Ramace

Ramipril
Consumer Medicine Information
 

NOTICE: This Consumer Medicine Information (CMI) is intended for persons living in Australia. This page contains answers to some common questions about Ramace. It does not contain all the information that is known about Ramace. It does not take the place of talking to your doctor or pharmacist. All medicines have risks and benefits. Your doctor has weighed the risk of you using this medicine against the benefits he/she expects it will have for you. If you have any concerns about using this medicine, ask your doctor or pharmacist. Bookmark or print this page, you may need to read it again.

What Ramace is used for

Ramace belongs to a group of medicines called angiotensin converting enzyme (ACE) inhibitors.
Ramace is used to treat:
high blood pressure (hypertension)
some heart conditions such as heart failure after a heart attack
kidney problems in some patients
Ramace is also used to reduce the risk of cardiovascular problems and complications in patients aged 55 years or more with heart or blood vessel disease, or diabetes.
Hypertension
Ramace is used to lower high blood pressure (hypertension). Everyone has blood pressure. This pressure helps get your blood all around your body. Your blood pressure may be different at different times of the day and can be influenced by how busy or worried you are. You have hypertension when your blood pressure stays higher than is needed, even when you are calm and relaxed.
There are usually no symptoms of hypertension. The only way of knowing that you have hypertension is to have your blood pressure checked on a regular basis. If high blood pressure is not treated it can lead to serious health problems, including stroke, heart disease and kidney failure.
Heart Failure after a Heart Attack
Ramace may be used after a heart attack. A heart attack occurs when one of the major blood vessels supplying blood to your heart becomes blocked. This means that your heart muscle cannot receive the oxygen it needs and becomes damaged. This may lead to further problems, such as heart failure, irregular heart rhythms and blood clots.
Heart failure means that the heart muscle is weak and cannot pump blood strongly enough to supply all the blood needed throughout the body. Heart failure is not the same as heart attack and does not mean that the heart stops. Heart failure may start off with no symptoms, but as the condition progresses, patients may feel short of breath or may get tired easily after light physical activity such as walking. Some patients may wake up short of breath at night. Fluid may collect in different parts of the body, often first noticed as swollen ankles and feet.
Kidney Problems
Ramace may be used to treat some kidney problems. Some conditions such as diabetes and hypertension can lead to kidney problems. These problems develop slowly over several years. Good control of your blood sugar and blood pressure are important in keeping your kidneys healthy, but may not always prevent kidney damage from occurring.
Prevention of Cardiovascular Problems and Complications
Ramace may be used to reduce the risk of some of the problems and complications that may arise in patients aged 55 or more who have problems such as coronary artery disease (heart disease caused by poor blood flow in the blood vessels of the heart), peripheral vascular disease (poor circulation in the hands or feet), or stroke.
Ramace may also be used to reduce the risk of cardiovascular problems and complications in patients with diabetes aged 55 years or more who may be considered at risk because of one or more additional factors such as high blood pressure, high cholesterol levels, kidney problems, a current smoker, or previous disease of the blood vessels.

How Ramace works

Ramace works by widening the blood vessels, which reduces the pressure in the vessels, making it easier for your heart to pump blood around your body. This helps increase the supply of oxygen to your heart, so that when you place extra demands on your heart, such as during exercise, your heart may cope better and you may not get short of breath as easily.
By increasing the supply of oxygen to your heart, your heart does not have to work as hard and it is under less stress, which may reduce the risk of further damage occurring to it following a heart attack.
Ramace also improves blood flow through the small blood vessels found in the kidneys, which helps the kidneys to work more efficiently. This in turn can help to slow down the progression of kidney damage that might result from having diabetes or high blood pressure.
Therefore, there are quite a few reasons why your doctor might have decided to treat you with Ramace. Your doctor may have also prescribed this medicine for another reason.
Ask your doctor or pharmacist if you have any questions about why Ramace has been prescribed for you.
Ramace is not addictive.
Ramace is available only with a doctor's prescription.

