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Ramipril: Drug information

Ramipril: Drug information
(For additional information see "Ramipril: Patient drug information")

For abbreviations, symbols, and age group definitions used in Lexicomp (show table)
ALERT: US Boxed Warning
Fetal toxicity:

When pregnancy is detected, discontinue ramipril as soon as possible. Drugs that act directly on the renin-angiotensin system can cause injury and death to the developing fetus.

Brand Names: US
  • Altace
Brand Names: Canada
  • AG-Ramipril;
  • Altace;
  • APO-Ramipril;
  • Auro-Ramipril;
  • DOM-Ramipril;
  • JAMP-Ramipril;
  • Mar-Ramipril;
  • MINT-Ramipril;
  • NRA-Ramipril;
  • Pharma-Ramipril;
  • PRIVA-Ramipril [DSC];
  • PRO-Ramipril-1.25;
  • PRO-Ramipril-10;
  • PRO-Ramipril-2.5;
  • PRO-Ramipril-5;
  • RAN-Ramipril [DSC];
  • SANDOZ Ramipril [DSC];
  • TARO-Ramipril;
  • TEVA-Ramipril
Pharmacologic Category
  • Angiotensin-Converting Enzyme (ACE) Inhibitor;
  • Antihypertensive
Dosing: Adult
Acute coronary syndrome

Acute coronary syndrome (off-label use):

Non–ST-elevation acute coronary syndrome:

Note: Initiate in stable patients prior to hospital discharge as a component of an appropriate medical regimen, which may include antiplatelet agent(s), a beta-blocker, and a statin. Continue indefinitely for patients with concurrent diabetes, left ventricular ejection fraction ≤40%, hypertension, or stable chronic kidney disease (Ref). Dosing recommendations are based on general dosing range in manufacturer's labeling.

Oral: Initial: 2.5 mg once daily; titrate slowly based on tolerability and response up to 20 mg/day in 1 or 2 divided doses.

ST-elevation acute coronary syndrome:

Note: In hemodynamically stable patients with large anterior ST-elevation myocardial infarction, consider starting within 24 hours of presentation as a component of an appropriate medical regimen, which may include antiplatelet agent(s), a beta-blocker, and a statin. Continue therapy indefinitely (Ref). Dosing recommendations are based on general dosing range in manufacturer's labeling.

Oral: Initial: 2.5 mg once daily initiated within 24 hours of presentation; titrate slowly based on tolerability and response up to 20 mg/day in 1 or 2 divided doses.

Heart failure with reduced ejection fraction

Heart failure with reduced ejection fraction:

Note: If tolerated, an angiotensin II receptor-neprilysin inhibitor is generally preferred over an angiotensin-converting enzyme inhibitor (Ref).

Oral: Initial: 1.25 or 2.5 mg once daily; increase dose (eg, double) as tolerated every ≥1 to 2 weeks to a target dose of 10 mg once daily (Ref). In hospitalized patients, may titrate more rapidly as tolerated (Ref).

Hypertension, chronic

Hypertension, chronic:

Note: For patients who warrant combination therapy (BP >20/10 mm Hg above goal or suboptimal response to initial monotherapy), may use with another appropriate agent (eg, long-acting dihydropyridine calcium channel blocker or thiazide diuretic) (Ref).

Oral: Initial: 2.5 mg once daily; evaluate response after ~2 to 4 weeks and titrate dose (eg, increase the daily dose by doubling) as needed, up to 20 mg/day in 1 or 2 divided doses; if additional blood pressure control is needed, consider combination therapy. Patients with severe asymptomatic hypertension and no signs of acute end organ damage should be evaluated for medication titration within 1 week (Ref).

Proteinuric chronic kidney disease, diabetic or nondiabetic

Proteinuric chronic kidney disease, diabetic or nondiabetic (off-label use):

Oral: Initial: 1.25 to 2.5 mg once daily depending on baseline BP; titrate gradually (eg, by doubling the dose every 2 to 4 weeks) up to the maximally tolerated dose, not to exceed 20 mg/day in 1 or 2 divided doses. If proteinuria target is not met despite optimized dosage, consider additional therapies (eg, sodium-glucose cotransporter-2 inhibitor) (Ref).

Reduction in risk of myocardial infarction, stroke, and death from cardiovascular causes

Reduction in risk of myocardial infarction, stroke, and death from cardiovascular causes:

Oral: Initial: 2.5 mg once daily for 1 week, then 5 mg once daily for the next 3 weeks, then increase as tolerated to maintenance dose of 10 mg/day in 1 or 2 divided doses.

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Adult

The renal dosing recommendations are based upon the best available evidence and clinical expertise. Senior Editorial Team: Bruce Mueller, PharmD, FCCP, FASN, FNKF; Jason A. Roberts, PhD, BPharm (Hons), B App Sc, FSHP, FISAC; Michael Heung, MD, MS.

Kidney impairment prior to treatment initiation:

Altered kidney function: Oral:

eGFR ≥30 mL/minute/1.73 m2: No dosage adjustment necessary (Ref).

eGFR 15 to <30 mL/minute/1.73 m2: Initial: 1.25 mg once daily; titrate gradually (eg, every 2 to 4 weeks) based on tolerability and response with frequent monitoring of BP, kidney function, and potassium (Ref); maximum dose: 5 mg/day in 1 or 2 divided doses (Ref).

eGFR <15 mL/minute/1.73 m2: Due to increased risk of adverse effects or complications (eg, hyperkalemia, kidney failure), use of alternative agents should be considered (Ref). If necessary, initiate therapy with 1.25 mg once daily; titrate gradually (eg, every 2 to 4 weeks) based on tolerability and response with frequent monitoring of BP, kidney function, and potassium; maximum dose: 5 mg/day in 1 or 2 divided doses (Ref).

Hemodialysis, intermittent (thrice weekly): Unlikely to be significantly dialyzable (Ref): Note: Avoid use if an AN69 hemofilter is used (associated with anaphylactoid reaction) (Ref).

Oral: Initial: 1.25 mg once daily administered post hemodialysis (Ref) or 2.5 mg 3 times weekly administered on dialysis days, after the dialysis session (Ref). Titrate gradually (eg, every 2 to 4 weeks) based on tolerability and response with frequent monitoring of BP, kidney function, and potassium; maximum dose: 5 mg/day in 1 or 2 divided doses (Ref).

Peritoneal dialysis: Unlikely to be significantly dialyzable (Ref):

Oral: Initial: 1.25 mg once daily (Ref). Titrate gradually (eg, every 2 to 4 weeks) based on tolerability and response with frequent monitoring of BP, kidney function, and potassium; maximum dose of 5 mg/day in 1 or 2 divided doses (Ref).

CRRT: Note: Avoid use if an AN69 hemofilter is used (associated with anaphylactoid reaction) (Ref).

Oral: Initial: 1.25 mg once daily (Ref). Titrate gradually (eg, every 2 to 4 weeks) based on tolerability and response with frequent monitoring of BP, kidney function, and potassium; maximum dose of 5 mg/day in 1 or 2 divided doses (Ref).

PIRRT (eg, sustained, low-efficiency diafiltration): Note: Avoid use if an AN69 hemofilter is used (associated with anaphylactoid reaction) (Ref).

Oral: Initial: 1.25 mg once daily (Ref). Titrate gradually (eg, every 2 to 4 weeks) based on tolerability and response with frequent monitoring of BP, kidney function, and potassium; maximum dose of 5 mg/day in 1 or 2 divided doses (Ref).

Alterations in kidney function during treatment:Small, transient increases in serum creatinine are likely to occur within 4 weeks following initiation of therapy or an increase in dose. If serum creatinine increases by >30%, review for possible etiologies (eg, acute kidney injury, volume depletion, concomitant medications, renal artery stenosis) before determining if dose reduction or discontinuation of ramipril therapy should be considered (Ref).

Dosing: Hepatic Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling, however ramipril is primarily metabolized by hepatic esterases; patients with hepatic impairment could develop markedly elevated plasma levels of ramipril. Use with caution, particularly in patients with ascites due to cirrhosis (Ref).

Dosing: Adjustment for Toxicity: Adult

Hyperkalemia: Assess for alternative or contributing factors (eg, diet, concomitant medications) of increased potassium, before determining if dose reduction or discontinuation of ramipril therapy should be considered (Ref).

Dosing: Older Adult

Refer to adult dosing; use with caution.

In the management of hypertension, consider lower initial doses and titrate to response (Ref).

Adverse Reactions (Significant): Considerations
Acute kidney injury

Use may be associated with increased blood urea nitrogen and increased serum creatinine, resulting in oliguria and acute kidney injury (AKI). Increases in serum creatinine are expected due to pharmacologic mechanism and generally stabilize within 20% to 30% of the baseline; higher increases may indicate high efferent tone (such as with hypovolemia, congestive heart failure, or renal artery stenosis) (Ref).

Mechanism: Related to pharmacologic action; inhibits efferent arteriolar vasoconstriction, lowering glomerular filtration pressure, which can lead to a reduction in the glomerular filtration rate (GFR). Kidney hypoperfusion from systemic hypotension may also occur (Ref).

Onset: Intermediate; increases in serum creatinine generally occur within 2 weeks of initiation and stabilize within 2 to 4 weeks (Ref). However, more immediate increases can occur in patients with other risk factors for AKI (Ref).

Risk factors:

• Patients with low renal blood flow whose GFR is dependent on efferent arteriolar vasoconstriction by angiotensin II including (Ref):

- Low effective circulating volume (sodium or volume depletion)

- Congestive heart failure

- Hypotension or shock

- Renal artery stenosis

• High dose at initiation (Ref)

• Older patients (Ref)

• Preexisting kidney impairment (Ref)

• Concurrent diuretic and/or nonsteroidal anti-inflammatory drug use (Ref)

Angioedema

Angioedema may occur rarely; edema may manifest in the head and neck (potentially compromising the airway) or the intestine (presenting with abdominal pain). Use is contraindicated in patients with idiopathic or hereditary angioedema or previous angioedema associated with any angiotensin-converting enzyme inhibitors or neprilysin inhibitors (Ref).

Mechanism: Related to pharmacologic action (ie, increased bradykinin and substance P, vascular permeability, and vasodilation) (Ref).

Onset: Varied; may occur at any time during treatment. Most cases occur within the first week of therapy but may also occur years after therapy (Ref).

Risk factors:

• Black patients (estimated 4- to 5-fold higher risk); the mechanism for this is not completely understood but may be related to genetic variants (Ref)

• Females (Ref)

• Smoking history (Ref)

• Previous history of angioedema (Ref)

• Age >65 years (Ref)

• Seasonal allergies (Ref)

• Concurrent use of mechanistic target of rapamycin (mTOR) inhibitors (eg, everolimus) (Ref)

• Concurrent use of neprilysin inhibitor (contraindicated)

Cough

A dry, hacking, nonproductive cough that is typically associated with tickling or scratching in the throat may occur with angiotensin converting enzyme inhibitors (ACEI) in adult and pediatric patients (Ref). Recurrence is likely with rechallenge (Ref). Resolution of cough typically occurs 1 to 4 weeks after ACEI discontinuation but may persist for up to 3 months (Ref).

