How does it work?

This medicine contains two active ingredients, ramipril and felodipine. Ramipril belongs to a group of medicines called ACE inhibitors which block the action of a chemical in the body called angiotensin converting enzyme (ACE). Normally ACE produces another chemical, angiotensin. Angiotensin has two actions. Firstly, it causes the blood vessels to tighten and narrow and secondly, it causes the kidneys to produce less urine. As ramipril stops the production of angiotensin, 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 a decrease in the workload of the heart. Felodipine belongs to a group of medicines called calcium channel blockers, which act on the heart and blood vessels. Felodipine slows the movement of calcium through cells, which has two results. Firstly, it decreases the rate at which the heart beats and secondly, it has a widening effect on blood vessels. The overall effect of this is to reduce blood pressure. The combination of these two medicines is particularly useful in the treatment of high blood pressure.

What is it used for?

High blood pressure (hypertension) in people already stabilised on the separate components of this medicine

Warning!

Avoid grapefruit juice while taking this medicine, as it may alter the amount of the medicine in the blood.

This medicine may reduce your ability to drive or operate machinery safely. Do not drive or operate machinery until you know how this medicine affects you and you are sure it won't affect your performance.

If you experience any signs of infection while taking this medicine, such as flu-like symptoms, high temperature (fever), sore throat or inflammation of the lining of the mouth (stomatitis), you should tell your doctor immediately.

If you should require local or general anaesthesia, it is important that you inform your anaesthetist you are taking this medicine.

Use with caution in

Angina pectoris

Asthma

Chronic disease characterised by thickening and scarring of the skin, joints and internal organs (scleroderma)

Decreased blood supply through the vessels of the brain (cerebrovascular insufficiency)

Decreased blood supply to the heart (coronary insufficiency)

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

Decreased kidney function

Decreased liver function

Heart disease characterised by thickening of the internal heart muscle and a blockage inside the heart (hypertrophic obstructive cardiomyopathy)

Heart failure

High blood pressure caused by compression or blockage of the arteries that carry blood to the kidneys (renovascular hypertension)

Long-term inflammation of skin and some internal organs (systemic lupus erythematosus)

Low blood sodium levels (hyponatraemia)

Narrowing of one of the valves in the heart

Narrowing of the artery which supplies blood to the kidneys (renal artery stenosis)

Narrowing of the main artery of the body (aortic stenosis)

Not to be used in

Allergy to ACE inhibitors, eg captopril

Angina not well controlled by medical treatment

Breastfeeding

Children

Defect of the heart's electrical message pathways resulting in decreased function of the heart (heart block)

Failure of the heart to maintain adequate circulation (cardiogenic shock)

Heart attack

History of swelling of the lips, face or tongue (angioedema)

People receiving therapy to remove certain types of fat from the blood using a machine (LDL apheresis)

People undergoing therapy to decrease allergy to bee or wasp stings (desensitisation).

Pregnancy

Removal of toxic products from the body with the help of a machine

Severely decreased kidney function

Severely decreased liver function

Stroke

Uncontrolled heart failure

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 in pregnancy, particularly in the second and third trimesters, as it may affect the growth and development of the foetus or have adverse effects on foetal tissues. Seek medical advice from your doctor.

This medicine passes into breast milk. Breastfeeding is not recommended when taking this medicine. Seek medical advice from 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

Rash

Faster than normal heart beat (tachycardia)

Inability of a man to have an erection (impotence)

Blood disorders

Ankle swelling

Dry cough

Decreased kidney function

Severe swelling of lips, face or tongue (angioedema)

Flushing

Heart attack (myocardial infarction)

Stroke (cerebrovascular accident)

Chest pain

Drop in blood pressure which may be accompanied by dizziness or fainting

Enlargement of the gums (gingival hyperplasia)

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.

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