Ramipril Editor's Pick

Ramipril (Altace) is an ACE inhibitor. ACE stands for angiotensin converting enzyme. Ramipril is used
to treat high blood pressure (hypertension) or congestive heart failure, and to improve survival after
a heart attack. Ramipril may also be used for purposes not listed in this medication guide.
Important...

Ramipril Prescribing Information

Dosage Form: capsule Indications and Usage for Ramipril Hypertension Ramipril Capsules, USP are
indicated for the treatment of hypertension. They may be used alone or in combination with thiazide
diuretics. Ramipril Dosage and Administration Hypertension The recommended initial dose for
patients not...

What is ramipril?

Ramipril (Altace) is an ACE inhibitor. ACE stands for angiotensin converting enzyme.

Ramipril is used to treat high blood pressure (hypertension) or congestive heart failure, and to
improve survival after a heart attack.

Ramipril may also be used for purposes not listed in this medication guide.

Before taking this medicine

You should not use this medicine if you are allergic to ramipril or to any other ACE inhibitor, such as
benazepril, captopril, fosinopril, enalapril, lisinopril, moexipril, perindopril, quinapril, or trandolapril.

You may also need to avoid taking ramipril with aliskiren if you have kidney disease.

To make sure ramipril is safe for you, tell your doctor if you have:

kidney disease (or if you are on dialysis);

liver disease;

diabetes

a connective tissue disease such as Marfan syndrome, Sjogren's syndrome, lupus, scleroderma, or
rheumatoid arthritis; or

if you are also taking telmisartan (Micardis).

Do not use if you are pregnant. If you become pregnant, stop taking this medicine and tell your
doctor right away. Ramipril can cause injury or death to the unborn baby if you take the medicine
during your second or third trimester. Use effective birth control.

It is not known whether ramipril passes into breast milk or if it could harm a nursing baby. You
should not breast-feed while using this medicine. How should I take ramipril?

Take ramipril exactly as prescribed by your doctor. Follow all directions on your prescription label.
Your doctor may occasionally change your dose. Do not take this medicine in larger or smaller
amounts or for longer than recommended.
Ramipril can be taken with or without food.

Swallow the tablet whole.

You may open the capsule and sprinkle the medicine into a half-cup (4 ounces) of water, apple juice,
or applesauce to make swallowing easier. Swallow without chewing. You may store the mixture for

up to 24 hours at room temperature, or up to 48 hours in a refrigerator.

Call your doctor if you have ongoing vomiting or diarrhea, or if you are sweating more than usual.
You can easily become dehydrated while taking ramipril. This can lead to very low blood pressure,
electrolyte disorders, or kidney failure.

Your blood pressure will need to be checked often, and you may need frequent blood tests to check
your potassium levels.

Drink plenty of water each day while you are taking this medication.

If you need surgery, tell the surgeon ahead of time that you are using ramipril. You may need to stop
using the medicine for a short time.

If you are being treated for high blood pressure, keep using this medication even if you feel well.
High blood pressure often has no symptoms. You may need to use blood pressure medication for the
rest of your life.

Store at room temperature away from moisture, heat, and light. Keep the bottle tightly closed when
not in use

Usual Adult Dose for Hypertension

Initial dose: 2.5 mg orally once a day for patients not taking a diuretic

Maintenance dose: 2.5 to 20 mg/day in one or two equally divided doses

Comments:

-Adjust dose according to blood pressure response.

-The antihypertensive effect may diminish toward the end of a once daily dosing interval; consider
increasing dose or twice daily administration.

-If blood pressure is not controlled with this drug alone, a diuretic may be added.

Use: Treatment of hypertension, to lower blood pressure, alone or in combination with a thiazide
diuretic.

Usual Adult Dose for Congestive Heart Failure

Initial dose: 2.5 mg orally twice a day

Maintenance dose: 5 mg orally twice a day

Comments:

-If possible, decrease concomitant diuretic dose to reduce likelihood of hypotension.

-After first initial dose, observe at least two hours and until blood pressure has stabilized at least an
additional hour.
-If patient becomes hypotensive on initial dose, reduce to 1.25 mg twice a day.

-After one week on initial dose, increase toward maintenance dose as tolerated; may increase about
every 3 weeks.

-Initial hypotension does not preclude subsequent titration with this drug, following effective
hypotension management.

Use: Treatment of stable patients who have demonstrated clinical signs of congestive heart failure
within the first few days after sustaining acute myocardial infarction.

Usual Adult Dose for Cardiovascular Risk Reduction

Initial dose: 2.5 mg orally once a day for one week; 5 mg orally once a day for next three weeks, then
increase as tolerated

Maintenance dose: 10 mg orally once a day

Comments:

-If patient is hypertensive or recently post myocardial infarction, may administer in divided doses.

Use: Reduce the risk of myocardial infarction, stroke, or death from cardiovascular causes in patients
55 years or older at high risk of developing a major cardiovascular event because of a history of
coronary artery disease, stroke, peripheral vascular disease, or diabetes that is accompanied by at
least one other cardiovascular risk factor (hypertension, elevated total cholesterol levels, low high-
density lipoprotein (HDL) levels, cigarette smoking, or documented microalbuminuria); can be used
in addition to other needed treatment such as antihypertensive, antiplatelet, or lipid lowering
therapy.

Renal Dose Adjustments

CrCl 40 mL/min or less: Reduce usual dose by 25%

CrCl less than 90 mL/min and hypertension: Initial dose: 1.25 mg orally once a day; may titrate up
until blood pressure controlled or to maximum dose of 5 mg/day.