Mechanism: Various proposed mechanisms. May be related to pharmacologic action (ie, increased bradykinin and substance P, resulting in accumulation in the lungs and bronchoconstriction) (Ref).

Onset: Varied; within hours to 4 weeks after initiation but can be delayed for up to 6 months (Ref).

Risk factors:

• Females (Ref)

• Possibly certain genetic variants (some of which may be independent of the bradykinin pathway) (Ref).

Hyperkalemia

Hyperkalemia (elevated serum potassium) may occur on therapy with angiotensin converting enzyme inhibitors (ACEI), including ramipril (Ref).

Mechanism: Related to pharmacologic action; inhibits formation of circulating angiotensin II, which leads to efferent arteriole vasodilation and subsequent lowering of glomerular filtration rate, which lowers potassium elimination. Additionally, interferes with the generation and release of aldosterone from the adrenal cortex, leading to an impairment of potassium excretion from the kidney (Ref).

Risk factors:

• Disease states associated with hyperkalemia (congestive heart failure, diabetes mellitus, chronic kidney disease) (Ref)

• Concurrent use of medications which cause hyperkalemia (ACEI, angiotensin receptor blockers, spironolactone, nonsteroidal anti-inflammatory drugs, beta blockers, heparin, tacrolimus, cyclosporine) (Ref)

• Acute kidney injury (elevated BUN and/or serum creatinine) (Ref)

• High dietary intake of potassium or concurrent use of potassium supplements (including potassium-containing salt substitutes) (Ref)

• Baseline elevated potassium level (≥5 mmol/L) (Ref)

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Frequency ranges include data from hypertension and heart failure trials. Higher rates of adverse reactions have generally been noted in patients with heart failure. However, the frequency of adverse effects associated with placebo is also increased in this population.

>10%:

Cardiovascular: Hypotension (11%)

Respiratory: Cough (8% to 12%) (table 1)

Ramipril: Adverse Reaction: Cough

Drug (Ramipril)

Placebo

Indication

Number of Patients (Ramipril)

Number of Patients (Placebo)

8%

4%

Cardiac failure post-myocardial infarction

1,004

982

12%

N/A

Hypertension

N/A

N/A

1% to 10%:

Cardiovascular: Angina pectoris (≤3%), orthostatic hypotension (2%), syncope (≤2%)

Endocrine & metabolic: Hyperkalemia (1%)

Gastrointestinal: Diarrhea (1%), nausea (≤2%), vomiting (≤2%)

Nervous system: Dizziness (2% to 4%), fatigue (≤2%), headache (5%), vertigo (2%)

Neuromuscular & skeletal: Asthenia (≤2%)

Renal: Increased serum creatinine (1%), renal insufficiency (1%)

<1%:

Cardiovascular: Edema, palpitations, symptomatic hypotension

Dermatologic: Diaphoresis, erythema multiforme, onycholysis, pemphigoid, pemphigus, skin photosensitivity, Stevens-Johnson syndrome, toxic epidermal necrolysis

Endocrine & metabolic: Weight gain

Gastrointestinal: Abdominal pain, anorexia, constipation, dysgeusia, dyspepsia, dysphagia, gastroenteritis, pancreatitis, sialorrhea, xerostomia

Genitourinary: Impotence

Hematologic & oncologic: Decreased hematocrit, decreased hemoglobin, hemolytic anemia, pancytopenia, purpuric disease, thrombocytopenia

Hepatic: Hepatic failure, hepatitis, jaundice

Hypersensitivity: Angioedema, nonimmune anaphylaxis

Nervous system: Amnesia, anxiety, depression, drowsiness, insomnia, malaise, nervousness, neuralgia, neuropathy, paresthesia, seizure

Neuromuscular & skeletal: Arthralgia, arthritis, myalgia, tremor

Ophthalmic: Visual disturbance

Otic: Hearing loss, tinnitus

Renal: Acute kidney injury, increased blood urea nitrogen

Respiratory: Dyspnea, epistaxis

Postmarketing:

Cardiovascular: Vasculitis

Dermatologic: Psoriasis (Song 2021)

Endocrine & metabolic: Hyponatremia, increased serum glucose, increased uric acid

Genitourinary: Proteinuria

Hematologic & oncologic: Agranulocytosis (Horowitz 2005), eosinophilia, increased erythrocyte sedimentation rate, leukopenia, positive ANA titer

Hepatic: Cholestatic jaundice (Yeung 2003), fulminant hepatic necrosis, increased serum bilirubin, increased serum transaminases

Nervous system: Visual hallucination (Doane 2013)

Respiratory: Eosinophilic pneumonitis

Miscellaneous: Fever

Contraindications

Hypersensitivity to ramipril, other ACE inhibitors, or any component of the formulation; hereditary/idiopathic angioedema or history of angioedema related to previous treatment with an ACE inhibitor; concomitant use with aliskiren in patients with diabetes mellitus; concomitant use or within 36 hours of switching to or from a neprilysin inhibitor (eg, sacubitril).

Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Canadian labeling: Additional contraindications (not in US labeling): Hemodynamically relevant bilateral renal artery stenosis or unilateral in the single kidney; hypotensive or hemodynamically unstable states; concomitant use with aliskiren in patients with moderate to severe kidney impairment (GFR <60 mL/minute/1.73 m2), hyperkalemia (>5 mMol/L) or congestive heart failure who are hypotensive; concomitant use with angiotensin II receptor blockers (ARBs) in patients with diabetes end organ damage, moderate to severe kidney impairment (GFR <60 mL/minute/1.73 m2), hyperkalemia (>5 mMol/L) or congestive heart failure who are hypotensive; combination with extracorporeal treatments leading to contact of blood with negatively charged surfaces (dialysis or hemofiltration with certain high-flux [eg, polyacrylonitrile] membranes and low-density lipoprotein apheresis with dextran); pregnancy; breastfeeding.

Warnings/Precautions

Concerns related to adverse effects:

• Anemia: ACE inhibitors can suppress the production of erythropoietin. This is more likely to occur in the presence of chronic kidney disease.

• Hypersensitivity reactions: Anaphylactic reaction/nonimmune anaphylaxis can occur with ACE inhibitors. Severe nonimmune anaphylaxis may be seen during hemodialysis (eg, CVVHD) with high-flux dialysis membranes (eg, AN69), and rarely, during low-density lipoprotein apheresis with dextran sulfate cellulose. Rare cases of nonimmune anaphylaxis have been reported in patients undergoing sensitization treatment with hymenoptera (bee, wasp) venom while receiving ACE inhibitors.

• Hypotension/syncope: Symptomatic hypotension with or without syncope can occur (usually with the first several doses); effects are most often observed in volume-depleted patients; correct volume depletion prior to initiation; close monitoring of patient is required especially with initial dosing and dosing increases; blood pressure must be lowered at a rate appropriate for the patient's clinical condition. Although dose reduction may be necessary, hypotension is not a reason for discontinuation of future ACE inhibitor use especially in patients with heart failure where a reduction in systolic blood pressure is a desirable observation.

Disease-related concerns:

• Aortic stenosis: Use with caution in patients with severe aortic stenosis; may reduce coronary perfusion resulting in ischemia.

• Ascites: Generally, avoid use in patients with ascites due to cirrhosis or refractory ascites; if use cannot be avoided in patients with ascites due to cirrhosis, monitor BP and kidney function carefully to avoid rapid development of kidney failure (AASLD [Runyon 2013]).

• Cardiovascular disease: Initiation of therapy in patients with ischemic heart disease or cerebrovascular disease warrants close observation due to the potential consequences posed by falling blood pressure (eg, MI, stroke). Fluid replacement, if needed, may restore blood pressure; therapy may then be resumed. Discontinue therapy in patients whose hypotension recurs.

• Collagen vascular disease: Use with caution in patients with collagen vascular disease especially with concomitant kidney impairment; may be at increased risk for hematologic toxicity.

• Hepatic impairment: Use with caution in patients with hepatic impairment (ramipril is primarily metabolized by hepatic esterases and these patients could develop markedly elevated plasma levels of ramipril).

• Hypertrophic cardiomyopathy with left ventricular outflow tract obstruction: Use with caution in patients with hypertrophic cardiomyopathy and left ventricular outflow tract obstruction since reduction in afterload may worsen symptoms associated with this condition (AHA/ACC [Ommen 2020]).

• Kidney impairment: Use with caution in patients with kidney impairment; dosage adjustment may be needed. Avoid rapid dosage escalation which may lead to further kidney impairment.

Special populations:

• Race/Ethnicity: In Black patients, the BP-lowering effects of ACE inhibitors may be less pronounced. The exact mechanism is not known; differences in the renin-angiotensin-aldosterone system, low renin levels, and salt sensitivity more commonly found in Black patients may contribute (Brewster 2013; Helmer 2018).

• Surgical patients: In patients on chronic ACE inhibitor therapy, intraoperative hypotension may occur with induction and maintenance of general anesthesia; use with caution before, during, or immediately after major surgery. Cardiopulmonary bypass, intraoperative blood loss, or vasodilating anesthesia increases endogenous renin release. Use of ACE inhibitors perioperatively will blunt angiotensin II formation and may result in hypotension. However, discontinuation of therapy prior to surgery is controversial. If continued preoperatively, avoidance of hypotensive agents during surgery is prudent (Hillis 2011). Based on current research and clinical guidelines in patients undergoing non-cardiac surgery, continuing ACE inhibitors is reasonable in the perioperative period. If ACE inhibitors are held before surgery, it is reasonable to restart postoperatively as soon as clinically feasible (ACC/AHA [Fleisher 2014]).

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Capsule, Oral:

Altace: 1.25 mg

Altace: 2.5 mg [contains fd&c red #40 (allura red ac dye), quinoline yellow (d&c yellow #10)]

Altace: 5 mg [contains fd&c blue #1 (brilliant blue), fd&c red #40 (allura red ac dye)]

Altace: 10 mg [contains fd&c blue #1 (brilliant blue)]

Generic: 1.25 mg, 2.5 mg, 5 mg, 10 mg

Generic Equivalent Available: US

Yes

Pricing: US

Capsules (Altace Oral)

1.25 mg (per each): $6.46

2.5 mg (per each): $7.63

5 mg (per each): $8.01

10 mg (per each): $9.37

Capsules (Ramipril Oral)

1.25 mg (per each): $0.38 - $1.53

2.5 mg (per each): $0.29 - $1.81

5 mg (per each): $0.31 - $1.89

10 mg (per each): $0.35 - $2.22

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Capsule, Oral:

Altace: 1.25 mg, 2.5 mg

Altace: 5 mg, 10 mg [contains fd&c blue #2 (indigotine,indigo carmine)]

Altace: 15 mg [contains fd&c blue #1 (brilliant blue)]

Generic: 1.25 mg, 2.5 mg, 5 mg, 10 mg, 15 mg

Tablet, Oral:

Generic: 1.25 mg [DSC], 2.5 mg [DSC], 5 mg [DSC], 10 mg [DSC]

Administration: Adult

Oral: Swallow capsule whole; may open the capsule and the mix contents with 120 mL of water, apple juice, or applesauce.

