Altace HCT

Brand Names: Altace HCT

Common Name: ramipril - hydrochlorothiazide

What is this drug used for?

This combination product contains two active ingredients: ramipril and hydrochlorothiazide. 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. It may take 2 to 4 weeks to see the full effects of this medication.

Your doctor may have suggested this medication for conditions other than the ones listed in these drug information articles. As well, some forms of this medication may not be used for all of the conditions discussed here. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

Is there any reason not to take this drug?

Ramipril - hydrochlorothiazide should not be used by anyone who:

• is allergic to ramipril, hydrochlorothiazide or to any of the ingredients of the medication
• is allergic to any other ACE inhibitor (e.g., enalapril, lisinopril, captopril)
• is allergic to sulfonamide medications (e.g., sulfamethoxazole),
• is pregnant or breast-feeding
• is not passing urine
• has had angioedema (a serious allergic reaction which causes the area around the throat and tongue to swell)

What about possible side effects?

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent. The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

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.

• back pain
• bronchitis
• cough
• difficulty sleeping
• dizziness
• headache
• nervousness
• sexual difficulties (for men)
• unusual tiredness or weakness

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not seek medical attention.

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

• blistering or peeling skin
• chest pain
• confusion or mood changes
• dizziness, lightheadedness, or fainting when rising from a lying or sitting position
• fast heartbeat, irregular heartbeat, or palpitations
• low blood pressure (dizziness, lightheadedness)
• numbness or tingling in the hands, feet, or lips
• signs of liver damage (abdominal pain, fever, nausea, vomiting, loss of appetite, or yellowing of the skin or eyes)
• skin rash with or without itching
• sore throat and fever
• swelling of the hands, feet, or ankles

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

• signs of an allergic reaction, including angioedema (shortness of breath or difficulty breathing; hives; swelling of the eyes, mouth, lips, or throat)

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

What if I am taking other drugs?

There may be an interaction between ramipril - hydrochlorothiazide and any of the following:

alcohol allopurinol antidiabetic medications (e.g., insulin, glyburide, gliclazide) barbiturates (e.g., phenobarbital, butalbital) corticosteroids (e.g., prednisone, prednisolone) cyclosporine digoxin diuretics (water pills; e.g., furosemide, amiloride, spironolactone, triamterene) epinephrine lithium

medications which lower blood pressure narcotic medication (e.g., codeine, morphine) nonsteroidal anti-inflammatory medications (NSAIDs; e.g., ibuprofen, indomethacin, naproxen) norepinephrine rituximab substances which increase potassium levels (e.g., potassium chloride, salt substitutes containing potassium) tubocurarine

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than the ones listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications that you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

Other information:

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Angioedema: This medication may cause a serious allergic reaction called angioedema, which may be fatal if not treated promptly. If you have difficulty breathing or notice hives or swelling of the face, lips, tongue, or throat, stop taking this medication and get emergency medical help at once. Other ACE inhibitors should not be taken in the future. People who have had angioedema caused by other substances may be at increased risk of angioedema while receiving this medication.

Blood disorders: In rare cases, a low white blood cell count has been reported by people taking this medication. Your doctor may occasionally monitor your level of white blood cells by performing blood tests. Low white blood cell levels may increase your risk for infection. If you notice any signs of infection (e.g., fever, sore throat), contact your doctor as soon as possible.

Cholesterol: Increases in cholesterol and triglyceride levels may occur when taking hydrochlorothiazide. Your doctor may monitor for this with blood tests.

Cough: People taking ramipril may develop a dry, persistent cough that usually disappears only after stopping ramipril.

Diabetes: Hydrochlorothiazide may make it more difficult for people with diabetes to control their blood sugar. An adjustment to doses of antidiabetic agents, including insulin, may be required. Monitor your blood sugar levels closely if you are taking this medication.

Drowsiness/reduced alertness: This medication may reduce alertness, especially at the beginning of treatment. Exercise caution when driving or performing tasks that require alertness.

Fluid and electrolyte balance: Your levels of electrolytes such as potassium, sodium, magnesium, and chloride may change due to this medication. Your doctor may periodically for tests to check that these are in balance. If you experience symptoms of fluid and electrolyte imbalance such as muscle pains or cramps; dryness of mouth; numbness in hands, feet, or lips; or racing heartbeat, contact your doctor as soon as possible.

Gout: High levels of uric acid may occur in the blood, or gout may be brought on for certain people receiving hydrochlorothiazide. If this occurs while you are taking this medication, contact your doctor.

Kidney function: Changes in kidney function have occurred in certain people who take this medication. People with kidney function impairment may require lower doses of this medication. Your doctor will monitor you closely while you are taking this medication

Liver function: This medication may cause liver problems. If you experience any signs of liver problems such as yellowing of the skin or eyes, fever, generally feeling unwell, abdominal pain, nausea, vomiting, loss of appetite, itching, muscle pain, rash, or swollen glands, contact your doctor immediately. People who have preexisting liver problems will need to be closely monitored by their doctor while taking this medication.

Low blood pressure: Occasionally, blood pressure drops too low after taking this medication. This usually happens after the first or second dose or when the dose is increased. It is more likely to occur for those who take diuretics, have a salt-restricted diet, are on dialysis, or are suffering from diarrhea or vomiting. To reduce the risk of dizziness, get up slowly from a lying or sitting position. If low blood pressure causes you to faint or feel lightheaded, contact a doctor.

Lupus: Hydrochlorothiazide may worsen or activate systemic lupus erythematosus.

Surgery: It is important that your physician and anesthesiologist know that you are taking this medication before you undergo any surgical procedures requiring general anesthesia.

Pregnancy: ACE inhibitors such as ramipril have the potential to cause serious problems during pregnancy. This medication should not be used during pregnancy. If you become pregnant while taking this medication, stop taking it immediately and contact your doctor.

Breast-feeding: It is not known if ramipril passes into breast milk. Hydrochlorothiazide passes into breast milk. If you are a breast-feeding mother and are taking this medication, it may affect your baby. This medication is not recommended for breast-feeding women. Talk to your doctor.

Children: The safety and effectiveness of using this medication have not been established for children. Its use by this age group is not recommended.

Seniors: Seniors may be more sensitive to the effects of this medication.

Special Instructions:

This combination medication is used to make taking the medication more convenient for people who are already taking both of the active ingredients (ramipril and hydrochlorothiazide). The usual recommended dose of this medication is one tablet taken once a day, with or without food. The dose will depend on your response to the medication and on your kidney function. This medication should be taken at the same time each day, preferably in the morning. Swallow the medication whole. Do not crush or chew it.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones given here, do not change the way that you are taking the medication without consulting your doctor.

It is important to use this medication exactly as prescribed by your doctor. If you miss a dose, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store this medication at room temperature and keep it out of the reach of children.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

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