Active Ingredient: Ramipril
For this indication, competent medicine agencies globally authorize below treatments:
For:
Regimen A: Oral, 1.25 milligrams ramipril, once daily, over the duration of 2 to 4 weeks. Afterwards, oral, between 1.25 milligrams ramipril and 10 milligrams ramipril, once daily. The maximum allowed total dose is 10 milligrams ramipril daily.
Regimen B: Oral, 2.5 milligrams ramipril, once daily, over the duration of 2 to 4 weeks. Afterwards, oral, between 2.5 milligrams ramipril and 10 milligrams ramipril, once daily. The maximum allowed total dose is 10 milligrams ramipril daily.
The dose should be individualised according to the patient profile and blood pressure control.
Ramipril may be used in monotherapy or in combination with other classes of antihypertensive medicinal products.
Starting dose:
Ramipril should be started gradually with an initial recommended dose of 2.5 mg daily.
Patients with a strongly activated renin-angiotensin-aldosterone system may experience an excessive drop in blood pressure following the initial dose. A starting dose of 1.25 mg is recommended in such patients and the initiation of treatment should take place under medical supervision.
Titration and maintenance dose:
The dose can be doubled at interval of two to four weeks to progressively achieve target blood pressure; the maximum permitted dose of ramipril is 10 mg daily. Usually the dose is administered once daily.
Hypotension may occur following initiation of therapy with ramipril; this is more likely in patients who are being treated concurrently with diuretics. Caution is therefore recommended since these patients may be volume and/or salt depleted.
If possible, the diuretic should be discontinued 2 to 3 days before beginning therapy with ramipril.
In hypertensive patients in whom the diuretic is not discontinued, therapy with ramipril should be initiated with a 1.25 mg dose. Renal function and serum potassium should be monitored. The subsequent dosage of ramipril should be adjusted according to blood pressure target.
It is recommended that ramipril is taken each day at the same time of the day.
Ramipril can be taken before, with or after meals, because food intake does not modify its bioavailability.
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