Ramipril (Ramipril)
Overview of Ramipril
Ramipril is oral angiotensin-converting enzyme (ACE) inhibitor used in the treatment of hypertension, heart failure. Ramipril is actually an inactive prodrug that is converted in the liver to itat, the active moiety, whose antihypertensive activity is sufficiently long to allow for once-daily administration. The pharmacodynamic characteristics of it most closely resemble those of benazepril, fosinopril, and quinapril, all of which are prodrugs. The active metabolite, itat, competes with angiotensin-converting enzyme for the substrate angiotensin I, blocking its conversion to angiotensin II, which is a potent vasoconstrictor and negative-feedback mediator for renin activity. Lower levels of angiotensin II produce a drop in blood pressure and a rise in plasma renin. It also inhibits Kininase II (identical to ACE), an enzyme that degrades bradykinin, a potent vasodilator, to inactive peptides, resulting in increased bradykinin levels. Bradykinin-induced vasodilation is thought to be of secondary importance in the blood-pressure lowering effect. A bradykinin mechanism may, however, contribute to ACE-inhibitor-induced angioneurotic edema.
Indication of Ramipril
Ramipril is primarily indicated in conditions like Benign gastric ulcer associated with H.pylori, Congestive heart failure (adjunct), Gastric acid reduction during anaesthesia, Heart failure, Hypertension, Iron deficiency anaemia, Mild to moderate hypertension, Prophylaxis of cardiovascular events/stroke.
Contraindication of Ramipril
Ramipril is contraindicated in conditions like Salt depletion,Hypotension,Arterial stenosis.
Side Effects of Ramipril
The severe or irreversible adverse effects of Ramipril, which give rise to further complications include Angioedema.,Ramipril produces potentially life-threatening effects which include Renal failure, Hypotension. which are responsible for the discontinuation of Ramipril therapy.,The signs and symptoms that are produced after the acute overdosage of Ramipril include Hypotension, Renal insufficiency.,The symptomatic adverse reactions produced by Ramipril are more or less tolerable and if they become severe, they can be treated symptomatically, these include Dizziness, Headache, Diarrhea, Rashes, Nausea and vomiting.
Precautions of Ramipril
Ramipril should be used with caution in patients with a history of angioedema, high blood levels of potassium, kidney disease or kidney dialysis, salt restrictive diet or liver disease. Consult the doctor before using salt substitutes or low salt milk. Get up slowly, to avoid dizziness and lightheadedness when rising from a seated or lying position. Limit intake of alcohol and use caution when exercising or during hot weather as these can aggravate dizziness and lightheadedness. It should be used only when clearly needed during the first three months of pregnancy, it is not recommended for use during the last six months of the pregnancy. Caution is advised when this is used in children and elderly.