Kétamine may be available in the countries listed below.
Kétamine (DCF) is known as Ketamine in the US.
International Drug Name Search
Glossary
| DCF | Dénomination Commune Française |
Fada Difenhidramina may be available in the countries listed below.
Diphenhydramine hydrochloride (a derivative of Diphenhydramine) is reported as an ingredient of Fada Difenhidramina in the following countries:
International Drug Name Search
PMS-Alendronate may be available in the countries listed below.
Alendronic Acid sodium trihydrate (a derivative of Alendronic Acid) is reported as an ingredient of PMS-Alendronate in the following countries:
International Drug Name Search
Class: Angiotensin-Converting Enzyme Inhibitors
VA Class: CV800
Chemical Name: [2S - [1[R*(R*)],2α,3aβ,6aβ]] - 1 - [2 - [[1 - (Ethoxycarbonyl) - 3 - phenylpropyl]amino] - 1 - oxopropy l]octahydrocylopenta[b]pyrrole-2-carboxylic acid
Molecular Formula: C21H28N2O5
CAS Number: 87333-19-5
Brands: Altace
May cause fetal and neonatal morbidity and mortality if used during pregnancy.1 38 39 40 41 42 43 44 45 46 88 89 (See Fetal/Neonatal Morbidity and Mortality under Cautions.)
If pregnancy is detected, discontinue ramipril as soon as possible.1 89
Nonsulfhydryl ACE inhibitor.1 2 3
Management of hypertension (alone or in combination with other classes of antihypertensive agents).1 2 4 11 38
One of several preferred initial therapies in hypertensive patients with heart failure, postmyocardial infarction, high coronary disease risk, diabetes mellitus, chronic renal failure, and/or cerebrovascular disease.69
Can be used as monotherapy for initial management of uncomplicated hypertension; however, thiazide diuretics are preferred by JNC 7.69
Reduction of the risk of mortality in hemodynamically stable patients who have demonstrated clinical signs of CHF within a few days following AMI.1 2 12 18 21 24 27 28 62 Also may reduce rate of heart failure-associated hospitalization and progression to severe and/or resistant heart failure.1 2 12 18 21 24 27 28 62
Reduction of the risk of cardiovascular death, MI, and stroke in patients ≥55 years of age who are at high risk for cardiovascular events (e.g., those with a history of CAD, stroke, peripheral vascular disease, or diabetes mellitus in addition to ≥1 other cardiovascular risk factor [e.g., hypertension, elevated total cholesterol and/or decreased HDL-cholesterol concentrations, smoking, documented microalbuminuria]) but who are not known to have low ventricular ejection fraction or heart failure.1 47 48
Reduction in the incidence of diabetic complications and in new diagnosis of diabetes also reported.47 48
Management of symptomatic CHF†, usually in conjunction with cardiac glycosides, diuretics, and β-blockers.62 70 71 72 73 74
A first-line agent in the treatment of diabetic nephropathy† in hypertensive patients with type 2 diabetes mellitus.78 79
Administer orally once or twice daily.1
Swallow capsules whole.1 Alternatively, open capsules and sprinkle contents on small amount (about 4 oz) of applesauce or mix in 120 mL of water or apple juice.1 Consume entire mixture to ensure that no drug is lost.1 (See Storage under Stability.)
