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Indications

Ramipril is suitable for the following conditions:

Hypertension lower blood pressure, as a single drug therapy or in combination with other antihypertensive drugs.

Congestive heart failure; can also be combined with diuretics.

Treats patients who show clinical symptoms of congestive heart failure in the first few days after acute myocardial infarction.

Treatment of obvious or early glomerulonephropathy that is not diabetic or diabetic.

Reduce the risk of myocardial infarction, stroke, or cardiovascular death in patients with increased cardiovascular risk, such as overt coronary artery disease (with or without history of myocardial infarction), history of stroke, history of peripheral vascular disease, or diabetes with at least one other Cardiovascular risk factors (microalbuminuria, high blood pressure, high levels of total cholesterol, low levels of high-density lipoprotein cholesterol, smoking).

Pharmacology

Ramipril is an angiotensin converting enzyme (ACE) inhibitor, which prevents the conversion of angiotensin I to the vasoconstrictor chemical angiotensin II after hydrolysis to ramiprilat. As a result, ramipril inhibits ACE, resulting in lower plasma angiotensin II levels, lower vasopressor activity, and lower aldosterone secretion. Ramipril's antihypertensive effect is thus achieved. It can also help with heart failure management and lowering the risk of stroke, myocardial infarction, and mortality from cardiovascular events. It has a lengthy half-life and is well tolerated, thus it can be used for long-term treatment.

Dosage & Administration

Dosage of Ramipril must be adjusted according to the patient tolerance and response.

Hypertension: For the management of hypertension in adults not receiving a diuretic, the usual initial dose of Ramipril is 1.25-2.5 mg once daily. Dosage generally is adjusted no more rapidly than at 2 week intervals. The usual maintenance dosage in adults is 2.5-20 mg daily given as a single dose or in 2 divided doses daily. If BP is not controlled with Ramipril alone, a diuretic may be added.

Congestive heart failure after myocardial infarction: In this case, Ramipril therapy may be initiated as early as 2 days after myocardial infarction. An initial dose of 2.5 mg twice daily is recommended, but if hypotension occurs, dose should be reduced to 1.25 mg twice daily. Therapy is then titrated to a target daily dose of 5 mg twice daily.

Prevention of major cardiovascular events: In this case, the recommended dose is 2.5 mg once daily for the first week of therapy and 5 mg once daily for the following 3 weeks; dosage then may be increased, as tolerated, to a maintenance dosage of 10 mg once daily.

Dosage in renal impairment:

For patients with hypertension and renal impairment: The recommended initial dose is 1.25 mg Ramipril once daily. Subsequent dosage should be titrated according to individual tolerance and BP response, up to a maximum of 5 mg daily.

For patients with heart failure and renal impairment: The recommended dose is 1.25 mg once daily. The dose may be increased to 1.25 mg twice daily and up to a maximum dose of 2.5 mg twice daily depending upon clinical response and tolerability.

Interaction

Concurrent use with diuretics might cause significant hypotension and, in the case of potassium sparing diuretics, hazardous hyperkalemia. Lithium concomitant medication may result in a higher serum lithium content. Reduced blood pressure can impair one's ability to drive and operate machines, which can be aggravated by drinking. NSAIDs may diminish Ramipril's antihypertensive efficacy and cause renal function to deteriorate.

Contraindications

Ramipril must not be used

in patients with hypersensitivity to ramipril, to any other ACE inhibitor, or any of the excipients of Ramipril.

in patients with a history of angioedema.

concomitantly with sacubitril/valsartan therapy. Do not initiate Ramipril until sacubitril/valsartan is eliminated from the body. In case of switch from Ramipril to sacubitril/valsartan, do not start sacubitril/valsartan until Ramipril is eliminated from the body.

in patients with haemodynamically relevant renal artery stenosis, bilateral or unilateral in the single kidney.

in patients with hypotensive or haemodynamically unstable states.

with aliskiren-containing medicines in patients with diabetes or with moderate to severe renal impairment (creatinine clearance <60 ml/min).

with angiotensin II receptor antagonists (AIIRAs) in patients with diabetic nephropathy.

during pregnancy.

Concomitant use of ACE inhibitors and extracorporeal treatments leading to contact of blood with negatively charged surfaces must be avoided, since such use may lead to severe anaphylactoid reactions. Such extracorporeal treatments include dialysis or haemofiltration with certain high-fux (e.g. polyacrylonitril) membranes and low-density lipoprotein apheresis with dextran sulfate.

Side Effects

Ramipril is well tolerated by the majority of people. Side symptoms such as dizziness, headache, fatigue, and asthenia are prevalent. Symptomatic hypotension, cough, nausea, vomiting, diarrhoea, rash, urticaria, oliguria, anxiety, and amnesia are some of the less common adverse effects. Rare cases of angioneurotic oedema, allergic responses, and hyperkalemia have been documented.

Pregnancy & Lactation

Ramipril should not be used when pregnant. As a result, pregnancy must be ruled out before beginning treatment. In circumstances where ACE inhibitor medication is required, pregnancy should be avoided. If the patient wants to become pregnant, ACE inhibitors must be stopped and replaced with a different type of medication. If the patient falls pregnant while taking Ramipril, the medication must be changed as soon as feasible with an ACE inhibitor-free therapy regimen. There is a danger of injury to the fetus if this is not done. Ramipril should not be taken when nursing.

Precautions & Warnings

Ramipril should be used with caution in patients with impaired renal function, hyperkalaemia, hypotension, and impaired hepatic function.

Therapeutic Class

Angiotensin-converting enzyme (ACE) inhibitors

Storage Conditions

Store at 30° or below, protect from light. Keep out of the reach of children. Do not use later than the date of expiry. To be dispensed only on the prescription of a registered physician.