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Can a fixed dose combination of ramipril and losartan be taken for hypertension?

Q: I read in your list of irrational fixed dose combination about ramipril + losartan. Recently, while in Mumbai, I consulted a nephrologist who prescribed Loram 2.5 (Losartan 50 mg + Ramipril 2.5 mg). This combination is manufactured by M.M. Labs in Gujarat. He asked me to stop lisnopril 2.5 and losartan 25 mg which I used to take individually. Is it better to stop Loram 2.5?

A:You have not mentioned the reasons behind you being prescribed losartan 50 mg + ramipril 2.5 mg as a fixed dose combination (FDC) in place of losartan 25 mg and lisinopril 2.5 mg. If your blood pressure is controlled with your current medicines, there is no apparent clinical reason to change the same. It is always better to prescribe all medicines separately rather than as an FDC. It is not possible to individualise dosage in patients given FDC. For example if you require losartan 25 mg and ramipril 2.5 mg, then how can you take an FDC? Such FDCs are not marketed in advanced countries like Europe and America. It has now been scientifically established that when two medicines are given for high blood pressure, one of them should invariably be a diuretic (the medicine that increases the output of urine) such as indapamide (sold under the trade name of Indicontin Continus).

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