Classifications: angiotensin-converting enzyme (ace) inhibitor; antihypertensive; Therapeutic: antihypertensive; ace inhibitor
Pregnancy Category: C first trimester; D second and third trimester
1.25 mg, 2.5 mg, 5 mg, 10 mg capsules
Reduces peripheral vascular resistance by inhibiting the formation of angiotensin II, a potent vasoconstrictor. Inhibition
of ACE also decreases serum aldosterone levels and reduces peripheral arterial resistance (afterload) as well as improves
cardiac output and exercise tolerance.
Lowers BP, and improves cardiac output as well as exercise tolerance.
Mild to moderate hypertension, CHF.
Hypersensitivity to ramipril or any other ACE inhibitor, patients with history of angioneurotic edema; jaundice; hyperkalemia;
pregnancy (category C first trimester and category D second and third trimester), lactation.
Impaired kidney or liver function, surgery or anesthesia; CHF. Safety and effectiveness in children are not established.
Route & Dosage
Adult: PO 2.55 mg q.d., may increase up to 20 mg/d in 12 divided doses
- Discontinue diuretics 23 d before initiation of drug. Limit initial dose to 1.25 mg if diuretics cannot be discontinued.
- Store at 15°30° C (59°86° F) and protect from moisture.
Adverse Effects (≥1%)CNS:
, headache. GI:
Nausea, vomiting, diarrhea
, eructation. Metabolic:
Hyperkalemia, hyponatremia. Skin: Erythema
, pruritus. Body as a Whole: Angioedema. Respiratory:
InteractionsDrug: potassium-sparing diuretics
may increase risk of hyperkalemia. May, elevate, serum lithium
levels, resulting in lithium toxicity
may attenuate antihypertensive effects.
60% absorbed from GI tract. Onset:
2 h. Peak:
68 h. Duration:
Up to 24 h. Distribution:
Crosses placenta; not known if distributed into breast milk. Metabolism:
Rapidly metabolized in liver to its active metabolite
, ramiprilat. Elimination:
4060% in urine, 40% in feces. Half-Life:
Assessment & Drug Effects
- Monitor BP at time of peak effectiveness, 36 h after dosing and at end of dosing interval just before next dose.
- Report diminished antihypertensive effect.
- Monitor for first-dose hypotension, especially in salt- or volume-depleted persons.
- Lab tests: Monitor BUN and serum creatinine periodically. Increases may necessitate dose reduction or discontinuation of
drug. Monitor serum potassium values.
- Observe for S&S of hyperkalemia (see Appendix F).
Patient & Family Education
- Discontinue drug and report S&S of angioedema to physician (e.g., swelling of face or extremities, difficulty breathing
- Maintain adequate fluid intake and avoid potassium supplements or salt substitutes unless specifically prescribed by the