A fixed-dose combination (FDC) of an ACE inhibitor (Ramipril) and an HMG-CoA reductase inhibitor (Atorvastatin). It is primarily indicated for the management of hypertension and dyslipidemia in patients with concomitant cardiovascular risk, particularly for secondary prevention in post-myocardial infarction and post-stroke patients. This combination addresses two major modifiable risk factors for atherosclerotic cardiovascular disease (ASCVD).
Adult: One tablet (Ramipril 20mg + Atorvastatin 5mg) once daily. Initiation: Preferably start with individual components at lower doses (e.g., Ramipril 2.5mg, Atorvastatin 10mg) and titrate before switching to FDC. The 20mg/5mg strength is a maintenance dose.
Note: Can be taken with or without food. Preferably taken at the same time each day, in the evening or at bedtime for Atorvastatin (though 24-hour efficacy allows morning dosing). Swallow whole with a glass of water. Do not crush or chew.
Ramipril inhibits Angiotensin Converting Enzyme (ACE), reducing the conversion of Angiotensin I to the potent vasoconstrictor Angiotensin II, leading to vasodilation, reduced aldosterone secretion (decreasing sodium/water retention), and increased bradykinin levels. Atorvastatin competitively inhibits HMG-CoA reductase, the rate-limiting enzyme in the mevalonate pathway of cholesterol synthesis in the liver, leading to upregulation of LDL receptors and increased clearance of LDL-cholesterol from the bloodstream.
Pregnancy: CONTRANDICATED. Ramipril: Pregnancy Category D (2nd & 3rd trimester). Can cause fetal injury, oligohydramnios, hypocalvaria, renal failure, and death. Atorvastatin: Pregnancy Category X. Cholesterol is essential for fetal development. Discontinue immediately upon detection of pregnancy.
Driving: Caution advised. May cause dizziness, vertigo, or fatigue, especially during initiation or dose escalation.
| Diuretics (especially loop/thiazide) | Potentiates hypotensive effect; risk of first-dose hypotension. | Major |
| Potassium-sparing diuretics (Spironolactone, Amiloride), Potassium supplements | Increased risk of hyperkalemia. | Major |
| NSAIDs (e.g., Ibuprofen, Diclofenac) | May reduce antihypertensive effect of Ramipril and increase risk of renal impairment. | Major |
| Aliskiren | Increased risk of renal impairment, hyperkalemia, and hypotension. Contraindicated in diabetes/renal impairment. | Major |
| Lithium | Ramipril may increase Lithium levels and toxicity. | Major |
| Potent CYP3A4 inhibitors (Itraconazole, Clarithromycin, HIV protease inhibitors, Cyclosporine, Gemfibrozil) | Markedly increase Atorvastatin levels, significantly raising risk of myopathy/rhabdomyolysis. | Major |
| Warfarin | Atorvastatin may potentiate anticoagulant effect; monitor INR closely. | Moderate |
| Oral Contraceptives | Atorvastatin may increase levels of norethindrone and ethinyl estradiol. | Moderate |
| Digoxin | Ramipril may slightly increase Digoxin levels. | Moderate |
| Colchicine | Increased risk of myopathy, especially in renal impairment. | Major |
Same composition (Ramipril (20mg) + Atorvastatin (5mg)), different brands: