Acecard 5 mg

Description

Acecard Tablet

Indications
Acecard tablets are prescribed for the following conditions:

• Hypertension: Used to lower blood pressure, either as a monotherapy or in combination with other antihypertensive agents.
• Congestive Heart Failure: Can be used alone or in combination with diuretics.
• Post-Myocardial Infarction Management: Recommended for patients who show signs of congestive heart failure within the first few days after an acute myocardial infarction.
• Nephropathy Treatment: Used for both diabetic and non-diabetic patients with overt glomerular or incipient nephropathy.
• Cardiovascular Risk Reduction: Helps lower the risk of myocardial infarction, stroke, or cardiovascular death in patients with high cardiovascular risk, such as those with coronary heart disease, previous stroke, peripheral vascular disease, or diabetes mellitus with additional risk factors (e.g., hypertension, microalbuminuria, smoking, dyslipidemia).

Take this medication only as prescribed by a registered physician.

Pharmacology
Ramipril, an angiotensin-converting enzyme (ACE) inhibitor, is converted into ramiprilat, which blocks the transformation of angiotensin I into the vasoconstrictor angiotensin II. By inhibiting ACE, ramipril reduces angiotensin II levels, leading to decreased vasopressor activity and aldosterone secretion. This results in lowered blood pressure and improved management of heart failure. Additionally, it helps prevent stroke, myocardial infarction, and cardiovascular-related deaths. Ramipril is long-acting, well-tolerated, and suitable for long-term therapy.

Dosage and Administration
The dosage of Ramipril must be tailored to individual tolerance and response.

• Hypertension: The usual starting dose is 1.25–2.5 mg once daily for adults not taking a diuretic. Dosage adjustments should be made at intervals of at least two weeks. Maintenance dosage typically ranges from 2.5–20 mg daily, taken as a single dose or divided into two doses. If blood pressure remains uncontrolled, a diuretic may be added.
• Congestive Heart Failure After Myocardial Infarction: Treatment should begin as early as two days after a heart attack. The initial recommended dose is 2.5 mg twice daily. If hypotension occurs, the dose should be reduced to 1.25 mg twice daily. The goal is to reach a maintenance dose of 5 mg twice daily.
• Prevention of Major Cardiovascular Events: An initial dose of 2.5 mg once daily for the first week, followed by 5 mg daily for the next three weeks, is recommended. The maintenance dose is 10 mg once daily, as tolerated.

Dosage Adjustments for Special Populations

• Renal Impairment (Hypertension): Initial dose is 1.25 mg once daily, titrated up to 5 mg daily based on response.
• Renal Impairment (Heart Failure): Start with 1.25 mg once daily, increasing to 1.25 mg twice daily, with a maximum of 2.5 mg twice daily if well-tolerated.
• Elderly Patients: A lower initial dose of 1.25 mg daily is recommended.
• Hepatic Impairment: Treatment should be initiated under close medical supervision. The maximum daily dose should not exceed 2.5 mg.
• Patients on Diuretics: It is advisable to discontinue the diuretic for 2–3 days before starting Ramipril or at least reduce the diuretic dose. The initial daily dose in these patients is usually 1.25 mg.

Administration
Ramipril tablets should be swallowed whole with a sufficient amount of liquid. Do not chew or crush the tablets. Food intake does not significantly affect its absorption, so it can be taken before, during, or after meals.

Drug Interactions

• Diuretics: Concurrent use may cause severe hypotension and, with potassium-sparing diuretics, lead to hyperkalemia.
• Lithium: May increase serum lithium levels, requiring monitoring.
• NSAIDs: May reduce the antihypertensive effects of Ramipril and impair renal function.
• Alcohol: Can intensify the blood pressure-lowering effect, leading to dizziness and fainting.

Contraindications
Ramipril should not be used in patients with:

• Hypersensitivity to Ramipril, ACE inhibitors, or excipients.
• History of angioedema.
• Concomitant treatment with sacubitril/valsartan.
• Hemodynamically significant renal artery stenosis (bilateral or unilateral in a single kidney).
• Hypotension or hemodynamic instability.
• Use of aliskiren-containing medicines in patients with diabetes or moderate to severe renal impairment (creatinine clearance <60 ml/min).
• Diabetic nephropathy when combined with angiotensin II receptor blockers.
• Pregnancy.

Patients undergoing extracorporeal treatments that involve blood contact with negatively charged surfaces (e.g., dialysis with high-flux membranes, LDL apheresis with dextran sulfate) should avoid Ramipril due to the risk of severe anaphylactoid reactions.

Side Effects
Common side effects include dizziness, headache, fatigue, and weakness. Less frequently, patients may experience:

• Hypotension
• Persistent cough
• Nausea, vomiting, diarrhea
• Skin rash, urticaria
• Anxiety, memory disturbances

Rare but severe reactions include angioedema, anaphylaxis, and hyperkalemia.

Pregnancy & Lactation

• Pregnancy: Ramipril must not be used during pregnancy. If pregnancy occurs, the medication should be discontinued immediately and replaced with a suitable alternative.
• Lactation: Not recommended for breastfeeding mothers.

Warnings & Precautions

• Use with caution in patients with impaired renal function, hyperkalemia, hypotension, or liver disease.
• Adjustments are needed for patients with volume or salt depletion, severe hypertension, or significant cardiovascular risks.

Overdose Effects & Management
Symptoms: Severe hypotension, shock, bradycardia, electrolyte imbalances, renal failure. Management:

• Immediate gastric lavage and administration of activated charcoal within 30 minutes.
• In cases of severe hypotension, treatment may include administration of alpha1-adrenergic agonists (e.g., norepinephrine, dopamine) or angiotensin II, along with fluid and electrolyte replacement.

Therapeutic Class
Angiotensin-Converting Enzyme (ACE) Inhibitors.

Storage Conditions

• Store below 30°C, away from direct light.
• Keep out of reach of children.
• Do not use beyond the expiration date.
• Dispensed only with a registered physician’s prescription.