Ramipril


Generic Medicine Info
Administration
May be taken with or without food.
Contraindications
History of angioedema (e.g. hereditary, idiopathic, due to previous angioedema with ACE inhibitors or angiotensin II receptor antagonists [AIIRAs]); extracorporeal treatments resulting to contact of blood with negatively charged surfaces (e.g. dialysis or haemofiltration with certain high-flux membranes [e.g. polyacrylonitril membranes] and low-density lipoprotein apheresis with dextran); haemodynamically relevant bilateral renal artery stenosis or unilateral in the single kidney; hypotensive or haemodynamically unstable states. Concurrent use with aliskiren in patients with diabetes mellitus or moderate to severe renal impairment (GFR <60 mL/min/1.73 m2); concurrent use or within 36 hours of shifting to or from sacubitril/valsartan. Pregnancy and lactation.
Special Precautions
Patients with severe hypertension, decompensated CHF; relevant left ventricular inflow or outflow impediment (e.g. aortic or mitral valve stenosis), hypertrophic cardiomyopathy with outflow tract obstruction, unstented unilateral or bilateral renal artery stenosis, volume or salt depletion, liver cirrhosis and/or ascites; transient or persistent heart failure post-MI, ischaemic heart disease or cerebrovascular disease, uncontrolled diabetes mellitus, hypoaldosteronism, acute cardiac decompensation, metabolic acidosis, collagen disease (e.g. SLE or scleroderma); history of airway surgery. Dehydrated patients. Patient undergoing major surgery or during anaesthetics. Desensitisation treatment (e.g. hymenoptera venom). Black race. Renal and hepatic impairment. Elderly. Patient Counselling This drug may cause dizziness, if affected, do not drive or operate machinery. Monitoring Parameters Evaluate renal function and electrolytes before and during treatment. Monitor blood pressure, BUN, serum creatinine, K levels and Na levels; CBC with differentials. Monitor for signs of angioedema. Assess pregnancy status prior to therapy.
Adverse Reactions
Significant: Angioedema (e.g. head and neck angioedema, intestinal angioedema), hyperkalaemia, hypotension (with or without syncope, orthostatic), cholestatic jaundice, syndrome of inappropriate antidiuretic hormone (SIADH), hyponatraemia; rarely, haematologic effects (e.g. neutropenia or agranulocytosis, thrombocytopenia, anaemia); cough, renal impairment and/or increase in serum creatinine, anaphylactoid/anaphylactic reactions. Cardiac disorders: Chest pain, arrhythmia. Gastrointestinal disorders: Nausea, vomiting, diarrhoea, dry mouth, gastrointestinal inflammation, digestive disturbances, abdominal discomfort, dyspepsia, constipation, dysgeusia. General disorders and administration site conditions: Asthenia, fatigue. Musculoskeletal and connective tissue disorders: Myalgia, muscle spasm. Nervous system disorders: Headache, dizziness, paraesthesia, vertigo. Respiratory, thoracic and mediastinal disorders: Bronchitis, sinusitis, dyspnoea. Skin and subcutaneous tissue disorders: Maculopapular rash, alopecia.
Potentially Fatal: Rarely, pancreatitis, airway obstruction (due to angioedema of the tongue, glottis or larynx), fulminant hepatic necrosis, Stevens-Johnson syndrome, toxic epidermal necrolysis.
Drug Interactions
May increase risk for angioedema with mammalian target of rapamycin (mTOR) inhibitors (e.g. everolimus, sirolimus, temsirolimus), dipeptidyl peptidase-4 (DPP-4) inhibitors (e.g. vildagliptin), neutral endopeptidase (NEP) inhibitor (e.g. racecadotril). May increase risk for hyperkalaemia with K salts, K-sparring diuretics, other drugs that increase K levels (e.g. heparin, trimethoprim/sulfamethoxazole, tacrolimus, ciclosporin). May increase risk of hypotension with other antihypertensive drugs (e.g. diuretics), other drugs that decrease blood pressure (e.g. anaesthetic, alfuzosin, baclofen, doxazosin, nitrates, prazosin, TCAs, tamsulosin, terazosin). May have decreased antihypertensive effect with vasopressor sympathomimetics and other drugs (e.g. dobutamine, dopamine, epinephrine, isoproterenol). May increase risk for haematologic reactions with allopurinol, cytostatics, corticosteroids, immunosuppressants, procainamide, other drugs that alter blood cell count. May increase serum levels and toxicity of lithium. May increase risk for hypoglycaemia with antidiabetic drugs (e.g. insulin). Reduced antihypertensive effect, increased risk of worsening renal function and increased serum K levels with NSAIDs.
CIMS Class
ACE Inhibitors/Direct Renin Inhibitors
ATC Classification
C09AA05 - ramipril ; Belongs to the class of ACE inhibitors. Used in the treatment of cardiovascular disease.
Disclaimer: This information is independently developed by CIMS based on ramipril from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to CIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, CIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2021 CIMS. All rights reserved. Powered by CIMSAsia.com
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