term use. Making some changes in your lifestyle will also help lower your blood pressure. These may include regular exercise, losing weight, not smoking, reducing alcohol intake, and reducing the amount of salt in your diet as advised by your doctor. The most common side effects of this medicine include feeling dizzy or drowsy, headache, dry cough, fatigue, nausea, vomiting, diarrhea, stomach pain and low blood pressure. Most of these are temporary and resolve with time. Talk to your doctor if any of the side effects bother you or do not go away. Before taking this medicine, let your doctor know if you have any kidney or liver problems. Pregnant or breastfeeding mothers should also consult their doctor before taking it. Your doctor may check your kidney function, blood pressure and potassium levels in your blood at regular intervals while you are taking this medicine. Ramipril is an angiotensin converting enzyme (ACE) inhibitor. It works by reducing stress on the heart and relaxing blood vessel so that blood flows more smoothly and the heart can pump blood more efficiently.

• Hypertension (high blood pressure) • Prevention of heart attack and stroke • Heart failure

Ramipril, a prodrug of ramiprilat, competitively inhibits ACE from converting angiotensin I to angiotensin II (a potent vasoconstrictor) resulting in increased plasma renin activity and reduced aldosterone (a hormone that causes water and Na retention) secretion. This promotes vasodilation thus producing a hypotensive effect and a beneficial effect in CHF.

Adult Dose: Oral Hypertension, Diabetic Nephropathy Adult: Hypertension Initial (not on diuretic): 2.5 mg once daily at bedtime. Initial (with diuretic): 1.25 mg once daily at bedtime. Maintenance: 2.5-5 mg/day as a single dose, Max: 10 mg/day. Congestive Heart failure Adult: Initially, 1.25 mg once daily. Max: 10 mg daily. Doses >2.5 mg may be given in 2 divided doses. Max Dosage: 10 mg daily in 1-2 divided doses. Post myocardial infarction Adult: Initially, 2.5 mg bid, may increase to 5 mg bid after 2 days. Start treatment: 3-10 days after infarction. Maintenance: 2.5-5 mg bid. Prophylaxis of cardiovascular events in high-risk patients, Stroke Prevention Adult: Initially, 2.5 mg once daily, may increase to 5 mg once daily after 1 wk if tolerated. Maintenance: 10 mg once daily after a further 3 wk. Hepatic impairment: Max: 2.5 mg/day. Child Dose: Safety and efficacy not established Renal Dose: Renal impairment: CrCl (ml/min) Dosage Recommendation 10-30 Initially, 1.25 mg/day. Max: 5 mg/day. 30-60 Not necessary to adjust the initial dose. Max maintenance dose: 5 mg/day.

Take this medicine in the dose and duration as advised by your doctor. Swallow it as a whole. Do not chew, crush or break it. Ramipril may be taken with or without food, but it is better to take it at a fixed time.

If you miss a dose of Ramipril, skip it and continue with your normal schedule. Do not double the dose.

Common: • Decreased blood pressure • Dizziness • Fatigue • Vomiting • Dry cough

[UNSAFE] Ramipril may decrease alertness, affect your vision or make you feel sleepy and dizzy. Do not drive if these symptoms occur. Ramipril can make you feel dizzy for the first few days, so rise slowly if you have been sitting or lying down. You can also prefer taking it at bedtime to avoid dizziness throughout the day. Let your doctor know about any cough, or throat irritation that does not go away. It may increase the level of potassium in blood. Avoid taking potassium supplements and potassium-rich foods such as banana and broccoli. Inform your doctor if you are pregnant, planning pregnancy or breastfeeding.

Hypersensitivity, bilateral renal artery stenosis, or a single kidney with unilateral renal artery stenosis. Aortic stenosis or outflow tract obstruction. History of angioedema (hereditary, idiopathic or due to previous angioedema w/ ACE inhibitors). Pregnancy and lactation.

May enhance hypotensive effect w/ diuretics and other antihypertensives. May increase risk of renal function deterioration w/ NSAIDs. May increase serum levels and toxicity of lithum. May increase hyperkalaemic effect w/ K-sparing diuretics and supplements. Potentially Fatal: Concomitant use w/ aliskiren aliskiren may increase the risk of hyperkalaemia, hypotension and nephrotoxicity in patients w/ diabetes or renal impairment

[UNSAFE] Ramipril may cause excessive drowsiness with alcohol.

[CONSULT YOUR DOCTOR] Ramipril is unsafe to use during pregnancy as there is definite evidence of risk to the developing baby. However, the doctor may rarely prescribe it in some life-threatening situations if the benefits are more than the potential risks. Please consult your doctor.

[CONSULT YOUR DOCTOR] Ramipril is probably unsafe to use during breastfeeding. Limited human data suggests that the drug may pass into the breastmilk and harm the baby.

[CAUTION] Ramipril should be used with caution in patients with kidney disease. Dose adjustment of Ramipril may be needed. Please consult your doctor. Regular monitoring of blood pressure is recommended for dose adjustment. [CAUTION] Ramipril should be used with caution in patients with liver disease. Dose adjustment of Ramipril may be needed. Please consult your doctor. Inform your doctor if you develop any signs and symptoms of jaundice while taking this medicine.

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