Omudhome Ogbru, PharmD
Omudhome Ogbru, PharmD
Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.
Medical and Pharmacy Editor:
GENERIC NAME: ramipril
BRAND NAME: Altace
DRUG CLASS AND MECHANISM: 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.
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 C to 30 C (59 F to 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 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.
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.
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