Piramil PLUS 5/25

Introduction
Piramil PLUS 5/25 is a medicine used to treat hypertension (high blood pressure). It is a combination of two medicines that helps to control blood pressure when a single medication is not effective. It helps to reduce the chances of any future heart attack and stroke. Piramil PLUS 5/25 is taken with or without food, preferably in the morning to avoid frequent urination at night. Keep taking it for as long as advised by your doctor. Even if you feel well, do not stop this medicine on your own because high blood pressure often has no symptoms. If you stop taking it, your condition may get worse. Keeping active with regular exercise, reducing your weight and eating a healthy diet will also help control your blood pressure. Follow your doctor’s advice while taking this medicine. Nausea, indigestion, taste change, and diarrhea are some common side effects of this medicine. Consult your doctor If any of these bother you, or get worse, or do not go away. Let your doctor know about cough or throat irritation that does not go away. Drink plenty of fluids while taking medicine to overcome muscle weakness, dry mouth, and extreme thirst. Dizziness may occur due to low blood pressure but this gets better with time. Before taking it, let your doctor know if you have any liver or kidney problems. Pregnant or breastfeeding women should also consult their doctor for advice before taking this medicine. You also need to tell your doctor what other medicines you are taking especially those used to treat high blood pressure or heart conditions. You should have your blood pressure, kidney function and the levels of salts such as potassium checked regularly to make sure that this medicine is working properly.

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Uses of Piramil PLUS 5/25
Hypertension (high blood pressure)
Side effects of Piramil PLUS 5/25
Common
Nausea
Indigestion
Taste change
Diarrhea
Stomach pain
Headache
Dizziness
Weakness
Glucose intolerance
Increased uric acid level in blood
Increased blood lipid level
Electrolyte imbalance
Cough
Decreased blood pressure
How to use Piramil PLUS 5/25
Take this medicine in the dose and duration as advised by your doctor. Swallow it as a whole. Do not chew, crush or break it. Piramil PLUS 5/25 may be taken with or without food, but it is better to take it at a fixed time.
How Piramil PLUS 5/25 works
Piramil PLUS 5/25 is a combination of two medicines: Ramipril and hydrochlorothiazide which lower blood pressure effectively. Ramipril is an angiotensin-converting enzyme (ACE) inhibitor. It works by reducing stress on the heart and relaxing blood vessels so that blood flows more smoothly and the heart can pump blood more efficiently. Hydrochlorothiazide is a diuretic that removes extra water and certain electrolytes from the body. Over time it also relaxes blood vessels and improves blood flow.
Quick Tips
You have been prescribed Piramil PLUS 5/25 for the treatment of high blood pressure.
It also lowers your risk of stroke and heart attack.
Take it in the morning with breakfast, to avoid getting up at night to urinate.
Piramil PLUS 5/25 may cause dizziness or sleepiness. Don’t drive or do anything requiring concentration until you know how it affects you.
To lower the chance of feeling dizzy or passing out, rise slowly if you have been sitting or lying down.
Inform you doctor about any cough, or throat irritation that doesn’t go away.
Piramil PLUS 5/25 may cause dehydration. Drink plenty of fluids and Inform your doctor if you develop extreme thirst, muscle weakness or very dry mouth.
Your doctor may regularly monitor your blood pressure, kidney function and the levels of salts such as potassium in your blood while you are taking this medicine.
Do not take Piramil PLUS 5/25 if you’re pregnant or planning pregnancy. It can cause birth defects or be fatal to your unborn baby.
Brief Description
Indication
Hypertension, Diabetic nephropathy, Congestive heart failure
Adult Dose
Oral Essential hypertension Adult: Per tablet contains ramipril 2.5 mg and hydrochlorthiazide 12.5 mg: 1 tablet daily up to a max of 4 tablets daily.

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Contraindication
Anuria, hypersensitivity, history of angioedema, bilateral renal artery stenosis, unilateral renal artery stenosis
Mode of Action
Ramipril is a long-acting ACE inhibitor which is metabolised into the active metabolite ramiprilat. Supine and standing blood pressures (BP) are reduced witho reflex tachycardia. Ventricular hypertrophy is reversed and renal blood flow increased. In CHF (CHF), pulmonary artery pressure and pulmonary capillary wedge pressure are reduced. Cardiac function is improved. Hydrochlorothiazide is a thiazide diuretic. It increases excretion of Na and chloride in approx equiv amounts. Natriuresis may be accompanied by some loss of K and bicarbonate. The rationale behind this combination is that these have a synergistic effect in lowering BP and offer an advantage of once-daily dosing convenience.

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Precaution
Severe renal disease, impaired hepatic, allergy or bronchial asthma, systemic lupus erythematosus, acute gout, diabetes mellitus, elderly, collagen vascular diseases, should be discontinued before carrying out tests for parathyroid function. Pregnancy and lactation.
Side Effect
Pancreatitis, jaundice, diarrhoea, nausea, vomiting, cramps, constipation, gastric irritation, anorexia, aplastic anaemia, agranulocytosis, leukopaenia, haemolytic anaemia, thrombocytopaenia, vasculitis, resp distress, including pneumonitis and pulmonary oedema, photosensitivity, fever, urticaria, rash, hyperglycaemia, glycosuria, hyperuricaemia, muscle spasm, vertigo, paraesthesias, dizziness, headache, restlessness, renal failure, renal dysfunction, interstitial nephritis, erythema multiforme including Stevens-Johnson syndrome, exfoliative dermatitis including toxic epidermal necrolysis, alopoecia, transient blurred vision, xanthopsia, impotence, dizziness, fatigue, headache, abdominal pain, cough, rarely symptomatic hypotension, angioneurotic oedema of face, lips, tongue, glottis and larynx, syncope, renal impairment, hypersensitivity reactions. Potentially Fatal: Anaphylactic reactions, electrolyte imbalance, hypotension.

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Interaction
Hydrochlorthiazide in combination with alcohol, barbiturates, or narcotics potentiates orthostatic hypotension. When coadministered with other antihypertensive gives additive effect. Absorption is reduced with cholestyramine and colestipol resins. Hypokalemia is observed with corticosteroids, tubocurarine responsiveness to the muscle relaxant is increased. It decreases the renal clearance of lithium and increases the risk of lithium toxicity. Non-steroidal anti-inflammatory agents can reduce the diuretic and natriuretic effect of hydrochlorthiazide. Ramipril with potassium-sparing diuretics results in severe hyperkaelemia. May increase serum lithium concentration, NSAIDs may reduce the effect of the drug and cause deterioration of renal function.

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