Ramipril

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Generic Name: Ramipril Brand Name(s): Generics only. No brands available.

Uses

What is Ramipril used for?

Ramipril is used to treat high blood pressure (hypertension). Lowering high blood pressure helps prevent strokes, heart attacks, and kidney problems. Ramipril is also used to improve survival after a heart attack. It may also be used in high risk patients (such as patients with heart disease/diabetes) to help prevent heart attacks and strokes. This medication may also be used to treat heart failure in patients who have had a recent heart attack.

Ramipril is an ACE inhibitor and works by relaxing blood vessels so that blood can flow more easily.

How should I take Ramipril?

Take this medication by mouth with or without food as directed by your doctor, usually once or twice daily.

If you are taking the capsule form of ramipril, swallow it whole. If you have difficulty swallowing the capsule, the capsule may be opened and the contents sprinkled onto cool applesauce (about 4 ounces) or mixed in half a glass of water or apple juice (4 ounces/120 milliliters). Swallow or drink the whole mixture.

The dosage is based on your medical condition and response to treatment.

To reduce your risk of side effects, your doctor may direct you to start this medication at a low dose and gradually increase your dose. Follow your doctor’s instructions carefully.

Use this medication regularly in order to get the most benefit from it. To help you remember, take it at the same time(s) each day. It is important to continue taking this medication even if you feel well. Most people with high blood pressure do not feel sick.

For the treatment of high blood pressure, it may take several weeks before you get the full benefit of this medication. Tell your doctor if your condition does not improve or if it worsens (such as your blood pressure readings remain high or increase).

How do I store Ramipril?

Ramipril is best stored at room temperature away from direct light and moisture. To prevent drug damage, you should not store Ramipril in the bathroom or the freezer. There may be different brands of Ramipril that may have different storage needs. It is important to always check the product package for instructions on storage, or ask your pharmacist. For safety, you should keep all medicines away from children and pets.

You should not flush Ramipril down the toilet or pour them into a drain unless instructed to do so. It is important to properly discard this product when it is expired or no longer needed. Consult your pharmacist for more details about how to safely discard your product.

Precautions & warnings

What should I know before using Ramipril?

Before taking ramipril, tell your doctor or pharmacist if you are allergic to it; or to other ACE inhibitors (such as benazepril); or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

Before using this medication, tell your doctor or pharmacist your medical history, especially of: history of an allergic reaction which included swelling of the face/lips/tongue/throat (angioedema), blood filtering procedures (such as LDL apheresis, dialysis), high level of potassium in the blood.

This drug may make you dizzy. Alcohol or marijuana can make you more dizzy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana.

To reduce the risk of dizziness and lightheadedness, get up slowly when rising from a sitting or lying position.

Too much sweating, diarrhea, or vomiting may cause loss of too much body water (dehydration) and increase your risk of lightheadedness. Report prolonged diarrhea or vomiting to your doctor. Be sure to drink enough fluids to prevent dehydration unless your doctor directs you otherwise.

Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).

This product may increase your potassium levels. Before using potassium supplements or salt substitutes that contain potassium, consult your doctor or pharmacist.

Older adults may be more sensitive to the side effects of this drug, including dizziness and increases in potassium level.

This medication is not recommended for use during pregnancy. It may harm an unborn baby. Consult your doctor for more details.

It is unknown if this medication passes into breast milk. Consult your doctor before breast-feeding.

Is it safe during pregnancy or breast-feeding?

There are no adequate studies in women for determining risk when using this Ramipril during pregnancy or while breastfeeding. Please always consult with your doctor to weigh the potential benefits and risks before taking Ramipril. Ramipril is pregnancy risk category D according to the US Food and Drug Administration (FDA).

FDA pregnancy risk category reference below:

  • A=No risk,
  • B=No risk in some studies,
  • C=There may be some risk,
  • D=Positive evidence of risk,
  • X=Contraindicated,
  • N=Unknown

Side effects

What side effects can occur from Ramipril?

Dizziness, lightheadedness, or tiredness may occur as your body adjusts to the medication. Dry cough may also occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.

Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

Tell your doctor right away if any of these unlikely but serious side effects occur: fainting, symptoms of a high potassium blood level (such as muscle weakness, slow/irregular heartbeat).

Although ramipril may be used to prevent kidney problems or treat people who have kidney problems, it may also rarely cause serious kidney problems or make them worse. Your doctor will check your kidney function while you are taking ramipril. Tell your doctor right away if you have any signs of kidney problems such as a change in the amount of urine.

This drug may rarely cause serious (possibly fatal) liver problems. Tell your doctor right away if you notice any of the following rare but serious side effects: yellowing eyes/skin, dark urine, severe stomach/abdominal pain, persistent nausea/vomiting.

A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

Not everyone experiences these side effects. There may be some side effects not listed above. If you have any concerns about a side-effect, please consult your doctor or pharmacist.

Interactions

What drugs may interact with Ramipril?

Some products that may interact with this drug include: aliskiren, certain drugs that weaken the immune system/increase the risk of infection (such as everolimus, sirolimus), lithium, drugs that may increase the level of potassium in the blood (such as ARBs including losartan/valsartan, birth control pills containing drospirenone), sacubitril, telmisartan.

