Therapeutic Classification: antihypertensives
Pharmacologic Classification: ace inhibitors
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).
Contraindicated in:
- Hypersensitivity;
- History of angioedema with previous use of ACE inhibitors;
- Concurrent use with aliskiren in patients with diabetes or moderate-to-severe renal impairment (CCr <60 mL/min);
- Concurrent use with sacubitril;
- OB: Can cause injury or death of fetus—if pregnancy occurs, discontinue immediately;
- Lactation: Discontinue drug or use formula.
Use Cautiously in:
- Black patients (monotherapy for hypertension less effective, may require additional therapy; higher risk of angioedema);
- Surgery/anesthesia (hypotension may be exaggerated);
- Women of childbearing potential;
- Renal impairment (especially renal artery stenosis), hypovolemia, hyponatremia, concurrent diuretic therapy–initial dose ↓ recommended;
- Pedi: Safety not established;
- Geri: Initial dose ↓ recommended.
Exercise Extreme Caution in:
- Family history of angioedema.
Hypertension
- PO (Adults ): 2.5 mg once daily, slowly may be ↑ up to 20 mg/day in 1–2 divided doses (initiate therapy at 1.25 mg/day in patients receiving diuretics).
Heart Failure Post-Myocardial Infarction
- PO (Adults ): 1.25–2.5 mg twice daily initially, may be ↑ slowly up to 5 mg twice daily.
Reduction in Risk of MI, Stroke, and Death from Cardiovascular Causes
- PO (Adults ): 2.5 mg once daily for 1 wk, then 5 mg once daily for 3 wk, then ↑ as tolerated to 10 mg once daily (can also be given in 2 divided doses).
Renal Impairment
- PO (Adults ): CCr <40 mL/min: Initiate therapy at 1.25 mg once daily, may be slowly titrated up to 5 mg/day in 1–2 divided doses.
