ramipriil

Ramipril is an angiotensin-converting enzyme (ACE) inhibitor used to treat high blood pressure and various heart and kidney conditions. It is a prodrug that is converted in the body to its active form, ramiprilat.

Medical uses include essential hypertension, heart failure (with or without reduced ejection fraction) as part of combination therapy, and to reduce the risk of cardiovascular events after myocardial infarction in certain patients. It is also used to slow progression of diabetic nephropathy in some individuals. The exact indications and dosing are determined by a clinician and may vary by country and patient.

Mechanism of action: ramiprilat inhibits ACE, decreasing the formation of angiotensin II and reducing aldosterone release. This leads to dilation of blood vessels, reduced blood pressure, and improved blood flow. ACE inhibition also increases bradykinin levels, which can contribute to both beneficial effects and side effects such as cough or, rarely, angioedema.

Administration and dosing: ramipril is taken by mouth and available in various strengths. Dosing is individualized and typically started at a low dose with gradual titration to a maintenance level. Common starting doses for hypertension are low; the daily dose may be adjusted up to a recommended maximum, often divided into multiple doses. Health professionals consider kidney function, age, blood pressure, and other medicines when adjusting therapy.

Side effects and contraindications: common effects include dizziness, cough, hyperkalemia, and hypotension. More serious but rare risks include angioedema and kidney function changes. Contraindications include pregnancy, bilateral renal artery stenosis, and history of ACE inhibitor-related angioedema. Caution is advised in patients with kidney impairment and in those taking potassium-sparing therapies.

Interactions and monitoring: monitor blood pressure, kidney function, and potassium levels. NSAIDs, certain diuretics, and lithium can interact with ramipril. Patients should discuss all medications and health conditions with their clinician.