Ramoril Plus
Generic Name
Ramipril 5 mg + Hydrochlorothiazide 12.5 mg Tablet
Manufacturer
Square Pharmaceuticals Ltd.
Country
Bangladesh
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| ramoril plus 5 mg tablet | ৳ 8.00 | ৳ 80.00 |
Description
Overview of the medicine
Ramoril Plus 5 mg Tablet is a combination medicine containing Ramipril (an ACE inhibitor) and Hydrochlorothiazide (a thiazide diuretic). It is primarily used to treat high blood pressure (hypertension) by helping to relax blood vessels and increase the removal of excess fluid from the body.
Uses & Indications
Dosage
Adults
Usually one tablet (Ramipril 5 mg / Hydrochlorothiazide 12.5 mg) once daily, taken at the same time each day, preferably in the morning.
Elderly
No specific dosage adjustment required for elderly patients with normal renal function; however, caution is advised.
Renal_impairment
Initial doses should be lower and titrated carefully. Contraindicated in severe renal impairment (creatinine clearance <30 mL/min).
How to Take
Take the tablet orally with water, preferably in the morning, with or without food. Do not chew or crush the tablet.
Mechanism of Action
Ramipril inhibits the Angiotensin-Converting Enzyme (ACE), preventing the conversion of angiotensin I to angiotensin II, leading to vasodilation, reduced aldosterone secretion, and decreased blood pressure. Hydrochlorothiazide acts on the distal convoluted tubule of the kidney to inhibit sodium and chloride reabsorption, increasing the excretion of sodium, chloride, and water, thereby lowering blood pressure.
Pharmacokinetics
Onset
Within 1-2 hours (for Ramipril), 2 hours (for Hydrochlorothiazide)
Excretion
Primarily renal excretion for both ramiprilat and hydrochlorothiazide.
Half life
Ramiprilat: 13-17 hours (effective half-life). Hydrochlorothiazide: 5.6-14.8 hours.
Absorption
Ramipril is rapidly absorbed and metabolized to its active form, ramiprilat. Hydrochlorothiazide is also well absorbed from the gastrointestinal tract.
Metabolism
Ramipril is extensively metabolized in the liver to ramiprilat (active metabolite) and other inactive metabolites. Hydrochlorothiazide is not metabolized.
Side Effects
Contraindications
- Hypersensitivity to ramipril, hydrochlorothiazide, or any sulfonamide-derived drugs.
- History of angioedema related to previous ACE inhibitor therapy.
- Severe renal impairment (creatinine clearance <30 mL/min) or anuria.
- Severe hepatic impairment.
- Pregnancy (2nd and 3rd trimesters).
- Bilateral renal artery stenosis.
- Concomitant use with aliskiren in patients with diabetes or renal impairment.
Drug Interactions
Lithium
Increased serum lithium concentrations and lithium toxicity.
Corticosteroids, ACTH
Increased risk of electrolyte depletion, particularly hypokalemia.
Other antihypertensive agents
Additive hypotensive effects.
Insulin and oral antidiabetics
May require dosage adjustments of antidiabetic drugs.
NSAIDs (Nonsteroidal Anti-Inflammatory Drugs)
May reduce the antihypertensive effect and increase the risk of renal function deterioration.
Potassium-sparing diuretics/Potassium supplements
May lead to hyperkalemia.
Storage
Store in a cool, dry place below 30°C. Protect from light and moisture. Keep out of reach of children.
Overdose
Symptoms may include severe hypotension, electrolyte disturbances (hypokalemia, hyponatremia, hypochloremia), dehydration, and renal failure. Treatment involves supportive measures, gastric lavage, administration of activated charcoal, and correction of fluid/electrolyte balance.
Pregnancy & Lactation
Contraindicated during the second and third trimesters of pregnancy due to fetal risk. Not recommended during the first trimester. Use in lactation is not advised as both ramipril and hydrochlorothiazide 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 therapy.
- Severe renal impairment (creatinine clearance <30 mL/min) or anuria.
- Severe hepatic impairment.
- Pregnancy (2nd and 3rd trimesters).
- Bilateral renal artery stenosis.
- Concomitant use with aliskiren in patients with diabetes or renal impairment.
Drug Interactions
Lithium
Increased serum lithium concentrations and lithium toxicity.
Corticosteroids, ACTH
Increased risk of electrolyte depletion, particularly hypokalemia.
Other antihypertensive agents
Additive hypotensive effects.
Insulin and oral antidiabetics
May require dosage adjustments of antidiabetic drugs.
NSAIDs (Nonsteroidal Anti-Inflammatory Drugs)
May reduce the antihypertensive effect and increase the risk of renal function deterioration.
Potassium-sparing diuretics/Potassium supplements
May lead to hyperkalemia.
Storage
Store in a cool, dry place below 30°C. Protect from light and moisture. Keep out of reach of children.
Overdose
Symptoms may include severe hypotension, electrolyte disturbances (hypokalemia, hyponatremia, hypochloremia), dehydration, and renal failure. Treatment involves supportive measures, gastric lavage, administration of activated charcoal, and correction of fluid/electrolyte balance.
Pregnancy & Lactation
Contraindicated during the second and third trimesters of pregnancy due to fetal risk. Not recommended during the first trimester. Use in lactation is not advised as both ramipril and hydrochlorothiazide are excreted in breast milk.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
Typically 24 to 36 months from manufacturing date
Availability
Pharmacies, hospitals
Approval Status
Approved (local regulatory body, e.g., DGDA in Bangladesh)
Patent Status
Off-patent (for generic components)
WHO Essential Medicine
YesClinical Trials
Clinical trials have demonstrated the efficacy and safety of ramipril/hydrochlorothiazide combinations in reducing blood pressure in patients with essential hypertension. Studies typically show superior efficacy compared to monotherapy.
Lab Monitoring
- Serum electrolytes (especially potassium, sodium)
- Renal function (BUN, creatinine, GFR)
- Liver function tests
- Blood pressure monitoring
Doctor Notes
- Emphasize the importance of adherence to therapy and regular follow-up.
- Counsel patients on potential side effects, especially dry cough and dizziness.
- Advise caution in patients with a history of angioedema or severe renal/hepatic impairment.
Patient Guidelines
- Take this medicine regularly as prescribed by your doctor, even if you feel well.
- Do not stop taking it suddenly without consulting your doctor.
- Avoid excessive potassium intake or potassium supplements unless advised by your doctor.
- Report any signs of swelling of the face, lips, tongue, or throat immediately.
- Monitor your blood pressure regularly.
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
This medicine may cause dizziness or fatigue, especially at the start of treatment or when the dose is changed. If affected, avoid driving or operating machinery.
Lifestyle Advice
- Adopt a healthy diet low in sodium and rich in fruits and vegetables.
- Engage in regular physical activity.
- Maintain a healthy weight.
- Limit alcohol consumption.
- Quit smoking.
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