Ramipril

Ramipril is a medication from a group of drugs called ACE inhibitors that is used to treat high blood pressure, heart failure, and diabetic kidney disease. It is also used to prevent cardiovascular disease in people at high risk. It is a useful first-line treatment for high blood pressure. It is taken by mouth and requires a prescription.

Pharmacodynamics

Ramipril inhibits the RAAS system by binding to and inhibiting ACE, thereby preventing the conversion of angiotensin I to angiotensin II. As plasma levels of angiotensin II decrease, there is less activation of the G-protein-coupled angiotensin receptors AT1 and AT2. AT1 in particular is involved in processes that increase blood pressure, which is why patients with persistently elevated blood pressure benefit from ACE inhibition.

Pharmacokinetics

Ramipril is approximately 60% absorbed in the gastrointestinal tract. Plasma protein binding of ramipril is approximately 73%. Ramipril is metabolized in the liver and 60% is excreted in the urine and 40% in the stool. The elimination half-life is 9-18 hours.

Drug Interactions

Some products that may interact with this drug are:

• Aliskiren
• medicines that weaken the immune system/increase the risk of infection (like everolimus, sirolimus)
• lithium
• medicines that can increase blood potassium levels (like ARBs including losartan/valsartan, birth control pills that contain drospirenone)
• Sacubitril
• Telmisartan

Some products have ingredients that may increase your blood pressure or worsen your heart failure: especially cough and cold medicines, diet medicines, or NSAIDs such as ibuprofen/naproxen.

Side effects

Common side effects are headache, dizziness, tiredness and cough.

Serious side effects may include liver problems, angioedema, kidney problems, and high blood potassium.

Use during pregnancy and lactation is not recommended.

Toxicological data

LD50 (rat, i.v.): 600 mg-kg-1