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Hydrochlorothiazide / Ramipril

    Hydrochlorothiazide / Ramipril

    DAE Class; Rx

    Common Brand Names; CO-TRITACE


    Ramipril belongs to the class of medications called ACE inhibitors. It works by relaxing blood vessels and by making the heart pump more efficiently. Hydrochlorothiazide belongs to the class of medications known as diuretics or “water pills” and helps control blood pressure by getting rid of excess salt and water.

    Ramipril – hydrochlorothiazide is used to treat high blood pressure. This combination medication is prescribed when your doctor feels it is appropriate for you to be taking both medications and you have taken ramipril and hydrochlorothiazide as separate medications without any problems.

    Do not take ramipril – hydrochlorothiazide if you:

    • are allergic to ramipril, hydrochlorothiazide, or any ingredients of the medication
    • are allergic to any other ACE inhibitor (e.g., enalapril, lisinopril, captopril)
    • are allergic to sulfonamide medications (e.g., sulfamethoxazole)
    • are pregnant or breast-feeding
    • are not passing urine
    • are taking the medication sacubitril – valsartan
    • are taking the medication aliskiren or angiotensin II receptor antagonists and have
      • diabetes
      • kidney disease
      • high levels of potassium in the blood
      • congestive heart failure with low blood pressure
    • have had angioedema (a serious allergic reaction which causes the area around the throat and tongue to swell)
    • have low blood pressure
    • have narrowing of arteries to one or both kidneys
    • are receiving dialysis
    • have severely reduced liver function
    • have severely reduced kidney function
    • have uncorrected potassium, sodium, or calcium levels in the blood
    • have diabetes and/or kidney disease and are taking the medication aliskiren or an angiotensin receptor blocker (ARB)

    Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

    • changes to sensory perception (e.g., vision, hearing, taste, smell)
    • constipation
    • cough (dry, persistent)
    • drowsiness
    • fatigue
    • flushing
    • headache
    • hair loss
    • muscle pain
    • muscle stiffness
    • nasal congestion
    • sensitivity to sunlight
    • sexual difficulties (for men)
    • trouble sleeping
    • unusual tiredness or weakness

    Check with your doctor as soon as possible if any of the following side effects occur:

    • abdominal pain
    • attention difficulties
    • breast enlargement (men)
    • dizziness, lightheadedness, or fainting when rising from a lying or sitting position
    • fast heartbeat, irregular heartbeat, or palpitations
    • signs of anemia (low red blood cells; e.g., dizziness, pale skin, unusual tiredness or weakness, shortness of breath)
    • signs of bleeding (e.g., unusual nosebleeds, bruising, blood in urine, coughing blood, bleeding gums, cuts that don’t stop bleeding)
    • signs of changed potassium levels (e.g., irregular heartbeat, muscle weakness, general feeling unwell)
    • signs of depression (e.g., poor concentration, changes in weight, changes in sleep, decreased interest in activities, thoughts of suicide)
    • signs of electrolyte imbalance (e.g., muscle pain or cramps, weakness, irregular heartbeat, thirst, confusion, lack of coordination)
    • signs of infection (symptoms may include fever or chills, severe diarrhea, shortness of breath, prolonged dizziness, headache, stiff neck, weight loss, or listlessness)
    • signs of kidney problems (e.g., decreased urination, nausea, vomiting, swelling of legs, hands, fatigue)
    • signs of liver damage (abdominal pain, fever, nausea, vomiting, loss of appetite, or yellowing of the skin or eyes)
    • signs of pancreatitis (e.g., abdominal pain on the upper left side, back pain, nausea, fever, chills, rapid heartbeat, swollen abdomen)
    • skin lesions that do not heal, new moles, or changes to existing moles
    • skin rash (with or without itching), fever, or joint pain
    • swelling of hands, ankles or feet
    • symptoms of high blood sugar (e.g., frequent urination, increased thirst, excessive eating, unexplained weight loss, poor wound healing, infections, fruity breath odour)
    • symptoms of increased pressure in the eyes (e.g., decreased or blurred vision, eye pain, red eye, swelling of the eye)
    • vision changes

    Stop taking the medication and seek immediate medical attention if any of the following occur:

    • abdominal pain (with or without nausea or vomiting)
    • asthma flare-ups
    • signs of an allergic reaction, including angioedema (shortness of breath or difficulty breathing; hives; swelling of the eyes, mouth, lips, or throat)
    • signs of a heart attack (e.g., chest pain or pressure, pain extending through shoulder and arm, nausea and vomiting, sweating)
    • signs of a severe skin reaction such as blistering, peeling, a rash covering a large area of the body, a rash that spreads quickly, or a rash combined with fever or discomfort
    • signs of stroke (e.g., sudden or severe headache; sudden loss of coordination; vision changes; sudden slurring of speech; or unexplained weakness, numbness, or pain in arm or leg)
    • symptoms of acute respiratory distress (ARDS; e.g., shortness of breath, chest tightness, cough, wheezing, fever weakness, confusion)

    Serious Warnings and Precautions
    When used in pregnancy, angiotensin converting enzyme (ACE) inhibitors can cause injury or even death of the developing fetus. When pregnancy is detected RAMIPRIL-HCTZ (ramipril/hydrochlorothiazide) should be discontinued as soon as possible.

    Hydrochlorothiazide / Ramipril


    • 5 mg ramipril/12.5 mg hydrochlorothiazide
    • 10 mg ramipril/12.5 mg hydrochlorothiazide
    • 10 mg ramipril/25 mg hydrochlorothiazide