Pharmacy Author: Omudhome Ogbru, PharmD
Medical and Pharmacy Editor: Jay W. Marks, MD

GENERIC NAME: ramipril

BRAND NAME: Altace

DRUG CLASS AND MECHANISM: Ramipril belongs in a class of drugs called angiotensin converting enzyme (ACE) inhibitors. ACE inhibitors are used for treating high blood pressure, 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 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 the blood pressure in the arteries going to the kidney. This reduces damage to the kidneys caused by high blood pressure. The FDA approved ramipril in 1991.

PRESCRIPTION: Yes

GENERIC AVAILABLE: Yes

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

STORAGE: Tablets and capsules should be stored at room temperature between 15-30 C (59-86 F).

PRESCRIBED FOR: Ramipril is used for the treatment of congestive heart failure (CHF) and hypertension (high blood pressure). Ramipril also prevents heart attacks, strokes and deaths due to heart disease in patients who have risk factors for such events. After a heart attack, ramipril reduces progression to severe or resistant heart failure, hospitalization related to heart failure, and heart disease-related death. Like other ACE inhibitors, ramipril may slow the progression of kidney failure in patients with hypertension or diabetes by reducing the damage to the kidneys caused by high blood pressure.

DOSING: The usual dose of ramipril is 2.5-20 mg a day as a single dose or two divided doses. Patients taking diuretics or who have renal artery stenosis (narrowing of the arteries going to the kidney) may require lower doses.

DRUG INTERACTIONS: The use of ACE inhibitors with potassium supplements, salt substitutes or diuretics [for example, spironolactone (Aldactone) that increase potassium in the blood may lead to excessive potassium levels. Potassium levels should be monitored whenever ACE inhibitors are used in combination with these drugs.

There have been reports of increased lithium (Eskalith, Lithobid) levels when lithium is used in combination with ACE inhibitors. The reason for this interaction is not known.

There have been reports that aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen (Advil, Children's Advil/Motrin, Medipren, Motrin, Nuprin, PediaCare Fever etc), indomethacin (Indocin, Indocin-SR), and naproxen (Anaprox, Naprelan, Naprosyn, Aleve) may reduce the effects of ACE inhibitors.

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).

Suggested Reading by Our Doctors

• ACE Inhibitors - Read about ACE inhibitors like Altace, lisinopril, enalapril, ramparil, Zestril and more. Information includes side effects, drug interactions, and pregnancy safety information.
• Kidney Failure - Learn about kidney failure, in which the body has fluid retention, risen blood pressure, toxin build up and lack of red blood cells. Symptoms include fatigue, nausea, and apetite loss.
• lisinopril, Zestril, Prinivil - Explains the medication lisinopril (Zestril, Prinivil) an ACE inhibitor drug used to treat elevated blood pressure and heart failure.

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