Ramipril is in a group of drugs called ACE inhibitors. ACE stands for angiotensin converting enzyme.

Ramipril is used to treat high blood pressure (hypertension), heart failure, and to improve survival after a heart attack.

Ramipril may also be used for purposes other than those listed in this medication guide.

How should I take Altace (Ramipril)?

Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Follow the directions on your prescription label.

Your doctor may occasionally change your dose to make sure you get the best results from this medication.

Take each dose with a full glass of water.

Ramipril can be taken with or without food.

Vomiting, diarrhea, or heavy sweating can cause you to become dehydrated. This can lead to very low blood pressure, electrolyte disorders, or kidney failure while you are taking ramipril. Drink 6 to 8 full glasses of water daily while you are taking this medication.

To be sure this medication is helping your condition, your blood pressure will need to be checked on a regular basis. Your kidney or liver function may also need to be tested. Do not miss any scheduled visits to your doctor.

If you need to have any type of surgery, tell the surgeon ahead of time that you are taking ramipril. You may need to stop using the medicine for a short time.

If you are being treated for high blood pressure, keep using this medication even if you feel fine. High blood pressure often has no symptoms.

Store ramipril at room temperature away from moisture and heat.

What are the possible side effects of Altace (Ramipril)?

Get emergency medical help if you have any of these signs of an allergic reaction: hives; severe stomach pain; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have any of these serious side effects:

• feeling light-headed, fainting
• urinating more or less than usual, or not at all
• fever, chills, body aches, flu symptoms
• pale skin, easy bruising or bleeding
• tired feeling, muscle weakness, and pounding or uneven heartbeats
• chest pain; or
• swelling, rapid weight gain

Less serious side effects may be more likely to occur, such as:

• cough
• dizziness, drowsiness, headache
• sleep problems (insomnia)
• decreased sex drive, impotence, or difficulty having an orgasm
• nausea, vomiting; or
• mild skin itching or rash

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

What other drugs affect Altace (Ramipril)?

Before taking ramipril, tell your doctor if you are taking any of the following drugs:

• lithium (Lithobid, Eskalith)
• a potassium supplement such as K-Dur, Klor-Con
• salt substitutes that contain potassium
• aspirin or other NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen (Motrin, Advil), diclofenac (Voltaren), diflunisal (Dolobid), etodolac (Lodine), flurbiprofen (Ansaid), indomethacin (Indocin), ketoprofen (Orudis), ketorolac (Toradol), mefenamic acid (Ponstel), meloxicam (Mobic), nabumetone (Relafen), naproxen (Aleve, Naprosyn), piroxicam (Feldene); or
• a diuretic (water pill) such as amiloride (Midamor), bumetanide (Bumex), chlorthalidone (Hygroton, Thalitone), ethacrynic acid (Edecrin), furosemide (Lasix), hydrochlorothiazide (HCTZ, HydroDiuril), indapamide (Lozol), metolazone (Mykrox, Zarxolyn), spironolactone (Aldactone), triamterene (Dyrenium, Maxzide, Dyazide), torsemide (Demadex)

If you are using any of these drugs, you may not be able to use ramipril or you may need dosage adjustments or special tests during treatment.

There may be other drugs not listed that can affect ramipril. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

What should I avoid while taking Altace (Ramipril)?

Ramipril can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.

Avoid drinking alcohol. It can further lower your blood pressure and may increase some of the side effects of ramipril.

Do not use salt substitutes or potassium supplements while taking ramipril, unless your doctor has told you to.

What happens if I overdose on Altace (Ramipril)?

Seek emergency medical attention if you think you have used too much of this medicine.

Symptoms of a ramipril overdose may include feeling extremely dizzy or light-headed, or fainting.

What happens if I miss a dose of Altace (Ramipril)?

Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at the next regularly scheduled time. Do not take extra medicine to make up the missed dose.

What is the most important information I should know about Altace (Ramipril)?

