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an angiotensin-converting enzyme inhibitor used in treatment of hypertension and congestive heart failure; administered orally.


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


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.


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

Indications and dosages


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


• Hypersensitivity to drug or other ACE inhibitors

• Angioedema with previous ACE inhibitor use or history of hereditary or idiopathic angioedema


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).


• 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


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.


/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.


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.


an angiotensin-converting enzyme inhibitor used in the management of heart failure in dogs.
References in periodicals archive ?
Effect of ramipril on walking times and quality of life among patients with peripheral artery disease and intermittent claudication: a randomized controlled trial.
This study dealt with the comparative study of telmisartan and ramipril as an antihypertensive in mild to moderate hypertension.
Patients on other anti-hypertensive therapy, patients of secondary hypertension, symptomatic heart failure, significant valvular heart disease, pericardial constriction or effusion, congenital heart disease, syncope episodes of unknown etiology, uncontrolled hypertension (BP > 160/100 mm Hg), pregnant, lactating and child bearing females, females on oral contraceptives, significant renal disease; serum creatinine > 2 mg/dl, significant liver disease; SGOT/SGPT > 2 times the normal values, known hypersensitivity to ACE inhibitors or ARBs, inability to tolerate ramipril or telmisartan, or use of steroid or NSAIDs were excluded from the study.
Ahimastos and colleagues enrolled 212 patients with PAD and intermittent claudication in the double-blind trial, randomly assigning 106 to 6 months of ramipril (10 mg/d) and 106 to matching placebo.
Immediately following the completion of the first phase assessments, ramipril was added at a dose of 5 mg per day and after 2 wk up-titrated to 10 mg per day to be taken between 1200-1400 h and was continued for 6 more weeks.
1 with the Ramipril Pycnogenol combination; the latter reached statistical significance.
000 patients, no statistically significant difference with respect to malignancies was observed in patients treated with telmisartan vs ramipril.
Conversely, the group taking Pycnogenol as an adjunct to Ramipril had an average of only 39 mg per 24-hour period, a decrease of nearly double compared with anti-hypertensive medication taken alone.
On the other hand, the group taking Pycnogenol as an adjunct to Ramipril had an average of only 39 mg per 24-hour period, a decrease of nearly double compared with anti-hypertensive medication taken alone.
Intervention: Telmisartan 80 mg/day + ramipril 10 mg/day.
5 mg), the beta-blocker atenolol (50 mg) and the ACE inhibitor ramipril (5 mg), which produced average reductions in systolic and diastolic blood pressure of 7.
5 mg), atenolol (50 mg), ramipril (5 mg), simvastatin (20 mg), and aspirin (100 mg) per day, or to 8 other groups, each with about 200 individuals, of aspirin alone, simvastatin alone, hydrochlorothiazide alone, three combinations of the two blood pressurelowering drugs, three blood pressurelowering drugs alone, or three blood pressure-lowering drugs plus aspirin.