Consumer Information for: NRA-RAMIPRIL
Consumer Information
Information about the product including what the product is used for, dosage, warnings, proper use and side effects. This summary will not tell you everything about the product. Contact your healthcare professional if you have any questions about the product.
What the medication is used for
High Blood Pressure (Hypertension)
NRA-RAMIPRIL lowers high blood pressure. It can be
used alone or together with a diuretic (“water pill”).
Managing your lifestyle
Keeping your blood pressure controlled
It takes more than just medication to reduce blood pressure.
Discuss the risk factors, and how they apply to your
lifestyle, with your doctor. You may have to modify some
of your daily habits to keep your blood pressure down.
Exercise regularly. It will help to keep your weight down,
make you feel more energetic and is a good way to deal
with stress. If you are not exercising regularly, be sure to
discuss a fitness plan with your doctor.
Remember, hypertension is a long-term disease without
symptoms. Just because you feel fine does not mean you can
stop taking your medication. If you stop, serious
complications of the disease may occur. Therefore, you
should continue to take NRA-RAMIPRIL regularly, as
prescribed by your doctor.
The “lifestyle” part of your treatment is as important as
your medication. By working as a team with your doctor,
you can help reduce the risk of complications to maintain
the style of life you are accustomed to.
- Alcohol: Avoid alcoholic beverages until you have discussed their use with your doctor. Alcohol consumption may alter your blood pressure and/or increase the possibility of dizziness or fainting.
- Diet: Generally, avoid fatty foods and food that is high in salt or cholesterol.
- Smoking: Avoid it completely.
What it does
NRA-RAMIPRIL is an angiotensin converting enzyme
(ACE) inhibitor. You can recognize ACE inhibitors
because their medicinal ingredient ends in ‘-PRIL’.
This medicine does not cure your disease. It helps to
control it. Therefore, it is important to continue taking
NRA-RAMIPRIL regularly even if you feel fine.
When it should not be used
Do not take NRA-RAMIPRIL if you:
- Are allergic to ramipril or to any non-medicinal ingredient in the formulation.
- Have experienced an allergic reaction (angioedema) with swelling of the hands, feet, or ankles, face, lips, tongue, throat, or sudden difficulty breathing or swallowing, to any ACE inhibitor or without a known cause. Be sure to tell your doctor, nurse, or pharmacist that this has happened to you.
- Have been diagnosed with hereditary angioedema: an increased risk of getting an allergic reaction that is passed down through families. This can be triggered by different factors, such as surgery, flu, or dental procedures.
- Are pregnant or intend to become pregnant. Taking NRA-RAMIPRIL during pregnancy can cause injury and even death to your baby.
- Are breastfeeding. NRA-RAMIPRIL passes into breast milk.
- Are taking ENTRESTO® (sacubitril/valsartan), due to the increased risk of serious allergic reaction which causes swelling of the face or throat (angioedema) when taken with NRA-Ramipril. You must wait at least 36 hours after your last dose of sacubitril/valsartan before taking NRA-RAMIPRIL.
- Have narrowing of the arteries to one or both kidneys (renal artery stenosis)
- Have hypotension (low blood pressure).
- Are on dialysis or LDL apheresis (a treatment to remove LDL cholesterol from the blood).
- Are already taking a blood pressure-lowering medicine that contains aliskiren (such as Rasilez) and you have one of the following conditions:
- Diabetes
- Kidney disease
- High Potassium levels
- Heart failure combined with low blood pressure
- Are taking an angiotensin receptor blocker (ARB), another medicine to treat your high blood pressure, or another ACE inhibitor and have one of the following conditions:
- Diabetes with end organ damage
- Kidney disease
- High Potassium levels
- Heart failure combined with low blood pressure
What the medicinal ingredient is
ramipril
What the non-medicinal ingredients are
NRA-Ramipril 1.25 mg: contains gelatin, methyl paraben,
propyl paraben, iron oxide yellow and titanium dioxide.
NRA-Ramipril 2.5 mg: contains gelatin, methyl paraben,
propyl paraben, carmoisine, ponceau 4R, sunset yellow
and titanium dioxide.
NRA-Ramipril 5 mg: contains gelatin, methyl paraben,
propyl paraben, brilliant blue, carmoisine, ponceau 4R,
and titanium dioxide.
NRA-Ramipril 10 mg: contains gelatin, methyl paraben,
propyl paraben, brilliant blue, carmoisine, erythrosine,
and titanium dioxide.
NRA-Ramipril 15 mg: contains gelatin, methyl paraben,
propyl paraben, brilliant blue, phloxine, iron oxide
black, and titanium dioxide.
