Indication

Ramipril is indicated in the following cases- hypertension; to lower blood pressure, as single-medicine therapy or in combination with other antihypertensive agents, e.g. diuretics and calcium antagonists, congestive heart failure; as adjunctive therapy to diuretics with or without cardiac glycosides, treatment of patients who have demonstrated clinical signs of congestive heart failure within the first few days after an acute myocardial infarction, prevention of myocardial infarction, stroke or cardiovascular death and reduction of need for revascularization procedures in patients with an increased cardiovascular risk such as manifestation of coronary heart disease (with or without a history of myocardial infarction), a history of stroke, or a history of peripheral vascular disease, prevention of myocardial infarction, stroke or cardiovascular death in diabetic patients.


Dosage & Administration

Dosage of Ramipril must be adjusted according to the patient tolerance and response. Hypertension: For the management of hypertension in adults not receiving a diuretic, the usual initial dose of Ramipril is 1.25 - 2.5 mg once daily. Dosage generally is adjusted no more rapidly than at 2-week intervals. The usual maintenance dosage in adults is 2.5 - 20 mg daily given as a single dose or in 2 divided doses. If BP is not controlled with Ramipril alone, a diuretic may be added. Congestive heart failure after myocardial infarction: In this case, Ramipril therapy may be initiated as early as 2 days after myocardial infarction. An initial dose of 2.5 mg twice daily is recommended, but if hypotension occurs, dose should be reduced to 1.25 mg twice daily. Therapy is then titrated to a target daily dose of 5 mg twice daily. Prevention of major cardiovascular events: In this case, the recommended dose is 2.5 mg twice daily for the first week of therapy and 5 mg once daily for the following 3 weeks; dosage then may be increased, as tolerated, to a maintenance dosage of 10 mg once daily. Dosage in renal impairment: For the patients with hypertension and renal impairment, the recommended initial dose is 1.25 mg Ramipril once daily. Subsequent dosage should be titrated according to individual tolerance and BP response, upto a maximum of 5 mg daily. For the patients with heart failure and renal impairment, the recommended dose is 1.25 mg once daily. The dose may be increased to 1.25 mg twice daily and upto a maximum dose of 2.5 mg twice daily depending upon clinical response and tolerability.


Precautions

Ramipril should be used with caution in patients with impaired renal function, hyperkalemia, hypotension, surgery/anesthesia and impaired hepatic function. Use in pregnancy: Pregnancy should be excluded before start of treatment with Ramipril and avoided during treatment. However, if pregnancy is detected, Ramipril should be discontinued as early as possible unless continued use is considered lifesaving. Use in lactation: Ramipril should not be used during lactation. Use in children: No information is yet available on the use of Ramipril in children.


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