A fixed-dose combination (FDC) antihypertensive medication containing an ACE inhibitor (Ramipril) and a thiazide diuretic (Hydrochlorothiazide). It provides synergistic blood pressure lowering by targeting the renin-angiotensin-aldosterone system (RAAS) and promoting sodium/water excretion. This combination is widely used in the Indian market for the management of essential hypertension, especially in patients requiring more than one drug to achieve target BP, and offers improved compliance.
Adult: One tablet (Ramipril 10mg + HCTZ 12.5mg) once daily. Initiation with this fixed dose is not recommended. Therapy should be initiated after individual titration of each component. Dose may be adjusted based on BP response, usually after 2-4 weeks. Maximum: Ramipril 10mg/day; HCTZ 25mg/day.
Note: Take orally once daily, preferably in the morning to avoid nocturia. Can be taken with or without food, but consistency is advised. Swallow whole with a glass of water. Ensure adequate hydration but avoid excessive fluid intake.
Ramipril competitively inhibits Angiotensin-Converting Enzyme (ACE), preventing the conversion of angiotensin I to the potent vasoconstrictor angiotensin II. This leads to vasodilation, reduced aldosterone secretion (decreasing sodium/water retention), and increased bradykinin levels (contributing to vasodilation and cough). Hydrochlorothiazide inhibits the Na+-Cl- symporter in the distal convoluted tubule of the nephron, increasing excretion of sodium, chloride, and water. This reduces plasma volume, cardiac output, and total peripheral resistance over time.
Pregnancy: CONTRANDICATED in second and third trimesters (ACE inhibitors can cause fetal injury: oligohydramnios, fetal lung hypoplasia, skeletal deformities, neonatal anuria, death). Discontinue as soon as pregnancy is detected. Category D (US FDA).
Driving: May cause dizziness, lightheadedness, or fatigue, especially during initiation. Patients should not drive or operate machinery until they know how the medication affects them.
| Potassium supplements / Potassium-sparing diuretics (Spironolactone, Amiloride) | Increased risk of severe hyperkalemia. | Major |
| NSAIDs (e.g., Ibuprofen, Diclofenac) | Reduce antihypertensive effect; increase risk of renal impairment and hyperkalemia. | Major |
| Lithium | HCTZ reduces renal clearance of Lithium, leading to toxicity. | Major |
| Antidiabetic drugs (Insulin, Sulfonylureas) | HCTZ may decrease glucose tolerance, requiring dose adjustment. | Moderate |
| Other antihypertensives / Vasodilators | Additive hypotensive effect. | Moderate |
| Allopurinol | Increased risk of hypersensitivity reactions with HCTZ. | Moderate |
| Cholestyramine / Colestipol | Reduce absorption of HCTZ. | Moderate |
| Alcohol, Barbiturates, Narcotics | Potentiation of orthostatic hypotension. | Moderate |
| Corticosteroids | Intensify electrolyte depletion (especially potassium). | Moderate |
| Digoxin | Hypokalemia or hypomagnesemia (from HCTZ) can increase risk of Digoxin toxicity. | Major |
Same composition (Ramipril (10mg) + Hydrochlorothiazide (12.5mg)), different brands: