ACE Inhibitor·Cardiovascular - Antihypertensives

Ramipril

Hypertension, Heart Failure (HFrEF, post-MI), secondary prevention of MI and stroke in high-risk CV patients, diabetic nephropathy

PBSACEiTritace, Ramace, Prilace1.25 mg tabletS4+1

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At a glance

Max Dose

10 mg/day

Half-life

13-17 h (Active)

Caution: Dry Cough

COMMON

High risk: Teratogenic

CRITICAL RISK

Cautions

Avoid / Cautions

History of ACEi angioedema. Bilateral renal artery stenosis. Pregnancy Category D (Absolute contraindication).

Where it stands

Rapid Summary

Overview

Potent, long-acting Angiotensin-Converting Enzyme (ACE) inhibitor. Cornerstone foundational therapy for hypertension, heart failure post-MI, diabetic nephropathy, and secondary cardiovascular prevention (HOPE trial).

Clinical Focus

Absolutely contraindicated in Pregnancy (Category D). Causes severe fetal renal dysgenesis, oligohydramnios, and neonatal hypoplasia. Cease immediately on confirmed pregnancy.

Bottom Line

Ramipril is a high-yield first-line ACE inhibitor with extensive clinical trial evidence for stroke and MI risk reduction, but must never be used in Pregnancy and mandates baseline and ongoing U&E monitoring.

Formulation & Access

Brand Names

Tritace, Ramace, Prilace

Oral Routes

Tablets / Capsules (1.25 mg, 2.5 mg, 5 mg, 10 mg).

Prescribing & PBS

Unrestricted General Benefit (S4).

Indications & Use

Primary

PBSTGA

Hypertension, Heart Failure (HFrEF, post-MI), secondary prevention of MI and stroke in high-risk CV patients, diabetic nephropathy.

Clinical Place

First-line ACE inhibitor supported by landmark trial evidence (HOPE study) demonstrating mortality and CV event reduction.

Quick reference

Class & Role

ACE Inhibitor — First-line antihypertensive, heart failure, post-MI, renal protection.

Route / Formulation

PO capsules/tablets: 1.25 mg, 2.5 mg, 5 mg, 10 mg (Tritace, Ramace, Prilace)

Usual Dose & Max

Start 2.5 mg OD, titrate to 5-10 mg OD. Max 10 mg/day.

Key Indication Doses

HTN: 2.5-10 mg OD. HF/Post-MI: 1.25-2.5 mg BD, target 5 mg BD. Renal: start 1.25 mg OD if eGFR < 30.

Best Uses

Key Risks

Renal: Hyperkalemia, AKI. Respiratory: Dry cough (10-15%). Immunological: Angioedema (CRITICAL).

Key Interactions

Triple Whammy: ACEi + Diuretic + NSAID (Severe AKI). Potassium-sparing diuretics (Spironolactone) cause hyperkalemia. Lithium toxicity.

Monitoring

Check U&E at baseline, 1-2 weeks after starting/titrating, then 6-12 monthly. Check BP.

Clinical Pearl

Switch to an ARB (Candesartan) if dry cough occurs. A creatinine increase up to 30% is expected and protective.

Access

Tritace, Ramace, Prilace1.25 mg tablet

Brand: Tritace, Ramace, Prilace
Formulation: Tablets / Capsules (1.25 mg, 2.5 mg, 5 mg, 10 mg).

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