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1 Contraindications/Precautions
Contraindicated in: Hypersensitivity; History of angioedema with previous use of PDF Page #1
ramipril (ra-mi-pril) ACE inhibitors; Concurrent use with aliskiren in patients with diabetes or moderate-
to-severe renal impairment (CCr 60 mL/min); OB: Can cause injury or death of fe-
Altace
tus if pregnancy occurs, discontinue immediately; Lactation: Discontinue drug
Classification or use formula.
Therapeutic: antihypertensives Use Cautiously in: Black patients (monotherapy for hypertension less effective,
Pharmacologic: ACE inhibitors may require additional therapy; higher risk of angioedema); Surgery/anesthesia (hy-
Pregnancy Category D potension may be exaggerated); Women of childbearing potential; Renal impairment
(especially renal artery stenosis), hypovolemia, hyponatremia, concurrent diuretic
Indications therapy initial doseprecommended; Pedi: Safety not established; Geri: Initial
Alone or with other agents in the management of hypertension. Reduction of risk of doseprecommended.
myocardial infarction, stroke, or death from cardiovascular causes in patients at least Exercise Extreme Caution in: Family history of angioedema.
55 years of age who are at high risk of developing a major cardiovascular event be- Adverse Reactions/Side Effects
cause of a history of coronary artery disease, stroke, peripheral vascular disease, or CNS: dizziness, fatigue, headache, vertigo, weakness. Resp: cough. CV: hypoten-
diabetes that is accompanied by at least one other cardiovascular risk factor. Reduc- sion, chest pain. GI: diarrhea, nausea, vomiting. GU: impaired renal function.
tion of risk of death, heart-failure related hospitalizations, and progression of heart Derm: rashes. F and E: hyperkalemia. Misc: ANGIOEDEMA.
failure in patients with signs of heart failure following myocardial infarction.
Interactions
Action Drug-Drug: Excessive hypotension may occur with concurrent use of diuretics.
Angiotensin-converting enzyme (ACE) inhibitors block the conversion of angiotensin Additive hypotension with other antihypertensive agents.qrisk of hyperkalemia
I to the vasoconstrictor angiotensin II. ACE inhibitors also prevent the degradation of with concurrent use of potassium supplements, potassium-sparing diuretics,
bradykinin and other vasodilatory prostaglandins. ACE inhibitors alsoqplasma renin or potassium-containing salt substitutes.qrisk of hyperkalemia, renal dysfunc-
levels andpaldosterone levels. Net result is systemic vasodilation. Therapeutic tion, hypotension, and syncope with concurrent use of angiotensin II receptor an-
Effects: Lowering of BP in hypertensive patients. Decreased risk of myocardial in- tagonists or aliskiren; avoid concurrent use with aliskiren in patients with diabetes
farction, stroke, or death from cardiovascular causes in high-risk patients. Increased or CCr 60 mL/min. NSAIDs and selective COX-2 inhibitors may blunt the anti-
survival and decreased heart failure progression after myocardial infarction. hypertensive effect andqthe risk of renal dysfunction.qlevels and mayqthe risk of
lithium toxicity.qrisk of renal dysfunction when used with telmisartan; concur-
Pharmacokinetics rent use not recommended.qrisk of angioedema with temsirolimus or everoli-
Absorption: 50 60% absorbed following oral administration. mus.
Distribution: Crosses the placenta; may enter breast milk.
Metabolism and Excretion: Converted by the liver to ramiprilat, the active me- Route/Dosage
tabolite; 60% excreted in urine; 40% in feces. Hypertension
Half-life: Ramiprilat: 13 17 hr (qin renal impairment). PO (Adults): 2.5 mg once daily, slowly may bequp to 20 mg/day in 1 2 divided
TIME/ACTION PROFILE (effect on BP single dose) doses (initiate therapy at 1.25 mg/day in patients receiving diuretics).
ROUTE ONSET PEAK DURATION Heart Failure Post-Myocardial Infarction
PO within 12 hr 36 hr 24 hr PO (Adults): 1.25 2.5 mg twice daily initially, may beqslowly up to 5 mg twice
Full effects may not be noted for several wk. daily.
Canadian drug name. Genetic Implication. CAPITALS indicate life-threatening, underlines indicate most frequent. Strikethrough Discontinued.