Before you take Ramace

When you must not take it

Do not take Ramace if you:
have had an allergy to Ramace or any other medicine containing ramipril, or an ACE inhibitor or any of the ingredients listed at the end of this leaflet.
Symptoms of an allergic reaction may include skin rash, itchiness, shortness of breath, swelling of the face, lips or tongue, abdominal pain, muscle pain or tenderness, or joint pain.
have taken any other "ACE inhibitor" medicine before, which caused your face, lips, tongue, throat, hands or feet to swell up, or made it hard for you to breathe.
If you have had an allergic reaction to an ACE inhibitor before, you may be allergic to Ramace.
or your family have a history of swelling of the face, lips, tongue, throat, intestines, hands or feet, for no apparent reason.
have kidney problems or a condition called "renal artery stenosis".
have problems or conditions affecting the flow of blood in and out of your heart (e.g. aortic or valvular stenosis).
have low blood pressure.
undergo dialysis using certain high-flux membranes.
are diabetic or have kidney problems and are being treated with aliskiren-containing medicines or a group of medicines known as AIIRAs (a medicine also used to treat high blood pressure).
are pregnant or intend to become pregnant.
Ramace may affect your developing baby if you take it during pregnancy.
are breastfeeding.
Ramace may pass into the breast milk and affect your breastfed baby.
Do not use Ramace after the expiry date (EXP) printed on the pack.
If you take this medicine after the expiry date has passed, it may not work as well.
Do not use Ramace if the packaging is torn or shows signs of tampering.

Before you start to take it

Tell your doctor if you have allergies to:
any other medicines
any other substances, such as foods, preservatives or dyes
Tell your doctor if you have or have had any medical conditions, especially the following:
kidney problems, or are having dialysis (note that your doctor may give you Ramace because of your kidney problems)
liver problems
heart problems (note that your doctor may give you Ramace because of your heart problems)
low blood pressure, which you may notice as dizziness or light-headedness
low white blood cell counts
diabetes (note that your doctor may give you Ramace because of your diabetes)
high levels of potassium in your blood
Systemic Lupus Erythematosus (SLE), scleroderma or other autoimmune conditions
Tell your doctor if you have a family history of swelling of the face, lips, tongue, throat, intestines, hands or feet.
You must also tell your doctor if you:
are following a very low or very high salt diet
are dehydrated, or have had a recent bout of vomiting or diarrhoea
are about to have surgery or a general anaesthetic
plan to become pregnant or breastfeed
If you have not told your doctor about any of the above, tell them before you start taking Ramace.

Taking other medicines

Tell your doctor or pharmacist if you are taking any other medicines, including any that you buy without a prescription from your pharmacy, supermarket or health food store.
Some medicines and Ramace may interfere with each other. These include:
other medicines used to treat high blood pressure, including those containing the active ingredient aliskiren
diuretics, also known as fluid or water tablets
lithium, a medicine used to treat mood swings and some types of depression
potassium supplements or potassium-containing salt substitutes
non-steroidal anti-inflammatory drugs (NSAIDs), medicines used to relieve pain, swelling and other symptoms of inflammation
insulin and tablets used to treat diabetes
heparin
general anaesthetics
medicines which may affect the blood cells, such as allopurinol, procainamide, corticosteroids, immunosuppressants, or medicines used to treat cancer
temsirolimus
if you are taking Ramace for high blood pressure, do not take any medicines (including the ones bought without a prescription) for appetite control, asthma, colds, coughs, hayfever or sinus problems unless you have discussed it with your doctor or pharmacist.
These medicines may be affected by Ramace, or may affect how well it works. You may need to use different amounts of your medicine, or you may need to take different medicines. Your doctor or pharmacist will advise you.
Your doctor or pharmacist may have more information on medicines to be careful with or to avoid while taking Ramace.

How to take Ramace

How much to take

Your doctor or pharmacist will tell you how many tablets or capsules you will need to take each day. This depends on your condition and whether or not you are taking any other medicines.
Take Ramace only when prescribed by your doctor.
Your doctor will select a dose when they prescribe Ramace for you. Some patients may need a lower starting dose. The usual dose of Ramace is:
for high blood pressure, 2.5 mg to 10 mg per day.
for heart failure, 5 mg to 10 mg per day.
for kidney problems, 1.25 mg to 5 mg per day.
for cardiovascular risk, 2.5 mg to 10 mg per day.
Depending on your response, your doctor may adjust the dose.
If two tablets are prescribed, your doctor may want you to take them both together or at different times. This will depend on the condition being treated and how you respond to Ramace.
Follow all directions given to you by your doctor or pharmacist carefully.
They may differ from the information contained in this leaflet.
If you do not understand the instructions on the box, ask your doctor or pharmacist for help.

How to take it

Ramace should be swallowed whole with plenty of fluid.

When to take it

Take Ramace at about the same time each day.
Taking your tablets or capsules at the same time each day will have the best effect. It will also help you remember when to take your medicine.
It does not matter if you take Ramace before or after food.

