BMA Concise Guide to Medicine & Drugs

Ramipril

Brand name Tritace

Used in the following combined preparations Triapin, Triapin mite

QUICK REFERENCE

Drug group ACE inhibitor and drug for hypertension

Overdose danger rating Medium

Dependence rating Low

Prescription needed Yes

Available as generic Yes

GENERAL INFORMATION

Ramipril belongs to the group of drugs known as ACE inhibitors. It works by reducing the production of substances that raise blood pressure, making the blood vessels relax and making it easier for the heart to pump blood. The drug is used to treat high blood pressure, to reduce strain on the heart in patients with heart failure after a heart attack, and to prevent future strokes and heart attacks in patients with established cardiovascular disease. It is also used to treat heart failure from other causes and to preserve kidney function in conditions such as diabetes mellitus. The first dose of an ACE inhibitor can cause blood pressure to drop suddenly, so a few hours’ bed rest afterwards is advisable.

Side effects are usually mild. Like all ACE inhibitors, ramipril can cause the body to retain potassium. It can also cause a persistent dry cough.

INFORMATION FOR USERS

Your drug prescription is tailored for you. Do not alter dosage without checking with your doctor.

How taken/used Tablets, capsules.

Frequency and timing of doses High blood pressure Usually once daily. Heart failure or after heart attack 1–2 x daily

Adult dosage range High blood pressure, heart failure or after a heart attack 1.25–10mg daily.

Onset of effect Within 2 hours; full beneficial effect may take several weeks.

Duration of action Up to 24 hours.

Diet advice Your doctor may advise you to decrease your salt intake to help control your blood pressure.

Storage Keep in original container at room temperature out of the reach of children.

Missed dose Take as soon as you remember. If your next dose is due within 6 hours, take a single dose now and skip the next. Subsequently, continue with your usual routine.

Stopping the drug Do not stop taking the drug without consulting your doctor. Treatment of hypertension and heart failure is normally lifelong, it may be necessary to substitute alternative therapy.

Exceeding the dose If you notice any unusual symptoms or if a large overdose has been taken, notify your doctor.

POSSIBLE ADVERSE EFFECTS

Ramipril can cause a variety of side effects but most are mild and transient. All adverse effects should be notified to your doctor. A mild rash and a dry cough are common. Sometimes the cough is persistent, which may necessitate withdrawal of the drug. Less commonly, ramipril may cause mouth ulcers, a sore mouth, dizziness, sore throat, or fever. Rarely, it may cause deterioration of kidney function, digestive tract disturbances, a severe rash, or severe swelling of the mouth or lips accompanied by breathing difficulties. If you develop swelling of the mouth or lips and/or breathing difficulties, you should stop taking the drug and seek immediate medical attention.

INTERACTIONS

Non-steroidal anti-inflammatory drugs (NSAIDs) may reduce the blood-pressure-lowering effect of ramipril and increase the risk of kidney damage.

Potassium supplements and potassium-sparing diuretics may cause excess levels of potassium in the body.

Ciclosporin and tacrolimus increase the risk of high potassium levels in the blood.

Lithium Ramipril may cause raised blood lithium levels and toxicity.

Vasodilators, diuretics, and other antihypertensives may increase the blood-pressure-lowering effect of ramipril.

SPECIAL PRECAUTIONS

Be sure to tell your doctor if:

· You have long-term liver or kidney problems.

· You have heart problems.

· You have had angioedema or a previous allergic reaction to ACE inhibitors.

· You are taking other medicines.

· You are pregnant or intend to become pregnant.

Pregnancy Not prescribed. There is evidence of harm to the developing fetus.

Breast-feeding Safety not established. Discuss with your doctor.

Infants and children Not recommended.

Over 60 Reduced dose may be necessary.

Driving and hazardous work Avoid such activities until you have learned how ramipril affects you because the drug can cause dizziness and fainting.

Alcohol Avoid. Alcohol may increase the blood-pressure-lowering and adverse effects of the drug.

Surgery and general anaesthetics Ramipril may have to be stopped before you have a general anaesthetic. Discuss with your doctor or dentist before any operation.

PROLONGED USE

No problems expected.

Monitoring Periodic checks on potassium levels, white blood cell count, kidney function, and urine are usually performed.