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Ramipril and hydrochlorothiazide (United States: Not available): Drug information

Ramipril and hydrochlorothiazide (United States: Not available): Drug information
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For additional information see "Ramipril and hydrochlorothiazide (United States: Not available): Patient drug information"

For abbreviations, symbols, and age group definitions show table
Brand Names: Canada
  • Altace HCT;
  • PMS-Ramipril/HCTZ;
  • TARO-Ramipril HCTZ
Pharmacologic Category
  • Angiotensin-Converting Enzyme (ACE) Inhibitor;
  • Antihypertensive;
  • Diuretic, Thiazide
Dosing: Adult
Hypertension

Hypertension: Oral: Initial: Ramipril 2.5 mg/hydrochlorothiazide 12.5 mg once daily; titrate to maximum ramipril 10 mg/hydrochlorothiazide 50 mg once daily. Patients already taking ramipril and/or hydrochlorothiazide may be switched to a combination product for individually titrated agents. Note: Patients receiving diuretics prior to initiating ramipril/hydrochlorothiazide should attempt to discontinue diuretic therapy at least 2 to 3 days prior to initiation, or at least reduce the diuretic dose; if unable to discontinue the diuretic, initiate ramipril at the lowest possible dose (eg, 1.25 mg daily). As clinically indicated may transition to ramipril/hydrochlorothiazide at an initial dose of ramipril ≤2.5 mg/hydrochlorothiazide 12.5 mg once daily.

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Adult

CrCl >60 mL/minute/1.73 m2: No dosage adjustment necessary.

CrCl 30 to 60 mL/minute/1.73 m2: Initial dose: Ramipril 2.5 mg/hydrochlorothiazide 12.5 mg once daily; Maximum dose: Ramipril 5 mg/hydrochlorothiazide 25 mg once daily

CrCl <30 mL/minute/1.73 m2: Use is contraindicated.

Dialysis: Use is contraindicated.

Dosing: Liver Impairment: Adult

Mild-to-moderate impairment: Maximum dose: 2.5 mg of ramipril/12.5 mg hydrochlorothiazide once daily. Initiate treatment under close medical supervision.

Severe impairment: Use is contraindicated.

Dosing: Older Adult

Refer to adult dosing. Initiate at reduced dosage and titrate cautiously.

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Observed with ramipril/hydrochlorothiazide. Also see individual agents.

1% to 10%:

Neuromuscular & skeletal: Back pain (1%)

Respiratory: Bronchitis (2%), cough increased (1%)

<1%, postmarketing, and/or case reports (limited to important or life-threatening): Abdominal pain, abnormal hepatic function test, acute myocardial infarction, acute renal failure, agranulocytosis, alopecia, altered sense of smell, angina pectoris, angioedema, anorexia, anxiety, apathy, aphthous stomatitis, arrhythmia, arthralgia, arthritis, asthenia, auditory disturbance, bone marrow depression, bronchospasm, burning sensation of skin, changes in liver function, chest pain, confusion, conjunctivitis, constipation, decreased appetite, decreased lacrimation, decreased libido, decreased red blood cells, dehydration, depression, diaphoresis, diarrhea, disturbance in attention, dizziness, drowsiness, dysgeusia, dyspepsia, dysphagia, dyspnea, enanthema, eosinophilia, equilibrium disturbance, erythema multiforme, erythroderma, exacerbation of psoriasis, exanthema, exfoliative dermatitis, fatigue, fever, gastritis, gastroenteritis, gastrointestinal disease, gastrointestinal pain, gingivitis, glossitis, gout, gynecomastia, headache, hemolytic anemia, hepatitis, hot flash, hypercalcemia, hypercholesterolemia, hyperglycemia, hyperkalemia, hypersensitivity reaction, hypertriglyceridemia, hyperuricemia, hypochloremia, hypokalemia, hypomagnesemia, hyponatremia, hypotension, impotence, increased blood urea nitrogen, increased serum bilirubin, increased serum creatinine, increased serum transaminases, insomnia, interstitial nephritis, ischemic heart disease, ischemic stroke, jaundice, leukocytosis, leukopenia, maculopapular rash, metabolic alkalosis, muscle cramps, muscle rigidity, myalgia, myasthenia, myocardial infarction, nasal congestion, nausea, nervousness, neuropathy, neutropenia, nonimmune anaphylaxis, orthostatic hypotension, palpitations, pancreatitis, pancytopenia, paresthesia, pemphigus, peripheral edema, pneumonitis, polydipsia, pruritus, psoriasis, restlessness, shock, SIADH, sialorrhea, sinusitis, skin photosensitivity, skin rash, sleep disorder, Stevens-Johnson syndrome, stomach pain, syncope, systemic lupus erythematosus, tachycardia, thrombosis, tinnitus, toxic epidermal necrolysis, tremor, urticaria, vasculitis, vertigo, visual disturbances, vomiting, xerostomia

Contraindications

Hypersensitivity to ramipril, hydrochlorothiazide, other ACE inhibitors or thiazides, sulfonamide-derived drugs, or any other component of the formulation; patients with a history of hereditary/idiopathic angioedema with or without treatment; anuria; hemodynamically relevant bilateral or unilateral (in patients with a single kidney) renal artery stenosis; hypotensive states; hemodynamically unstable states; use within 36 hours of switching to or from sacubitril/valsartan; concomitant use of aliskiren containing drugs in patients with diabetes mellitus (type 1 or 2), moderate to severe renal impairment (GFR <60 mL/minute/1.73 m2), hyperkalemia (>5 mMol/L) and/or heart failure who are hypotensive; concomitant use of angiotensin II receptor antagonists (ARBs) in patients with diabetes with end organ damage, moderate to severe kidney impairment (GFR <60 mL/minute/1.73 m2), hyperkalemia (>5 mMol/L), and/or heart failure who are hypotensive; severe hepatic impairment; severe renal impairment (CrCl <30 mL/minute/1.73 m2) or on dialysis; combination with extracorporeal treatments leading to contact of blood with negatively charged surfaces (ie, dialysis or hemofiltration with certain high-flux [eg, polyacrylonitrile] membranes and low-density lipoprotein apheresis with dextran sulfate); clinically relevant electrolyte disturbances (eg, hypokalemia, hyponatremia, or hypercalcemia); pregnancy; breastfeeding

Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Note: Although the FDA-approved product labeling states this medication is contraindicated in patients with hypersensitivity to sulfonamide-containing drugs, the scientific basis of this cross-sensitivity has been challenged.