Use: Labeled Indications

Heart failure with reduced ejection fraction: Treatment of heart failure after myocardial infarction.

Hypertension, chronic: Management of hypertension.

Reduction in risk of myocardial infarction, stroke, and death from cardiovascular causes: To reduce the risk of MI, stroke, and death in patients ≥55 years of age at high risk of developing major cardiovascular events.

Use: Off-Label: Adult

Non–ST-elevation acute coronary syndrome; Proteinuric chronic kidney disease, diabetic or nondiabetic; ST-elevation acute coronary syndrome

Medication Safety Issues
Sound-alike/look-alike issues:

Ramipril may be confused with enalapril, Monopril, Amaryl

Altace may be confused with Altace HCT, alteplase, Amaryl, Amerge, Artane

Metabolism/Transport Effects

None known.

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.

Alfuzosin: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Aliskiren: May enhance the hyperkalemic effect of Angiotensin-Converting Enzyme Inhibitors. Aliskiren may enhance the hypotensive effect of Angiotensin-Converting Enzyme Inhibitors. Aliskiren may enhance the nephrotoxic effect of Angiotensin-Converting Enzyme Inhibitors. Management: Aliskiren use with ACEIs or ARBs in patients with diabetes is contraindicated. Combined use in other patients should be avoided, particularly when CrCl is less than 60 mL/min. If combined, monitor potassium, creatinine, and blood pressure closely. Risk D: Consider therapy modification

Allopurinol: Angiotensin-Converting Enzyme Inhibitors may enhance the potential for allergic or hypersensitivity reactions to Allopurinol. Risk C: Monitor therapy

Alteplase: Angiotensin-Converting Enzyme Inhibitors may enhance the adverse/toxic effect of Alteplase. Specifically, the risk for angioedema may be increased. Risk C: Monitor therapy

Amifostine: Blood Pressure Lowering Agents may enhance the hypotensive effect of Amifostine. Management: When used at chemotherapy doses, hold blood pressure lowering medications for 24 hours before amifostine administration. If blood pressure lowering therapy cannot be held, do not administer amifostine. Use caution with radiotherapy doses of amifostine. Risk D: Consider therapy modification

Amphetamines: May diminish the antihypertensive effect of Antihypertensive Agents. Risk C: Monitor therapy

Angiotensin II: Angiotensin-Converting Enzyme Inhibitors may enhance the therapeutic effect of Angiotensin II. Risk C: Monitor therapy

Angiotensin II Receptor Blockers: May enhance the adverse/toxic effect of Angiotensin-Converting Enzyme Inhibitors. Angiotensin II Receptor Blockers may increase the serum concentration of Angiotensin-Converting Enzyme Inhibitors. Management: Use of telmisartan and ramipril is not recommended. It is not clear if any other combination of an ACE inhibitor and an ARB would be any safer. Consider alternatives when possible. Monitor blood pressure, renal function, and potassium if combined. Risk D: Consider therapy modification

Antipsychotic Agents (Second Generation [Atypical]): Blood Pressure Lowering Agents may enhance the hypotensive effect of Antipsychotic Agents (Second Generation [Atypical]). Risk C: Monitor therapy

Aprotinin: May diminish the antihypertensive effect of Angiotensin-Converting Enzyme Inhibitors. Risk C: Monitor therapy

Arginine: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

AzaTHIOprine: Angiotensin-Converting Enzyme Inhibitors may enhance the myelosuppressive effect of AzaTHIOprine. Risk C: Monitor therapy

Barbiturates: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Benperidol: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Brigatinib: May diminish the antihypertensive effect of Antihypertensive Agents. Brigatinib may enhance the bradycardic effect of Antihypertensive Agents. Risk C: Monitor therapy

Brimonidine (Topical): May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Bromperidol: May diminish the hypotensive effect of Blood Pressure Lowering Agents. Blood Pressure Lowering Agents may enhance the hypotensive effect of Bromperidol. Risk X: Avoid combination

Dapoxetine: May enhance the orthostatic hypotensive effect of Angiotensin-Converting Enzyme Inhibitors. Risk C: Monitor therapy

Dexmethylphenidate: May diminish the therapeutic effect of Antihypertensive Agents. Risk C: Monitor therapy

Diazoxide: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Dipeptidyl Peptidase-IV Inhibitors: May enhance the adverse/toxic effect of Angiotensin-Converting Enzyme Inhibitors. Specifically, the risk of angioedema may be increased. Risk C: Monitor therapy

Drospirenone-Containing Products: May enhance the hyperkalemic effect of Angiotensin-Converting Enzyme Inhibitors. Risk C: Monitor therapy

DULoxetine: Blood Pressure Lowering Agents may enhance the hypotensive effect of DULoxetine. Risk C: Monitor therapy

Eplerenone: May enhance the hyperkalemic effect of Angiotensin-Converting Enzyme Inhibitors. Risk C: Monitor therapy

Everolimus: May enhance the adverse/toxic effect of Angiotensin-Converting Enzyme Inhibitors. Specifically, the risk of angioedema may be increased. Risk C: Monitor therapy

Ferric Gluconate: Angiotensin-Converting Enzyme Inhibitors may enhance the adverse/toxic effect of Ferric Gluconate. Risk C: Monitor therapy

Ferric Hydroxide Polymaltose Complex: Angiotensin-Converting Enzyme Inhibitors may enhance the adverse/toxic effect of Ferric Hydroxide Polymaltose Complex. Specifically, the risk for angioedema or allergic reactions may be increased. Risk C: Monitor therapy

Finerenone: Angiotensin-Converting Enzyme Inhibitors may enhance the hyperkalemic effect of Finerenone. Risk C: Monitor therapy

Flunarizine: May enhance the therapeutic effect of Antihypertensive Agents. Risk C: Monitor therapy

Gelatin (Succinylated): Angiotensin-Converting Enzyme Inhibitors may enhance the adverse/toxic effect of Gelatin (Succinylated). Specifically, the risk of a paradoxical hypotensive reaction may be increased. Risk C: Monitor therapy

Grass Pollen Allergen Extract (5 Grass Extract): Angiotensin-Converting Enzyme Inhibitors may enhance the adverse/toxic effect of Grass Pollen Allergen Extract (5 Grass Extract). Specifically, ACE inhibitors may increase the risk of severe allergic reaction to Grass Pollen Allergen Extract (5 Grass Extract). Risk X: Avoid combination

Heparin: May enhance the hyperkalemic effect of Angiotensin-Converting Enzyme Inhibitors. Risk C: Monitor therapy

Heparins (Low Molecular Weight): May enhance the hyperkalemic effect of Angiotensin-Converting Enzyme Inhibitors. Risk C: Monitor therapy

Herbal Products with Blood Pressure Increasing Effects: May diminish the antihypertensive effect of Antihypertensive Agents. Risk C: Monitor therapy

Herbal Products with Blood Pressure Lowering Effects: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Hypotension-Associated Agents: Blood Pressure Lowering Agents may enhance the hypotensive effect of Hypotension-Associated Agents. Risk C: Monitor therapy

Icatibant: May diminish the antihypertensive effect of Angiotensin-Converting Enzyme Inhibitors. Risk C: Monitor therapy

Indoramin: May enhance the hypotensive effect of Antihypertensive Agents. Risk C: Monitor therapy

Iron Dextran Complex: Angiotensin-Converting Enzyme Inhibitors may enhance the adverse/toxic effect of Iron Dextran Complex. Specifically, patients receiving an ACE inhibitor may be at an increased risk for anaphylactic-type reactions. Risk C: Monitor therapy

Lanthanum: May decrease the serum concentration of Angiotensin-Converting Enzyme Inhibitors. Management: Administer angiotensin-converting enzyme (ACE) inhibitors at least two hours before or after lanthanum. Risk D: Consider therapy modification

Levodopa-Foslevodopa: Blood Pressure Lowering Agents may enhance the hypotensive effect of Levodopa-Foslevodopa. Risk C: Monitor therapy

Lithium: Angiotensin-Converting Enzyme Inhibitors may increase the serum concentration of Lithium. Management: Lithium dosage reductions will likely be needed following the addition of an ACE inhibitor. Monitor for increased concentrations/toxic effects of lithium if an ACE inhibitor is initiated/dose increased, or if switching between ACE inhibitors. Risk D: Consider therapy modification

Loop Diuretics: May enhance the hypotensive effect of Angiotensin-Converting Enzyme Inhibitors. Loop Diuretics may enhance the nephrotoxic effect of Angiotensin-Converting Enzyme Inhibitors. Risk C: Monitor therapy

Lormetazepam: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Methylphenidate: May diminish the antihypertensive effect of Antihypertensive Agents. Risk C: Monitor therapy

Molsidomine: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Naftopidil: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Nicergoline: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Nicorandil: May enhance the hyperkalemic effect of Angiotensin-Converting Enzyme Inhibitors. Risk C: Monitor therapy

Nicorandil: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Nitroprusside: Blood Pressure Lowering Agents may enhance the hypotensive effect of Nitroprusside. Risk C: Monitor therapy

Nonsteroidal Anti-Inflammatory Agents: Angiotensin-Converting Enzyme Inhibitors may enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents. Specifically, the combination may result in a significant decrease in renal function. Nonsteroidal Anti-Inflammatory Agents may diminish the antihypertensive effect of Angiotensin-Converting Enzyme Inhibitors. Risk C: Monitor therapy

Nonsteroidal Anti-Inflammatory Agents (Topical): May diminish the therapeutic effect of Angiotensin-Converting Enzyme Inhibitors. Risk C: Monitor therapy

Obinutuzumab: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Management: Consider temporarily withholding blood pressure lowering medications beginning 12 hours prior to obinutuzumab infusion and continuing until 1 hour after the end of the infusion. Risk D: Consider therapy modification

Pentoxifylline: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Pholcodine: Blood Pressure Lowering Agents may enhance the hypotensive effect of Pholcodine. Risk C: Monitor therapy

Phosphodiesterase 5 Inhibitors: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Polyethylene Glycol-Electrolyte Solution: Angiotensin-Converting Enzyme Inhibitors may enhance the nephrotoxic effect of Polyethylene Glycol-Electrolyte Solution. Risk C: Monitor therapy

Potassium Salts: May enhance the hyperkalemic effect of Angiotensin-Converting Enzyme Inhibitors. Risk C: Monitor therapy

Potassium-Sparing Diuretics: May enhance the hyperkalemic effect of Angiotensin-Converting Enzyme Inhibitors. Risk C: Monitor therapy

Prazosin: Antihypertensive Agents may enhance the hypotensive effect of Prazosin. Risk C: Monitor therapy

Pregabalin: Angiotensin-Converting Enzyme Inhibitors may enhance the adverse/toxic effect of Pregabalin. Specifically, the risk of angioedema may be increased. Risk C: Monitor therapy

