Medical uses – Indications for its use include:
- Congestive heart failure;
- Following heart attack in patients with clinical evidence of heart failure;
- Susceptible patients over 55 years: prevention of heart attack, stroke, cardiovascular death or need of revascularization procedures.
Renovascular disease (impaired blood flow in the kidneys), severe renal impairment (especially in patients with one kidney or with bilateral renal artery stenosis), volume-depleted patients, history of angioedema while on an ACE inhibitor, pregnancy, hypotension.
- low blood sugar (in patients taking medication for diabetes), causing sweating or shakiness
- dry cough
- dizziness and light-headedness due to low blood pressure
- tiredness and fatigue, especially in the early stages
- mouth dryness in the early stages
- nausea, vomiting, diarrhea (persistent in rare cases)
- change in amount of urine
- signs of infection (e.g., fever, chills, persistent sore throat)
- yellowing of eyes or skin, dark urine
- stomach or abdominal pain
- neutropenia (low white blood cells)
- impotence (erectile dysfunction)
Serious allergic reactions to this drug are unlikely, but immediate medical attention must be sought if they occur. Symptoms of a serious allergic reaction include, but are not limited to a rash or swelling of the face, mouth, tongue, or throat.
In extreme cases, ramipril may lead to potentially fatal liver problems.
Mechanism of action
ACE inhibitors, as the name suggests, inhibit the actions of angiotensin converting enzyme (ACE), thereby lowering the production of angiotensin II and also decreasing the breakdown of bradykinin. The decrease in angiotensin II results in relaxation of arteriole smooth muscle leading to a decrease in total peripheral resistance, reducing blood pressure as the blood is pumped through widened vessels. Its effect on bradykinin is responsible for the dry cough side effect.
Ramipril, a prodrug or precursor drug, is converted to the active metabolite (metabolic product) ramiprilat by liver esteraseenzymes. Ramiprilat is mostly excreted by the kidneys. The half-life of ramiprilat is variable (3–16 hours), and is prolonged by heart and liver failure, as well as kidney failure.
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