BLACK BOX WARNING
- fetal toxicity
ramipril
Brand: Altace
⚠ BBW Prototype: lisinopril
Drug Class: ACE inhibitor
Drug Family: antihypertensive
Subclass: prodrug ACE inhibitor
Organ Systems: cardiovascularrenal
Mechanism of Action
Prodrug converted to ramiprilat; inhibits ACE reducing angiotensin II and aldosterone.
ACE (angiotensin-converting enzyme)
Indications
- hypertension
- heart failure post-MI
- cardiovascular risk reduction (HOPE trial)
- diabetic nephropathy
Contraindications
- pregnancy
- ACE-inhibitor angioedema history
- bilateral RAS
Adverse Effects
Common
- cough
- hyperkalemia
- hypotension
Serious
- angioedema
- AKI
- teratogenicity
Pharmacokinetics (ADME)
| Absorption | 50-60% bioavailability |
| Distribution | moderate tissue binding |
| Metabolism | hepatic to ramiprilat |
| Excretion | renal (60%), fecal (40%) |
| Half-life | 13-17 hours |
| Onset | 1-2 hours |
| Peak | 3-6 hours |
| Duration | 24 hours |
| Protein Binding | 73% |
| Vd | moderate |
Drug Interactions
| Drug / Agent | Mechanism | Severity |
|---|---|---|
| potassium-sparing diuretics | additive hyperkalemia | major |
| NSAIDs | blunted antihypertensive effect | moderate |
Nursing Considerations
- HOPE trial evidence for CV risk reduction
- Monitor BP, K+, creatinine
- Watch for first-dose hypotension, especially volume-depleted patients
Clinical Pearls
- HOPE trial: reduced MI, stroke, CV death in high-risk patients without heart failure
- High tissue ACE binding
Safety Profile
Pregnancy contraindicated
Lactation avoid
Renal Adjustment Required
Hepatic Adjustment Required
TDM Not required
Concordance Terms
Cross-referenced clinical concepts — click any term to see all content where it appears.