Warnings/Precautions

Concerns related to adverse effects:

• Angioedema: At any time during treatment (especially following first dose) angioedema may occur rarely with ACE inhibitors; it may involve the head and neck (potentially compromising airway) or the intestine (presenting with abdominal pain). Black patients may be at an increased risk. Risk may also be increased with concomitant use of mTOR inhibitor (eg, everolimus) therapy. Prolonged frequent monitoring may be required especially if tongue, glottis, or larynx are involved as they are associated with airway obstruction. Patients with a history of airway surgery may have a higher risk of airway obstruction. Aggressive early and appropriate management is critical.

• Cholestatic jaundice: A rare toxicity associated with ACE inhibitors includes cholestatic jaundice, which may progress to fulminant hepatic necrosis; discontinue if marked elevation of hepatic transaminases or jaundice occurs. Consider discontinuing therapy if symptoms of hepatic dysfunction (eg, fever, malaise, muscle pain, rash) present within the first weeks to months of therapy.

• Cough: An ACE inhibitor cough is a dry, hacking, nonproductive one that usually occurs within the first few months of treatment and should generally resolve within 1 to 4 weeks after discontinuation of the ACE inhibitor. Other causes of cough should be considered (eg, pulmonary congestion in patients with heart failure) and excluded prior to discontinuation.

• Dermatologic malignancy: Non-melanoma skin and lip cancer (basal cell carcinoma and squamous cell carcinoma) has been reported with hydrochlorothiazide use; risk may be increased with cumulative use. Use with caution in patients at high risk for non-melanoma skin cancer including personal or family history of skin cancer, immunosuppressive therapy or light-colored skin. Monitor skin for new or changing lesions. Limit sunlight exposure and avoid the use of sunlamps/tanning equipment. Daily sunscreen (SPF ≥30) use, sun protective clothing and hats, and other protective measures are recommended.

• Electrolyte disturbances: Hyperkalemia may occur with ACE inhibitors; risk factors include renal dysfunction, diabetes mellitus, and concomitant use of potassium-sparing diuretics, potassium supplements, and/or potassium-containing salts. Use cautiously, if at all, with these agents and monitor potassium closely. Thiazide diuretics may cause hypokalemia, hypochloremic alkalosis, hypomagnesemia, and hyponatremia. Use is contraindicated with clinically relevant electrolyte disturbances (eg, hypokalemia, hyponatremia, or hypercalcemia).

• Gout: In certain patients with a history of gout, a familial predisposition to gout, or chronic renal failure, gout can be precipitated by hydrochlorothiazide. This risk may be increased with doses ≥25 mg (Gurwitz 1997).

• Hypersensitivity reactions: Anaphylactic/anaphylactoid reactions can occur with ACE inhibitors. Severe anaphylactoid reactions may be seen during hemodialysis (eg, CVVHD) with high-flux dialysis membranes (eg, AN69), and rarely, during low density lipoprotein apheresis with dextran sulfate cellulose. Rare cases of anaphylactoid reactions have been reported in patients undergoing sensitization treatment with hymenoptera (bee, wasp) venom while receiving ACE inhibitors; reactions have been avoided by temporarily interrupting ACE inhibitor therapy (≥24 hours) but have reappeared upon rechallenge. Hypersensitivity reactions may also occur with hydrochlorothiazide; risk is increased in patients with a history of allergy or bronchial asthma.

• Hypotension/syncope: Symptomatic hypotension with or without syncope can occur (usually with the first several doses); effects are most often observed in volume-depleted patients; correct volume depletion prior to initiation; close monitoring of patient is required especially with initial dosing and dosing increases; blood pressure must be lowered at a rate appropriate for the patient's clinical condition. Advise patients to use caution when driving or operating machinery during therapy initiation or with dose increases; hypotensive effects may impair ability to perform these tasks. Although dose reduction may be necessary, hypotension is not a reason for discontinuation of future ACE inhibitor use especially in patients with heart failure where a reduction in systolic blood pressure is a desirable observation.

• Neutropenia/agranulocytosis: Another ACE Inhibitor, captopril, has been associated with bone marrow suppression including rare cases of agranulocytosis, neutropenia, or leukopenia with myeloid hyperplasia. Patients with collagen vascular disease (eg, systemic lupus erythematosus) and/or renal disease are at a higher risk of developing bone marrow suppression.

• Ocular effects: Hydrochlorothiazide may cause acute transient myopia and acute angle-closure glaucoma, typically occurring within hours to weeks following initiation; discontinue therapy immediately in patients with acute decreases in visual acuity or ocular pain. Additional treatments may be needed if uncontrolled intraocular pressure persists. Risk factors may include a history of sulfonamide or penicillin allergy.

• Photosensitivity: Photosensitization may occur; discontinue use if photosensitivity reactions occur.

• Renal function deterioration: May be associated with deterioration of renal function and/or increases in serum creatinine, particularly in patients with low renal blood flow (eg, renal artery stenosis, heart failure) whose glomerular filtration rate (GFR) is dependent on efferent arteriolar vasoconstriction by angiotensin II; deterioration may result in oliguria, acute renal failure, and progressive azotemia. Small increases in serum creatinine may occur following initiation; consider discontinuation only in patients with progressive and/or significant deterioration in renal function.

• Skin cancer, nonmelanoma: Prolonged use (≥3 years) may increase the risk for squamous cell carcinoma up to 4 times and increase the risk for basal cell carcinoma up to 1.25 times compared to patients not treated with hydrochlorothiazide (Pedersen 2018; Pottegård 2017).

