Ramipril is an ACE inhibitor used for the management of hypertension and the reduction of cardiovascular mortality following myocardial infarction in hemodynamically stable patients with clinical signs of congestive heart failure.

SKU: DP9911 Category:


Hypertension: The most common indication in current clinical practice.
Prevention of Heart failure progression after myocardial infarction (MI): Ramipril is used after MI to prevent the progression of asymptomatic heart failure with reduced ejection fraction. Low-dose ramipril is often initiated within a few hours after the confirmed myocardial infarction.
Risk Reduction: Ramipril is prescribed to reduce the risk of MI, stroke, and death in patients more than 55 years old with a high risk of atherosclerotic disease and major adverse cardiac events.
Heart Failure with reduced ejection fraction (Off-label): It is used in the management of symptomatic heart failure with reduced ejection fraction to reduce morbidity and mortality.



Initial (not on diuretic): 2.5 mg PO qDay

Initial (with diuretic): 1.25 mg PO qDay

Maintenance: 2.5-20 mg/day PO qDay or divided q12hr

Heart Failure (Post-Myocardial Infarction)

Stable patients with CHF signs within a few days of acute MI

Initial: 2.5 mg PO q12hr; may titrate to 5 mg PO q12hr; decrease to 1.25 mg q12hr if hypotension occurs; monitor for >2 hr after initial dose and reduce concomitant diuretic if hypotension occurs

Maintenance: After 1 week, increase dose (if tolerated) to target dose of 5 mg q12hr

Myocardial Infarction/Stroke Prevention

Reduce risk of MI, stroke, or death from cardiovascular causes in patients ≥55 years

Initial: 2.5 mg PO qDay for 1 week, THEN 5 mg qDay for 3 weeks

Maintenance: Increase as tolerated to 10 mg qDay; for hypertensive or recently post-MI patients, give 5 mg PO BID

Dosing considerations

Reduce risk of MI, stroke, or death from cardiovascular causes in patients ≥55 years at high risk of developing a major cardiovascular event because of a history of coronary artery disease, stroke, or peripheral vascular disease, or of diabetes that is accompanied by at least 1 other cardiovascular risk factor (hypertension, elevated total cholesterol levels, low HDL levels, cigarette smoking, or documented microalbuminuria)

Diabetic Nephropathy (Off-label)

Initial (not on diuretic): 2.5 mg PO qDay

Initial (with diuretic): 1.25 mg PO qDay

Maintenance: 2.5-20 mg PO qDay; daily dose may be either increased or divided BID if antihypertensive effect is diminished toward the end of the dosing interval.


Dry cough: In the lung tissues, ramipril inhibits the degradation of bradykinin which is a substrate of angiotensin-converting enzyme. Higher levels of Bradykinin cause a dry cough. It usually occurs within a few months of treatment and resolves within one month after discontinuation of the medication.

Postural hypotension: Some patients may develop postural hypotension and may also have fallen as a result, which can lead to a higher risk of head injuries and bone fractures, especially in elderly patients. Dizziness and lightheadedness are related to postural hypotension when patients suddenly stand up from a sitting or lying position. Patients should receive counseling regarding symptoms of postural hypotension during treatment initiation.

Elevated serum creatinine: Ramipril may cause a transient increase in serum creatinine in 1% to 2% of the patients.

Hyperkalemia: In 1% to 10% of patients, hyperkalemia has been present.

Anxiety-like symptoms: Patients who are known to have anxiety or tremors should be watched for these symptoms for a few weeks at a minimum when initiating ramipril.

Angioedema: Ramipril can cause angioedema at any time during treatment. It involves the head and neck (which may compromise the airway) or the intestine