Makindo Medical Notes

Related Subjects: |Hypertension |Acute Heart Failure |Chronic Heart Failure

Significant hypotension with first dose. Start low dose and in bed perhaps at night for initiation. Seen more when used to manage heart failure rather than hypertension. If occurs - lie patient down and raise legs and start IV if BP still low.

About: Always check the BNF link here

• Competitively inhibit angiotensin converting enzyme
• Prevent formation of Angiotensin II a potent vasoconstrictor
• Can lead to increased Bradykinin
• Blood pressure reduction without reflex tachycardia

Indications/Dose

• Hypertension - often as combination therapy
• Cardiac failure due to systolic dysfunction
• Diabetic nephropathy, Reduce cardiac remodelling post-MI
• Start the lowest dose with heart failure but aim for highest tolerated dose

Dose range: Check U+E, BP, target BP. Check BNF

Name	Dose	Frequency	Route
Ramipril (starting)	1.25-2.5 mg OD depending on BP and renal function	OD	PO
Ramipril (long term)	5-10 mg OD depending on BP and renal function.	OD	PO

Cautions

• May not be effective in African-Caribbean patients

Contraindications

• Pregnancy - cause birth defects
• Caution in severe aortic stenosis and hypertrophic cardiomyopathy

Interactions

• Alteplase leads to Angioneurotic oedema in stroke thrombolysis
• Avoid with NSAIDS
• Hyperkalaemia (caution with potassium sparing diuretics)

Side effects

• Significant Postural hypotension with the first dose. See above
• Raised bradykinin causes Cough, Angioneurotic oedema
• Reduced renal perfusion with bilateral renal artery stenosis
• Hyperkalaemia (caution with potassium sparing diuretics)
• Urticaria, taste disturbance

Monitoring

• Check renal function 4 days and 2 weeks following initiation
• Check renal function 1 week after any increase in dose