Ramipril Indometacin

Review all oral medications to assess their potential toxicity given the patient s current state. Suggest stopping the indometacin, ramipril and gli-clazide, with a view to restarting the latter two when the patient is more stable. Continue the ranitidine, as the patient is at risk of developing stress ulceration. 

Other ACE inhibitors. A placebo-controlled, randomised, crossover study in 16 hypertensive patients found that indometacin 50 mg twice daily reduced the blood pressure-lowering effects of cilazapril 2.5 mg daily. The reduction was greater when cilazapril was added to indometacin than when indometacin was added to cilazapril (approximately 60% versus 30% reduction in hypotensive effect measured 3 hours after the morning dose). The antihypertensive effects of perindopril 4 to 8 mg daily were also found to be reduced by about 30% by indometacin 50 mg twice daily in 10 hypertensive patients. A brief mention is made in a review that the pharmacodynamics of ramipril were unaffected by indometacin (dosage not stated) given to healthy subjects for 3 days. Indometacin 25 mg three times daily did not alter the hypotensive effects of trandolapril 2 mg daily in 17 hypertensive patients. ... 

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See also in sourсe #XX -- [ ]

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