Comparative Pharmacology
Head-to-head clinical analysis: MONOPRIL HCT versus RAMIPRIL.
Peer-Reviewed Evidence
Head-to-head clinical analysis: MONOPRIL HCT versus RAMIPRIL.
MONOPRIL-HCT vs RAMIPRIL
Comparing the clinical profiles, pharmacokinetic behaviors, and safety indices of these two therapeutic agents.
Fosinopril is an angiotensin-converting enzyme (ACE) inhibitor that inhibits the conversion of angiotensin I to angiotensin II, reducing vasoconstriction and aldosterone secretion; hydrochlorothiazide is a thiazide diuretic that inhibits sodium and chloride reabsorption in the distal convoluted tubule, increasing electrolyte and water excretion.
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 (10-20 mg fosinopril / 12.5-25 mg hydrochlorothiazide) orally once daily; maximum dose 80 mg fosinopril / 50 mg hydrochlorothiazide per day.
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
Fosinoprilat: 11.5-12 h (terminal half-life extended in renal and hepatic impairment); hydrochlorothiazide: 5.6-14.8 h (varies with renal function).
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.
Fosinopril: renal (44%), biliary (46%); hydrochlorothiazide: renal (>95% as unchanged drug).
Primarily renal (60% as unchanged drug and metabolites) and fecal (40% via biliary elimination).
Category C
Category D/X
ACE Inhibitor/Diuretic Antihypertensive
ACE Inhibitor
"The risk or severity of adverse effects can be increased when Ramipril is combined with Bumetanide."