Ramipril

GENERIC NAME: ramipril

DRUG CLASS AND MECHANISM
Ramipril belongs in a class of drugs called angiotensin converting enzyme (ACE) inhibitors. ACE inhibitors are used for treating high blood pressure, heart failure and for preventing kidney failure due to high blood pressure and diabetes. Other ACE inhibitors are enalapril (Vasotec), quinapril (Accupril), captopril (Capoten), fosinopril (Monopril), benazepril (Lotensin), lisinopril (Zestril, Prinivil), moexipril (Univasc) and trandolapril (Mavik).

ACE is important because it is an enzyme responsible for producing the chemical, angiotensin II. Angiotensin II causes muscles in most arteries, including the arteries of the heart, to contract, thereby narrowing the arteries and elevating blood pressure. ACE inhibitors such as ramipril lower blood pressure by reducing the production of angiotensin II, thereby relaxing arterial muscle and enlarging arteries. When the blood pressure is lower, the heart - including the failing heart - does not have to work as hard to pump blood. The arteries supplying the heart with blood also enlarge during treatment with ACE inhibitors. This increases the flow of blood and oxygen to the heart, further improving the ability of the heart to pump blood.

The effects of ACE inhibitors are particularly beneficial to people with congestive heart failure. In the kidneys, the narrowing of the arteries by angiotensin II decreases blood flow. ACE inhibitors enlarge and reduce the blood pressure in the arteries going to the kidney. This reduces damage to the kidneys caused by high blood pressure. The FDA approved ramipril in 1991.

PRESCRIPTION: Yes

GENERIC AVAILABLE: Yes

PREPARATIONS: Capsules or tablets: 1.25, 2.5, 5 and 10 mg

PRESCRIBED FOR
Ramipril is used for the treatment of congestive heart failure (CHF) and hypertension (high blood pressure). Ramipril also prevents heart attacks, strokes and deaths due to heart disease in patients who have risk factors for such events. After a heart attack, ramipril reduces progression to severe or resistant heart failure, hospitalization related to heart failure, and heart disease-related death. Like other ACE inhibitors, ramipril may slow the progression of kidney failure in patients with hypertension or diabetes by reducing the damage to the kidneys caused by high blood pressure.

DOSING
The usual dose of ramipril is 2.5-20 mg a day as a single dose or two divided doses. Patients taking diuretics or who have renal artery stenosis (narrowing of the arteries going to the kidney) may require lower doses.

DRUG INTERACTIONS
The use of ACE inhibitors with potassium supplements, salt substitutes or diuretics [for example, spironolactone (Aldactone) that increase potassium in the blood may lead to excessive potassium levels. Potassium levels should be monitored whenever ACE inhibitors are used in combination with these drugs.

There have been reports of increased lithium (Eskalith, Lithobid) levels when lithium is used in combination with ACE inhibitors. The reason for this interaction is not known.

There have been reports that aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen (Advil, Children's Advil/Motrin, Medipren, Motrin, Nuprin, PediaCare Fever etc), indomethacin (Indocin, Indocin-SR), and naproxen (Anaprox, Naprelan, Naprosyn, Aleve) may reduce the effects of ACE inhibitors.

USES
This drug belongs to a group of medications called ACE inhibitors. It is used to treat high blood pressure (hypertension). It works by relaxing blood vessels, causing them to widen. Lowering high blood pressure helps prevent strokes, heart attacks and kidney problems.This medication is also used to prevent heart problems (such as heart attacks) and/or strokes in certain high risk patients, and with other drugs (e.g., "water pills"/diuretics, digoxin) to treat congestive heart failure.OTHER This section contains uses of this drug that are not listed in the approved professional labeling for the drug but that may be prescribed by your health care professional. Use this drug for a condition that is listed in this section only if it has been so prescribed by your health care professional.This medication may also be used to help protect the kidneys from damage due to diabetes.

HOW TO USE
Take this medication by mouth, usually once or twice a day; or as directed by your doctor. You may take this drug with or without food. Use this medication regularly in order to get the most benefit from it. Remember to use it at the same time(s) each day.Swallow the capsule form whole. If you cannot swallow the capsule, open it and sprinkle the contents on a small amount (4 ounces) of applesauce or mix with apple juice or water. Swallow or drink the entire mixture.Do not take potassium supplements or salt substitutes containing potassium without talking to your doctor or pharmacist first. This medicine can raise your potassium levels, which rarely can cause serious side effects such as muscle weakness or very slow heartbeats. Tell your doctor immediately if these effects occur.The dosage is based on your medical condition and response to therapy. For the treatment of high blood pressure, it may take several weeks before the full benefit of this drug occurs or several weeks to months when used for congestive heart failure.It is important to continue taking this medication even if you feel well. Most people with high blood pressure do not feel sick.

