Ramipril

Ramipril is oral angiotensin-converting enzyme (ACE) inhibitor used in the treatment of hypertension, heart failure. Ramipril is actually an inactive prodrug that is converted in the liver to itat, the active moiety, whose antihypertensive activity is sufficiently long to allow for once-daily administration. The pharmacodynamic characteristics of it most closely resemble those of benazepril, fosinopril, and quinapril, all of which are prodrugs. The active metabolite, itat, competes with angiotensin-converting enzyme for the substrate angiotensin I, blocking its conversion to angiotensin II, which is a potent vasoconstrictor and negative-feedback mediator for renin activity. Lower levels of angiotensin II produce a drop in blood pressure and a rise in plasma renin. It also inhibits Kininase II (identical to ACE), an enzyme that degrades bradykinin, a potent vasodilator, to inactive peptides, resulting in increased bradykinin levels. Bradykinin-induced vasodilation is thought to be of secondary importance in the blood-pressure lowering effect. A bradykinin mechanism may, however, contribute to ACE-inhibitor-induced angioneurotic edema.


Adult Dose
Dose: 2.5 mg
Single Dose: 2.5 (2.5)
Frequency: 24 hourly
Route: PO
Instructions: Initially in 1-2 div.doses.
Neonatal
Dose:
Single Dose:
Frequency:
Route:
Instructions: Not recommended in this age group
Paedriatic
Dose:
Single Dose:
Frequency:
Route:
Instructions: Not recommended in this age group
Characteristics
. It is of Synthetic origin and belongs to Phenylproplycarboxy acid. It belongs to Angiotensin converting enzyme inhibitor-ACEI pharmacological group on the basis of mechanism of action and also classified in Antihypertensive Agents pharmacological group.The Molecular Weight of Ramipril is 416.50. Its pKa is 3.1, 5.6.
Contraindications
Ramipril is contraindicated in conditions like Salt depletion,Hypotension,Arterial stenosis.
Effects
The severe or irreversible adverse effects of Ramipril, which give rise to further complications include Angioedema.Ramipril produces potentially life-threatening effects which include Renal failure, Hypotension. which are responsible for the discontinuation of Ramipril therapy.The signs and symptoms that are produced after the acute overdosage of Ramipril include Hypotension, Renal insufficiency.The symptomatic adverse reactions produced by Ramipril are more or less tolerable and if they become severe, they can be treated symptomatically, these include Dizziness, Headache, Diarrhea, Rashes, Nausea and vomiting.
Indications
Ramipril is primarily indicated in conditions like Benign gastric ulcer associated with H.pylori, Congestive heart failure (adjunct), Gastric acid reduction during anaesthesia, Heart failure, Hypertension, Iron deficiency anaemia, Mild to moderate hypertension, Prophylaxis of cardiovascular events/stroke.
Interactions
Ramipril is known to interact with other drugs, the details of drug interactions is as follows:DrugDetailsSeverityOnsetManagementAlcoholAlprostadilEnhanced hypotensive effects when alprostadil given with ACE inhibitors (e.g Ramipril)IndomethacinLithiumTelmisartanWhen co-administering telmisartan and ramipril, the response may be greater because of the possibly additive pharmacodynamic effects of the combined drugs, and also because of the increased exposure to ramipril and ramiprilat in the presence of telmisartan.Moderate These interactions are sometimes beneficial and sometimes may pose threats to life. Always consult your physician for the change of dose regimen or an alternative drug of choice that may strictly be required.
Interfrence
Tests for Renin Concentrations
Risks
Drug should not be given to Paediatrics, Pregnant Mothers, patients suffering from Kidney dysfunction, Geriatrics, and Neonates.If prescribing authority justifies the benefits of the drug against the possible damages he/she should reevaluate them and consult the reference material and previous studies.
Storage
Caps Store Below 40°C. Protect from Sunlight and Moisture.
Warnings
Ramipril should be used with caution in patients with a history of angioedema, high blood levels of potassium, kidney disease or kidney dialysis, salt restrictive diet or liver disease. Consult the doctor before using salt substitutes or low salt milk. Get up slowly, to avoid dizziness and lightheadedness when rising from a seated or lying position. Limit intake of alcohol and use caution when exercising or during hot weather as these can aggravate dizziness and lightheadedness. It should be used only when clearly needed during the first three months of pregnancy, it is not recommended for use during the last six months of the pregnancy. Caution is advised when this is used in children and elderly.
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