Prostacyclin Analogues: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Quinagolide: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Racecadotril: May enhance the adverse/toxic effect of Angiotensin-Converting Enzyme Inhibitors. Specifically, the risk for angioedema may be increased with this combination. Risk C: Monitor therapy

Ranolazine: May enhance the adverse/toxic effect of Angiotensin-Converting Enzyme Inhibitors. Risk C: Monitor therapy

Sacubitril: Angiotensin-Converting Enzyme Inhibitors may enhance the adverse/toxic effect of Sacubitril. Specifically, the risk of angioedema may be increased with this combination. Risk X: Avoid combination

Salicylates: May enhance the nephrotoxic effect of Angiotensin-Converting Enzyme Inhibitors. Salicylates may diminish the therapeutic effect of Angiotensin-Converting Enzyme Inhibitors. Risk C: Monitor therapy

Silodosin: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Sirolimus Products: May enhance the adverse/toxic effect of Angiotensin-Converting Enzyme Inhibitors. Specifically, the risk for angioedema may be increased. Risk C: Monitor therapy

Sodium Phosphates: Angiotensin-Converting Enzyme Inhibitors may enhance the nephrotoxic effect of Sodium Phosphates. Specifically, the risk of acute phosphate nephropathy may be enhanced. Risk C: Monitor therapy

Sparsentan: May enhance the adverse/toxic effect of Angiotensin-Converting Enzyme Inhibitors. Risk X: Avoid combination

Tacrolimus (Systemic): Angiotensin-Converting Enzyme Inhibitors may enhance the hyperkalemic effect of Tacrolimus (Systemic). Risk C: Monitor therapy

Telmisartan: May enhance the adverse/toxic effect of Ramipril. Telmisartan may increase the serum concentration of Ramipril. Concentrations of the active metabolite, ramiprilat, may also be increased. Risk X: Avoid combination

Temsirolimus: May enhance the adverse/toxic effect of Angiotensin-Converting Enzyme Inhibitors. Specifically, the risk of angioedema may be increased. Risk C: Monitor therapy

Terazosin: Antihypertensive Agents may enhance the hypotensive effect of Terazosin. Risk C: Monitor therapy

Thiazide and Thiazide-Like Diuretics: May enhance the hypotensive effect of Angiotensin-Converting Enzyme Inhibitors. Thiazide and Thiazide-Like Diuretics may enhance the nephrotoxic effect of Angiotensin-Converting Enzyme Inhibitors. Risk C: Monitor therapy

Tolvaptan: May enhance the hyperkalemic effect of Angiotensin-Converting Enzyme Inhibitors. Risk C: Monitor therapy

Trimethoprim: May enhance the hyperkalemic effect of Angiotensin-Converting Enzyme Inhibitors. Risk C: Monitor therapy

Urapidil: May interact via an unknown mechanism with Angiotensin-Converting Enzyme Inhibitors. Management: Avoid concomitant use of urapidil and angiotensin-converting enzyme (ACE) inhibitors. Risk D: Consider therapy modification

Urokinase: May enhance the adverse/toxic effect of Angiotensin-Converting Enzyme Inhibitors. Specifically, the risk of angioedema may be increased. Risk C: Monitor therapy

Reproductive Considerations

Avoid use of angiotensin-converting enzyme (ACE) inhibitor therapy in patients who may become pregnant and who are not using effective contraception (ADA 2021).

Medications considered acceptable for the treatment of chronic hypertension during pregnancy may generally be used in patients trying to conceive. Angiotensin-converting enzyme (ACE) inhibitors are fetotoxic. Transition patients prior to conception to an agent preferred for use during pregnancy unless treatment with an ACE inhibitor is absolutely necessary (ACC/AHA [Whelton 2018]; ACOG 2019; NICE 2019).

When ACE inhibitors are used for the treatment of proteinuric chronic kidney disease in patients who could become pregnant, discontinue use at the first positive pregnancy test (ADA 2023; Fakhouri 2023).

ACE inhibitors are not recommended for the treatment of heart failure in patients planning to become pregnant (AHA/ACC/HFSA [Heidenreich 2022]).

Pregnancy Considerations

Ramipril crosses the placenta.

Drugs that act on the renin-angiotensin system can cause injury and death to the developing fetus. Exposure to an angiotensin-converting enzyme (ACE) inhibitor during the first trimester of pregnancy may be associated with an increased risk of fetal malformations (ACOG 2019; ESC [Regitz-Zagrosek 2018]). Following exposure during the second or third trimesters, drugs that act on the renin-angiotensin system are associated with oligohydramnios. Oligohydramnios, due to decreased fetal renal function, may lead to fetal lung hypoplasia and skeletal malformations. Oligohydramnios may not appear until after an irreversible fetal injury has occurred. ACE inhibitor use during pregnancy is also associated with anuria, hypotension, renal failure, skull hypoplasia, and death in the fetus/neonate. Monitor infants exposed to an ACE inhibitor in utero for hyperkalemia, hypotension, and oliguria. Exchange transfusions or dialysis may be required to reverse hypotension or improve renal function.

Chronic maternal hypertension is also associated with adverse events in the fetus/infant. Chronic maternal hypertension may increase the risk of birth defects, low birth weight, premature delivery, stillbirth, and neonatal death. Actual fetal/neonatal risks may be related to the duration and severity of maternal hypertension. Untreated chronic hypertension may also increase the risks of adverse maternal outcomes, including gestational diabetes, preeclampsia, delivery complications, stroke, and myocardial infarction (ACOG 2019).

Discontinue ACE inhibitors as soon as possible once pregnancy is detected. Agents other than ACE inhibitors are recommended for the treatment of chronic hypertension during pregnancy (ACOG 2019; ESC [Cífková 2020]; SOGC [Magee 2022]). Consider the use of ACE inhibitors only for pregnant patients with hypertension refractory to other medications (ACOG 2019). Closely monitor pregnant patients on ACE inhibitors with serial ultrasounds.

ACE inhibitors are not recommended for the treatment of heart failure or proteinuric chronic kidney disease during pregnancy (AHA/ACC/HFSA [Heidenreich 2022]; ESC [Regitz-Zagrosek 2018]; Fakhouri 2023).

Breastfeeding Considerations

Ramipril and its metabolites were not detected in breast milk following a single oral dose of 10 mg. It is not known if multiple doses will produce detectable levels.

Breastfeeding is not recommended by the manufacturer. When postpartum treatment with an angiotensin-converting enzyme (ACE) inhibitor is needed, consider use of an agent other than ramipril (AHA/ACC/HFSA [Heidenreich 2022]; ESC [Cífková 2020]). Avoid breastfeeding if high maternal doses of an ACE inhibitor are needed (ACOG 2019).

Monitoring Parameters

Blood pressure; BUN, serum creatinine; electrolytes (eg, potassium [especially in patients on concomitant potassium-sparing diuretics, potassium supplements, and/or potassium-containing salts]); if patient has collagen vascular disease and/or kidney impairment, periodically monitor CBC with differential. If angioedema is suspected, assess risk of airway obstruction (eg, involvement of tongue, glottis, larynx, and/or history of airway surgery).

Mechanism of Action

Ramipril is an ACE inhibitor which prevents the formation of angiotensin II from angiotensin I and exhibits pharmacologic effects that are similar to captopril. Ramipril must undergo enzymatic saponification by esterases in the liver to its biologically active metabolite, ramiprilat. The pharmacodynamic effects of ramipril result from the high-affinity, competitive, reversible binding of ramiprilat to angiotensin-converting enzyme, thus preventing the formation of the potent vasoconstrictor angiotensin II. This isomerized enzyme-inhibitor complex has a slow rate of dissociation, which results in high potency and a long duration of action; a CNS mechanism may also be involved in the hypotensive effect as angiotensin II increases adrenergic outflow from CNS; vasoactive kallikreins may be decreased in conversion to active hormones by ACE inhibitors, thus reducing blood pressure

Pharmacokinetics (Adult Data Unless Noted)

Onset of action: 1-2 hours

Duration: 24 hours

Absorption: Well absorbed (50% to 60%)

Distribution: Plasma levels decline in a triphasic fashion; rapid decline is a distribution phase to peripheral compartment, plasma protein and tissue ACE (half-life: 2-4 hours); second phase is an apparent elimination phase representing the clearance of free ramiprilat (half-life: 9-18 hours); and final phase is the terminal elimination phase representing the equilibrium phase between tissue binding and dissociation

Protein binding: Ramipril: 73%; Ramiprilat: 56%

Metabolism: Hepatic to the active form, ramiprilat

Bioavailability: Ramipril: 28%; Ramiprilat: 44%

Half-life elimination: Ramiprilat: Effective: 13-17 hours; Terminal: >50 hours

Time to peak, serum: Ramipril: ~1 hour; Ramiprilat: 2-4 hours

Excretion: Urine (60%) and feces (40%) as parent drug and metabolites

Pharmacokinetics: Additional Considerations (Adult Data Unless Noted)

Altered kidney function: In patients with CrCl <40 mL/minute, peak levels of metabolite approximately doubled. AUC was 3 to 4 times larger. Urinary excretion of metabolite is reduced. Higher peak and trough ramiprilat levels.

Hepatic function impairment: Slowed metabolism of ramiprilat. Ramipril plasma levels increase about 3-fold.

Brand Names: International
International Brand Names by Country
For country code abbreviations (show table)