SIDE EFFECTS
You may experience dizziness, light-headedness, fatigue, nausea, vomiting, diarrhea, dry cough or blurred vision as your body adjusts to the medication. If any of these effects persist or worsen, notify your doctor or pharmacist promptly.Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor immediately if any of these unlikely but serious side effects occur: fainting, decreased sexual ability.Tell your doctor immediately if any of these highly unlikely but very serious side effects occur: change in the amount of urine, signs of infection (e.g., fever, chills, persistent sore throat).This drug may rarely cause serious (possibly fatal) liver problems. If you notice any of the following highly unlikely but very serious side effects, seek immediate medical attention: yellowing eyes or skin, dark urine, stomach/abdominal pain, persistent fatigue, persistent nausea.A serious allergic reaction to this drug is unlikely, but seek immediate medical attention if it occurs. Symptoms of a serious allergic reaction include: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

PRECAUTIONS
Before taking ramipril, tell your doctor or pharmacist if you are allergic to it; or to other ACE inhibitors (e.g., benazepril, captopril); or if you have any other allergies (including an allergic reaction after exposure to certain membranes used for blood filtering).This medication should not be used if you have certain medical conditions. Before using this medicine, consult your doctor or pharmacist if you have: history of an allergic reaction which included swelling of the face/lips/tongue/throat (angioedema).Before using this medication, tell your doctor or pharmacist your medical history, especially of: kidney disease, liver disease, high blood levels of potassium, severe dehydration (and loss of electrolytes such as sodium), blood vessel disease (e.g., collagen vascular diseases such as lupus, scleroderma).This drug may make you dizzy. Do not drive, use machinery, or do any activity that requires alertness until you are sure you can perform such activities safely. Limit alcoholic beverages.To minimize dizziness and light-headedness due to lowering of your blood pressure, get up slowly when rising from a seated or lying position. Serious loss of body fluids can also lower your blood pressure and worsen dizziness. Drink adequate fluids to prevent from becoming dehydrated. If you are on restricted fluid intake, consult your doctor for further instructions. Be careful not to become too overheated during exercise which can lead to excessive sweating. Consult your doctor if you experience severe vomiting or diarrhea.Before having surgery, tell your doctor or dentist that you are taking this medication.Caution is advised when using this drug in the elderly because they may be more sensitive to its effects, especially dizziness.This medication is not recommended for use during pregnancy due to the risk for harm to an unborn baby. Consult your doctor for more details. (See also Warning section.)It is not known if this drug passes into breast milk. Breast-feeding is not recommended due to the potential harm to the nursing infant. Consult your doctor before breast-feeding.

DRUG INTERACTIONS
Your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with them first.Before using this medication, tell your doctor or pharmacist of all prescription and nonprescription products you may use, especially of: drugs that suppress the immune system (e.g., azathioprine), lithium, non-steroidal anti-inflammatory drugs (NSAIDs such as celecoxib, ibuprofen, indomethacin), potassium-sparing "water pills" (diuretics such as amiloride, spironolactone, triamterene), potassium supplements (e.g., potassium chloride) or salt substitutes, telmisartan, trimethoprim-containing medications (e.g., sulfamethoxazole/trimethoprim), gold injections.A very serious reaction may occur if you are getting injections for bee/wasp sting allergy (desensitization) and are also taking ramipril. Make sure all your doctors know which medicines you are using.Check the labels on all your medicines (e.g., cough-and-cold products, diet aids) because they may contain ingredients that could increase your heart rate or blood pressure. Ask your pharmacist about the safe use of those products.This document does not contain all possible interactions. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share the list with your doctor and pharmacist.

OVERDOSE
If overdose is suspected, contact your local poison control center or emergency room immediately. US residents can call the US national poison hotline at 1-800-222-1222. Canadian residents should call their local poison control center directly. Symptoms of overdose may include: unusually fast or slow heartbeat, severe dizziness, fainting.

MISSED DOSE
If you miss a dose, use it as soon as you remember. If it is near the time of the next dose, skip the missed dose and resume your usual dosing schedule. Do not double the dose to catch up.

STORAGE
Store at room temperature between 59-86 degrees F (15-30 degrees C) away from light and moisture. Do not store in the bathroom. If you have opened the capsule form and mixed it with food or liquid, this mixture can be kept at room temperature for 24 hours or refrigerated for 48 hours. Keep all medicines away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.MEDICAL ALERT: Your condition can cause complications in a medical emergency. For enrollment information call MedicAlert at 1-800-854-1166 (USA) or 1-800-668-1507 (Canada).

WARNING: This drug can cause serious (possibly fatal) harm to an unborn baby if used during pregnancy. Therefore, it is important to prevent pregnancy while taking this medication. Consult your doctor for more details and to discuss the use of reliable forms of birth control while taking this medication. If you are planning pregnancy, become pregnant, or think you may be pregnant, contact your doctor immediately.



Note : This product information is intended only for residents of the India. Taj Pharmaceuticals Limited, medicines help to treat and prevent a range of conditions—from the most common to the most challenging—for people around the world.