Initially, 1.25–2.5 mg once daily in patients not receiving diuretic therapy.1 2 3 11 38 Adjust dosage at approximately monthly intervals (more aggressively in high-risk patients) to achieve BP control.1
In patients currently receiving diuretic therapy, discontinue diuretic, if possible, 2–3 days before initiating ramipril.1 May cautiously resume diuretic therapy if BP not controlled adequately with ramipril alone.1 If diuretic cannot be discontinued, increase sodium intake or initiate ramipril at 1.25 mg daily under close medical supervision.1
Usual dosage: 2.5–20 mg daily,69 given in 1 dose or 2 divided doses.1 11 38
If effectiveness diminishes toward end of dosing interval in patients treated once daily, consider increasing dosage or administering drug in 2 divided doses.1 38
Initially, 2.5 mg twice daily, beginning as early as 2 days after MI.1 12 If hypotension occurs, reduce dosage to 1.25 mg twice daily.1 After 1 week at initial dosage, adjust dosage as tolerated at 3-week intervals to target dosage of 5 mg twice daily.1 1
Following initial dose, monitor closely for ≥2 hours and until BP has stabilized for at least an additional hour.1 To minimize risk of hypotension, reduce diuretic dosage, if possible.1
Initially, 2.5 mg once daily for 1 week, followed by 5 mg once daily for 3 weeks; subsequently increase dosage as tolerated to maintenance dosage of 10 mg once daily.1 In patients with hypertension or those with recent MI, may administer total daily dosage in divided doses.1
Initial dosage of 1.25 mg once daily recommended in patients with renal artery stenosis.1
In patients with Clcr <40 mL/minute per 1.73 m2, 25% of the usual doses are expected to induce full therapeutic concentrations of ramiprilat.1
Initially, 1.25 mg once daily in patients with Clcr <40 mL/minute per 1.73 m2.1 Titrate until BP is controlled or to maximum dosage of 5 mg daily.1
Initially, 1.25 mg once daily in patients with Clcr <40 mL/minute per 1.73 m2.1 May increase dosage to 1.25 mg twice daily; subsequently titrate according to clinical response and tolerance up to maximum dosage of 2.5 mg twice daily.1
Correct volume and/or salt depletion prior to initiation of therapy or initiate therapy at dosage of 1.25 mg once daily.1
Known hypersensitivity (e.g., history of angioedema) to ramipril or another ACE inhibitor.1
Clinical syndrome that usually is manifested initially by cholestatic jaundice and may progress to fulminant hepatic necrosis (occasionally fatal) reported rarely with ACE inhibitors.1
If jaundice or marked elevation of liver enzymes occurs, discontinue drug and monitor patient.1
Possible symptomatic hypotension, particularly in volume- and/or salt depleted patients (e.g., those receiving prolonged diuretic therapy or undergoing dialysis, those with dietary salt restriction, patients with diarrhea or vomiting).1 Risk of excessive hypotension, sometimes associated with oliguria, azotemia, and, rarely, acute renal failure and death in patients with CHF with or without associated renal insufficiency.1
Hypotension may occur in patients undergoing surgery or during anesthesia with agents that produce hypotension; recommended treatment is fluid volume expansion.1
To minimize potential for hypotension, consider recent antihypertensive therapy, extent of BP elevation, sodium intake, fluid status, and other clinical circumstances.1 Correct volume and/or salt depletion (e.g., by withholding diuretic therapy, increasing sodium intake) prior to initiation of ramipril or reduce initial dosage.1 (See Dosage and also Special Populations, under Dosage and Administration.)
In patients at risk of excessive hypotension, initiate therapy under close medical supervision; monitor closely for first 2 weeks following initiation of ramipril or any increase in ramipril or diuretic dosage.1
If hypotension occurs, place patient in supine position, and if necessary, administer IV infusion of physiological saline.1 Ramipril therapy usually can be continued following restoration of volume and BP.1
Neutropenia and agranulocytosis reported with captopril; risk appears to depend principally on presence of renal impairment and/or presence of collagen vascular disease (e.g., systemic lupus erythematosus, scleroderma);1 also reported in patients receiving immunosuppressive therapy.5 6 Hematologic effects (e.g., agranulocytosis; pancytopenia; bone marrow depression; reductions in hemoglobin content or leukocyte, erythrocyte, or platelet counts) reported rarely with ramipril.1
Consider monitoring leukocytes in patients with collagen vascular disease, especially if renal impairment exists.1
