Comparative Pharmacology
Head-to-head clinical analysis: LEXXEL versus RAMIPRIL.
Peer-Reviewed Evidence
Head-to-head clinical analysis: LEXXEL versus RAMIPRIL.
LEXXEL vs RAMIPRIL
Comparing the clinical profiles, pharmacokinetic behaviors, and safety indices of these two therapeutic agents.
LEXXEL is a combination of felodipine, a dihydropyridine calcium channel blocker that inhibits calcium influx into vascular smooth muscle and cardiac muscle, causing vasodilation and reduced myocardial contractility, and enalapril, an angiotensin-converting enzyme (ACE) inhibitor that prevents conversion of angiotensin I to angiotensin II, reducing vasoconstriction, aldosterone secretion, and sodium reabsorption.
Ramipril is a prodrug that is hydrolyzed in the liver to its active metabolite ramiprilat, which inhibits angiotensin-converting enzyme (ACE), thereby decreasing angiotensin II production, reducing vasoconstriction, aldosterone secretion, and sodium retention.
1 tablet (felodipine 5 mg / enalapril 5 mg) orally once daily, may increase to 2 tablets once daily after 2-4 weeks if needed.
Initial: 2.5 mg orally once daily; Maintenance: 2.5-20 mg/day in 1-2 divided doses; Maximum: 20 mg/day.
None Documented
None Documented
Clinical Note
moderateRamipril + Torasemide
"The risk or severity of adverse effects can be increased when Ramipril is combined with Torasemide."
Clinical Note
moderateRamipril + Etacrynic acid
"The risk or severity of adverse effects can be increased when Ramipril is combined with Etacrynic acid."
Clinical Note
moderateRamipril + Furosemide
"The risk or severity of adverse effects can be increased when Ramipril is combined with Furosemide."
Clinical Note
moderateRamipril + Bumetanide
Enalapril: ~1.3 hours; Enalaprilat: terminal half-life ~35-38 hours, with multiple-dose accumulation half-life ~11 hours; effective half-life for ACE inhibition ~24 hours.
Terminal half-life of ramiprilat is 13–17 hours (prolonged to 50 hours in renal impairment). Accumulation half-life is 110 hours after multiple doses.
Renal: ~35-50% as unchanged drug (enalaprilat), biliary/fecal: ~15-30% as metabolites and unchanged drug; total renal elimination of enalaprilat accounts for ~60-80% of dose.
Primarily renal (60% as unchanged drug and metabolites) and fecal (40% via biliary elimination).
Category C
Category D/X
ACE Inhibitor + Calcium Channel Blocker
ACE Inhibitor
"The risk or severity of adverse effects can be increased when Ramipril is combined with Bumetanide."