Ramipril

Benjamin Clanner-Engelshofen is a freelance writer in the medical department. He studied biochemistry and pharmacy in Munich and Cambridge / Boston (USA) and noticed early on that he particularly enjoyed the interface between medicine and science. That is why he went on to study human medicine.

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The active substance ramipril is a medicine used to treat high blood pressure and heart failure (heart failure). It was patented by Aventis (now: Sanofi) in the USA in 1991. Since the expiry of patent protection, it has been included in numerous drugs. In treatment, ramipril is used either alone or in combination with other active substances. Children and pregnant women should not take the active ingredient or only take it after consulting a doctor, as ramipril side effects can include growth disorders.

This is how Ramipril works

Ramipril is what is called an ACE inhibitor. ACE ("Angiotensin Converting Enzyme") is a substance that is involved in a complex system that regulates blood pressure. When ACE is inhibited, the body produces lower amounts of the hormone angiotensin II. This constricts the blood vessels and thus keeps the blood pressure high. In addition, it leads to a reduced excretion of water in the kidneys - this also leads to high blood pressure values.

After oral intake of ramipril, the concentration of the active substance in the blood increases to its maximum value after about an hour. However, the ACE inhibitor ramipril must first be converted into the active form (ramiprilat) in the body. In this form, the drug reaches its maximum blood concentration after two to four hours and then falls off again. Ramiprilat is eliminated through the kidneys - after about 7 to 13 hours, half of the active ingredient has disappeared from the body. With regular intake, consistently high levels of the active ingredient are reached after about four days.

When is ramipril used?

The active ingredient ramipril is mainly used to treat high blood pressure (arterial hypertension). Also for heart failure (reduced cardiac output), special kidney diseases, for the prevention of heart attack and in its aftercare. The drug is mostly used long-term.

This is how ramipril is used

The active ingredient ramipril is only available on the market in Germany as a finished medicinal product in the form of tablets. Treatment usually starts with small doses of 1.25 to 2.5 milligrams once a day. The dose is slowly increased over several weeks to the maintenance dose determined by the doctor. The manufacturers offer the tablets with active ingredient quantities of 2.5, 5 and 10 milligrams, so that the individual dose can be easily adjusted. Since the constant level of the active ingredient only sets in after around four days, it is important to take it regularly, regardless of meals, but at the same time of day.

If the blood pressure cannot be reduced sufficiently with ramipril alone, the guideline for the treatment of high blood pressure recommends a combination with a diuretic (water drainage agent) or a calcium channel blocker. If the treatment with ramipril is stopped, you do not have to expect an increased rise in blood pressure (rebound effect) - as with other active substances. In consultation with the doctor, ramipril can be discontinued without you gradually dosing it.

What are the side effects of Ramipril?

If treatment is started with too high a dose of ramipril, an unexpectedly large drop in blood pressure may occur. Therefore, the active ingredient is dosed gradually. Like any drug, this active ingredient has side effects. Ramipril causes the following common symptoms (in one to ten percent of those treated):

headache
fatigue
stomach pain
Vomit
Muscle cramps and pain
increased blood potassium levels

What should be considered when taking ramipril?

Patients with impaired kidney function must take a lower dose of ramipril as they remove the active substance more slowly. In patients with impaired liver function, the conversion into the effective form takes longer, therefore a delayed onset of action is to be expected.

The therapeutic benefit of ramipril has been proven from two years of age to old age. However, possible stunted growth needs to be considered when treating children. Ramipril should not be used during pregnancy and breastfeeding.

Because of the side effects, you must be particularly careful with ramipril therapy if you are also using drugs that:

change the concentration of potassium in the blood (e.g. effervescent potassium tablets, heparin, potassium-sparing diuretics).
can change the number of blood cells (e.g. allopurinol, immunosuppressants, corticosteroids, cytostatics).

Ramipril can also increase the blood sugar lowering effects of insulin and other oral anti-diabetic drugs. Simultaneous use of non-steroidal anti-inflammatory drugs (e.g. acetylsalicylic acid, ibuprofen, diclofenac) reduces the effect of ramipril. Patients who take the active ingredient should switch to drugs containing the active ingredient paracetamol if they experience pain and fever.

This is how you get drugs with the active ingredient ramipril

Since ramipril affects important body functions, the active ingredient is only available on prescription in every dosage; it can only be obtained from the pharmacy.

Since when is Ramipril known?

Aventis (today: Sanofi) filed a patent application for Ramipril in the USA in 1991 and brought it onto the market after successful completion of clinical trials. The patent protection was canceled early after 16 years by court proceedings, which opened up the market for other manufacturers. Since then, the ramipril active ingredient has been offered by various manufacturers as a so-called generic. The original preparation is also still on the market.

The name “ACE inhibitor of the second generation” comes from the fact that ramipril is a further development of the captopril, which is also still used today. It is the derivative of a substance in the poison of the Jararaca lance viper, which was developed in the USA in 1975 and approved in 1981. However, this active ingredient is very sensitive to air and moisture, it sometimes leads to rashes and taste disorders, which is why there was a need for improvement. More than ten other ACE inhibitors have been developed to date and are used worldwide.

More interesting facts about ramipril

Most of the negative symptoms experienced during treatment with ramipril can be attributed to the lowering of the blood pressure. The patients have usually become so used to their excessively high values that normal blood pressure initially leads to symptoms. However, this and most of the possible ramipril side effects improve after a few days to weeks of therapy.

The dry cough mentioned under the ramipril side effects can only start several weeks after the start of therapy with ramipril. In this case, ramipril is usually replaced by an angiotensin II receptor blocker (from the group of "sartans").

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