Ramipril
Ramipril (Altace)
Ramipril
( RAM-ih-prill)
Pregnancy Category: D Altace (Rx)

Classification: Angiotensin-converting enzyme inhibitor

See Also: See also Angiotensin-Converting Enzyme Inhibitors .

Action/Kinetics: Onset: 1-2 hr. Time to peak serum levels: 1 hr (1-2 hr for ramiprilat, the active metabolite). Peak effect: 3-6 hr. Ramiprilat has approximately six times the ACE inhibitory activity than ramipril. t 1/2: 1-2 hr (13-17 hr for ramiprilat); prolonged in impaired renal function. Duration: 24 hr. Metabolized in the liver with 60% excreted through the urine and 40% in the feces. Food decreases the rate, but not the extent, of absorption of ramipril.

Uses: Alone or in combination with other antihypertensive agents (especially thiazide diuretics) for the treatment of hypertension. Treatment of CHF following MI to decrease risk of CV death and decrease the risk of failure-related hospitalization and progression to severe or resistant heart failure.

Contraindications: Lactation.

Special Concerns: Geriatric clients may manifest higher peak blood levels of ramiprilat.

Side Effects: CV: Hypotension, chest pain, palpitations, angina pectoris, orthostatic hypotension, MI, CVA, arrhythmias. GI: N&V, abdominal pain, diarrhea, dysgeusia, anorexia, constipation, dry mouth, dyspepsia, enzyme changes suggesting pancreatitis, dysphagia, gastroenteritis, increased salivation. CNS: Headache, dizziness, fatigue, insomnia, sleep disturbances, somnolence, depression, nervousness, malaise, vertigo, anxiety, amnesia, convulsions tremor. Respiratory: Cough, dyspnea, URI, asthma, bronchospasm. Hematologic: Leukopenia, anemia, eosinophilia. Rarely, decreases in hemoglobin or hematocrit. Dermatologic: Diaphoresis, photosensitivity, pruritus, rash, dermatitis, purpura, alopecia, erythema multiforme, urticaria. Body as a whole: Paresthesias, angioedema, asthenia, syncope, fever, muscle cramps, myalgia, arthralgia, arthritis, neuralgia, neuropathy, influenza, edema. Miscellaneous: Impotence, tinnitus, hearing loss, vision disturbances, epistaxis, weight gain, proteinuria, angioneurotic edema, edema, flu syndrome.

Laboratory Test Alterations: H&H.

How Supplied: Capsule: 1.25 mg, 2.5 mg, 5 mg, 10 mg

Dosage
?Capsules Hypertension.
Initial: 2.5 mg once daily in clients not taking a diuretic; maintenance: 2.5-20 mg/day as a single dose or two equally divided doses. Clients taking diuretics or who have a C _CR less than 40 mL/min/1.73 m ²: initially 1.25 mg/day; dose may then be increased to a maximum of 5 mg/day.
CHF following MI.
Initial: 2.5 mg b.i.d. Clients intolerant of this dose may be started on 1.25 mg b.i.d. The target maintenance dose is 5 mg b.i.d.