Ramipril
An ACE inhibitor prodrug used for high blood pressure, heart failure after a heart attack, and to cut heart attack and stroke risk.
Drug card
- Class
- ACE inhibitor
- How it works
- Blocking the enzyme that makes angiotensin II, so vessels relax
- Used for
- High blood pressure
- Preventing heart attack and stroke in high-risk people
- Heart failure after a heart attack
- Kidney disease, to slow further damage
- Known for
- Dry, persistent cough
- Angioedema (swelling of lips, tongue, face)
- Its name
- -pril means an ACE inhibitor
Study it as a flashcard, and it comes back before you forget it.
Mechanism of action
How does ramipril work?
Ramipril is a prodrug: the liver cleaves its ester group to give ramiprilat, the active diacid that inhibits ACE. Ramiprilat binds ACE strongly and comes off it slowly, so its action is long. Unlike captopril, it has no sulfhydryl group.
Like other ACE inhibitors: They block angiotensin-converting enzyme (ACE), so less angiotensin I is turned into angiotensin II. Arterioles relax, aldosterone release falls (potassium rises a little) and renin climbs because angiotensin II no longer holds it back. ACE also breaks down bradykinin; the bradykinin that builds up is thought to cause the dry cough and angioedema.
Uses
What is ramipril used for?
- High blood pressure
- Preventing heart attack and stroke in high-risk people
- Heart failure after a heart attack
- Kidney disease, to slow further damage
Side effects
Side effects of ramipril
- Dry, persistent coughKnown for
- Angioedema (swelling of lips, tongue, face)Known forSerious
- High potassium (hyperkalemia)Serious
- Dizziness on standing (postural hypotension)
- Low blood pressure, mainly after a heart attack
- Headache
- Tiredness and weakness
- Worsening kidney functionSerious
- Harm to the unborn baby (fetal toxicity)Serious
- Liver injury: jaundice, hepatitis, liver failure (rare)Serious
- PancreatitisSerious
- Neutropenia and agranulocytosis (rare)Serious
Known for marks what an exam expects you to know it for.
Watch for
Cautions and what sets it apart
- Avoid adding an ARB such as telmisartan: more low blood pressure, high potassium and kidney problems, with no extra benefit.
- Recent diuretic use can make the first doses lower blood pressure too far.
- It raises lithium levels, so the pair needs care.
Good to know: Besides treating blood pressure, it is licensed to cut heart attack, stroke and cardiovascular death in high-risk people aged 55 or over.
Remember it
A way to remember it
CAPTOPRIL
- C
- Cough
- A
- Angioedema
- P
- Potassium up
- T
- Taste change
- O
- hypOtension
- P
- Pregnancy: avoid
- R
- Rash
- I
- Increased renin
- L
- Lower angiotensin II
The letters of captopril, itself an ACE inhibitor, spell out the class's main effects and the pregnancy rule.
A mnemonic widely used in teaching
Its name
-pril means ACE inhibitor
Prodrugs such as enalapril and ramipril are turned into active forms named -prilat (enalaprilat). Don't confuse it with -tril: sacubitril blocks neprilysin, not ACE.
- Every drug name stem
Its class
ACE inhibitors
Other ACE inhibitors with a card:
Easily mixed up with angiotensin receptor blockers and angiotensin receptor-neprilysin inhibitors.
Sources
Checked against
Written for biofideX in plain words, after checking these references:
For learning pharmacology, not for treatment decisions: no doses are given, and a prescriber, pharmacist or the product's own label is the word on any one patient. Spotted a mistake? Tell us and we'll correct it.
Blood pressure
Ramipril is one of 27 drugs practiced together here: their classes, how they work, what they treat and what they're known for.
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