Hypace
Generic Name
hypace-5-mg-tablet
Manufacturer
Acme Pharmaceuticals (Hypothetical)
Country
Bangladesh
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| hypace 5 mg tablet | ৳ 8.00 | ৳ 80.00 |
Description
Overview of the medicine
Hypace 5 mg Tablet contains Ramipril, an ACE inhibitor used to treat high blood pressure, heart failure, and to reduce the risk of cardiovascular events like heart attack and stroke. It works by relaxing blood vessels, which lowers blood pressure and makes it easier for your heart to pump blood.
Uses & Indications
Dosage
Adults
Hypertension: Initial dose 2.5 mg once daily. Maintenance dose usually 2.5 mg to 10 mg once daily. Max 10 mg/day. Heart failure: Initial dose 1.25 mg once daily. Target dose 10 mg once daily, adjusted over weeks. Post-MI: Initial 2.5 mg twice daily, adjusted to 5 mg twice daily. Cardiovascular risk reduction: Initial 2.5 mg once daily, target 10 mg once daily.
Elderly
Initial dose 1.25 mg once daily. Dosage should be titrated carefully based on patient response and renal function.
Renal_impairment
For creatinine clearance 30-60 mL/min, initial dose 1.25 mg once daily, max 5 mg/day. For creatinine clearance <30 mL/min, initial dose 1.25 mg once daily, max 2.5 mg/day. Contraindicated in dialysis patients.
How to Take
Take Hypace 5 mg Tablet orally, usually once daily, with or without food. It should be swallowed whole with sufficient liquid. Do not chew or crush the tablet.
Mechanism of Action
Ramipril is a prodrug that is converted to its active metabolite, ramiprilat, in the liver. Ramiprilat competitively inhibits angiotensin-converting enzyme (ACE), preventing the conversion of angiotensin I to angiotensin II. Angiotensin II is a potent vasoconstrictor and stimulates aldosterone secretion, which leads to sodium and water retention. By inhibiting ACE, ramiprilat causes vasodilation, reduces peripheral vascular resistance, decreases aldosterone secretion, and lowers blood pressure. It also reduces cardiac preload and afterload.
Pharmacokinetics
Onset
Antihypertensive effect begins within 1-2 hours, peak effect within 3-6 hours.
Excretion
Primarily renal (approximately 60%) and hepatic/biliary excretion (approximately 40%) as metabolites. Renal impairment significantly prolongs elimination.
Half life
Ramipril has a short half-life (1-3 hours), but its active metabolite, ramiprilat, has an effective half-life of 13-17 hours due to extensive tissue binding.
Absorption
Well absorbed after oral administration, approximately 50-60%. Food may delay absorption but does not affect the extent. It is a prodrug rapidly hydrolyzed to ramiprilat.
Metabolism
Undergoes extensive hepatic metabolism, primarily by esterases, to its active metabolite ramiprilat and other inactive metabolites.
Side Effects
Contraindications
- Hypersensitivity to ramipril or any other ACE inhibitor, or to any of the excipients.
- History of angioedema (hereditary, idiopathic, or due to previous ACE inhibitor or ARB therapy).
- Concomitant use with sacubitril/valsartan.
- Bilateral renal artery stenosis or unilateral renal artery stenosis in a single functioning kidney.
- Pregnancy (especially second and third trimesters).
- Concomitant use with aliskiren-containing products in patients with diabetes mellitus or renal impairment (GFR <60 mL/min/1.73 m²).
Drug Interactions
Lithium
ACE inhibitors can increase serum lithium concentrations and enhance lithium toxicity. Monitor lithium levels.
Aliskiren
Concomitant use with aliskiren is contraindicated in patients with diabetes or renal impairment (GFR <60 mL/min/1.73 m²) due to increased risk of hypotension, hyperkalemia, and renal impairment.
Sacubitril/Valsartan
Contraindicated due to increased risk of angioedema. A washout period of 36 hours is required when switching between these drugs.
Diuretics and other antihypertensive agents
May lead to additive hypotensive effects. Close monitoring is recommended.
Non-steroidal anti-inflammatory drugs (NSAIDs)
May reduce the antihypertensive effect and increase the risk of renal impairment, especially in dehydrated or elderly patients.
Mammalian Target of Rapamycin (mTOR) Inhibitors (e.g., sirolimus, everolimus, temsirolimus)
Increased risk of angioedema.
Potassium-sparing diuretics, potassium supplements, or potassium-containing salt substitutes
Increased risk of hyperkalemia. Serum potassium should be monitored.
Storage
Store below 30°C in a cool, dry place. Protect from moisture and direct sunlight. Keep out of reach of children.
Overdose
Symptoms of overdose may include severe hypotension (low blood pressure), shock, bradycardia, electrolyte disturbances (hyperkalemia), and renal failure. Management involves symptomatic and supportive care. IV fluids to restore blood pressure, vasopressors if needed. Hemodialysis may be considered for active ramiprilat, but its utility is limited due to high protein binding.
Pregnancy & Lactation
Pregnancy: Hypace 5 mg Tablet is contraindicated during pregnancy, especially in the second and third trimesters, due to the risk of fetal injury and death. If pregnancy is detected, discontinue use immediately. Lactation: Not recommended during breastfeeding as ramipril and its metabolites may be excreted in human milk. Consult your doctor for alternative treatment.