CrCl less than 90 mL/min and heart failure: Initial dose: 1.25 mg orally once a day; may increase to
1.25 mg twice daily and to maximum dose of 2.5 mg twice daily.

Renal artery stenosis: Initial dose: 1.25 mg orally once a day

Ramipril Side Effects

In Summary

Commonly reported side effects of ramipril include: hypotension and increased cough. See below for
a comprehensive list of adverse effects.

For the Consumer

Applies to ramipril: oral capsule, oral tablet

As well as its needed effects, ramipril may cause unwanted side effects that require medical
attention.

Major Side Effects

If any of the following side effects occur while taking ramipril, check with your doctor immediately:

More common:

Blurred vision

confusion

dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position

sweating

unusual tiredness or weakness

Less common:

Arm, back, or jaw pain

chest pain or discomfort

chest tightness or heaviness

chills

cloudy urine

cold sweats

decrease in urine output or decrease in urine-concentrating ability

fainting

fast or irregular heartbeat

nausea

shortness of breath

Minor Side Effects

Some ramipril side effects may not need any medical attention. As your body gets used to the
medicine these side effects may disappear. Your health care professional may be able to help you
prevent or reduce these side effects, but do check with them if any of the following side effects
continue, or if you are concerned about them:

More common:

Cough

Less common:

Diarrhea

feeling of constant movement of self or surroundings

sensation of spinning

vomiting
For Healthcare Professionals

Applies to ramipril: oral capsule, oral tablet

General

The most common adverse reaction is hypotension.[Ref]

Cardiovascular

Very common (10% or more): Hypotension (11%)

Common (1% to 10%): Angina pectoris, postural hypotension, orthostatic blood pressure decreased

Uncommon (0.1% to 1%): Symptomatic hypotension, myocardial ischemia, myocardial infarction,

tachycardia, arrhythmia, palpitation, flushing

Rare (less than 0.1%): Vascular stenosis, hypoperfusion, vasculitis

Frequency not reported: Disturbed orthostatic regulation, Raynaud's phenomenon[Ref]

Gastrointestinal

Common (1% to 10%): Nausea, vomiting, diarrhea, gastrointestinal inflammation, digestive

disturbances, abdominal discomfort, dyspepsia

Uncommon (0.1% to 1%): Pancreatitis, pancreatic enzymes increased, abdominal pain, small bowel
angioedema, gastritis, constipation, dry mouth

Rare (less than 0.1%): Glossitis

Frequency not reported: Dysphagia, gastroenteritis, increased salivation, gastric pain, aphthous
stomatitis

Common medications checked in combination with ramipril

Aspirin Low Strength (aspirin)

CoQ10 (ubiquinone)

Crestor (rosuvastatin)

Cymbalta (duloxetine)

Fish Oil (omega-3 polyunsaturated fatty acids)

Januvia (sitagliptin)

Lantus (insulin glargine)

Lasix (furosemide)

Lipitor (atorvastatin)

Lyrica (pregabalin)

Metoprolol Succinate ER (metoprolol)

 Metoprolol Tartrate (metoprolol)

Nexium (esomeprazole)

Paracetamol (acetaminophen)

Plavix (clopidogrel)

Synthroid (levothyroxine)

Vitamin B12 (cyanocobalamin)

Vitamin C (ascorbic acid)

Vitamin D3 (cholecalciferol)

Zetia (ezetimibe)

ramipril alcohol/food Interactions

There is 1 alcohol/food interaction with ramipril

ramipril disease Interactions

There are 8 disease interactions with ramipril which include:

Angioedema

Bone Marrow Suppression

Chf

Hemodialysis

Hyperkalemia

Hypotension

Liver Disease

Renal Dysfunction

Ramipril side effects

Get emergency medical help if you have any signs of an allergic reaction to ramipril: hives; severe
stomach pain; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have:

a light-headed feeling, like you might pass out;

chest pain;

little or no urination, or urinating more than usual;

sudden weakness or ill feeling, fever, chills, sore throat, painful mouth sores, pain when
swallowing, skin sores, cold or flu symptoms; or

high potassium - nausea, slow or unusual heart rate, weakness, loss of movement. Common
ramipril side effects may include
 headache;

cough; or

dizziness, weakness, tired feeling.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice
about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Ramipril dosing information

Usual Adult Dose for Diabetic Nephropathy:

Initial dose: 2.5 mg orally once a day for patients not receiving a diuretic

Maintenance dose: 2.5 to 20 mg/day orally in 1 to 2 divided doses

Usual Adult Dose for Hypertension:

Initial dose: 2.5 mg orally once a day for patients not receiving a diuretic

Maintenance dose: 2.5 to 20 mg/day orally in 1 to 2 divided doses

Usual Adult Dose for Congestive Heart Failure:

Initial dose: 2.5 mg orally twice a day

Maintenance dose: 5 mg orally twice a day

Usual Adult Dose for Left Ventricular Dysfunction:

Initial dose: 2.5 mg orally twice a day

Maintenance dose: 5 mg orally twice a day

Usual Adult Dose for Myocardial Infarction:

Initial dose: 2.5 mg orally twice a day

Maintenance dose: 5 mg orally twice a day

What other drugs will affect ramipril?

Other drugs may interact with ramipril, including prescription and over-the-counter medicines,
vitamins, and herbal products. Tell each of your health care providers about all medicines you use
now and any medicine you start or stop using.