Ramipril

May be taken with or without food.

History of angioedema (e.g. hereditary, idiopathic, due to previous angioedema with ACE inhibitors or angiotensin II receptor antagonists [AIIRAs]); extracorporeal treatments resulting to contact of blood with negatively charged surfaces (e.g. dialysis or haemofiltration with certain high-flux membranes [e.g. polyacrylonitril membranes] and low-density lipoprotein apheresis with dextran); haemodynamically relevant bilateral renal artery stenosis or unilateral in the single kidney; hypotensive or haemodynamically unstable states. Concurrent use with aliskiren in patients with diabetes mellitus or moderate to severe renal impairment (GFR <60 mL/min/1.73 m²); concurrent use or within 36 hours of shifting to or from sacubitril/valsartan. Pregnancy and lactation.

Patients with severe hypertension, decompensated CHF; relevant left ventricular inflow or outflow impediment (e.g. aortic or mitral valve stenosis), hypertrophic cardiomyopathy with outflow tract obstruction, unstented unilateral or bilateral renal artery stenosis, volume or salt depletion, liver cirrhosis and/or ascites; transient or persistent heart failure post-MI, ischaemic heart disease or cerebrovascular disease, uncontrolled diabetes mellitus, hypoaldosteronism, acute cardiac decompensation, metabolic acidosis, collagen disease (e.g. SLE or scleroderma); history of airway surgery. Dehydrated patients. Patient undergoing major surgery or during anaesthetics. Desensitisation treatment (e.g. hymenoptera venom). Black race. Renal and hepatic impairment. Elderly. Patient Counselling This drug may cause dizziness, if affected, do not drive or operate machinery. Monitoring Parameters Evaluate renal function and electrolytes before and during treatment. Monitor blood pressure, BUN, serum creatinine, K levels and Na levels; CBC with differentials. Monitor for signs of angioedema. Assess pregnancy status prior to therapy.

Significant: Angioedema (e.g. head and neck angioedema, intestinal angioedema), hyperkalaemia, hypotension (with or without syncope, orthostatic), cholestatic jaundice, syndrome of inappropriate antidiuretic hormone (SIADH), hyponatraemia; rarely, haematologic effects (e.g. neutropenia or agranulocytosis, thrombocytopenia, anaemia); cough, renal impairment and/or increase in serum creatinine, anaphylactoid/anaphylactic reactions. Cardiac disorders: Chest pain, arrhythmia. Gastrointestinal disorders: Nausea, vomiting, diarrhoea, dry mouth, gastrointestinal inflammation, digestive disturbances, abdominal discomfort, dyspepsia, constipation, dysgeusia. General disorders and administration site conditions: Asthenia, fatigue. Musculoskeletal and connective tissue disorders: Myalgia, muscle spasm. Nervous system disorders: Headache, dizziness, paraesthesia, vertigo. Respiratory, thoracic and mediastinal disorders: Bronchitis, sinusitis, dyspnoea. Skin and subcutaneous tissue disorders: Maculopapular rash, alopecia.
Potentially Fatal: Rarely, pancreatitis, airway obstruction (due to angioedema of the tongue, glottis or larynx), fulminant hepatic necrosis, Stevens-Johnson syndrome, toxic epidermal necrolysis.

May increase risk for angioedema with mammalian target of rapamycin (mTOR) inhibitors (e.g. everolimus, sirolimus, temsirolimus), dipeptidyl peptidase-4 (DPP-4) inhibitors (e.g. vildagliptin), neutral endopeptidase (NEP) inhibitor (e.g. racecadotril). May increase risk for hyperkalaemia with K salts, K-sparring diuretics, other drugs that increase K levels (e.g. heparin, trimethoprim/sulfamethoxazole, tacrolimus, ciclosporin). May increase risk of hypotension with other antihypertensive drugs (e.g. diuretics), other drugs that decrease blood pressure (e.g. anaesthetic, alfuzosin, baclofen, doxazosin, nitrates, prazosin, TCAs, tamsulosin, terazosin). May have decreased antihypertensive effect with vasopressor sympathomimetics and other drugs (e.g. dobutamine, dopamine, epinephrine, isoproterenol). May increase risk for haematologic reactions with allopurinol, cytostatics, corticosteroids, immunosuppressants, procainamide, other drugs that alter blood cell count. May increase serum levels and toxicity of lithium. May increase risk for hypoglycaemia with antidiabetic drugs (e.g. insulin). Reduced antihypertensive effect, increased risk of worsening renal function and increased serum K levels with NSAIDs.

ACE Inhibitors/Direct Renin Inhibitors

C09AA05 - ramipril ; Belongs to the class of ACE inhibitors. Used in the treatment of cardiovascular disease.