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.
CNS: dizziness, fatigue, headache, vertigo, weakness.
Resp: cough.
CV: hypotension, chest pain.
GI: diarrhea, nausea, vomiting.
GU: impaired renal function.
Derm: rashes.
F and E: hyperkalemia.
Misc: 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.
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).
(effect on BP — single dose†)
†Full effects may not be noted for several wk.
