Class: ACEI, Antihypertensive
Dosage Forms. Capsule: 1.25 mg, 2.5 mg, 5 mg, 10 mg
Common FDA Label Indication, Dosing, and Titration.
1. CHF: 1.25-2.5 mg po bid × 7 d, may titrate to 5 mg po bid
2. Hypertension: 2.5 mg po daily, may titrate to 2.5-20 mg po daily
3. Myocardial infarction: 1.25-2.5 mg po bid × 7 d, may titrate to 5 mg po bid
1. Diabetic nephropathy, kidney disease: 1.25-10 mg po daily
MOA. Ramipril is a competitive ACE inhibitor. It also reduces serum aldosterone, leading to decreased sodium retention, potentiates the vasodilator kallikrein–kinin system, and can alter prostanoid metabolism, inhibit the sympathetic nervous system, and inhibit the tissue renin–angiotensin system.
Drug Characteristics: Ramipril
Medication Safety Issues: Ramipril
Drug Interactions: Ramipril
Adverse Reactions: Ramipril
Efficacy Monitoring Parameters. Decreased BP, resolution of signs/symptoms of CHF.
Toxicity Monitoring Parameters. Signs/symptoms of angioedema (swelling of the face, eyes, lips, tongue, or throat), severe persistent cough, hypotension; monitor baseline and periodic electrolytes, SCr, BUN, and urine protein.
Key Patient Counseling Points. Avoid pregnancy. Use potassium supplements or salt substitutes only under medical supervision. May cause dizziness that may worsen if dehydrated.
Clinical Pearls. Observe patients who are volume depleted for at least 2 h after taking the initial dose of ramipril. Contents of capsule may be mixed with water, apple juice, or apple sauce for administration.