GENERIC NAME: ramipril

BRAND NAME: Altace

DRUG CLASS AND MECHANISM: Ramipril belongs in a class of drugs called angiotensin converting enzyme (ACE) inhibitors which are used for treating high blood pressure and heart failure and for preventing kidney failure due to high blood pressure and diabetes. Other ACE inhibitors are enalapril (Vasotec), quinapril (Accupril), captopril (Capoten), fosinopril (Monopril), benazepril (Lotensin), lisinopril (Zestril, Prinivil), moexipril (Univasc) and trandolapril (Mavik). ACE is important because it produces the protein, angiotensin II. Angiotensin II contracts the muscles of most arteries in the body, including the heart, thereby narrowing the arteries and elevating the blood pressure. In the kidney, the narrowing caused by angiotensin II also increases blood pressure and decreases the flow of blood. ACE inhibitors such as ramipril lower blood pressure by reducing the production of angiotensin II, thereby relaxing the arterial muscles and enlarging the arteries. The enlargement of the arteries throughout the body reduces the blood pressure against which the heart must pump blood, and it becomes easier for the heart to pump blood. The arteries supplying the heart with blood also enlarge. This increases the flow of blood and oxygen to the heart, and this improves further the ability of the heart to pump blood. The effects of ACE inhibitors are particularly beneficial to people with congestive heart failure . In the kidneys, the enlargement of the arteries also reduces blood pressure and increases blood flow. The FDA approved ramipril in 1991.

PRESCRIPTION: yes

GENERIC AVAILABLE: no

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

STORAGE: Store tablets and capsules at room temperature between 15-30°C (59-86°F).

PRESCRIBED FOR: Ramipril is used for the treatment of heart failure (congestive heart failure or CHF) and high blood pressure (hypertension). Treatment also prevents heart attacks, strokes and deaths due to heart disease. Ramipril slows the progression of kidney failure in patients with diabetes.

DOSING: The usual dose of ramipril is 2.5-20 mg a day as a single dose or two divided doses.

DRUG INTERACTIONS: The use of ACE inhibitors with potassium supplements, salt substitutes or diuretics (e.g., spironolactone ) that increase potassium in the blood may lead to excessive potassium levels. Potassium levels should be monitored whenever ace inhibitors are use in combination with these drugs. There have been reports of increased lithium (Eskalith) levels when lithium is used in combination with ACE inhibitors. The reason for this interaction is not known.

PREGNANCY: ACE inhibitors, including ramipril, are harmful to the fetus and, therefore, should not be used during pregnancy.

NURSING MOTHERS: Ramipril should not be administered to women who are breast feeding.

SIDE EFFECTS: Ramipril generally is well tolerated, and side effects are usually mild and transient. A dry, persistent cough has been reported with the use of ramipril and other ACE inhibitors. Coughing resolves after discontinuing the drug. Other side effects include abdominal pain , constipation , diarrhea , rash , dizziness , fatigue, headache , loss of taste, loss of appetite, nausea, vomiting, fainting and numbness or tingling in the hands or feet. Ramipril and other ACE inhibitors also may cause kidney failure and increased levels of potassium in the blood. The most serious but, fortunately, very rare side effects are liver failure and angioedema (swelling of lips and throat that can obstruct breathing).

Pharmacy Author: Omudhome Ogbru, Pharm.D.
Medical Editor: Jay Marks, M.D.

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