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ramipril
Altace, Ramace‡, Tritace‡

Pregnancy Risk Category C (D in second and third trimesters)

How supplied
Capsules:
1.25 mg, 2.5 mg, 5 mg, 10 mg

Action
Unknown. Thought to be involved with inhibiting conversion of angiotensin I to angiotensin II, a potent vasoconstrictor. Reduced formation of angiotensin II decreases peripheral arterial resistance, thus decreasing aldosterone secretion.

Indications & dosage
Hypertension
--
Adults:
initially, 2.5 mg P.O. once daily for patients not receiving a diuretic, and 1.25 mg P.O. once daily for patients receiving a diuretic. Dosage increased as needed, based on patient response. Maintenance dose is 2.5 to 20 mg daily as a single dose or in divided doses.
Adjust-a-dose:
For renally impaired patients with creatinine clearance below 40 ml/minute, give 1.25 mg P.O. daily. Dosage is adjusted gradually based on response. Maximum daily dose is 5 mg.
Heart failure
--
Adults:
initially, 2.5 mg P.O. b.i.d. If hypotension occurs, dosage decreased to 1.25 mg P.O. b.i.d. Dosage may be gradually increased to maximum of 5 mg P.O. b.i.d., p.r.n.
Adjust-a-dose:
For renally impaired patients with creatinine clearance below 40 ml/minute, give 1.25 mg P.O. daily. Dosage is adjusted gradually based on response. Maximum daily dose is 2.5 mg b.i.d.

Adverse reactions
CNS:
headache, dizziness, fatigue, asthenia, malaise, light-headedness, anxiety, amnesia, depression, insomnia, nervousness, neuralgia, neuropathy, paresthesia, somnolence, tremor, vertigo, syncope.
CV:
heart failure, orthostatic hypotension, angina, chest pain, palpitations, MI, edema.
EENT:
epistaxis, tinnitus.
GI:
nausea, vomiting, abdominal pain, anorexia, constipation, diarrhea, dyspepsia, dry mouth, gastroenteritis.
GU:
impotence, elevated BUN and creatinine levels.
Hematologic:
decreased hemoglobin and hematocrit level.
Hepatic:
elevated liver enzyme and bilirubin levels.
Metabolic:
hyperglycemia, hyperkalemia, weight gain.
Musculoskeletal:
arthralgia, arthritis, myalgia.
Respiratory:
dyspnea; dry, persistent, tickling, nonproductive cough.
Skin:
hypersensitivity reactions, rash, dermatitis, pruritus, photosensitivity, increased diaphoresis.
Other:
elevated uric acid levels.

Interactions
Drug-drug.
Diuretics: excessive hypotension, especially at start of therapy. Discontinue diuretic at least 3 days before therapy begins, increase sodium intake, or reduce starting dose of ramipril.
Insulin, oral antidiabetics:
risk of hypoglycemia, especially at start of ramipril therapy. Monitor closely.
Lithium:
increased serum lithium levels. Use together cautiously and monitor serum lithium levels.
Potassium-sparing diuretics, potassium supplements:
increased risk of hyperkalemia because ramipril attenuates potassium loss. Monitor plasma potassium levels closely.
Drug-food.
Salt substitutes containing potassium: increased risk of hyperkalemia because ramipril attenuates potassium loss. Monitor plasma potassium levels closely.

Effects on diagnostic tests
None reported.

Contraindications
Contraindicated in patients with hypersensitivity to ACE inhibitors or history of angioedema related to treatment with an ACE inhibitor.

Nursing considerations

Patient teaching

*Liquid contains alcohol. **May contain tartrazine.  †Canada  ‡Australia  §U.K.  OTCOver the counter
Reactions may be common, uncommon, life-threatening, or COMMON AND LIFE-THREATENING

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