A fixed-dose combination (FDC) of an ACE inhibitor (Ramipril) and an Angiotensin II Receptor Blocker (ARB, Losartan). This dual blockade of the Renin-Angiotensin-Aldosterone System (RAAS) provides synergistic antihypertensive and cardioprotective effects. It is primarily indicated for the management of hypertension not adequately controlled by monotherapy, and for specific high-risk cardiovascular conditions. Its use is subject to strict clinical guidelines due to the risk of hyperkalemia, hypotension, and renal impairment.
Adult: One tablet (Ramipril 5mg + Losartan 50mg) once daily. Initiation under medical supervision, often after failed monotherapy. Dose may be titrated based on response and tolerability, but the maximum recommended combined dose is Ramipril 10mg + Losartan 100mg per day.
Note: Can be taken with or without food. Food may slightly slow absorption but does not affect overall bioavailability. Administer at the same time each day, preferably in the morning. If a dose is missed, take it as soon as remembered unless it is almost time for the next dose. Do not double the dose.
Provides dual blockade of the RAAS at two distinct points. Ramipril inhibits the Angiotensin-Converting Enzyme (ACE), preventing the conversion of Angiotensin I to the potent vasoconstrictor Angiotensin II and decreasing the breakdown of bradykinin (a vasodilator). Losartan competitively and selectively blocks the AT1 receptor, through which Angiotensin II exerts its effects (vasoconstriction, aldosterone secretion, sympathetic activation, vascular hypertrophy). This dual blockade more completely suppresses the deleterious effects of Angiotensin II.
Pregnancy: CONTRANDICATED in second and third trimesters (FDA Category D). Can cause fetal injury and death, including oligohydramnios, fetal hypocalvaria, pulmonary hypoplasia, renal tubular dysplasia, and anuria. Discontinue immediately if pregnancy is detected.
Driving: May cause dizziness, lightheadedness, or fatigue, especially during initiation or dose escalation. Patients should not drive or operate machinery until they know how the medication affects them.
| Potassium supplements / Salt substitutes (high K+) | Increased risk of severe hyperkalemia | Major |
| Potassium-sparing diuretics (Spironolactone, Eplerenone, Amiloride) | Increased risk of severe hyperkalemia | Major |
| NSAIDs (e.g., Ibuprofen, Diclofenac, Naproxen) | Reduced antihypertensive effect; increased risk of renal impairment and hyperkalemia | Major |
| Diuretics (especially loop and thiazide, initiated concurrently) | Risk of first-dose hypotension and volume depletion | Major |
| Lithium | Increased serum lithium levels and toxicity | Major |
| Aliskiren | Increased risk of hyperkalemia, hypotension, and renal impairment (contraindicated in diabetes/CKD) | Major |
| Other antihypertensives (Beta-blockers, CCBs) | Additive hypotensive effect | Moderate |
| Antidiabetics (Insulin, Sulfonylureas) | Increased risk of hypoglycemia (Ramipril may improve insulin sensitivity) | Moderate |
| Allopurinol, Procainamide, Immunosuppressants | Increased risk of hypersensitivity reactions and blood dyscrasias with Ramipril | Moderate |
| Rifampicin | May reduce levels of Losartan's active metabolite | Moderate |
| Fluconazole | May increase Losartan levels (CYP2C9 inhibition) | Moderate |