Ramipril (marketed as Tritace or Altace) is an angiotensin-converting enzyme (ACE) inhibitor, used to treat hypertension and congestive heart failure. ACE inhibitors lower the production of angiotensin II, therefore relaxing arterial muscles while at the same time enlarging the arteries, allowing the heart to pump blood more easily, and increasing blood flow due to more blood being pumped into and through bigger passageways.

Ramipril is a prodrug and is converted to the active metabolite ramiprilat by liver esterase enzymes. Ramiprilat is mostly excreted by the kidneys. The half-life of ramiprilat is variable (3-16 hours), and is prolonged by heart and liver failure, as well as kidney failure.

Indications

Indications for its use include:
Mild to moderate hypertension;
Congestive heart failure;
Following myocardial infarction in patients with clinical evidence of heart failure;
Susceptible patients over 55 years: prevention of myocardial infarction, stroke, cardiovascular death or need of revascularization procedures.

Cautions
Do not take potassium supplements without seeking medical advice.
Do not take during pregnancy

Contraindications

Renovascular disease, severe renal impairment (especially in patients with one kidney or with bilateral renal artery stenosis), volume-depleted patients, history of angioedema while on an ACE inhibitor, pregnancy, hypotension.

Side-effects
may cause swelling of the mouth, tongue, or throat
low blood sugar in patients taking other medicine for diabetes which shows as sweating or shakiness
persistent dry cough, dizziness, and light-headedness due to low blood pressure.

Dose
2.5 to 20 mg per day
initial dose of 1.25mg per day

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