Ramipril and Hydrochlorothiazide

ACE Inhibitor · ACE inhibitor/Thiazide diuretic

Indications

Essential hypertension when a combination preparation is indicated.

Dosage

Adults: Initially 1 tab of 2.5/12.5 mg/day, may be increased at intervals of 2-3 wk. Max 10 mg ramipril/50 mg hydrochlorothiazide. Children: Not recommended.

Adverse Effects

Light headedness, concentration disturbances, impaired reactions, fatigue, weakness, dizziness, renal function deterioration, decline in serum Na conc, hypochloraemia, hypomagnesaemia, hypercalcaemia, metabolic alkalosis, changes in serum K, electrolyte imbalance, cutaneous & mucosal reactions, anaphylactic reactions, respiratory system & CNS disorders, GI disturbances, blood picture changes, vasculitis, myalgia, arthralgia, liver disorders, eosinophilia, increased uric acid conc.

Risk Factor (Pregnancy/Lactation)

Pregnancy: Contraindicated in pregnancy. Lactation: Contraindicated or not recommended. Contraindications: History of angioneurotic oedema, renal artery stenosis, relevant left-ventricular inflow or outflow impediment, electrolyte disturbance. Precautions: Dehydration, hypovolaemia or salt depletion should be corrected before initiating treatment. Severe & malignant hypertension, concomitant with severe heart failure. Patients pre-treated with diuretics. Pronounced fall in BP. Monitor renal function, electrolytes, glucose, WBC count.

Interactions

Salts, NSAIDs, pressor amines, corticosteroids, carbenoxolone, large amounts of liquorice, laxatives, other kaliuretic agents, K salts, K-sparing diuretics, heparin, digitalis prep, lithium salts, allopurinol, immunosuppressants, procainamide, cytostatics, methyldopa, antidiabetic agents, cholestyramine, curare-type muscle relaxants, alcohol, high-flux dialyser membranes, dextran sulphate.

Advice to Patient

Take with or without meals. Do not chew or crush tablets, swallow whole.

Pharmacokinetics

RAMIPRIL: Onset of action: 1-2 hrs. Duration: 24 hrs. Absorption: Well absorbed (50%-60%). Metabolism: Hepatic to the active form, ramiprilat. Bioavailability: Ramipril: 28%. Ramiprilat: 44%. Half-life elimination: Ramiprilat: Effective: 13-17 hrs. Terminal: >50 hrs. Time to peak, serum: Ramipril: Approx. 1 hr. Ramiprilat: 2-4 hrs. Excretion: Urine (60%). Faeces (40%). HYDROCHLOROTHIAZIDE: Onset of action: Diuresis: Infants: 2-6 hrs. Adults: Approx. 2 hrs. Peak effect: 4-6 hrs. Duration: Infants: 8 hrs. Adults: 6-12 hrs. Absorption: Well absorbed, absorption is decreased in patients with CHF. Metabolism: Not metabolized. Bioavailability: 65%-75%. Half-life elimination: Approx. 6-15 hrs. Time to peak: Approx. 1-5 hrs. Excretion: Urine.

Compiled by Healify Pharmacy from published drug references. How we compile it →

Always consult a pharmacist or doctor.