Vasotec is used for treating high blood pressure, heart failure, and other heart problems.
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Category: Blood Pressure
Vasotec is used for treating high blood pressure, heart failure, and other heart problems.
Active Ingredient: Enalapril
Vasotec (Renipril) as known as: Acepril, Acetensil, Alapren, Alicante, Alphapril, Amprace, Analept, Anapril, Angiotec, Antiprex, Atens, Auspril, Bagopril, Bajaten, Baripril, Baypril, Benalapril, Bidinatec, Biocronil, Bitensil, Bql, Calnate, Carlon, Cetampril, Cinbenon, Ciplatec, Clipto, Controlvas, Convertase, Converten, Convertin, Corodil, Corprilor, Corvo, Cosil, Crinoren, Dabonal, Daren, Defluin, Denapril, Dentromin, Dilvas, Dinid, Ditensil, Ditensor, Docenala, Ecaprilat, Ecaprinil, Ednyt, Ekaril, Elpradil, Ena, Ena-puren, Enabeta, Enacard, Enacodan, Enacor, Enadigal, Enadura, Enafril, Enal, Enalabell, Enaladex, Enaladil, Enalafel, Enalagamma, Enalaprili maleas, Enalaprilmaleat, Enalaprilo, Enalaprilum, Enalaprol, Enalart, Enalbal, Enaldun, Enalek, Enalich, Enalin, Enalind, Enalten, Enam, Enap, Enap r, Enaprel, Enapren, Enaprex, Enapril, Enapril-h, Enaprotec, Enarenal, Enaril, Enatec, Enatral, Enazil, Encardil, Enecal, Enetil, Enpril, Envas, Ephicord, Epril, Eril, Eritril, Eupressin, Fabotensil, Feliberal, Fibrosan, Gadopril, Glenamate, Glioten, Gnostocardin, Grifopril, Hasitec, Herten, Hiperpril, Hiperson, Hipertan, Hipertin, Hipoartel, Hipopril, Hypace, Iecatec, Ileveran, Imotoran, Innovace, Innozide, Insup, Intonis, Invoril, Istopril, Jutaxan, Kalpiren, Kaparlon-s, Kinfil, Kintec, Konveril, Korandil, Lapril, Laprilen, Lariludon, Lenaberic, Lenimec, Leovinezal, Lerite, Linatil, Lotrial, Lowtril, M-enalapril, Maxen, Megapress, Meipril, Mepril, Minipril, Myoace, Nacor, Nalabest, Nalapril, Naprilene, Narapril, Neotensin, Norpril, Nuril, Octorax, Ofnifenil, Olinapril, Olivin, Pharmapress, Pharpril, Pms-enalapril, Pralenal, Pres, Presopril, Pressitan, Presuren, Prilace, Prilan, Prilenap, Prilenor, Priltenk, Pulsol, Rablas, Raserpril, Reca, Reminal, Renacardon, Renapril, Renaton, Renil, Renipril, Renistad, Renitec, Reniten, Renivace, Reniveze, Renopent, Revinbace, Selis, Silverit, Spaciol, Stadelant, Stadenace, Sulocten, Supotron, Tenace, Tenaten, Tencas, Tensapril, Tensazol, Tesoren, Ulticadex, Unipril, Vapresan, Vasolapril, Vasopren, Vasopril, Vexopril, Vimapril, Virfen, Vitobel, Xanef, Zacool
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Laurus winteriana (Canella). Ramipril.
Ramipril (medical condition): There is evidence to indicate that exposure to Ramipril during pregnancy. more »
Ramipril: A long-acting angiotensin-converting enzyme inhibitor. It is a prodrug that is transformed in the liver to its active metabolite ramiprilat.
Source: Diseases Database
Ramipril. A long-acting angiotensin-converting enzyme inhibitor. It is a prodrug that is transformed in the liver to its active metabolite ramiprilat.
