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Ramipril

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Ramipril, Altace

  • See Also
  1. ACE Inhibitor
  • Indications
  1. See ACE Inhibitor
  • Mechanism
  1. See ACE Inhibitor
  2. Non-sulfhydryl Angiotensin Converting Enzyme (ACE) inhibitor
  3. Ramipril is a prodrug, converted to its active form Ramiprilat in the liver via de-esterification
  • Dosing
  • Adults
  1. Adequate 24 hour Blood Pressure control may require twice daily dosing
  2. Hypertension
    1. Start 2.5 mg orally daily
      1. Start 1.25 mg/day in renal dysfunction or concurrent Diuretic use
    2. Target 2.5 to 20 mg orally daily or divided twice daily
    3. Maximum: 20 mg/day
  3. Congestive Heart Failure (CHF) or Post-Myocardial Infarction
    1. Start 2.5 mg orally twice daily
    2. Target 5 mg orally twice daily
  4. Cardiovascular disease (CAD, CVA) secondary prevention
    1. Start 2.5 mg orally daily for 1 week
    2. Next 5 mg orally daily for 3 weeks
    3. Titrate to target 10 mg orally daily
  5. Diabetic Nephropathy (not FDA approved)
    1. Target 10 mg orally daily
  6. Maximum 20 mg/day
  • Supplied
  1. Available as generic capsule (1.25, 2.5, 5, 10 mg)
  2. May dissolve capsules in apple sauce or in 4 ounces (120 ml) water or apple juice
    1. Stable for 24 hours at room Temperature (48 hours in refrigerator)
  • Metabolism
  1. Excretion both renal and hepatic
  • Adverse Effects
  1. See ACE Inhibitor
  • Drug Interactions
  1. See ACE Inhibitor
  2. Risk of Hypoglycemia with concurrent Insulin or Oral Hypoglycemic medications
  • Safety
  1. See ACE Inhibitor
  2. Pregnancy Category X
  3. Avoid in Lactation
  • Resources
  1. Ramipril (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=0fc34cd8-86e6-4034-73bd-4263a68ba046
  • References
  1. (2016) Presc Lett, Resource #321151, ACE Inhibitor Antihypertensive Dose Comparison
  2. (2020) Med Lett Drugs Ther 62(1598): 73-80
  3. Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 68-9
  4. Hamilton (2020) Tarascon Pocket Pharmacopoeia