Cardace 2.5

Kats said:

Hi,

I have BP of aroun 150-160.
I have been adviced to take Cardace 2.5 (Rampiril)

Is it ok if I break up the tab in 2 & take 1/2 in morning
& 1/2 in evening.

Would this have a phsiological effect different from taking
the whole tab @ one time

Regards
KS

you might consider lisinopril, a generic 'tissue' ACE instead. As to your
particular tablet for ramipril, I do not believe it would be harmful, but
you must ask your pharmacist.

However, this would not change the physiological effect of the drug if OK
with your pharmacist.

--
~~~
Patrick Blanchard, M.D., A.B.F.P.
Board Certified in Family Practice

"Patrick Blanchard, M.D." <[email hidden]> wrote in message news:<[email hidden]>...

Quoted message said:

Kats said:

Hi,

I have BP of aroun 150-160.
I have been adviced to take Cardace 2.5 (Rampiril)

Is it ok if I break up the tab in 2 & take 1/2 in morning
& 1/2 in evening.

Would this have a phsiological effect different from taking
the whole tab @ one time

Regards
KS

you might consider lisinopril, a generic 'tissue' ACE instead.

(Raised eyebrow)

Lisinopril is *not* a tissue ACE inhibitor.

Quoted message said:

As to your
particular tablet for ramipril, I do not believe it would be harmful, but
you must ask your pharmacist.

Why don't you know that a 1.25 mg BID dosing for ramipril is ok?
And, more importantly, why don't you seem to know that the patient
should consult his/her physician (rather than pharmacist) for changes
in prescribed dosing instructions?

Quoted message said:

However, this would not change the physiological effect of the drug if OK
with your pharmacist.

It will alter the pharmacokinetics so that BP lowering effects may be
better tolerated.

As is probably the case for others in this NG, I have my doubts about
your being *the* Dr. Patrick Blanchard listed in the AMA physician
database as practicing in Kansas (You may certainly try to prove that
you are).

Nonetheless, for your self-edification, would suggest you read the
following:

http://www.clevelandclinicmeded.com/ccjm/Mar2001/ace.htm

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
http://www.heartmdphd.com

MD/PhD said:

"Patrick Blanchard, M.D." <[email hidden]> wrote in message
news:<[email hidden]>...

Quoted message said:

Kats said:

Hi,

I have BP of aroun 150-160.
I have been adviced to take Cardace 2.5 (Rampiril)

Is it ok if I break up the tab in 2 & take 1/2 in morning
& 1/2 in evening.

Would this have a phsiological effect different from taking
the whole tab @ one time

Regards
KS

you might consider lisinopril, a generic 'tissue' ACE instead.

(Raised eyebrow)

Lisinopril is *not* a tissue ACE inhibitor.

Dr. Blanchard disagrees in reply:
I should have stipulated lisinopril; it is a 'tissue-like' ACE. You see it
was in quotation.

Illustrative reference (www.pubmed.gov):
Cushman DW, [censored] FL, Fung WC, Grover GJ, Harvey CM, Scalese RJ, Mitch SL,
DeForrest JM.
Comparisons in vitro, ex vivo, and in vivo of the actions of seven
structurally diverse inhibitors of angiotensin converting enzyme (ACE).
Br J Clin Pharmacol. 1989;28 Suppl 2:115S-130S; discussion 130S-131S.

an exerpt from the illustrative reference...
.... Following oral administration of the drugs to SHR, the degree and
duration of ACE inhibition in aorta and lung correlated with the
antihypertensive actions, with ramipril, lisinopril, and zofenopril
producing effects of the greatest magnitude and duration. 5. Ramipril and
enalapril did not inhibit brain ACE ex vivo; captopril and zofenopril had
modest but short-lasting effects; and fosinopril, lisinopril, and SQ 29,852
had long-lasting inhibitory actions, which, with the latter two, were
delayed in onset. 6. All of the drugs produced significant inhibition of
kidney ACE, with ramipril and fosinopril having somewhat weaker effects,
perhaps due to biliary routes of excretion. 7. Captopril, fosinopril, and
particularly zofenopril inhibited cardiac ACE ex vivo with degrees and
durations that were marked compared with those of the other drugs;
preliminary studies with isolated hearts suggest a possible relationship
between inhibition of cardiac ACE and preservation of cardiac function
subsequent to ischaemia.

Quoted message said:

Quoted message said:

As to your particular tablet for ramipril, I do not believe it would be
harmful, but you must ask your pharmacist.

Why don't you know that a 1.25 mg BID dosing for ramipril is ok?
And, more importantly, why don't you seem to know that the patient
should consult his/her physician (rather than pharmacist) for changes
in prescribed dosing instructions?

Dr. Blanchard disagrees in reply:
She wants to break the pill in half, and because I depend on the phamacist
to keep track of all the different tablet formulations of different drugs,
even trade (like ramipril). Pharmaceutical companies can alter the way a
pill is manufactured and not relay that information on to me.

Quoted message said:

Quoted message said:

However, this would not change the physiological effect of the drug if
OK with your pharmacist.

It will alter the pharmacokinetics so that BP lowering effects may be
better tolerated.

As is probably the case for others in this NG, I have my doubts about
your being *the* Dr. Patrick Blanchard listed in the AMA physician
database as practicing in Kansas (You may certainly try to prove that
you are).

Nonetheless, for your self-edification, would suggest you read the
following:

http://www.clevelandclinicmeded.com/ccjm/Mar2001/ace.htm

Dr. Blanchard disagrees in reply:

Thank you for this information. I find it useful, although it does not
compare ramipril and lisinopril however.

--
~~~
Patrick Blanchard, M.D., A.B.F.P.
Board Certified in Family Practice

