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Ramipril

 
Dental Dictionary: ramipril
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n

trade name: Altace; drug class: angiotensin-converting enzyme (ACE) inhibitor; action: selectively suppresses renin-angiotensin-aldosterone system; inhibits ACE; prevents conversion of angiotensin I to angiotensin II; results in dilation of arterial and venous vessels; uses: hypertension, alone or in combination with thiazide diuretics; congestive heart failure immediately after myocardial infarction.

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Drug Info: Ramipril
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Brand names: Altace®

Chemical formula:



Ramipril Oral capsule

What is this medicine?

RAMIPRIL is an ACE inhibitor. This medicine is used to prevent a heart attack, stroke, or other vascular event in people who are at high risk. It is also used to treat high blood pressure and heart failure after a heart attack.

This medicine may be used for other purposes; ask your health care provider or pharmacist if you have questions.

What should I tell my health care provider before I take this medicine?

They need to know if you have any of these conditions:
•diabetes
•heart or blood vessel disease
•immune system disease like lupus or scleroderma
•kidney disease
•liver disease
•low blood pressure
•previous swelling of the tongue, face, or lips with difficulty breathing, difficulty swallowing, hoarseness, or tightening of the throat
•an unusual or allergic reaction to lisinopril, other ACE inhibitors, insect venom, foods, dyes, or preservatives
•pregnant or trying to get pregnant
•breast-feeding

How should I use this medicine?

Take this medicine by mouth with a drink of water. Follow the directions on your prescription label. You may take this medicine with or without food. Take your medicine at regular intervals. Do not take more medicine than directed. Do not stop taking your medicine unless your doctor tells you to.

Talk to your pediatrician regarding the use of this medicine in children. Special care may be needed.

Overdosage: If you think you have taken too much of this medicine contact a poison control center or emergency room at once.
NOTE: This medicine is only for you. Do not share this medicine with others.

What if I miss a dose?

If it is almost time for your next dose, take only that dose. Do not take double or extra doses.

What may interact with this medicine?

•diuretics
•lithium
•NSAIDs, medicines for pain and inflammation, like ibuprofen or naproxen
•over-the-counter herbal supplements like hawthorn
•potassium supplements
•salt substitutes

This list may not describe all possible interactions. Give your health care provider a list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use. Also tell them if you smoke, drink alcohol, or use illegal drugs. Some items may interact with your medicine.

What should I watch for while using this medicine?

Visit your doctor or health care professional for regular check ups. Check your blood pressure as directed. Ask your doctor what your blood pressure should be, and when you should contact him or her. If you are diabetic, check your blood sugar as directed.

Women should inform their doctor if they wish to become pregnant or think they might be pregnant. There is a potential for serious side effects to an unborn child. Talk to your health care professional or pharmacist for more information.

Check with your doctor if you have severe diarrhea or vomiting, or if you sweat a lot or become dehydrated. The loss of body fluids can be dangerous while taking this medicine.

A few patients have had strong allergic reactions during desensitization treatment with hymenoptera venom and during some kinds of dialysis. Talk to your doctor if you are going to have either of these procedures.

If you are going to have surgery, tell your doctor or health care professional that you are taking this medicine.

What side effects may I notice from receiving this medicine?

Side effects that you should report to your doctor or health care professional as soon as possible:
•abdominal pain with or without nausea or vomiting
•allergic reactions like skin rash or hives, swelling of the hands, feet, face, lips, throat, or tongue
•dark urine
•difficulty breathing
•dizzy, lightheaded or fainting spell
•fever or sore throat
•irregular heart beat, chest pain
•numbness or tingling in fingers or toes
•pain or difficulty passing urine
•unusually weak
•yellowing of the eyes or skin

Side effects that usually do not require medical attention (report to your doctor or health care professional if they continue or are bothersome):
•change in sex drive or performance
•change in taste
•cough
•headache
•tired

This list may not describe all possible side effects. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Where should I keep my medicine?

Keep out of the reach of children.

Store at room temperature between 15 and 30 degrees C (59 and 86 degrees F). Protect from moisture. Keep container tightly closed. Throw away any unused medicine after the expiration date.

Last updated: 7/1/2002

Important Disclaimer: The drug information provided here is for educational purposes only. It is intended to supplement, not substitute for, the diagnosis, treatment and advice of a medical professional. This drug information does not cover all possible uses, precautions, side effects and interactions. It should not be construed to indicate that this or any drug is safe for you. Consult your medical professional for guidance before using any prescription or over the counter drugs.

Veterinary Dictionary: ramipril
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Home > Library > Animal Life > Veterinary Dictionary

An angiotensin-converting enzyme inhibitor used in the management of heart failure in dogs.

Wikipedia: Ramipril
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Home > Library > Miscellaneous > Wikipedia
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 This article needs additional citations for verification.
Please help improve this article by adding reliable references. Unsourced material may be challenged and removed. (November 2007)
Ramipril
Systematic (IUPAC) name
(2S,3aS,6aS)-1-[(2S)-2-{[(2S)-1-ethoxy-1-oxo-4-phenylbutan-2-yl]amino}propanoyl]-octahydrocyclopenta[b]pyrrole-2-carboxylic acid
Identifiers
CAS number 87333-19-5
ATC code C09AA05
PubChem 5362129
DrugBank APRD00009
ChemSpider 4514937
Chemical data
Formula C23H32N2O5 
Mol. mass 416.511 g/mol
SMILES eMolecules & PubChem
Pharmacokinetic data
Bioavailability 28%
Protein binding 73% (ramipril)
56% (ramiprilat)
Metabolism Hepatic, to ramiprilat
Half life 2 to 4 hours
Excretion Renal (60%) and fecal (40%)
Therapeutic considerations
Pregnancy cat.