  • (AE) United Arab Emirates: Cardace | Cardiopril | Fortace | Triltec | Tritace;
  • (AR) Argentina: Lostapres | Tritace;
  • (AT) Austria: Hypren | Lannapril | Ramipril 1a pharma gmbh | Ramipril Actavis | Ramipril g.l. | Ramipril hexal pharma | Ramipril interpharm | Ramipril krka | Ramipril pfizer | Ramipril Ratiopharm | Ramipril sandoz | Ramipril-genericon pharma | Tritace;
  • (AU) Australia: Apo Ramipril | Chemmart Ramipril | Genrx Ramipril | Pharmacor Ramipril | Prilace | Ramace | Ramipril an | Ramipril apotex | Ramipril ch | Ramipril Ga | Ramipril Generic Health | Ramipril pfizer | Ramipril PS | Ramipril rbx | Ramipril sandoz | Ramipril terry white chem | Ramipril Winthrop | Ramipril-DP | Terry White Chemists Ramipril | Tritace | Tryzan | Vascalace;
  • (BD) Bangladesh: Acecard | Aceril | Cardace | Cartace | Hypace | Mypril | Nuvace | Piramil | Pricard | Primace | Protace | R Pil | Racard | Ramace | Ramicard | Ramil | Ramilok | Ramipress | Ramipro | Ramoril | Ripril | Tritace | Unipril;
  • (BE) Belgium: Ramace | Ramipril ab | Ramipril doc | Ramipril eg | Ramipril eurogenerics | Ramipril hcs | Ramipril Mylan | Ramipril pfizer | Ramipril sandoz | Ramipril teva | Tritace;
  • (BF) Burkina Faso: Triatec;
  • (BG) Bulgaria: Ampril | Cardifriend | Corpril | Neorami | Ramigamma | Ramimed | Ramipril teva | Tritace | Vivace;
  • (BR) Brazil: Ecator | Naprix | Triatec;
  • (CH) Switzerland: Ramipril Actavis | Ramipril mepha | Ramipril sandoz | Ramipril Winthrop | Ramipril zentiva | Triatec | Vesdil;
  • (CI) Côte d'Ivoire: Genpress | Provace | Ramcor | Ramipril SP | Ramizid | Rampil | Rapril | Rasgil;
  • (CL) Chile: Ramipres | Triatec | Tritace;
  • (CN) China: Rui su tan | Tritace;
  • (CO) Colombia: Ramcor | Tritace;
  • (CZ) Czech Republic: Amprilan | Apo Ramipril | Hartil | Medoram | Piramil | Ramicard | Ramigamma | Ramil | Ramipril Actavis | Ramipril aurovitas | Ramipril krka | Ramipril Polpharma | Ramipril Ratiopharm | Tritace;
  • (DE) Germany: Corcula | Delix | Delix Protect | Rami Q | Ramicard | Ramiclair | Ramigamma | Ramilich | Ramipril 1a pharma | Ramipril AAA | Ramipril abz | Ramipril accedo | Ramipril al | Ramipril aurobindo | Ramipril beta | Ramipril Corax | Ramipril ct | Ramipril dura | Ramipril galex | Ramipril Heumann | Ramipril hexal | Ramipril Hormosan | Ramipril KSK | Ramipril puren | Ramipril q-pharm | Ramipril Ratiopharm | Ramipril sandoz | Ramipril stada | Ramipril tad | Ramipril-Isis | Triatec | Unipril | Vagulan | Vesdil | Zabien;
  • (DK) Denmark: Ramipril durascan | Ramipril hexal | Ramipril Medis | Ramipril Nycomed | Ramipril Unp;
  • (DO) Dominican Republic: Certara | Lotensor | Miocardin | Prilan | Ramicar | Ramipres | Ramiril | Rampril | Rowepril | Tritace | Tritace Prevent;
  • (EC) Ecuador: Osmopril | Tritace;
  • (EE) Estonia: Ampril | Cardace | Corpril | Ramicor | Ramigamma;
  • (EG) Egypt: Bigastus | Corpril | Ramipress | Ramitac | Rampecardin | Rampitensive | Recardopril | Right ace | Tritace;
  • (ES) Spain: Acovil | Carasel | Ramipril Acost | Ramipril Actavis | Ramipril aurobindo | Ramipril aurovitas spain | Ramipril bexal | Ramipril cinfa | Ramipril Combix | Ramipril hcs | Ramipril Normon | Ramipril Pharmacia | Ramipril Ratiopharm | Ramipril sandoz | Ramipril stada | Ramipril Tarbis | Ramipril tecnigen | Ramipril tevagen | Ramipril UR;
  • (FI) Finland: Cardace | Gepril | Ramace | Ramipril Actavis | Ramipril hexal | Ramipril medgener | Ramipril pfizer | Ramipril Ratiopharm | Ramipril sandoz | Ramipril teva;
  • (FR) France: Ramipril Actavis | Ramipril almus | Ramipril Alter | Ramipril Arrow | Ramipril Biogaran | Ramipril Bouchara Recordati | Ramipril Cristers | Ramipril evolugen | Ramipril isomed | Ramipril krka | Ramipril Qualimed | Ramipril ranbaxy | Ramipril Ratiopharm | Ramipril rpg | Ramipril sandoz | Ramipril Zydus | Triatec | Triateckit;
  • (GB) United Kingdom: Lopace | Ramipril Arrow | Ramipril aurobindo | Ramipril cox | Ramipril focus | Ramipril kent | Ramipril pfizer | Ramipril sandoz | Ranace | Tritace;
  • (GR) Greece: Piramil | Ramisyn | Stibenyl | Triatec;
  • (HK) Hong Kong: Apo Ramipril | Ramil | Tritace;
  • (HR) Croatia: Ampril | Blocar | Piramil | Prilen | Ramed | Ramipril Farmal | Ramipril Genericon | Ramipril Pliva | Tritace;
  • (HU) Hungary: Amprilan | Corpril | Emren | Hartil | Ramace | Ramicard | Ramigamma | Ramipril 1a pharma | Ramipril aurobindo | Ramipril Bril | Ramipril galex | Ramipril pfizer | Ramipril prevent | Ramipril Ratiopharm | Ramipril zentiva | Ramitren | Tritace;
  • (ID) Indonesia: Cardace | Hyperil | Ramixal | Redutens | Tenapril | Triatec | Vivace;
  • (IE) Ireland: Bellramil | Bytrite | Loavel | Ramic | Ramilo | Ramipril krka | Ramipril Niche | Ramipril teva | Ramitace | Ramyte | Tritace;
  • (IL) Israel: Ramipril inovamed | Ramitens | Tritace;
  • (IN) India: Acepril | Alvace | Cardace | Cardica | Cardiopril | Conram | Cordimil | Corpril | Ecator | Etoril | Heartace | Hopace | Hopecard | Hopril | Kapril | Loypril | Macpril | Myoram | Novapril | Odipril | Opril | Preface | Prilace | Proace | R Pril | Race | Raface | Ramace | Ramcor | Ramey | Ramfirst | Ramicard | Ramichek | Ramicure | Ramidil | Ramifast | Ramihart | Ramil | Ramilat | Ramilong | Ramipil | Ramipres | Ramipro | Ramirica | Ramiril | Ramisave | Ramistar | Ramiten | Ramiwon | Ramizen | Ramloz | Rampril | Ramril | Ramvas | Ramveda | Ramy 24 | Rapril | Rebeat | Ril | Rip | Rl | Rovace | Saface | Sclerace | Servace | Starace | Topril | Uniace | Unoram | Variace | X-Pril | Zigpril | Zipril | Ziram | Zorem;
  • (IT) Italy: Eclipse | Herzatec | Krupil | Norapril | Quark | Ramicor | Ramieca | Ramipril abc | Ramipril Actavis | Ramipril almus | Ramipril Angenerico | Ramipril Arrow | Ramipril doc | Ramipril eg | Ramipril fg | Ramipril ipso | Ramipril krka | Ramipril Merck | Ramipril Pensa | Ramipril pfizer | Ramipril pharmeg | Ramipril sandoz | Ramipril tecnigen | Ramipril Winthrop | Tensiram | Triatec | Unipril;
  • (JO) Jordan: Triprel | Tritace;
  • (KE) Kenya: Ramcor | Ramifast | Ramitace | Ramitas | Ramiz | Ramizid | Ramshal | Tritace | Variace;
  • (KR) Korea, Republic of: Heartpril | Heartpril protect | Jenipril | Ramace | Rameril | Ramiipil | Raminel | Ramiprin | Ramiryl | Ramitel | Ramiteril | Rampistar | Rampril | Tripril | Tripril Protect | Tritace | Tritace protect;
  • (KW) Kuwait: Triltec | Tritace;
  • (LB) Lebanon: Acuril | Apo Ramipril | Genpress | Mapril | Norapril | Normopril | Ramil | Tritace;
  • (LT) Lithuania: Cardace | Corpril | Meramyl | Ramicor | Ramigamma | Ramimed | Ramipril aurobindo | Ramipril billev | Ramipril Ingen pharma | Ramirace | Ramitren;
  • (LU) Luxembourg: Ramace | Ramipril eg | Ramipril hexal | Tritace;
  • (LV) Latvia: Ampril | Cardace | Corpril | Ramicor | Ramigamma | Ramimed | Ramipres | Ramipril billev | Ramipril Medochemie | Ramipril tad | Ramitren;
  • (MA) Morocco: Altec | Corpril | Genpress | Mirzam | Ramipril Winthrop | Ramitec | Tecpril | Tecram | Tensiotec | Triatec | Vicardia;
  • (MX) Mexico: Benatol | Intemipril | Prilver | Ramace | Ramipril kendrick | Tritace | Tritace Prevent | Venesden;
  • (MY) Malaysia: Apo Ramipril | Ramil | Ramtace | Tripril | Tritace;
  • (NG) Nigeria: Acinova | Codix ramipril | Liface | Multichris ramipril | Ramitace | Ramizid | Tritace;
  • (NL) Netherlands: Ramipril A | Ramipril accord | Ramipril Actavis | Ramipril aurobindo | Ramipril krka | Ramipril PCH | Ramipril ranbaxy | Tritace;
  • (NO) Norway: Ramipril hexal | Ramipril Winthrop | Triatec;
  • (NZ) New Zealand: Tryzan;
  • (PE) Peru: Ramcor | Raminor;
  • (PH) Philippines: Amipril | Kardia | Tritace | Winthrop Ramipril;
  • (PK) Pakistan: Adytum | Hiace | Hyperace | Mapril | Neofuraline | Normipil | Ramipace | Ramivel | Tritace;
  • (PL) Poland: Ampril | Apo Rami | Awerpil | Axtil | Delix | Dopril | Ivipril | Mitrip | Piramil | Polpril | Ramicor | Ramipril accord | Ramipril Actavis | Ramipril Arrow | Ramipril aurobindo | Ramipril aurovitas | Ramipril billev | Ramipril pfizer | Ramipril Ratiopharm | Ramiprilum 123ratio | Ramistad | Ramve | Tritace | Vivace;
  • (PR) Puerto Rico: Altace;
  • (PT) Portugal: Prilamil | Ramipril aurobindo | Ramipril aurovitas | Ramipril generis | Ramipril Jaba | Ramipril krka | Ramipril Wynn | Romace | Triatec | Verzatec;
  • (PY) Paraguay: Ramicor | Ramicor 10 pcv | Tritace;
  • (QA) Qatar: Triltec | Tritace;
  • (RO) Romania: Amprigen | Ampril | Emren | Hartil | Ramigamma | Ramipril ac | Ramipril atb | Ramipril aurobindo | Ramipril sandoz | Ramipril stada | Ramipril teva | Ramiran | Ramitren | Vivace | Zenra;
  • (RU) Russian Federation: Amprilan | Corpril | Hartil | Piramil | Pyramil | Rami sandoz | Ramicardiya | Ramigamma | Ramipril nanolek | Ramipril vertex | Tritace | Vasolong;
  • (SA) Saudi Arabia: Tritace;
  • (SE) Sweden: Pramace | Ramipril aristo | Ramipril Arrow | Ramipril aurobindo | Ramipril copyfarm | Ramipril ebb | Ramipril hexal | Ramipril krka | Ramipril ranbaxy | Ramipril Ratiopharm | Ramipril stada | Triatec;
  • (SG) Singapore: Tritace;
  • (SI) Slovenia: Ampril | Meramyl | Ramigamma | Tritace;
  • (SK) Slovakia: Ramigamma | Ramil | Ramimed | Ramipril Actavis | Tritace;
  • (TH) Thailand: Cardace | Corpril | Piramil | Ramace | Ramiril | Ramtace | Tritace | Vaspril;
  • (TN) Tunisia: Ramitec | Rapril | Triatec;
  • (TR) Turkey: Blokace | Delix | Delix Protect | Race | Raliks | Revil;
  • (TW) Taiwan: Maxipril | Ramey | Ramily | Ramitace | Rapmitec | Roopril | Sipo | Syntace | Tritace;
  • (UA) Ukraine: Ampril | Angiram | Baraton | Laceran | Polapril | Prevencor | Ramag | Rami sandoz | Ramigamma | Ramimed | Ramipril pfizer | Ramizes;
