A fixed-dose triple combination antihypertensive therapy containing an ACE inhibitor (Ramipril), an ARB (Telmisartan), and a thiazide diuretic (Hydrochlorothiazide). This combination provides synergistic blood pressure lowering through complementary mechanisms, targeting the Renin-Angiotensin-Aldosterone System (RAAS) at two points and reducing plasma volume. It is indicated for patients with essential hypertension not adequately controlled on dual therapy. The combination may improve adherence and offers a convenient once-daily dosing regimen.
Adult: One tablet once daily. Dose may be titrated after 2-4 weeks of therapy based on response. This is a maximum strength FDC; not for initial titration.
Note: Take orally once daily, with or without food. Preferably taken in the morning to avoid nocturia due to diuretic effect. Swallow whole with a glass of water. Maintain adequate fluid intake unless contraindicated. Do not skip doses. If a dose is missed, take it as soon as remembered unless it's almost time for the next dose; do not double the dose.
This combination exerts a multi-pronged attack on hypertension. Ramipril inhibits Angiotensin Converting Enzyme (ACE), reducing the conversion of Angiotensin I to the potent vasoconstrictor Angiotensin II and decreasing aldosterone secretion. Telmisartan selectively and competitively blocks the AT1 receptor, preventing the action of any Angiotensin II (including that generated via non-ACE pathways). Hydrochlorothiazide inhibits sodium reabsorption in the distal convoluted tubule, causing natriuresis, diuresis, and a reduction in plasma volume. The combination results in vasodilation, reduced peripheral resistance, decreased aldosterone-mediated sodium/water retention, and volume depletion, leading to significant BP reduction.
Pregnancy: CONTRANDICATED in second and third trimesters (Pregnancy Category D). Drugs that act directly on the RAAS can cause injury and death to the developing fetus, including oligohydramnios, fetal renal failure, hypoplastic lung development, skull hypoplasia, and fetal death. Discontinue as soon as pregnancy is detected.
Driving: Dizziness, lightheadedness, or syncope may occur, especially during initiation of therapy. Patients should be cautioned about driving or operating machinery until their response to the therapy is known.
| Other Antihypertensives (Beta-blockers, CCBs, Alpha-blockers) | Additive hypotensive effect; risk of severe hypotension. | Major |
| Potassium-sparing diuretics (Spironolactone, Eplerenone, Amiloride) | Profoundly increased risk of severe hyperkalemia. | Major |
| NSAIDs (e.g., Ibuprofen, Diclofenac, Naproxen) | Reduced antihypertensive effect; increased risk of renal impairment and hyperkalemia. | Major |
| Lithium | HCTZ reduces renal clearance of Lithium, leading to Lithium toxicity. | Major |
| Oral Antidiabetics (Insulin, Sulfonylureas) | HCTZ may decrease glucose tolerance, requiring dose adjustment. | Moderate |
| Allopurinol | Increased risk of hypersensitivity reactions when combined with HCTZ. | Moderate |
| Digoxin | Hypokalemia or hypomagnesemia (from HCTZ) can predispose to Digoxin toxicity. | Moderate |
| Cholestyramine/Colestipol | Reduced absorption of HCTZ. Separate administration by at least 4 hours. | Moderate |
| Alcohol, Barbiturates, Narcotics | Potentiation of orthostatic hypotension. | Moderate |
Same composition (Ramipril (2.5mg) + Telmisartan (40mg) + Hydrochlorothiazide (12.5mg)), different brands: