Tritace
Generic Name
Ramipril
Manufacturer
Sanofi (original brand manufacturer)
Country
Originates from France (Sanofi)
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| tritace 25 mg tablet | ৳ 9.53 | ৳ 133.42 |
Description
Overview of the medicine
Ramipril is an Angiotensin-Converting Enzyme (ACE) inhibitor used to treat high blood pressure (hypertension), congestive heart failure, and to reduce the risk of heart attack, stroke, and death from cardiovascular causes in high-risk patients.
Uses & Indications
Dosage
Adults
Hypertension: Initial dose 2.5 mg once daily; maintenance 2.5-10 mg once daily. Heart Failure: Initial 1.25 mg once daily, titrate up. Post-MI: Initial 2.5 mg twice daily. Prevention of CV events: 2.5 mg once daily, titrate up to 10 mg.
Elderly
Lower starting doses (e.g., 1.25 mg once daily) and careful titration are recommended due to potential for reduced renal function.
Renal_impairment
Initial dose 1.25 mg once daily for patients with creatinine clearance < 60 mL/min. Maximum dose 5 mg/day for severe impairment.
How to Take
Take orally, once daily, with or without food. Swallow the tablet whole with a sufficient amount of liquid. Do not chew or crush.
Mechanism of Action
Ramipril works by inhibiting the angiotensin-converting enzyme (ACE), which prevents the conversion of angiotensin I to angiotensin II. This leads to vasodilation, reduced aldosterone secretion, and decreased blood pressure. It also reduces cardiac preload and afterload.
Pharmacokinetics
Onset
Antihypertensive effect begins within 1-2 hours, peak effect within 3-6 hours.
Excretion
Mainly renal (60% as ramiprilat and its metabolites), with some fecal excretion.
Half life
Ramipril: approximately 1 hour. Ramiprilat: 13-17 hours (effective half-life with multiple doses).
Absorption
Well absorbed (50-60%), rapidly hydrolyzed in the liver to its active metabolite, ramiprilat. Bioavailability is approximately 28% for ramipril and 44% for ramiprilat.
Metabolism
Primarily hepatic hydrolysis to active ramiprilat and several inactive metabolites.
Side Effects
Contraindications
- History of angioedema (hereditary, idiopathic, or prior ACE inhibitor-induced)
- Pregnancy (especially 2nd and 3rd trimesters)
- Bilateral renal artery stenosis
- Severe hypotension
- Concomitant use with aliskiren in patients with diabetes mellitus or renal impairment (GFR < 60 mL/min/1.73 m²)
- Hypersensitivity to ramipril or any other ACE inhibitor
Drug Interactions
NSAIDs
May reduce antihypertensive effect and increase risk of renal impairment.
Lithium
Increased serum lithium levels and toxicity.
Aliskiren
Concomitant use contraindicated in diabetic or renal impaired patients due to increased risk of hypotension, hyperkalemia, and renal impairment.
Diuretics
Increased hypotensive effect. Consider dose reduction of diuretic or ramipril.
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 of overdose include severe hypotension, bradycardia, electrolyte disturbances, and renal failure. Treatment is symptomatic and supportive. Lay the patient supine, intravenous fluid administration, and if severe, consider hemodialysis (ramiprilat is poorly dialyzable, but dialysis can remove ramipril).
Pregnancy & Lactation
Contraindicated in the 2nd and 3rd trimesters of pregnancy due to risk of fetal injury or death. Use in the 1st trimester is generally not recommended unless clearly necessary. Not recommended during breastfeeding due to potential excretion in breast milk.
Side Effects
Contraindications
- History of angioedema (hereditary, idiopathic, or prior ACE inhibitor-induced)
- Pregnancy (especially 2nd and 3rd trimesters)
- Bilateral renal artery stenosis
- Severe hypotension
- Concomitant use with aliskiren in patients with diabetes mellitus or renal impairment (GFR < 60 mL/min/1.73 m²)
- Hypersensitivity to ramipril or any other ACE inhibitor
Drug Interactions
NSAIDs
May reduce antihypertensive effect and increase risk of renal impairment.
Lithium
Increased serum lithium levels and toxicity.
Aliskiren
Concomitant use contraindicated in diabetic or renal impaired patients due to increased risk of hypotension, hyperkalemia, and renal impairment.
Diuretics
Increased hypotensive effect. Consider dose reduction of diuretic or ramipril.
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 of overdose include severe hypotension, bradycardia, electrolyte disturbances, and renal failure. Treatment is symptomatic and supportive. Lay the patient supine, intravenous fluid administration, and if severe, consider hemodialysis (ramiprilat is poorly dialyzable, but dialysis can remove ramipril).
Pregnancy & Lactation
Contraindicated in the 2nd and 3rd trimesters of pregnancy due to risk of fetal injury or death. Use in the 1st trimester is generally not recommended unless clearly necessary. Not recommended during breastfeeding due to potential excretion in breast milk.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
Typically 2-3 years from manufacturing date.
Availability
Available in pharmacies and hospitals
Approval Status
Approved by regulatory bodies worldwide, including FDA and DGDA (Bangladesh)
Patent Status
Patents expired, generic versions available
WHO Essential Medicine
YesClinical Trials
Ramipril has been extensively studied in numerous clinical trials, including the HOPE trial (Heart Outcomes Prevention Evaluation), which demonstrated its effectiveness in reducing cardiovascular events in high-risk patients.
Lab Monitoring
- Blood pressure
- Serum potassium levels
- Renal function (serum creatinine, blood urea nitrogen)
- Complete blood count (especially in patients with renal impairment or collagen vascular disease)
Doctor Notes
- Monitor blood pressure, renal function, and serum potassium regularly.
- Counsel patients on the importance of adherence and reporting symptoms of angioedema or persistent cough.
- Adjust dose carefully in elderly patients and those with renal impairment.
Patient Guidelines
- Take medicine regularly as prescribed by your doctor.
- Do not stop taking the medicine suddenly without consulting your doctor.
- Report any swelling of the face, lips, tongue, or throat immediately to your doctor (angioedema).
- Inform your doctor about all other medications you are taking, including over-the-counter drugs and herbal supplements.
Missed Dose Advice
If you miss a dose, take it as soon as you remember. However, 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
May cause dizziness or fatigue, especially at the start of treatment or when changing doses. Exercise caution when driving or operating machinery.
Lifestyle Advice
- Follow a low-sodium diet as advised by your doctor.
- Engage in regular physical activity.
- Maintain a healthy weight.
- Avoid smoking and limit alcohol intake.
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