  • (UG) Uganda: Ramizid;
  • (UY) Uruguay: Ramicor | Raminorm | Tritace | Tritace Prevent;
  • (VE) Venezuela, Bolivarian Republic of: Altace | Dagredos | Piramil | Ramidil | Ramipres | Topril | Triten;
  • (ZA) South Africa: Apex ramipril | Arrow ramipril | Austell Ramipril | Liracen | Ramace | Ramipril hexal | Ramiwin | Rampil | Retace | Rilace | Simayla ramipril | Tritace;
  • (ZM) Zambia: Angiram | Corpril | Ramcor | Topril | Tritace;
  • (ZW) Zimbabwe: Topril | Tritace
  1. Adelborg K, Nicolaisen SK, Hasvold P, Palaka E, Pedersen L, Thomsen RW. Predictors for repeated hyperkalemia and potassium trajectories in high-risk patients - A population-based cohort study. PLoS One. 2019;14(6):e0218739. doi:10.1371/journal.pone.0218739 [PubMed 31226134]
  2. Agodoa LY, Appel L, Bakris GL, et al; African American Study of Kidney Disease and Hypertension (AASK) Study Group. Effect of ramipril vs amlodipine on renal outcomes in hypertensive nephrosclerosis: a randomized controlled trial. JAMA. 2001;285(21):2719-2728. doi:10.1001/jama.285.21.2719 [PubMed 11386927]
  3. Alderman CP. Adverse effects of the angiotensin-converting enzyme inhibitors. Ann Pharmacother. 1996;30(1):55-61. doi:10.1177/106002809603000110 [PubMed 8773167]
  4. Alharbi FF, Kholod AAV, Souverein PC, et al. The impact of age and sex on the reporting of cough and angioedema with renin-angiotensin system inhibitors: a case/noncase study in VigiBase. Fundam Clin Pharmacol. 2017;31(6):676-684. doi:10.1111/fcp.12313 [PubMed 28767167]
  5. Alencar RC, Cobas RA, Gomes MB. Allergic reaction related to ramipril use: a case report. Diabetol Metab Syndr. 2010;2:4. doi:10.1186/1758-5996-2-4 [PubMed 20180980]
  6. ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: The antihypertensive and lipid-lowering treatment to prevent heart attack trial (ALLHAT). JAMA. 2002;288(23):2981-2997. [PubMed 12479763]
  7. Altace (ramipril) [prescribing information]. New York, NY: Pfizer; April 2017.
  8. Altace capsules and tablets (ramipril) [product labeling]. Laval, Quebec, Canada: Bausch Health, Canada Inc; January 2021.
  9. American College of Obstetricians and Gynecologists (ACOG). ACOG Practice Bulletin No. 203: Chronic hypertension in pregnancy. Obstet Gynecol. 2019;133(1):e26-e50. [PubMed 30575676]
  10. American Diabetes Association (ADA). Standards of medical care in diabetes–2021. Diabetes Care. 2021;44(suppl 1):S1-S232. https://care.diabetesjournals.org/content/44/Supplement_1. Accessed January 13, 2021.
  11. American Diabetes Association (ADA). Standards of care in diabetes–2023. Diabetes Care. 2023;46(suppl 1):S1-S280. https://diabetesjournals.org/care/issue/46/Supplement_1. Accessed April 12, 2023.
  12. Amsterdam EA, Wenger NK, Brindis RG, et al; American College of Cardiology; American Heart Association Task Force on Practice Guidelines; Society for Cardiovascular Angiography and Interventions; Society of Thoracic Surgeons; American Association for Clinical Chemistry. 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;64(24):e139-e228. doi:10.1016/j.jacc.2014.09.017 [PubMed 25260718]
  13. Aronow WS, Fleg JL, Pepine CJ, et al. ACCF/AHA 2011 expert consensus document on hypertension in the elderly: A report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents. Circulation. 2011;123(21):2434-506. [PubMed 21518977]
  14. Aurell M, Delin K, Herlitz H, Ljungman S, Witte PU, Irmisch R. Pharmacokinetics and pharmacodynamics of ramipril in renal failure. Am J Cardiol. 1987;59(10):65D-69D. doi:10.1016/0002-9149(87)90056-7 [PubMed 3034036]
  15. Baker-Smith CM, Benjamin DK Jr, Califf RM, Murphy MD, Li JS, Smith PB. Cough in pediatric patients receiving angiotensin-converting enzyme inhibitor therapy or angiotensin receptor blocker therapy in randomized controlled trials. Clin Pharmacol Ther. 2010;87(6):668-6671. doi:10.1038/clpt.2009.231 [PubMed 20130570]
  16. Bakris GL, Weir MR. Angiotensin-converting enzyme inhibitor-associated elevations in serum creatinine: is this a cause for concern? Arch Intern Med. 2000;160(5):685-693. [PubMed 10724055]
  17. Banerji A, Blumenthal KG, Lai KH, Zhou L. Epidemiology of ACE inhibitor angioedema utilizing a large electronic health record. J Allergy Clin Immunol Pract. 2017;5(3):744-749. doi:10.1016/j.jaip.2017.02.018 [PubMed 28377081]
  18. Bezalel S, Mahlab-Guri K, Asher I, Werner B, Sthoeger ZM. Angiotensin-converting enzyme inhibitor-induced angioedema. Am J Med. 2015;128(2):120-125. doi:10.1016/j.amjmed.2014.07.011 [PubMed 25058867]
  19. Bianchi S, Aucella F, De Nicola L, Genovesi S, Paoletti E, Regolisti G. Management of hyperkalemia in patients with kidney disease: a position paper endorsed by the Italian Society of Nephrology. J Nephrol. 2019;32(4):499-516. doi:10.1007/s40620-019-00617-y [PubMed 31119681]
  20. Biggins SW, Angeli P, Garcia-Tsao G, et al. Diagnosis, evaluation, and management of ascites, spontaneous bacterial peritonitis and hepatorenal syndrome: 2021 practice guidance by the American Association for the Study of Liver Diseases. Hepatology. 2021;74(2):1014-1048. doi:10.1002/hep.31884 [PubMed 33942342]
  21. Brewster LM, Seedat YK. Why do hypertensive patients of African ancestry respond better to calcium blockers and diuretics than to ACE inhibitors and β-adrenergic blockers? A systematic review. BMC Med. 2013;11:141. doi:10.1186/1741-7015-11-141 [PubMed 23721258]
  22. Brown T, Gonzalez J, Monteleone C. Angiotensin-converting enzyme inhibitor-induced angioedema: A review of the literature. J Clin Hypertens (Greenwich). 2017;19(12):1377-1382. doi:10.1111/jch.13097 [PubMed 28994183]
  23. Brown NJ, Ray WA, Snowden M, Griffin MR. Black Americans have an increased rate of angiotensin converting enzyme inhibitor-associated angioedema. Clin Pharmacol Ther. 1996;60(1):8-13. doi:10.1016/S0009-9236(96)90161-7 [PubMed 8689816]
  24. Brown NJ, Snowden M, Griffin MR. Recurrent angiotensin-converting enzyme inhibitor--associated angioedema. JAMA. 1997;278(3):232-233. doi:10.1001/jama.278.3.232 [PubMed 9218671]
  25. Canadian Diabetes Association Clinical Practice Guidelines Expert Committee. Canadian Diabetes Association 2013 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada. Can J Diabetes. 2013; 35(suppl 1):1-212.
  26. Cattran DC, Appel GB, Coppo R. Treatment and prognosis of IgA nephropathy. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed December 13, 2023.
  27. Chase MP, Fiarman GS, Scholz FJ, et al, “Angioedema of the Small Bowel Due to an Angiotensin-Converting Enzyme Inhibitor,” J Clin Gastroenterol, 2000, 31(3):254-7. [PubMed 11034011]
  28. Chiu AG, Newkirk KA, Davidson BJ, Burningham AR, Krowiak EJ, Deeb ZE. Angiotensin-converting enzyme inhibitor-induced angioedema: a multicenter review and an algorithm for airway management. Ann Otol Rhinol Laryngol. 2001;110(9):834-840. doi:10.1177/000348940111000906 [PubMed 11558759]
  29. Cífková R, Johnson MR, Kahan T, et al. Peripartum management of hypertension: a position paper of the ESC Council on Hypertension and the European Society of Hypertension. Eur Heart J Cardiovasc Pharmacother. 2020;6(6):384-393. doi:10.1093/ehjcvp/pvz082 [PubMed 31841131]
  30. Conlin P, Moore T, Swartz S, et al. Effect of indomethacin on blood pressure lowering by captopril and losartan in hypertensive patients. Hypertension. 2000;36(3):461-465. [PubMed 10988282]
  31. Debusmann ER, Pujadas JO, Lahn W, et al. Influence of renal function on the pharmacokinetics of ramipril (HOE 498). Am J Cardiol. 1987;59(10):70D-78D. doi:10.1016/0002-9149(87)90057-9 [PubMed 3034037]
  32. Dicpinigaitis PV. Angiotensin-converting enzyme inhibitor-induced cough: ACCP evidence-based clinical practice guidelines. Chest. 2006;129(1 suppl):169S-173S. doi:10.1378/chest.129.1_suppl.169S [PubMed 16428706]
  33. Doane J, Stults B. Visual hallucinations related to angiotensin-converting enzyme inhibitor use: case reports and review. J Clin Hypertens (Greenwich). 2013;15(4):230-233. doi:10.1111/jch.12063 [PubMed 23551721]
  34. Duerr M, Glander P, Diekmann F, Dragun D, Neumayer HH, Budde K. Increased incidence of angioedema with ACE inhibitors in combination with mTOR inhibitors in kidney transplant recipients. Clin J Am Soc Nephrol. 2010;5(4):703-708. doi:10.2215/CJN.07371009 [PubMed 20093343]
  35. Effects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus: Results of the HOPE study and MICRO-HOPE substudy. Heart outcomes prevention evaluation (HOPE) study investigators. Lancet. 2000;355(9200):253-259. [PubMed 10675071]
  36. Expert opinion. Senior Renal Editorial Team: Bruce Mueller, PharmD, FCCP, FASN, FNKF; Jason A. Roberts, PhD, BPharm (Hons), B App Sc, FSHP, FISAC; Michael Heung, MD, MS.
  37. Fakhouri F, Schwotzer N, Cabiddu G, et al. Glomerular diseases in pregnancy: pragmatic recommendations for clinical management. Kidney Int. 2023;103(2):264-281. doi:10.1016/j.kint.2022.10.029 [PubMed 36481180]
  38. Fihn SD, Blankenship JC, Alexander KP, et al. 2014 ACC/AHA/AATS/PCNA/SCAI/STS focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines, and the American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation. 2014;130(19):1749-1767. doi:10.1161/CIR.0000000000000095 [PubMed 25070666]
  39. Fihn SD, Gardin JM, Abrams J, et al. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation. 2012;126(25):3097-3137. [PubMed 23166211]
  40. Fillastre JP, Baguet JC, Dubois D, et al. Kinetics, safety, and efficacy of ramipril after long-term administration in hemodialyzed patients. J Cardiovasc Pharmacol. 1996;27(2):269-274. doi:10.1097/00005344-199602000-00014 [PubMed 8720427]