How long to take it

Ramace helps control your condition, but does not cure it. Therefore you must take Ramace every day. Continue taking your medicine for as long as your doctor tells you.

If you forget to take it

If it is almost time for your next dose, skip the dose you missed and take your next dose when you are meant to.
Otherwise, take it as soon as you remember, and then go back to taking your medicine as you would normally.
Do not take a double dose to make up for the dose that you missed.
If you are not sure what to do or if you have trouble remembering when to take Ramace, ask your doctor or pharmacist.

If you take too much (overdose)

Immediately telephone your doctor or the Poisons Information Centre (in Australia telephone 13 11 26), or go to Accident and Emergency at the nearest hospital if you think that you or anyone else may have taken too much Ramace. Do this even if there are no signs of discomfort or poisoning.
You may need urgent medical attention.
If you take too much Ramace, you may feel light-headed, dizzy or you may faint. You may also experience slow heart beat.

While you are taking Ramace

Things you must do

Tell all the doctors, dentists and pharmacists who are treating you that you are taking Ramace.
If you are about to be started on any new medicine, tell your doctor and pharmacist that you are taking Ramace.
Make sure you drink enough water during exercise and hot weather when you are taking Ramace, especially if you sweat a lot.
If you do not drink enough water while taking Ramace, you may feel faint, light-headed or sick. This is because your blood pressure is dropping suddenly. If you continue to feel unwell, tell your doctor.
If you have excess vomiting or diarrhoea while taking Ramace, tell your doctor.
You may lose too much water and salt and your blood pressure may drop too much.
If you feel light-headed or dizzy after taking your first dose of Ramace, or when your dose is increased, tell your doctor immediately.
If you plan to have surgery that needs a general anaesthetic, tell your doctor or dentist that you are taking Ramace.
Your blood pressure may drop suddenly.
If you become pregnant or intend to become pregnant while taking Ramace, tell your doctor immediately.
If you are about to have any blood tests, tell your doctor that you are taking Ramace.
Ramace may interfere with the results of some tests.
Have your blood pressure checked when your doctor says, to make sure Ramace is working.
Go to your doctor regularly for a check-up.
Your doctor may occasionally do a blood test to check your potassium levels and see how your kidneys are working.

Things you must not do

Do not give Ramace to anyone else, even if they have the same condition as you.
Do not take Ramace to treat any other complaints unless your doctor or pharmacist tells you to.
Do not stop taking Ramace, or lower or increase the dosage, without checking with your doctor.

Things to be careful of

If you feel light-headed, dizzy or faint when getting out of bed or standing up, get up slowly.
Standing up slowly, especially when you get up from bed or chairs, will help your body get used to the change in position and blood pressure. If this problem continues or gets worse, talk to your doctor.
Be careful driving or operating machinery until you know how Ramace affects you.
As with other ACE inhibitor medicines, Ramace may cause dizziness, light-headedness, tiredness or drowsiness in some people. Make sure you know how you react to Ramace before you drive a car, operate machinery, or do anything else that could be dangerous if you are dizzy or light-headed. If this occurs do not drive. If you drink alcohol, dizziness or light-headedness may be worse.

Things that may help your condition

Some self help measures suggested below may help your condition. Talk to your doctor or pharmacist about these measures and for more information.
Alcohol - your doctor may advise you to limit your alcohol intake.
Diet - eat a healthy low-fat diet which includes plenty of fresh vegetables, fruit, bread, cereals and fish. Also eat less fat and sugar.
Exercise - regular exercise helps to reduce blood pressure and helps get the heart fitter, but it is important not to overdo it. Walking is good exercise, but try to find a route that is reasonably flat. Before starting any exercise, ask your doctor about the best kind of programme for you.
Salt - your doctor may advise you to watch the amount of salt in your diet. To reduce your salt intake you should avoid using salt in cooking or at the table.
Smoking - your doctor may advise you to stop or at least cut down smoking.
Weight - your doctor may suggest losing some weight to help lower your blood pressure and help lessen the amount of work your heart has to do. Some people may need a dietician's help to lose weight.

