Hydrochlorthiazide in combination with alcohol , barbiturates or narcotics potentiates orthostatic hypotension When coadministered with antihypertensives gives additive effect.

Absorption is reduced with cholestyramine and colestipol resins Hypokalemia is observed with corticosteroids Tubocurarine responsiveness to muscle relaxants is increased It decreases renal clearance of lithium and increases lithiym toxicity NSAIDs can reduce the diuretic and natriuretic effect of hydrochlorthiazide Ramipril with potassium sparing diuretic results in severe hyperkalemia May increase serum lithium concentration NSAIDs may reduce the effect of the drug and deterioration of renal function.

Hypertension

Pancreatitis, jaundice, diarrhea, Nausea, vomiting, Ccramps, constipation, Gastric irritation, Anorexia, Aplastic anemia, agranulocytosis, Leukopaenia, Haemolytic anemia Thrombocytopenia Vasculitis Stevens-johnson syndrome

Anuria, hypersenstivity, history of angioedema Bilateral renal artery stenosis, Unilateral renal stenosis

Special precautions-

Severe renal disease Impaired hepatic or bronchial asthma Sytemic lupus erythematosus acute gout, Diabetes mellitus

Elderly

Collgen vascular disease Should be discontinued before carrying tests for parathyroid function Pregnancy, lactation

Indication-

Hypertension

Dosage-

Adult- Ramipril 2.5mg + Hydrochlorthiazide 12.5mg - 1 tablet daily up to max of 4 tabs

Pharmacology:

The efficacy and safety of fixed dose combination of ramipril 2.5mg and hydrochlothiazide 12.5mg was evaluated with individual drugs as monotherapy in a double blind , parallel multicentre study for a period of 8 weeks.

Patients were at randon given ramipril 2.5mg or hydrochlothizide 12.5mg or fixed dose of ramipril 2.5mg and hydrochlothiazide 12.5mg. At the end of the study it was found that the decrease in supine diastolic blood pressure was greater in ramipril-hydrochlorthiazide fixed dose combination group than in either of the ramipril or hydrochlothiazide monotherapy groups.

Reduction in the diastolic and systolic blood pressure was also greatest in the combination group. The study also reported lower incidence of adverse effects in the combination group than in either of the monotherapy groups.

Observe caution if required to be used during pregnancy and lactation