Ramipril + Hydrochlorothiazide
Rx
Generic NameRamipril + Hydrochlorothiazide
Therapeutic ClassACE Inhibitor + Thiazide Diuretic
Common Strength2.5/12.5 mg, 5/12.5 mg, 5/25 mg per tablet
Max / 24hAs per physician guidance; titrate based on blood pressure response
PregnancyContraindicated
Indications ▼
Hypertension: Management of essential hypertension in adults, particularly in patients whose blood pressure is not adequately controlled with monotherapy.
Combination Therapy: Indicated when dual therapy is appropriate, especially in patients requiring both renin–angiotensin system inhibition and diuretic therapy for optimal blood pressure control.
Cardiovascular Risk Reduction: Helps reduce the risk of stroke, myocardial infarction, and other cardiovascular events in hypertensive patients at high cardiovascular risk.
Volume-Dependent Hypertension: Particularly beneficial in patients with fluid retention or salt-sensitive hypertension.
Secondary Hypertension (Adjunct Use): May be used as part of combination regimens in selected cases under specialist supervision.
Mechanism & Pharmacokinetics ▼
Mechanism: Ramipril inhibits ACE, reducing angiotensin II formation, leading to vasodilation and decreased aldosterone. Hydrochlorothiazide inhibits sodium and chloride reabsorption in distal renal tubules, increasing diuresis and reducing plasma volume. Combined effect lowers blood pressure more effectively.
Pharmacokinetics: Ramipril is converted to active metabolite ramiprilat; peak in 2–4 hours. Hydrochlorothiazide absorbed orally with peak plasma levels in 1–5 hours. Both drugs excreted renally; half-lives: ramipril 13–17 hours (ramiprilat 13–17h), hydrochlorothiazide 6–15 hours.
Dosage & Administration ▼
| Indication | Dose | Frequency |
|---|---|---|
| Hypertension (Initial) | 2.5/12.5 mg | Once daily |
| Hypertension (Maintenance) | 5/12.5 mg or 5/25 mg | Once daily |
Note: Dose adjustment required in renal impairment, elderly, or patients with electrolyte abnormalities. Monitor blood pressure, potassium, and renal function regularly.
Side Effects ▼
Cough (ACE inhibitor related)
Hypotension, dizziness
Hyperkalemia
Renal impairment
Electrolyte disturbances (hypokalemia, hyponatremia)
Contraindications ▼
Hypersensitivity to ramipril, hydrochlorothiazide, or any component
History of angioedema related to ACE inhibitors
Pregnancy (Category D in 2nd/3rd trimester)
Severe renal impairment or anuria
Severe hepatic impairment
Drug Interaction ▼
Potassium supplements or potassium-sparing diuretics: hyperkalemia risk
NSAIDs: may reduce antihypertensive effect and increase renal risk
Other antihypertensives: additive hypotensive effect
Diabetes medications: monitor for hypoglycemia
Pregnancy & Lactation ▼
Contraindicated during pregnancy, especially 2nd and 3rd trimesters
Use during breastfeeding only if benefits outweigh risks
Clinical / Research Summary ▼
Clinical Role: Effective combination therapy for hypertension when monotherapy is insufficient.
Advantage: Dual mechanism improves blood pressure control.
Limitation: Risk of hypotension, electrolyte disturbances, and renal impairment; careful monitoring needed.
Monitoring: Blood pressure, electrolytes, renal function, signs of angioedema.
Patient Counseling Points ▼
Take exactly as prescribed, preferably in the morning to avoid nocturia
Report dizziness, swelling, or rapid weight changes
Regular monitoring of blood pressure, electrolytes, and renal function
Do not stop abruptly without consulting physician
Storage & Handling ▼
Store below 30°C
Protect from moisture and light
Keep out of reach of children
Brand Names (Bangladesh & Global) ▼
Protace-H®
Ramicard Plus 2.5/12.5®
Ramicard Plus 5/25®
Ramoril Plus 2.5/12.5®
Ramoril Plus 5/25®
Medical Disclaimer: For educational purposes only. Not a substitute for professional medical advice.
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