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Ramipril, sold under the brand name Altace among others, is an angiotensin-converting enzyme (ACE) inhibitor, used to treat high blood pressure ( hypertension ) and congestive heart failure. By inhibiting an enzyme, ACE inhibitors relax the muscles around small arteries (arterioles). The arterioles expand and allow blood to flow through more easily. This reduces blood pressure.
Contents
1 Medical uses
2 Contraindications
3 Adverse effects
4 Mechanism of action
5 US patent
6 Brand names
7 Clinical trials
8 See also
9 References
10 External links
Medical uses
Indications for its use include:
High blood pressure
Congestive heart failure
Following heart attack in patients with clinical evidence of heart failure
Susceptible patients over 55 years: prevention of heart attack, stroke, cardiovascular death, or need of revascularization procedures
Kidney damage due to diabetes with protein in the urine (In low doses it is used as a prophylaxis for developing nephropathy and related secondary cardiovascular events.)
Contraindications
Contraindications to its use include renovascular disease (impaired blood flow in the kidneys), severe renal impairment (especially in patients with one kidney or with bilateral renal artery stenosis ), volume-depleted patients, a history of angioedema while on an ACE inhibitors, pregnancy, and hypotension.
Adverse effects
Shakiness
Dry cough
Dizziness and light-headedness due to low blood pressure
Fatigue, especially in the early stages
Mouth dryness in the early stages
Nausea
Fainting
Signs of infection (e.g., fever, chills, persistent sore throat)
Chest pain
Neutropenia (low white blood cells)
Impotence (erectile dysfunction)
Serious allergic reactions to this drug are unlikely, but immediate medical attention must be sought if they occur. Symptoms of a serious allergic reaction include, but are not limited to a rash or swelling of the face, mouth, tongue, or throat. In extreme cases, ramipril may lead to potentially fatal liver problems.
Mechanism of action
See also: Renin–angiotensin system
Ramipril 1.25-mg oral capsule, letter codes and icons may differ
ACE inhibitors inhibit the actions of angiotensin converting enzyme (ACE), thereby lowering the production of angiotensin II and decreasing the breakdown of bradykinin. The decrease in angiotensin II results in relaxation of arteriole smooth muscle leading to a decrease in total peripheral resistance, reducing blood pressure as the blood is pumped through widened vessels. Its effect on bradykinin is responsible for the dry cough side effect.
Ramipril, a prodrug or precursor drug, is converted to the active metabolite ramiprilat by carboxylesterase 1. Ramiprilat is mostly excreted by the kidneys. Its half-life is variable (3–16 hours), and is prolonged by heart and liver failure, as well as kidney failure.
US patent
The compound was protected by the U.S. Patent 5,061,722 which was assigned to the German pharmaceutical company Hoechst AG (since merged into Aventis ) on 29 October 1991. The patent was scheduled to expire on 29 October 2008. On 11 September 2007, in an appeal by the Indian company Lupin Ltd., the United States Court of Appeals for the Federal Circuit reversed a district court trial verdict and found that Aventis’s patent on ramipril was invalid for “obviousness”, opening this drug to generic manufacturers.
Brand names
It is marketed as Prilace by Arrow Pharmaceuticals in Australia, Ramipro by Westfield Pharma in the Philippines, Tritace by Sanofi-Aventis in Italy and United States and Altace by King Pharmaceuticals in the United States, Novapril by Pharmanova in Ghana, Ramitens by PharmaSwiss, Ampril by Krka in Slovenia, Corpril by Cemelog-BRS in Hungary, Piramil and Prilinda by Hemofarm in Serbia, by Lek in Poland and by Novartis and Opsonin Pharma Limited as Ramace in Bangladesh, and in Canada as Altace (Sonfi) and Ramipril (Pharmascience).
Ramipril is marketed in India under the brand names Cardace, Zigpril, Ramistar, Odipril and Zorem. Ramipril is marketed in Myanmar under brand name Endpril.
Clinical trials
The Heart Outcomes and Prevention Evaluation trial
The AIRE trial showed a 27% reduction in mortality for patients receiving ramipril for chronic heart failure following a myocardial infarction.
Ramipril was found to have similar results as telmisartan, an angiotensin II receptor blocker.
See also
Angiotensin-converting enzyme (ACE) inhibitor
Hypertension
Hypotension
Heart failure
Chest pain

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