• Sulfonamide (“sulfa”) allergy: The FDA-approved product labeling for many medications containing a sulfonamide chemical group includes a broad contraindication in patients with a prior allergic reaction to sulfonamides. There is a potential for cross-reactivity between members of a specific class (eg, two antibiotic sulfonamides). However, concerns for cross-reactivity have previously extended to all compounds containing the sulfonamide structure (SO2NH2). An expanded understanding of allergic mechanisms indicates cross-reactivity between antibiotic sulfonamides and nonantibiotic sulfonamides may not occur or at the very least this potential is extremely low (Brackett 2004; Johnson 2005; Slatore 2004; Tornero 2004). In particular, mechanisms of cross-reaction due to antibody production (anaphylaxis) are unlikely to occur with nonantibiotic sulfonamides. T-cell-mediated (type IV) reactions (eg, maculopapular rash) are less well understood and it is not possible to completely exclude this potential based on current insights. In cases where prior reactions were severe (Stevens-Johnson syndrome/TEN), some clinicians choose to avoid exposure to these classes.

Disease-related concerns:

• Aortic stenosis: Use with caution in patients with severe aortic stenosis; may reduce coronary perfusion resulting in ischemia.

• Bariatric surgery: Dehydration: Avoid diuretics in the immediate postoperative period after bariatric surgery; electrolyte disturbances and dehydration may occur. Diuretics may be resumed, if indicated, once oral fluid intake goals are met (Ziegler 2009)

• Cardiovascular disease: Initiation of therapy in patients with ischemic heart disease or cerebrovascular disease warrants close observation due to the potential consequences posed by falling blood pressure (eg, MI, stroke). Fluid replacement, if needed, may restore blood pressure; therapy may then be resumed. Discontinue therapy in patients whose hypotension recurs.

• Collagen vascular disease: Use ACE inhibitors with caution in patients with collagen vascular disease especially with concomitant renal impairment; may be at increased risk for hematologic toxicity. Hydrochlorothiazide may cause systemic lupus erythematosus (SLE) exacerbation or activation.

• Diabetes: Use hydrochlorothiazide with caution in patients with prediabetes or diabetes mellitus; may see a change in glucose control.

• Hepatic impairment: In progressive liver disease, avoid electrolyte and acid/base imbalances that might lead to hepatic encephalopathy/coma.

• Hypercalcemia: Thiazide diuretics may decrease renal calcium excretion; consider avoiding use in patients with hypercalcemia.

• Hypercholesterolemia: Use with caution in patients with moderate or high cholesterol concentrations; increased cholesterol and triglyceride levels have been reported with thiazides.

• Hypertrophic cardiomyopathy with left ventricular outflow tract obstruction: Use with caution in patients with hypertrophic cardiomyopathy and left ventricular outflow tract obstruction since reduction in afterload may worsen symptoms associated with this condition.

• Parathyroid disease: Thiazide diuretics reduce calcium excretion; pathologic changes in the parathyroid glands with hypercalcemia and hypophosphatemia have been observed with prolonged use; should be discontinued prior to testing for parathyroid function.

• Renal artery stenosis: Use is contraindicated in patients with hemodynamically relevant bilateral or unilateral (in patients with a single kidney) renal artery stenosis; may be associated with oliguria, progressive azotemia, and rarely, acute renal failure and/or death.

• Renal impairment: Use ACE inhibitors with caution in pre-existing renal insufficiency; dosage adjustment may be needed. Avoid rapid dosage escalation which may lead to further renal impairment. Patients with renal impairment may be at increased risk for hematologic toxicity. Cumulative effects of hydrochlorothiazide may develop, including azotemia, in patients with impaired renal function. Avoid hydrochlorothiazide in severe renal disease (ineffective).

Special populations:

• Pregnancy: [Canadian Boxed Warning]: ACEIs can cause injury and death to the developing fetus when used in pregnancy. ACEIs should be discontinued as soon as possible once pregnancy is detected.

Other warnings/precautions:

• Surgery: In patients on chronic ACE inhibitor therapy, intraoperative hypotension may occur with induction and maintenance of general anesthesia; use with caution before, during, or immediately after major surgery. Cardiopulmonary bypass, intraoperative blood loss, or vasodilating anesthesia increases endogenous renin release. Use of ACE inhibitors perioperatively will blunt angiotensin II formation and may result in hypotension. However, discontinuation of therapy prior to surgery is controversial. If continued preoperatively, avoidance of hypotensive agents during surgery is prudent (Hillis 2011).

Product Availability

Not available in the US

Generic Equivalent Available: US

May be product dependent

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Tablet, Oral:

Altace HCT: Ramipril 5 mg and hydrochlorothiazide 25 mg, Ramipril 10 mg and hydrochlorothiazide 25 mg, Ramipril 5 mg and hydrochlorothiazide 12.5 mg, Ramipril 10 mg and hydrochlorothiazide 12.5 mg, Ramipril 2.5 mg and hydrochlorothiazide 12.5 mg [contains corn starch]

Generic: Ramipril 10 mg and hydrochlorothiazide 12.5 mg, Ramipril 10 mg and hydrochlorothiazide 25 mg, Ramipril 2.5 mg and hydrochlorothiazide 12.5 mg, Ramipril 5 mg and hydrochlorothiazide 12.5 mg, Ramipril 5 mg and hydrochlorothiazide 25 mg

Administration: Adult

Oral: Administer in the morning with one-half glass of water and without regard to meals. Do not chew or crush tablets.

Use: Labeled Indications

Note: Not approved in the United States.

Hypertension: Treatment of primary hypertension.

Medication Safety Issues
Sound-alike/look-alike issues:

Altace HCT may be confused with alteplase, Artane, Altace

Older Adult: High-Risk Medication:

Beers Criteria: Diuretics (hydrochlorothiazide) are identified in the Beers Criteria as a potentially inappropriate medication to be used with caution in patients 65 years and older due to the potential to cause or exacerbate syndrome of inappropriate antidiuretic hormone secretion (SIADH) or hyponatremia; monitor sodium concentration closely when initiating or adjusting the dose in older adults (Beers Criteria [AGS 2023]).

Other safety concerns:

ALERT: Canadian Boxed Warning: Health Canada-approved labeling includes a boxed warning. See Warnings/Precautions section for a concise summary of this information. For verbatim wording of the boxed warning, consult the product labeling.

Metabolism/Transport Effects

Refer to individual components.