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2 with normal saline. Discontinuing diuretic therapy or cautiously increasing salt in-
take 2 3 days prior to initiation may decrease risk. Monitor closely for at least 1
Reduction in Risk of MI, Stroke, and Death from Cardiovascular hr after BP has stabilized. Resume diuretics if BP is not controlled. PDF Page #2
Causes PO: Capsules may be opened and sprinkled on applesauce, or dissolved in 4 oz
PO (Adults): 2.5 mg once daily for 1 wk, then 5 mg once daily for 3 wk, thenqas water or apple juice for patients with difficulty swallowing. Effectiveness is same as
tolerated to 10 mg once daily (can also be given in 2 divided doses). capsule. Pre-prepared mixtures can be stored for up to 24 hr at room temperature
or up to 48 hr if refrigerated.
Renal Impairment
PO (Adults): CCr 40 mL/min Initiate therapy at 1.25 mg once daily, may be Patient/Family Teaching
slowly titrated up to 5 mg/day in 1 2 divided doses. Emphasize the importance of continuing to take medication as directed at the
same time each day, even if feeling well. Take missed doses as soon as remem-
NURSING IMPLICATIONS bered but not if almost time for next dose. Do not double doses. Warn patient not
Assessment to discontinue ACE inhibitor therapy unless directed by health care professional.
Hypertension: Monitor BP and pulse frequently during initial dose adjustment Caution patient to avoid salt substitutes containing potassium or foods containing
and periodically during therapy. Notify health care professional of significant high levels of potassium or sodium unless directed by health care professional.
changes. Caution patient to change positions slowly to minimize orthostatic hypotension.
Monitor frequency of prescription refills to determine compliance. Use of alcohol, standing for long periods, exercising, and hot weather may in-
Assess patient for signs of angioedema (dyspnea, facial swelling). crease orthostatic hypotension.
Heart Failure: Monitor weight and assess patient routinely for resolution of fluid Instruct patient to notify health care professional of all Rx or OTC medications, vi-
overload (peripheral edema, rales/crackles, dyspnea, weight gain, jugular venous tamins, or herbal products being taken and consult health care professional be-
distention). fore taking any new medications especially cough, cold, or allergy medications.
Lab Test Considerations: Monitor renal function. May causeqBUN and se- May cause dizziness. Caution patient to avoid driving and other activities requiring
rum creatinine. alertness until response to medication is known.
May cause hyperkalemia. Advise patient to inform health care professional of medication regimen prior to
Monitor CBC periodically during therapy in patients with collagen vascular disease treatment or surgery.
and/or renal disease. May rarely causepin hemoglobin and hematocrit as well as Instruct patient to notify health care professional if rash; mouth sores;
neutropenia and eosinophilia. sore throat; fever; swelling of hands or feet; irregular heartbeat; chest
May causeqAST, ALT, alkaline phosphatase, serum bilirubin, uric acid, and glu- pain; dry cough; hoarseness; swelling of face, eyes, lips, or tongue; or if
cose. difficulty swallowing or breathing occurs. Persistent dry cough may occur
and may not subside until medication is discontinued. Consult health care profes-
Potential Nursing Diagnoses
sional if cough becomes bothersome. Also notify health care professional if nau-
Decreased cardiac output (Indications) (Side Effects)
sea, vomiting, or diarrhea occurs and continues.
Deficient knowledge, related to medication regimen (Patient/Family Teaching)
Advise women of childbearing age to use contraception and notify health care pro-
Noncompliance (Patient/Family Teaching)
fessional if pregnancy is planned or suspected or if breast feeding. If pregnancy is
Implementation detected, discontinue medication as soon as possible.
Correct volume depletion, if possible, before initiation of therapy. Precipitous Emphasize the importance of follow-up examinations to evaluate effectiveness of
drop in BP during first 1 3 hr following first dose may require volume expansion medication.
2015 F.A. Davis Company CONTINUED
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PDF Page #3
CONTINUED
ramipril
Hypertension: Encourage patient to comply with additional interventions for hy-
pertension (weight reduction, low-sodium diet, discontinuation of smoking, mod-
eration of alcohol consumption, regular exercise, and stress management). Medi-
cation controls but does not cure hypertension.
Instruct patient and family on correct technique for monitoring BP. Advise them to
check BP at least weekly and to report significant changes to health care profes-
sional.
Evaluation/Desired Outcomes
Decrease in BP without appearance of side effects.
Reduction in risk of myocardial infarction, stroke, or death from cardiovascular
causes in patients at high-risk for these events.
Reduction of risk of death, progression of heart failure, or heart failure-related
hospitalizations following myocardial infarction.
Why was this drug prescribed for your patient?

Canadian drug name. Genetic Implication. CAPITALS indicate life-threatening, underlines indicate most frequent. Strikethrough Discontinued.