A fixed-dose combination (FDC) antihypertensive medication containing an ACE inhibitor (Ramipril) and a thiazide diuretic (Hydrochlorothiazide). It provides synergistic blood pressure lowering by reducing angiotensin II formation and increasing sodium and water excretion. This combination is widely used in the Indian market for patients requiring more than one drug to achieve blood pressure control, improving compliance and offering cost-effectiveness.
Adult: One tablet (Ramipril 5mg + HCTZ 12.5mg) once daily. Dose may be titrated after 2-4 weeks based on response. Maximum: Ramipril 10mg + HCTZ 25mg per day (as per available FDC strengths).
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 inhibits the 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 and water retention), and decreased bradykinin degradation. Hydrochlorothiazide inhibits the sodium-chloride symporter in the distal convoluted tubule of the nephron, promoting excretion of sodium, chloride, and water. The combination results in complementary mechanisms: reduced peripheral resistance (ramipril) and reduced plasma volume (HCTZ).
Pregnancy: CONTRANDICATED in second and third trimesters (ACE inhibitors cause fetal toxicity: oligohydramnios, fetal lung hypoplasia, skeletal deformations, renal failure, 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) | Reduced antihypertensive effect; increased risk of renal impairment | Major |
| Lithium | Increased lithium levels and toxicity (HCTZ reduces renal clearance) | 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 | Moderate |
| Cholestyramine / Colestipol | Reduced absorption of HCTZ | Moderate |
| Corticosteroids | Enhanced hypokalemic effect (HCTZ) | Moderate |
| Alcohol | Potentiation of orthostatic hypotension | Moderate |
Same composition (Ramipril (5mg) + Hydrochlorothiazide (12.5mg)), different brands: