Racard

Introduction
Racard belongs to a group of medicines known as angiotensin converting enzyme (ACE) inhibitors. It is widely used to treat high blood pressure and heart failure and may be prescribed after a heart attack. It also lowers the chances of having a heart attack or stroke. Racard can be prescribed either alone or in combination with other medicines. It may be taken empty stomach or with a meal. This medicine should be taken at the same time each day to get the maximum benefit. It is important to continue taking it regularly even if you feel well or even if your blood pressure is controlled. Most people with high blood pressure do not feel any symptoms, but if you stop taking this medicine, your condition could get worse. This is a widely used medicine and is considered safe for long-term use. Making some changes in your lifestyle will also help lower your blood pressure. These may include regular exercise, losing weight, not smoking, reducing alcohol intake, and reducing the amount of salt in your diet as advised by your doctor. The most common side effects of this medicine include feeling dizzy or drowsy, headache, dry cough, fatigue, nausea, vomiting, diarrhea, stomach pain and low blood pressure. Most of these are temporary and resolve with time. Talk to your doctor if any of the side effects bother you or do not go away. Before taking this medicine, let your doctor know if you have any kidney or liver problems. Pregnant or breastfeeding mothers should also consult their doctor before taking it. Your doctor may check your kidney function, blood pressure and potassium levels in your blood at regular intervals while you are taking this medicine.

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Uses of Racard
Hypertension (high blood pressure)
Prevention of heart attack and stroke
Heart failure
Side effects of Racard
Common
Decreased blood pressure
Dizziness
Fatigue
Vomiting
Dry cough
How to use Racard
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. Racard may be taken with or without food, but it is better to take it at a fixed time.
How Racard works
Racard is an angiotensin converting enzyme (ACE) inhibitor. It works by reducing stress on the heart and relaxing blood vessel so that blood flows more smoothly and the heart can pump blood more efficiently.
What if you forget to take Racard?
If you miss a dose of Racard, skip it and continue with your normal schedule. Do not double the dose.
Quick Tips
Racard can make you feel dizzy for the first few days, so rise slowly if you have been sitting or lying down. You can also prefer taking it at bedtime to avoid dizziness throughout the day.
Let your doctor know about any cough, or throat irritation that does not go away.
It may increase the level of potassium in blood. Avoid taking potassium supplements and potassium-rich foods such as banana and broccoli.
Inform your doctor if you are pregnant, planning pregnancy or breastfeeding.
Brief Description
Indication
Congestive heart failure, MI, HTN, CV events, Stroke
Administration
May be taken with or without food.
Adult Dose
Oral Hypertension, Diabetic Nephropathy Adult: Hypertension Initial (not on diuretic): 2.5 mg once daily at bedtime. Initial (with diuretic): 1.25 mg once daily at bedtime. Maintenance: 2.5-5 mg/day as a single dose, Max: 10 mg/day. Congestive Heart failure Adult: Initially, 1.25 mg once daily. Max: 10 mg daily. Doses >2.5 mg may be given in 2 divided doses. Max Dosage: 10 mg daily in 1-2 divided doses. Post myocardial infarction Adult: Initially, 2.5 mg bid, may increase to 5 mg bid after 2 days. Start treatment: 3-10 days after infarction. Maintenance: 2.5-5 mg bid. Prophylaxis of cardiovascular events in high-risk patients, Stroke Prevention Adult: Initially, 2.5 mg once daily, may increase to 5 mg once daily after 1 wk if tolerated. Maintenance: 10 mg once daily after a further 3 wk. Hepatic impairment: Max: 2.5 mg/day.

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Child Dose
Safety and efficacy not established
Renal Dose
Renal impairment: CrCl (ml/min) Dosage Recommendation 10-30 Initially, 1.25 mg/day. Max: 5 mg/day. 30-60 Not necessary to adjust the initial dose. Max maintenance dose: 5 mg/day.

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Contraindication
Hypersensitivity, bilateral renal artery stenosis, or a single kidney with unilateral renal artery stenosis. Aortic stenosis or outflow tract obstruction. History of angioedema (hereditary, idiopathic or due to previous angioedema w/ ACE inhibitors). Pregnancy and lactation.
Mode of Action
Ramipril, a prodrug of ramiprilat, competitively inhibits ACE from converting angiotensin I to angiotensin II (a potent vasoconstrictor) resulting in increased plasma renin activity and reduced aldosterone (a hormone that causes water and Na retention) secretion. This promotes vasodilation thus producing a hypotensive effect and a beneficial effect in CHF.
Precaution
Renal impairment, hypovolaemia, hyperkalaemia, valvular stenosis; before, during or immediately after anaesthesia. Severe resistant hypertension, elderly, peripheral vascular disease or generalised atherosclerosis. Patient Counselling Inform patients to refrain from activities involving mental alertness and physical coordination after drug intake. Monitoring Parameters Correct volume and/or salt depletion prior to treatment. Monitor BP, serum creatinine and K levels. Monitor renal function during the 1st few wk of treatment and periodically thereafter. Lactation: Possibly excreted in breast milk; nursing not recommended

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Side Effect
>10% Cough (7-8%),Hypotension (2-11%) 1-10% Headache (1-5%),Angina pectoris (3%),Dizziness (2-4%),Nausea (2%),Vomiting (2%),Postural hypotension (2%),Syncope (2%),Vertigo (2%),Abnormal kidney function (1%),Diarrhea (1%) <1% Angioedema (0.3%) Potentially Fatal: Severe hypotension and renal failure, angioedema. _ Interaction May enhance hypotensive effect w/ diuretics and other antihypertensives. May increase risk of renal function deterioration w/ NSAIDs. May increase serum levels and toxicity of lithum. May increase hyperkalaemic effect w/ K-sparing diuretics and supplements. Potentially Fatal: Concomitant use w/ aliskiren aliskiren may increase the risk of hyperkalaemia, hypotension and nephrotoxicity in patients w/ diabetes or renal impairment _