Ramipril

Aka: Ramipril, Altace

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II. Indications

  1. See ACE Inhibitor

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

  1. See ACE Inhibitor

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

X. Resources

  1. Ramipril (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=0fc34cd8-86e6-4034-73bd-4263a68ba046

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

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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
FPNotebook does not benefit financially from showing this medication data or their pharmacy links. This information is provided only to help medical providers and their patients see relative costs. Insurance plans negotiate lower medication prices with suppliers. Prices shown here are out of pocket, non-negotiated rates. See Needy Meds for financial assistance information. GoodRx is another tool for finding lower drug prices.

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