Source: MeSH 2007
Angiotensin-converting enzyme inhibitors are the drugs of choice in renal hypertension. The efficacy and safety of ramipril in adults has been proved; however, data on effectiveness of ramipril in children are few. The aim of the present study was to investigate the effect of ramipril on blood pressure (BP) and proteinuria in children with chronic kidney diseases.Methods
A total of 31 children (median age 11.3 years, range 1.9–19.8 years) with various chronic nephropathies and hypertension or proteinuria were prospectively treated with ramipril for 6 months. Blood pressure was evaluated using ambulatory BP monitoring and hypertension was defined as mean BP equal to or greater than the 95th percentile for healthy children. Proteinuria was defined as protein excretion ≥100 mg/m 2 /24 h. The starting dose of ramipril was 1.5 mg/m 2 /24 h once daily. In 27 children it was given as monotherapy.Results
The median decrease in ambulatory BP was 11 mm Hg for daytime systolic, 10 mm Hg for daytime and nighttime diastolic, and 8 mm Hg for nighttime systolic BP. Hypertension normalized in 55% of the children. Proteinuria decreased in 84% of the children with pathologic proteinuria; the median decrease was 51%. A positive correlation was found between initial proteinuria and change of proteinuria (r = 0.95, P < .001). Glomerular filtration rate and serum potassium level did not change significantly. One child developed a cough that was believed to be related to ramipril.Conclusions
Ramipril is an effective and safe drug in children with chronic kidney diseases associated with hypertension, proteinuria, or both.Keywords
This work was supported by grants IGA MH CR reg. Nr. NE 6295/3 and NE 7629-3.
Address correspondence and reprint requests to Dr. Tomáš Seeman, First Department of Paediatrics, V Uvalu 84, 15006 Prague 5, Czech Republic
Copyright © 2004 American Journal of Hypertension, Ltd. Published by Elsevier Inc. All rights reserved.
Ramipril is a prescription medication used mainly to treat high blood pressure and congestive heart failure. It belongs to a class of drugs called ACE inhibitors and is sold under the brand name Altace ® .Side Effects of Ramipril
As with any medicine, there are possible side effects with ramipril. Not everyone who takes the drug will experience side effects. When side effects do occur, in most cases they are minor and either require no treatment or can easily be treated by your doctor.
Common ramipril side effects include, but are not limited to:
(Click Ramipril Side Effects to learn about the specific side effects of this medication.)
Omudhome Ogbru, PharmD
Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.
Medical and Pharmacy Editor:
Jay W. Marks, MD
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.GENERIC NAME: ramipril BRAND NAME: Altace
DRUG CLASS AND MECHANISM: Ramipril belongs to a class of drugs called angiotensin converting enzyme (ACE) inhibitors that are used for treating high blood pressure. heart failure and for preventing kidney failure due to high blood pressure and diabetes. Other ACE inhibitors include enalapril (Vasotec ), quinapril (Accupril ), captopril (Capoten ), fosinopril (Monopril ), benazepril (Lotensin ), lisinopril (Zestril. Prinivil ), moexipril (Univasc ) and trandolapril (Mavik ). ACE is important because it is an enzyme responsible for producing the chemical, angiotensin II. Angiotensin II causes muscles in most arteries, including the arteries of the heart, to contract, thereby narrowing the arteries and elevating blood pressure. ACE inhibitors such as ramipril lower blood pressure by reducing the production of angiotensin II, thereby relaxing arterial muscle and enlarging arteries. When the blood pressure is lower, the heart--including the failing heart--does not have to work as hard to pump blood. The arteries supplying the heart with blood also enlarge during treatment with ACE inhibitors. This increases the flow of blood and oxygen to the heart, further improving the ability of the heart to pump blood.
Medically Reviewed by a Doctor on 12/26/2014
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Suggested Reading on ramipril, Altace by Our Doctors Related Diseases & Conditions
Ramipril blocks ACE from converting angiotensin I to angiotensin II, a powerful vasoconstrictor, leading to decreased blood pressure, decreased aldosterone secretion, a small increase in serum potassium levels, and sodium and fluid loss; increased prostaglandin synthesis also may be involved in the antihypertensive action.Indications of Ramipril
Use caution in the presence ofAdverse effects of Ramipril GU. Proteinuria, renal insufficiency, renal failure. polyuria, oliguria, urinary frequency
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Renipril -a drug to lower blood pressure.Renipril Composition and dosage form
The preparation of the combined action, active substances are enalapril maleate and hydrochlorothiazide ACE inhibitor diuretic. Available in tablets of 20mg, white with separating facet.
