Antihypertensives agents , telmisartan, NSAIDs, potassium sparing diuretics potassium supplements lithium anti-diabetes allopurinol immunosuppressants heparin sodium aurothiomalate ACTH

Hypertension inadequately controlled

First dose hypotension nausea, vomiting dizziness, headache abdominal pain diarrhoea angioneurotic edema liver dysfunction chloestatic jaundice visual hallucinations

History of angioneurotic edema renal artery stenosis aortic or mitral valve stenosis outflow obstruction hypotension haemodynamic instability Pregnancy Lactation

Special Precautions-

Haemodialysis ( avoid in patients dialysed with high flux membranes ) renal impairment, reduce dose and assess renal function prior to and during therapy monitor WBC in collagen vascular disease risk of severe hypotension, heart failure, aortic or mitral valve stenosis or with salt/fluid depletion

Diabetes-

monitor electrolytes and BUN ( if high ) and for hyhyperkalemia in diabetes or renal insufficiency Discontinue if angioedema or intestinal angioedema ( abdominal pain with or without nausea or vomtting Gout asthma

Hypertension inadequately controlled

Dosage-

Initially one tablet daily to be increased if reqd.

children - not recommended

Not available

Pharmacology:

Ramipril and its metabolite ramiprilat act by inhibiting angiotensin converting enzyme (ACE) which catalyses the conversion of angiotensin I to the vasoconstrictor substance angiotensin II Hydrochlothiazide affects the distil renal tubular mechanism of electrolyte reabsorption. It increases excretion of sodium and chloride in approximately equivalent amounts.

Clinical efficacy:

Efficacy and safety of the fixed dose combination of ramipril and hydrochlorthiazide ( dosage (2.5/12.5) mg or (5./25)mg were evaluated on multicentre study. Studies have shown that the decrease in supine diastolic blood pressure(the main efficacy parameter) was greater in the ramipril-hydrochlorthiazide combination group than in either ramipril or the hydrochlotiazide monotherapy groups. The combination was well tolerated and the efficacy of ramipril in combination with hydrochlorthiazide was maintained over the extension of a short term study in over one year period of investigation. The above clinical studies reflect the importance of fixed low dose combination therapy for the management of hypertension. Ramipril plus hydrochlorthiazide combination has shown its efectiveness in the management of hypertension.

Not available

Use contraindicated. Observe caution