Ramicard Plus
Generic Name
Ramipril + Hydrochlorothiazide
Manufacturer
Square Pharmaceuticals Ltd.
Country
Bangladesh
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| ramicard plus 25 mg tablet | ৳ 5.05 | ৳ 70.70 |
Description
Overview of the medicine
Ramicard Plus 25 mg tablet is a combination medicine containing Ramipril, an ACE inhibitor, and Hydrochlorothiazide, a thiazide diuretic. It is primarily used to treat essential hypertension in patients whose blood pressure is not adequately controlled with Ramipril or Hydrochlorothiazide alone.
Uses & Indications
Dosage
Adults
Typically one tablet (5 mg Ramipril / 25 mg Hydrochlorothiazide) once daily. Dosage should be individualized based on blood pressure response.
Elderly
Lower initial doses may be considered, with careful titration due to potential for reduced renal function and increased sensitivity.
Renal_impairment
Contraindicated in severe renal impairment (creatinine clearance < 30 ml/min). For moderate impairment, dose adjustment may be necessary and careful monitoring is advised.
How to Take
Oral. Can be taken with or without food, preferably at the same time each day.
Mechanism of Action
Ramipril inhibits ACE, reducing angiotensin II production, leading to vasodilation, decreased aldosterone secretion, and reduced sodium and water retention. Hydrochlorothiazide increases the excretion of sodium and chloride by inhibiting their reabsorption in the distal convoluted tubule, leading to increased urine output and reduced plasma volume. The combination results in additive antihypertensive effects.
Pharmacokinetics
Onset
Ramipril: 1-2 hours. Hydrochlorothiazide: 2 hours. Peak effect of combination in 3-6 hours.
Excretion
Primarily renal excretion for both ramiprilat and hydrochlorothiazide.
Half life
Ramiprilat: 13-17 hours (effective half-life). Hydrochlorothiazide: 6-15 hours.
Absorption
Ramipril is rapidly absorbed and hydrolyzed to its active metabolite ramiprilat. Hydrochlorothiazide is also well absorbed from the GI tract.
Metabolism
Ramipril is extensively metabolized in the liver to ramiprilat and other inactive metabolites. Hydrochlorothiazide is not metabolized and is excreted unchanged.
Side Effects
Contraindications
- Hypersensitivity to ramipril, hydrochlorothiazide, or any sulfonamide-derived drugs.
- History of angioedema related to previous ACE inhibitor treatment.
- Severe renal impairment (creatinine clearance < 30 ml/min), anuria, severe hepatic impairment.
- Pregnancy (especially 2nd and 3rd trimesters) and lactation.
- Concomitant use with aliskiren in patients with diabetes or renal impairment.
Drug Interactions
NSAIDs
May reduce the antihypertensive effect and increase the risk of renal function deterioration.
Digoxin
Increased risk of digitalis toxicity due to hypokalemia caused by hydrochlorothiazide.
Lithium
Increased serum lithium levels and lithium toxicity.
Corticosteroids, ACTH
Increased electrolyte depletion, particularly hypokalemia.
Other antihypertensives
Additive hypotensive effect.
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, electrolyte disturbances (hypokalemia, hyponatremia), renal failure. Management involves supportive care, intravenous fluid administration, and correction of electrolyte imbalances. Hemodialysis is not effective for ramiprilat.
Pregnancy & Lactation
Contraindicated in pregnancy, especially during the second and third trimesters, due to risk of fetal harm/death. Not recommended during breastfeeding as both components are excreted in breast milk.
Side Effects
Contraindications
- Hypersensitivity to ramipril, hydrochlorothiazide, or any sulfonamide-derived drugs.
- History of angioedema related to previous ACE inhibitor treatment.
- Severe renal impairment (creatinine clearance < 30 ml/min), anuria, severe hepatic impairment.
- Pregnancy (especially 2nd and 3rd trimesters) and lactation.
- Concomitant use with aliskiren in patients with diabetes or renal impairment.
Drug Interactions
NSAIDs
May reduce the antihypertensive effect and increase the risk of renal function deterioration.
Digoxin
Increased risk of digitalis toxicity due to hypokalemia caused by hydrochlorothiazide.
Lithium
Increased serum lithium levels and lithium toxicity.
Corticosteroids, ACTH
Increased electrolyte depletion, particularly hypokalemia.
Other antihypertensives
Additive hypotensive effect.
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, electrolyte disturbances (hypokalemia, hyponatremia), renal failure. Management involves supportive care, intravenous fluid administration, and correction of electrolyte imbalances. Hemodialysis is not effective for ramiprilat.
Pregnancy & Lactation
Contraindicated in pregnancy, especially during the second and third trimesters, due to risk of fetal harm/death. Not recommended during breastfeeding as both components are excreted in breast milk.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
Typically 2-3 years from the date of manufacture.
Availability
Pharmacies, Hospitals
Approval Status
Approved by regulatory authorities (e.g., DGDA, FDA)
Patent Status
Generic available, patents expired for individual components
WHO Essential Medicine
YesClinical Trials
Extensive clinical trials have demonstrated the efficacy and safety of ramipril and hydrochlorothiazide in reducing blood pressure and cardiovascular events in hypertensive patients.
Lab Monitoring
- Serum electrolytes (Potassium, Sodium, Magnesium, Calcium) - regularly due to diuretic component.
- Renal function tests (Creatinine, BUN) - especially before starting and periodically during treatment.
- Blood pressure - regular monitoring.
- Liver function tests - periodically.
Doctor Notes
- Emphasize the importance of consistent medication adherence and regular follow-up.
- Counsel patients on signs of angioedema and the need for immediate medical attention.
- Caution against concurrent use of NSAIDs due to potential for reduced antihypertensive effect and renal impairment.
- Monitor potassium levels closely, especially in patients also on other drugs affecting potassium.
Patient Guidelines
- Take as directed by your doctor, usually once daily.
- Do not stop taking the medicine abruptly without consulting your doctor.
- Report any swelling of the face, lips, tongue, or throat immediately (signs of angioedema).
- Avoid potassium-rich foods or potassium supplements unless advised by your doctor.
Missed Dose Advice
If a dose is missed, take it as soon as you remember, unless it is almost time for the 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 fatigue, especially at the start of treatment or when changing dose. Avoid driving or operating machinery until you know how the medicine affects you.
Lifestyle Advice
- Adopt a healthy lifestyle including a balanced diet, regular exercise, and stress management.
- Limit alcohol intake and avoid smoking.
- Monitor blood pressure regularly at home if advised by your doctor.
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