Renipril contains 10 mg enalapril maleate + 12.5 mg of hydrochlorothiazide and excipients: Povidone, potato starch, colloidal silicon dioxide, lactose, calcium stearate.Pharmacological Properties
main active ingredient is Renipril enalapril, an angiotensin-converting enzyme ACE. The mechanism of action involves blocking Renipril angiotensin synthesis, which leads to a reduction in total peripheral vascular resistance, load on the heart, and blood pressure reduction in both systole and diastole. Effect on Renipril vein is more pronounced than in an artery. Increases the synthesis of prostaglandins, while preventing the destruction of bradykinin. Increases blood circulation in the heart and kidneys, does not affect the circulation of the brain. Prolonged use Renipril reduces left ventricular hypertrophy, dilation slowing its development, thereby stopping the progression of heart failure. Renipril improves blood circulation in the heart muscle ischemia on background, reduces platelet aggregation, so effective in post-MI states.
Renipril action on the kidneys due to the content in it the second active substance, hydrochlorothiazide. helps reduce intraglomerular hypertension, glomerular sclerosis and preventing the development of chronic renal failure, stimulates diuresis.
This medicine refers to preparations of indirect action: in the body, it is hydrolyzed to form enalaprilat, which is an ACE inhibitor. Reviews Reniprile from experts suggest that the antihypertensive effect occurs within an hour after administration per os, reaching a peak after 4-6 hours, persists for days. Therapeutic effect in the treatment of chronic heart failure occurs with prolonged use Renipril -at least 6 months.Indications
In accordance with the instructions Renipril shown in the following conditions:
In accordance with an instruction to be taken orally Renipril regardless of me altime drink sufficient quantities of water.
When hypertension: initial dose is 5 mg once a day for a week. Two to three hours after taking the drug the patient should be under medical supervision, as there can be significant fluctuations in blood pressure. In the absence of clinical effect in a week the daily dose is increased by another 5mg. Thus, the daily dose Renipril indications can be reduced to 40mg per 1 or 2 divided doses. 40mg per day -maximum daily dose. For the treatment of hypertension secondary to moderate severity sufficient dosage is 10mg per day. Depending on the indication, 2-3 weeks reduce the dose, switching to maintenance dose.
When: starting dose is 2.5 to 5 mg per day, the maximum dose -20 mg per day.
the treatment of chronic heart failure according to the instructions Renipril administered in an initial dosage of 2.5 mg once a day 1. increasing the dose of 2.5 mg every 3-4 days, while choosing the optimal dosage. The maximum allowable daily dose should not exceed 40mg per day, 1 or 2 doses. Systolic pressure of 110 mmHg and below, the initial dose is 1.25 mg, the same limitation for elderly patients, because enalapril they have a longer period of excretion.
If any function of the left ventricle Renipril taken at a dosage of 2.5 mg two times a day. If necessary, the dosage is gradually increased, bringing to 20 mg, divided into 2 doses.
Reniprilom Treatment should be constantly monitoring your blood pressure at reducing its excessive dosage of the drug is reduced.Side Effects
According to the reviews on Reniprile in its application were recorded following undesirable effects:
In accordance with the instructions Renipril prescribed with caution in conjunction with other drugs. since it can amplify, attenuate, or otherwise modify their action.Overdose
acute symptoms of overdose may be seizures, confusion, collapse, myocardial infarction, atrial fibrillation, including death. Significant overdose Renipril requires emergency care in hospital. Assign hemodialysis, intravenous plasma expanders, drugs, stabilizing blood pressure.Contraindications Renipril
In accordance with the instructions Renipril contraindicated in the following conditions:
wary appoint Renipril during pregnancy, breastfeeding, as well as elderly patients.Storage
Keep out of reach of direct light, in a dry place at room temperature for 3 years.
