General Toxicity Notes
Blood pressure is the best guide to dose and interval. Hypotensive effects magnified by natriuretic agents or sodium depletion. May cause hyperkalemia, metabolic acidosis. Acute renal dysfunction with bilateral or transplant renal artery stenosis, low renal perfusion pressure. Dry cough in 5-10% of patients.
Half-Life (Normalesrd) Hours
8-10/14-16
Plasma Protein Binding %
55-70
Volume Of Distribution L/Kg
1.2
Dose For Normal Renal Function
2.5mg q24h
Second Dose
Second Dose: 5-10 mg q24h
Adjustment For Renal Failure Method
D
Adjustment For Renal Failure Gfr, Ml/Min >50 [Recommended Level]
100% [A]
Adjustment For Renal Failure Gfr, Ml/Min 10-50 [Recommended Level]
25-50% [A]
Adjustment For Renal Failure Gfr, Ml/Min <10 [Recommended Level]
25% [A]
Supplement For Dialysis [Recommendation Level]: Ihd
IHD: Dose after dialysis, [A]
Supplement For Dialysis [Recommendation Level]: Pd
PD: Dose for GFR <10, [D]
Supplement For Dialysis [Recommendation Level]: Crrt
CRRT: Dose for GFR 10-50, titrate, [D]
References
Fillastre JP, Baguet JC, Dubois D, Vauquier J, Godin M, Legallicier B, et al. Kinetics, safety, and efficacy of ramipril after long-term administration in hemodialyzed patients. J Cardiovasc Pharmacol. 1996; 27: 269-74. [PMID: 8720427] / Frampton JE, Peters DH. Ramipril. An updated review of its therapeutic use in essential hypertension and heart failure. Drugs. 1995; 49: 440-66. [PMID: 7774515] / Meisel S, Shamiss A, Rosenthal T. Clinical pharmacokinetics of ramipril. Clin Pharmacokinet. 1994; 26: 7-15. [PMID: 8137599] / Schunkert H, Kindler J, Gassmann M, Lahn W, Irmisch R, Ritz E, et al. Pharmaco-kinetics of ramipril in hypertensive patients with renal insufficiency. Eur J Clin Pharmacol. 1989; 37: 249-56. [PMID: 2533075]
Toxicity Notes
Active metabolite is ramiprilat. Data are for ramiprilat.