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Wikipedia - Ramipril

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Ramipril
Systematic (IUPAC) name
(2S,3aS,6aS)-1-[(2S)-2-{[(2S)-1-ethoxy-1-oxo-4-phenylbutan-2-yl]amino}propanoyl]-octahydrocyclopenta[b]pyrrole-2-carboxylic acid
Identifiers
CAS number 87333-19-5
ATC code C09AA05
PubChem CID 5362129
DrugBank APRD00009
ChemSpider 4514937
Chemical data
Formula C23H32N2O5 
Mol. mass 416.511 g/mol
SMILES eMolecules & PubChem
Pharmacokinetic data
Bioavailability 28%
Protein binding 73% (ramipril)
56% (ramiprilat)
Metabolism Hepatic, to ramiprilat
Half-life 2 to 4 hours
Excretion Renal (60%) and fecal (40%)
Therapeutic considerations
Pregnancy cat. D
Legal status POM (UK) ?-only (US)
Routes Oral
 YesY(what is this?)  (verify)

Ramipril (marketed as Ramipro by Westfield Pharma in the Philippines, marketed by Sanofi-Aventis as Tritace and by King Pharmaceuticals as Altace in the United States) is an angiotensin-converting enzyme (ACE) inhibitor, used to treat hypertension and congestive heart failure. ACE inhibitors lower the production of angiotensin II, therefore relaxing arterial muscles while at the same time enlarging the arteries, allowing the heart to pump blood more easily, and increasing blood flow due to more blood being pumped into and through larger passageways.

Ramipril is a prodrug and is converted to the active metabolite ramiprilat by liver esterase enzymes.[1] Ramiprilat is mostly excreted by the kidneys. The half-life of ramiprilat is variable (3-16 hours), and is prolonged by heart and liver failure, as well as kidney failure.

It is marketed by King Pharmaceuticals under the brand name Altace. The compound was protected by U.S. Patent 5,061,722 which was assigned to Aventis. The patent was scheduled to expire on 2008-10-29. On 2007-09-11, in an appeal by Lupin Pharmaceuticals the United States Court of Appeals for the Federal Circuit reversed a district court trial verdict, finding that Aventis's patent on Altace was invalid for obviousness - opening the gate of this medicine to generic manufacturers. Ramipril is marketed in India under the brand names of Cardace, Zigpril and Zorem.

Contents

[edit] Indications

Indications for its use include:

[edit] Cautions

  • Do not take potassium supplements without seeking medical advice.
  • Do not take during pregnancy

[edit] Contraindications

Renovascular disease, severe renal impairment (especially in patients with one kidney or with bilateral renal artery stenosis), volume-depleted patients, history of angioedema while on an ACE inhibitor, pregnancy, hypotension.

[edit] Side-effects

  • may cause swelling of the mouth, tongue, or throat
  • low blood sugar in patients taking other medicine for diabetes which shows as sweating or shakiness
  • Dry cough may develop, dizziness, and light-headedness due to low blood pressure. (It is recommended to start treatment with the lowest dose.)
  • decreased sex drive
  • tiredness and fatigue especially in the early stages
  • mouth dryness in the early stages

[edit] Dose

Patients are started on the lowest dose and titrated up every 3 - 4 weeks as required.

Dosage comes in the following forms: 1.25 mg, 2.5 mg, 5 mg, 10 mg

[edit] Clinical trials

The HOPE trial [3] [4] seemed to show that ramipril possessed cardioprotective qualities which extended beyond its qualities as an anti-hypertensive. The HOPE trial and the interpretation of the results have been criticised.[5]

The AIRE trial [1] [6] showed a 27% reduction in mortality.

Ramipril was found to have similar results as telmisartan.[7]

[edit] References

  1. ^ a b Frampton JE, Peters DH (March 1995). "Ramipril. An updated review of its therapeutic use in essential hypertension and heart failure". Drugs 49 (3): 440–66. PMID 7774515. 
  2. ^ Pilote L, Abrahamowicz M, Eisenberg M, Humphries K, Behlouli H, Tu JV (May 2008). "Effect of different angiotensin-converting-enzyme inhibitors on mortality among elderly patients with congestive heart failure". CMAJ 178 (10): 1303–11. doi:10.1503/cmaj.060068. PMID 18458262. 
  3. ^ http://www.hypertensiononline.org/slides2/slide01.cfm?q=ramipril&dpg=10
  4. ^ http://ebm.bmj.com/cgi/content/extract/5/2/47
  5. ^ http://www.medscape.com/viewarticle/430926 "Debate: Do ACE Inhibitors Have Unique Properties, Beyond Their Antihypertensive Effect?"
  6. ^ "Effect of ramipril on mortality and morbidity of survivors of acute myocardial infarction with clinical evidence of heart failure. The Acute Infarction Ramipril Efficacy (AIRE) Study Investigators". Lancet 342 (8875): 821–8. October 1993. PMID 8104270. 
  7. ^ Yusuf S, Teo KK, Pogue J, et al (April 2008). "Telmisartan, ramipril, or both in patients at high risk for vascular events". N. Engl. J. Med. 358 (15): 1547–59. doi:10.1056/NEJMoa0801317. PMID 18378520. 

[edit] See also

[edit] External links

v • d • e
Antihypertensives: agents acting on the renin-angiotensin system (C09)
ACE inhibitors
("-pril")
AIIRAs/
("-sartan")
Renin inhibitors/
("-kiren")
Retrieved from "http://en.wikipedia.org/wiki/Ramipril"

This article is licensed under the GNU Free Documentation License. It uses material from the Wikipedia article "Ramipril".

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