Drug reference

Ramipril

BNF 80 (2020–2021)

Source: BNF 80 (2020–2021)
PDF pages: 206, 207

Review source pages for extracted sections and age labels. BNF dose snippets show only their first line.

Overview

Indications And Dose

Hypertension ▶BY MOUTH ▶Adult: Initially 1.25–2.5 mg once daily, increased if necessary up to 10 mg once daily, dose to be increased at intervals of 2–4 weeks Symptomatic heart failure (adjunct) (under close medical supervision) ▶BY MOUTH ▶Adult: Initially 1.25 mg once daily, increased if tolerated to 10 mg daily, preferably taken in 2 divided doses, increase dose gradually at intervals of 1–2 weeks Prophylaxis after myocardial infarction in patients with clinical evidence of heart failure (started at least 48 hours after infarction) ▶BY MOUTH ▶Adult: Initially 2.5 mg twice daily for 3 days, then increased to 5 mg twice daily Prophylaxis after myocardial infarction in patients with clinical evidence of heart failure (started at least 48 hours after infarction) when initial dose not tolerated ▶BY MOUTH ▶Adult: 1.25 mg twice daily for 2 days, then increased to 2.5 mg twice daily, then increased to 5 mg twice daily, withdraw treatment if dose cannot be increased to 2.5 mg twice daily Prevention of cardiovascular events in patients with atherosclerotic cardiovascular disease or with diabetes mellitus and at least one additional risk factor for cardiovascular disease ▶BY MOUTH ▶Adult: Initially 2.5 mg once daily for 1–2 weeks, then increased to 5 mg once daily for a further 2–3 weeks, then increased to 10 mg once daily Nephropathy (consult product literature) ▶BY MOUTH ▶Adult: Initially 1.25 mg once daily for 2 weeks, then increased to 2.5 mg once daily for a further 2 weeks, then increased if tolerated to 5 mg once daily

PDF page 206

Safety

Interactions

→Appendix 1: ACE inhibitors

PDF page 206

Side Effects

▶Common or very common Gastrointestinal disorders. increased risk of infection. muscle spasms ▶Uncommon Anxiety. appetite decreased. asthma exacerbated. depressed mood. ﬂushing. libido decreased. myocardial ischaemia. nasal congestion. proteinuria aggravated. vision disorders ▶Rare or very rare Conjunctivitis. hearing impairment. hepatic disorders. hypoperfusion. movement disorders. onycholysis. oral disorders. tremor. vascular stenosis. vasculitis ▶Frequency not known Altered smell sensation. bone marrow failure. cerebrovascular insufﬁciency. concentration impaired. enanthema. gynaecomastia. hypersensitivity. Raynaud’s phenomenon. SIADH. toxic epidermal necrolysis

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Breast Feeding

Not recommended; alternative treatment options, with better established safety information during breast-feeding, are available.

PDF page 206

Hepatic Impairment

Ramipril is a prodrug. Manufacturer advises caution. Dose adjustments Manufacturer advises maximum 2.5 mg daily.

PDF page 206

Renal Impairment

Dose adjustments Max. daily dose 5 mg if eGFR 30–60 mL/minute/1.73 m2; max. initial dose 1.25 mg once daily (do not exceed 5 mg daily) if eGFR less than 30 mL/minute/1.73 m2.

