Ramipril
Therapeutic Class: Cardiovascular (Angiotensin-converting enzyme (ACE) inhibitors)
Indications:
Ramipril is indicated in the following cases-
Ramipril 1.25: Each film-coated tablet contains Ramipril BP 1.25 mg.
Ramipril 2.5: Each film-coated tablet contains Ramipril BP 2.5 mg.
Ramipril 5: Each film-coated tablet contains Ramipril BP 5 mg.
Ramipril 10: Each film-coated tablet contains Ramipril BP 10 mg.
Description:
Ramipril is an angiotensin-converting enzyme (ACE) inhibitor, which after hydrolysis to ramiprilat, blocks the conversion of angiotensin-I to the vasoconstrictor substance, angiotensin II. So, inhibition of ACE by ramipril results in decreased plasma angiotensin II, which leads to decreased vasopressor activity and decreased aldosterone secretion. Thus ramipril exerts its antihypertensive activity. It is also effective in the management of heart failure and reduction of the risk of stroke, myocardial infarction and death from cardiovascular events. It is long-acting and well-tolerated; so, can be used in long term therapy.
Dosage & Administration:
The dosage of Ramipril must be adjusted according to the patient tolerance and response.
Hypertension: For the management of hypertension in adults not receiving a diuretic, the usual initial dose of Ramipril is 1.25 - 2.5 mg once daily. Dosage generally is adjusted no more rapidly than at 2-week intervals. The usual maintenance dosage in adults is 2.5 - 20 mg daily given as a single dose or in 2 divided doses daily. If BP is not controlled with Ramipril alone, a diuretic may be added.
Congestive heart failure after myocardial infarction: In this case, Ramipril therapy may be initiated as early as 2 days after myocardial infarction. An initial dose of 2.5 mg twice daily is recommended, but if hypotension occurs, the dose should be reduced to 1.25mg twice daily. Therapy is then titrated to a target daily dose of 5 mg twice daily.
Prevention of major cardiovascular events: In this case, the recommended dose is 2.5 mg once daily for the first week of therapy and 5 mg once daily for the following 3 weeks; dosage then may be increased, as tolerated, to a maintenance dosage of 10 mg once daily.
Dosage in renal impairment: For patients with hypertension and renal impairment, the recommended initial dose is 1.25 mg Ramipril once daily. Subsequent dosage should be titrated according to individual tolerance and BP response, up to a maximum of 5 mg daily. For patients with heart failure and renal impairment, the recommended dose is 1.25 mg once daily. The dose may be increased to 1.25 mg twice daily and up to a maximum dose of 2.5 mg twice daily depending upon clinical response and tolerability.
Side Effects:
Ramipril is generally well tolerated. Dizziness, headache, fatigue and asthenia are commonly reported side effects. Other side effects occurring less frequently include symptomatic hypotension, cough, nausea, vomiting, diarrhoea, rash, urticaria, oliguria, anxiety, amnesia etc. Angioneurotic oedema, anaphylactic reactions and hyperkalemia have also been reported rarely.
Precautions:
Ramipril should be used with caution in patients with impaired renal function, hyperkalemia, hypotension, surgery/anaesthesia and impaired hepatic function.
Use in Pregnancy & Lactation:
Pregnancy: Pregnancy should be excluded before the start of treatment with Ramipril and avoided during treatment. However, if pregnancy is detected, Ramipril should be discontinued as early as possible unless continued use is considered life-saving.
Lactation: Ramipril should not be used during lactation.
Use in children
No information is yet available on the use of Ramipril in children.
Overdose:
Limited data on human overdosage are available. The most likely clinical manifestations would be symptoms attributable to hypotension. Because the hypotensive effect of Ramipril is achieved through vasodilation and effective hypovolemia, it is reasonable to treat Ramipril overdosage by infusion of normal saline solution.
Ramipril is indicated in the following cases-
- Mild to severe hypertension, where it may be used alone or in combination with thiazide diuretics.