Possible fetal and neonatal morbidity and mortality when used during pregnancy.1 88 89 (See Boxed Warning.) Such potential risks occur throughout pregnancy, especially during the second and third trimesters.89
Also may increase the risk of major congenital malformations when administered during the first trimester of pregnancy.88 89
Discontinue as soon as possible when pregnancy is detected, unless continued use is considered lifesaving.89 Nearly all women can be transferred successfully to alternative therapy for the remainder of their pregnancy.44 46
Anaphylactoid reactions and/or head and neck angioedema possible; if associated with laryngeal edema, may be fatal.1 Immediate medical intervention (e.g., epinephrine) for involvement of tongue, glottis, or larynx.1
Intestinal angioedema possible; consider in differential diagnosis of patients who developabdominal pain.1
Anaphylactoid reactions reported in patients receiving ACE inhibitors while undergoing LDL apheresis with dextran sulfate absorption or following initiation of hemodialysis that utilized high-flux membrane.1
Life-threatening anaphylactoid reactions reported in at least 2 patients receiving ACE inhibitors while undergoing desensitization treatment with hymenoptera venom.1
Contraindicated in patients with a history of angioedema associated with ACE inhibitors.1 47 Patients with history of angioedema unrelated to ACE inhibitors may be at increased risk of angioedema associated with ACE inhibitor therapy.1
Transient increases in BUN and Scr possible, especially in patients with preexisting renal impairment or those receiving concomitant diuretic therapy.1 Possible increases in BUN and Scr in patients with unilateral or bilateral renal artery stenosis; generally reversible following discontinuance of ramipril and/or diuretic therapy.1
Possible oliguria, progressive azotemia, and, rarely, acute renal failure and/or death in patients with severe CHF.1
Closely monitor renal function for the first few weeks of therapy in hypertensive patients with unilateral or bilateral renal-artery stenosis.1 Some patients may require dosage reduction or discontinuance of ACE inhibitor or diuretic therapy.1
Possible hyperkalemia, especially in patients with renal impairment or diabetes mellitus and those receiving drugs that can increase serum potassium concentration (e.g., potassium-sparing diuretics, potassium supplements, potassium-containing salt substitutes).1 (See Interactions.)
Persistent and nonproductive cough; resolves after drug discontinuance.1
Category C (1st trimester); Category D (2nd and 3rd trimesters).1 (See Fetal/Neonatal Morbidity and Mortality under Cautions and see Boxed Warning.)
Undetectable in human milk following single oral dose; not known whether distributed into milk following multiple doses.1 Use not recommended.1
Safety and efficacy not established in children <18 years of age.1
No substantial differences in safety and efficacy relative to younger adults, but increased sensitivity cannot be ruled out.1
Use with caution in patients with cirrhosis and/or ascites, due to possible increased activity of renin-angiotensin-aldosterone system.1
Possible marked increase in plasma ramipril concentrations; peak plasma ramiprilat concentrations not appreciably altered. (See Absorption: Special Populations, under Pharmacokinetics.)1
Systemic exposure to ramiprilat may be increased.1 (See Pharmacokinetics.) Initial dosage adjustment may be necessary depending on degree of renal impairment.1 (See Renal Impairment under Dosage and Administration.)
Deterioration of renal function may occur.1 (See Renal Effects under Cautions.)
BP reduction may be smaller in black patients compared with nonblack patients;1 14 15 67 68 however, no apparent population difference during combined therapy with ACE inhibitor and thiazide diuretic.11 14 16 17 38 Use in combination with a diuretic.11 14 16 17 38
Higher incidence of angioedema reported with ACE inhibitors in blacks compared with other races.1 68 69
Patients with hypertension: Headache, dizziness, fatigue.1
Patients with CHF: Dizziness, cough, nausea, vomiting, angina pectoris, syncope, postural hypotension, vertigo, hypotension.1
Drug | Interaction | Comments |
|---|---|---|
Antacid | Pharmacokinetic interaction unlikely1 | |
Antidiabetic agents (insulin, oral agents) | Possible hypoglycemia in diabetic patients1 | Monitor closely for symptoms of hypoglycemia following initiation or dosage adjustment of ramipril; adjust dosage of antidiabetic agent as necessary1 |
Cimetidine | Pharmacokinetic interaction unlikely1 | |
Digoxin | Pharmacokinetic interaction unlikely1 | |
