ramipril, Altace (cont.)
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:
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.
Combining ramipril or other ACE inhibitors with NSAIDs in patients who are elderly, volume-depleted (including those on diuretic therapy), or with poor kidney function may result in reduced kidney function, including kidney failure. These effects usually are reversible.
Nitritoid reactions (symptoms include facial flushing, nausea, vomiting and low blood pressure [hypotension]) may occur when injectable gold (sodium aurothiomalate), used in the treatment of rheumatoid arthritis, is combined with ACE inhibitors, including ramipril.
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 breastfeeding.
SIDE EFFECTS: Ramipril generally is well-tolerated, and side effects usually are 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. Individuals with bilateral renal artery stenosis (narrowing of the arteries going to the both kidneys) should not take ramipril or other ACE inhibitors because they may develop kidney failure. The most serious but, fortunately, very rare side effects are liver failure and angioedema (swelling of lips and throat that can obstruct breathing).
Reference: FDA Prescribing Information
Last Editorial Review: 4/1/2013
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