What's Ramipril and What's It Used For?

Ramipril is a drug used to lower blood pressure in hypertensive people, but also to prevent kidney damage and possible circulatory pathologies.

Written and verified by el biólogo Samuel Antonio Sánchez Amador.

Last update: 06 August, 2021

Ramipril is a medication that belongs to the group of compounds that inhibit the action of angiotensin-converting enzyme (ACE). It’s used to treat high blood pressure, heart failure and diabetic nephropathy. However, it’s also useful as a preventive measure for cardiovascular problems in the geriatric population at risk.

Ramipril is the active compound, but some medicines contain it under other designations, such as Acovil ® and Carasel ®. There are also generics that directly bear the name of the drug, such as Ramipril Aurovitas Spain ®. Finally, it should be noted that there are multicomponent drugs with ramipril in their composition, such as Triapin ®.

This drug was patented in 1981 and its use was approved in the medical field in 1989. In 2018 it was the 155th drug in terms of the number of prescriptions in the United States, with more than 3 million prescriptions per year.

What’s ramipril used for?

As we’ve said, ramipril is a drug that inhibits angiotensin-converting enzyme (ACE). In order to explain its mechanism of action, we must give some context as regards the functioning of the renin-angiotensin-aldosterone system (RAAS):

1. Angiotensin is made in the liver and released into the bloodstream as a prohormone. On the other hand, renin is an enzyme that’s secreted in the juxtaglomerular cells of the kidney and is released when there’s arterial hypotension and low blood volume.
2. Renin acts directly on angiotensin in its prohormone form, removing 10 amino acids from its structure. This is how angiotensin I is formed.
3. Angiotensin I increases blood pressure through vasoconstriction mechanisms.
4. When it passes through the lungs, angiotensin I is converted into angiotensin II by the action of ACE. This type of angiotensin causes vasoconstriction of the arterioles, promotes the release of aldosterone, and increases the release of adrenergic compounds from the central nervous system, which results in an increase in blood pressure.

Ramipril inhibits the action of angiotensin-converting enzyme (ACE), thus preventing the synthesis of angiotensin II. Therefore, the stimulation of the sympathetic nervous system decreases, renal reabsorption reduces, and, in turn, this favors the relaxation of the arterial muscles. As a result, blood pressure drops.

Medical applications

Here are some of the pathologies in which this pharmacological mechanism can be useful:

• Hypertension: A patient is considered to have has arterial hypertension when their systolic and diastolic pressure is greater than 130/80 millimeters of mercury, respectively. In patients with the pathology, ramipril is taken 1 or 2 times a day.
• Reducing the risk of heart failure (prophylaxis): Ramipril is used to prevent patients at risk from suffering from a heart attack, a stroke, and other related conditions. In general, its use is conceived in people over 55 years of age with a cardiovascular history.
• Prevention of kidney damage: As studies indicate, this drug is useful to prevent serious damage to the kidneys.

How is ramipril administered?

Ramipril is sold to the public in various formats. We’ll consult the prospectus of one of its variants to tell you everything you need to know about its presentation and dosage.

Presentation

This drug is sold in the form of pills to be taken orally, as only this form of administration has been legalized. The pills have different concentrations of active ingredient per unit: 1.25 milligrams, 2.5 milligrams, 5 milligrams, and 10 milligrams.

Dosage

The dosage will depend on the concentration of the active ingredient in each tablet, as a 10-milligram tablet is equivalent to 4 of 2.5 milligrams, for example. Treatment of the underlying condition usually starts with the lowest version (1.25 milligrams).

Here are the dosages for each medical condition, but keep in mind that they vary according to the specific brand:

• Treatment of high blood pressure: The starting dose is 1.25 milligrams or 2.5 milligrams a day.
• Reduction of cardiovascular risks: The starting dose is 1 tablet of 2.5 milligrams every 24 hours. However, maintenance therapy is 10 milligrams a day in a single dose.
• Treatment to slow the progression of kidney damage: This starts with 1.25 or 2.5 milligrams. The maintenance dose is 5 to 10 milligrams a day.
• For heart failure: Start with 1.25 milligrams a day. The maximum dose is 10 milligrams a day.
• Treatment after a heart attack: The same dosage as for heart failure.