  41. Fleisher LA, Fleischmann KE, Auerbach AD, et al. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;130(24):e278-e333. [PubMed 25085961]
  42. Fox KM and EURopean Trial on Reduction of Cardiac Events With Perindopril in Stable Coronary Artery Disease Investigators. Efficacy of perindopril in reduction of cardiovascular events among patients with stable coronary artery disease: Randomised, double-blind, placebo-controlled, multicentre trial (the EUROPA study). Lancet. 2003;362(9386):782-788. [PubMed 13678872]
  43. Funder JW, Carey RM, Mantero F, et al. The management of primary aldosteronism: case detection, diagnosis, and treatment: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2016;101(5):1889-1916. doi:10.1210/jc.2015-4061 [PubMed 26934393]
  44. Go AS, Bauman M, King SM, et al. An effective approach to high blood pressure control: a science advisory from the American Heart Association, the American College of Cardiology, and the Centers for Disease Control and Prevention. Hypertension. Published online November 15, 2013. [PubMed 24243703]
  45. Gruppo Italiano di Studi Epidemiologici in Nefrologia (GISEN). Randomised placebo-controlled trial of effect of ramipril on decline in glomerular filtration rate and risk of terminal renal failure in proteinuric, non-diabetic nephropathy. Lancet. 1997;349(9069):1857-1863. [PubMed 9217756]
  46. Hallberg P, Persson M, Axelsson T, et al. Genetic variants associated with angiotensin-converting enzyme inhibitor-induced cough: a genome-wide association study in a Swedish population. Pharmacogenomics. 2017;18(3):201-213. doi:10.2217/pgs-2016-0184 [PubMed 28084903]
  47. Heerspink HJ, Gao P, de Zeeuw D, et al. The effect of ramipril and telmisartan on serum potassium and its association with cardiovascular and renal events: results from the ONTARGET trial. Eur J Prev Cardiol. 2014;21(3):299-309. doi:10.1177/2047487313510678 [PubMed 24191305]
  48. Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines. Circulation. 2022;145(18):e895-e1032. doi:10.1161/CIR.0000000000001063 [PubMed 35363499]
  49. Helmer A, Slater N, Smithgall S. A review of ACE inhibitors and ARBs in black patients with hypertension. Ann Pharmacother. 2018;52(11):1143-1151. doi:10.1177/1060028018779082 [PubMed 29808707]
  50. Hillis LD, Smith PK, Anderson JL, et al. 2011 ACCF/AHA guideline for coronary artery bypass graft surgery: A report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation. 2011;24(23):2610-2642. [PubMed 22064600]
  51. Horowitz N, Molnar M, Levy Y, Pollack S. Ramipril-induced agranulocytosis confirmed by a lymphocyte cytotoxicity test. Am J Med Sci. 2005;329(1):52-53. doi:10.1097/00000441-200501000-00010 [PubMed 15654181]
  52. Israili ZH, Hall WD. Cough and angioneurotic edema associated with angiotensin-converting enzyme inhibitor therapy. A review of the literature and pathophysiology. Ann Intern Med. 1992;117(3):234-242. doi:10.7326/0003-4819-117-3-234 [PubMed 1616218]
  53. Jackeviciute J, Pilvinis V, Pilviniene R. Fatal outcome of late-onset angiotensin-converting enzyme inhibitor induced angioedema: A case report. Medicine (Baltimore). 2018;97(31):e11695. doi:10.1097/MD.0000000000011695 [PubMed 30075570]
  54. James PA, Oparil S, Carter BL, et al. 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults: Report From the Panel Members Appointed to the Eighth Joint National Committee (JNC 8). JAMA. Published online December 18, 2013. [PubMed 24352797]
  55. January CT, Wann LS, Alpert JS, et al. 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. Circulation. Published online March 28, 2014. [PubMed 24682347]
  56. Jiménez-Marrero S, Enjuanes C, Yun S, Comín-Colet J. Use of potassium-binder patiromer for up-titration of renin-angiotensin-aldosterone system inhibition therapy in a patient with chronic heart failure and reduced ejection fraction followed in a multidisciplinary integrated chronic care management programme: a case report. Eur Heart J Case Rep. 2020;4(4):1-4. doi:10.1093/ehjcr/ytaa103 [PubMed 32974448]
  57. Kammerl MC, Schaefer RM, Schweda F, Schreiber M, Riegger GA, Krämer BK. Extracorporal therapy with AN69 membranes in combination with ACE inhibition causing severe anaphylactoid reactions: still a current problem? Clin Nephrol. 2000;53(6):486-488. [PubMed 10879671]
  58. Kernan WN, Ovbiagele B, Black HR, et al; American Heart Association Stroke Council, Council on Cardiovascular and Stroke Nursing, Council on Clinical Cardiology, and Council on Peripheral Vascular Disease. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association [published correction appears in Stroke. 2015;46(2):e54]. Stroke. 2014;45(7):2160-2236. doi:10.1161/STR.0000000000000024 [PubMed 24788967]
  59. Kidney Disease: Improving Global Outcomes (KDIGO) Blood Pressure Work Group. KDIGO 2021 clinical practice guideline for the management of blood pressure in chronic kidney disease. Kidney Int. 2021b;99(3S):S1-S87. doi:10.1016/j.kint.2020.11.003 [PubMed 33637192]
  60. Kidney Disease: Improving Global Outcomes (KDIGO). Chapter 10: immunoglobulin A nephropathy. Kidney Int Suppl (2011). 2012;2(2):209-217. doi:10.1038/kisup.2012.23 [PubMed 25018935]
  61. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 clinical practice guidelines for the evaluation and management of chronic kidney disease. Kidney Inter, Suppl. 2013;3:1-150. https://kdigo.org/wp-content/uploads/2017/02/KDIGO_2012_CKD_GL.pdf.
  62. Kidney Disease: Improving Global Outcomes (KDIGO). Clinical practice guideline for the management of blood pressure in chronic kidney disease. Kidney International Supplements. 2012;2(5);337-414.
  63. Kidney Disease: Improving Global Outcomes (KDIGO) Diabetes Work Group. KDIGO 2020 clinical practice guideline for diabetes management in chronic kidney disease. Kidney Int. 2020;98(4S):S1-S115. doi:10.1016/j.kint.2020.06.019 [PubMed 32998798]
  64. Kidney Disease: Improving Global Outcomes (KDIGO) Diabetes Work Group. KDIGO 2022 clinical practice guideline for diabetes management in chronic kidney disease. Kidney Int. 2022;102(suppl 5):S1-S127. doi:10.1016/j.kint.2022.06.008 [PubMed 36272764]
  65. Kidney Disease: Improving Global Outcomes (KDIGO) Glomerular Diseases Work Group. KDIGO 2021 clinical practice guideline for the management of glomerular diseases. Kidney Int. 2021a;100(suppl 4):S1-S276. doi:10.1016/j.kint.2021.05.021 [PubMed 34556256]
  66. Kostis JB, Kim HJ, Rusnak J, et al. Incidence and characteristics of angioedema associated with enalapril. Arch Intern Med. 2005;165(14):1637-1642. doi:10.1001/archinte.165.14.1637 [PubMed 16043683]
  67. Kostis WJ, Shetty M, Chowdhury YS, Kostis JB. ACE inhibitor-induced angioedema: A review. Curr Hypertens Rep. 2018;20(7):55. doi:10.1007/s11906-018-0859-x [PubMed 29884969]
  68. Li PK, Chow KM, Wong TY, Leung CB, Szeto CC. Effects of an angiotensin-converting enzyme inhibitor on residual renal function in patients receiving peritoneal dialysis. A randomized, controlled study. Ann Intern Med. 2003;139(2):105-112. doi:10.7326/0003-4819-139-2-200307150-00010 [PubMed 12859160]
  69. Magee LA, Smith GN, Bloch C, et al. Guideline no. 426: hypertensive disorders of pregnancy: diagnosis, prediction, prevention, and management. J Obstet Gynaecol Can. 2022;44(5):547-571.e1. doi:10.1016/j.jogc.2022.03.002 [PubMed 35577426]
  70. Mann JFE, Bakris GL. Antihypertensive therapy and progression of nondiabetic chronic kidney disease in adults. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed March 10, 2021b.
  71. Mann JFE, Flack JM. Choice of drug therapy in primary (essential) hypertension. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed March 7, 2023.
  72. Maroteau C, Siddiqui MK, Veluchamy A, et al. Exome sequencing reveals common and rare variants in F5 associated with ACE inhibitor and angiotensin receptor blocker-induced angioedema. Clin Pharmacol Ther. 2020;108(6):1195-1202. doi:10.1002/cpt.1927 [PubMed 32496628]
  73. Meyer TE. Primary pharmacologic therapy of heart failure with reduced ejection fraction in adults. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed November 2, 2021.
  74. Miller DR, Oliveria SA, Berlowitz DR, Fincke BG, Stang P, Lillienfeld DE. Angioedema incidence in US veterans initiating angiotensin-converting enzyme inhibitors. Hypertension. 2008;51(6):1624-1630. doi:10.1161/HYPERTENSIONAHA.108.110270 [PubMed 18413488]
  75. Montinaro V, Cicardi M. ACE inhibitor-mediated angioedema. Int Immunopharmacol. 2020;78:106081. doi:10.1016/j.intimp.2019.106081 [PubMed 31835086]
  76. Morimoto T, Gandhi TK, Fiskio JM, et al. An evaluation of risk factors for adverse drug events associated with angiotensin-converting enzyme inhibitors. J Eval Clin Pract. 2004;10(4):499-509. doi:10.1111/j.1365-2753.2003.00484.x [PubMed 15482412]
  77. Mu G, Xiang Q, Zhou S, et al. Association between genetic polymorphisms and angiotensin-converting enzyme inhibitor-induced cough: a systematic review and meta-analysis. Pharmacogenomics. 2019;20(3):189-212. doi:10.2217/pgs-2018-0157 [PubMed 30672376]
  78. Mu G, Xiang Q, Zhang Z, et al. PNPT1 and PCGF3 variants associated with angiotensin-converting enzyme inhibitor-induced cough: a nested case-control genome-wide study. Pharmacogenomics. 2020;21(9):601-614. doi:10.2217/pgs-2019-0167 [PubMed 32397904]
  79. Nadeem S, Hashmat S, Defreitas MJ, et al. Renin angiotensin system blocker fetopathy: a Midwest Pediatric Nephrology Consortium report. J Pediatr. 2015;167(4):881-885. [PubMed 26130112]
