Ramipril (Altace)

• Type of Drug: Angiotensin-converting-enzyme (ACE) inhibitor.
• Prescribed for: High blood pressure and congestive heart failure.

Ramipril (Altace) General Information

ACE inhibitors work by preventing the conversion of a hormone called angiotensin I to another hormone called angiotensin II, a potent blood-vessel constrictor. Preventing this conversion relaxes blood vessels and helps to reduce blood pressure and relieve the symptoms of heart failure by making it easier for a failing heart to pump blood around your body. The production of other hormones and enzymes that participate in the regulation of blood-vessel dilation is also affected by the ACE inhibitors and probably plays a role in the effectiveness of these medicines. Ramipril begins working about an hour after you take it and lasts for a full 24 hours.

Some people who start taking an ACE inhibitor after they are already on a diuretic experience a rapid blood-pressure drop after their first dose or when the dose is increased. To prevent this from happening, you may be told to stop taking the diuretic 2 or 3 days before starting Ramipril or increase your salt intake during that time. The diuretic may then be restarted gradually. Heart failure patients generally have been on Digoxin and a diuretic before beginning treatment with an ACE inhibitor.

Ramipril (Altace) Cautions and Warnings

Do not take any ACE inhibitor if you have had an allergic reaction to it in the past. Occasionally, severe allergic reactions have occurred in people undergoing desensitization treatments or certain kinds of kidney dialysis. ACE inhibitors can, rarely, cause very low blood pressure, and can affect your kidneys, especially if you have congestive heart failure. It is advisable for your doctor to check your urine for changes during the first few months of treatment.

People with liver disease who are taking Ramipril may require a lower dosage because they have more drug in their blood and are more likely to develop drug side effects.

ACE inhibitors can affect white-blood-cell count, possibly increasing your susceptibility to infection. Blood counts should be monitored periodically.

Ramipril (Altace) Possible Side Effects

• Most common: chronic cough. The cough is more common in women than men and usually goes away a few days after you stop taking the medicine.
• Less common: dizziness, tiredness, headache, nausea, and fatigue.
• Other: itching, fever, chest pain, angina, heart attack, stroke, abdominal pain, low blood pressure, dizziness when rising from a sitting or lying position, abnormal heart rhythms, heart palpitations, sleeping difficulty, tingling in the hands or feet, vomiting, appetite loss, abnormal tastes, hepatitis and jaundice, blood in the stool, swollen tongue, hair loss, rash, unusual sensitivity to the sun, flushing, anxiety, sleeplessness, nervousness, reduced sex drive, muscle cramps or weakness, impotence, arthritis, muscle aches, asthma, bronchitis, respiratory infection, sinus irritation, breathing difficulty, weakness, confusion, depression, feelings of ill health, sweating, kidney problems, urinary infection, anemia, blurred vision, and swelling of the arms, legs, lips, face, and throat. These side effects occur very infrequently but can be bothersome.

Ramipril (Altace) Drug Interactions

• The blood-pressure-lowering effect of Ramipril is additive with diuretic drugs and beta blockers. Any other drug that can reduce blood pressure should be used with caution if you are taking Ramipril.
• Ramipril may increase potassium levels in your blood, especially when taken with Dyazide or other potassium-sparing diuretics.
• Ramipril may increase the effects of Lithium; this combination should be used with caution.
• Antacids may reduce the amount of Ramipril absorbed into the blood. Separate doses of the two medicines by at least 2 hours.
• Capsaicin may cause or aggravate the cough associated with Ramipril therapy.
• Indomethacin may reduce the blood-pressure-lowering effects of Ramipril.
• Phenothiazine tranquilizers and antiemetics may increase the effects of Ramipril.
• The combination of Allopurinol and Ramipril increases the chance of a drug reaction,
• Ramipril increases blood levels of Digoxin, possibly increasing the chance of Digoxin-related side effects.
• Cough associated with Ramipril may be reduced by Sulindac, Diclofenlac, Indomethacin, Nifedipine, Cromolyn Sodium, or nebulized Bupivacaine. More study is needed to confirm these interactions.

Ramipril (Altace) Food Interactions

Ramipril is affected by larger amounts of food in the Stomach and should be taken on an empty stomach or at least 1 hour before or 2 hours after a meal. However, the contents of Ramipril capsules may be mixed with a small amount (about 4 ounces) of applesauce or some apple juice or water and stored for up to 2 days in the refrigerator before you take it.

Usual Dose

2.5 to 20 mg a day. People with moderate to severe kidney disease should begin with 1.25 mg per day and can be increased up to 5 mg a day.

Overdosage

The principal effect of Ramipril overdose is a rapid drop in blood pressure, as evidenced by dizziness or fainting. Take the overdose victim to a hospital emergency room immediately. ALWAYS remember to bring the medicine bottle.

Ramipril (Altace) Special Information

Call your doctor if you develop swelling of the face or throat, if you have sudden difficulty breathing, or if you develop a sore throat, mouth sores, abnormal heartbeat, chest pain, a persistent rash, or loss of taste perception.

Ramipril can cause unexplained swelling of the face, lips, hands, and feet, which can also affect the larynx (throat) and tongue and interfere with breathing. If this happens, the victim should be taken to a hospital emergency room at once for treatment.

You may get dizzy if you rise to your feet too quickly from a sitting or lying position.

Avoid strenuous exercise and/or very hot weather because heavy sweating or dehydration can cause a rapid blood-pressure drop.

Avoid nonprescription diet pills, decongestants, and stimulants that can raise blood pressure.

If you forget to take a dose of Ramipril, take it as soon as you remember. If it is within 8 hours of your next dose, skip the one you forgot and continue with your regular schedule. Do not take a double dose.

Special Populations

Pregnancy/Breast-feeding
ACE inhibitors have caused low blood pressure, kidney failure, slow formation of the skull, and death in developing fetuses when taken during the last 6 months of, pregnancy. Women who are pregnant should not take Ramipril. Women who may become pregnant while taking Ramipril should use an effective contraceptive method and stop taking the medicine if they do become pregnant.
It is not known if Ramipril passes into breast milk, However, nursing mothers who must take this drug should consider an alternative feeding method since infants, especially newborns, are more susceptible to the effects of these medicines than adults.

Seniors
Older adults may be more sensitive to the effects of Ramipril than younger adults because of the possibility of normal reductions in kidney function. Your dosage must be individualized to your needs.