Ramipril is an ACE-i (Angiotensin Converting Enzyme inhibitor) which is used medically for following different disease processes.
There may be a few other unlicensed uses in other countries. Please refer to local guidelines for more details.
Angiotensin II: Angiotensin II has various effects that help in blood pressure optimization.
Ramipril inhibits Angiotensin-Converting Enzyme and decreases Angiotensin II formation. As a result, sympathetic activity goes down, sodium and water reabsorption from the kidneys reduces, smooth muscles in the arterioles also relax. As a result, blood pressure decreases.
Only oral administration is licensed. In the United States, capsule form is available. Capsules can be opened to mix the contents with 120 ml of water, applesauce, or juice for the patient not able to swallow capsules.
Available strengths: 1.25 mg, 2.5 mg, 5 mg, and 10 mg.
Ramipril is often started at the lowest dose and titrated according to blood pressure response.
The HOPE (Heart Outcome Prevention Study) study conducted in 2008 demonstrated that after administering ramipril 10mg for 12 weeks, clinically there is no significant change in renal function of patients who had renal artery stenosis. Therefore according to the HOPE study, ramipril can be safely used in patients with renal artery stenosis.
Ramipril overdose can result in severe hypotension (due to vasodilation and effective hypovolemia).
A study conducted in 2006 to investigate the effects of ramipril overdose on blood pressure concluded that in most cases, a drop in blood pressure occurs within the first 4 to 4.5 hours after ingestion. Monitoring the patient for a minimum of 6 hours after taking the overdose is essential. If the blood pressure remains normal at in the first 6 hours after exposure, then the patient can be considered for discharge. 
Health care professionals including family physicians, specialists, nurses, and pharmacists are valuable sources of information for patients. The nurses, pharmacists, and clinicians should work as an interprofessional team to increase the patient's knowledge about the medication and provide them information about possible side effects to look for, helping them become more compliant with their medications, and subsequently improve their blood pressure control and overall clinical outcome. This interprofessional approach to education will lead to better outcomes. [Level 5]
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