Ramipril

eMC SPC for Ramipril 10 mg Tablets. A starting dose of 1.25 mg is recommended in patients with a strongly activated renin-angiotensin-aldosterone system, and treatment should be initiated under medical supervision. In hypertensive patients in whom a diuretic is not discontinued, initiate at 1.25 mg (if possible stop the diuretic 2-3 days before starting) and monitor renal function and serum potassium. Cardiovascular prevention: initial 2.5 mg once daily; double after one or two weeks, then after a further two to three weeks increase to the target maintenance dose of 10 mg once daily. Diabetes with microalbuminuria, and non-diabetic nephropathy with macroproteinuria >= 3 g/day: initial 1.25 mg once daily, doubling to 2.5 mg after two weeks and then to 5 mg after a further two weeks. Diabetes with at least one cardiovascular risk: initial 2.5 mg once daily, doubling to 5 mg after one or two weeks and then to 10 mg after a further two or three weeks (target 10 mg daily). Symptomatic heart failure (patients stabilised on diuretic therapy): initial 1.25 mg daily, titrated by doubling every one to two weeks up to a maximum daily dose of 10 mg; two administrations per day are preferable. Secondary prevention after acute myocardial infarction with heart failure: from 48 hours after MI in a clinically and haemodynamically stable patient, 2.5 mg twice daily for three days; if 2.5 mg is not tolerated give 1.25 mg twice daily for two days before increasing to 2.5 mg and then 5 mg twice daily; subsequently double at intervals of one to three days up to the target maintenance dose of 5 mg twice daily; if the dose cannot be increased to 2.5 mg twice daily the treatment should be withdrawn. Severe (NYHA IV) heart failure immediately after MI: experience is lacking; if treated, start at 1.25 mg once daily with particular caution on dose increase. Hepatic impairment: initiate only under close medical supervision; maximum daily dose 2.5 mg. Elderly: lower initial doses and more gradual titration; a reduced initial dose of 1.25 mg should be considered. The §4.2 paediatric population text was truncated in the fetched source, so no paediatric posology could be extracted — clinician to verify against a children's formulary.