Ramipril is an angiotensin-converting enzyme (ACE) inhibitor, used to treat high blood pressure and congestive heart failure.
USE
Hypertension;
Congestive heart failure;
Following heart attack in patients with clinical evidence of heart failure;
Susceptible patients over 55 years: prevention of heart attack, stroke, cardiovascular death or need of revascularization procedures.
Diabetic nephropathy (kidney damage due to diabetes) with microalbuminuria (protein in the urine); in low doses it is used as a prophylaxis for developing nephropathy and related secondary cardiovascular events.
DOSING: The usual dose of ramipril for hypertension is 2.5-20 mg a day as a single dose or two divided doses. Patients taking diuretics or who have reduced kidney function may require lower doses. Heart failure is initially treated with 1.25-2.5 mg twice daily then titrated up to 10 mg once daily or 5 mg twice daily. The dose for preventing heart attacks and strokes is 2.5-10 mg daily.
IUPAC Name - (2S,3aS,6aS)-1-[(2S)-2-{[(2S)-1-ethoxy-1-oxo-4-phenylbutan-2-yl]amino}propanoyl]-octahydrocyclopenta[b]pyrrole-2-carboxylic acid
STORAGE: Tablets and capsules should be stored at room temperature between 15 C to 30 C (59 F to 86 F).
CONTRA INDICATIONS - Renovascular disease (impaired blood flow in the kidneys), severe renal impairment (especially in patients with one kidney or with bilateral renal artery stenosis), volume-depleted patients, history of angioedema while on an ACE inhibitor, pregnancy, hypotension.
ADVERSE EFFECTS -
low blood sugar (in patients taking medication for diabetes), causing sweating or shakiness
dry cough
dizziness and light-headedness due to low blood pressure
tiredness and fatigue, especially in the early stages
mouth dryness in the early stages
nausea, vomiting, diarrhea (persistent in rare cases)
fainting
change in amount of urine
signs of infection (e.g., fever, chills, persistent sore throat)
yellowing of eyes or skin, dark urine
stomach or abdominal pain
neutropenia (low white blood cells)
impotence (erectile dysfunction)
Serious allergic reactions to this drug are unlikely, but immediate medical attention must be sought if they occur. Symptoms of a serious allergic reaction include, but are not limited to a rash or swelling of the face, mouth, tongue, or throat.
In extreme cases, ramipril may lead to potentially fatal liver problems.
MECHANISM OF ACTION -
ACE inhibitors, as the name suggests, inhibit the actions of angiotensin converting enzyme (ACE), thereby lowering the production of angiotensin II and also decreasing the breakdown of bradykinin. The decrease in angiotensin II results in relaxation of arteriole smooth muscle leading to a decrease in total peripheral resistance, reducing blood pressure as the blood is pumped through widened vessels. Its effect on bradykinin is responsible for the dry cough side effect.
Ramipril, a prodrug or precursor drug, is converted to the active metabolite (metabolic product) ramiprilat by liver esterase enzymes.[4] Ramiprilat is mostly excreted by the kidneys. The half-life of ramiprilat is variable (3–16 hours), and is prolonged by heart and liver failure, as well as kidney failure.
DRUG INTERACTIONS: The use of ACE inhibitors with potassium supplements, salt substitutes or diuretics (for example, spironolactone [Aldactone] that increase potassium in the blood may lead to excessive potassium levels. Potassium levels should be monitored whenever ACE inhibitors are used in combination with these drugs.
PATENT -
The compound was protected by U.S. Patent 5,061,722 which was assigned to Aventis on 29 October 1991. The patent was scheduled to expire on 29 October 2008. On 11 September 2007, in an appeal by the Indian company Lupin Ltd., the United States Court of Appeals for the Federal Circuit reversed a district court trial verdict and found that Aventis's patent on ramipril was invalid for "obviousness" - opening this medicine to generic manufacturers.
Ramipril is marketed in India under the brand names of Cardace, Zigpril, Ramistar and Zorem.
BRANDS
Artere Tabet Valiant Healthcare Limited
Artere (5 mg) Tabet Alchemist Lifesciences Ltd.
Cardace Tabet Alcare David Ltd.
Cardiopril Cap Dr. Reddy s Laboratories
Conram Tabet Concertina Pharma Pvt. Ltd
Cordimil Cap Ind - Swift
Corpril Cap Ranbaxy
Dexace (10 mg) Tabet Dexter Laboratories Pvt. Ltd.
Ecator (10 mg) Tabet Torrent Labs (P) Ltd.
G -Pril Tabet Hinglaj Labs of India
Gopril (10 mg)Tabet CMG Biotech
GR Pace (10 mg)Tabet G R Laboratories Pvt. Ltd.
Hopace Tab Micro Labs Ltd (Cardicare)
Hoperam(1.25mg)Tabet Zinnia Life Sciences
Kepry Tabet Cadex Laboratories
Megapril Tabet Biomax
Misry Tabet Biocin Healthcare
Nexrami Tabet Nexus Biotech
Panpril -5 Tabet Panvik Pharmaceuticals
Polypril (10mg)Tabet Druto Laboratories
Preface Tabet Centaur Pharmaceuticals Pvt.Ltd.
Proace (2.5mg)Tabet Alembic Chemical Works Co Ltd
Race (1.25mg)Tablet Alkem Laboratories Ltd
Ramace (10mg)Cap Astra Zeneca Pharma India Limited
Ramcor 5 Cap IPCA Laboratories (Innova Division)
Ramey Cap Cadila Pharmaceuticals (Recon Healthcare)
Rami -Ten tab Twilight Merchantiles (P) Ltd.
Ramic (1.25 mg)Tab D.R.John & Lab
Ramicard tab Intra Labs India Pvt Ltd
Ramichek (1.25mg)tab Indoco Remedies Ltd
Ramihart (2.5mg)Tab Mankind Pharmaceuticals Pvt. Ltd.
Ramil (1.25 mg) Tab Aurobindo Pharma Ltd. (Argus)
Ramipres (10 mg) Tab Cipla Limited
Ramipro Cap Emcure Pharmaceuticals
Ramiril Cap Micro Labs
Ramistar (10 mg)Cap Lupin Laboratories Ltd.
Rampril (10 mg)Cap Themis Medicare Ltd.
Ramsho (1.25 mg)Tab Aamorb Pharmaceuticals Pvt Ltd (Xeena)
Rebeat (5 mg) Tab Le Renon Healthcare Pvt.Ltd
Rigapril (10mg) Tab Quadriga Biotech Pvt Ltd
RL Tab 1.25 Sunij Pharma Pvt Ltd
Saface Tab Morepen Laboratories Ltd.
Servace Cap Bal Pharma (Servetus Division)
Topril Cap Torrent Pharmaceuticals
Variace (1.25mg) Tab Win-Medicare Limited
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