Ramipril 

Brand Name: Altace

Generic Available

Common Dosage Forms:

Capsules: 1.25 mg, 2.5 mg, 5 mg, 10 mg

FDA Indications/Dosages:

For the treatment of hypertension, alone or in combination with thiazide diuretics: Initially give 2.5 mg once daily. Maintenance dose is between 2.5-20 mg/day in one or two doses.

Initial dose when using diuretics: Begin with 1.26 mg daily or temporarily discontinue diuretic therapy beginning 3 days before initial dose.

Reduction in the risk of myocardial infarction, stroke, and death from cardiovascular causes: Begin with 2.5 mg for 7 days, increase to 5 mg for 21 days, then adjust dose as tolerated.

Treatment of heart failure in post-MI patients: Begin with 2.5 mg twice a day.

Dosing in renal function impairment: Give 1.25 mg to a maximum of 5 mg daily in patients with CrCl of <40 mL/min/1.73m^2.

Monitor: K, BP, CrCl, WBC

Pharmacology/Pharmacokinetics: Ramipril’s mechanism of action is thought to be due to its suppression of the renin-aldosterone system by competitively inhibiting the angiotensin-converting enzyme (ACE). ACE converts angiotensin I to angiotensin II, one of the most potent vasoconstrictors known. Inhibition of ACE decreases plasma angiotensin II which leads to decreased aldosterone secretion. The latter may cause an increase in serum potassium. The net result is a decrease in peripheral arterial resistance. Ramipril is metabolized to the more active ramiprilat in the liver. Peak plasma levels of ramiprilat are reached in 2-4 hours. Protein binding is approximately 60%. Half-life of ramiprilat is 13-17 hours. Elimination occurs through the urine (60%) and the feces (40%).

Drug Interactions: Indomethacin may decrease therapeutic effects. Capsaicin may increase the incidence of coughing. Because of potassium-sparing effect, use caution when given with potassium-sparing diuretics and potassium supplements. Lithium toxicity may occur. Increased adverse effects may occur when used with other renin-angiotensin system blockers or aliskiren.

Contraindications/Precautions: Contraindicated in combination with neprilysin inhibitor (sacubitril). DO NOT USE DURING PREGNANCY. Use with caution in nursing mothers, in patients with impaired renal function, collagen vascular disease (may cause agranulocytosis), or aortic stenosis, and in patients undergoing surgery or anesthesia. Rare occurrences of angioedema and neutropenia have been seen in patients taking ACE inhibitors. Patients should report to their physician any signs of facial swelling, difficulty in breathing, or infection (unexplained fever or sore throat). Rarely, ACE inhibitors have been associated with a syndrome that starts with cholestatic jaundice or hepatitis and progresses to fulminant hepatic necrosis and sometimes death. Pregnancy Category D.

Adverse Effects: Mild adverse effects include cough, headache, dizziness, and fatigue. A potentially serious side effect is angioedema.

Patient Consultation:

Do not discontinue medication unless otherwise directed by your physician.

Capsules may be swallowed whole, or their contents sprinkled over soft food and consumed (without chewing). They also may be mixed into water or apple juice and consumed. Pre-mixed solutions are stable for 24 hours at room temperature and 48 hours under refrigeration.

Avoid nonprescription cough, cold, and allergy medications unless otherwise directed.

Avoid salt substitutes containing potassium.

Report any signs of facial swelling, difficulty in breathing, or infection (unexplained fever or sore throat) to your physician.

Store in a cool, dry place away from sunlight and children.

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