RAMIPRIL

RAMIPRIL (ram'i-pril) Altace Classifications: angiotensin-converting enzyme (ace) inhibitor; antihypertensive; Therapeutic: antihypertensive; ace inhibitor Prototype: Enalapril Pregnancy Category: C first trimester; D second and third trimester

Availability

1.25 mg, 2.5 mg, 5 mg, 10 mg capsules

Action

Reduces peripheral vascular resistance by inhibiting the formation of angiotensin II, a potent vasoconstrictor. Inhibition of ACE also decreases serum aldosterone levels and reduces peripheral arterial resistance (afterload) as well as improves cardiac output and exercise tolerance.

Therapeutic Effect

Lowers BP, and improves cardiac output as well as exercise tolerance.

Uses

Mild to moderate hypertension, CHF.

Contraindications

Hypersensitivity to ramipril or any other ACE inhibitor, patients with history of angioneurotic edema; jaundice; hyperkalemia; pregnancy (category C first trimester and category D second and third trimester), lactation.

Cautious Use

Impaired kidney or liver function, surgery or anesthesia; CHF. Safety and effectiveness in children are not established.

Route & Dosage

Hypertension, CHF Adult: PO 2.5–5 mg q.d., may increase up to 20 mg/d in 1–2 divided doses

Administration

Oral

• Discontinue diuretics 2–3 d before initiation of drug. Limit initial dose to 1.25 mg if diuretics cannot be discontinued.
• Store at 15°–30° C (59°–86° F) and protect from moisture.

Adverse Effects (≥1%)

CNS: Dizziness, fatigue, headache. GI: Nausea, vomiting, diarrhea, eructation. Metabolic: Hyperkalemia, hyponatremia. Skin: Erythema, pruritus. Body as a Whole: Angioedema. Respiratory: Cough.

Interactions

Drug: potassium-sparing diuretics may increase risk of hyperkalemia. May, elevate, serum lithium levels, resulting in lithium toxicity. nsaids may attenuate antihypertensive effects.

Pharmacokinetics

Absorption: 60% absorbed from GI tract. Onset: 2 h. Peak: 6–8 h. Duration: Up to 24 h. Distribution: Crosses placenta; not known if distributed into breast milk. Metabolism: Rapidly metabolized in liver to its active metabolite, ramiprilat. Elimination: 40–60% in urine, 40% in feces. Half-Life: 2–3 h.

Nursing Implications

Assessment & Drug Effects

• Monitor BP at time of peak effectiveness, 3–6 h after dosing and at end of dosing interval just before next dose.
• Report diminished antihypertensive effect.
• Monitor for first-dose hypotension, especially in salt- or volume-depleted persons.
• Lab tests: Monitor BUN and serum creatinine periodically. Increases may necessitate dose reduction or discontinuation of drug. Monitor serum potassium values.
• Observe for S&S of hyperkalemia (see Appendix F).

Patient & Family Education

• Discontinue drug and report S&S of angioedema to physician (e.g., swelling of face or extremities, difficulty breathing or swallowing).
• Maintain adequate fluid intake and avoid potassium supplements or salt substitutes unless specifically prescribed by the physician.

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Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug