Indications

Ramil (Ramipril) is an ACE inhibitor indicated for:

• Hypertension: To lower blood pressure, as a single agent or in combination therapy.
• Congestive Heart Failure: Also used in combination with diuretics.
• Post-myocardial Infarction: For patients who develop clinical signs of heart failure within the first few days after an acute myocardial infarction.
• Nephropathy: Treatment of non-diabetic or diabetic nephropathy.
• Cardiovascular Risk Reduction: To reduce the risk of myocardial infarction, stroke, or cardiovascular death in patients with increased cardiovascular risk.

Pharmacology

Ramipril is a prodrug that is hydrolyzed to ramiprilat, which blocks the angiotensin-converting enzyme (ACE). This leads to a decrease in angiotensin II, a potent vasoconstrictor. The result is reduced blood pressure, decreased aldosterone secretion, and overall antihypertensive activity.

Dosage & Administration

Dosage must be individualized.

• Hypertension:
  • Initial: 1.25-2.5 mg once daily.
  • Maintenance: 2.5-20 mg daily, as a single dose or in two divided doses.
• Congestive Heart Failure (post-MI): Initial dose of 2.5 mg twice daily, titrated up to 5 mg twice daily.
• Prevention of Major Cardiovascular Events: Initial dose of 2.5 mg once daily, gradually increased to a maintenance dose of 10 mg once daily.
• Renal Impairment: Initial dose is 1.25 mg once daily.
• Administration: Tablets should be swallowed whole with liquid and can be taken with or without food.

Interaction

• Diuretics: Concomitant use can lead to serious hypotension and hyperkalemia.
• Lithium: May increase serum lithium concentrations.
• NSAIDs: May reduce the antihypertensive effect and cause renal function deterioration.
• Sacubitril/Valsartan: Do not use concomitantly due to the risk of angioedema.

Contraindications

Ramipril is contraindicated in patients with:

• Hypersensitivity to ramipril or other ACE inhibitors.
• A history of angioedema.
• Hemodynamically significant renal artery stenosis.
• Hypotensive or unstable states.
• Concomitant use with aliskiren in patients with diabetes or renal impairment.
• Concomitant use with AIIRAs in patients with diabetic nephropathy.
• Pregnancy.

Side Effects

Common side effects include dizziness, headache, fatigue, and cough. Less frequent side effects include symptomatic hypotension, nausea, vomiting, diarrhea, and rash. Rare but serious side effects include angioneurotic edema and hyperkalemia.

Pregnancy & Lactation

Ramipril must not be used during pregnancy, as there is a risk of harm to the fetus. It is also not recommended during breastfeeding.

Precautions & Warnings

Use with caution in patients with:

• Impaired renal or hepatic function.
• Hyperkalemia or hypotension.
• A history of angioedema.

Overdose Effects

Overdosage may cause excessive hypotension, shock, bradycardia, and renal failure. Management includes gastric lavage and supportive measures.

Therapeutic Class

Ramil belongs to the class of Angiotensin-converting enzyme (ACE) inhibitors.

Storage Conditions

Store at or below 30°C, protected from light. Keep out of the reach of children.