Keep away from children!
The evidence for the efficacy of ramipril in relieving the symptoms of peripheral arterial disease is very limited.
Two small RCTs (Ahimastos et al. 2006. n=40 and Shahin et al. 2013a. n=33) found that, compared with placebo, over 24 weeks, ramipril 10 mg daily improved maximum and pain‑free walking times and distances in people with stable intermittent claudication, a symptom of peripheral arterial disease. However, while these differences were statistically significant, the clinical importance of the results is unclear. No adverse effects were reported in 1 study. In the other study, the adverse effect most often reported with ramipril was cough, which led to discontinuation in some cases.
The studies have many limitations and ramipril has not been compared directly with other treatments for intermittent claudication. Higher quality evidence on the efficacy and safety of ramipril is needed in order to determine its place in therapy.
A third study (n=212) was originally included in this evidence summary but has now been removed. This follows a statement published in the Journal of the American Medical Association (JAMA), which advises that the study has been retracted after the lead author admitted to fabricating the results of this and a related study. This author was also the lead author for another study included in this evidence summary (Ahimastos et al. 2006 ) and it is unclear whether the integrity of that study is also affected. However, because of the paucity of evidence, the decision has been taken to present the results, with the proviso that the data may not be robust.
Regulatory status: Ramipril is licensed for reducing cardiovascular risk in people with peripheral arterial disease, but its use to treat symptoms of peripheral arterial disease is off‑label.
Compared with placebo over 24 weeks, ramipril 10 mg daily statistically significantly improved:
mean maximum walking time and mean pain‑free walking time (Ahimastos et al. 2006. n=40; both p<0.001; clinical importance unclear)
mean maximum walking distance and mean pain‑free walking distance (Shahin et al. 2013a. n=33; both p=0.001; clinical importance unclear).
According to the summary of product characteristics for Tritace. common adverse effects of ramipril (seen in between 1 in 10 and 1 in 100 people) include headache, dizziness, cough, sinusitis, dyspnoea, gastrointestinal disturbances, rash, muscle spasms, myalgia, hyperkalaemia, hypotension, syncope, chest pain and fatigue.
No adverse effects were reported the study by Ahimastos et al. (2006). In Shahin et al. (2013a). the adverse effect most often reported with ramipril was cough, which led to discontinuation in some cases.
Renal function should be assessed before and during ramipril treatment, particularly in people with renal impairment.
The results of the studies may not be generalisable to people with certain comorbid conditions (for example, disease limiting mobility or renal impairment).
Most of the participants in the studies were white and it is known that ACE inhibitors are less effective for treating hypertension in people of African or Caribbean family origin; therefore, the studies may not apply to this population.
It is not known how ramipril compares with other treatments for intermittent claudication.
The cost of 28 days' treatment with ramipril 10 mg is £1.28 for capsules, £1.32 for tablets and £358.40 for 2.5 mg/5 ml oral solution (Drug Tariff. October 2015).Introduction and current guidance
Peripheral arterial disease, also known as peripheral vascular disease, is a condition in which arteries that carry blood to the legs (or less commonly the arms) are narrowed or blocked. Peripheral arterial disease is generally caused by atherosclerosis and it is associated with an increased risk of cardiovascular events even when it is asymptomatic. The most common initial symptom of peripheral arterial disease is pain in the legs while walking, which is relieved by rest, known as intermittent claudication.
Treatment options for intermittent claudication include management of cardiovascular risk factors (for example, smoking, obesity, diabetes, hypertension, using antiplatelet drugs and statins), supervised exercise and vasoactive drug treatment (naftidrofuryl oxalate). See the NICE guideline on lower limb peripheral arterial disease: diagnosis and management for more information.Product overview
Ramipril is an angiotensin‑converting enzyme inhibitor (ACE inhibitor) that is licensed for treating hypertension, renal disease and symptomatic heart failure. It is also licensed for the secondary prevention of acute myocardial infarction, and the reduction of cardiovascular morbidity and mortality in people with manifest atherothrombotic cardiovascular disease (including peripheral arterial disease) or diabetes with at least one cardiovascular risk factor. See the summary of product characteristics for Tritace for more information.