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program by clicking on the “Launch drug interactions program” link above.

Agents with Clinically Relevant Anticholinergic Effects: May increase serum concentration of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor

Ajmaline: Sulfonamides may increase adverse/toxic effects of Ajmaline. Specifically, the risk for cholestasis may be increased. Risk C: Monitor

Alcohol (Ethyl): May increase orthostatic hypotensive effects of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor

Alfuzosin: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Aliskiren: May increase hyperkalemic effects of Angiotensin-Converting Enzyme Inhibitors. Aliskiren may increase nephrotoxic effects of Angiotensin-Converting Enzyme Inhibitors. Aliskiren may increase hypotensive effects of Angiotensin-Converting Enzyme Inhibitors. Management: Aliskiren use with ACEIs or ARBs in patients with diabetes is contraindicated. Combined use in other patients should be avoided, particularly when CrCl is less than 60 mL/min. If combined, monitor potassium, creatinine, and blood pressure closely. Risk D: Consider Therapy Modification

Allopurinol: Angiotensin-Converting Enzyme Inhibitors may increase hypersensitivity effects of Allopurinol. Risk C: Monitor

Allopurinol: Thiazide and Thiazide-Like Diuretics may increase hypersensitivity effects of Allopurinol. Risk C: Monitor

Alteplase: Angiotensin-Converting Enzyme Inhibitors may increase adverse/toxic effects of Alteplase. Specifically, the risk for angioedema may be increased. Risk C: Monitor

Amifostine: Blood Pressure Lowering Agents may increase hypotensive effects of Amifostine. Management: When used at chemotherapy doses, hold blood pressure lowering medications for 24 hours before amifostine administration. If blood pressure lowering therapy cannot be held, do not administer amifostine. Use caution with radiotherapy doses of amifostine. Risk D: Consider Therapy Modification

Aminolevulinic Acid (Systemic): Photosensitizing Agents may increase photosensitizing effects of Aminolevulinic Acid (Systemic). Risk X: Avoid

Aminolevulinic Acid (Topical): Photosensitizing Agents may increase photosensitizing effects of Aminolevulinic Acid (Topical). Risk C: Monitor

Amphetamines: May decrease antihypertensive effects of Antihypertensive Agents. Risk C: Monitor

Angiotensin II Receptor Blockers: May increase adverse/toxic effects of Angiotensin-Converting Enzyme Inhibitors. Angiotensin II Receptor Blockers may increase serum concentration of Angiotensin-Converting Enzyme Inhibitors. Management: Use of telmisartan and ramipril is not recommended. It is not clear if any other combination of an ACE inhibitor and an ARB would be any safer. Consider alternatives when possible. Monitor blood pressure, renal function, and potassium if combined. Risk D: Consider Therapy Modification

Angiotensin II: Angiotensin-Converting Enzyme Inhibitors may increase therapeutic effects of Angiotensin II. Risk C: Monitor

Antidiabetic Agents: Hyperglycemia-Associated Agents may decrease therapeutic effects of Antidiabetic Agents. Risk C: Monitor

Antidiabetic Agents: Thiazide and Thiazide-Like Diuretics may decrease therapeutic effects of Antidiabetic Agents. Risk C: Monitor

Antipsychotic Agents (Second Generation [Atypical]): Blood Pressure Lowering Agents may increase hypotensive effects of Antipsychotic Agents (Second Generation [Atypical]). Risk C: Monitor

Aprotinin: May decrease antihypertensive effects of Angiotensin-Converting Enzyme Inhibitors. Risk C: Monitor

Arginine: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Arsenic Trioxide: Thiazide and Thiazide-Like Diuretics may increase hypotensive effects of Arsenic Trioxide. Thiazide and Thiazide-Like Diuretics may increase QTc-prolonging effects of Arsenic Trioxide. Management: When possible, avoid concurrent use of arsenic trioxide with drugs that can cause electrolyte abnormalities, such as the thiazide and thiazide-like diuretics. Risk D: Consider Therapy Modification

AzaTHIOprine: Angiotensin-Converting Enzyme Inhibitors may increase myelosuppressive effects of AzaTHIOprine. Risk C: Monitor

Barbiturates: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Benperidol: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Beta2-Agonists: May increase hypokalemic effects of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor

Bile Acid Sequestrants: May decrease absorption of Thiazide and Thiazide-Like Diuretics. Management: Separate administration of bile acid sequestrants and oral thiazide diuretics by at least 4 hours. Monitor for decreased therapeutic effects of thiazide diuretics if coadministered with a bile acid sequestrant. Risk D: Consider Therapy Modification

Brigatinib: May decrease antihypertensive effects of Antihypertensive Agents. Brigatinib may increase bradycardic effects of Antihypertensive Agents. Risk C: Monitor

Brimonidine (Topical): May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Bromperidol: May decrease hypotensive effects of Blood Pressure Lowering Agents. Blood Pressure Lowering Agents may increase hypotensive effects of Bromperidol. Risk X: Avoid

Calcium Salts: Thiazide and Thiazide-Like Diuretics may increase serum concentration of Calcium Salts. Risk C: Monitor

Cardiac Glycosides: Thiazide and Thiazide-Like Diuretics may increase adverse/toxic effects of Cardiac Glycosides. Specifically, cardiac glycoside toxicity may be enhanced by the hypokalemic and hypomagnesemic effect of thiazide diuretics. Risk C: Monitor

Corticosteroids (Systemic): May increase hypokalemic effects of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor

CycloPHOSphamide: Thiazide and Thiazide-Like Diuretics may increase adverse/toxic effects of CycloPHOSphamide. Specifically, granulocytopenia may be enhanced. Risk C: Monitor

Dapoxetine: May increase orthostatic hypotensive effects of Angiotensin-Converting Enzyme Inhibitors. Risk C: Monitor

Desmopressin: Hyponatremia-Associated Agents may increase hyponatremic effects of Desmopressin. Risk C: Monitor

Dexketoprofen: May increase adverse/toxic effects of Sulfonamides. Risk C: Monitor

Dexmethylphenidate: May decrease therapeutic effects of Antihypertensive Agents. Risk C: Monitor

