Ramipril

RAMIPRIL

Manufacturer: A-S Medication Solutions

Score: 148.0

Quick Summary

Ramipril is an angiotensin-converting enzyme (ACE) inhibitor used to treat hypertension, reduce the risk of myocardial infarction, stroke, and death from cardiovascular causes, and manage heart failure post-myocardial infarction. It works by inhibiting the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor, thereby decreasing blood pressure and reducing the risk of cardiovascular events. The usual maintenance dosage range is 2.5 mg to 20 mg per day, and it can be used alone or in combination with other medications. However, ramipril is contraindicated in patients with a history of angioedema, and it should be used with caution in patients with renal impairment, pregnancy, or nursing mothers.

Key Clinical Findings and Indications

Hypertension
Reduction in the risk of myocardial infarction, stroke, and death from cardiovascular causes
Heart failure post-myocardial infarction

Important Safety Information

Warning

When pregnancy is detected, discontinue ramipril as soon as possible. Drugs that act directly on the renin-angiotensin system can cause injury and death to the developing fetus.

Contraindications

Hypersensitivity to this product or any other ACE inhibitor
Combination with a neprilysin inhibitor (e.g., sacubitril)
Do not co-administer aliskiren with ramipril in patients with diabetes

Adverse Reactions

Headache
Dizziness
Fatigue
Cough
Angioedema

Dosing Recommendations

General Guidance

Renal Impairment: Establish baseline renal function in patients initiating ramipril. Usual regimens of therapy with ramipril may be followed in patients with estimated creatinine clearance >40 mL/min. However, in patients with worse impairment, 25% of the usual dose of ramipril is expected to produce full therapeutic levels of ramiprilat.

Hypertension

Adult Dose

Initial dose is 2.5 mg to 20 mg once daily. Adjust dosage according to blood pressure response after 2 to 4 weeks of treatment.

Pediatric Dose

Not established

Reduction in the risk of myocardial infarction, stroke, and death from cardiovascular causes

Adult Dose

2.5 mg once daily for 1 week, 5 mg once daily for 3 weeks, and increased as tolerated to a maintenance dose of 10 mg once daily

Pediatric Dose

Not established

Heart failure post-myocardial infarction

Adult Dose

Starting dose of 2.5 mg twice daily. If patient becomes hypotensive at this dose, decrease dosage to 1.25 mg twice daily.

Pediatric Dose

Not established

Special Population Considerations

Pregnancy

Use of drugs that act on the renin-angiotensin system during the second and third trimesters of pregnancy reduces fetal renal function and increases fetal and neonatal morbidity and death.
When pregnancy is detected, discontinue ramipril as soon as possible.

Nursing Mothers

Ingestion of a single 10 mg oral dose of ramipril resulted in undetectable amounts of ramipril and its metabolites in breast milk.
Do not use ramipril in nursing mothers.

Pediatric Use

Safety and effectiveness in pediatric patients have not been established.
Irreversible kidney damage has been observed in very young rats given a single dose of ramipril.

Geriatric Use

Of the total number of patients who received ramipril in U.S. clinical studies of ramipril, 11% were ≥65 years of age while 0.2% were ≥75 years of age.
No overall differences in effectiveness or safety were observed between these patients and younger patients.