Ramoril
Generic Name
Ramipril
Manufacturer
Incepta Pharmaceuticals Ltd.
Country
Bangladesh
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| ramoril 10 mg tablet | ৳ 12.00 | ৳ 120.00 |
Description
Overview of the medicine
Ramoril 10 mg Tablet contains Ramipril, an ACE inhibitor used to treat high blood pressure, heart failure, and to reduce the risk of heart attack and stroke. It also helps protect the kidneys.
Uses & Indications
Dosage
Adults
Hypertension: Initially 2.5 mg once daily, adjusted according to response, usual maintenance dose 2.5-10 mg once daily. Max 10 mg/day. Heart failure: Initially 1.25 mg once daily, titrate up to 10 mg once daily based on response. Post-MI: Initially 2.5 mg twice daily, increase to 5 mg twice daily.
Elderly
Start with a lower dose (e.g., 1.25 mg once daily) and titrate carefully, especially if there are renal or hepatic impairments.
Renal_impairment
Initial dose should be reduced (e.g., 1.25 mg once daily) and titrated cautiously based on creatinine clearance and patient response. Regular monitoring of renal function and potassium levels is essential.
How to Take
Take Ramoril 10 mg tablet orally, usually once daily, with or without food. Swallow the tablet whole with water. Do not crush, chew, or break it.
Mechanism of Action
Ramipril is converted to its active metabolite ramiprilat, which inhibits the angiotensin-converting enzyme (ACE). This inhibition leads to decreased production of angiotensin II, a potent vasoconstrictor, and reduced aldosterone secretion. This results in vasodilation, decreased blood pressure, and reduced cardiac workload.
Pharmacokinetics
Onset
Onset of antihypertensive effect within 1-2 hours.
Excretion
Primarily excreted by the kidneys (approximately 60% as metabolites and unchanged drug); some excretion via bile.
Half life
The effective half-life of ramiprilat is 13-17 hours, allowing for once-daily dosing.
Absorption
Approximately 50-60% of oral ramipril is absorbed and rapidly hydrolyzed in the liver to its active metabolite ramiprilat. Food does not significantly affect absorption.
Metabolism
Ramipril is extensively metabolized by hepatic esterases to ramiprilat (active) and other inactive metabolites.
Side Effects
Contraindications
- History of angioedema related to previous ACE inhibitor treatment
- Hereditary or idiopathic angioedema
- Pregnancy (especially second and third trimesters)
- Bilateral renal artery stenosis
- Concomitant use with aliskiren in patients with diabetes or renal impairment
Drug Interactions
Lithium
Increased serum lithium levels and lithium toxicity.
Aliskiren
Concomitant use contraindicated in patients with diabetes or renal impairment.
Diuretics
Increased risk of hypotension, especially with initial ramipril dose.
NSAIDs (Nonsteroidal Anti-inflammatory Drugs)
Reduced antihypertensive effect of ramipril and increased risk of renal impairment.
mTOR inhibitors (e.g., sirolimus, everolimus)
Increased risk of angioedema.
Potassium-sparing diuretics/Potassium supplements
Increased risk of hyperkalemia.
Storage
Store below 30°C in a dry place, away from direct sunlight and moisture. Keep out of reach of children.
Overdose
Symptoms of overdose include severe hypotension, shock, bradycardia, electrolyte disturbances, and renal failure. Treatment is supportive and symptomatic, focusing on correcting hypotension (e.g., IV fluid administration) and monitoring vital signs and laboratory parameters.
Pregnancy & Lactation
Ramipril is contraindicated during the second and third trimesters of pregnancy due to risks of fetal injury and death. It is not recommended during the first trimester. It is also not recommended during breastfeeding due to potential excretion into breast milk and unknown effects on the infant.
Side Effects
Contraindications
- History of angioedema related to previous ACE inhibitor treatment
- Hereditary or idiopathic angioedema
- Pregnancy (especially second and third trimesters)
- Bilateral renal artery stenosis
- Concomitant use with aliskiren in patients with diabetes or renal impairment
Drug Interactions
Lithium
Increased serum lithium levels and lithium toxicity.
Aliskiren
Concomitant use contraindicated in patients with diabetes or renal impairment.
Diuretics
Increased risk of hypotension, especially with initial ramipril dose.
NSAIDs (Nonsteroidal Anti-inflammatory Drugs)
Reduced antihypertensive effect of ramipril and increased risk of renal impairment.
mTOR inhibitors (e.g., sirolimus, everolimus)
Increased risk of angioedema.
Potassium-sparing diuretics/Potassium supplements
Increased risk of hyperkalemia.
Storage
Store below 30°C in a dry place, away from direct sunlight and moisture. Keep out of reach of children.
Overdose
Symptoms of overdose include severe hypotension, shock, bradycardia, electrolyte disturbances, and renal failure. Treatment is supportive and symptomatic, focusing on correcting hypotension (e.g., IV fluid administration) and monitoring vital signs and laboratory parameters.
Pregnancy & Lactation
Ramipril is contraindicated during the second and third trimesters of pregnancy due to risks of fetal injury and death. It is not recommended during the first trimester. It is also not recommended during breastfeeding due to potential excretion into breast milk and unknown effects on the infant.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
Typically 2-3 years from the date of manufacture, specific expiry date is printed on the packaging.
Availability
Available in pharmacies
Approval Status
Approved (Globally and in Bangladesh)
Patent Status
Off-patent
WHO Essential Medicine
YesClinical Trials
Ramipril has been extensively studied in numerous clinical trials, including landmark trials like HOPE (Heart Outcomes Prevention Evaluation) which demonstrated its benefits in reducing cardiovascular events in high-risk patients.
Lab Monitoring
- Blood pressure monitoring (regularly)
- Serum electrolytes (especially potassium levels, regularly)
- Renal function tests (e.g., serum creatinine, BUN, GFR, regularly)
- Complete blood count (periodically, especially with signs of infection or unexplained bleeding)
Doctor Notes
- Initiate therapy with a low dose and titrate slowly, especially in elderly or volume-depleted patients.
- Monitor blood pressure, renal function (creatinine, GFR), and serum potassium regularly, particularly after dose adjustments.
- Counsel patients on the risk of angioedema and instruct them to seek immediate medical attention if symptoms occur.
- Advise against concomitant use with NSAIDs or potassium-sparing diuretics without close monitoring.
Patient Guidelines
- Take the medicine exactly as prescribed by your doctor.
- Do not stop taking Ramoril suddenly without consulting your doctor.
- Inform your doctor immediately if you experience swelling of the face, lips, tongue, or throat (angioedema), difficulty breathing, or persistent dry cough.
- Avoid potassium-rich salt substitutes or potassium supplements unless advised by your doctor.
- Monitor your blood pressure regularly as advised by your healthcare provider.
Missed Dose Advice
If you miss a dose, 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
Ramoril may cause dizziness or lightheadedness, especially after the first dose or when the dose is increased. If you experience these symptoms, avoid driving or operating machinery until you know how the medicine affects you.
Lifestyle Advice
- Maintain a healthy diet low in sodium and saturated fats.
- Engage in regular physical activity as recommended by your doctor.
- Quit smoking and limit alcohol consumption.
- Manage stress effectively through relaxation techniques or hobbies.
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