ramipril

CLINICAL USE

Angiotensin-converting enzyme inhibitor:Hypertension Secondary prevention of myocardial infarction (MI), stroke or cardiovascular deathHeart failure

DOSE IN NORMAL RENAL FUNCTION

1.25–10 mg once a dayProphylaxis after a MI: 2.5–5 mg twice daily

PHARMACOKINETICS

Molecular weight :416.5

%Protein binding :56 (as ramiprilat)

%Excreted unchanged in urine : <2

Volume of distribution (L/kg) :1.2

half-life – normal/ESRD (hrs) :13–17/Increased (as ramiprilat)

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

20 to 50 : Dose as in normal renal function

10 to 20 : Initial dose 1.25 mg daily and increase according to response

<10 : Initial dose 1.25 mg daily and increase according to response

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD :Unknown dialysability. Dose as in GFR <10 mL/min

HD :Not dialysed. Dose as in GFR <10 mL/min

HDF/high flux :Dialysed. Dose as in GFR <10 mL/min

CAV/VVHD :Dialysed. Dose as in GFR 10 to 20 mL/min

IMPORTANT DRUG INTERACTIONS

Potentially hazardous interactions with other drugs

Anaesthetics: enhanced hypotensive effect

Analgesics: antagonism of hypotensive effect and increased risk of renal impairment with NSAIDs; hyperkalaemia with ketorolac and other NSAIDs

Ciclosporin: increased risk of hyperkalaemia and nephrotoxicity

Diuretics: enhanced hypotensive effect; hyperkalaemia with potassium-sparing diuretics

Epoetin: increased risk of hyperkalaemia; antagonism of hypotensive effect

Lithium: reduced excretion (possibility of enhanced lithium toxicity)

Potassium salts: increased risk of hyperkalaemia

Tacrolimus: increased risk of hyperkalaemia and nephrotoxicity

ADMINISTRATION

Reconstition

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Route

Oral

Rate of Administration

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Comments

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OTHER INFORMATION

Metabolised to active metabolite, ramiprilatRenal failure has been reported in association with ACE inhibitors in patients with renal artery stenosis, post renal transplant, and those with congestive heart failureA high incidence of anaphylactoid reactions has been reported in patients dialysed with high-flux polyacrylonitrile membranes and treated concomitantly with an ACE inhibitor – this combination should therefore be avoidedHyperkalaemia and other side effects more common in patients with impaired renal functionClose monitoring of renal function during therapy is necessary in those patients with known renal insufficiencyNormal doses have been used in CKD 5 .

See how to identify renal failure stages according to GFR calculation

See how to diagnose irreversible renal disease

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