DESCRIPTIONAn ACE inhibitor used as an adjunct to diuretics for the treatment of heart failure. It is also used to treat mild to moderate hypertension and after heart attacks to prevent disease progression in patients with heart failure.
ORIGINAL USES (ON-LABEL)
To reduce risk of cardiac events, high blood pressure, congestive heart failure, after heart attacks.
NEWLY DISCOVERED USES (OFF-LABEL)
Diabetic nephropathy
MECHANISM OF ACTION
Antihypertensive, hypoproliferative, and cardioprotective effects attributable to competitive inhibition of angiotensin-converting enzyme (ACE) yielding decreased plasma concentrations of angiotensin II, plasma aldosterone concentrations, systemic vascular resistance, blood pressure, preload, and afterload, not accompanied by changes in heart rate, pressor sensitivity to exogenous norepinephrine, or baroreceptor sensitivity.
POTENTIAL SIDE EFFECTS
Chest pain, too low blood pressure (especially after first dose), cough, fainting, headache, dizziness, fatigue, weakness, rash, abnormal taste, nausea, shortness of breath.
CAUTIONS
- Do not use if you have had tongue, lip, throat, or mouth swelling (symptoms of angioedema) after taking other drugs in the same class or if you have these symptoms unrelated to drug therapy. Angioedema can occur at any time during treatment, but especially following the first dose. Report symptoms to your doctor.
- Do not use in pregnant patients who are in the second or third trimester.
- Do not use with certain kidney problems (kidney artery stenosis, decreased kidney function).
- Avoid rapid dosage increases, which may lead to kidney problems.
Potassium supplements, cotrimoxazole (high dose), angiotension II receptor antagonists (candesartan, losartan, irbesartan, etc.) or potassium sparing diuretics (amiloride, spironolactone, triamterene), digoxin, lithium, and certain drugs used to treat diabetes (sulfonylureas). Aspirin (high doses) or indomethacin may aggravate the beneficial effects of this drug.
FOOD INTERACTIONS
Unknown
HERBAL INTERACTIONS
St. John's wort, capsaicin, dong quai, ephedra, yohimbe, ginseng, large amounts of natural licorice.
PREGNANCY AND BREAST-FEEDING CAUTIONS
FDA Pregnancy Risk Category C for first trimester. FDA Pregnancy Risk Category D for second and third trimester. Excreted in breast milk. Do not use this drug during breast-feeding.
SPECIAL INFORMATION
Report vomiting, diarrhea, excessive perspiration, or dehydration; also sore throat, fever, swelling of face, lips, tongue, or if difficulty in breathing occurs or if persistent cough develops; may cause lightheadedness during first few days of therapy; if a cough develops which is bothersome, consult physician. Capsule is usually swallowed whole but may be sprinkled on applesauce or mixed in water or juice.
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What is Altace?
Ramipril lowers blood pressure by inhibiting the production of chemicals that cause blood vessels to constrict.
Ramipril lowers blood pressure by inhibiting the production of chemicals that cause blood vessels to constrict.
BRAND NAME
Altace
GENERIC NAME
Ramipril
CHEMICAL CLASS
Angiotensin-converting enzyme (ACE) inhibitor, nonsulfhydryl
THERAPEUTIC CLASS
Blood pressure (Antihypertensive)
Altace
GENERIC NAME
Ramipril
CHEMICAL CLASS
Angiotensin-converting enzyme (ACE) inhibitor, nonsulfhydryl
THERAPEUTIC CLASS
Blood pressure (Antihypertensive)
AVAIL FORMS
Capsules — Oral 1.25 mg, 2.5 mg, 5 mg, 10 mg.
Capsules — Oral 1.25 mg, 2.5 mg, 5 mg, 10 mg.
DOSAGE
Adult and Child >16 yr
Hypertension: PO 2.5 mg qd initially (1.25 mg if on concomitant diuretic); usual maintenance dose, 2.5-20 mg qd.
Congestive heart failure (left ventricular dysfunction): PO 1.25-2.5 mg bid; max daily dose, 10 mg, usually divided.
Myocardial infarction: PO 1.25 mg initially, followed by 2.5 mg 12 hr later and full titration to 10 mg qd begun within 24 hr.
Cardiac risk reduction:PO 10 mg qd, as tolerated (HOPE Trial).
Dosage in renal failure: PO 25%-50% dosage reduction for CrCl 10-50 ml/min; 50%-75% reduction for CrCl <10 ml/min.
Adult and Child >16 yr
Hypertension: PO 2.5 mg qd initially (1.25 mg if on concomitant diuretic); usual maintenance dose, 2.5-20 mg qd.
Congestive heart failure (left ventricular dysfunction): PO 1.25-2.5 mg bid; max daily dose, 10 mg, usually divided.
Myocardial infarction: PO 1.25 mg initially, followed by 2.5 mg 12 hr later and full titration to 10 mg qd begun within 24 hr.
Cardiac risk reduction:PO 10 mg qd, as tolerated (HOPE Trial).
Dosage in renal failure: PO 25%-50% dosage reduction for CrCl 10-50 ml/min; 50%-75% reduction for CrCl <10 ml/min.