Ramipril

Ramipril - ACE inhibitors have a beneficial role in all grades of heart failure, usually combined with a _-blocker and diuretics. Potassium-sparing diuretics should be discontinued before starting an ACE inhibitor because of the risk of hyperkalaemia. However, low-dose spironolactone may also be beneficial in severe heart failure, and when used together with an ACE inhibitor serum potassium needs to be monitored
closely.

Uses
Hypertension
Heart failure

Contraindications
Aortic stenosis
HOCM
Porphyria
Angioedema (idiopathic or hereditary)
Known or suspected renal artery stenosis (co-existing diabetes, PVD, hypertension)

Administration
• Orally: 1.25 mg once daily, increased gradually to a maximum of
10 mg daily (daily doses of 2.5 mg or more may be taken in 1–2 divided doses)

Monitor:
BP
Serum potassium and creatinine

In renal impairment:

CC (ml/min)	Initial dose (mg)	Maximum once daily dose (mg)
0–30	1.25	5

Cautions

Risk of sudden and precipitous fall in BP in the following patients:

Dehydrated

Salt-depleted (Na+ <130 mmol/l)

High-dose diuretics (>80 mg furosemide daily)

Concomitant NSAID (↑ risk of renal damage)

Concomitant potassium-sparing diuretics (hyperkalaemia)

Peripheral vascular disease or generalised atherosclerosis (risk of clinically silent renovascular disease)

Adverse effects

Hypotension

Tachycardia

Dry cough

Rash

Pancreatitis

Altered LFT

Acidosis

Angioedema

Organ failure

Renal: reduce dose; hyperkalaemia more common

Renal replacement therapy

No further dose modification is required during renal replacement therapy