| name | Ramipril |
| classification | ACE inhibitor (Angiotensin-Converting Enzyme inhibitor) |
| pharmacokinetics | | absorption | Ramipril is absorbed well after oral administration, with peak plasma concentrations typically reached within 1-3 hours. Bioavailability is around 50%. | | distribution | Ramipril is widely distributed throughout the body. It is metabolized to its active metabolite, ramiprilat, which is responsible for the majority of the drug's pharmacological effects. | | metabolism | Ramipril is primarily metabolized in the liver via the cytochrome P450 system. The major metabolite, ramiprilat, exhibits a longer half-life than ramipril. | | excretion | The drug and its metabolites are primarily excreted in the urine. Renal impairment can affect the excretion rate, necessitating dosage adjustments in patients with reduced kidney function. |
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| suggested dosage | | initial | Typically, ramipril is initiated at a low dose, such as 2.5 mg daily, and gradually titrated upwards to the target dosage, based on the patient's response and blood pressure control. Individualized dosages are required. | | maintenance | Maintenance doses range from 2.5 mg to 10 mg daily, depending on the patient's response. A maximum daily dose of 10 mg is often considered, but higher dosages might be used in certain situations under careful medical supervision. | | notes | Dosage adjustments may be needed for patients with renal impairment. Consult with a healthcare professional for personalized dosing. |
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| indications | | 1 | High blood pressure (hypertension) | | 2 | Heart failure | | 3 | Diabetic nephropathy | | 4 | Chronic kidney disease | | 5 | After myocardial infarction (MI) |
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| safety in pregnancy | | category d | Category D; use during pregnancy should be carefully considered only when potential benefits outweigh the risks. No known studies are available of sufficient quality to assess the risks. | | advice | Ramipril is generally not recommended for use during pregnancy, unless the benefit-risk assessment is performed by a qualified clinician. |
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| safety in breastfeeding | | caution | Ramipril may be excreted in breast milk. Use with caution in nursing mothers and potentially consider alternative therapy when feasible. |
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| side effects | | 1 | Dizziness | | 2 | Headache | | 3 | Fatigue | | 4 | Cough | | 5 | Hypotension (low blood pressure) | | 6 | Kidney problems | | 7 | Angioedema (swelling of the face, throat, or tongue) | | 8 | Hyperkalemia (high potassium levels in the blood) |
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| alternatives | |
| contraindications | | 1 | Pregnancy (unless benefit outweighs risk) | | 2 | History of angioedema | | 3 | Severe kidney impairment | | 4 | Bilateral renal artery stenosis | | 5 | Hypersensitivity to ramipril or other ACE inhibitors |
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| interactions | | 1 | Potassium-sparing diuretics | | 2 | NSAIDs | | 3 | Lithium | | 4 | Other medications that can affect blood pressure or kidney function. |
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| warnings and precautions | | 1 | Monitor blood pressure closely, especially during the first few weeks of treatment. | | 2 | Monitor kidney function regularly, especially in patients with pre-existing kidney disease. | | 3 | Monitor for signs of angioedema, such as swelling of the face, mouth, or throat. Discontinue the medication immediately if angioedema occurs. | | 4 | Avoid abrupt discontinuation of the medication. Tapering may be necessary. |
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| additional informations | | patient specific considerations | For a 25-year-old male weighing 70kg, the initial dosage and monitoring should be closely followed based on individual needs. Close supervision by a doctor is critical. | | special notes | Patients with a history of liver or kidney disease may need adjusted doses. |
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