NRA-Ramipril is available in hard gelatin capsules in the
following potencies:
1.25 mg: Yellow/white coloured hard gelatin capsules, size 4;
with ‘1.25’ imprinted in black on body, filled with a
homogenous white to off white powder.
2.5 mg: Orange/white coloured hard gelatin capsules, size 4;
with ‘2.5’ imprinted in black on body, filled with a
homogenous white to off white powder.
5.0 mg: Maroon/white coloured hard gelatin capsules, size 4;
with ‘5’ imprinted in black on body, filled with a homogenous
white to off white powder.
10.0 mg: Blue/white coloured hard gelatin capsules, size 4;
with ‘10’ imprinted in black on body, filled with a
homogenous white to off white powder.
15.0mg: Blue / grey colored size ‘3’ hard gelatin
capsules, with “15” imprinted in black on body, filled
with white to off-white blend.
What dosage form it comes in
Capsules 1.25 mg, 2.5 mg, 5.0 mg, 10.0mg and 15.0 mg.
Warnings and precautions
Serious Warnings and Precautions
NRA-RAMIPRIL should not be used during pregnancy. If you discover that you are pregnant while taking NRARAMIPRIL, stop the medication and please contact your doctor, nurse, or pharmacist as soon as possible.
BEFORE you use NRA-RAMIPRIL talk to your doctor, nurse, or pharmacist if you:
- Are allergic to any drug used to lower blood pressure.
- Have recently received or are planning to get allergy shots for bee or wasp stings.
- Have narrowing of an artery or a heart valve.
- Have had a heart attack or stroke.
- Have heart failure.
- Have diabetes, liver or kidney disease.
- Are on dialysis or LDL apheresis (a treatment to remove LDL cholesterol from the blood).
- Are dehydrated or suffer from excessive vomiting, diarrhea, or sweating.
- Are taking a salt substitute that contains potassium, potassium supplements, or a potassium-sparing diuretic (a specific kind of “water pill”). Or other medicinal products that may increase potassium. Use of NRARAMIPRIL with these medicines is not recommended.
- Are on a low-salt diet.
- Are receiving gold (sodium aurothiomalate) injections.
- Are less than 18 years old.
- Are taking a medicine that contains aliskiren, such as Rasilez, used to lower high blood pressure. The combination with NRA-Ramipril is not recommended. Are taking an angiotensin receptor blocker (ARB). You can recognize an ARB because its medicinal ingredient ends in “-SARTAN”. The combination with ramipril is not recommended
- Are taking drugs such as:
- Temsirolimus and everolimus (used to treat cancer),
- sirolimus (used to prevent organ rejection after a transplant).
- Sitagliptin or other gliptins (used to treat Type II diabetes)
- A neutral endopeptidase inhibitor
If you are going to have surgery and will be given an anesthetic, be sure to tell your doctor or dentist that you are taking NRA-RAMIPRIL.
Driving and using machines: Before you perform tasks which may require special attention, wait until you know how you respond to NRA-RAMIPRIL. Dizziness, lightheadedness, or fainting can especially occur after the first dose and when the dose is increased.
Raynaud's phenomenon is a condition resulting from poor circulation in the extremities (i.e., fingers and toes). It may begin or get worse.
Interactions with this medication
As with most medicines, interactions with other drugs are
possible. Tell your doctor, nurse, or pharmacist about all
the medicines you take, including drugs prescribed by
other doctors, vitamins, minerals, natural supplements, or
alternative medicines.
The following may interact with NRA-RAMIPRIL:
- Agents increasing serum potassium, such as a salt substitute that contains potassium, potassium supplements, or a potassium-sparing diuretic (a specific kind of “water pill”). Or other medicinal products that may increase potassium. Use of NRA-RAMIPRIL with these medicines is not recommended.
- Alcohol
- Allopurinol used to treat gout.
- Antidiabetic drugs, including insulin and oral medicines, such as gliptins (e.g. sitagliptin).
- Lithium used to treat bipolar disease.
- Gold for the treatment of rheumatoid arthritis.
- Nonsteroidal anti-inflammatory drugs (NSAIDs), used to reduce pain and swelling. Examples include
- ibuprofen, naproxen, and celecoxib.
- Blood pressure lowering drugs, including diuretics (“water pills”), aliskiren-containing products (e.g. Rasilez), or angiotensin receptor blockers (ARBs).
- Nitrates used to treat angina (chest pain)
- Acetylsalicylic acid (aspirin)
- Heparin used to prevent and treat blood clots
- Immunosuppressants used to lower the body’s ability to reject a transplanted organ
- Corticosteroids used to treat joint pain and swelling or for other conditions.
