Primace
Generic Name
Ramipril
Manufacturer
Sanofi
Country
Global (originally Germany)
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| primace 25 mg tablet | ৳ 5.00 | ৳ 50.00 |
Description
Overview of the medicine
Primace 25 mg Tablet contains Ramipril, an ACE inhibitor used to treat high blood pressure (hypertension), heart failure, and to reduce the risk of heart attack or stroke in high-risk patients. It works by relaxing blood vessels, which allows blood to flow more easily.
Uses & Indications
Dosage
Adults
Hypertension: Initially 2.5 mg once daily, adjusted based on response. Usual maintenance dose is 2.5-10 mg daily. For 25 mg strength, typically not used for initial or maintenance therapy. Use of 25 mg must be under strict medical supervision due to potential for severe hypotension. Heart Failure: Initially 1.25 mg once daily, titrated up to a maximum of 10 mg daily. Post-MI Heart Failure: Initially 2.5 mg twice daily, adjusted based on tolerability. Reduction of Cardiovascular Risk: Initially 2.5 mg once daily, increasing to 10 mg once daily.
Elderly
Lower initial doses (e.g., 1.25 mg once daily) may be considered, particularly in those with renal impairment, with careful titration.
Renal_impairment
Initial dose should be reduced (e.g., 1.25 mg once daily) in patients with creatinine clearance <60 mL/min/1.73m². Maximum dose should be adjusted based on the degree of impairment. Use of 25 mg strength is generally not recommended in renal impairment.
How to Take
Take orally, usually once daily, with or without food. Swallow the tablet whole with a sufficient amount of liquid. Do not chew or crush.
Mechanism of Action
Ramipril is an ACE inhibitor. It works by inhibiting the angiotensin-converting enzyme (ACE), which prevents the conversion of angiotensin I to angiotensin II. Angiotensin II is a potent vasoconstrictor, and its reduction leads to vasodilation, decreased peripheral vascular resistance, and reduced blood pressure. It also decreases aldosterone secretion, leading to reduced sodium and water retention.
Pharmacokinetics
Onset
Onset of action within 1-2 hours; maximal effect within 3-6 hours.
Excretion
Primarily excreted via the kidneys (approx. 60% as metabolites and unchanged drug), with some fecal excretion.
Half life
Effective half-life of ramiprilat is 13-17 hours, longer with chronic dosing.
Absorption
Rapidly absorbed after oral administration, peak plasma concentrations of ramiprilat (active metabolite) are reached within 2-4 hours. Bioavailability is about 28% for ramiprilat.
Metabolism
Extensively metabolized in the liver to its active metabolite ramiprilat, and inactive diketopiperazine ester and acid.
Side Effects
Contraindications
- History of angioedema related to previous ACE inhibitor therapy
- Hereditary or idiopathic angioedema
- Concomitant use with aliskiren in patients with diabetes mellitus or renal impairment
- Pregnancy (especially second and third trimesters)
- Bilateral renal artery stenosis or severe unilateral renal artery stenosis in a single functioning kidney
- Hypersensitivity to ramipril or any other ACE inhibitor or excipients
Drug Interactions
NSAIDs
May reduce antihypertensive effect and increase risk of renal impairment.
Lithium
Increased serum lithium concentrations and toxicity.
Aliskiren
Contraindicated in patients with diabetes or renal impairment (eGFR <60 ml/min/1.73 m2).
Diuretics
Increased risk of hypotensive effects, especially with initial dose.
Dual blockade of RAAS
Increased risk of hypotension, hyperkalemia, and renal function changes with other RAAS inhibitors (e.g., ARBs) compared to monotherapy.
Potassium-sparing diuretics/Potassium supplements
Increased risk of hyperkalemia.
Storage
Store below 30°C in a dry place, away from light and moisture. Keep out of reach of children.
Overdose
Symptoms: Severe hypotension, shock, bradycardia, electrolyte disturbances, renal failure. Management: Symptomatic and supportive treatment. If recent ingestion, gastric lavage and administration of activated charcoal. Hypotension can be treated with IV fluids and vasopressors. Hemodialysis is effective in removing ramiprilat.
