Angeril

Indications

• High blood pressure (hypertension).
• Heart failure, and heart failure after a heart attack.
• Lowering the risk of heart attack, stroke and death from heart disease in people at high risk, such as those with known heart or blood vessel disease, or diabetes with other risk factors.
• Kidney disease with protein in the urine, including kidney disease caused by diabetes.

How It Works

Ramipril is an ACE inhibitor (angiotensin-converting enzyme inhibitor). It reduces the production of angiotensin II, a hormone that narrows blood vessels. As a result, the blood vessels relax, blood pressure falls, the heart does not have to work as hard, and the kidneys are better protected.

Dosage and Administration

• High blood pressure: usually started at 1.25 to 2.5 mg once a day and increased gradually by the doctor. The usual dose is 2.5 to 5 mg once a day, up to a maximum of 10 mg a day.
• Preventing heart attack and stroke: usually started at 2.5 mg once a day and increased over a few weeks to 10 mg once a day, as prescribed.
• Heart failure and after a heart attack: started at a low dose and adjusted as prescribed.
• Older people and people with kidney problems usually need lower doses.

Swallow with water at the same time each day, with or without food. The doctor will usually check kidney function and blood potassium before starting and during treatment.

Interactions

• Potassium supplements, salt substitutes, Spironolactone, Amiloride and Trimethoprim can raise blood potassium to a dangerous level.
• Painkillers such as Ibuprofen and Diclofenac can reduce its effect and harm the kidneys.
• Diuretics (water tablets) can cause a large fall in blood pressure when ramipril is started.
• It can raise blood levels of Lithium.
• Combining it with Losartan-type medicines (angiotensin receptor blockers) or Aliskiren is usually avoided because of kidney and potassium problems.
• Sacubitril with Valsartan must not be taken within 36 hours of ramipril because of the risk of serious swelling.
• Insulin and diabetes tablets: blood sugar may fall more than usual at first.

Contraindications

• Allergy to ramipril or any other ACE inhibitor.
• A past history of angioedema (sudden swelling of the face, lips, tongue or throat).
• Pregnancy.
• Taking Sacubitril with Valsartan in the last 36 hours.
• Taking Aliskiren if you have diabetes or kidney impairment.
• Narrowing of the arteries to both kidneys.

Side Effects

Common: a dry, tickly cough that does not go away, dizziness (especially after the first doses), headache, tiredness, raised blood potassium and changes in kidney tests.

Get urgent medical help for swelling of the face, lips, tongue or throat, or difficulty breathing or swallowing (this can happen at any time during treatment), fainting, yellowing of the skin or eyes, severe stomach pain, passing much less urine, or fever with a sore throat that does not settle.

Pregnancy and Lactation

Pregnancy: must not be used. It can seriously harm the unborn baby, especially after the first three months. If you become pregnant or are planning a pregnancy, tell your doctor straight away so the medicine can be changed. Breastfeeding: not recommended, especially for newborn or premature babies; the doctor can choose a more suitable medicine.

Precautions and Warnings

If you have vomiting, diarrhoea or are not drinking enough, blood pressure may drop too low and the kidneys may be affected; contact your doctor, who may advise stopping it for a few days. Tell the doctor or dentist before surgery or an anaesthetic. Use with care in kidney or liver disease. Stand up slowly if you feel dizzy. Keep your blood test appointments. Do not stop the medicine without talking to your doctor.

Overdose

Too much can cause very low blood pressure, severe dizziness, fainting, a slow heartbeat and kidney problems. Lie down with the legs raised and seek emergency medical help.

Therapeutic Class

ACE inhibitor (blood pressure and heart medicine).

Storage

Store below 30°C in a dry place, away from light and out of the reach of children.