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Ramipril

Generic name: Ramipril
Brand names: Altace

Why is Ramipril prescribed?

Ramipril is used in the treatment of high blood pressure. It is effective when used alone or in combination with other high blood pressure medications, especially thiazide-type water pills (diuretics). Ramipril works by preventing the conversion of a chemical in your blood called angiotensin I into a more potent substance that increases salt and water retention in your body. It also enhances blood flow in your circulatory system. It is a member of the group of drugs called ACE inhibitors.

Ramipril is also prescribed to reduce the chances of heart attack, stroke, and heart-related death in people 55 years or older who are in danger of such an event. Typical candidates include those who suffer from coronary artery disease, poor circulation, stroke, or diabetes and have at least one other risk factor, such as high blood pressure, high cholesterol levels, low HDL ("good") cholesterol, or cigarette smoking.

If you do suffer a heart attack and develop heart failure, Ramipril can be prescribed to prevent the condition from getting worse.

Most important fact about Ramipril

If you are taking Ramipril for high blood pressure, you must take the drug regularly for it to be effective. Since blood pressure declines gradually, it may be several weeks before you get the full benefit of Ramipril; and you must continue taking it even if you are feeling well. Ramipril does not cure high blood pressure; it merely keeps it under control.

How should you take Ramipril?

Take Ramipril exactly as prescribed by your doctor. If you have difficulty swallowing the capsule, you can sprinkle the contents on a small amount (about 4 ounces) of applesauce, or mix the contents with 4 ounces of water or apple juice. Be sure to eat or drink the entire mixture so that you get the full dose of the drug. You can prepare the mixture ahead of time; it will keep for 24 hours at room temperature or 48 hours in the refrigerator.

--If you miss a dose...

If you forget to take a dose, take it as soon as you remember. If it is almost time for your next dose, skip the one you missed and go back to your regular schedule. Never take 2 doses at the same time.

--Storage instructions...

Store Ramipril at room temperature in a tightly closed container.

What side effects may occur?

Side effects cannot be anticipated. If any develop or change in intensity, inform your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue taking Ramipril.

• More common side effects may include:
  Chest pain, cough (in people with high blood pressure), dizziness, low blood pressure (in people with congestive heart failure)

People prescribed the drug after a heart attack may also experience light-headedness when standing; more severe heart failure is also a possibility.

Why should Ramipril not be prescribed?

If you are sensitive to or have ever had an allergic reaction to Ramipril, or if you have a history of swelling of the face, tongue, or throat while taking similar drugs such as Capoten, Vasotec, and Zestril, you should not take Ramipril. Make sure that your doctor is aware of any drug reactions that you have experienced.

Special warnings about Ramipril

If you develop swelling of the face around your lips, tongue, or throat or difficulty swallowing, difficulty breathing, swelling of arms and legs, or infection, sore throat, and fever, you should contact your doctor immediately. You may have a serious side effect of the drug and need emergency treatment.

If you develop abdominal pain with or without nausea and vomiting, contact your doctor. ACE inhibitors such as Ramipril have been known to cause intestinal swelling.

If you are taking Ramipril, your kidney function should be given a complete assessment and should continue to be monitored.

If you notice your skin or the whites of your eyes turning yellow, notify your doctor. Your liver may be affected, and you may have to stop taking Ramipril. Your doctor should routinely test your liver function while you are on Ramipril.

Ramipril should be used with caution if you have impaired kidney function, since rare cases of kidney failure have been reported. Also use caution if you have impaired liver function, or if you have a connective tissue disease such as lupus erythematosis or scleroderma.

If you are taking diuretics and Ramipril, or have congestive heart failure, you may develop excessively low blood pressure.

Do not use salt substitutes containing potassium or potassium supplements without consulting your doctor. Ramipril can cause increased potassium levels in your blood, especially if you have diabetes and kidney problems.

Light-headedness can occur when taking Ramipril, especially during the first days of therapy, and should be reported to your doctor. If fainting occurs, stop taking the medication and notify your doctor immediately.

Dehydration, excessive sweating, severe diarrhea, or vomiting could deplete your body"s fluids, causing your blood pressure to drop dangerously.

Ramipril may reduce the number of infection-fighting white blood cells in your bloodstream, especially if you have a kidney problem or a connective tissue disorder such as lupus. Contact your doctor immediately if you develop a sore throat or fever, which could be a sign of this condition.

ACE inhibitors such as Ramipril have been known to cause severe allergic reactions in people undergoing desensitization therapy with bee or wasp venom. These drugs have also caused severe reactions in kidney dialysis patients.

Possible food and drug interactions when taking Ramipril

If Ramipril is taken with certain other drugs, the effects of either could be increased, decreased, or altered. It is especially important to check with your doctor before combining Ramipril with the following:

Alcohol
Diuretics such as hydrochlorothiazide (found in many blood pressure medicines)
Diuretics that don"t wash out potassium, such as spironolactone (Aldactone) and the diuretic component in Dyazide, Maxzide, Moduretic, and others
Lithium (Eskalith, Lithobid)
Nonsteroidal anti-inflammatory drugs such as Motrin, Naprosyn, and Orudis
Oral diabetes drugs such as DiaBeta, Glucotrol, Micronase, and Orinase
Potassium supplements such as K-lyte and K-Tab
Potassium-containing salt substitutes

Special information if you are pregnant or breastfeeding

When used during the second and third trimesters, Ramipril can lead to birth defects, prematurity, and death in developing and newborn babies. If you are pregnant or plan to become pregnant and are taking Ramipril, Ramipril should be discontinued as soon as possible. Contact your doctor immediately. Ramipril may appear in breast milk and could affect a nursing infant. If Ramipril is essential to your health, your doctor may advise you to avoid breastfeeding.

Recommended dosage

ADULTS

As a precaution, your doctor may have you take the first dose of Ramipril in his office. To reduce the risk of a severe drop in blood pressure, the dosage of any diuretic you"re taking should be reduced or, if possible, eliminated.

High blood pressure

For patients not on diuretics, the usual starting dose is 2.5 milligrams, taken once daily. After blood pressure is under control, the dosage will range from 2.5 to 20 milligrams a day in a single dose or divided into 2 equal doses. If Ramipril proves insufficient, the doctor may then add a diuretic.

Heart attack and stroke prevention

Patients usually receive 2.5 milligrams once a day for the first week. The dose is then increased to 5 milligrams once a day for the next 3 weeks, and to as much as 10 milligrams daily for the long term. The doctor may recommend dividing each dose into two smaller ones if you have high blood pressure or are recovering from a recent heart attack.

Heart failure after a heart attack

The usual starting dose is 2.5 milligrams taken twice a day. If your blood pressure drops severely, your doctor will reduce the dose to 1.25 milligrams, then slowly increase it back to the starting dose, aiming for a maintenance dose of 5 milligrams twice a day.

If you have kidney problems, your doctor may
prescribe a lower than normal dose.

CHILDREN

The safety and effectiveness of Ramipril in children have not been established.

Overdosage

Any medication taken in excess can have serious consequences. If you suspect an overdose, seek medical attention immediately.

Symptoms of low blood pressure are likely to be the primary warning of an Ramipril overdose.