Pregnancy & Lactation
Pregnancy: Category D (based on fetal toxicity). Should be discontinued as soon as pregnancy is detected due to risk of fetal injury and death. Lactation: Ramipril and its metabolites are excreted in human milk in very small amounts. Caution should be exercised when Primace is administered to a nursing woman.
Side Effects
Contraindications
- History of angioedema related to previous ACE inhibitor therapy
- Hereditary or idiopathic angioedema
- Concomitant use with aliskiren in patients with diabetes mellitus or renal impairment
- Pregnancy (especially second and third trimesters)
- Bilateral renal artery stenosis or severe unilateral renal artery stenosis in a single functioning kidney
- Hypersensitivity to ramipril or any other ACE inhibitor or excipients
Drug Interactions
NSAIDs
May reduce antihypertensive effect and increase risk of renal impairment.
Lithium
Increased serum lithium concentrations and toxicity.
Aliskiren
Contraindicated in patients with diabetes or renal impairment (eGFR <60 ml/min/1.73 m2).
Diuretics
Increased risk of hypotensive effects, especially with initial dose.
Dual blockade of RAAS
Increased risk of hypotension, hyperkalemia, and renal function changes with other RAAS inhibitors (e.g., ARBs) compared to monotherapy.
Potassium-sparing diuretics/Potassium supplements
Increased risk of hyperkalemia.
Storage
Store below 30°C in a dry place, away from light and moisture. Keep out of reach of children.
Overdose
Symptoms: Severe hypotension, shock, bradycardia, electrolyte disturbances, renal failure. Management: Symptomatic and supportive treatment. If recent ingestion, gastric lavage and administration of activated charcoal. Hypotension can be treated with IV fluids and vasopressors. Hemodialysis is effective in removing ramiprilat.
Pregnancy & Lactation
Pregnancy: Category D (based on fetal toxicity). Should be discontinued as soon as pregnancy is detected due to risk of fetal injury and death. Lactation: Ramipril and its metabolites are excreted in human milk in very small amounts. Caution should be exercised when Primace is administered to a nursing woman.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
Typically 24-36 months from the date of manufacture, specific to manufacturer and formulation.
Availability
Pharmacies, hospitals
Approval Status
Approved by major regulatory bodies (e.g., FDA, EMA)
Patent Status
Generic available (original patent expired)
WHO Essential Medicine
YesClinical Trials
Ramipril has been extensively studied in large-scale clinical trials (e.g., HOPE trial) demonstrating its efficacy in reducing cardiovascular events in high-risk patients and in the treatment of hypertension and heart failure.
Lab Monitoring
- Serum creatinine
- Blood urea nitrogen (BUN)
- Serum potassium
- Liver function tests
- Complete blood count (periodically)
Doctor Notes
- Ramipril 25 mg is an unusually high dose. Verify the brand and generic if this strength is encountered. Standard maximum daily dose is typically 10 mg.
- Monitor renal function and serum potassium regularly, especially in patients with pre-existing renal impairment or those on diuretics/potassium supplements.
- Educate patients on symptoms of angioedema and advise immediate medical attention if they occur.
- Counsel on adherence, as withdrawal can lead to rebound hypertension.
Patient Guidelines
- Take your medicine at the same time each day.
- Do not stop taking this medicine without consulting your doctor.
- Avoid sudden changes in position to prevent dizziness.
- Report any symptoms like swelling of face, lips, tongue, or throat immediately.
- Limit alcohol consumption.
- Inform your doctor about all other medications you are taking.
Missed Dose Advice
If a dose is missed, take it as soon as you remember. If it is almost time for your next dose, 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
May cause dizziness or fatigue, especially at the start of treatment or when the dose is increased. Patients should be cautioned about operating machinery or driving until they know how Primace affects them.
Lifestyle Advice
- Adopt a healthy diet low in sodium and saturated fats.
- Engage in regular physical activity.
- Maintain a healthy weight.
- Quit smoking and limit alcohol intake.
- Manage stress effectively.
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