Ramil
Generic Name
Ramipril
Manufacturer
Drug International Ltd.
Country
Bangladesh
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| ramil 5 mg tablet | ৳ 8.03 | ৳ 80.30 |
Description
Overview of the medicine
Ramil 5 mg Tablet contains Ramipril, an ACE inhibitor used to treat high blood pressure (hypertension), congestive heart failure, and to reduce the risk of cardiovascular events like heart attack and stroke. It can also be used in patients with diabetic nephropathy.
Uses & Indications
Dosage
Adults
Hypertension: Initial 2.5 mg once daily; maintenance 2.5-10 mg once daily. Heart failure: Initial 1.25 mg once daily; maintenance 2.5-10 mg once daily. Post-MI heart failure: Initial 2.5 mg twice daily; maintenance 5 mg twice daily.
Elderly
Lower initial doses (e.g., 1.25 mg once daily) may be considered, with careful titration due to potential for greater hypotensive effects and altered renal function.
Renal_impairment
For creatinine clearance <30 mL/min, initial dose 1.25 mg once daily, max dose 5 mg/day. Monitor renal function and potassium closely.
How to Take
Ramil tablets should be taken orally, once daily, preferably at the same time each day. It can be taken with or without food. Swallow the tablet whole with sufficient liquid; do not chew or crush.
Mechanism of Action
Ramipril is a prodrug that is hydrolyzed in the liver to its active metabolite, ramiprilat. Ramiprilat inhibits the angiotensin-converting enzyme (ACE), which is responsible for converting angiotensin I to angiotensin II. Angiotensin II is a potent vasoconstrictor, so its reduction leads to vasodilation (widening of blood vessels) and decreased blood pressure. It also reduces aldosterone secretion, leading to decreased sodium and water retention.
Pharmacokinetics
Onset
Antihypertensive effect typically begins 1-2 hours after administration.
Excretion
Approximately 60% of the dose is excreted renally (as ramiprilat and its metabolites) and about 40% via feces/biliary route.
Half life
The effective half-life of ramiprilat is prolonged with multiple doses, ranging from 13-17 hours, allowing for once-daily dosing.
Absorption
Rapidly absorbed from the gastrointestinal tract, with peak plasma concentrations occurring within 1 hour for ramipril and 2-4 hours for ramiprilat. Bioavailability is approximately 50-60%.
Metabolism
Ramipril is a prodrug that undergoes extensive hepatic metabolism to its active metabolite, ramiprilat, and other inactive metabolites.
Side Effects
Contraindications
- History of angioedema related to previous ACE inhibitor therapy.
- Bilateral renal artery stenosis or unilateral stenosis in a single functioning kidney.
- Pregnancy (especially second and third trimesters) and breastfeeding.
- Concomitant use with aliskiren in patients with diabetes mellitus or moderate to severe renal impairment (CrCl <60 mL/min).
- Hypersensitivity to ramipril or any other ACE inhibitor.
Drug Interactions
Lithium
ACE inhibitors can increase serum lithium levels and lead to lithium toxicity. Monitor lithium levels closely.
Aliskiren
Concomitant use is contraindicated in patients with diabetes or renal impairment due to increased risk of hypotension, hyperkalemia, and renal impairment.
Diuretics
May cause excessive blood pressure reduction, especially at the start of therapy. Dose reduction of diuretic or ramipril may be required.
Sacubitril/Valsartan
Increased risk of angioedema. Contraindicated within 36 hours of each other.
NSAIDs (Nonsteroidal Anti-inflammatory Drugs)
May reduce the antihypertensive effect of ramipril and increase the risk of renal function deterioration, including acute renal failure.
Potassium-sparing diuretics/Potassium supplements
Increased risk of hyperkalemia (high potassium levels). Close monitoring of serum potassium is necessary.
Storage
Store in a cool and dry place, below 30°C. Protect from light and moisture. Keep out of reach of children.
Overdose
Symptoms of overdose include severe hypotension, shock, bradycardia, electrolyte disturbances, and renal failure. Management involves supportive care, including intravenous fluid administration for hypotension. If ingestion is recent, gastric lavage or induced emesis may be considered. Ramiprilat is poorly dialyzable.
Pregnancy & Lactation
Ramil is contraindicated during the second and third trimesters of pregnancy due to the risk of fetal injury or death. It is not recommended during the first trimester. Breastfeeding mothers should avoid Ramil, as ramiprilat can pass into breast milk and potentially harm the infant.
