Ramipril inhibits angiotensin-converting enzyme and decreases angiotensin II formation. As a result, sympathetic activity goes down, sodium and water reabsorption from the kidneys reduces, smooth muscles in the arterioles also relax. As a result, blood pressure decreases. Only oral administration is licensed. In the United States, capsule form is available.
Capsules can be opened to mix the contents with ml of water, applesauce, or juice for the patient not able to swallow capsules. Ramipril is often started at the lowest dose and titrated according to blood pressure response. Dry cough : In the lung tissues, ramipril inhibits the degradation of bradykinin which is a substrate of angiotensin-converting enzyme.
Higher levels of Bradykinin cause a dry cough. This side effect is more prevalent in patients of Afro-Caribbean descent than in other cohorts. It usually occurs within a few months of treatment and resolves within one month after discontinuation of the medication.
Postural hypotension : Some patients may develop postural hypotension and may also have fallen as a result, which can lead to a higher risk of head injuries and bone fractures, especially in elderly patients. Dizziness and lightheadedness are related to postural hypotension when patients suddenly stand up from a sitting or lying position.
Patients should receive counseling regarding symptoms of postural hypotension during treatment initiation. Anxiety-like symptoms: Patients who are known to have anxiety or tremors should be watched for these symptoms for a few weeks at a minimum when initiating ramipril. Angioedema: Ramipril can cause angioedema at any time during treatment. It involves the head and neck which may compromise the airway or the intestine. A few other rare side effects include hypoperfusion, movement disorders, onycholysis, and oral disorders.
Hypersensitivity: Hypersensitivity to ramipril, other ACE-i, or any component of the formulation is a major contraindication. Angioedema: hereditary or idiopathic or previous history of angioedema after treatment with an ACE inhibitor.
Hyperkalemia : Aldosterone is responsible for the excretion of potassium from the kidney. Therefore low levels of aldosterone can result in hyperkalemia. Hyponatremia : Angiotensin II results in increased release of aldosterone from the adrenal glands.
In the absence of angiotensin II, there is low production of aldosterone. Aldosterone is responsible for reabsorbing sodium and water from the kidneys. Therefore if a patient is already hyponatremic, the use of ramipril and other ACE-i can worsen their hyponatremia. Pregnancy: Ramipril is absolutely contraindicated in pregnancy.
Oligohydramnios and skull defects have been reported with concurrent use of ACE-i in pregnant ladies. The HOPE Heart Outcome Prevention Study study conducted in demonstrated that after administering ramipril 10mg for 12 weeks, clinically, there is no significant change in renal function of patients who had renal artery stenosis.
It also appears to have a protective effect on the heart and slows the progression of the heart failure. This protective action also helps to reduce the risk of heart, kidney or blood vessel problems in people who are at risk of these.
Some medicines are not suitable for people with certain conditions, and sometimes a medicine can only be used if extra care is taken. For these reasons, before you start taking ramipril it is important that your doctor knows:. Along with their useful effects, most medicines can cause unwanted side-effects although not everyone experiences them. The table below contains some of the more common ones associated with ramipril. The best place to find a full list of the side-effects which can be associated with your medicine, is from the manufacturer's printed information leaflet supplied with the medicine.
Alternatively, you can find an example of a manufacturer's information leaflet in the reference section below. Speak with your doctor or pharmacist if any of the following continue or become troublesome. Important : if you experience any of the following rare but serious symptoms, stop taking ramipril and contact your doctor for advice straightaway:.
If you experience any other symptoms which you think may be due to the medicine, speak with your doctor or pharmacist for further advice. Never take more than the prescribed dose. If you suspect that you or someone else might have taken an overdose of this medicine, go to the accident and emergency department of your local hospital. Take the container with you, even if it is empty.
This medicine is for you. Never give it to other people even if their condition appears to be the same as yours. Do not keep out-of-date or unwanted medicines. Ramipril consistently reduced heart failure rate both in those with relative risk, 0. Ramipril also reduced the heart failure rate more in patients with baseline systolic pressure above the median mm Hg relative risk, 0.
These patients have a greatly increased risk of fatal and non-fatal ischaemic, arrhythmic, and haemodynamic events. In this selected high-risk subset of patients we investigated the effect of therapy with the angiotensin converting enzyme ACE inhibitor rampiril, postulating that it would lengthen survival.
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