ramipril

Ramipril belongs to a class of drugs called angiotensin converting enzyme (ACE) inhibitors that are used for treating high blood pressure, heart failure and for preventing kidney failure due to high blood pressure and diabetes. Other ACE inhibitors include enalapril (Vasotec), quinapril (Accupril), captopril (Capoten), fosinopril (Monopril), benazepril (Lotensin), lisinopril (Zestril, Prinivil), moexipril (Univasc), and trandolapril (Mavik).

ACE is important because it is an enzyme responsible for producing the chemical, angiotensin II. Angiotensin II causes muscles in most arteries, including the arteries of the heart, to contract, thereby narrowing the arteries and elevating blood pressure. ACE inhibitors such as ramipril lower blood pressure by reducing the production of angiotensin II, thereby relaxing arterial muscle and enlarging arteries.

When the blood pressure is lower, the heart—including the failing heart—does not have to work as hard to pump blood. The arteries supplying the heart with blood also enlarge during treatment with ACE inhibitors. This increases the flow of blood and oxygen to the heart, further improving 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 narrowing of the arteries by angiotensin II decreases blood flow. ACE inhibitors enlarge and reduce blood pressure in the arteries that supply blood to the kidneys. This reduces damage to the kidneys resulting from high blood pressure. The FDA approved ramipril in 1991.

Ramipril generally is well-tolerated, and side effects usually are mild and transient.

Common side effects include a dry, persistent cough and increased potassium in the blood (hyperkalemia). Coughing resolves after discontinuing the drug.

Other important 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.

The usual dose of ramipril for hypertension is 2.5-20 mg a day as a single dose or two divided doses. Patients taking diuretics or who have reduced kidney function may require lower doses. Heart failure is initially treated with 1.25-2.5 mg twice daily then titrated up to 10 mg once daily or 5 mg twice daily. The dose for preventing heart attacks and strokes is 2.5-10 mg daily.

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

Ramipril should not be administered to women who are breastfeeding.

What preparations of ramipril are available?

• Capsules or tablets: 1.25, 2.5, 5 and 10 mg

How should I keep ramipril stored?

• Tablets and capsules should be stored at room temperature between 15 C to 30 C (59 F to 86 F).