Side Effects
Contraindications
- Hypersensitivity to ramipril or any other ACE inhibitor, or to any of the excipients.
- History of angioedema (hereditary, idiopathic, or due to previous ACE inhibitor or ARB therapy).
- Concomitant use with sacubitril/valsartan.
- Bilateral renal artery stenosis or unilateral renal artery stenosis in a single functioning kidney.
- Pregnancy (especially second and third trimesters).
- Concomitant use with aliskiren-containing products in patients with diabetes mellitus or renal impairment (GFR <60 mL/min/1.73 m²).
Drug Interactions
Lithium
ACE inhibitors can increase serum lithium concentrations and enhance lithium toxicity. Monitor lithium levels.
Aliskiren
Concomitant use with aliskiren is contraindicated in patients with diabetes or renal impairment (GFR <60 mL/min/1.73 m²) due to increased risk of hypotension, hyperkalemia, and renal impairment.
Sacubitril/Valsartan
Contraindicated due to increased risk of angioedema. A washout period of 36 hours is required when switching between these drugs.
Diuretics and other antihypertensive agents
May lead to additive hypotensive effects. Close monitoring is recommended.
Non-steroidal anti-inflammatory drugs (NSAIDs)
May reduce the antihypertensive effect and increase the risk of renal impairment, especially in dehydrated or elderly patients.
Mammalian Target of Rapamycin (mTOR) Inhibitors (e.g., sirolimus, everolimus, temsirolimus)
Increased risk of angioedema.
Potassium-sparing diuretics, potassium supplements, or potassium-containing salt substitutes
Increased risk of hyperkalemia. Serum potassium should be monitored.
Storage
Store below 30°C in a cool, dry place. Protect from moisture and direct sunlight. Keep out of reach of children.
Overdose
Symptoms of overdose may include severe hypotension (low blood pressure), shock, bradycardia, electrolyte disturbances (hyperkalemia), and renal failure. Management involves symptomatic and supportive care. IV fluids to restore blood pressure, vasopressors if needed. Hemodialysis may be considered for active ramiprilat, but its utility is limited due to high protein binding.
Pregnancy & Lactation
Pregnancy: Hypace 5 mg Tablet is contraindicated during pregnancy, especially in the second and third trimesters, due to the risk of fetal injury and death. If pregnancy is detected, discontinue use immediately. Lactation: Not recommended during breastfeeding as ramipril and its metabolites may be excreted in human milk. Consult your doctor for alternative treatment.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
Typically 24 to 36 months from the date of manufacture. Refer to the packaging for the exact expiry date.
Availability
Available in pharmacies nationwide
Approval Status
Approved by regulatory authorities
Patent Status
Off-patent (Generic versions available)
WHO Essential Medicine
YesClinical Trials
Ramipril has been extensively studied in numerous clinical trials, including major studies like the HOPE (Heart Outcomes Prevention Evaluation) trial, which demonstrated its efficacy in reducing cardiovascular events in high-risk patients. These trials have established ramipril's role in hypertension, heart failure, and cardiovascular risk reduction.
Lab Monitoring
- Blood pressure monitoring regularly.
- Renal function (serum creatinine and estimated GFR) before initiation and periodically during treatment.
- Serum potassium levels, especially in patients with renal impairment, diabetes, or those concurrently taking potassium-sparing diuretics.
- Complete blood count (CBC) to monitor for blood dyscrasias, especially in patients with collagen vascular disease or on concomitant immunosuppressant therapy.
Doctor Notes
- Counsel patients on the importance of adherence to therapy and potential side effects, particularly cough and angioedema.
- Monitor blood pressure, renal function, and serum potassium regularly, especially when initiating therapy or adjusting doses.
- Advise against concomitant use of potassium supplements or salt substitutes containing potassium.
- Consider alternative therapy for patients who develop persistent dry cough.
- Inform patients about the fetal toxicity risk and contraindication in pregnancy.
Patient Guidelines
- Take Hypace 5 mg Tablet exactly as prescribed by your doctor, usually once daily.
- Do not stop taking this medication abruptly without consulting your doctor, even if you feel well, as it can worsen your condition.
- Report any signs of swelling of the face, lips, tongue, or throat (angioedema) immediately to your doctor, and seek emergency medical attention.
- Inform your doctor about all other medications, supplements, and herbal products you are taking.
- Avoid potassium-containing salt substitutes or potassium supplements unless advised by your doctor.
Missed Dose Advice
If you miss a dose, take it as soon as you remember. However, if it is almost time for your next dose, skip the missed dose and resume your regular dosing schedule. Do not double the dose to catch up.
Driving Precautions
Hypace 5 mg Tablet may cause dizziness or lightheadedness, especially after the first dose or when the dose is increased. Exercise caution when driving or operating machinery until you know how this medication affects you.
Lifestyle Advice
- Adopt a healthy lifestyle including a low-sodium diet, regular exercise, and maintaining a healthy weight.
- Limit alcohol consumption as it can further lower blood pressure.
- Quit smoking to improve overall cardiovascular health.
- Monitor your blood pressure regularly at home, if advised by your doctor, and keep a record.
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