PDF page 206

Dose and formulations

Medicinal Forms

There can be variation in the licensing of different medicines containing the same drug. Forms available from special-order manufacturers include: oral suspension, oral solution Oral solution ▶Ramipril (Non-proprietary) Ramipril 500 microgram per 1 ml Ramipril 2.5mg/5ml oral solution sugar-free | 150 ml P £99.13 DT = £96.00 Tablet ▶Ramipril (Non-proprietary) Ramipril 1.25 mg Ramipril 1.25mg tablets | 28 tablet P £5.00 DT = £1.96 Ramipril 2.5 mg Ramipril 2.5mg tablets | 28 tablet P £6.76 DT = £1.84 Ramipril 5 mg Ramipril 5mg tablets | 28 tablet P £9.42 DT = £1.86 Ramipril 10 mg Ramipril 10mg tablets | 28 tablet P £12.81 DT = £1.84 ▶Tritace (Sanofi) Ramipril 1.25 mg Tritace 1.25mg tablets | 28 tablet P £5.09 DT = £1.96 Ramipril 2.5 mg Tritace 2.5mg tablets | 28 tablet P £7.22 DT = £1.84 Ramipril 5 mg Tritace 5mg tablets | 28 tablet P £10.05 DT = £1.86 Ramipril 10 mg Tritace 10mg tablets | 28 tablet P £13.68 DT = £1.84 Capsule ▶Ramipril (Non-proprietary) Ramipril 1.25 mg Ramipril 1.25mg capsules | 28 capsule P £2.00 DT = £0.95 Ramipril 2.5 mg Ramipril 2.5mg capsules | 28 capsule P £1.99 DT = £0.94 Ramipril 5 mg Ramipril 5mg capsules | 28 capsule P £2.05 DT = £0.90 Ramipril 10 mg Ramipril 10mg capsules | 28 capsule P £2.20 DT = £1.08

PDF pages 206, 207

Dose text by age group

Adult

Initially 1.25–2.5 mg once daily, increased if

First-line fragment. Read the complete Indications and Dose section above.

PDF page 206

Adult

Initially 1.25 mg once daily, increased if

First-line fragment. Read the complete Indications and Dose section above.

PDF page 206

Adult

Initially 2.5 mg twice daily for 3 days, then

First-line fragment. Read the complete Indications and Dose section above.

PDF page 206

Adult

1.25 mg twice daily for 2 days, then increased to

First-line fragment. Read the complete Indications and Dose section above.

PDF page 206

Adult

Initially 2.5 mg once daily for 1–2 weeks, then

First-line fragment. Read the complete Indications and Dose section above.

PDF page 206

Adult

Initially 1.25 mg once daily for 2 weeks, then

First-line fragment. Read the complete Indications and Dose section above.

PDF page 206

Age labels are extracted for navigation. Check the complete source section and current local guidance before clinical use.

Drug reference

Ramipril

BNF 80 (2020–2021)

Source: BNF 80 (2020–2021)
PDF pages: 206, 207

Review source pages for extracted sections and age labels. BNF dose snippets show only their first line.

Overview

Indications And Dose

PDF page 206

Safety

Interactions

→Appendix 1: ACE inhibitors

PDF page 206

Side Effects

PDF page 206

Breast Feeding

Not recommended; alternative treatment options, with better established safety information during breast-feeding, are available.

PDF page 206

Hepatic Impairment

Ramipril is a prodrug. Manufacturer advises caution. Dose adjustments Manufacturer advises maximum 2.5 mg daily.

PDF page 206

Renal Impairment

Dose adjustments Max. daily dose 5 mg if eGFR 30–60 mL/minute/1.73 m2; max. initial dose 1.25 mg once daily (do not exceed 5 mg daily) if eGFR less than 30 mL/minute/1.73 m2.

PDF page 206

Dose and formulations

Medicinal Forms

PDF pages 206, 207

Dose text by age group

Adult

Initially 1.25–2.5 mg once daily, increased if

First-line fragment. Read the complete Indications and Dose section above.

PDF page 206

Adult

Initially 1.25 mg once daily, increased if

First-line fragment. Read the complete Indications and Dose section above.

PDF page 206

Adult

Initially 2.5 mg twice daily for 3 days, then

First-line fragment. Read the complete Indications and Dose section above.

PDF page 206

Adult

1.25 mg twice daily for 2 days, then increased to

First-line fragment. Read the complete Indications and Dose section above.

PDF page 206

Adult

Initially 2.5 mg once daily for 1–2 weeks, then

First-line fragment. Read the complete Indications and Dose section above.

PDF page 206

Adult

Initially 1.25 mg once daily for 2 weeks, then

First-line fragment. Read the complete Indications and Dose section above.

PDF page 206

Age labels are extracted for navigation. Check the complete source section and current local guidance before clinical use.