Do not use this medication without telling your doctor if you are pregnant or planning a pregnancy. Ramipril could cause birth defects in the baby if you take the medication during pregnancy. Use an effective form of birth control. Stop using this medication and tell your doctor right away if you become pregnant during treatment.

Ramipril can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.

Vomiting, diarrhea, or heavy sweating can cause you to become dehydrated. This can lead to very low blood pressure, electrolyte disorders, or kidney failure while you are taking ramipril. Drink 6 to 8 full glasses of water daily while you are taking this medication.

What should I discuss with my healthcare provider before taking Altace (Ramipril)?

Do not use this medication if you are allergic to ramipril or to any other ACE inhibitor, such as benazopril (Lotensin), captopril (Capoten), fosinopril (Monopril), enalapril (Vasotec), lisinopril (Prinivil, Zestril), moexipril (Univasc), perindopril (Aceon), quinapril (Accupril), or trandolapril (Mavik).

Before using ramipril, tell your doctor if you are allergic to any drugs, or if you have:

• kidney disease (or if you are on dialysis)
• liver disease
• heart disease or congestive heart failure
• diabetes; or
• a connective tissue disease such as Marfan syndrome, Sjogren’s syndrome, lupus, scleroderma, or rheumatoid arthritis

If you have any of these conditions, you may not be able to use ramipril, or you may need a dosage adjustment or special tests during treatment.

FDA pregnancy category D. Do not use this medication without telling your doctor if you are pregnant or planning a pregnancy. Ramipril could cause birth defects in the baby if you take the medication during pregnancy. Use an effective form of birth control. Stop using this medication and tell your doctor right away if you become pregnant during treatment.

Ramipril can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

 Altace

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Capoten is used in the treatment of high blood pressure and congestive heart failure. When prescribed for high blood pressure, it is effective used alone or combined with diuretics. If it is prescribed for congestive heart failure, it is used in combination with digitalis and diuretics. Capoten is in a family of drugs known as “ACE (angiotensin converting enzyme) inhibitors.” It works by preventing a chemical in your blood called angiotensin I from converting into a more potent form that increases salt and water retention in your body. Capoten also enhances blood flow throughout your blood vessels.

How should you take Capoten?

Capoten should be taken 1 hour before meals. If you are taking an antacid such as Mylanta, take it 2 hours prior to Capoten.

Take this medication exactly as prescribed. Stopping Capoten suddenly could cause your blood pressure to increase.

–If you miss a dose…

Take it as soon as you remember. If it is almost time for your next dose, skip the one you missed and go back to your regular schedule. Never take two doses at the same time.

–Storage instructions…

Store Capoten at room temperature, away from moisture, in a tightly closed container.

What side effects may occur?

Side effects cannot be anticipated. If any develop or change in intensity, inform your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue taking Capoten.

• More common side effects may include:
  Itching, loss of taste, low blood pressure, rash

Why should Capoten not be prescribed?

• If you are sensitive to or have ever had an allergic reaction to Capoten or similar drugs such as Vasotec, you should not take this medication. Make sure that your doctor is aware of any drug reactions that you have experienced.

Special warnings about Capoten

If you develop swelling of the face around your lips, tongue or throat (or of your arms and legs) or have difficulty swallowing, you should stop taking Capoten and contact your doctor immediately. You may need emergency treatment.

If you are receiving bee or wasp venom to prevent an allergic reaction to stings, use of Capoten at the same time may cause a severe allergic reaction.

If you are taking Capoten, a complete assessment of your kidney function should be done; and your kidney function should continue to be monitored. If you have kidney disease, Capoten should be used only if you have taken other blood pressure medications and your doctor has determined that the results were unsatisfactory.

Some people taking Capoten have had a severe allergic reaction during kidney dialysis.

If you are taking Capoten for your heart, be careful not to increase physical activity too quickly. Check with your doctor as to how much exercise is safe for you.

