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Altace (Ramipril)

Brand Name: Altace, Tritace

Generic Name : Ramipril

Manufacturer : Aventis

Medicine Categories : Antianginal : ACE Inhibitors

FDA Pregnant Category :

Category C : Either studies in animals have revealed adverse effects on the fetus (teratogenic or embryocidal or other) and there are no controlled studies in women, or studies in women and animals are not available. Drugs should be given only if the potential benefit justifies the potential risk to the fetus.Buy Altace ,Tritace ,Ramipril online

Category D in 2nd & 3rd trimesters

What is it used for?

- Heart failure, in combination with other medicines
- Individuals with heart failure after having had a heart attack
- Mild to moderate high blood pressure
- Reducing risk of heart attack, stroke, death and the need for surgery to reestablish a blood supply (revascularisation) in certain people at risk (listed above)

How does it work?

Ramipril belongs to a group of medicines called ACE inhibitors. These work by blocking the action of a chemical in the body called angiotensin converting enzyme (ACE). Normally ACE produces another chemical, angiotensin II. Thus ramipril reduces the amount of angiotensin II in the blood.Buy Altace ,Tritace ,Ramipril online

Angiotensin II has two actions. Firstly it acts on blood vessels to make them narrow and secondly it acts on the kidney to produce less urine.

As ramipril stops the production of angiotensin II, these actions are reversed. Therefore more urine is produced by the kidneys, which results in less fluid in the blood vessels. The blood vessels also widen.

The overall effect of this is a drop in blood pressure, and therefore a decrease in the effort required by the heart to pump blood around the body. This can help treat high blood pressure and also heart failure, where the pumping action of the heart has become less effective.

Buy Altace ,Tritace ,Ramipril onlineACE inhibitors have also been shown to improve survival following a heart attack, and to reduce the risk of further heart attacks. Ramipril has been shown to reduce the risk of heart attack, stroke and the need for proceedures to reestablish blood supply (revascularistion) in various groups of people who are at risk of these problems. These have been established as people over 55 with any of the following:-

- evidence of heart disease, for example, a previous heart attack, angina not well controlled by medical treatment, multiple heart bypass or reconstruction of a multiple blood vessels (angioplasty)

- previous stroke

- disease of the blood vessels in the extremities (peripheral vascular disease)

- diabetes and one or more of the following: high blood pressure, high total cholesterol levels, low HDL cholesterol levels, currently a smoker, evidence of previous blood vessel disease or protein in the urine.

How should Altace (Ramipril) be used?

Altace comes as a capsule to take by mouth. It is usually taken once or twice a day on an empty stomach, 1 hour before or 2 hours after a meal. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take Altace exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

Altace controls high blood pressure and heart failure but does not cure them. Continue to take Altace even if you feel well. Do not stop taking Altace without talking to your doctor.

Warning

- There is insufficient information regarding the safety and efficacy of this medicine in children. It is not recommended for children.

- Alcohol may enhance the blood pressure lowering effect of this medicine, which may result in dizziness or fainting.

- Your kidney function should be monitored prior to starting and regularly throughout treatment with this medicine.

Use with caution in

- Decreased fluid volume in the body due to, eg diuretic therapy, low salt diet, kidney dialysis, diarrhoea, vomiting

- Decreased kidney function
- Decreased liver function

-Diseases affecting connective tissue, eg scleroderma, systemic lupus erythematosus, rheumatoid arthritis (collagen vascular diseases)
- Elderly people
- People also taking diuretics

Not to be used in

- Any condition in which there is obstruction to the pumping of blood out of the heart (outflow tract obstruction)
- Breastfeeding
- History of swelling of the lips, face or tongue (angioedema)

- Kidney failure requiring a certain type of haemodialysis (high-flux membrane)
- Low blood pressure (hypotension)
- Narrowing of one of the valves in the heart (mitral valve stenosis)

- Narrowing of the artery which supplies blood to the kidneys (renal artery stenosis)
- Narrowing of the main artery of the body (aortic stenosis)
- People receiving therapy to remove certain types of fat from the blood using a machine (LDL apheresis)

- People with unstable blood circulation
- Pregnancy

This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy.

If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.

Pregnancy and Breastfeeding

Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby.Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.

- This medicine should not be used during pregnancy as it may be harmful to the unborn baby. Seek medical advice from your doctor.

- This medicine should not be used by breastfeeding mothers. Discuss this with your doctor.

Side effects

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.

- Headache
- Inability of a man to have an erection (impotence)
- Chest pain (angina)
- Confusion
- Skin rashes
- Disturbances of the gut such as diarrhoea, constipation, nausea, vomiting or abdominal pain
- Dry cough
- Abnormal heart beats (arrhythmias)
- Severe skin rash (erythema multiforme)
- Severe swelling of lips, face or tongue (angioedema)
- Dizziness
- Alteration in taste
- Heart attack (myocardial infarction)
- A drop in blood pressure that occurs when going from lying down to sitting or standing, which results in dizziness and lightheadedness (postural hypotension)
- Stroke (cerebrovascular accident)
- Disorders of the blood, kidney or liver
- Decreased kidney function

The side effects listed above may not include all of the side effects reported by the drug's manufacturer.

For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.

How can this medicine affect other medicines?

When taken together with other medicines that decrease blood pressure there is an increased risk of a large drop in blood pressure, particularly with the first dose.

People taking high doses of diuretics such as frusemide should, if possible, have their diuretic dose reduced or stopped before introducing ramipril, in order to reduce the risk of a profound drop in blood pressure.