D
Legal status

POM(UK) ℞-only(US)
Routes Oral
 Yes check.svgY(what is this?)  (verify)

Ramipril (marketed as Ramipro by Westfield Pharma in the Philippines, marketed by Sanofi-Aventis as Tritace and by King Pharmaceuticals as Altace in the United States) is an angiotensin-converting enzyme (ACE) inhibitor, used to treat hypertension and congestive heart failure. ACE inhibitors lower the production of angiotensin II, therefore relaxing arterial muscles while at the same time enlarging the arteries, allowing the heart to pump blood more easily, and increasing blood flow due to more blood being pumped into and through larger passageways.

Ramipril is a prodrug and is converted to the active metabolite ramiprilat by liver esterase enzymes.[1] Ramiprilat is mostly excreted by the kidneys. The half-life of ramiprilat is variable (3-16 hours), and is prolonged by heart and liver failure, as well as kidney failure.

It is marketed by King Pharmaceuticals under the brand name Altace. The compound was protected by the U.S. Patent 5,061,722 (was scheduled to expire on 29th Oct, 2008) assigned to Aventis. On September 11, 2007 in an appeal by Lupin Pharmaceuticals the United States Court of Appeals for the Federal Circuit reversed a district court trial verdict, finding that Aventis's patent on Altace was invalid for obviousness - opening the gate of this medicine to generic manufacturers. Ramipril is marketed in India under the brand names of Cardace, Zigpril and Zorem.

Contents

Indications

Indications for its use include:

Cautions

  • Do not take potassium supplements without seeking medical advice.
  • Do not take during pregnancy

Contraindications

Renovascular disease, severe renal impairment (especially in patients with one kidney or with bilateral renal artery stenosis), volume-depleted patients, history of angioedema while on an ACE inhibitor, pregnancy, hypotension.

Side-effects

  • may cause swelling of the mouth, tongue, or throat
  • low blood sugar in patients taking other medicine for diabetes which shows as sweating or shakiness
  • Dry cough may develop, dizziness, and light-headedness due to low blood pressure. (It is recommended to start treatment with the lowest dose.)
  • decreased sex drive
  • tiredness and fatigue especially in the early stages
  • mouth dryness in the early stages

Dose

Patients are started on the lowest dose and titrated up every 3 - 4 weeks as required.

Dosage comes in the following forms: 1.25 mg, 2.5 mg, 5 mg, 10 mg

Clinical trials

The HOPE trial [3] [4] seemed to show that ramipril possessed cardioprotective qualities which extended beyond its qualities as an anti-hypertensive. The HOPE trial and the interpretation of the results have been criticised.[5]

The AIRE trial [1] [6] showed a 27% reduction in mortality.

Ramipril was found to have similar results as telmisartan.[7]

References

  1. ^ a b Frampton JE, Peters DH (March 1995). "Ramipril. An updated review of its therapeutic use in essential hypertension and heart failure". Drugs 49 (3): 440–66. PMID 7774515. 
  2. ^ Pilote L, Abrahamowicz M, Eisenberg M, Humphries K, Behlouli H, Tu JV (May 2008). "Effect of different angiotensin-converting-enzyme inhibitors on mortality among elderly patients with congestive heart failure". CMAJ 178 (10): 1303–11. doi:10.1503/cmaj.060068. PMID 18458262. 
  3. ^ http://www.hypertensiononline.org/slides2/slide01.cfm?q=ramipril&dpg=10
  4. ^ http://ebm.bmj.com/cgi/content/extract/5/2/47
  5. ^ http://www.medscape.com/viewarticle/430926 "Debate: Do ACE Inhibitors Have Unique Properties, Beyond Their Antihypertensive Effect?"
  6. ^ "Effect of ramipril on mortality and morbidity of survivors of acute myocardial infarction with clinical evidence of heart failure. The Acute Infarction Ramipril Efficacy (AIRE) Study Investigators". Lancet 342 (8875): 821–8. October 1993. PMID 8104270. 
  7. ^ Yusuf S, Teo KK, Pogue J, et al (April 2008). "Telmisartan, ramipril, or both in patients at high risk for vascular events". N. Engl. J. Med. 358 (15): 1547–59. doi:10.1056/NEJMoa0801317. PMID 18378520. 

See also

External links

v • d • e
Antihypertensives: agents acting on the renin-angiotensin system (C09)
ACE inhibitors
("-pril")
AIIRAs/
("-sartan")
Renin inhibitors/
("-kiren")

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Copyrights:

Dental Dictionary. Mosby's Dental Dictionary. Copyright © 2004 by Elsevier, Inc. All rights reserved.  Read more
Drug Info. Gold Standard. Copyright © 2008 by Gold Standard. All rights reserved.  Read more
Veterinary Dictionary. Saunders Comprehensive Veterinary Dictionary 3rd Edition. Copyright © 2007 by D.C. Blood, V.P. Studdert and C.C. Gay, Elsevier. All rights reserved.  Read more
Wikipedia. This article is licensed under the Creative Commons Attribution/Share-Alike License. It uses material from the Wikipedia article "Ramipril".  Read more