Ramipril

Source: UK SPC (eMC) section 4.2 for Ramipril 10mg Tablets (https://www.medicines.org.uk/emc/product/8067/smpc). HYPERTENSION - VERBATIM: 'Ramipril should be started gradually with an initial recommended dose of 2.5 mg daily... A starting dose of 1.25 mg is recommended in [patients with a strongly activated renin-angiotensin-aldosterone system] and the initiation of treatment should take place under medical supervision... The dose can be doubled at interval of two to four weeks to progressively achieve target blood pressure; the maximum permitted dose of Ramipril is 10 mg daily. Usually the dose is administered once daily.' CARDIOVASCULAR PREVENTION: initial 2.5 mg once daily; double the dose after one or two weeks and, after another two to three weeks, increase to the target maintenance dose of 10 mg once daily, depending on tolerability. DIURETIC-TREATED PATIENTS: if possible discontinue the diuretic 2-3 days before starting ramipril; if the diuretic is not discontinued in hypertensive patients, initiate at 1.25 mg and monitor renal function and serum potassium. DIABETES WITH MICROALBUMINURIA: initial 1.25 mg once daily, doubling to 2.5 mg after two weeks then 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 then 10 mg after a further two or three weeks; target daily dose 10 mg. NON-DIABETIC NEPHROPATHY (macroproteinuria >= 3 g/day): initial 1.25 mg once daily, doubling to 2.5 mg after two weeks then 5 mg after a further two weeks. SYMPTOMATIC HEART FAILURE: in patients stabilised on diuretic therapy, initial 1.25 mg daily, titrated by doubling the dose every one to two weeks up to a maximum daily dose of 10 mg; two administrations per day are preferable. SECONDARY PREVENTION AFTER ACUTE MI WITH HEART FAILURE: starting 48 hours after myocardial infarction in a clinically and haemodynamically stable patient, 2.5 mg twice daily for three days; if the initial 2.5 mg dose is not tolerated, give 1.25 mg twice a day for two days before increasing to 2.5 mg then 5 mg twice a day; thereafter double the daily dose 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maintenance dose of 5 mg twice daily; if the dose cannot be increased to 2.5 mg twice a day the treatment should be withdrawn. Sufficient experience is lacking in severe (NYHA IV) heart failure immediately after myocardial infarction; if treated, start at 1.25 mg once daily with particular caution on any dose increase. HEPATIC IMPAIRMENT: initiate only under close medical supervision; maximum daily dose 2.5 mg. ELDERLY: lower initial doses and more gradual titration because of a greater chance of undesirable effects, especially in very old and frail patients - a reduced initial dose of 1.25 mg should be considered. PAEDIATRIC: safety and efficacy in children has not yet been established and no specific recommendation on posology can be made. Note: the UK section 4.5 was not retrieved in this bundle - the interactions below come from the section 4.2, 4.3 and 4.4 text.