Ramipril

Pronunciation

Ramipril 10mg

Ramipril 2.5mg

Ramipril 5mg

Generic Name:	Ramipril
Class:	Cardiovascular Drug
Subclass:	ACE inhibitor
Legal Classification:	P1S1S3

Drug Names

Generic Name 藥物化學名稱	HA Code 藥物代碼	Legal Classification法律藥物分類	Brand Name 品牌名稱
Ramipril Tablet 2.5mg	RAMI01	P1S1S3	TRITACE
Ramipril Tablet 5mg	RAMI02	P1S1S3	TRITACE

Mechanism of Action

Ramipril is an inhibitor of angiotensin-I converting enzyme (ACE inhibitor). The beneficial effects of ACE inhibitors appear to result primarily from the suppression of the plasma renin-angiotensin-aldosterone system. Renin is synthesized by the kidneys and released into the circulation where it converts angiotensinogen to angiotensin-I. Angiotensin-I is then converted by angiotensin converting enzyme to angiotensin-II. Angiotensin-II is a potent vasoconstrictor responsible for arterial vasoconstriction and increased blood pressure, as well as for stimulation of the adrenal gland to secrete aldosterone. Inhibition of ACE results in decreased plasma angiotensin-II, which leads to decreased vasopressor activity and to reduced aldosterone secretion. The latter decrease may result in an increase in serum potassium concentration. Ramipril is used in the treatment of hypertension and heart failure. Ramipril helps to reduce the risk of future strokes and heart attacks. It also improves your survival if you are taking it following for heart attack or after a heart attack. It works by widening your blood vessels and making it easier for your heart to pump blood around your body. This can improve the symptoms of heart failure.

Route of Administration

Ramipril is administered orally in a single daily dose

Dosage

Depending on why you are taking ramipril, the usual starting dose is between 1.25mg and 2.5mg once a day.

• Hypertension – 2.5mg to 5mg once a day
• Heart failure – 5mg twice a day of 10mg once a day
• Kidney disease (nephropathy) – 5mg or 10mg once a day

The maximum dose is 5mg twice a day or 10mg once a day.

When will I feel better?

The antihypertensive effect becomes apparent 1 to 2 hours after oral administration. The peak effect of a single dose is usually reached 3 to 6 hours after oral administration. The antihypertensive effect of a single dose usually lasts for 24 hours.

The maximum antihypertensive effect of continued treatment with ramipril is generally apparent after 3 to 4 weeks.

If you are taking perindopril for heart failure, it may take weeks, even months, before you feel better.

Side Effects

System Organ Class	Frequency	Adverse reactions
Nervous system disorder	Common	Dizziness, headache, vertigo
	Uncommon	Confusion
Respiratory disorders	Common	Dry, tickly (non-productive) cough, dyspnoea, bronchitis, sinusitis
Eye disorders	Common	Visual disturbances including blurred vision
Ear disorders	Rare	tinnitus
Skin disorders	Common	Itching , rash
	uncommon	angioedema
Gastro-intestinal disorders	Common	Nausea, vomiting, diarrhoea, abdominal pain, dyspepsia,
	Uncommon	Dry mouth, constipation
	Rare	pancreatitis
	rare	glossitis
Cardiac disorders	Uncommon	Palpitations, tachycardia
Vascular disorder	common	Hypotension
	Uncommon	flushing
	Rare	glossitis
Vascular disorder	Common	Hypotension
	Uncommon	flushing
	Rare	vasculitis
Musculoskeletal disorders	Common	Muscle cramps

Pharmacokinetics

Following oral administration ramipril is rapidly absorbed from the gastrointestinal tract: peak plasma concentration is reached within 1 hour. Based on urinary recovery, the extent of absorption is at least 56% and is not significantly influenced by the presence of food in the gut. The bioavailability of the active metabolite ramiprilat after oral administration of 2.5 mg and 5 mg ramipril is 45%.

Peak plasma concentrations of ramiprilat are reached 2-4 hours after ramipril intake. Steady state plasma concentrations of ramiprilat after once daily dosing with the usual doses of ramipril are reached by about the fourth day of treatment.

Metabolism

Ramipril is almost completely metabolized to ramiprilat.

Elimination

Excretion of the metabolites is primarily renal. After multiple once-daily doses of ramipril, the effective half-life of ramiprilat was 13-17 hours.

Special population

Patients with renal impairment

Renal excretion of ramiprilat is reduced in patients with impaired renal function, and renal ramiprilat clearance is proportionally related to creatinine clearance.

Patients with hepatic impairment

In patients with impaired liver function, the metabolism of ramipril to ramiprilat was delayed, and plasma ramipril levels in these patients were increased.

Drug Management

Safety: Your very first dose may make you feel dizzy, so it is best to take it at bedtime. After the first dose, if you do not feel dizzy, you can take ramipril in the morning.

PREGNANCY should be avoided in pregnancy unless essential.

BREAST FEEDING not recommended.

HEPATIC IMPAIRMENT Max. daily dose 2.5mg. Ramipril is a prodrug and requires close monitoring in patients with hepatic impairment.

RENAL IMPAIRMENT

Max. daily dose 5mg if eGFR 31-60 ml/minute/1.73 m2

Max. initial dose 1.25 mg once daily (do not exceed 5 mg daily) if eGFR < 30ml/minute/1.73 m2

MONITORING REQUIREMENTS Renal function and electrolytes should be checked before starting ACE inhibitors (or increasing the dose) and monitored during treatment (more frequently if side effects mentioned are present).

Drug Interaction:

Diuretics: prior treatment with high dose diuretics may result in volume depletion and a risk of hypotension when initiating therapy with Lisinopril. Potassium sparing diuretics (triamterene, amiloride and spironolactone) or potassium supplement: may cause significant increase in serum potassium. Co-trimoxazole (trimethoprim/sulfamethoxazole): taking concomitant co-trimoxazole may be at increased risk for hyperkalaemia

Caution:

• Concomitant diuretics – first dose hypotension (especially in patients taking high doses of diuretics, on a low-sodium diet, on dialysis, dehydrated , or with heart failure)
• Use with care in those with a history of angioedema
• Use with care in patients with severe or symptomatic aortic stenosis (risk of hypotension)

FAQ

How should I take the tablet?

You will usually take ramipril once or twice a day. Swallow ramipril tablet whole with a drink of water, with or without food. Your doctor may suggest that you take your first dose before bedtime because it can make you feel dizzy. After the very first dose, if you do not feel dizzy, take ramipril at the same time every day.

What should I avoid while taking?

Should avoid potassium rich foods: lisinopril has the capacity to increase potassium level in the blood. High levels of potassium can lead to irregular heartbeat. It is better to avoid potassium-rich foods like bananas.

What happen if I miss a dose?

If you forget to take a dose and you usually take ramipril:

• Once a day – take it as soon as you remember unless it is less than 12 hours until your next dose. In this case leave out the missed dose and take your next dose at the usual time.
• Twice a day – take it as soon as you remember unless it is less than 4 hours until your next dose. In this case leave out the missed dose and take your next dose at the usual time.

Never take 2 doses to make up for a forgotten one.