Diacerein: May increase therapeutic effects of Diuretics. Specifically, the risk for dehydration or hypokalemia may be increased. Risk C: Monitor

Diazoxide Choline: May increase adverse/toxic effects of Thiazide and Thiazide-Like Diuretics. Specifically, the hyperglycemic and hyperuricemic effects may be increased. Risk C: Monitor

Diazoxide: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Diazoxide: Thiazide and Thiazide-Like Diuretics may increase adverse/toxic effects of Diazoxide. Risk C: Monitor

Dichlorphenamide: Thiazide and Thiazide-Like Diuretics may increase hypokalemic effects of Dichlorphenamide. Risk C: Monitor

Dipeptidyl Peptidase-IV Inhibitors: May increase adverse/toxic effects of Angiotensin-Converting Enzyme Inhibitors. Specifically, the risk of angioedema may be increased. Risk C: Monitor

Dofetilide: HydroCHLOROthiazide may increase QTc-prolonging effects of Dofetilide. HydroCHLOROthiazide may increase serum concentration of Dofetilide. Risk X: Avoid

Drospirenone-Containing Products: May increase hyperkalemic effects of Angiotensin-Converting Enzyme Inhibitors. Risk C: Monitor

DULoxetine: Blood Pressure Lowering Agents may increase hypotensive effects of DULoxetine. Risk C: Monitor

EPINEPHrine (Systemic): Diuretics may increase arrhythmogenic effects of EPINEPHrine (Systemic). Diuretics may decrease vasopressor effects of EPINEPHrine (Systemic). Risk C: Monitor

Everolimus: May increase adverse/toxic effects of Angiotensin-Converting Enzyme Inhibitors. Specifically, the risk of angioedema may be increased. Risk C: Monitor

Ferric Gluconate: Angiotensin-Converting Enzyme Inhibitors may increase adverse/toxic effects of Ferric Gluconate. Risk C: Monitor

Ferric Hydroxide Polymaltose Complex: Angiotensin-Converting Enzyme Inhibitors may increase adverse/toxic effects of Ferric Hydroxide Polymaltose Complex. Specifically, the risk for angioedema or allergic reactions may be increased. Risk C: Monitor

Finerenone: Angiotensin-Converting Enzyme Inhibitors may increase hyperkalemic effects of Finerenone. Risk C: Monitor

Flunarizine: May increase therapeutic effects of Antihypertensive Agents. Risk C: Monitor

Gelatin (Succinylated): Angiotensin-Converting Enzyme Inhibitors may increase adverse/toxic effects of Gelatin (Succinylated). Specifically, the risk of a paradoxical hypotensive reaction may be increased. Risk C: Monitor

Grass Pollen Allergen Extract (5 Grass Extract): Angiotensin-Converting Enzyme Inhibitors may increase adverse/toxic effects of Grass Pollen Allergen Extract (5 Grass Extract). Specifically, ACE inhibitors may increase the risk of severe allergic reaction to Grass Pollen Allergen Extract (5 Grass Extract). Risk X: Avoid

Heparin: May increase hyperkalemic effects of Angiotensin-Converting Enzyme Inhibitors. Risk C: Monitor

Heparins (Low Molecular Weight): May increase hyperkalemic effects of Angiotensin-Converting Enzyme Inhibitors. Risk C: Monitor

Herbal Products with Blood Pressure Increasing Effects: May decrease antihypertensive effects of Antihypertensive Agents. Risk C: Monitor

Herbal Products with Blood Pressure Lowering Effects: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Hypotension-Associated Agents: Blood Pressure Lowering Agents may increase hypotensive effects of Hypotension-Associated Agents. Risk C: Monitor

Icatibant: May decrease antihypertensive effects of Angiotensin-Converting Enzyme Inhibitors. Risk C: Monitor

Iloperidone: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Indoramin: May increase hypotensive effects of Antihypertensive Agents. Risk C: Monitor

Ipragliflozin: May increase adverse/toxic effects of Thiazide and Thiazide-Like Diuretics. Specifically, the risk for intravascular volume depletion may be increased. Risk C: Monitor

Iron Dextran Complex: Angiotensin-Converting Enzyme Inhibitors may increase adverse/toxic effects of Iron Dextran Complex. Specifically, patients receiving an ACE inhibitor may be at an increased risk for anaphylactic-type reactions. Risk C: Monitor

Isocarboxazid: May increase antihypertensive effects of Antihypertensive Agents. Risk X: Avoid

Isocarboxazid: May increase hypotensive effects of Diuretics. Risk X: Avoid

Ivabradine: Thiazide and Thiazide-Like Diuretics may increase arrhythmogenic effects of Ivabradine. Risk C: Monitor

Lanthanum: May decrease serum concentration of Angiotensin-Converting Enzyme Inhibitors. Management: Administer angiotensin-converting enzyme (ACE) inhibitors at least two hours before or after lanthanum. Risk D: Consider Therapy Modification

Levodopa-Foslevodopa: Blood Pressure Lowering Agents may increase hypotensive effects of Levodopa-Foslevodopa. Risk C: Monitor

Levosulpiride: Thiazide and Thiazide-Like Diuretics may increase adverse/toxic effects of Levosulpiride. Risk X: Avoid

Licorice: May increase hypokalemic effects of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor

Lithium: Angiotensin-Converting Enzyme Inhibitors may increase serum concentration of Lithium. Management: Lithium dosage reductions will likely be needed following the addition of an ACE inhibitor. Monitor for increased concentrations/toxic effects of lithium if an ACE inhibitor is initiated/dose increased, or if switching between ACE inhibitors. Risk D: Consider Therapy Modification

Lithium: Thiazide and Thiazide-Like Diuretics may decrease excretion of Lithium. Management: Reduce the lithium dose if coadministered with thiazide or thiazide-like diuretics. Monitor serum lithium levels during coadministration with thiazide and thiazide-like diuretics. Risk D: Consider Therapy Modification

Loop Diuretics: May increase hypotensive effects of Angiotensin-Converting Enzyme Inhibitors. Loop Diuretics may increase nephrotoxic effects of Angiotensin-Converting Enzyme Inhibitors. Risk C: Monitor