- Procainamide used to treat irregular heartbeat
- Cytostatic medicines used to treat certain types of cancer.
- mTOR inhibitors used to lower the body’s ability to reject a transplant (e.g., sirolimus) or to treat certain types of cancer (e.g., tersirolimus, everolimus).
- Neutral endopeptidase (NEP) inhibitors.
Proper use of this medication
Take NRA-RAMIPRIL exactly as prescribed. It is recommended to take your dose at about the same time every day.
Usual Dose
High Blood Pressure: The recommended initial dosage of
NRA-RAMIPRIL is 2.5 mg once daily. Your doctor will
determine the appropriate dosage.
For patients taking diuretics (“water pills”) or with
impaired kidney function: The recommended initial
dosage of NRA-RAMIPRIL is 1.25 mg daily.
Overdose
Missed Dose
If you have forgotten to take your dose during the day, carry on with the next one at the usual time. Do not double dose.
Side effects and what to do about them
Side effects may include:
- Dizziness, difficulty in maintaining your balance while standing
- drowsiness, fatigue, weakness
- cough, nasal or sinus congestion, swollen lymph nodes, bronchitis, aggravated asthma
- rash, itching, flushing, inflammation of the eye (pink eye), skin inflammation or red skin, burning sensation, inflammation of the mouth or tongue
- headache
- abdominal pain
- sad mood, difficulty with sleep, restlessness, attention disturbances
- loss of hair
- taste modifications or loss of taste, vision or hearing modifications
- impotence/reduced libido, breast enlargement in males
NRA-Ramipril can cause abnormal blood test results. Your doctor will decide when to perform blood tests and will interpret the results.
| Symptom / effect | Talk with your doctor, nurse, or pharmacist only if severe | Talk with your doctor, nurse, or pharmacist in all cases | Stop taking drug and seek immediate help |
|---|---|---|---|
| Common | |||
| Low blood pressure: Dizziness, fainting, lightheadedness May occur when you go from lying or sitting to standing up | ✔ | ||
| Increased levels of potassium in the blood: Irregular heartbeat, muscle weakness and generally feeling unwell | ✔ | ||
| Uncommon | |||
| Allergic reaction: Rash, hives, swelling of the face, arms and legs, lips, tongue or throat, difficulty swallowing or breathing. | ✔ | ||
| Kidney Disorder: change in frequency of urination, nausea, vomiting, swelling of extremities, fatigue. | ✔ | ||
| Liver Disorder: yellowing of the skin or eyes, dark urine, abdominal pain, nausea, vomiting, loss of appetite | ✔ | ||
| Electrolyte Imbalance: weakness, drowsiness, muscle pain or cramps, irregular heartbeat | ✔ | ||
| Rare | |||
| Decreased Platelets: bruising, bleeding, fatigue and weakness | ✔ | ||
| Decreased White Blood Cells: infections, fatigue, fever, aches, pains, and flu-like symptoms | ✔ | ||
| Heart Attack: chest pain and/or discomfort, pain in the jaw, shoulders, arm and/or back, shortness of breath, sweating, lightheadedness, nausea | ✔ | ||
| Cerebro-vascular accident/ Stroke: weakness, trouble speaking, trouble seeing, headache, dizziness | ✔ | ||
| Intestinal Angioedema: abdominal pain (with or without nausea or vomiting) | ✔ | ||
This is not a complete list of side effects. For any unexpected effects while taking NRA-RAMIPRIL, contact your doctor, nurse or pharmacist.
How to store
Store NRA-Ramipril in original container at room
temperature (15- 30ºC). Protect from light and moisture,
and not beyond the date indicated on the container.
Keep out of reach and sight of children.
Reporting side effects
You can report any suspected adverse reactions associated with the use of health products to the Canada Vigilance Program by one of the following three ways:
- Report online at www.healthcanada.gc.ca/medeffect
- Call toll-free at 1-866-234-2345
- Complete a Canada Vigilance Reporting Form and:
- Fax toll-free to 1-866-678-6789, or
- Mail to:
Canada Vigilance Program
Health Canada
Postal Locator 0701E
Ottawa ON K1A 0K9
Postage paid labels, Canada Vigilance Reporting Form and the adverse reaction reporting guidelines are available on the MedEffectTM Canada Web site at www.healthcanada.gc.ca/medeffect.
NOTE: Should you require information related to the management of side effects, contact your health professional. The Canada Vigilance Program does not provide medical advice.
More information
This document plus the full product monograph, prepared
for health professionals can be obtained by contacting
Nora Pharma Inc.
205-2900 Boul Cote-Vertu,
Saint-Laurent, Quebec
H4R 3E8
Date of Revision: February 27, 2019
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