Q Rami
Q Rami Uses, Dosage, Side Effects, Food Interaction and all others data.
Q Rami is an angiotensin converting enzyme (ACE) inhibitor, which after hydrolysis to ramiprilat, blocks the conversion of angiotensin I to the vasoconstrictor substance, angiotensin II. So, inhibition of ACE by ramipril results in decreased plasma angiotensin II, which leads to decreased vasopressor activity and decreased aldosterone secretion. Thus ramipril exerts its antihypertensive activity. It is also effective in the management of heart failure and reduction of the risk of stroke, myocardial infarction and death from cardiovascular events. It is long acting and well tolerated; so, can be used in long term therapy.
Q Rami is an ACE inhibitor similar to benazepril, fosinopril and quinapril. It is an inactive prodrug that is converted to ramiprilat in the liver, the main site of activation, and kidneys. Q Ramiat confers blood pressure lowing effects by antagonizing the effect of the RAAS. The RAAS is a homeostatic mechanism for regulating hemodynamics, water and electrolyte balance. During sympathetic stimulation or when renal blood pressure or blood flow is reduced, renin is released from the granular cells of the juxtaglomerular apparatus in the kidneys. In the blood stream, renin cleaves circulating angiotensinogen to ATI, which is subsequently cleaved to ATII by ACE. ATII increases blood pressure using a number of mechanisms. First, it stimulates the secretion of aldosterone from the adrenal cortex. Aldosterone travels to the distal convoluted tubule (DCT) and collecting tubule of nephrons where it increases sodium and water reabsorption by increasing the number of sodium channels and sodium-potassium ATPases on cell membranes. Second, ATII stimulates the secretion of vasopressin (also known as antidiuretic hormone or ADH) from the posterior pituitary gland. ADH stimulates further water reabsorption from the kidneys via insertion of aquaporin-2 channels on the apical surface of cells of the DCT and collecting tubules. Third, ATII increases blood pressure through direct arterial vasoconstriction. Stimulation of the Type 1 ATII receptor on vascular smooth muscle cells leads to a cascade of events resulting in myocyte contraction and vasoconstriction. In addition to these major effects, ATII induces the thirst response via stimulation of hypothalamic neurons. ACE inhibitors inhibit the rapid conversion of ATI to ATII and antagonize RAAS-induced increases in blood pressure. ACE (also known as kininase II) is also involved in the enzymatic deactivation of bradykinin, a vasodilator. Inhibiting the deactivation of bradykinin increases bradykinin levels and may sustain the effects of ramiprilat by causing increased vasodilation and decreased blood pressure.
| Trade Name | Q Rami |
| Availability | Prescription only |
| Generic | Ramipril |
| Ramipril Other Names | Ramipril, Ramiprilum |
| Related Drugs | Praluent, Repatha, amlodipine, aspirin, lisinopril, metoprolol, losartan, furosemide, carvedilol, hydrochlorothiazide |
| Type | Tablet |
| Formula | C23H32N2O5 |
| Weight | Average: 416.5106 Monoisotopic: 416.231122144 |
| Protein binding | Protein binding of ramipril is about 73% and that of ramiprilat about 56%. Protein binding is independent of concentration over the range of 0.1μg/mL-10μg/mL |
| Groups | Approved |
| Therapeutic Class | Angiotensin-converting enzyme (ACE) inhibitors |
| Manufacturer | Q Check Speciality Care Pvt Ltd |
| Available Country | India |
| Last Updated: | September 19, 2023 at 7:00 am |
Uses
Q Ramiis used for the following cases:
- Mild to severe hypertension
- Congestive Heart failure.
- To reduce the risk of stroke, myocardial infarction and death from cardiovascular events in patients with a history of cardiovascular disease.
- Proteinuric non-diabetic nephropathy.
Q Rami is also used to associated treatment for these conditions: Cardiovascular Events, Diabetic Nephropathy, Heart Failure, Heart Failure With Reduced Ejection Fraction (HFrEF), High Blood Pressure (Hypertension), Myocardial Infarction, Nondiabetic proteinuric chronic kidney disease, Stroke, High risk cardiovascular event
How Q Rami works
Q Rami inhibits the RAAS system by binding to and inhibiting ACE thereby preventing the conversion of angiotensin I to angiotensin II. As plasma levels of angiotensin II fall, less activation of the G-protein coupled receptors angiotensin receptor I (AT1R) and angiotensin receptor II (AT2R) occurs.
