Instructions for Starting Ramipril ('Tritace')

Online Version
GHP0719_01_07
Author: Associate Specialist
Review due: January 2010
Instructions for
starting Ramipril
('Tritace')
Patient Information for the
Gloucestershire Health Community

Introduction
Ramipril, also known by its brand name
“Tritace”, is a blood pressure lowering
tablet which has been used in Britain for
many years. More recently it has been
shown to offer significant protection
against heart attacks and strokes in people
at high risk of these diseases. Ramipril
can reduce the risk of strokes and heart
attacks by about 25% and even people with
normal blood pressure have been shown
to benefit. Ramipril is usually prescribed in
combination with other tablets which have
been shown to lower the risk of strokes and
heart attacks.
There are, unfortunately, some people who
cannot take ramipril because their kidneys
are sensitive to it. To minimise the risk
of any adverse effect on the kidneys we
normally start to use ramipril at a low dose,
gradually increasing to the full dose over
a number of weeks. This gradual increase
in dosage is known as titration. During
titration we monitor your blood pressure
and kidney function with at least three
blood tests and you should have received
three red and green pathology request
forms for this purpose.
How to start taking ramipril
Please ask your hospital or family doctor
to give you a prescription for a “Tritace
Titration Pack”.
You will then be issued with a white box
containing 35 capsules of 3 different
strengths in 3 separate cartons. You
will have been given 3 red and green
pathology request forms for your blood
tests.
Start with the first carton taking one
2.5mg strength capsule daily for the first
7 days. Make an appointment to see your
family doctor’s practice nurse for your first
blood test at or as near as possible to the
end of that week. Take along one of the
red and green pathology request forms
so that the nurse will know which sample
to take. She should also check your blood
pressure.
At the end of the first week, when you
have finished all of the capsules in the
first carton, remove the cardboard divider
in the main box to find a second carton
containing 21 capsules of 5mg strength.
Start taking one 5mg strength capsule
daily. Make an appointment for your
second blood test in another week’s time.
Don’t forget to take another red and
green form with you and to have your
blood pressure checked. After the blood
test there should still be another 14 tablets
of 5mg strength left in the second carton.
Continue to take one daily until finished.
Online Version
When the second carton is finished,
remove the second cardboard divider to
find the third carton which contains 7
capsules of the full 10mg strength. Take
one daily and make an appointment for
your third blood test and blood pressure
check at the end of that week. While
making the appointment warn the nurse
that you will be needing some more 10mg
strength ramipril tablets when the last
carton runs out and she can then remind
your doctor to write a new prescription
for you. Remember to take the last red
and green form with you for your blood
test and don’t forget to collect your repeat
prescription.
If at any stage your blood tests or blood
pressure measurements are of concern,
either your own doctor or someone from
the hospital will be in touch with further
instructions. Provided all of the blood
tests and blood pressure measurements are
satisfactory you should continue to take
one 10mg strength ramipril tablet daily in
addition to your other tablets. You may
be called back to an outpatient Clinic at
Cheltenham General Hospital to check that
you are taking your tablets correctly and to
have any further questions answered.
We hope these instructions have been clear.
If not and you are still unsure about what
you should be doing please telephone
Helen Brooke, Stroke Specialist Nurse
at Cheltenham General Hospital 08454
222222, Bleep 1002. She will be happy to
run through the instructions again with
you.
You may find it useful to take this leaflet
with you for your doctor and nurse to see
but please remember to take it home again
afterwards.