RAMIPRIL

COMMON BRAND NAME(S): Altace

GENERIC NAME(S): RAMIPRIL

Description: Ramipril, an angiotensin-converting enzyme (ACE) inhibitor, resulting in increased plasma renin activity and reduced aldosterone (a hormone that causes water and Na retention) secretion. This promotes relaxation of the blood vessels and lowering the blood pressure.

Onset: 1-2 hr.

Duration: 24 hr.

Pharmacokinetics:

Absorption: Well absorbed from the GI tract (50-60%). Bioavailability: 28% (ramipril); 44% (ramiprilat). Time to peak plasma concentration: 2-4 hr (ramiprilat).

Distribution: Plasma protein binding: Approx 56% (ramiprilat); 73% (ramipril).

Metabolism: Undergoes enzymatic saponification by esterases to form ramiprilat (active metabolite).

Excretion: Mainly via urine (60%, as ramiprilat); faeces (approx 40%). Elimination half-life: 13-17 hr (ramiprilat).

Uses

Ramipril is used to treat high blood pressure (hypertension). Lowering high blood pressure helps prevent strokes, heart attacks, and kidney problems. Ramipril is also used to improve survival after a heart attack. It may also be used in high risk patients (such as patients with heart disease/diabetes) to help prevent heart attacks and strokes. This medication may also be used to treat heart failure in patients who have had a recent heart attack.

Ramipril is an ACE inhibitor and works by relaxing blood vessels so that blood can flow more easily.

OTHER USES:

This medication may also be used to help protect the kidneys from harm due to diabetes.

How to use ramipril:

Take this medication by mouth with or without food as directed by your doctor, usually once or twice daily.

If you are taking the capsule form of ramipril, swallow it whole. If you have difficulty swallowing the capsule, the capsule may be opened and the contents sprinkled onto cool applesauce (about 4 ounces) or mixed in half a glass of water or apple juice (4 ounces/120 milliliters). Swallow or drink the whole mixture.

The dosage is based on your medical condition and response to treatment.

To reduce your risk of side effects, your doctor may direct you to start this medication at a low dose and gradually increase your dose. Follow your doctor’s instructions carefully.

Use this medication regularly in order to get the most benefit from it. To help you remember, take it at the same time(s) each day. It is important to continue taking this medication even if you feel well. Most people with high blood pressure do not feel sick.

For the treatment of high blood pressure, it may take several weeks before you get the full benefit of this medication. Tell your doctor if your condition does not improve or if it worsens (such as your blood pressure readings remain high or increase).

Warnings

This drug can cause serious (possibly fatal) harm to an unborn baby if used during pregnancy. Therefore, it is important to prevent pregnancy while taking this medication. Consult your doctor for more details and to discuss the use of reliable forms of birth control while taking this medication. If you are planning pregnancy, become pregnant, or think you may be pregnant, contact your doctor immediately.

Pregnancy Risk: Category D (Positive evidence of risk)

Side Effects

Dizziness, lightheadedness, or tiredness may occur as your body adjusts to the medication. Dry cough may also occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.

Tell your doctor right away if any of these unlikely but serious side effects occur:

fainting,
symptoms of a high potassium blood level (such as muscle weakness, slow/irregular heartbeat),
signs of infection (such as fever, chills, persistent sore throat),
change in the amount of urine.

This drug may rarely cause serious (possibly fatal) liver problems. Tell your doctor right away if you notice any of the following rare but serious side effects: yellowing eyes/skin, dark urine, severe stomach/abdominal pain, persistent nausea/vomiting.

A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

Precautions

Precautions:

Before taking ramipril, tell your doctor or pharmacist if you are allergic to it; or to other ACE inhibitors (such as benazepril); or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

Before using this medication, tell your doctor or pharmacist your medical history, especially of: history of an allergic reaction which included swelling of the face/lips/tongue/throat (angioedema), blood filtering procedures (such as LDL apheresis, dialysis), high level of potassium in the blood, collagen vascular disease (such as lupus, scleroderma).

This drug may make you dizzy. Do not drive, use machinery, or do any activity that requires alertness until you are sure you can perform such activities safely. Limit alcoholic beverages.

To reduce the risk of dizziness and lightheadedness, get up slowly when rising from a sitting or lying position.

Too much sweating, diarrhea, or vomiting may cause loss of too much body water (dehydration) and increase your risk of lightheadedness. Report prolonged diarrhea or vomiting to your doctor. Be sure to drink enough fluids to prevent dehydration unless your doctor directs you otherwise.

Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).

This product may increase your potassium levels. Before using potassium supplements or salt substitutes that contain potassium, consult your doctor or pharmacist.

Older adults may be more sensitive to the side effects of this drug, including dizziness and increases in potassium level.

This medication is not recommended for use during pregnancy. It may harm an unborn baby. Consult your doctor for more details. (See also Warning section.)

It is unknown if this medication passes into breast milk. Consult your doctor before breast-feeding.

Interactions:

Overdose & Brands

Overdose:

If overdose is suspected, contact a poison control center or emergency room immediately.

Notes

Do not share this medication with others.

Lifestyle changes such as stress reduction programs, exercise and dietary changes may increase the effectiveness of this medicine. Talk to your doctor or pharmacist about lifestyle changes that might benefit you.

Laboratory and/or medical tests (such as kidney function, potassium levels) should be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details.

Check your blood pressure regularly while taking this medication. Learn how to monitor your own blood pressure at home, and share the results with your doctor.

Missed Dose

If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose and resume your usual dosing schedule. Do not double the dose to catch up.

Storage

Store at room temperature away from light and moisture. If you are taking the capsule form of ramipril and have opened the capsule and mixed the contents with food or liquid, then the mixture can be kept at room temperature for up to 24 hours or refrigerated for up to 48 hours. Do not store in the bathroom. Keep all medications away from children and pets.

Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.

Brands:

Available Brands

Kardia [ Kyung Dong Pharm ]
Ramipro [ InnoGen Pharmaceuticals ]
Tritace [ sanofi-aventis ]

Also marketed as

Amipril [ Bal Pharma ]
Sanofi Pasteur Ramipril [ Sanofi Pasteur ]