Generic Name

Ramipril

Precaution

Renal impairment, hypovolaemia, hyperkalaemia, valvular stenosis; before, during or immediately after anaesthesia. Severe resistant hypertension, elderly, peripheral vascular disease or generalised atherosclerosis. Patient Counselling Inform patients to refrain from activities involving mental alertness and physical coordination after drug intake. Monitoring Parameters Correct volume and/or salt depletion prior to treatment. Monitor BP, serum creatinine and K levels. Monitor renal function during the 1st few wk of treatment and periodically thereafter. Lactation: Possibly excreted in breast milk; nursing not recommended

Indication

Congestive heart failure, MI, HTN, CV events, Stroke

Contra Indication

Hypersensitivity, bilateral renal artery stenosis, or a single kidney with unilateral renal artery stenosis. Aortic stenosis or outflow tract obstruction. History of angioedema (hereditary, idiopathic or due to previous angioedema w/ ACE inhibitors). Pregnancy and lactation.

Dose

N/A

Side Effect

>10% Cough (7-8%),Hypotension (2-11%) 1-10% Headache (1-5%),Angina pectoris (3%),Dizziness (2-4%),Nausea (2%),Vomiting (2%),Postural hypotension (2%),Syncope (2%),Vertigo (2%),Abnormal kidney function (1%),Diarrhea (1%) <1% Angioedema (0.3%) Potentially Fatal: Severe hypotension and renal failure, angioedema.

Pregnancy Category

Mode of Action

Ramipril, a prodrug of ramiprilat, competitively inhibits ACE from converting angiotensin I to angiotensin II (a potent vasoconstrictor) resulting in increased plasma renin activity and reduced aldosterone (a hormone that causes water and Na retention) secretion. This promotes vasodilation thus producing a hypotensive effect and a beneficial effect in CHF.

Interaction

May enhance hypotensive effect w/ diuretics and other antihypertensives. May increase risk of renal function deterioration w/ NSAIDs. May increase serum levels and toxicity of lithum. May increase hyperkalaemic effect w/ K-sparing diuretics and supplements. Potentially Fatal: Concomitant use w/ aliskiren aliskiren may increase the risk of hyperkalaemia, hypotension and nephrotoxicity in patients w/ diabetes or renal impairment

Pregnancy Category Note

Pregnancy category: D Discontinue as soon as pregnancy detected; during the second and third trimesters of pregnancy, therapy can result in fetal injury (eg, hypotension, neonatal skull hypoplasia, anuria, reversible and irreversible renal failure) and death Lactation: Possibly excreted in breast milk; nursing not recommended

Adult Dose

Oral Hypertension, Diabetic Nephropathy Adult: Hypertension Initial (not on diuretic): 2.5 mg once daily at bedtime. Initial (with diuretic): 1.25 mg once daily at bedtime. Maintenance: 2.5-5 mg/day as a single dose, Max: 10 mg/day. Congestive Heart failure Adult: Initially, 1.25 mg once daily. Max: 10 mg daily. Doses >2.5 mg may be given in 2 divided doses. Max Dosage: 10 mg daily in 1-2 divided doses. Post myocardial infarction Adult: Initially, 2.5 mg bid, may increase to 5 mg bid after 2 days. Start treatment: 3-10 days after infarction. Maintenance: 2.5-5 mg bid. Prophylaxis of cardiovascular events in high-risk patients, Stroke Prevention Adult: Initially, 2.5 mg once daily, may increase to 5 mg once daily after 1 wk if tolerated. Maintenance: 10 mg once daily after a further 3 wk. Hepatic impairment: Max: 2.5 mg/day.

Child Dose

Safety and efficacy not established

Renal Dose

Renal impairment: CrCl (ml/min) Dosage Recommendation 10-30 Initially, 1.25 mg/day. Max: 5 mg/day. 30-60 Not necessary to adjust the initial dose. Max maintenance dose: 5 mg/day.

Administration

May be taken with or without food.