AT1R mediates vasoconstriction, inflammation, fibrosis, and oxidative stress through a variety of signaling pathways. These include Gq coupling to the inositol triphosphate pathway, activation of phospholipases C, A2, and D which contribute to eicosanoid production, activation of Ca2+ These counteracting effects are shared by the Mas receptor which is activated by Ang(1-7), a subtype of angiotensin produced by plasma esterases from AngI or by ACE2 from AngII produced through a secondary pathway by tonin and cathepsin G. Ang(1-7) also activates AT2R although the bulk of its effect is mediated by MasR.
ACE is also responsible for the breakdown of bradykinin. The resulting buildup of bradykinin due to ACE inhibition is thought to mediate the characteristic dry-cough as a side effect of ACE inhibitor medications.
Dosage
Q Rami dosage
Dosage of Q Rami must be adjusted according to the patient tolerance and response.
Hypertension: For the management of hypertension in adults not receiving a diuretic, the usual initial dose of Q Rami is 1.25 - 2.5 mg once daily. Dosage generally is adjusted no more rapidly than at 2 week intervals. The usual maintenance dosage in adults is 2.5 - 20 mg daily given as a single dose or in 2 divided doses daily. If BP is not controlled with Q Rami alone, a diuretic may be added.
Congestive heart failure after myocardial infarction: In this case, Q Rami therapy may be initiated as early as 2 days after myocardial infarction. An initial dose of 2.5 mg twice daily is recommended, but if hypotension occurs, dose should be reduced to 1.25 mg twice daily. Therapy is then titrated to a target daily dose of 5 mg twice daily.
Prevention of major cardiovascular events: In this case, the recommended dose is 2.5 mg once daily for the first week of therapy and 5 mg once daily for the following 3 weeks; dosage then may be increased, as tolerated, to a maintenance dosage of 10 mg once daily.
Side Effects
Q Rami is generally well tolerated. Dizziness, headache, fatigue and asthenia are commonly reported side effects. Other side effects occurring less frequently include symptomatic hypotension, cough, nausea, vomiting, diarrhoea, rash, urticaria, oliguria, anxiety, amnesia etc. Angioneurotic oedema, anaphylactic reactions and hyperkalaemia have also been reported rarely.
Toxicity
Symptoms of overdose may include excessive peripheral vasodilation (with marked hypotension and shock), bradycardia, electrolyte disturbances, and renal failure. Cases of ACE inhibitor induced hepatotoxicity have been reported in humans and presented as acute jaundice and elevated liver enzymes. Removal of the ACE inhbitor resulted in a decline in liver enzymes and re-challenge produced a subsequent increase.
There were no observed tumerogenic effects at chronic doses up to 500mg/kg/day to rats for 24 months or at doses up to 1000mg/kg/day to mice for 18 months. For both species doses were administered by gavage and equivalent to 200 time the maximum recommended human exposure based on body surface area.
No mutagenic activity was detected in the Ames test in bacteria, the micronucleus test in mice, unscheduled DNA synthesis in a human cell line, or a forward gene-mutation assay in a Chinese hamster ovary cell line. Several metabolites of ramipril also produced negative results in the Ames test.
No effects on fertility were seen in rats at doses up to 500mg/kg/day. No teratogenicity was observed in rats and cynomolgus monkeys at doses 400 times the maximum recommended human exposure nor in rabbites at 2 times the maximum recommended human exposure.
LD50 10 g/kg (rat). LD50 10.5 g/kg (mouse). LD50 1 g/kg (dog).
Precaution
Q Rami should be used with caution in patients with impaired renal function, hyperkalaemia, hypotension, and impaired hepatic function.
Interaction
With Diuretics: Patients on diuretics, especially those in whom diuretic therapy was recently instituted, may occasionally experience an excessive reduction of blood pressure after initiation of therapy with ramipril.
With Potassium Supplements and Potassium-sparing Diuretics: Q Rami can attenuate potassium loss caused by thiazide diuretics. Potassium-sparing diuretics (spironolactone, amiloride, triamterene, and others) or potassium supplements can increase the risk of hyperkalemia.
