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. |
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.