Nurses Compass
Drug Guide
Ramipril
Classification
Therapeutic: Antihypertensive, Heart Failure
Pharmacological: ACE inhibitor (Angiotensin-Converting Enzyme inhibitor)
FDA Approved Indications
- Hypertension
- Heart failure post-myocardial infarction
- Reduce risk of cardiovascular events in patients at high risk
Mechanism of Action
Ramipril inhibits the angiotensin-converting enzyme (ACE), which decreases the production of angiotensin II, leading to vasodilation, reduced blood pressure, and decreased workload on the heart.
Dosage and Administration
Adult: Typically 2.5 mg once daily, titrated up to a maximum of 20 mg once daily based on response.
Pediatric: Not commonly used in children; consult specific guidelines.
Geriatric: Start at lower dose due to increased risk of hypotension and renal impairment.
Renal Impairment: Use with caution; dose adjustment may be necessary based on renal function.
Hepatic Impairment: Adjust dose cautiously; use lower initial doses.
Pharmacokinetics
Absorption: Rapidly absorbed from the gastrointestinal tract.
Distribution: Widely distributed; protein binding ~65%.
Metabolism: Primarily inactive; some metabolism to related compounds.
Excretion: Excreted mainly via the kidneys.
Half Life: Approximately 13-17 hours, allowing for once-daily dosing.
Contraindications
- History of angioedema related to previous ACE inhibitor therapy
- Bilateral renal artery stenosis
- Hypersensitivity to ramipril or other ACE inhibitors
Precautions
- Pregnancy (category D), lactation, renal impairment, volume depletion, hyperkalemia
Adverse Reactions - Common
- Cough (Common)
- Dizziness, headache (Common)
- Fatigue (Less common)
Adverse Reactions - Serious
- Angioedema (Rare)
- Hypotension (Less common)
- Elevated serum potassium (hyperkalemia) (Less common)
- Acute renal failure (Rare)
Drug-Drug Interactions
- Diuretics, especially potassium-sparing (e.g., spironolactone)
- Other antihypertensives
- Lithium
- NSAIDs
Drug-Food Interactions
N/ADrug-Herb Interactions
N/ANursing Implications
Assessment: Monitor blood pressure, renal function, and serum electrolytes regularly.
Diagnoses:
- Risk for hypotension
- Electrolyte imbalance
- Impaired renal function
Implementation: Administer as prescribed, observe for signs of angioedema or hypotension.
Evaluation: Assess blood pressure response and laboratory parameters to ensure safety and efficacy.
Patient/Family Teaching
- Notify healthcare provider if swelling of face, lips, or tongue occurs.
- Report any signs of hyperkalemia (muscle weakness, irregular heartbeat).
- Avoid potassium supplements or potassium-sparing diuretics unless directed by a healthcare provider.
- Do not discontinue abruptly to avoid rebound hypertension.
Special Considerations
Black Box Warnings:
- Pregnancy: can cause fetal injury and death; discontinue as soon as pregnancy is detected.
Genetic Factors: Genetic polymorphisms may affect drug metabolism and response.
Lab Test Interference: May elevate Serum Potassium and BUN/Creatinine levels; monitor as needed.
Overdose Management
Signs/Symptoms: Severe hypotension, dizziness, syncope.
Treatment: Administer IV fluids as needed; use vasopressors if hypotension persists; consider activated charcoal if ingestion is recent.
Storage and Handling
Storage: Store at room temperature, 20°C to 25°C (68°F to 77°F).
Stability: Stable under recommended conditions for the duration of the shelf life.