Loop Diuretics: May increase hypotensive effects of Antihypertensive Agents. Risk C: Monitor

Lormetazepam: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Mecamylamine: Thiazide and Thiazide-Like Diuretics may increase adverse/toxic effects of Mecamylamine. Management: Consider avoiding the use of mecamylamine and thiazide diuretics. If combined, mecamylamine prescribing information suggests reducing the mecamylamine dose by 50% in order to avoid excessive hypotension. Risk D: Consider Therapy Modification

Metergoline: May decrease antihypertensive effects of Blood Pressure Lowering Agents. Blood Pressure Lowering Agents may increase orthostatic hypotensive effects of Metergoline. Risk C: Monitor

Methenamine: Thiazide and Thiazide-Like Diuretics may decrease therapeutic effects of Methenamine. Risk C: Monitor

Methotrexate: HydroCHLOROthiazide may increase nephrotoxic effects of Methotrexate. Risk C: Monitor

Methoxsalen (Systemic): Photosensitizing Agents may increase photosensitizing effects of Methoxsalen (Systemic). Risk C: Monitor

Methylphenidate: May decrease antihypertensive effects of Antihypertensive Agents. Risk C: Monitor

Molsidomine: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Multivitamins/Fluoride (with ADE): May increase hypercalcemic effects of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor

Multivitamins/Minerals (with ADEK, Folate, Iron): Thiazide and Thiazide-Like Diuretics may increase hypercalcemic effects of Multivitamins/Minerals (with ADEK, Folate, Iron). Risk C: Monitor

Multivitamins/Minerals (with AE, No Iron): Thiazide and Thiazide-Like Diuretics may increase serum concentration of Multivitamins/Minerals (with AE, No Iron). Specifically, thiazide diuretics may decrease the excretion of calcium, and continued concomitant use can also result in metabolic alkalosis. Risk C: Monitor

Naftopidil: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Neuromuscular-Blocking Agents (Nondepolarizing): Thiazide and Thiazide-Like Diuretics may increase neuromuscular-blocking effects of Neuromuscular-Blocking Agents (Nondepolarizing). Risk C: Monitor

Nicergoline: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Nicorandil: May increase hyperkalemic effects of Angiotensin-Converting Enzyme Inhibitors. Risk C: Monitor

Nicorandil: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Nitroprusside: Blood Pressure Lowering Agents may increase hypotensive effects of Nitroprusside. Risk C: Monitor

Nonsteroidal Anti-Inflammatory Agents (Topical): May decrease therapeutic effects of Angiotensin-Converting Enzyme Inhibitors. Risk C: Monitor

Nonsteroidal Anti-Inflammatory Agents (Topical): May decrease therapeutic effects of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor

Nonsteroidal Anti-Inflammatory Agents: May decrease antihypertensive effects of Angiotensin-Converting Enzyme Inhibitors. Angiotensin-Converting Enzyme Inhibitors may increase adverse/toxic effects of Nonsteroidal Anti-Inflammatory Agents. Specifically, the combination may result in a significant decrease in renal function. Risk C: Monitor

Nonsteroidal Anti-Inflammatory Agents: May decrease therapeutic effects of Thiazide and Thiazide-Like Diuretics. Thiazide and Thiazide-Like Diuretics may increase nephrotoxic effects of Nonsteroidal Anti-Inflammatory Agents. Risk C: Monitor

Obinutuzumab: May increase hypotensive effects of Blood Pressure Lowering Agents. Management: Consider temporarily withholding blood pressure lowering medications beginning 12 hours prior to obinutuzumab infusion and continuing until 1 hour after the end of the infusion. Risk D: Consider Therapy Modification

Opioid Agonists: May increase adverse/toxic effects of Diuretics. Opioid Agonists may decrease therapeutic effects of Diuretics. Risk C: Monitor

Palopegteriparatide: Thiazide and Thiazide-Like Diuretics may increase therapeutic effects of Palopegteriparatide. Thiazide and Thiazide-Like Diuretics may decrease therapeutic effects of Palopegteriparatide. Risk C: Monitor

Pentoxifylline: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Perazine: May increase hypotensive effects of Antihypertensive Agents. Risk C: Monitor

Pholcodine: Blood Pressure Lowering Agents may increase hypotensive effects of Pholcodine. Risk C: Monitor

Phosphodiesterase 5 Inhibitors: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Piperacillin: May increase hypokalemic effects of Diuretics. Risk C: Monitor

Polyethylene Glycol-Electrolyte Solution: Angiotensin-Converting Enzyme Inhibitors may increase nephrotoxic effects of Polyethylene Glycol-Electrolyte Solution. Risk C: Monitor

Polyethylene Glycol-Electrolyte Solution: Diuretics may increase nephrotoxic effects of Polyethylene Glycol-Electrolyte Solution. Risk C: Monitor

Porfimer: Photosensitizing Agents may increase photosensitizing effects of Porfimer. Risk X: Avoid

Potassium Salts: May increase hyperkalemic effects of Angiotensin-Converting Enzyme Inhibitors. Risk C: Monitor

Potassium-Sparing Diuretics: May increase hyperkalemic effects of Angiotensin-Converting Enzyme Inhibitors. Risk C: Monitor

Prazosin: Antihypertensive Agents may increase hypotensive effects of Prazosin. Risk C: Monitor

Pregabalin: Angiotensin-Converting Enzyme Inhibitors may increase adverse/toxic effects of Pregabalin. Specifically, the risk of angioedema may be increased. Risk C: Monitor

Promazine: Thiazide and Thiazide-Like Diuretics may increase QTc-prolonging effects of Promazine. Risk X: Avoid

Prostacyclin Analogues: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Quinagolide: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Racecadotril: May increase adverse/toxic effects of Angiotensin-Converting Enzyme Inhibitors. Specifically, the risk for angioedema may be increased with this combination. Risk C: Monitor

Ranolazine: May increase adverse/toxic effects of Angiotensin-Converting Enzyme Inhibitors. Risk C: Monitor

Reboxetine: May increase hypokalemic effects of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor

Sacubitril: Angiotensin-Converting Enzyme Inhibitors may increase adverse/toxic effects of Sacubitril. Specifically, the risk of angioedema may be increased with this combination. Risk X: Avoid