If you are taking Capoten for congestive heart failure, your blood pressure may drop temporarily after the first few doses and you may feel light-headed for a time. Your doctor should monitor you closely when you start taking the medication or when your dosage is increased.

If you are taking high doses of diuretics and Capoten, you may develop excessively low blood pressure. Your doctor may reduce your diuretic dose so that your blood pressure doesn’t drop too far.

Possible food and drug interactions when taking Capoten

If Capoten is taken with certain other drugs, the effects of either could be increased, decreased, or altered. It is especially important to check with your doctor before combining Capoten with the following:

Allopurinol (Zyloprim)
Aspirin
Blood pressure drugs known as beta blockers, such as Inderal and Tenormin
Cyclosporine (Sandimmune)
Digoxin (Lanoxin)
Diuretics such as HydroDIURIL
Lithium (Lithonate)
Nitroglycerin and similar heart medicines (Nitro-Dur, Transderm-Nitro, others)
Nonsteroidal anti-inflammatory drugs such as Indocin and Feldene
Potassium preparations such as Micro-K and Slow-K
Potassium-sparing diuretics such as Aldactone and Midamor

Do not use potassium-containing salt substitutes while taking Capoten.

Special information if you are pregnant or breastfeeding

ACE inhibitors such as Capoten have been shown to cause injury and even death to the developing baby when used in pregnancy during the second and third trimesters. If you are pregnant or plan to become pregnant, contact your doctor immediately. Capoten appears in breast milk and could affect a nursing infant. If this medication is essential to your health, your doctor may advise you to discontinue breastfeeding until your treatment is finished.

Recommended dosage

ADULTS

High Blood Pressure

The usual starting dose is 25 milligrams taken 2 or 3 times a day. If you have any problems with your kidneys or suffer from other major health problems, your starting dose may be lower. Depending on how your blood pressure responds, your doctor may increase your dose later, up to a total of 150 milligrams 2 or 3 times a day. The maximum recommended daily dose is 450 milligrams.

Heart Failure

For most people, the usual dose is 25 milligrams taken 3 times a day. A daily dosage of 450 milligrams should not be exceeded.

After a Heart Attack

The usual starting dose is 6.25 milligrams, taken once, followed by 12.5 milligrams 3 times a day. Your doctor will increase the dose over the next several days to 25 milligrams taken 3 times a day and then, over the next several weeks, to 50 milligrams 3 times a day.

Kidney Disease in Diabetes

The usual dose is 25 milligrams taken 3 times a day.

CHILDREN

The safety and effectiveness of Capoten in children have not been established.

Overdosage

Any medication taken in excess can cause symptoms of overdose. If you suspect an overdose of Capoten, seek medical attention immediately.

Light-headedness or dizziness due to a sudden drop in blood pressure is the primary effect of a Capoten overdose.

Capoten

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Ezetimibe and simvastatin are cholesterol-lowering medicines. They reduce the amount of cholesterol (a type of fat) absorbed by the body and block the production of cholesterol in the body.

The combination of ezetimibe and simvastatin lowers “bad” cholesterol in the blood, (also called LDL, or low-density lipoprotein) and raises “good” cholesterol (also called HDL, or high-density lipoprotein). Lowering your LDL and raising your HDL cholesterol levels may reduce your risk of hardened arteries, which can lead to heart attacks, stroke, and circulation problems.

Ezetimibe and simvastatin may also be used for other purposes not listed in this medication guide.

Ezetimibe and simvastatin is only part of a complete program of treatment that also includes diet, exercise, and weight control. Follow your diet, medication, and exercise routines very closely.

It may take up to 2 weeks of using this medicine before your cholesterol levels improve. For best results, keep using the medication as directed. Your cholesterol will need to be measured using blood tests at regular intervals. Do not miss any scheduled visits to your doctor. This medication can cause birth defects in an unborn baby. Do not use if you are pregnant. Use an effective form of birth control, and tell your doctor if you become pregnant during treatment. In rare cases, ezetimibe and simvastatin can cause a condition that results in the breakdown of skeletal muscle tissue. This condition can lead to kidney failure. Call your doctor at once if you have unexplained muscle pain or tenderness, muscle weakness, fever or flu symptoms, and dark colored urine.