Some products have ingredients that could raise your blood pressure or worsen your heart failure. Tell your pharmacist what products you are using, and ask how to use them safely (especially cough-and-cold products, diet aids, or NSAIDs such as ibuprofen/naproxen).

A very serious reaction may occur if you are getting injections for bee/wasp sting allergy (desensitization) and are also taking ramipril. Make sure all your doctors know which medicines you are using.

Ramipril may interact with other drugs that you are currently taking, which can change how your drug works or increase your risk for serious side effects. To avoid any potential drug interactions, you should keep a list of all the drugs you are using (including prescription drugs, nonprescription drugs and herbal products) and share it with your doctor and pharmacist. For your safety, do not start, stop, or change the dosage of any drugs without your doctor’s approval.

Does food or alcohol interact with Ramipril?

Ramipril may interact with food or alcohol by altering the way the drug works or increase the risk for serious side effects. Please discuss with your doctor or pharmacist any potential food or alcohol interactions before using this drug.

What health conditions may interact with Ramipril?

Ramipril may interact with your health condition. This interaction may worsen your health condition or alter the way the drug works. It is important to always let your doctor and pharmacist know all the health conditions you currently have.

Dosage

The information provided is not a substitute for any medical advice. You should ALWAYS consult with your doctor or pharmacist before using this Ramipril.

What is the dose of Ramipril for an adult?

Usual Adult Dose for Hypertension

Initial dose: 2.5 mg orally once a day for patients not taking a diuretic

Maintenance dose: 2.5 to 20 mg/day in one or two equally divided doses

Comments:

-Adjust dose according to blood pressure response.

-The antihypertensive effect may diminish toward the end of a once daily dosing interval; consider increasing dose or twice daily administration.

-If blood pressure is not controlled with this drug alone, a diuretic may be added.

Use: Treatment of hypertension, to lower blood pressure, alone or in combination with a thiazide diuretic.

Usual Adult Dose for Congestive Heart Failure

Initial dose: 2.5 mg orally twice a day

Maintenance dose: 5 mg orally twice a day

Comments:

-If possible, decrease concomitant diuretic dose to reduce likelihood of hypotension.

-After first initial dose, observe at least two hours and until blood pressure has stabilized at least an additional hour.

-If patient becomes hypotensive on initial dose, reduce to 1.25 mg twice a day.

-After one week on initial dose, increase toward maintenance dose as tolerated; may increase about every 3 weeks.

-Initial hypotension does not preclude subsequent titration with this drug, following effective hypotension management.

Use: Treatment of stable patients who have demonstrated clinical signs of congestive heart failure within the first few days after sustaining acute myocardial infarction.

Usual Adult Dose for Cardiovascular Risk Reduction

Initial dose: 2.5 mg orally once a day for one week; 5 mg orally once a day for next three weeks, then increase as tolerated

Maintenance dose: 10 mg orally once a day

Comments:

-If patient is hypertensive or recently post myocardial infarction, may administer in divided doses.

Use: Reduce the risk of myocardial infarction, stroke, or death from cardiovascular causes in patients 55 years or older at high risk of developing a major cardiovascular event because of a history of coronary artery disease, stroke, peripheral vascular disease, or diabetes that is accompanied by at least one other cardiovascular risk factor (hypertension, elevated total cholesterol levels, low high-density lipoprotein (HDL) levels, cigarette smoking, or documented microalbuminuria); can be used in addition to other needed treatment such as antihypertensive, antiplatelet, or lipid lowering therapy.

Renal Dose Adjustments

CrCl 40 mL/min or less: Reduce usual dose by 25%

CrCl less than 90 mL/min and hypertension: Initial dose: 1.25 mg orally once a day; may titrate up until blood pressure controlled or to maximum dose of 5 mg/day.

CrCl less than 90 mL/min and heart failure: Initial dose: 1.25 mg orally once a day; may increase to 1.25 mg twice daily and to maximum dose of 2.5 mg twice daily.

Renal artery stenosis: Initial dose: 1.25 mg orally once a day

Other Comments

Administration advice:

-Capsules may be opened and sprinkled in 4 ounces of applesauce, apple juice, or water; mixture may be stored 24 hours at room temperature or 48 hours refrigerated.

Monitoring:

-Monitor serum potassium periodically.

-In hypertensive patients with unilateral or bilateral renal artery stenosis, monitor renal function during the first few weeks of therapy.

-Consider monitoring white blood cells in patients with collagen vascular disease, especially if associated with renal impairment.

What is the dose of Ramipril for a child?

The dosage has not been established in pediatric patients. It may be unsafe for your child. It is always important to fully understand the safety of the drug before using. Please consult with your doctor or pharmacist for more information.

How is Ramipril available?

Ramipril is available in the following dosage forms and strengths:

  • Oral capsule,
  • Oral tablet.

What should I do in case of an emergency or overdose?

In case of an emergency or an overdose, call your local emergency services or go to your nearest emergency room.

What should I do if I miss a dose?

If you miss a dose of Ramipril, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and take your regular dose as scheduled. Do not take a double dose.

Hello Health Group does not provide medical advice, diagnosis or treatment.

Review Date: April 21, 2018 | Last Modified: April 21, 2018

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