Buy Altace Online

What is Altace?

Altace (ramipril) is in a group of drugs called ACE inhibitors. ACE stands for angiotensin converting enzyme.

Altace is used to treat high blood pressure (hypertension) or congestive heart failure, and to improve survival after a heart attack.

Altace may also be used for other purposes not listed in this medication guide.

Important information about Altace

Do not use Altace if you are pregnant. Stop using this medicine and tell your doctor right away if you become pregnant. Avoid drinking alcohol. It can further lower your blood pressure and may increase some of the side effects of Altace. Do not use salt substitutes or potassium supplements while taking Altace, unless your doctor has told you to.

Conditions that may cause very low blood pressure include: vomiting, diarrhea, heavy sweating, dehydration, a low salt diet, or taking diuretics (water pills). Tell your doctor if you have a prolonged illness that causes diarrhea or vomiting.

Your blood pressure will need to be checked often. Your kidney or liver function may also need to be tested. Visit your doctor regularly.

If you need surgery, tell the surgeon ahead of time that you are using Altace. You may need to stop using the medicine for a short time.

If you are being treated for high blood pressure, keep using Altace even if you feel fine. High blood pressure often has no symptoms.

Before taking Altace

You should not use Altace if you are allergic to ramipril or to any other ACE inhibitor, such as benazepril (Lotensin), captopril (Capoten), fosinopril (Monopril), enalapril (Vasotec), lisinopril (Prinivil, Zestril), moexipril (Univasc), perindopril (Aceon), quinapril (Accupril), or trandolapril (Mavik).

To make sure you can safely take Altace, tell your doctor if you have any of these other conditions:

  • kidney disease (or if you are on dialysis);

  • liver disease;

  • diabetes;

  • a connective tissue disease such as Marfan syndrome, Sjogren's syndrome, lupus, scleroderma, or rheumatoid arthritis;

  • if you are also taking telmisartan (Micardis); or

  • if you have ever had a severe allergic reaction.

FDA pregnancy category D. Do not use Altace if you are pregnant. Stop using this medication and tell your doctor right away if you become pregnant. Altace can cause injury or death to the unborn baby if you take the medicine during your second or third trimester. Use effective birth control while taking this medicine. Ramipril can pass into breast milk and may harm a nursing baby. You should not breast-feed while taking Altace.

How should I take Altace?

Take Altace exactly as prescribed by your doctor. Do not take in larger or smaller amounts or for longer than recommended. Follow the directions on your prescription label.

Your doctor may occasionally change your dose to make sure you get the best results.

Altace can be taken with or without food.

Swallow the tablet whole.

You may open the Altace capsule and sprinkle the medicine into a half-cup (4 ounces) of water, apple juice, or applesauce to make swallowing easier. Swallow without chewing. You may store the mixture for up to 24 hours at room temperature, or up to 48 hours in a refrigerator.

Conditions that may cause very low blood pressure include: vomiting, diarrhea, heavy sweating, dehydration, a low salt diet, or taking diuretics (water pills). Tell your doctor if you have a prolonged illness that causes diarrhea or vomiting.

To be sure Altace is helping your condition, your blood pressure will need to be checked often. Your kidney or liver function may also need to be tested. Visit your doctor regularly.

If you need surgery, tell the surgeon ahead of time that you are using Altace. You may need to stop using the medicine for a short time.

If you are being treated for high blood pressure, keep using Altace even if you feel fine. High blood pressure often has no symptoms.

Store Altace at room temperature away from moisture and heat.

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. Overdose symptoms may include feeling extremely dizzy or light-headed, or fainting.

What should I avoid while taking Altace?

Avoid drinking alcohol. It can further lower your blood pressure and may increase some of the side effects of Altace. Do not use salt substitutes or potassium supplements while taking Altace, unless your doctor has told you to.

Avoid getting up too fast from a sitting or lying position, or you may feel dizzy. Get up slowly and steady yourself to prevent a fall.

Altace side effects

Get emergency medical help if you have any of these signs of an allergic reaction to Altace: hives; severe stomach pain; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop taking Altace and call your doctor at once if you have a serious side effect such as:

  • feeling like you might pass out;

  • high potassium level (slow heart rate, weak pulse, muscle weakness, tingly feeling;

  • dry mouth, thirst, confusion, swelling, and urinating less than usual or not at all;

  • pale skin, dark colored urine, easy bruising or bleeding;

  • jaundice (yellowing of the skin or eyes); or

  • fever, chills, body aches, flu symptoms, sores in your mouth and throat.

Less serious Altace side effects may include:

  • cough;

  • tired feeling, headache;

  • dizziness, spinning sensation; or

  • nausea, vomiting.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect Altace?

Tell your doctor about all other medicines you use, especially:

  • a diuretic (water pill);

  • gold injections to treat arthritis;

  • lithium (Lithobid, Eskalith);

  • a potassium supplement such as K-Dur, Klor-Con;

  • salt substitutes that contain potassium; or

  • aspirin or other NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn, Naprelan, Treximet), celecoxib (Celebrex), diclofenac (Cataflam, Voltaren), indomethacin (Indocin), meloxicam (Mobic), and others.

This list is not complete and other drugs may interact with Altace. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.

