II. Indications
- See ACE Inhibitor
III. Mechanism
- See ACE Inhibitor
- Non-sulfhydryl Angiotensin Converting Enzyme (ACE) inhibitor
- Ramipril is a prodrug, converted to its active form Ramiprilat in the liver via de-esterification
IV. Medications
- Ramipril oral capsules:1.25 mg, 2.5 mg, 5 mg, and 10 mg.
- Ramipril suspension (Vostally, 1 mg/ml)
- Released in 2025
V. Dosing: Adults
- Adequate 24 hour Blood Pressure control may require twice daily dosing
-
Hypertension
- Start 2.5 mg orally daily
- Start 1.25 mg/day in renal dysfunction or concurrent Diuretic use
- Target 2.5 to 20 mg orally daily or divided twice daily
- Maximum: 20 mg/day
- Start 2.5 mg orally daily
-
Congestive Heart Failure (CHF) or Post-Myocardial Infarction
- Start 2.5 mg orally twice daily
- Target 5 mg orally twice daily
- Cardiovascular disease (CAD, CVA) secondary prevention
- Start 2.5 mg orally daily for 1 week
- Next 5 mg orally daily for 3 weeks
- Titrate to target 10 mg orally daily
-
Diabetic Nephropathy (not FDA approved)
- Target 10 mg orally daily
- Maximum 20 mg/day
VI. Supplied
- Available as generic capsule (1.25, 2.5, 5, 10 mg)
- May dissolve capsules in apple sauce or in 4 ounces (120 ml) water or apple juice
- Stable for 24 hours at room Temperature (48 hours in refrigerator)
VII. Metabolism
- Excretion both renal and hepatic
VIII. Adverse Effects
- See ACE Inhibitor
IX. Drug Interactions
- See ACE Inhibitor
- Risk of Hypoglycemia with concurrent Insulin or Oral Hypoglycemic medications
X. Safety
- See ACE Inhibitor
- Pregnancy Category X
- Avoid in Lactation
XI. Resources
XII. References
- (2016) Presc Lett, Resource #321151, ACE Inhibitor Antihypertensive Dose Comparison
- (2020) Med Lett Drugs Ther 62(1598): 73-80
- Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 68-9
- Hamilton (2020) Tarascon Pocket Pharmacopoeia
Images: Related links to external sites (from Bing)
Related Studies
| ramipril (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| RAMIPRIL 1.25 MG CAPSULE | Generic | $0.09 each |
| RAMIPRIL 10 MG CAPSULE | Generic | $0.07 each |
| RAMIPRIL 2.5 MG CAPSULE | Generic | $0.06 each |
| RAMIPRIL 5 MG CAPSULE | Generic | $0.07 each |