Normipil (ramipril): Uses, Dosage & Side Effects

What it's for (Indications)

Treatment of hypertension (mild to moderate, as well as general hypertension), reduction in the risk of myocardial infarction, stroke, or death from cardiovascular causes, and treatment of heart failure post-myocardial infarction.

Dosage Information

Type	Guideline
Standard	For hypertension, the recommended initial dose is 2.5 mg to 20 mg once daily. Adjust dosage according to blood pressure response after 2 to 4 weeks of treatment. The usual maintenance dose is 2.5 mg to 20 mg daily as a single dose or equally divided doses. For reduction in the risk of myocardial infarction, stroke, or death from cardiovascular causes, the regimen is 2.5 mg once daily for 1 week, followed by 5 mg once daily for 3 weeks, and then increased as tolerated to a maintenance dose of 10 mg once daily. For heart failure post-myocardial infarction, a starting dose of 2.5 mg twice daily is recommended; if the patient becomes hypotensive, decrease to 1.25 mg twice daily. The dose can be increased as tolerated toward a target of 5 mg twice daily, with dosage increases about 3 weeks apart. Dosage adjustments may be required in special situations, such as renal impairment.

Type

Guideline

Standard

For hypertension, the recommended initial dose is 2.5 mg to 20 mg once daily. Adjust dosage according to blood pressure response after 2 to 4 weeks of treatment. The usual maintenance dose is 2.5 mg to 20 mg daily as a single dose or equally divided doses. For reduction in the risk of myocardial infarction, stroke, or death from cardiovascular causes, the regimen is 2.5 mg once daily for 1 week, followed by 5 mg once daily for 3 weeks, and then increased as tolerated to a maintenance dose of 10 mg once daily. For heart failure post-myocardial infarction, a starting dose of 2.5 mg twice daily is recommended; if the patient becomes hypotensive, decrease to 1.25 mg twice daily. The dose can be increased as tolerated toward a target of 5 mg twice daily, with dosage increases about 3 weeks apart. Dosage adjustments may be required in special situations, such as renal impairment.

Safety & Warnings

Common Side Effects

Common side effects include headache, dizziness, cough, fatigue, and indigestion.
A small increase in serum potassium may also occur.
Please report any suspected adverse reactions to your healthcare provider.

Serious Warnings

Black Box Warning: WARNING: FETAL TOXICITY. When pregnancy is detected, discontinue ramipril as soon as possible. Drugs that act directly on the renin-angiotensin system can cause injury and death to the developing fetus.
Not recommended for use during pregnancy or lactation due to fetal toxicity risk (see black box warning).
Avoid driving or operating machinery as this medicine may affect your ability.
Avoid consuming alcohol while taking this medication.
Use with caution and is not suggested in patients undergoing hemodialysis or those with liver impairments.
Not recommended in patients with aortic stenosis or outflow obstruction.
Patients should be monitored for hyperkalemia.
Patients with a history of angioedema, particularly related to previous ACE inhibitor treatment, or with hereditary/idiopathic angioedema, require careful monitoring.

How it Works (Mechanism of Action)

Ramipril and ramiprilat inhibit Angiotensin-Converting Enzyme (ACE), preventing the conversion of angiotensin I to the potent vasoconstrictor angiotensin II. This leads to decreased vasopressor activity, reduced aldosterone secretion, and consequently, a reduction in blood pressure. This mechanism may also result in a small increase in serum potassium.