Other: Neither ramipril nor its metabolites have been found to interact with food, digoxin, antacid, furosemide, cimetidine, indomethacin, and simvastatin. The combination of ramipril and propranolol showed no adverse effects on dynamic parameters (blood pressure and heart rate). The co-administration of ramipril and warfarin did not adversely affect the anticoagulant effects of the latter drug.
Food Interaction
- Avoid potassium-containing products. Potassium products increase the risk of hyperkalemia.
- Take with or without food. The absorption is unaffected by food.
[Moderate] GENERALLY AVOID: Moderate-to-high dietary intake of potassium can cause hyperkalemia in some patients who are using angiotensin converting enzyme (ACE) inhibitors.
In some cases, affected patients were using a potassium-rich salt substitute.
ACE inhibitors can promote hyperkalemia through inhibition of the renin-aldosterone-angiotensin (RAA) system.
MANAGEMENT: It is recommended that patients who are taking ACE inhibitors be advised to avoid moderately high or high potassium dietary intake.
Particular attention should be paid to the potassium content of salt substitutes.
Q Rami Drug Interaction
Moderate: aspirin, aspirin, insulin glargine, furosemide, pregabalinUnknown: ubiquinone, rosuvastatin, duloxetine, apixaban, omega-3 polyunsaturated fatty acids, atorvastatin, metoprolol, metoprolol, esomeprazole, acetaminophen, clopidogrel, levothyroxine, cyanocobalamin, ascorbic acid, cholecalciferol
Q Rami Disease Interaction
Major: angioedema, bone marrow suppression, CHF, hemodialysis, hyperkalemia, hypotensionModerate: liver disease, renal dysfunction
Elimination Route
The extent of absorption is at least 50-60%.. Food decreases the rate of absorption from the GI tract without affecting the extent of absorption. The absolute bioavailabilities of ramipril and ramiprilat were 28% and 44%, respectively, when oral administration was compared to intravenous administration. The serum concentration of ramiprilat was unchanged when capsules were opened and the contents dissolved in water, dissolved in apple juice, or suspended in apple sauce.
Half Life
Plasma concentrations of ramiprilat decline in a triphasic manner. Initial rapid decline represents distribution into tissues and has a half life of 2-4 hours. The half life of the apparent elimination phase is 9-18 hours, which is thought to represent clearance of free drug. The half-life of the terminal elimination phase is > 50 hours and thought to represent clearance of drug bound to ACE due to its slow dissociation. The half life of ramiprilat after multiple daily doses (MDDs) is dose-dependent, ranging from 13-17 hours with 5-10 mg MDDs to 27-36 hours for 2.5 mg MDDs.
Clearance
The renal clearance of ramipril and ramiprilat was reported to be 7.2 and 77.4 mL/min/1.73m2. The mean renal clearance of ramipril and ramiprilat is reported to be 10.7 and 126.8 mL/min in healthy elderly patients with normal renal function, additionally the Cmax of ramiprilat is approximately 20% higher in this population. While the pharmacokinetics of ramipril appear unaffected by reduced renal function, the plasma concentration and half-life of ramiprilat are increased. In patient's with hepatic failure the concentration of ramipril is initially increased while the tmax of ramiprilat is prolonged due to a reduced ability to metabolize the drug. However, steady state concentrations of ramiprilat are the same in hepatic failure as in healthy patients.
Elimination Route
Following oral administration, about 60% of the dose is eliminated in the urine as unchanged ramipril (6
Pregnancy & Breastfeeding use
If pregnancy is detected, ramipril should be discontinued as early as possible unless continued use is considered life saving. Q Rami should not be used during lactation.
Contraindication
It is contraindicated in patients who are hypersensitive to any component of this product and in patients with a history of angioedema related to previous treatment with a ACE inhibitor.
Special Warning
Dosage in renal impairment: For the patients with hypertension and renal impairment, the recommended initial dose is 1.25 mg Q Rami once daily. Subsequent dosage should be titrated according to individual tolerance and BP response, up to a maximum of 5 mg daily. For the patients with heart failure and renal impairment, the recommended dose is 1.25 mg once daily. The dose may be increased to 1.25 mg twice daily and up to a maximum dose of 2.5 mg twice daily depending upon clinical response and tolerability.
