ramipril

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ramipril

 [rah-mi´pril]
an angiotensin-converting enzyme inhibitor used in treatment of hypertension and congestive heart failure; administered orally.

ramipril

Altace, Apo-Ramipril (CA), Co Ramipril (CA), Lopace (CA), Novo-Ramipril*, Ratio-Ramipril (CA), Sandoz Ramipril (CA), Tritace (UK)

Pharmacologic class: Angiotensinconverting enzyme (ACE) inhibitor

Therapeutic class: Antihypertensive

Pregnancy risk category D

Action

Inhibits conversion of angiotensin I to angiotensin II, a potent vasoconstrictor. Increases plasma renin levels and reduces aldosterone levels, causing systemic vasodilation and decreased cardiac output.

Availability

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

Indications and dosages

Hypertension

Adults: Initially, 2.5 mg P.O. daily in patients not receiving diuretics; may increase dosage slowly p.r.n. according to response. For maintenance, 2.5 to 20 mg/day P.O. as a single dose or in two equally divided doses. If ramipril alone doesn't control blood pressure, a diuretic may be added.

To reduce the risk of myocardial infarction (MI), cerebrovascular accident, or death from cardiovascular causes

Adults: Initially, 2.5 mg P.O. daily for 1 week, followed by 5 mg P.O. daily for the next 3 weeks, then increased as tolerated to a maintenance dosage of 10 mg P.O. daily. In hypertensive patients and those who've had a recent MI, may divide maintenance dose.

Heart failure after MI

Adults: Initially, 2.5 mg P.O. b.i.d.; may decrease to 1.25 mg b.i.d. if higher dosage causes hypotension. Titrate toward target dosage of 5 mg b.i.d. at 3-week intervals.

Dosage adjustment

• Renal impairment
• Concurrent diuretic use

Off-label uses

• Angina associated with syndrome X
• Atherosclerosis
• Mitral insufficiency
• Renovascular hypertension
• Diabetic or nondiabetic nephropathy
• Erythrocytosis

Contraindications

• Hypersensitivity to drug or other ACE inhibitors
• Angioedema with previous ACE inhibitor use or history of hereditary or idiopathic angioedema

Precautions

Use cautiously in:
• autoimmune diseases, aortic stenosis, hypertrophic cardiomyopathy, cerebrovascular or cardiac insufficiency, collagen vascular disease, febrile illness, hepatic or renal impairment, hypotension, neutropenia, chronic cough, proteinuria, renal artery stenosis
• risk factors for development of hyperkalemia (including renal insufficiency, diabetes mellitus, concurrent use of potassium-sparing diuretics, potassium supplements, or potassium-containing salt substitutes)
• family history of angioedema
• concurrent immunosuppressant or diuretic therapy
• black patients
• elderly patients
• pregnant patients
• breastfeeding patients (avoid use)
• children (safety not established).

Administration

• If possible, discontinue diuretics 2 to 3 days before ramipril therapy begins to prevent severe hypotension.
• If patient can't swallow capsule, open it and mix contents in water or apple juice or sprinkle in small amount of applesauce.
• Know that drug may be used alone or with other antihypertensives.

Adverse reactions

CNS: dizziness, light-headedness, fatigue, headache, vertigo, asthenia

CV: hypotension, orthostatic hypotension, angina pectoris, tachycardia, MI, heart failure

EENT: blurred vision, sinusitis

GI: nausea, vomiting, diarrhea

Hematologic: purpura, agranulocytosis

Metabolic: hyperkalemia

Musculoskeletal: muscle cramps

Respiratory: cough, asthma, upper respiratory tract infection, bronchospasm

Skin: rash, pruritus, urticaria, photosensitivity, angioedema, anaphylactoid reactions

Other: fever

Interactions

Drug-drug.Diuretics, other antihypertensives: increased hypotension

Gold (sodium aurothiomalate): increased risk of rare nitritoid reactions (including facial flushing, nausea, vomiting, and hypotension)

Lithium: increased lithium blood level and risk of toxicity

Nonsteroidal anti-inflammatory drugs: may result in deterioration of renal function, including acute renal failure and attenuated ACE inhibitor antihypertensive effect

Potassium-sparing diuretics, potassium supplements: increased risk of hyperkalemia

Drug-diagnostic tests.Alanine aminotransferase, alkaline phosphatase, aspartate aminotransferase, bilirubin, blood urea nitrogen, creatinine, potassium: increased levels

Drug-food.Any food: decreased rate (but not extent) of drug absorption Salt substitutes containing potassium: increased risk of hyperkalemia

Patient monitoring

• Assess vital signs and cardiovascular status. Ask patient if he's experiencing angina.
• Monitor CBC and liver function tests.
• Closely monitor potassium level. Watch for signs and symptoms of hyperkalemia.

Stay alert for signs and symptoms of hypersensitivity reactions (including angioedema), especially in black patients after first dose
• Evaluate for dry, nonproductive cough.

Patient teaching

• Tell patient he may take with or without food.

Instruct patient to immediately report swelling of tongue or face or difficulty breathing.
• Teach patient how to monitor and record blood pressure.
• Tell patient drug may cause dry, nonproductive cough. Instruct him to report this problem if it becomes bothersome.
• Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness.
• Advise patient to move slowly when sitting up or standing, to avoid dizziness from sudden blood pressure decrease.
• Inform patient that excessive fluid loss (as from sweating, vomiting, or diarrhea) and inadequate fluid intake increase risk of light-headedness (especially in hot weather).
• Tell patient to avoid salt substitutes containing potassium.
• Advise female patient to tell prescriber if she is pregnant. Caution her not to take drug during third trimester or when breastfeeding.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, foods, herbs, and behaviors mentioned above.

ramipril

/ra·mi·pril/ (rah-mi´pril) an angiotensin-converting enzyme inhibitor used in treatment of hypertension and congestive heart failure and the prevention of a major cardiovascular event in high-risk patients.

ramipril

An ANGIOTENSIN CONVERTING ENZYME inhibitor drug that has been shown to be capable of greatly extending life after heart attack. The drug is especially useful in the condition of dilated cardiomyopathy and in reducing the risk of heart attack and stroke in predisposed persons. A brand name is Tritace.

ramipril (ram´əpril),

n brand name: Altace;
drug class: angiotensin-converting enzyme (ACE) inhibitor;
action: selectively suppresses renin-angiotensin-aldosterone system; inhibits ACE; prevents conversion of angiotensin I to angiotensin II; results in dilation of arterial and venous vessels;
uses: hypertension, alone or in combination with thiazide diuretics; congestive heart failure immediately after myocardial infarction.

ramipril

an angiotensin-converting enzyme inhibitor used in the management of heart failure in dogs.