RiPril
Generic Name
Ramipril
Manufacturer
Example Pharma Ltd.
Country
Bangladesh
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| ripril 25 mg tablet | ৳ 5.00 | ৳ 50.00 |
Description
Overview of the medicine
RiPril 25 mg Tablet contains Ramipril, an Angiotensin-Converting Enzyme (ACE) inhibitor. It is primarily used to treat high blood pressure (hypertension), heart failure, and to reduce the risk of heart attack, stroke, and kidney problems in high-risk patients. Note: 25 mg is a very high strength for Ramipril, usually exceeding standard daily maximum doses. This strength may be intended for specific, highly resistant cases under strict medical supervision or might indicate a non-standard formulation.
Uses & Indications
Dosage
Adults
The usual starting dose for Ramipril is 2.5 mg once daily. The maintenance dose is typically 2.5 mg to 10 mg once daily. For RiPril 25 mg tablet, this strength far exceeds the typical daily maximum (10 mg, sometimes up to 20 mg). Use of 25 mg must be strictly under specialist medical supervision for highly resistant cases, or if it is part of a complex, non-standard regimen. Patients should not initiate treatment with this high strength. Maximum recommended daily dose for hypertension is usually 10 mg.
Elderly
Lower initial doses (e.g., 1.25 mg) are often recommended, with gradual titration. The 25 mg strength is generally not suitable for initial therapy or titration in elderly patients.
Renal_impairment
Significant dose reduction is required. For patients with creatinine clearance < 30 mL/min, the starting dose is 1.25 mg once daily, with a maximum of 5 mg daily. The 25 mg strength is not appropriate for patients with renal impairment and could be harmful.
How to Take
Take orally with or without food, usually once daily. It is advisable to take the tablet at the same time each day.
Mechanism of Action
Ramipril acts by inhibiting the Angiotensin-Converting Enzyme (ACE), which leads to decreased production of angiotensin II and increased levels of bradykinin. This results in vasodilation (widening of blood vessels), reduced aldosterone secretion, and decreased blood pressure. It also reduces cardiac remodeling and fibrosis.
Pharmacokinetics
Onset
Onset of action typically occurs within 1-2 hours, with peak effects at 3-6 hours.
Excretion
Excreted primarily via the kidneys (approximately 60%) as Ramiprilat and other metabolites, with some fecal excretion.
Half life
Ramipril has a short half-life (1-2 hours), but its active metabolite, Ramiprilat, has a prolonged effective half-life of 13-17 hours due to tight binding to ACE.
Absorption
Rapidly absorbed from the gastrointestinal tract, approximately 50-60%. Bioavailability is about 28% for Ramipril and 44% for its active metabolite, Ramiprilat.
Metabolism
Extensively metabolized in the liver 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 in a solitary kidney
- Concomitant use with aliskiren-containing products in patients with diabetes mellitus or renal impairment
Drug Interactions
Lithium
Increased serum lithium concentrations and toxicity.
Aliskiren
Increased risk of hypotension, hyperkalemia, and renal impairment, especially in patients with diabetes or renal impairment.
Diuretics
Increased hypotensive effect, risk of acute renal failure.
NSAIDs (Nonsteroidal Anti-inflammatory Drugs)
Reduced antihypertensive effect, increased risk of renal impairment, including acute renal failure.
Mammalian target of Rapamycin (mTOR) inhibitors (e.g., sirolimus, everolimus, temsirolimus)
Increased risk for angioedema.
Potassium-sparing diuretics, potassium supplements, or potassium-containing salt substitutes
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
The most likely manifestation of overdose is hypotension. Treatment involves symptomatic and supportive measures, including intravenous fluid infusion to restore blood pressure and, if necessary, hemodialysis to remove Ramiprilat from the circulation.
Pregnancy & Lactation
Ramipril is contraindicated in the second and third trimesters of pregnancy due to risks of fetal injury and death. It is not recommended during the first trimester. Use in lactating mothers is also not recommended due to potential risks to the infant; a decision should be made whether to discontinue nursing or the drug, considering the importance of the drug to the mother.
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 in a solitary kidney
- Concomitant use with aliskiren-containing products in patients with diabetes mellitus or renal impairment
Drug Interactions
Lithium
Increased serum lithium concentrations and toxicity.
Aliskiren
Increased risk of hypotension, hyperkalemia, and renal impairment, especially in patients with diabetes or renal impairment.
Diuretics
Increased hypotensive effect, risk of acute renal failure.
NSAIDs (Nonsteroidal Anti-inflammatory Drugs)
Reduced antihypertensive effect, increased risk of renal impairment, including acute renal failure.
Mammalian target of Rapamycin (mTOR) inhibitors (e.g., sirolimus, everolimus, temsirolimus)
Increased risk for angioedema.
Potassium-sparing diuretics, potassium supplements, or potassium-containing salt substitutes
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
The most likely manifestation of overdose is hypotension. Treatment involves symptomatic and supportive measures, including intravenous fluid infusion to restore blood pressure and, if necessary, hemodialysis to remove Ramiprilat from the circulation.
Pregnancy & Lactation
Ramipril is contraindicated in the second and third trimesters of pregnancy due to risks of fetal injury and death. It is not recommended during the first trimester. Use in lactating mothers is also not recommended due to potential risks to the infant; a decision should be made whether to discontinue nursing or the drug, considering the importance of the drug to the mother.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
36 months from manufacturing date
Availability
Available in various markets, brand-specific
Approval Status
Approved (Generally for Ramipril)
Patent Status
Off-patent
WHO Essential Medicine
YesClinical Trials
Ramipril has been extensively studied in numerous clinical trials, including HOPE, AIRE, and MICRO-HOPE, demonstrating its efficacy in cardiovascular risk reduction, hypertension, and heart failure. Specific trials for a 25 mg single-tablet strength are not widely reported, suggesting it's a non-standard or highly specialized formulation.
Lab Monitoring
- Serum electrolytes (especially potassium)
- Renal function (creatinine, BUN)
- Blood pressure (regularly)
Doctor Notes
- RiPril 25 mg is an unusually high dose for Ramipril; extreme caution is advised. Ensure the patient truly requires such a high dose and is under specialist care.
- Monitor blood pressure, renal function, and serum potassium regularly, especially when initiating therapy or titrating the dose.
- Educate patients on the symptoms of angioedema and hyperkalemia and advise them to seek immediate medical attention if these occur.
- Consider alternative ACE inhibitors or ARBs if persistent cough is intolerable.
Patient Guidelines
- Take exactly as prescribed, do not stop without consulting your doctor.
- Avoid sudden changes in position (e.g., standing up quickly) to prevent dizziness.
- Report any swelling of the face, lips, tongue, or throat immediately to your doctor.
- Regularly monitor your blood pressure at home if advised by your doctor.
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 resume your regular dosing schedule. Do not double the dose.
Driving Precautions
This medicine may cause dizziness or fatigue, especially at the start of treatment or when the dose is increased. If affected, avoid driving or operating machinery.
Lifestyle Advice
- Maintain a healthy diet low in sodium and high in fruits and vegetables.
- Engage in regular physical activity as advised by your doctor.
- Limit alcohol consumption.
- Quit smoking.
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