Ramipril 1.25 mg Tablet

What is Ramoril?

Ramoril contains Ramipril, an angiotensin-converting enzyme (ACE) inhibitor that lowers blood pressure and reduces cardiovascular risk. It is long-acting and well tolerated, making it suitable for long-term therapy in hypertension and heart failure.

Indications

Ramoril is indicated for hypertension (as monotherapy or combined with other antihypertensives), congestive heart failure (also with diuretics), post-myocardial infarction heart failure, diabetic or non-diabetic nephropathy, and reduction of risk of myocardial infarction, stroke, or cardiovascular death in patients with increased cardiovascular risk.

Pharmacology

Ramipril is hydrolyzed to ramiprilat, which blocks the conversion of angiotensin I to angiotensin II, decreasing vasopressor activity and aldosterone secretion. This produces antihypertensive effects and benefits in heart failure and cardiovascular risk reduction.

Dosage & Administration

Hypertension: Initial dose 1.25-2.5 mg once daily, adjusted at 2-week intervals; usual maintenance 2.5-20 mg daily.
CHF after MI: Initiate as early as 2 days post-MI, 2.5 mg twice daily (reduce to 1.25 mg twice daily if hypotension), titrated to 5 mg twice daily.
Cardiovascular risk reduction: 2.5 mg once daily for week 1, 5 mg once daily for next 3 weeks, then up to 10 mg once daily.
Renal impairment: Initial dose 1.25 mg once daily, maximum 5 mg daily (hypertension) or 2.5 mg twice daily (heart failure).
Tablets should be swallowed with sufficient liquid; not chewed or crushed. May be taken before, during, or after meals.

Interaction

Concomitant diuretics may cause serious hypotension and, with potassium-sparing diuretics, dangerous hyperkalaemia. Lithium levels may increase. NSAIDs may reduce antihypertensive effect and worsen renal function. Alcohol may exacerbate effects on driving ability.

Contraindications

Hypersensitivity to ramipril or other ACE inhibitors; history of angioedema; concomitant use with sacubitril/valsartan; haemodynamically relevant renal artery stenosis; hypotensive or haemodynamically unstable states; concomitant aliskiren in diabetic or renally impaired patients; concomitant angiotensin II receptor antagonists in diabetic nephropathy; pregnancy.

Side Effects

Generally well tolerated. Commonly: dizziness, headache, fatigue, asthenia. Less frequently: symptomatic hypotension, cough, nausea, vomiting, diarrhoea, rash, urticaria, oliguria, anxiety, amnesia. Rarely: angioneurotic oedema, anaphylactic reactions, hyperkalaemia.

Pregnancy & Lactation

Contraindicated during pregnancy; pregnancy must be excluded before starting treatment and avoided during therapy. If pregnancy occurs, switch to an alternative regimen without ACE inhibitors promptly. Not recommended during breastfeeding.

Precautions & Warnings

Use with caution in impaired renal function, hyperkalaemia, hypotension, and impaired hepatic function. Elderly patients and those previously on diuretics should start at a reduced dose (1.25 mg daily).

Therapeutic Class

Angiotensin-converting enzyme (ACE) inhibitors.

Storage Conditions

Store at 30°C or below, protect from light. Keep out of the reach of children.