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 5 mg capsule | ৳ 8.00 | ৳ 80.00 |
Description
Overview of the medicine
Primace 5 mg capsule contains Ramipril, an angiotensin-converting enzyme (ACE) inhibitor, used primarily to treat high blood pressure and heart failure, and to reduce the risk of heart attack, stroke, and death in patients at high cardiovascular risk.
Uses & Indications
Dosage
Adults
Initial dose 2.5 mg once daily; usual maintenance dose 2.5-10 mg once daily. Max 10 mg/day. Dosing should be individualized based on patient response.
Elderly
Lower initial doses (e.g., 1.25 mg once daily) may be considered, with careful titration.
Renal_impairment
For creatinine clearance <30 mL/min, initial dose 1.25 mg once daily. Max dose 5 mg/day. Not recommended for hemodialysis patients.
How to Take
Primace capsules should be swallowed whole with a sufficient amount of liquid, 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), preventing the conversion of angiotensin I to angiotensin II. Angiotensin II is a potent vasoconstrictor and stimulates aldosterone secretion. By reducing angiotensin II levels, Ramipril causes vasodilation, decreases peripheral vascular resistance, and reduces sodium and water retention, leading to a decrease in blood pressure.
Pharmacokinetics
Onset
1-2 hours
Excretion
Mainly renal, with about 60% of the dose excreted in urine and 40% in feces, primarily as metabolites.
Half life
Ramipril: 1-2 hours; Ramiprilat: 13-17 hours (functional half-life due to tight ACE binding)
Absorption
Rapidly absorbed after oral administration. Peak plasma concentrations are reached within 1 hour for Ramipril and 2-4 hours for its active metabolite, Ramiprilat. Bioavailability is about 28% for Ramipril and higher for Ramiprilat.
Metabolism
Primarily hepatic hydrolysis to its active metabolite, Ramiprilat, and other inactive metabolites.
Side Effects
Contraindications
- Hypersensitivity to Ramipril or any other ACE inhibitor or excipients
- History of angioedema related to previous ACE inhibitor therapy
- Hereditary or idiopathic angioedema
- Second and third trimesters of pregnancy
- Bilateral renal artery stenosis or unilateral stenosis in a single functioning kidney
- Concomitant use with aliskiren in patients with diabetes or renal impairment
Drug Interactions
NSAIDs
May reduce antihypertensive effect and increase risk of renal impairment, hyperkalemia.
Lithium
Increased serum lithium levels and lithium toxicity.
Aliskiren
Contraindicated in diabetic or renally impaired patients due to increased risk of renal impairment, hyperkalemia, and hypotension.
Diuretics
Increased hypotensive effect, risk of severe hypotension.
mTOR inhibitors (e.g., everolimus, sirolimus)
Increased risk of angioedema.
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 may include severe hypotension, shock, bradycardia, electrolyte disturbances, and renal failure. Treatment is primarily symptomatic and supportive, including IV fluid expansion for hypotension and vasopressors if needed. Hemodialysis is not effective for removing Ramiprilat.
Pregnancy & Lactation
Contraindicated during the second and third trimesters of pregnancy due to fetal toxicity. Not recommended during the first trimester. Use in breastfeeding mothers is not recommended due to potential excretion into breast milk and adverse effects on the infant.
Side Effects
Contraindications
- Hypersensitivity to Ramipril or any other ACE inhibitor or excipients
- History of angioedema related to previous ACE inhibitor therapy
- Hereditary or idiopathic angioedema
- Second and third trimesters of pregnancy
- Bilateral renal artery stenosis or unilateral stenosis in a single functioning kidney
- Concomitant use with aliskiren in patients with diabetes or renal impairment
Drug Interactions
NSAIDs
May reduce antihypertensive effect and increase risk of renal impairment, hyperkalemia.
Lithium
Increased serum lithium levels and lithium toxicity.
Aliskiren
Contraindicated in diabetic or renally impaired patients due to increased risk of renal impairment, hyperkalemia, and hypotension.
Diuretics
Increased hypotensive effect, risk of severe hypotension.
mTOR inhibitors (e.g., everolimus, sirolimus)
Increased risk of angioedema.
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 may include severe hypotension, shock, bradycardia, electrolyte disturbances, and renal failure. Treatment is primarily symptomatic and supportive, including IV fluid expansion for hypotension and vasopressors if needed. Hemodialysis is not effective for removing Ramiprilat.
Pregnancy & Lactation
Contraindicated during the second and third trimesters of pregnancy due to fetal toxicity. Not recommended during the first trimester. Use in breastfeeding mothers is not recommended due to potential excretion into breast milk and adverse effects on the infant.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
24 months
Availability
Pharmacies, hospitals
Approval Status
Approved by regulatory authorities worldwide
Patent Status
Generic available (Patent expired)
WHO Essential Medicine
YesClinical Trials
Ramipril has been extensively studied in major clinical trials such as HOPE (Heart Outcomes Prevention Evaluation) and MICRO-HOPE, demonstrating significant cardiovascular benefits.
Lab Monitoring
- Blood pressure
- Serum potassium levels
- Renal function (BUN, creatinine)
- Complete blood count (periodically)
Doctor Notes
- Counsel patients on the persistent dry cough and advise not to discontinue without consultation.
- Monitor renal function and serum potassium, particularly in elderly and renally impaired patients, and those on diuretics.
- Caution with concomitant use of NSAIDs and potassium-sparing diuretics.
Patient Guidelines
- Take exactly as prescribed by your doctor.
- Do not stop taking this medication without consulting your doctor, even if you feel well.
- Report any swelling of the face, lips, tongue, or throat immediately to your doctor.
- Avoid potassium-rich foods or salt substitutes without medical advice.
Missed Dose Advice
If a dose is missed, 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
May cause dizziness or lightheadedness, especially at the start of treatment or when changing dose. Exercise caution when driving or operating machinery until you know how this medicine affects you.
Lifestyle Advice
- Maintain a healthy diet low in sodium.
- Engage in regular physical activity.
- Avoid smoking and excessive alcohol consumption.
- Monitor your blood pressure regularly at home.
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