Side Effects
Contraindications
- History of angioedema related to previous ACE inhibitor therapy.
- Bilateral renal artery stenosis or unilateral stenosis in a single functioning kidney.
- Pregnancy (especially second and third trimesters) and breastfeeding.
- Concomitant use with aliskiren in patients with diabetes mellitus or moderate to severe renal impairment (CrCl <60 mL/min).
- Hypersensitivity to ramipril or any other ACE inhibitor.
Drug Interactions
Lithium
ACE inhibitors can increase serum lithium levels and lead to lithium toxicity. Monitor lithium levels closely.
Aliskiren
Concomitant use is contraindicated in patients with diabetes or renal impairment due to increased risk of hypotension, hyperkalemia, and renal impairment.
Diuretics
May cause excessive blood pressure reduction, especially at the start of therapy. Dose reduction of diuretic or ramipril may be required.
Sacubitril/Valsartan
Increased risk of angioedema. Contraindicated within 36 hours of each other.
NSAIDs (Nonsteroidal Anti-inflammatory Drugs)
May reduce the antihypertensive effect of ramipril and increase the risk of renal function deterioration, including acute renal failure.
Potassium-sparing diuretics/Potassium supplements
Increased risk of hyperkalemia (high potassium levels). Close monitoring of serum potassium is necessary.
Storage
Store in a cool and dry place, below 30°C. Protect from light and moisture. Keep out of reach of children.
Overdose
Symptoms of overdose include severe hypotension, shock, bradycardia, electrolyte disturbances, and renal failure. Management involves supportive care, including intravenous fluid administration for hypotension. If ingestion is recent, gastric lavage or induced emesis may be considered. Ramiprilat is poorly dialyzable.
Pregnancy & Lactation
Ramil is contraindicated during the second and third trimesters of pregnancy due to the risk of fetal injury or death. It is not recommended during the first trimester. Breastfeeding mothers should avoid Ramil, as ramiprilat can pass into breast milk and potentially harm the infant.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
3 years from the date of manufacture.
Availability
Pharmacies nationwide
Approval Status
Approved
Patent Status
Expired
WHO Essential Medicine
YesClinical Trials
Ramipril's efficacy and safety have been established through numerous clinical trials, including large-scale studies like the HOPE (Heart Outcomes Prevention Evaluation) trial, which demonstrated its benefits in reducing cardiovascular morbidity and mortality in high-risk patients.
Lab Monitoring
- Serum creatinine and blood urea nitrogen (BUN) levels should be monitored regularly, especially at the start of therapy, during dose titration, and in patients with pre-existing renal impairment.
- Serum potassium levels should be monitored, especially in patients at risk of hyperkalemia (e.g., renal impairment, concomitant potassium-sparing diuretics).
- Liver function tests should be performed periodically.
Doctor Notes
- Prior to initiating Ramil, assess renal function and electrolytes. Monitor these parameters regularly throughout treatment, especially in vulnerable patient populations (e.g., elderly, those on diuretics, or with pre-existing renal impairment).
- Educate patients on the symptoms of angioedema and emphasize the importance of immediate medical attention should these occur. Advise patients not to take OTC NSAIDs without consulting.
Patient Guidelines
- Take Ramil exactly as prescribed by your doctor; do not stop taking it without medical advice.
- Report any swelling of the face, lips, tongue, or throat (angioedema) or persistent dry cough immediately to your doctor.
- Avoid potassium supplements or salt substitutes containing potassium without consulting your doctor.
- Be cautious when driving or operating machinery, especially when starting treatment, as dizziness may occur.
Missed Dose Advice
If you miss a dose, take it as soon as you remember, unless it is almost time for your next dose. In that case, skip the missed dose and resume your regular dosing schedule. Do not take a double dose to make up for a missed one.
Driving Precautions
Ramil may cause dizziness, lightheadedness, or fatigue, especially at the start of treatment or when the dose is increased. Patients should exercise caution when driving or operating machinery until they know how the medicine affects them.
Lifestyle Advice
- Adopt a healthy lifestyle including a balanced diet low in sodium and saturated fats.
- Engage in regular physical activity as advised by your doctor.
- Limit alcohol consumption and avoid smoking to improve cardiovascular health.
- Monitor your blood pressure at home regularly if advised by your doctor.
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