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R-pril

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Indications:

Treatment of hypertension; for stable patients who have demonstrated clinical signs of CHF within the first few days after sustaining acute MI; reduce risk of MI, stroke, or death from CV causes in patients at high risk.

Contraindications:

Hypersensitivity to ACE inhibitors (particularly history of angioedema).

Adverse reactions:

Cardiovascular Hypotension (11%); angina pectoris (3%); postural hypotension, syncope (2%). CNS Dizziness (4%). EENT Vertigo (2%). GI Nausea, vomiting (2%); diarrhea (1%). Genitourinary Abnormal renal function (1%). Hematologic Neutropenia, agranulocytosis. Metabolic Hyperkalemia (1%). Respiratory Cough (8%). Miscellaneous Angioedema (0.3%); anaphylactoid reactions.

Interactions:

Antacids Ramipril bioavailability may be decreased. Separate administration times by 1 to 2 h. Capsaicin May exacerbate cough. Digoxin Increased or decreased digoxin levels. Diuretics Increased risk of hypotension. Indomethacin, salicylates (eg, aspirin) May reduce hypotensive effects, especially in low-renin or volume-dependent hypertensive patients. Lithium May cause increased lithium levels and symptoms of lithium toxicity. Loop diuretics Effects of loop diuretics may be decreased. Phenothiazines Enhanced hypotensive effects. Potassium supplements, potassium-sparing diuretics May cause increased potassium serum levels.

Warnings:

Warnings Pregnancy When used in pregnancy during the second and third trimesters, ACE inhibitors can cause injury and even death to the developing fetus. When pregnancy is detected, discontinue therapy as soon as possible. Pregnancy Category D (second, third trimester); Category C (first trimester). Discontinue use in pregnant patients; fetal/neonatal injury and death have occurred. Closely observe infants with histories of in utero exposure. Lactation Undetermined. Children Safety and efficacy not established. Elderly May show higher blood levels of active metabolite. Renal Function Dosage reduction is required in patients with renal function impairment. May further decrease renal function with elevations in BUN and serum creatinine caused by decreased renal perfusion. Hepatic Function Use drug with caution. Dosage reduction may be required because of impaired metabolism. Angioedema Angioedema may occur. Use drug with extreme caution in patients with hereditary angioedema. Cough Chronic cough may occur during treatment; it is more common in women. Hepatic failure Rarely, ACE inhibitors have been associated with a syndrome that starts with cholestatic jaundice and progresses to fulminant hepatic necrosis and sometimes death. Hypotension/first-dose effect Significant decreases in BP may occur following first dose, especially in severely salt- or volume-depleted patients (such as those receiving diuretics) or those with heart failure. Neutropenia and agranulocytosis Neutropenia and agranulocytosis have occurred with similar agents; risk appears greater in presence of renal dysfunction, heart failure, or immunosuppression. Proteinuria Proteinuria has occurred with agents in this class, especially with high doses or prior renal disease.

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