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CARDIOVASCULAR SYSTEM › AGENTS ACTING ON THE RENIN-ANGIOTENSIN SYSTEM › ACE INHIBITORS, PLAIN › ACE inhibitors, plain
ramipril
C09AA05
Forms & Strengths
- Capsules: 1.25 mg
- Capsules: 2.5 mg
- Capsules: 5 mg
- Capsules: 10 mg
Adult Dosing
- Hypertension: Initial 2.5 mg once daily; maintenance 2.5 to 20 mg daily in 1 or 2 divided doses
- Heart Failure post-Myocardial Infarction: Initial 2.5 mg twice daily; titrate to target 5 mg twice daily
- Reduction in Risk of MI, Stroke, Death from CV Causes: Initial 2.5 mg once daily for 1 week, then 5 mg once daily for 3 weeks, then titrate to maintenance 10 mg once daily
Pediatric Dosing
- Safety and efficacy in pediatric patients have not been established
Indications
- Treatment of hypertension to lower blood pressure
- Reduction of myocardial infarction, stroke, and death from cardiovascular causes in patients at high risk
- Treatment of heart failure post-myocardial infarction
Mechanism of Action
- Competitive inhibition of angiotensin-converting enzyme (ACE), preventing the conversion of angiotensin I to angiotensin II
- Decreases systemic vascular resistance, lowers blood pressure, and reduces aldosterone secretion
- Suppresses the renin-angiotensin-aldosterone system (RAAS) and inhibits degradation of bradykinin
Contraindications
- History of angioedema related to previous treatment with an ACE inhibitor
- Hereditary or idiopathic angioedema
- Co-administration with aliskiren in patients with diabetes
- Do not co-administer with or within 36 hours of switching to an angiotensin receptor-neprilysin inhibitor (ARNIs like sacubitril/valsartan)
Adverse Reactions
- Dizziness
- Headache
- Fatigue
- Cough (dry, persistent)
- Hyperkalemia
- Hypotension
- Elevated serum creatinine / renal impairment
- Angioedema
Drug Interactions
- Dual blockade of the RAAS with ARBs, ACE inhibitors, or aliskiren increases risk of hypotension, hyperkalemia, and renal function changes
- Potassium supplements, potassium-sparing diuretics, or salt substitutes containing potassium increase risk of hyperkalemia
- NSAIDs may decrease the antihypertensive effect and increase the risk of renal impairment
- Lithium toxicity risk increased due to decreased renal clearance
- Mammalian target of rapamycin (mTOR) inhibitors (e.g., temsirolimus) or DPP-4 inhibitors may increase risk of angioedema
Curated Content: Needs Vetting Before Put to Clinical Use