Ramilon - Tablet Ramipril - 2.5mg 1 Tablet(s) / Tablet Virgo Pharmaceuticals Ltd. Introduction: Ramilon belongs to a group of medicines known as angiotensin converting enzyme (ACE) inhibitors. It is widely used to treat high blood pressure and heart failure and may be prescribed after a heart attack. It also lowers the chances of having a heart attack or stroke. Ramilon can be prescribed either alone or in combination with other medicines. It may be taken empty stomach or with a meal. This medicine should be taken at the same time each day to get the maximum benefit. It is important to continue taking it regularly even if you feel well or even if... Uses of Ramilon: Hypertension (high blood pressure)Prevention of heart attack and strokeHeart failure Side effects of Ramilon: Decreased blood pressureDizzinessFatigueVomitingDry cough How to use Ramilon: Take this medicine in the dose and duration as advised by your doctor. Swallow it as a whole. Do not chew, crush or break it. Ramilon may be taken with or without food, but it is better to take it at a fixed time. How Ramilon works: Ramilon is an angiotensin converting enzyme (ACE) inhibitor. It works by reducing stress on the heart and relaxing blood vessel so that blood flows more smoothly and the heart can pump blood more efficiently. What if you forget to take Ramilon?: If you miss a dose of Ramilon, skip it and continue with your normal schedule. Do not double the dose. Indication: Congestive heart failure, MI, HTN, CV events, Stroke Administration: May be taken with or without food. Adult Dose: Oral Hypertension, Diabetic Nephropathy Adult: Hypertension Initial (not on diuretic): 2.5 mg once daily at bedtime. Initial (with diuretic): 1.25 mg once daily at bedtime. Maintenance: 2.5-5 mg/day as a single dose, Max: 10 mg/day. Congestive Heart failure Adult: Initially, 1.25 mg once daily. Max: 10 mg daily. Doses >2.5 mg may be given in 2 divided doses. Max Dosage: 10 mg daily in 1-2 divided doses. Post myocardial infarction Adult: Initially, 2.5 mg bid, may increase to 5 mg bid after 2 days. Start treatment: 3-10 days after infarction. Maintenance: 2.5-5 mg bid. Prophylaxis of cardiovascular events in high-risk... Child Dose: Safety and efficacy not established Renal Dose: Renal impairment: CrCl (ml/min) Dosage Recommendation 10-30 Initially, 1.25 mg/day. Max: 5 mg/day. 30-60 Not necessary to adjust the initial dose. Max maintenance dose: 5 mg/day. Contraindication: Hypersensitivity, bilateral renal artery stenosis, or a single kidney with unilateral renal artery stenosis. Aortic stenosis or outflow tract obstruction. History of angioedema (hereditary, idiopathic or due to previous angioedema w/ ACE inhibitors). Pregnancy and lactation. Mode of Action: Ramipril, a prodrug of ramiprilat, competitively inhibits ACE from converting angiotensin I to angiotensin II (a potent vasoconstrictor) resulting in increased plasma renin activity and reduced aldosterone (a hormone that causes water and Na retention) secretion. This promotes vasodilation thus producing a hypotensive effect and a beneficial effect in CHF. Precaution: Renal impairment, hypovolaemia, hyperkalaemia, valvular stenosis; before, during or immediately after anaesthesia. Severe resistant hypertension, elderly, peripheral vascular disease or generalised atherosclerosis. Patient Counselling Inform patients to refrain from activities involving mental alertness and physical coordination after drug intake. Monitoring Parameters Correct volume and/or salt depletion prior to treatment. Monitor BP, serum creatinine and K levels. Monitor renal function during the 1st few wk of treatment and periodically thereafter. Lactation: Possibly excreted in breast milk; nursing not recommended Side Effect: >10% Cough (7-8%),Hypotension (2-11%) 1-10% Headache (1-5%),Angina pectoris (3%),Dizziness (2-4%),Nausea (2%),Vomiting (2%),Postural hypotension (2%),Syncope (2%),Vertigo (2%),Abnormal kidney function (1%),Diarrhea (1%) <1% Angioedema (0.3%) Potentially Fatal: Severe hypotension and renal failure, angioedema. Interaction: May enhance hypotensive effect w/ diuretics and other antihypertensives. May increase risk of renal function deterioration w/ NSAIDs. May increase serum levels and toxicity of lithum. May increase hyperkalaemic effect w/ K-sparing diuretics and supplements. Potentially Fatal: Concomitant use w/ aliskiren aliskiren may increase the risk of hyperkalaemia, hypotension and nephrotoxicity in patients w/ diabetes or renal impairment