Patrick Blanchard said:

MD/PhD said:

"Patrick Blanchard, M.D." <[email hidden]> wrote in message
news:<[email hidden]>...

Quoted message said:

On 3 Nov 2003 02:52:27 -0800, Kats <[email hidden]> wrote:

> Hi,
>
> I have BP of aroun 150-160.
> I have been adviced to take Cardace 2.5 (Rampiril)
>
> Is it ok if I break up the tab in 2 & take 1/2 in morning
> & 1/2 in evening.
>
> Would this have a phsiological effect different from taking
> the whole tab @ one time
>
> Regards
> KS
>
you might consider lisinopril, a generic 'tissue' ACE instead.

(Raised eyebrow)

Lisinopril is *not* a tissue ACE inhibitor.

Dr. Blanchard disagrees in reply:
I should have stipulated lisinopril; it is a 'tissue-like' ACE. You see it
was in quotation.

Sounds like you now agree it is *not* a tissue ACE inhibitor

Quoted message said:

Illustrative reference (www.pubmed.gov):
Cushman DW, [censored] FL, Fung WC, Grover GJ, Harvey CM, Scalese RJ, Mitch SL,
DeForrest JM.
Comparisons in vitro, ex vivo, and in vivo of the actions of seven
structurally diverse inhibitors of angiotensin converting enzyme (ACE).
Br J Clin Pharmacol. 1989;28 Suppl 2:115S-130S; discussion 130S-131S.

an exerpt from the illustrative reference...
... Following oral administration of the drugs to SHR, the degree and
duration of ACE inhibition in aorta and lung correlated with the
antihypertensive actions, with ramipril, lisinopril, and zofenopril
producing effects of the greatest magnitude and duration. 5. Ramipril and
enalapril did not inhibit brain ACE ex vivo; captopril and zofenopril had
modest but short-lasting effects; and fosinopril, lisinopril, and SQ 29,852
had long-lasting inhibitory actions, which, with the latter two, were
delayed in onset. 6. All of the drugs produced significant inhibition of
kidney ACE, with ramipril and fosinopril having somewhat weaker effects,
perhaps due to biliary routes of excretion. 7. Captopril, fosinopril, and
particularly zofenopril inhibited cardiac ACE ex vivo with degrees and
durations that were marked compared with those of the other drugs;
preliminary studies with isolated hearts suggest a possible relationship
between inhibition of cardiac ACE and preservation of cardiac function
subsequent to ischaemia.

This reference says nothing about lisinopril being like a tissue ACE inhibitor.

Quoted message said:

Quoted message said:

Quoted message said:

As to your particular tablet for ramipril, I do not believe it would be
harmful, but you must ask your pharmacist.

Why don't you know that a 1.25 mg BID dosing for ramipril is ok?
And, more importantly, why don't you seem to know that the patient
should consult his/her physician (rather than pharmacist) for changes
in prescribed dosing instructions?

Dr. Blanchard disagrees in reply:
She wants to break the pill in half,

for BID dosing.

Quoted message said:

and because I depend on the phamacist
to keep track of all the different tablet formulations of different drugs,
even trade (like ramipril).

we are talking about dosing.

Quoted message said:

Pharmaceutical companies can alter the way a
pill is manufactured and not relay that information on to me.

Perhaps you should let the pharmaceutical reps relay that info to you. You can
also check the PDR. You do have one of those don't you?

Quoted message said:

Quoted message said:

Quoted message said:

However, this would not change the physiological effect of the drug if
OK with your pharmacist.

It will alter the pharmacokinetics so that BP lowering effects may be
better tolerated.

As is probably the case for others in this NG, I have my doubts about
your being *the* Dr. Patrick Blanchard listed in the AMA physician
database as practicing in Kansas (You may certainly try to prove that
you are).

Well?

Quoted message said:

Quoted message said:

Nonetheless, for your self-edification, would suggest you read the
following:

http://www.clevelandclinicmeded.com/ccjm/Mar2001/ace.htm

Dr. Blanchard disagrees in reply:

Thank you for this information. I find it useful, although it does not
compare ramipril and lisinopril however.

It does by distinguishing tissue ACE inhibitors such as ramipril from
non-tissue (ie lisinopril).

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
http://www.heartmdphd.com