Diuretics | Increased hypotensive effect1 | If possible, discontinue diuretic before initiating ramipril1 (see Dosage and also Special Populations, under Dosage and Administration) |
Diuretics, potassium-sparing (amiloride, spironolactone, triamterene) | Enhanced hyperkalemic effect1 | Use with caution; monitor serum potassium concentrations frequently1 |
Lithium | Increased serum lithium concentrations; possible toxicity1 | Use with caution; monitor serum lithium concentrations frequently1 |
NSAIAs | Potential for reduction of renal function and increase in serum potassium1 No interaction observed with indomethacin1 | |
Potassium supplements or potassium-containing salt substitutes | Enhanced hyperkalemic effect1 | Use with caution; monitor serum potassium concentrations frequently1 |
Simvastatin | Pharmacokinetic interaction unlikely1 | |
Warfarin | Pharmacologic interaction unlikely1 |
Following oral administration, peak plasma concentrations of ramipril usually attained within 1 hour.1 Peak plasma concentrations of ramiprilat attained within 2–4 hours after oral dose.1 About ≥50–60% of an oral dose is absorbed.1
Following multiple oral doses (≥2 mg), >90% inhibition of plasma ACE activity achieved 4 hours after dosing.1
Following multiple oral doses (≥2 mg), inhibition of >80% of plasma ACE activity persists for about 24 hours.1
Food decreases rate but not extent of absorption.1 Opening the capsules and sprinkling the contents on applesauce or mixing the contents in apple juice does not alter serum concentrations of ramiprilat.1 (See Oral Administration under Dosage and Administration.)
In patients with hepatic impairment, plasma concentrations of ramipril are increased; peak plasma ramiprilat concentrations are similar to those in individuals with normal hepatic function.1
In patients with renal impairment (Clcr <40 mL/minute per 1.73m2), plasma concentrations and AUC of ramiprilat are increased, and time to peak plasma ramiprilat concentrations is slightly prolonged.1
Distributes into a large peripheral compartment.1 Crosses the placenta.1 Undetectable in human milk following single oral dose; not known whether distributed into milk following multiple doses.1
Ramipril: About 73%.1
Ramiprilat: About 56%.1
Metabolized mainly in the liver, principally to an active metabolite, ramiprilat.1
Excreted in urine (60%) as unchanged drug and ramiprilat and in feces (approximately 40%).1
Triphasic; apparent elimination half-life of ramiprilat: Approximately 13–17 hours.1
In patients with Clcr <40 mL/minute per 1.73m2, urinary excretion of ramipril, ramiprilat, and their metabolites is decreased.1
15–30 ºC.1
Mixtures of ramipril with applesauce, water, or apple juice (see Oral Administration under Dosage and Administration) are stable for 24 hours at room temperature and 48 hours when refrigerated.1
Prodrug; has little pharmacologic activity until metabolized to ramiprilat.1
Suppresses the renin-angiotensin-aldosterone system.1
Risk of angioedema, anaphylactoid reactions, or other sensitivity reactions.1 47 Importance of reporting sensitivity reactions (e.g., edema of face, eyes, lips, tongue, larynx, or extremities; hoarseness; swallowing or breathing with difficulty) immediately to clinician and of discontinuing the drug.1
Importance of reporting signs of infection (e.g., sore throat, fever).1
Risk of hypotension.1 Importance of informing clinicians promptly if lightheadedness or fainting occurs.1
Importance of adequate fluid intake; risk of volume depletion with excessive perspiration, dehydration, vomiting, or diarrhea.1
Risks of use during pregnancy.1 88 89 (See Boxed Warning.)
Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs (including salt substitutes containing potassium).1
Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.1
Importance of advising patients of other important precautionary information.1 (See Cautions.)
Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.
* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name
Routes | Dosage Forms | Strengths | Brand Names | Manufacturer |
|---|---|---|---|---|
Oral | Capsules | 1.25 mg* | Altace | Monarch |
Ramipril Capsules | Cobalt | |||
2.5 mg* | Altace | Monarch | ||
Ramipril Capsules | Cobalt | |||
5 mg* | Altace | Monarch | ||
Ramipril Capsules | Cobalt | |||
10 mg* | Altace | Monarch | ||
Ramipril Capsules | Cobalt |
This pricing information is subject to change at the sole discretion of DS Pharmacy. This pricing information was updated 03/2011. Actual costs to patients will vary depending on the use of specific retail or mail-order locations and health insurance copays.
