Generic
Ramipril
70 brands available in the market
At a glance
Ramipril is an ACE inhibitor used for hypertension, congestive heart failure, and after myocardial infarction. It reduces the risk of heart attack, stroke, or cardiovascular death.
Description
Ramipril is a prodrug that is hydrolyzed to ramiprilat, which inhibits ACE, preventing conversion of angiotensin I to angiotensin II, resulting in vasodilation and blood pressure reduction. It has beneficial effects in CHF and reduces cardiovascular event risk.
Indications
- Hypertension
- Congestive heart failure
- After acute myocardial infarction (with clinical signs of heart failure)
- Non-diabetic or diabetic glomerular nephropathy
- High cardiovascular risk (coronary heart disease, stroke, peripheral vascular disease, diabetes + risk factors)
Therapeutic class
Angiotensin-converting enzyme (ACE) inhibitors
Pharmacological class
ACE Inhibitor
Pharmacology
Ramipril is a prodrug that is converted to ramiprilat, which inhibits ACE, reducing angiotensin II production and causing vasodilation. It decreases aldosterone secretion and increases plasma renin activity, resulting in blood pressure reduction and decreased cardiovascular event risk.
Mechanism of action
Lowers blood pressure by inhibiting ACE to reduce angiotensin II production.
Dosage
Adult Dose (Oral):
- Hypertension (without diuretic): 1.25-2.5 mg/day initially; 2.5-20 mg/day maintenance (single or 2 divided doses)
- Hypertension (with diuretic): 1.25 mg/day initially
- Heart failure (post-MI): 2.5 mg twice daily initially; 5 mg twice daily target
- Cardiovascular event prevention: 2.5 mg/day (1 week); 5 mg/day (next 3 weeks); 10 mg/day maintenance
- Hepatic impairment: Max 2.5 mg/day
- Renal impairment (CrCl 10-30): 1.25 mg/day initially; max 5 mg/day
- Elderly: 1.25 mg/day initially
Administration
- May be taken with or without food; take at a fixed time
- Swallow tablet whole; do not chew, crush, or break
- Take with sufficient liquid
Missed dose
If you miss a dose, skip it and continue with your normal schedule; do not double the dose.
Side effects
Common Side Effects:
- Dizziness
- Headache
- Fatigue
- Asthenia
- Dry cough
- Nausea
- Vomiting
- Diarrhea
- Hypotension
Precautions & warnings
- May affect driving ability; do not drive if dizzy or drowsy
- May cause dizziness for the first few days; rise slowly
- Avoid alcohol (may exacerbate hypotension)
- Avoid potassium supplements and potassium-rich foods
- Do not use during pregnancy and lactation
Contraindications
- Hypersensitivity to ramipril, other ACE inhibitors, or any excipient
- History of angioedema
- Concomitant use with sacubitril/valsartan
- Hemodynamically relevant renal artery stenosis
- Hypotensive or hemodynamically unstable states
- With aliskiren-containing medicines in patients with diabetes or moderate-severe renal impairment
- With AIIRAs in diabetic nephropathy
- Pregnancy
Drug interactions
- Diuretics: Serious hypotension; potassium-sparing diuretics: Hyperkalemia
- Lithium: Increased serum lithium concentration
- NSAIDs: Reduced antihypertensive effect and renal function deterioration
- Alcohol: Enhanced hypotensive effect
Food interactions
Alcohol with Ramipril may cause excessive drowsiness.
Use in pregnancy
Use in Pregnancy: Unsafe during pregnancy; definite evidence of risk to the fetus; do not use.
Pregnancy Category: D — always consult a doctor before taking during pregnancy.
Use in lactation
Use in Lactation: Probably unsafe; limited human data suggests drug may pass into breast milk; do not use.
Pediatric use
Safety and efficacy not established in pediatric patients.
Geriatric use
Elderly patients require 1.25 mg/day initial dose.
Renal / hepatic impairment
Renal Impairment: CrCl 20-50: 1.25 mg/day initially, max 5 mg/day; CrCl 10-20: 1.25 mg/day initially; consult your doctor.
Hepatic Impairment: Caution; initiate under close medical supervision; max 2.5 mg/day; consult your doctor.
Overdose effects
Overdose: Excessive peripheral vasodilation (hypotension, shock), bradycardia, electrolyte disturbances, renal failure; treatment: gastric lavage, volume and salt replacement, α1-agonists (norepinephrine, dopamine) or angiotensin II.
Storage conditions
Store at 30°C or below, protect from light; do not use after expiry date; keep out of reach of children.
Chemical structure
Ramipril