section name header

Pronunciation

ra-MI-pril

Classifications

Therapeutic Classification: antihypertensives

Pharmacologic Classification: ace inhibitors

Indications

REMS


Action

  • Angiotensin-converting enzyme (ACE) inhibitors block the conversion of angiotensin I to the vasoconstrictor angiotensin II. ACE inhibitors also prevent the degradation of bradykinin and other vasodilatory prostaglandins. ACE inhibitors also plasma renin levels and aldosterone levels. Net result is systemic vasodilation.
Therapeutic effects:
  • Lowering of BP in hypertensive patients.
  • Decreased risk of myocardial infarction, stroke, or death from cardiovascular causes in high-risk patients.
  • Increased survival and decreased heart failure progression after myocardial infarction.

Pharmacokinetics

Absorption: 50–60% absorbed following oral administration.

Distribution: Crosses the placenta; may enter breast milk.

Metabolism/Excretion: Converted by the liver to ramiprilat, the active metabolite; 60% excreted in urine; 40% in feces.

Half-Life: Ramiprilat:13–17 hr ( in renal impairment).

Time/Action Profile

(effect on BP—single dose)
ROUTEONSETPEAKDURATION
POwithin 1–2 hr3–6 hr24 hr



Full effects may not be noted for several wk.



Contraind./Precautions

Contraindicated in:

Use Cautiously in:

Adv. Reactions/Side Effects

CV: hypotension, chest pain

Derm: rashes

F and E: hyperkalemia

GI: diarrhea, nausea, vomiting

GU: impaired renal function

Neuro: dizziness, fatigue, headache, vertigo, weakness

Resp: cough

Misc: ANGIOEDEMA

Interactions

Drug-drug:

Route/Dosage

Hypertension

Heart Failure Post-Myocardial Infarction

Reduction in Risk of MI, Stroke, and Death from Cardiovascular Causes

Renal Impairment

Availability

(Generic available)

Assessment

Lab Test Considerations:

Implementation

Patient/Family Teaching

Evaluation/Desired Outcomes

US Brand Names

Altace