Acecard
Generic Name
Ramipril
Manufacturer
Beximco Pharmaceuticals Ltd.
Country
Bangladesh
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| acecard 5 mg tablet | ৳ 8.00 | ৳ 80.00 |
Description
Overview of the medicine
Ramipril is an ACE inhibitor used to treat high blood pressure, congestive heart failure, and to reduce the risk of cardiovascular events such as heart attack and stroke.
Uses & Indications
Dosage
Adults
For hypertension, initial dose 2.5 mg once daily; usual maintenance dose 2.5 mg to 10 mg once daily. For heart failure, initial dose 1.25 mg once daily, titrating up to a maximum of 10 mg once daily. For cardiovascular risk reduction, initial dose 2.5 mg once daily, increasing to a maintenance dose of 10 mg once daily.
Elderly
Similar to adults, but starting with a lower dose (e.g., 1.25 mg) and titrating carefully due to potential for greater sensitivity and decreased renal function.
Renal_impairment
Adjust dose based on creatinine clearance. For creatinine clearance <30 mL/min, initial dose of 1.25 mg once daily and a maximum dose of 5 mg once daily is recommended.
How to Take
Acecard 5 mg Tablet should be taken orally, usually once daily, with or without food. It is recommended to take it at approximately the same time each day.
Mechanism of Action
Ramipril inhibits the angiotensin-converting enzyme (ACE), which is responsible for the conversion of angiotensin I to angiotensin II. Angiotensin II is a potent vasoconstrictor and stimulates aldosterone secretion. By inhibiting ACE, Ramipril leads to vasodilation, reduced peripheral vascular resistance, and decreased blood pressure.
Pharmacokinetics
Onset
Onset of antihypertensive effect is typically within 1-2 hours.
Excretion
Primarily eliminated via the kidneys (approximately 60%) and feces (approximately 40%) as metabolites and unchanged drug.
Half life
The effective half-life of ramiprilat is 13-17 hours after multiple doses.
Absorption
Rapidly absorbed after oral administration, with peak plasma concentrations reached within 1 hour. Ramipril is extensively metabolized to its active metabolite, ramiprilat. Bioavailability of ramiprilat is approximately 15-28%.
Metabolism
Ramipril is a prodrug and is extensively metabolized in the liver by esterases to its active metabolite, ramiprilat, and inactive diketopiperazine ester and acid.
Side Effects
Contraindications
- History of angioedema related to previous ACE inhibitor treatment
- Hereditary or idiopathic angioedema
- Concomitant use with aliskiren in patients with diabetes mellitus or moderate to severe renal impairment (GFR <60 mL/min/1.73m²)
- Pregnancy (especially second and third trimesters)
- Hypersensitivity to ramipril or any other ACE inhibitor, or to any of the excipients
Drug Interactions
Lithium
Increased serum lithium levels and lithium toxicity. Monitor lithium levels.
Aliskiren
Concomitant use contraindicated in patients with diabetes or renal impairment.
Diuretics
Increased hypotensive effect. Monitor blood pressure closely, especially after initial dose or dose increase of Ramipril.
Non-Steroidal Anti-inflammatory Drugs (NSAIDs)
Reduced antihypertensive effect and increased risk of renal impairment, especially in dehydrated or elderly patients.
Potassium-sparing diuretics/Potassium supplements/Salt substitutes containing potassium
Increased risk of hyperkalemia. Monitor serum potassium levels.
Mammalian Target of Rapamycin (mTOR) Inhibitors (e.g., sirolimus, everolimus, temsirolimus)
Increased risk of angioedema.
Storage
Store in a cool, dry place below 30°C, away from direct sunlight and moisture. Keep out of reach of children.
Overdose
Symptoms of overdose may include severe hypotension (low blood pressure), shock, bradycardia, electrolyte disturbances, and renal failure. Treatment is symptomatic and supportive. Intravenous fluid administration and vasopressors may be used to restore blood pressure. Hemodialysis may be considered for removal of ramiprilat from circulation.
Pregnancy & Lactation
Acecard is contraindicated during the second and third trimesters of pregnancy due to significant risk of fetal injury and death (Black Box Warning). It is not recommended during breastfeeding as ramiprilat may pass into breast milk.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
Typically 2-3 years from the date of manufacture, specific expiration date printed on the packaging.
Availability
Pharmacies nationwide
Approval Status
Approved by regulatory authorities (e.g., FDA, DGDA)
Patent Status
Generic available
WHO Essential Medicine
YesClinical Trials
Ramipril has been extensively studied in various clinical trials, including landmark studies like the Heart Outcomes Prevention Evaluation (HOPE) study, which demonstrated its efficacy in reducing cardiovascular events in high-risk patients. Other trials have supported its use in hypertension, heart failure, and diabetic nephropathy.
Lab Monitoring
- Serum creatinine and electrolytes (especially potassium) should be monitored regularly, particularly at the initiation of therapy, with dose changes, and in patients with renal impairment or heart failure.
- Blood pressure should be monitored regularly.
Doctor Notes
- Counsel patients regarding the common side effect of dry cough and emphasize that it is usually benign but should be reported if troublesome.
- Monitor renal function (creatinine, BUN) and serum electrolytes (especially potassium) periodically, particularly after initiation, dose titration, or in patients with pre-existing renal impairment.
- Advise patients to immediately report any signs of angioedema (e.g., swelling of face, lips, tongue, or throat) and discontinue the medication.
- Caution against concomitant use with potassium-sparing diuretics or potassium supplements unless serum potassium is closely monitored.
Patient Guidelines
- Take Acecard exactly as prescribed by your doctor. Do not stop taking it without consulting your doctor.
- Immediately report any signs of angioedema (swelling of the face, lips, tongue, or throat) and seek emergency medical attention.
- Avoid potassium supplements or salt substitutes containing potassium unless advised by your doctor.
- Inform your doctor if you are pregnant, planning to become pregnant, or breastfeeding.
Missed Dose Advice
If you miss a dose, take it as soon as you remember, unless it is almost time for your next dose. In that case, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one.
Driving Precautions
Acecard may cause dizziness or lightheadedness, especially at the start of treatment or when changing dose. If you experience these symptoms, avoid driving or operating machinery.
Lifestyle Advice
- Maintain a healthy lifestyle by adopting a balanced, low-sodium diet and engaging in regular physical activity.
- Limit alcohol consumption and avoid smoking, as these can negatively impact blood pressure and cardiovascular health.
- Regularly monitor your blood pressure at home as advised by your doctor.
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