Use in children: No information is yet available on the use of Q Rami in children.
Acute Overdose
Limited data on human overdosage are available. The most likely clinical manifestations would be symptoms attributable to hypotension. Because the hypotensive effect of Q Rami is achieved through vasodilation and effective hypovolemia, it is reasonable to treat Q Rami overdosage by infusion of normal saline solution.
Storage Condition
Store at cool & dry place, protect from light and moisture.
Innovators Monograph
You find simplified version here Q Rami
Q Rami contains Ramipril see full prescribing information from innovator Q Rami Monograph, Q Rami MSDS, Q Rami FDA label
FAQ
What is Q Rami used for?
Q Rami used to treat high blood pressure and heart failure. It's also prescribed after a heart attack. Q Rami helps prevent future strokes, heart attacks and kidney problems. Q Rami also improves your survival if you're taking it for heart failure or after a heart attack.
How safe is Q Rami?
Q Rami is generally safe to take for a long time. In fact, it works best when you take it for a long time. But taking Q Rami for a long time can sometimes cause your kidneys to not work as well as they should. Your doctor will check how well your kidneys are working with regular blood tests.
What are the common side effects of Q Rami?
Common side effects of Q Rami are include:
- a dry, tickly cough that does not go away.
- feeling dizzy or lightheaded, especially when you stand up or sit up quickly (this is more likely to happen when you start taking ramipril or move on to a higher dose)
- headaches.
- diarrhoea and being sick (vomiting)
- a mild skin rash.
- blurred vision.
Is Q Rami safe during pregnancy?
Q Rami is not normally recommended in pregnancy or when breastfeeding. But it may be prescribed if your doctor thinks the benefits of the medicine outweigh the risks.
Is Q Rami safe during breastfeeding?
Q Rami use in breastfeeding is not recommended alternative treatments with more established safety profiles during breastfeeding are preferable, especially while nursing a newborn or preterm baby.
Can I drink alcohol with Q Rami?
During the first few days of taking Q Rami or after a dose increase, it's best to stop drinking alcohol until you see how the medicine affects you.
Can I drive after taking Q Rami?
Q Rami can cause blurred vision and make some people feel dizzy, especially when you first start taking it or after taking a bigger dose.If this happens to you, do not drive a car, ride a bike, or use tools or machinery.
How should I take Q Rami?
Q Rami usual to take Q Rami once or twice a day. You may be advised to take your first dose before bedtime, because it can make you dizzy. After the very first dose, you can take Q Rami at any time during the day. Try to take it at the same time every day.
What does Q Rami do to the kidneys?
In clinical trials of renal effects, Q Rami has been shown to increase cortical nephron flow in hypertension and to reduce proteinuria in patients with and without diabetes and/or hypertension.
How long should I take Q Rami?
The antihypertensive effect of a single dose usually lasts for 24 hours.
Why does Q Rami cause a cough?
Q Rami can increases the cough reflex.
Can Q Rami cause anxiety?
Patients who are known to have anxiety or tremors should be watched for these symptoms for a few weeks at a minimum when initiating Q Rami.
How long does a Q Rami cough last?
Q Rami related cough was defined as cough not related to the signs of respiratory tract infections, and that disappeared up to 4–8 weeks after the cessation of the Q Rami treatment.
Can Q Rami cause eye problems?
Q Rami can cause certain eye problems. If left untreated, this can lead to lasting eyesight loss.
Does Q Rami affect arthritis?
Q Rami improves vascular function and reduces markers of low-grade chronic inflammation and oxidative stress in patients with Rheumatoid Arthritis.
Can I just stop taking Q Rami?
Don't stop taking Q Rami without talking to your doctor. Stopping this drug suddenly can cause your blood pressure to spike. This may increase your chance for a heart attack or stroke.
Does Q Rami cause depression?
Diuretics didn't seem to impact depression risk.
What happens if I miss a dose?
Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.
Can I take overdose of Q Rami?
An overdose of Q Rami can cause dizziness, sleepiness and a pounding heartbeat. The amount of Q Rami that can lead to an overdose varies from person to person.
