Primace
Generic Name
Ramipril
Manufacturer
Square Pharmaceuticals Ltd.
Country
Bangladesh
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| primace 10 mg tablet | ৳ 12.00 | ৳ 120.00 |
Description
Overview of the medicine
Primace 10 mg Tablet contains Ramipril, an ACE inhibitor primarily used to treat high blood pressure, heart failure, and to reduce cardiovascular risk.
Uses & Indications
Dosage
Adults
Hypertension: Initial 2.5 mg once daily, adjusted to 5-10 mg daily. Max 10 mg/day. Heart failure: Initial 1.25 mg once daily, adjusted up to 10 mg daily. Post-MI: Initial 2.5 mg twice daily. Diabetic Nephropathy: Initial 1.25-2.5 mg once daily, up to 10 mg daily.
Elderly
Lower initial doses (e.g., 1.25 mg once daily) may be considered, with careful titration, especially in those with impaired renal function.
Renal_impairment
Dosage adjustment required. For CrCl <30 mL/min, initial dose 1.25 mg once daily, max 5 mg/day. Contraindicated in severe renal artery stenosis.
How to Take
Administer orally once daily, with or without food. Swallow the tablet whole with a glass of water. Do not chew or crush.
Mechanism of Action
Ramipril inhibits the Angiotensin-Converting Enzyme (ACE), preventing the conversion of angiotensin I to angiotensin II. This leads to vasodilation, reduced aldosterone secretion, and decreased blood pressure.
Pharmacokinetics
Onset
1-2 hours for antihypertensive effect
Excretion
Primarily excreted via the kidneys (approximately 60% of dose) and through bile (approximately 40% of dose).
Half life
Ramiprilat has a prolonged effective half-life of 13-17 hours, allowing for once-daily dosing.
Absorption
Well absorbed after oral administration, with peak plasma concentrations occurring within 1 hour. Bioavailability is approximately 28% for Ramiprilat (active metabolite).
Metabolism
Extensively metabolized in the liver to its active metabolite, ramiprilat, and other inactive metabolites.
Side Effects
Contraindications
- History of angioedema related to previous ACE inhibitor treatment
- Hereditary or idiopathic angioedema
- Concomitant use with aliskiren in patients with diabetes or renal impairment
- Pregnancy (second and third trimesters)
- Bilateral renal artery stenosis
- Hypersensitivity to ramipril or any other ACE inhibitor
Drug Interactions
NSAIDs
Reduced antihypertensive effect; increased risk of renal impairment.
Lithium
Increased serum lithium concentrations and toxicity. Monitor lithium levels.
Aliskiren
Contraindicated in diabetes or renal impairment (CrCl < 60 mL/min) due to increased risk of hyperkalemia, hypotension, and renal impairment.
Diuretics
Increased hypotensive effect. Monitor blood pressure and renal function.
Potassium-sparing diuretics/Potassium supplements
Increased risk of hyperkalemia. Monitor serum potassium.
Storage
Store below 30°C in a dry place, away from light and moisture. Keep out of reach of children.
Overdose
Symptoms include severe hypotension, shock, bradycardia, electrolyte disturbances, and renal failure. Treatment is symptomatic and supportive; includes intravenous fluids for hypotension.
Pregnancy & Lactation
Category D in 2nd/3rd trimesters (fetal toxicity, renal dysfunction, mortality). Discontinue immediately if pregnancy is detected. Not recommended during breastfeeding due to potential risks to the infant.
Side Effects
Contraindications
- History of angioedema related to previous ACE inhibitor treatment
- Hereditary or idiopathic angioedema
- Concomitant use with aliskiren in patients with diabetes or renal impairment
- Pregnancy (second and third trimesters)
- Bilateral renal artery stenosis
- Hypersensitivity to ramipril or any other ACE inhibitor
Drug Interactions
NSAIDs
Reduced antihypertensive effect; increased risk of renal impairment.
Lithium
Increased serum lithium concentrations and toxicity. Monitor lithium levels.
Aliskiren
Contraindicated in diabetes or renal impairment (CrCl < 60 mL/min) due to increased risk of hyperkalemia, hypotension, and renal impairment.
Diuretics
Increased hypotensive effect. Monitor blood pressure and renal function.
Potassium-sparing diuretics/Potassium supplements
Increased risk of hyperkalemia. Monitor serum potassium.
Storage
Store below 30°C in a dry place, away from light and moisture. Keep out of reach of children.
Overdose
Symptoms include severe hypotension, shock, bradycardia, electrolyte disturbances, and renal failure. Treatment is symptomatic and supportive; includes intravenous fluids for hypotension.
Pregnancy & Lactation
Category D in 2nd/3rd trimesters (fetal toxicity, renal dysfunction, mortality). Discontinue immediately if pregnancy is detected. Not recommended during breastfeeding due to potential risks to the infant.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
Typically 2-3 years from the manufacturing date, check specific packaging for details.
Availability
Available in pharmacies worldwide
Approval Status
Approved by major regulatory authorities
Patent Status
Generic available, original patent expired
WHO Essential Medicine
YesClinical Trials
Extensive clinical trials (e.g., HOPE study, REIN study) have demonstrated Ramipril's efficacy in reducing cardiovascular events and mortality in high-risk patients, and in slowing the progression of renal disease.
Lab Monitoring
- Serum creatinine and BUN (before treatment and periodically during treatment)
- Serum potassium (before treatment and periodically during treatment)
- Complete blood count (periodically)
Doctor Notes
- Counsel patients on potential for dry cough and orthostatic hypotension.
- Monitor renal function and electrolytes regularly, especially in elderly or patients with pre-existing renal impairment.
- Advise patients to report angioedema symptoms immediately.
- Avoid in pregnancy due to fetal toxicity, switch to alternative antihypertensive if pregnancy occurs.
- Avoid concomitant use with ARBs or Aliskiren, particularly in diabetic or renal impaired patients.
Patient Guidelines
- Take exactly as prescribed by your doctor.
- Do not stop taking this medicine without consulting your doctor.
- Avoid potassium supplements or salt substitutes containing potassium without medical advice.
- Report any signs of swelling of the face, lips, tongue, or throat immediately.
Missed Dose Advice
If you miss a dose, take it as soon as you remember, unless it is almost time for your next dose. Do not double the dose to catch up.
Driving Precautions
May cause dizziness, especially after the first dose or when the dose is increased. Exercise caution when driving or operating machinery.
Lifestyle Advice
- Maintain a healthy diet low in sodium.
- Engage in regular physical activity.
- Avoid smoking and excessive alcohol consumption.
- Monitor blood pressure regularly at home if advised by your doctor.
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