This evidence summary considers the evidence for using ramipril to treat the symptoms of peripheral arterial disease (intermittent claudication), rather than for reducing cardiovascular risk in people with peripheral arterial disease. The use of ramipril to treat symptoms of peripheral arterial disease is off‑label.Evidence review
This evidence summary discusses 2 randomised controlled trials (RCTs: Ahimastos et al. 2006 and Shahin et al. 2013a [n=40 and n=33 respectively]) that evaluated ramipril for treating people with stable intermittent claudication and concurrent medical treatment, and no comorbid conditions limiting walking ability or renal impairment. Participants were randomised to receive ramipril 10 mg daily or placebo for 24 weeks (including a 2‑week dose titration period using ramipril 5 mg daily in Shahin et al. 2013a ).
Ahimastos et al. (2006) found that ramipril 10 mg daily statistically significantly increased mean maximum walking time (451 seconds, p<0.001) and mean pain‑free walking time (227 seconds, p<0.001) c ompared with placebo over 24 weeks. Shahin et al. (2013a) reported walking distance rather than time and found that, compared with placebo, ramipril 10 mg daily statistically significantly improved mean maximum walking distance (131 m, p=0.001) and mean pain‑free walking distance (122 m, p=0.001) over 24 weeks. Although unclear from the data reported, improvements from baseline in the studies may be clinically important (see the evidence review section of this evidence summary for more details).
Ahimastos et al. (2006) found that ramipril 10 mg daily improved Walking Impairment Questionnaire distance, speed and stair‑climbing scores at 24 weeks compared with baseline (all p<0.001) but no comparisons with placebo are reported.
According to the summary of product characteristics for Tritace. common adverse effects of ramipril (seen in between 1 in 10 and 1 in 100 people) include headache, dizziness, cough, sinusitis, dyspnoea, gastrointestinal disturbances, rash, muscle spasms, myalgia, hyperkalaemia, hypotension, syncope, chest pain and fatigue. Renal function should be assessed before and during ramipril treatment, particularly in people with renal impairment.
No adverse effects were reported the study by Ahimastos et al. (2006). In Shahin et al. (2013a). the adverse effect most often reported with ramipril was cough, which led to discontinuation in some cases.
The 2 studies were small (n=33 and n=40), affecting their statistical power to detect differences between the groups. Participants had stable intermittent claudication that limited their mobility and exercise tolerance, and stable concurrent medical therapies. The results may not be generalisable to people with less severe intermittent claudication or comorbid conditions (for example, concomitant disease limiting walking, including coronary artery disease, or renal impairment). Most of the participants in the studies were white and it is known that ACE inhibitors are less effective for treating hypertension in people of African or Caribbean family origin; therefore, the studies of intermittent claudication may not apply to this population. The treatment period was 24 weeks and it is not known whether benefits will be maintained in the longer term. It is also not known how ramipril compares with other treatments for intermittent claudication because the studies were placebo controlled.Context and estimated impact for the NHS
The cost of 28 days' treatment with ramipril 10 mg is £1.28 for capsules, £1.32 for tablets and £358.40 for 2.5 mg/5 ml oral solution (Drug Tariff. October 2015).Information for the public
A plain English summary is available on the NICE website. This sets out the main points from the evidence summary in non‑technical language and may be especially helpful for people with peripheral arterial disease who are thinking about trying ramipril.
About this evidence summary
'Evidence summaries: unlicensed or off‑label medicines' summarise the published evidence for selected unlicensed or off‑label medicines that are considered to be of significance to the NHS, where there are no clinically appropriate licensed alternatives. The summaries provide information for clinicians and patients to inform their decision‑making and support the construction and updating of local formularies.
The summaries support decision‑making on the use of an unlicensed or off-label medicine for an individual patient, where there are good clinical reasons for its use, usually when there is no licensed medicine for the condition requiring treatment, or the licensed medicine is not appropriate for that individual.
The strengths and weaknesses of the relevant evidence are critically reviewed within this summary, but this summary is not NICE guidance .