- Congestive heart failure.
- To reduce the risk of stroke, myocardial infarction and death from cardiovascular events in patients with a history of cardiovascular disease.
- Proteinuric non-diabetic nephropathy.
Ramipril 1.25: Each film-coated tablet contains Ramipril BP 1.25 mg.
Ramipril 2.5: Each film-coated tablet contains Ramipril BP 2.5 mg.
Ramipril 5: Each film-coated tablet contains Ramipril BP 5 mg.
Ramipril 10: Each film-coated tablet contains Ramipril BP 10 mg.
Description:
Ramipril is an angiotensin-converting enzyme (ACE) inhibitor, which after hydrolysis to ramiprilat, blocks the conversion of angiotensin-I to the vasoconstrictor substance, angiotensin II. So, inhibition of ACE by ramipril results in decreased plasma angiotensin II, which leads to decreased vasopressor activity and decreased aldosterone secretion. Thus ramipril exerts its antihypertensive activity. It is also effective in the management of heart failure and reduction of the risk of stroke, myocardial infarction and death from cardiovascular events. It is long-acting and well-tolerated; so, can be used in long term therapy.
Dosage & Administration:
The dosage of Ramipril must be adjusted according to the patient tolerance and response.
Hypertension: For the management of hypertension in adults not receiving a diuretic, the usual initial dose of Ramipril is 1.25 - 2.5 mg once daily. Dosage generally is adjusted no more rapidly than at 2-week intervals. The usual maintenance dosage in adults is 2.5 - 20 mg daily given as a single dose or in 2 divided doses daily. If BP is not controlled with Ramipril alone, a diuretic may be added.
Congestive heart failure after myocardial infarction: In this case, Ramipril therapy may be initiated as early as 2 days after myocardial infarction. An initial dose of 2.5 mg twice daily is recommended, but if hypotension occurs, the dose should be reduced to 1.25mg twice daily. Therapy is then titrated to a target daily dose of 5 mg twice daily.
Prevention of major cardiovascular events: In this case, the recommended dose is 2.5 mg once daily for the first week of therapy and 5 mg once daily for the following 3 weeks; dosage then may be increased, as tolerated, to a maintenance dosage of 10 mg once daily.
Dosage in renal impairment: For patients with hypertension and renal impairment, the recommended initial dose is 1.25 mg Ramipril once daily. Subsequent dosage should be titrated according to individual tolerance and BP response, up to a maximum of 5 mg daily. For patients with heart failure and renal impairment, the recommended dose is 1.25 mg once daily. The dose may be increased to 1.25 mg twice daily and up to a maximum dose of 2.5 mg twice daily depending upon clinical response and tolerability.
Side Effects:
Ramipril is generally well tolerated. Dizziness, headache, fatigue and asthenia are commonly reported side effects. Other side effects occurring less frequently include symptomatic hypotension, cough, nausea, vomiting, diarrhoea, rash, urticaria, oliguria, anxiety, amnesia etc. Angioneurotic oedema, anaphylactic reactions and hyperkalemia have also been reported rarely.
Precautions:
Ramipril should be used with caution in patients with impaired renal function, hyperkalemia, hypotension, surgery/anaesthesia and impaired hepatic function.
Use in Pregnancy & Lactation:
Pregnancy: Pregnancy should be excluded before the start of treatment with Ramipril and avoided during treatment. However, if pregnancy is detected, Ramipril should be discontinued as early as possible unless continued use is considered life-saving.
Lactation: Ramipril should not be used during lactation.
Use in children
No information is yet available on the use of Ramipril in children.
Overdose:
Limited data on human overdosage are available. The most likely clinical manifestations would be symptoms attributable to hypotension. Because the hypotensive effect of Ramipril is achieved through vasodilation and effective hypovolemia, it is reasonable to treat Ramipril overdosage by infusion of normal saline solution.
Store at a cool & dry place, protect from light and moisture.
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