ramipril + enalapril + captopril + perindopril + lisinopril

This is a combination of five angiotensin-converting enzyme (ACE) inhibitors—ramipril, enalapril, captopril, perindopril, and lisinopril. Each of these drugs individually inhibits the angiotensin-converting enzyme, which reduces the production of angiotensin II. This leads to vasodilation (widening of blood vessels), decreased blood pressure, and reduced workload on the heart. ACE inhibitors are primarily used for treating hypertension (high blood pressure), heart failure, and certain types of chronic kidney disease. The simultaneous use or combination of multiple ACE inhibitors is not standard clinical practice due to increased risk for adverse effects such as hypotension, hyperkalemia (elevated potassium), renal dysfunction, and angioedema[1][2][3][4][5]. There is no evidence supporting additional benefit from combining multiple ACE inhibitors; instead it significantly increases risks[6].