For the Consumer

Applies to ramipril: oral capsule, oral tablet

Along with its needed effects, ramipril (the active ingredient contained in Altace) may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur while taking ramipril:

More Common
  • Blurred vision
  • confusion
  • dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
  • sweating
  • unusual tiredness or weakness
Less Common
  • Arm, back, or jaw pain
  • chest pain or discomfort
  • chest tightness or heaviness
  • chills
  • cloudy urine
  • cold sweats
  • decrease in urine output or decrease in urine-concentrating ability
  • fainting
  • fast or irregular heartbeat
  • nausea
  • shortness of breath

Some side effects of ramipril may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More Common
  • Cough
Less Common
  • Diarrhea
  • feeling of constant movement of self or surroundings
  • sensation of spinning
  • vomiting

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Applies to ramipril: oral capsule, oral tablet

General

Ramipril is generally well-tolerated. Most side effects are reported as often in patients taking placebo. Less than 3% of patients discontinue ramipril (the active ingredient contained in Altace) due to an adverse drug event.

Nervous system

Nervous system side effects include headache, dizziness, and lightheadedness in 2% to 5% of patients. Asthenia and fatigue occur in 2% of patients.

Cardiovascular

Cardiovascular problems are limited mainly to hypotension in 0.5% of patients. Angioneurotic edema is reported in 0.1% to 0.5% of patients, and may be fatal.

The exact mechanism by which ACE inhibitors produce angioedema is not well known, but is believed to involve stimulation of the kallikrein-kinin system, particularly in patients who are genetically or environmentally predisposed.

Gastrointestinal

Rare cases of abdominal pain associated with elevated enzymes suggestive of pancreatitis are reported.

Gastrointestinal complaints of nausea or dyspepsia are reported in approximately 1% of patients. Rare problems include general abdominal pain or fullness, dry mouth, dysphasia, constipation, diarrhea, gastroenteritis, anorexia, vomiting, increased salivation, and dysgeusia.

Respiratory

Respiratory side effects are limited to an idiosyncratic and reversible cough in approximately 3% of patients.

Several agents have been studied for treating cough with ACE inhibitors. No long term trials exist to allow a definitive treatment option. Cromolyn has the most data showing some benefit. Other agents studied include baclofen, theophylline, sulindac, and benzonatate.

Renal

In one study of 13 patients with congestive heart failure, mean creatinine clearance increased during ramipril (the active ingredient contained in Altace) therapy.

Renal insufficiency occurs in approximately 1% to 2% of patients and is usually transient. In general, ACE inhibitor-induced renal insufficiency is much more likely in sodium- or intravascular volume-depleted patients, or in those patients on concomitant diuretic therapy.

Metabolic

Metabolic changes include significant increases in serum potassium in 1% to 2% of patients. Extremely rare cases of hyponatremia have been associated with the use of ramipril (the active ingredient contained in Altace) (and other ACE inhibitors) in the elderly.

Ramipril has not been associated with deleterious changes in blood glucose or serum lipids in patients with diabetes mellitus.

Increases in serum potassium are associated with ACE inhibitors because they decrease aldosterone secretion, which usually promotes renal potassium excretion.

The mechanism of hyponatremia (rare) is unknown. Hyponatremia associated with ACE inhibitors presents like SIADH and may be due to inhibition of bradykinin metabolism or direct stimulation of ADH secretion by angiotensin II in the central nervous system (angiotensin I accumulates during ACE inhibitor therapy and crosses the blood-brain barrier).

Ramipril, like other ACE inhibitors does not appear to exert a significant effect on plasma glucose, insulin, or C-peptide levels.

Genitourinary

Genitourinary complaints are limited to impotence in 0.4% of patients.

Hypersensitivity

Hypersensitivity reactions to angiotensin converting enzyme (ACE) inhibitors may be life threatening. Angioedema of the face, extremities, lips, tongue, glottis and/or pharynx have been reported rarely in patients receiving ACE inhibitors. In addition, intestinal angioedema has been reported in patients treated with ACE inhibitors. It is recommended that any patient with dyspnea, dysphagia, or significant facial angioedema stop therapy immediately and avoid ACE inhibitor therapy in general.

Dermatitis, pruritus, and photosensitivity have also been reported.

Patients with intestinal angioedema generally present with abdominal pain (with or without nausea or vomiting) and in some cases there was no prior history of facial angioedema, and C-1 esterase levels were normal. These symptoms resolve after stopping the ACE inhibitor.

Hematologic

Hematologic side effects including agranulocytosis have been associated with ACE inhibitors including ramipril (the active ingredient contained in Altace)

ACE inhibitors have been used to treat post renal transplant erythrocytosis. Data have shown that they may decrease circulating erythropoietin levels in these patients.

Musculoskeletal

Musculoskeletal pains--both arthralgias and myalgias--have rarely been associated with the use of some ACE inhibitors, including ramipril (the active ingredient contained in Altace)

Dermatologic

Dermatologic side effects are typically the result of hypersensitivity reactions. Rare cases of pemphigus, including lichen planus pemphigoides, have been associated with the use of ramipril (the active ingredient contained in Altace) and other ACE inhibitors. In addition, Stevens-Johnson syndrome has been associated with ramipril therapy.

Drug-induced pemphigus has also been associated with a related drug, captopril. The mechanism remains unknown but drugs containing a thiol group may be involved as they are able to produce acantholysis of epidermal cells in vitro. Drugs containing an amide group have also been associated with pemphigus. These include enalapril which also induced acantholysis in vitro. (Four cases of enalapril-induced pemphigus have been reported.) Spontaneous remission of the skin lesions after drug withdrawal is less common with drugs containing the amide group compared with drugs containing the thiol group (15% vs. 50%).

Hepatic

Hepatic side effects including hepatic failure, hepatitis, jaundice and pancreatitis have been reported rarely.