Altace 1.25MG Capsules (MONARCH PHARMACEUTICALS): 30/$67.99 or 90/$185.97
Altace 10MG Capsules (MONARCH PHARMACEUTICALS): 30/$85.99 or 90/$239.95
Altace 2.5MG Capsules (MONARCH PHARMACEUTICALS): 30/$76.99 or 90/$211.97
Altace 5MG Capsules (MONARCH PHARMACEUTICALS): 30/$75.99 or 90/$209.97
Ramipril 10MG Capsules (WATSON LABS): 30/$65.99 or 90/$179.97
Ramipril 2.5MG Capsules (WATSON LABS): 30/$49.99 or 90/$139.97
Ramipril 5MG Capsules (WATSON LABS): 30/$55.99 or 90/$149.99
This report on medications is for your information only, and is not considered individual patient advice. Because of the changing nature of drug information, please consult your physician or pharmacist about specific clinical use.
The American Society of Health-System Pharmacists, Inc. and Drugs.com represent that the information provided hereunder was formulated with a reasonable standard of care, and in conformity with professional standards in the field. The American Society of Health-System Pharmacists, Inc. and Drugs.com make no representations or warranties, express or implied, including, but not limited to, any implied warranty of merchantability and/or fitness for a particular purpose, with respect to such information and specifically disclaims all such warranties. Users are advised that decisions regarding drug therapy are complex medical decisions requiring the independent, informed decision of an appropriate health care professional, and the information is provided for informational purposes only. The entire monograph for a drug should be reviewed for a thorough understanding of the drug's actions, uses and side effects. The American Society of Health-System Pharmacists, Inc. and Drugs.com do not endorse or recommend the use of any drug. The information is not a substitute for medical care.
AHFS Drug Information. © Copyright, 1959-2011, Selected Revisions April 2008. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.
† Use is not currently included in the labeling approved by the US Food and Drug Administration.
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Alten may be available in the countries listed below.
Tretinoin is reported as an ingredient of Alten in the following countries:
International Drug Name Search
Ondansetron Aurobindo may be available in the countries listed below.
Ondansetron hydrochloride (a derivative of Ondansetron) is reported as an ingredient of Ondansetron Aurobindo in the following countries:
International Drug Name Search
Chlorprothixene Sine may be available in the countries listed below.
Chlorprothixene is reported as an ingredient of Chlorprothixene Sine in the following countries:
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Moxicam may be available in the countries listed below.
Meloxicam is reported as an ingredient of Moxicam in the following countries:
International Drug Name Search
Lafayette Isoniazid may be available in the countries listed below.
Isoniazid is reported as an ingredient of Lafayette Isoniazid in the following countries:
International Drug Name Search
Loplac may be available in the countries listed below.
Losartan potassium salt (a derivative of Losartan) is reported as an ingredient of Loplac in the following countries:
International Drug Name Search
See also: Generic Norgesic
Norgesic Forte is a brand name of aspirin/caffeine/orphenadrine, approved by the FDA in the following formulation(s):
Yes. The following products are equivalent to Norgesic Forte:
Note: Fraudulent online pharmacies may attempt to sell an illegal generic version of Norgesic Forte. These medications may be counterfeit and potentially unsafe. If you purchase medications online, be sure you are buying from a reputable and valid online pharmacy. Ask your health care provider for advice if you are unsure about the online purchase of any medication.
See also: About generic drugs.
There are no current U.S. patents associated with Norgesic Forte.
Kineldar may be available in the countries listed below.
Epalrestat is reported as an ingredient of Kineldar in the following countries:
International Drug Name Search
Koortslip SDG may be available in the countries listed below.
Aciclovir is reported as an ingredient of Koortslip SDG in the following countries:
International Drug Name Search
Amoxiclav beta may be available in the countries listed below.
Amoxicillin trihydrate (a derivative of Amoxicillin) is reported as an ingredient of Amoxiclav beta in the following countries:
Clavulanic Acid potassium (a derivative of Clavulanic Acid) is reported as an ingredient of Amoxiclav beta in the following countries:
International Drug Name Search
