Ramipril(ra mi’ pril)
Altace
PREGNANCY CATEGORY D
Drug Classes
ACE inhibitor
Antihypertensive
Therapeutic Actions
Ramipril blocks ACE from converting angiotensin I to angiotensin II, a powerful vasoconstrictor, leading to decreased BP, decreased aldosterone secretion, a small increase in serum potassium levels, and sodium and fluid loss; increased prostaglandin synthesis also may be involved in the antihypertensive action.
Indications
Treatment of hypertension alone or in combination with thiazide-type diuretics
Treatment of HF in stable patients in the first few days after MI
To decrease the risk of MI, stroke, death from CV disease in patients 55 yr and older who are at risk for developing CAD
Contraindications and Cautions
Contraindicated with allergy to ramipril, pregnancy (embryocidal in preclinical studies).
Use cautiously with impaired renal function, HF, salt or volume depletion, lactation.
Available Forms
Capsules—1.25, 2.5, 5, 10 mg
Dosages
Adults
Hypertension: Initial dose, for patients not on a diuretic, 2.5 mg PO daily. Adjust dosage according to BP response, usually 2.5–20 mg/day as a single dose or in two equally divided doses. If BP is not controlled, a diuretic may be added.
HF: Initial dose, 2.5 mg PO bid; if patient becomes hypotensive, 1.25 mg PO bid may be used while adjusting up to target dose of 5 mg PO bid; increase dose every 3 wk until target dose is reached. Discontinue diuretic 2–3 days before beginning therapy; if not possible, administer initial dose of 1.25 mg.
Decrease risk of CV events: Initial dose, 2.5 mg PO once daily for 1 wk, then 5 mg PO once daily for next 3 wk; for maintenance, 10 mg PO daily.
Pediatric patients
Safety and efficacy not established.
Geriatric patients
Greater sensitivity to drug effects is possible.
Patients with renal impairment
Excretion is reduced in renal failure. Use smaller initial dose: 25% of normally used dose is suggested; for hypertension, 1.25 mg PO daily in patients with CrCl less than 40 mL/min; dosage may be titrated upward until pressure is controlled or a maximum of 5 mg/day.
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