Salicylates: May decrease therapeutic effects of Angiotensin-Converting Enzyme Inhibitors. Salicylates may increase nephrotoxic effects of Angiotensin-Converting Enzyme Inhibitors. Risk C: Monitor

Selective Serotonin Reuptake Inhibitor: May increase hyponatremic effects of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor

Silodosin: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Sirolimus Products: May increase adverse/toxic effects of Angiotensin-Converting Enzyme Inhibitors. Specifically, the risk for angioedema may be increased. Risk C: Monitor

Sodium Phosphates: Angiotensin-Converting Enzyme Inhibitors may increase nephrotoxic effects of Sodium Phosphates. Specifically, the risk of acute phosphate nephropathy may be enhanced. Risk C: Monitor

Sodium Phosphates: Diuretics may increase nephrotoxic effects of Sodium Phosphates. Specifically, the risk of acute phosphate nephropathy may be enhanced. Risk C: Monitor

Sotagliflozin: HydroCHLOROthiazide may decrease therapeutic effects of Sotagliflozin. Sotagliflozin may decrease serum concentration of HydroCHLOROthiazide. Risk C: Monitor

Sparsentan: May increase adverse/toxic effects of Angiotensin-Converting Enzyme Inhibitors. Risk X: Avoid

Tacrolimus (Systemic): Angiotensin-Converting Enzyme Inhibitors may increase hyperkalemic effects of Tacrolimus (Systemic). Risk C: Monitor

Temsirolimus: May increase adverse/toxic effects of Angiotensin-Converting Enzyme Inhibitors. Specifically, the risk of angioedema may be increased. Risk C: Monitor

Terazosin: Antihypertensive Agents may increase hypotensive effects of Terazosin. Risk C: Monitor

Tolvaptan: May increase hyperkalemic effects of Angiotensin-Converting Enzyme Inhibitors. Risk C: Monitor

Topiramate: Thiazide and Thiazide-Like Diuretics may increase hypokalemic effects of Topiramate. Thiazide and Thiazide-Like Diuretics may increase serum concentration of Topiramate. Risk C: Monitor

Toremifene: Thiazide and Thiazide-Like Diuretics may increase hypercalcemic effects of Toremifene. Risk C: Monitor

Trimethoprim: May increase hyperkalemic effects of Angiotensin-Converting Enzyme Inhibitors. Management: Consider avoiding coadministration if possible. If combined, monitor serum potassium closely, particularly for patients with other risk factors (eg, renal impairment, older age, and other medications that increase potassium. Risk X: Avoid

Urapidil: And Angiotensin-Converting Enzyme Inhibitors may interact via an unclear mechanism. Management: Avoid concomitant use of urapidil and angiotensin-converting enzyme (ACE) inhibitors. Risk D: Consider Therapy Modification

Urokinase: May increase adverse/toxic effects of Angiotensin-Converting Enzyme Inhibitors. Specifically, the risk of angioedema may be increased. Risk C: Monitor

Verteporfin: Photosensitizing Agents may increase photosensitizing effects of Verteporfin. Risk C: Monitor

Vitamin D Analogs: Thiazide and Thiazide-Like Diuretics may increase hypercalcemic effects of Vitamin D Analogs. Risk C: Monitor

Food Interactions

See individual agents.

Pregnancy Considerations

[Canadian Boxed Warning]: When used in pregnancy, angiotensin converting-enzyme (ACE) inhibitors can cause injury or even death of the developing fetus. When pregnancy is detected ramipril/hydrochlorothiazide should be discontinued as soon as possible.

Refer to individual monographs for additional information.

Breastfeeding Considerations

Ramipril and thiazide diuretics are found in breast milk. Use in breastfeeding women is contraindicated. See individual agents.

Monitoring Parameters

Blood pressure; BUN, serum creatinine; electrolytes (more frequent serum potassium in patients with renal impairment), glucose, and uric acid regularly; CBC with differential periodically (more frequently if patient has collagen vascular disease and/or renal impairment or is taking medications known to affect blood counts); new or changing skin lesions.

Pharmacokinetics (Adult Data Unless Noted)

See individual agents.

Brand Names: International
International Brand Names by Country
For country code abbreviations (show table)

