Ramipril
Ramipril
Altace
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Summary
Classes
Common uses
Hypertension0, Heart failure0, Post-myocardial infarction (LV dysfunction)0, Cardiovascular risk reduction in high-risk patients (per HOPE)0
Pharmacy
Starting dose
2.5 mg PO once daily (1.25 mg in CHF or volume depletion); titrate to 5-10 mg/d
Preparations
1.25, 2.5, 5, 10 mg capsules
US FDA Max
20 mg/d (hypertension); 10 mg/d (other indications typical)
Pharmacology
Routes
Oral
Onset
BP effect 1-2 hours; max at 6 hours
Duration
24 hours
Half-life
~13-17 hours (ramiprilat, the active metabolite)[1]
Bioavailability
~28% (oral; food slows but does not reduce absorption)[1]
Pregnancy
Contraindicated in pregnancy (all trimesters); fetal renal injury, oligohydramnios, skull hypoplasia, hypotension[1]
Legal status
Rx-only in US
Purported mechanism
Ramipril is a prodrug hydrolyzed to ramiprilat, a long-acting ACE inhibitor that blocks conversion of angiotensin I to angiotensin II, reducing vasoconstriction, aldosterone secretion, and renal sodium retention.0 The HOPE trial (2000) demonstrated cardiovascular risk reduction in high-risk patients with vascular disease or diabetes, independent of BP lowering — establishing the broader "ACE inhibitors for vascular protection" indication beyond hypertension and heart failure[1].
References
- ↑ 1.0 1.1 1.2 1.3 FDA Prescribing Information, Altace (ramipril), Pfizer/King, current revision. https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/019901s063lbl.pdf