Side effects

Tell your doctor or pharmacist as soon as possible if you do not feel well while you are taking Ramace.
Ramace helps most people, but it may have unwanted side effects in a few people. All medicines can have side effects. Sometimes they are serious, most of the time they are not. You may need medical treatment if you get some of the side effects.
Ask your doctor or pharmacist to answer any questions you may have.
Following is a list of possible side effects. Do not be alarmed by this list. You may not experience any of them.
Tell your doctor if you notice any of the following and they worry you:
feeling light-headed, dizzy or faint
dry cough
headache
feeling sick (nausea) or vomiting
stomach pain or discomfort
diarrhoea
indigestion
loss of taste or taste disturbances
upper respiratory tract infections
muscle cramps or spasms
aching muscles, muscle tenderness or weakness, not caused by exercise
unusual tiredness or weakness, fatigue
ringing or buzzing in the ears
forgetfulness or confusion
These side effects are usually mild.
Tell your doctor as soon as possible if you notice any of the following:
disturbed vision
symptoms of sunburn (such as redness, itching, swelling, blistering) which may occur more quickly than normal
itchy or raised skin rash, hives or nettlerash
signs of anaemia such as tiredness, being short of breath and looking pale
yellowing of the skin and/or eyes
fast or irregular heart beat
shortness of breath or tightness in the chest
numbness, tingling and colour change (white, blue then red) in the fingers or toes when exposed to the cold
severe upper stomach pain, often with nausea and vomiting
frequent infections such as fever, severe chills, sore throat or mouth ulcers
passing little or no urine or more urine than is normal for you
bleeding or bruising more easily than normal
These may be serious side effects. You may need medical attention. Serious side effects are rare.
If any of the following happen, stop taking Ramace and either tell your doctor immediately or go to Accident and Emergency at your nearest hospital:
fainting within a few hours of taking a dose
severe dizziness and confusion with visual disturbances and speech problems
swelling of the face, lips, mouth, tongue or throat which may cause difficulty in swallowing or breathing
pink or red itchy spots on the skin which may blister and progress to form raised, red, pale-centred marks
severe blisters and bleeding in the lips, eyes, mouth, nose and genitals
chest pain
These are very serious side effects. You may need urgent medical attention or hospitalisation. These side effects are very rare.
Other side effects not listed above may occur in some patients. Tell your doctor or pharmacist if you notice anything that is making you feel unwell.

After using Ramace

Storage

Keep your Ramace tablets or capsules in the blister pack until it is time to take them.
If you take them out of the pack they may not keep well.
Keep your Ramace tablets or capsules in a cool dry place where the temperature stays below 25°C.
Do not store Ramace or any other medicine in the bathroom or near a sink. Do not leave it on window sills or in the car.
Heat and dampness can destroy some medicines.
Keep it where children cannot reach it.
A locked cupboard at least one-and-a-half metres above the ground is a good place to store medicines.

Disposal

If your doctor or pharmacist tells you to stop taking Ramace, or the tablets or capsules have passed their expiry date, ask your pharmacist what to do with any that are left over.

Product description

What it looks like

Ramace is available in four different strengths (1.25 mg, 2.5 mg and 5 mg tablets and 10 mg capsules).
Each strength appears as follows:
1.25 mg tablets: white to pale yellowish white, capsule-shaped, scored tablets with 1.25 and HMN on one side, and 1.25 and a logo on the other side.
2.5 mg tablets: yellow, capsule-shaped, scored tablets with 2.5 and HMR on one side, and 2.5 and a logo on the other side.
5 mg tablets: red, capsule-shaped, scored tablets with 5 and HMP on one side, and 5 and a logo on the other side.
10 mg capsules: blue and white, and unmarked.
Ramace is available in blister packs of 30 tablets or capsules.

Ingredients

Ramace tablets contain 1.25 mg, 2.5 mg or 5 mg of ramipril as the active ingredient. The other ingredients are hypromellose, pregelatinised maize starch, microcrystalline cellulose, sodium stearyl fumarate, iron oxide yellow (2.5 mg only) and iron oxide red (5 mg only).
Ramace capsules contain 10 mg of ramipril as the active ingredient. The other ingredients are pregelatinised maize starch, gelatin, indigo carmine, erythrosine, iron oxide black and titanium dioxide.
Ramace does not contain lactose, sucrose, gluten or tartrazine.

Manufacturer

Ramace is supplied in Australia by:
sanofi-aventis australia pty ltd
12-24 Talavera Road
Macquarie Park NSW 2113
Australian Register Numbers:
1.25 mg tablets: AUST R 54973
2.5 mg tablets: AUST R 56243
5 mg tablets: AUST R 56223
10 mg capsules: AUST R 78576
This leaflet was prepared in February 2014.
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