  80. National Institute for Health and Care Excellence (NICE). Hypertension in pregnancy: diagnosis and management. http://www.nice.org.uk/guidance/ng133. Published June 25, 2019. Accessed December 1, 2022.
  81. Nishimura RA, Otto CM, Bonow RO, et al, 2014 AHA/ACC Guideline for the Management of Patients with Valvular Heart Disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129(23):2440-92. doi:10.1161/CIR.0000000000000029 [PubMed 24589852]
  82. Nürnberger J, Daul A, Philipp T. Patient mit schwerer Hyperkaliämie -- ein Notfall nach RALES [A patient with severe hyperkalaemia -- an emergency after RALES]. Dtsch Med Wochenschr. 2005;130(36):2008-2011. German. doi:10.1055/s-2005-872620 [PubMed 16143930]
  83. O'Gara PT, Kushner FG, Ascheim DD, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2013;127(4):e362-e425. [PubMed 23247304]
  84. Oktaviono YH, Kusumawardhani N. Hyperkalemia associated with angiotensin converting enzyme inhibitor or angiotensin receptor blockers in chronic kidney disease. Acta Med Indones. 2020;52(1):74-79. [PubMed 32291375]
  85. Ommen SR, Mital S, Burke MA, et al. 2020 AHA/ACC guideline for the diagnosis and treatment of patients with hypertrophic cardiomyopathy: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2020;76(25):e159-e240. doi:10.1016/j.jacc.2020.08.045 [PubMed 33229116]
  86. Overlack A. ACE inhibitor-induced cough and bronchospasm. Incidence, mechanisms and management. Drug Saf. 1996;15(1):72-78. doi:10.2165/00002018-199615010-00006 [PubMed 8862965]
  87. Packer M, Poole-Wilson PA, Armstrong PW, et al. Comparative Effects of Low and High Doses of the Angiotensin-Converting Enzyme Inhibitor, Lisinopril, on Morbidity and Mortality in Chronic Heart Failure. Circulation. 1999;100(23):2312-2318. [PubMed 10587334]
  88. Palmer BF. Managing hyperkalemia caused by inhibitors of the renin-angiotensin-aldosterone system. N Engl J Med. 2004;351(6):585-592. doi:10.1056/NEJMra035279 [PubMed 15295051]
  89. Perkovic V. Treatment of diabetic kidney disease. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed August 2, 2023.
  90. Pfeffer MA, Greaves SC, Arnold JM, et al. Early Versus Delayed Angiotensin-Converting Enzyme Inhibition Therapy in Acute Myocardial Infarction. The Healing and Early Afterload Reducing Therapy Trial. Circulation. 1997;95(12):2643-2651. [PubMed 9193433]
  91. Pfeffer MA, McMurray JJ, Velazquez EJ, et al. Valsartan, captopril, or both in myocardial infarction complicated by heart failure, left ventricular dysfunction, or both. N Engl J Med. 2003;349(20):1893-1906. [PubMed 14610160]
  92. Prieto-García L, Pericacho M, Sancho-Martínez SM, et al. Mechanisms of triple whammy acute kidney injury. Pharmacol Ther. 2016;167:132-145. doi:10.1016/j.pharmthera.2016.07.011 [PubMed 27490717]
  93. Quan A . Fetopathy associated with exposure to angiotensin converting enzyme inhibitors and angiotensin receptor antagonists. Early Hum Dev. 2006;82(1):23-28. [PubMed 16427219]
  94. Raebel MA. Hyperkalemia associated with use of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers. Cardiovasc Ther. 2012;30(3):e156-e166. doi:10.1111/j.1755-5922.2010.00258.x [PubMed 21883995]
  95. Reardon LC, Macpherson DS. Hyperkalemia in outpatients using angiotensin-converting enzyme inhibitors. How much should we worry? Arch Intern Med. 1998;158(1):26-32. doi:10.1001/archinte.158.1.26 [PubMed 9437375]
  96. Refer to manufacturer's labeling.
  97. Regitz-Zagrosek V, Roos-Hesselink JW, Bauersachs J, et al. 2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy. Eur Heart J. 2018;39(34):3165-3241. [PubMed 30165544]
  98. Rosenbaum AJ, Luciano JA, Marburger R, Hume E. Acute kidney injury in the setting of knee arthroplasty: a case report and discussion investigating Angiotensin-converting enzyme inhibitors as the culprit. HSS J. 2011;7(2):183-186. doi:10.1007/s11420-010-9189-5 [PubMed 22754420]
  99. Rosendorff C, Lackland DT, Allison M, et al; American Heart Association, American College of Cardiology, and American Society of Hypertension. Treatment of hypertension in patients with coronary artery disease: A scientific statement from the American Heart Association, American College of Cardiology, and American Society of Hypertension. J Am Soc Hypertens. 2015;9(6):453-498. doi:10.1016/j.jash.2015.03.002. [PubMed 25840695]
  100. Runyon BA; AASLD. Introduction to the revised American Association for the Study of Liver Diseases Practice Guideline management of adult patients with ascites due to cirrhosis 2012. Hepatology. 2013;57(4):1651-1653. doi:10.1002/hep.26359. [PubMed 23463403]
  101. Sandoz Ramipril tablets (ramipril) [product labeling]. Boucherville, Quebec, Canada: Sandoz Canada Inc; October 2020.
  102. Sangole NV, Dadkar VN. Adverse drug reaction monitoring with angiotensin converting enzyme inhibitors: a prospective, randomized, open-label, comparative study. Indian J Pharmacol. 2010;42(1):27-31. doi:10.4103/0253-7613.62408 [PubMed 20606833]
  103. Sato A, Fukuda S. A prospective study of frequency and characteristics of cough during ACE inhibitor treatment. Clin Exp Hypertens. 2015;37(7):563-568. doi:10.3109/10641963.2015.1026040 [PubMed 25992489]
  104. Sato R, Ikuma M, Takagi K, et al. Exposure of drugs for hypertension, diabetes, and autoimmune disease during pregnancy and perinatal outcomes: an investigation of the regulator in Japan. Medicine (Baltimore). 2015;94(1):e386. [PubMed 25569668]
  105. Schoolwerth AC, Sica DA, Ballermann BJ, Wilcox CS; Council on the Kidney in Cardiovascular Disease and the Council for High Blood Pressure Research of the American Heart Association. Renal considerations in angiotensin converting enzyme inhibitor therapy: a statement for healthcare professionals from the Council on the Kidney in Cardiovascular Disease and the Council for High Blood Pressure Research of the American Heart Association. Circulation. 2001;104(16):1985-1991. doi:10.1161/hc4101.096153 [PubMed 11602506]
  106. Schunkert H, Kindler J, Gassmann M, et al. Pharmacokinetics of ramipril in hypertensive patients with renal insufficiency. Eur J Clin Pharmacol. 1989;37(3):249-256. doi:10.1007/BF00679779 [PubMed 2533075]
  107. Scott J, Jones T, Redaniel MT, May MT, Ben-Shlomo Y, Caskey F. Estimating the risk of acute kidney injury associated with use of diuretics and renin angiotensin aldosterone system inhibitors: A population based cohort study using the clinical practice research datalink. BMC Nephrol. 2019;20(1):481. doi:10.1186/s12882-019-1633-2 [PubMed 31888533]
  108. Slater EE, Merrill DD, Guess HA, et al. Clinical profile of angioedema associated with angiotensin converting-enzyme inhibition. JAMA. 1988;260(7):967-970. [PubMed 2840522]
  109. Smith SC Jr, Benjamin EJ, Bonow RO, et al. AHA/ACCF secondary prevention and risk reduction therapy for patients with coronary and other atherosclerotic vascular disease: 2011 update: A guideline from the American Heart Association and American College of Cardiology Foundation. Circulation. 2011;124(22):2458-2473. [PubMed 22052934]
  110. Smoger SH and Sayed MA. Simultaneous mucosal and small bowel angioedema due to captopril. South Med J. 1998;91(11):1060-1063. [PubMed 9824192]
  111. Song G, Yoon HY, Yee J, Kim MG, Gwak HS. Antihypertensive drug use and psoriasis: a systematic review, meta- and network meta-analysis. Br J Clin Pharmacol. Published online October 5, 2021. doi:10.1111/bcp.15060 [PubMed 34611920]
  112. Vleeming W, van Amsterdam JG, Stricker BH, de Wildt DJ. ACE inhibitor-induced angioedema. Incidence, prevention and management. Drug Saf. 1998;18(3):171-188. doi:10.2165/00002018-199818030-00003 [PubMed 9530537]
  113. von Vigier RO, Mozzettini S, Truttmann AC, Meregalli P, Ramelli GP, Bianchetti MG. Cough is common in children prescribed converting enzyme inhibitors. Nephron. 2000;84(1):98. doi:10.1159/000045552 [PubMed 10644922]
  114. Weir MR. Are drugs that block the renin-angiotensin system effective and safe in patients with renal insufficiency? Am J Hypertens. 1999;12(12, pt 3):195S-203S. doi:10.1016/s0895-7061(99)00104-1 [PubMed 10619572]
  115. Weir MR, Rolfe M. Potassium homeostasis and renin-angiotensin-aldosterone system inhibitors. Clin J Am Soc Nephrol. 2010;5(3):531-548. doi:10.2215/CJN.07821109 [PubMed 20150448]
  116. Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines. Hypertension. 2018;71(6):e13-e115. doi:10.1161/HYP.0000000000000065 [PubMed 29133356]
  117. Woodard-Grice AV, Lucisano AC, Byrd JB, Stone ER, Simmons WH, Brown NJ. Sex-dependent and race-dependent association of XPNPEP2 C-2399A polymorphism with angiotensin-converting enzyme inhibitor-associated angioedema. Pharmacogenet Genomics. 2010;20(9):532-536. doi:10.1097/FPC.0b013e32833d3acb [PubMed 20625347]
  118. Wyskida K, Jura-Szołtys E, Smertka M, Owczarek A, Chudek J. Factors that favor the occurrence of cough in patients treated with ramipril--a pharmacoepidemiological study. Med Sci Monit. 2012;18(9):PI21-P128. doi:10.12659/msm.883336 [PubMed 22936201]
  119. Yeo WW, Chadwick IG, Kraskiewicz M, Jackson PR, Ramsay LE. Resolution of ACE inhibitor cough: changes in subjective cough and responses to inhaled capsaicin, intradermal bradykinin and substance-P. Br J Clin Pharmacol. 1995;40(5):423-429. [PubMed 8703645]
  120. Yeung E, Wong FS, Wanless IR, et al. Ramipril-associated hepatotoxicity. Arch Pathol Lab Med. 2003;127(11):1493-1497. doi:10.5858/2003-127-1493-RH [PubMed 8703645]
  121. Yusuf S, Sleight P, Pogue J, et al. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. The Heart Outcomes Prevention Evaluation Study Investigators. N Engl J Med. 2000;342(3):145-153. [PubMed 10639539]
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