This medicine reduces the ability of the body to remove lithium, which may give rise to increased lithium levels in the blood and adverse effects.

If taken together with potassium sparing diuretics, potassium supplements or potassium containing salt substitutes there is an increased risk of raised blood potassium level (hyperkalaemia). These should only be used with frequent monitoring of blood potassium levels.

When taken with insulin or oral antidiabetic medicines there may be an enhanced blood sugar lowering effect, resulting in very low blood sugar levels (hypoglycaemia). This is unpredictable and blood sugar should be monitored in people with diabetes starting treatment with ramipril.

The use of ramipril with diuretics, ciclosporin or non-steroidal anti-inflammatory drugs (NSAIDs) may increase the risk of kidney problems and alterations to the potassium balance in the body.

There may be an increased risk of a low white blood cell count (leukopenia) when ramipril is taken with allopurinol, anti-cancer medicines, medicines that suppress the immune system or corticosteroids. Regular blood monitoring is required, particularly if people taking these medicines also have decreased kidney function or collagen vascular diseases.

Recommended dosage

Dosage is based on the desired effect and on how the patient tolerates the drug. Therapy with Tritace is usually long-term; the physician determines the duration of treatment in each individual case.
Treatment of Hypertension: It is recommended that Tritace is taken once daily, starting with a dose of 2.5 mg, and that the dose be doubled at intervals of 2-3 weeks if necessary, and depending on the patient's response.
The usual maintenance dose is 2.5-5 mg Tritace daily, whereas the maximum permitted daily dose is 10 mg.

Where fluid or salt deficiency has not been completely corrected, in cases of severe hypertension, as well as in patients in whom a hypotensive reaction would constitute a particular risk (eg, with flow-reducing narrowing of the coronary heart vessels or those supplying the brain), a reduced initial dose of 1.25 mg Tritace must be considered.

In patients pre-treated with a drug that promotes fluid excretion (diuretic), consideration must be given to discontinuing the diuretic at least 2-3 days or (depending on the duration of action of the diuretic) longer before starting treatment with Tritace, or at least to reducing the diuretic dose. The physician will decide in each individual case whether such discontinuation or dose reduction is possible and how long it can last. The initial dose in patients previously treated with a diuretic is generally 1.25 mg Tritace.

Treatment of Congestive Heart Failure: The recommended initial dose is 1.25 mg Tritace once daily. Depending on the patient's response, the dose may be increased. It is recommended that the dose, if increased, be doubled at intervals of 1-2 weeks. If a daily dose of 2.5 mg Tritace is required, this may be taken as a single dose or as 2 divided doses.

The maximum permitted daily dose is 10 mg Tritace.
In patients pre-treated with a diuretic, consideration must be given to discontinuing the diuretic at least 2-3 days or (depending on the duration of action of the diuretic) longer before starting treatment with Tritace, or at least to reducing the diuretic dose.
Treatment After Myocardial Infarction: The recommended initial dose is 5 mg Tritace daily divided into 2 single doses of 2.5 mg each, 1 in the morning and 1 in the evening. If the patient does not tolerate this initial dosage, it is recommended that 1.25 mg be given twice daily for 2 days.

In either event, depending on the patient's response, the dose may then be increased. It is recommended that the dose, if increased, be doubled at intervals of 1-3 days.
At a later time, the total daily dose, initially divided, may be taken as a single daily dose.

The maximum permitted daily dose is 10 mg Tritace.
Sufficient experience is still lacking in the treatment of patients with severe (NYHA IV) heart failure immediately after myocardial infarction. Should the decision be made to nevertheless treat these patients, it is recommended that therapy be started with the lowest possible daily dose (1.25 mg Tritace once daily) and that the dosage be increased only with particular caution.

Where fluid or salt deficiency has not been completely corrected, in cases of severe hypertension, in patients in whom a hypotensive reaction would constitute a particular risk (eg, with flow-reducing narrowing of the coronary heart vessels or those supplying the brain), as well as in patients pre-treated with a drug that promotes fluid excretion (diuretic), a reduced initial dose of 1.25 mg Tritace daily must be considered.

Patients with Impaired Renal and Liver Function: Treatment of hypertension, congestive heart failure and myocardial infarction: In patients with impaired renal function, ie a creatinine clearance between 50 and 20 mL/min/1.73 m2 body surface area, the initial dose is generally reduce to 1.25 mg Tritace. The maximum permitted daily dose is 5 mg Tritace in such cases. When creatinine clearance cannot be measured, it can be calculated based on the serum creatinine level using the following formula (Cockcroft's equation):

Men:
Creatinine Clearance (mL / min) = {Body weight (kg) x (140 - age in years)} / {72 x serum creatinine (mg / dL)}
Women: Multiply the product of the above equation by 0.85

In patients with impaired liver function, the response to the treatment with Tritace may either be increased or reduced. Treatment in these patients must therefore be initiated only under close medical supervision. Maximum permitted daily dose in this case is 2.5 mg Tritace.

Administration: The tablets are to be swallowed whole with a sufficient amount of liquid (approximately glass of water). They may be taken before, during or after a meal.

Overdosage

Any medication taken in excess can have serious consequences. If you suspect an overdose, seek medical attention immediately.
Symptoms of Altace overdose include:
Symptoms of low blood pressure are likely to be the primary warning of an Altace overdose.

When you miss a dose

If you forget to take 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 2 doses at the same time.

Storage

Store below 25 C.

 

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