  • (AE) United Arab Emirates: Co Tritace;
  • (AR) Argentina: Tritace 5 hct;
  • (AT) Austria: Hypren plus | Lannapril plus | Ramicomp | Ramipril hct sandoz | Ramipril hydrochlorothiazide ratiopharm | Ramipril hydrochlorthiazide 1a pharma gmbh | Ramipril hydrochlorthiazide hexal pharma | Ramipril hydrochlorthiazide interpharm | Ramipril/Hct Alternova | Ramipril/hctz krka | Tritazide;
  • (BD) Bangladesh: Piramil Plus | Ramicard plus;
  • (BE) Belgium: Ramipril/hctz krka | Tritazide;
  • (BF) Burkina Faso: Tritazide | Zidram;
  • (BG) Bulgaria: Ampril hd | Ampril hl | Cardifriend co | Hartil Htc | Ramimed HCT | Tritace plus;
  • (BR) Brazil: Ecator H | Naprix d | Ramipril+hidroclorotiazida | Triatec d;
  • (CH) Switzerland: Co Ramipril Sandoz | Ramipril HCT | Ramipril HCT Actavis | Ramipril hct mepha | Ramipril HCT Zentiva | Ramipril HCT-Zentiva | Triatec comp;
  • (CI) Côte d'Ivoire: Co rampil | Corapril | Ramipril hctz SP | Ramithiazide | Ramizid hct | Rasgil htz | Tritazide | Zidram;
  • (CZ) Czech Republic: Amprilan H | Hartil H | Medoram Plus H | Miril Plus H | Ramil h | Ramipril H | Tritazide;
  • (DE) Germany: Delix plus | Hypren plus | Rami hct | Rami-q comp. | Ramicard plus | Ramiclair plus | Ramigamma hct | Ramilich comp | Ramiplus al | Ramiplus stada | Ramipril Actavis comp | Ramipril beta comp | Ramipril comp | Ramipril comp basics | Ramipril comp heumann | Ramipril comp Q pharm | Ramipril dura plus | Ramipril hc | Ramipril HCT Aaa | Ramipril hct accedo | Ramipril HCT Almus | Ramipril HCT Aristo | Ramipril hct gamma | Ramipril hct sandoz | Ramipril HEXAL comp | Ramipril Plus | Ramipril Teva Comp | Ramipril-ratiopharm comp. | Ramiwald hct | Triatec plus;
  • (DK) Denmark: Ramipril/hydrochlorthiazid ratiopharm | Triatec comp.;
  • (DO) Dominican Republic: Certara Diu | Lotensor HCT | Miocardin D | Ramipres H | Tritace hct;
  • (EE) Estonia: Ampril hd | Ampril hl | Cardace comp | Cardace Forte | Cardace plus | Co-ramicor;
  • (EG) Egypt: Avivapril | Ramipril comp | Ramipril comp ls | Recardopril-d | Right ace comp | Tritace Comp | Tritace max;
  • (ES) Spain: Ramipril + hydrochlorotiazida ranbaxy | Ramipril/hidroclorotiazida krka | Ramipril/Hidroclorotiazida Tecnigen;
  • (FI) Finland: Cardace comp | Ramipril hydrochlorothiazide ratiopharm | Ramipril/hydroklortiazid actavis;
  • (FR) France: Ramipril/hydrochlorothiazide Actavis | Ramipril/hydrochlorothiazide Biogaran | Ramipril/hydrochlorothiazide eg | Ramipril/hydrochlorothiazide mylan pharma | Ramipril/hydrochlorothiazide sandoz | Ramipril/hydrochlorothiazide teva | Ramipril/hydrochlorothiazide zentiva;
  • (GR) Greece: Piramil Plus | Ramipril+hct/actavis | Ramisyn plus | Stibenyl HCT | Triatec plus;
  • (HR) Croatia: Ampril hd | Ampril hl | Blocar Plus | Piramil H | Piramil HL | Prilen Plus | Ramicomp | Ramipril H | Ramipril Plus Pliva | Ramzid | Revil Plus | Tritazide;
  • (HU) Hungary: Amprilan hd | Amprilan hl | Hartil hct | Ramace plusz | Ramipril HCT-Zentiva | Ramipril-HCT Hexal | Tritace hct;
  • (ID) Indonesia: Triatec plus;
  • (IL) Israel: Ramipril Plus | Tritace Comp;
  • (IN) India: Alram | Cardace-h | Cardiopril H | Ecator H | Kapril H | Macpril H | Preface-h | Race H | Rachet | Ramace h | Ramcor-h | Ramfirst h | Ramicon h | Ramicure h | Ramidil-h | Ramifast h | Ramihart-H | Ramilat h | Ramilong h | Ramipil h | Ramipres H | Ramipro-h | Ramirica H | Ramisave-h | Ramistar-h | Ramiten-d | Rampril-h | Rexace h | Rl-ht | Saface-h | Servace-h | Topril-h | Variace H | Zipril H | Zorem-ht;
  • (IT) Italy: Avedar | Herzaplus | Idroquark | Ivrex | Kruplus | Norazide | Ramipril + Idroclorotiazide Krka | Ramipril e idroclorotiazide epifarma | Ramipril e idroclorotiazide ipso pharma | Ramipril e idroclorotiazide ranbaxy | Ramipril Idr.Pen | Ramipril+hct fg | Ramipril+hct pmg | Triatec hct | Uniprildiur;
  • (KE) Kenya: Tritazide;
  • (KR) Korea, Republic of: Tritace plus;
  • (KW) Kuwait: Co Tritace;
  • (LB) Lebanon: Triltec Plus | Tritace Comp;
  • (LT) Lithuania: Ampril hd | Ampril hl | Hartil hct | Ramimed HCT | Ramipril HCT Actavis;
  • (LU) Luxembourg: Tritazide;
  • (LV) Latvia: Ampril hd | Ampril hl | Cardace comp | Co-ramicor | Hartil hct | Ramimed HCT;
  • (MX) Mexico: Dynyel | Tritazide;
  • (NG) Nigeria: Tritazide;
  • (NL) Netherlands: Ramipril/hydrochloorthiazide | Ramipril/Hydrochloorthiazide Actavis | Ramipril/Hydrochloorthiazide PCH | Ramipril/hydrochloorthiazide sandoz | Tritazide;
  • (PK) Pakistan: Ramipace d | Triatec;
  • (PL) Poland: Mitripiazyd | Ramizek hct | Tritace comb;
  • (PT) Portugal: Ramicor D | Ramipril + hidroclorotiazida | Ramipril + hidroclorotiazida Labesfal | Ramipril + Hidroclorotiazida Teva | Triatec composto;
  • (PY) Paraguay: Tritace 5 hct;
  • (QA) Qatar: Co-Tritace;
  • (RO) Romania: Ampril hd | Emren hct | Hartil hct | Ramipril hct medochemie | Tensil hct;
  • (RU) Russian Federation: Amprilan nd | Amprilan nl | Hartil d | Ramazid h | Tritace plus;
  • (SE) Sweden: Ramipril/hydroklortiazid actavis | Ramipril/Hydroklortiazid ebb | Ramipril/hydroklortiazid hexal | Ramipril/Hydroklortiazid Orifarm;
  • (SI) Slovenia: Ampril hd | Ampril hl | Marilamed | Tritazide;
  • (SK) Slovakia: Ampril hl | Ramimed HCT | Ramipril H | Tritazide;
  • (TH) Thailand: Tritazide;
  • (TN) Tunisia: Corapril | Tritazide;
  • (TR) Turkey: Delix plus | Race Plus | Revil Plus;
  • (UA) Ukraine: Ampril hd | Ampril hl | Euroramipril h | Hartil H | Laceran hct | Mipril h | Ramag h | Ramazid h | Rami sandoz comp | Ramimed combi | Ramiten h | Ramizes com;
  • (VE) Venezuela, Bolivarian Republic of: Ramipres hct;
  • (ZA) South Africa: Co ramiwin | Tritace plus;
  • (ZW) Zimbabwe: Ramipril/hydrochlorothiazide
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