How should I take ezetimibe and simvastatin?

Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Follow the directions on your prescription label.

Take ezetimibe and simvastatin once a day with or without food. Try to take it at the same time every day.

It may take up to 2 weeks of using this medicine before your cholesterol levels improve. For best results, keep using the medication as directed. Your cholesterol will need to be measured using blood tests at regular intervals. Do not miss any scheduled visits to your doctor. Store ezetimibe and simvastatin at room temperature away from moisture and heat.

What happens if I miss a dose?

Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at the next regularly scheduled time. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine.

An overdose of ezetimibe and simvastatin is not expected to produce life-threatening symptoms.

What should I avoid while taking ezetimibe and simvastatin?

Avoid eating foods that are high in fat or cholesterol. Ezetimibe and simvastatin will not be as effective in lowering your cholesterol if you do not follow a cholesterol-lowering diet plan.

If you take another cholesterol-lowering medication such as cholestyramine (Locholest, Prevalite, Questran), colestipol (Colestid), or colesevelam (Welchol), take your ezetimibe and simvastatin dose at least 2 hours before or 4 hours after the other medication(s).

Grapefruit and grapefruit juice may interact with ezetimibe and simvastatin and lead to potentially dangerous effects. Discuss the use of grapefruit products with your doctor. Do not increase or decrease the amount of grapefruit products in your diet without first talking to your doctor.

Avoid drinking alcohol while taking ezetimibe and simvastatin. Alcohol may increase your risk of liver damage. Avoid exposure to sunlight or artificial UV rays (sunlamps or tanning beds). Ezetimibe and simvastatin can make your skin more sensitive to sunlight and sunburn may result. Use a sunscreen (minimum SPF 15) and wear protective clothing if you must be out in the sun.

Ezetimibe and simvastatin side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop using ezetimibe and simvastatin and call your doctor at once if you have any of these serious side effects:

• muscle pain, tenderness, or weakness with fever or flu symptoms and dark colored urine;
• decreased urine or rust-colored urine; or
• blurred vision.

Less serious side effects may include:

• stomach pain, nausea, diarrhea;
• cough, sore throat, runny or stuffy nose;
• tiredness;
• headache;
• skin rash or itching;
• joint pain, back pain;
• insomnia.

This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect.

What other drugs will affect ezetimibe and simvastatin?

Many drugs can interact with ezetimibe and simvastatin. Below is just a partial list. Tell your doctor if you are using:

• amiodarone (Cordarone, Pacerone);
• cholestyramine (Questran), colestipol (Colestid), or colesevelam (Welchol);
• cyclosporine (Sandimmune, Neoral);
• danazol (Danocrine);
• digoxin (Lanoxin, Lanoxicaps);
• gemfibrozil (Lopid), fenofibrate (Tricor) or clofibrate (Atromid-S);
• nefazodone (Serzone);
• niacin (Nicolar, Nicobid, Slo-Niacin, others);
• verapamil (Calan, Covera-HS, Isoptin, Verelan).
• warfarin (Coumadin);
• an antibiotic such as clarithromycin (Biaxin), erythromycin (E-Mycin, E.E.S., Ery-Tab, others), itraconazole (Sporanox), ketoconazole (Nizoral), or telithromycin (Ketek); or
• HIV medicines such as amprenavir (Agenerase), atazanavir (Reyataz), efavirenz (Sustiva), fosamprenavir (Lexiva), indinavir (Crixivan), lopinavir/ritonavir (Kaletra), nelfinavir (Viracept), ritonavir (Norvir), saquinavir (Invirase), or tipranavir (Aptivus).

This list is not complete and there may be other drugs not listed that can affect ezetimibe and simvastatin. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

 Vytorin

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