II. Indications

III. Mechanism

  1. See ACE Inhibitor
  2. Non-sulfhydryl Angiotensin Converting Enzyme (ACE) inhibitor
  3. Ramipril is a prodrug, converted to its active form Ramiprilat in the liver via de-esterification

IV. Dosing: Adults

  1. Adequate 24 hour Blood Pressure control may require twice daily dosing
  2. Hypertension
    1. Start 2.5 mg orally daily
      1. Start 1.25 mg/day in renal dysfunction or concurrent Diuretic use
    2. Target 2.5 to 20 mg orally daily or divided twice daily
    3. Maximum: 20 mg/day
  3. Congestive Heart Failure (CHF) or Post-Myocardial Infarction
    1. Start 2.5 mg orally twice daily
    2. Target 5 mg orally twice daily
  4. Cardiovascular disease (CAD, CVA) secondary prevention
    1. Start 2.5 mg orally daily for 1 week
    2. Next 5 mg orally daily for 3 weeks
    3. Titrate to target 10 mg orally daily
  5. Diabetic Nephropathy (not FDA approved)
    1. Target 10 mg orally daily
  6. Maximum 20 mg/day

V. Supplied

  1. Available as generic capsule (1.25, 2.5, 5, 10 mg)
  2. May dissolve capsules in apple sauce or in 4 ounces (120 ml) water or apple juice
    1. Stable for 24 hours at room Temperature (48 hours in refrigerator)

VI. Metabolism

  1. Excretion both renal and hepatic

VII. Adverse Effects

VIII. Drug Interactions

  1. See ACE Inhibitor
  2. Risk of Hypoglycemia with concurrent Insulin or Oral Hypoglycemic medications

IX. Safety

  1. See ACE Inhibitor
  2. Pregnancy Category X
  3. Avoid in Lactation

XI. References

  1. (2016) Presc Lett, Resource #321151, ACE Inhibitor Antihypertensive Dose Comparison
  2. (2020) Med Lett Drugs Ther 62(1598): 73-80
  3. Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 68-9
  4. Hamilton (2020) Tarascon Pocket Pharmacopoeia

Images: Related links to external sites (from Bing)

Related Studies

Cost: Medications

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

Ontology: Ramipril (C0072973)

Definition (NCI) A prodrug and nonsulfhydryl angiotensin converting enzyme (ACE) inhibitor with antihypertensive activity. Ramipril is converted in the liver by de-esterification into its active form ramiprilat, which inhibits ACE, thereby blocking the conversion of angiotensin I to angiotensin II. This abolishes the potent vasoconstrictive actions of angiotensin II and leads to vasodilatation. This agent also causes an increase in bradykinin levels and a decrease in angiotensin II-induced aldosterone secretion by the adrenal cortex, thereby promoting diuresis and natriuresis.
Definition (MSH) A long-acting angiotensin-converting enzyme inhibitor. It is a prodrug that is transformed in the liver to its active metabolite ramiprilat.
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D017257
SnomedCT 108564000, 386872004
LNC LP171634-1
English Ramipril, Cyclopenta(b)pyrrole-2-carboxylic acid, 1-(2-((1-(ethoxycarbonyl)-3-phenylpropyl)amino)-1-oxopropyl)octahydro-, (2S-(1(R*(R*)),2alpha,3abeta,6abeta))-, ramipril, ramipril (medication), RAMIPRIL, Ramipril [Chemical/Ingredient], Ramipril (product), Ramipril (substance)
Swedish Ramipril
Czech ramipril
Finnish Ramipriili
Russian RAMIPRIL, РАМИПРИЛ
Japanese ラミプリル
Croatian RAMIPRIL
Polish Ramipryl
Spanish ramipril (producto), ramipril (sustancia), ramiprilo, ramipril, Ramipril
French Ramipril
German Ramipril
Italian Ramiprile
Portuguese Ramipril

Ontology: Altace (C0878061)

Definition (CHV) brand name of a high blood pressure medication
Definition (CHV) brand name of a high blood pressure medication
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D017257
English Altace, tritace, altace [brand name], altace, triatec, Triatec, Tritace, Astra Brand of Ramipril, Aventis Brand of Ramipril, Aventis Pharma Brand of Ramipril, Delix, Hoechst Brand of Ramipril, Monarch Brand of Ramipril, Ramace, Zabien, Acovil