This medicine can be taken before, with, or after meals. It shouldn’t be crushed or chewed.

Who shouldn’t take this medicine?

As indicated in the Vademecum portal, ramipril shouldn’t be given to anyone with a history of hypersensitivity to the drug or to any other ACE inhibitor. Nor is its use conceived in people who have suffered angioedema or in those who have developed edema after treatment with a drug of this type.

On the other hand, use should be stopped drastically when there’s hyperkalemia, which means circulating potassium levels greater than 5 milliequivalents per liter. Because ramipril disrupts the way aldosterone works, it can cause this mismatch.

Ramipril in pregnancy

As indicated by the Statpearls medical portal, treatment with this drug is strictly contraindicated in pregnant women. ACE inhibitors have been associated with skeletal malformations in fetuses, especially in the second and third trimesters of pregnancy. Nor should it be administered during lactation.

What are the possible side effects of ramipril?

Like any drug, ramipril can report various side effects. Here are the most significant:

• Common side effects (affects 1 in 10 people): Headaches, fatigue, feeling dizzy, lightheadedness and hypotension, dry cough, muscle cramps, and skin rash.
• Uncommon (1 in 100 patients): Vertigo, tingling and pricking of the skin, trouble sleeping, restlessness, anxiety, nasal congestion, intestinal angioedema, anorexia, flushing, excessive sweating, excessive urine production, fever, decreased sexual desire, and joint pain.
• Rare (affects 1 in 1000 people): Confusion, redness of the tongue, rash, and severe peeling of the skin.
• Very rare (1 in 10,000 patients): Hypersensitivity to sun exposure.

Although this list of side effects is quite extensive, you shouldn’t worry if you’re prescribed this drug. Typically, you’ll have a dry cough, postural hypotension – dizziness when you get up – and certain symptoms of anxiety. If these clinical signs are too bothersome or get worse, don’t hesitate to go to the doctor.

What should I do if I miss a dose?

In general, most patients take this drug once a day. If you forget the dose, take the medicine as soon as possible.

However, if you remember the following day, then it’s best to skip the forgotten dose and continue with the treatment as usual. Never take 2 pills to make up for a forgotten one.

How should I act in case of an overdose?

A Ramipril overdose – more than 10 milligrams in 24 hours – can cause severe hypotension, due to its vasodilator effects. The disorder will occur with blurred vision, vertigo, fainting, drowsiness, weakness, and dizziness.

However, the drop in blood pressure doesn’t occur until 4 hours after the drug is consumed. If you suspect that you have ingested more pills than normal, it’s best that you go to emergencies and inform the professionals of your situation. There they’ll monitor your vital signs.

How to store or dispose of this medicine

This medicine should be kept out of the reach and sight of children at all times. In addition, it’s best for the pills to always remain in their original blister or bottle, at a temperature below 30 degrees Celsius and away from sources of humidity.

On the other hand, if you’re going to dispose of the drug because you no longer need it or because it has expired, never throw it directly into the trash or down the toilet. For the good of the planet, recycle any medicine that you can no longer consume.

Ramipril: few contraindications, but prohibited in pregnancy

Ramipril is a very useful drug, especially in people who have suffered a heart problem or are at risk of suffering it. By inhibiting the action of the angiotensin-converting enzyme, it allows arterial vasodilation and reduces blood pressure. This can cause very dangerous conditions in the geriatric population at risk.

In addition, it’s a drug that has very few contraindications, so it’s usually useful in almost all conditions. However, it’s one of the few drugs sold in pharmacies under prescription that has been shown to be very harmful to the fetus during pregnancy.