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
Clinical data
Trade names Altace
AHFS/Drugs.com monograph
MedlinePlus a692027
Pregnancy cat. D
Legal status POM (UK) -only (US)
Routes Oral
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%)
CAS number 87333-19-5 YesY
ATC code C09AA05
PubChem CID 5362129
DrugBank APRD00009
ChemSpider 4514937 YesY
KEGG D00421 YesY
Chemical data
Formula C23H32N2O5 
Mol. mass 416.511 g/mol
SMILES eMolecules & PubChem
 N(what is this?)  (verify)

Ramipril (marketed as Prilace by Arrow Pharmaceuticals in Australia, Ramipro by Westfield Pharma in the Philippines, Tritace by Sanofi-Aventis and Altace by King Pharmaceuticals in the United States) is an angiotensin-converting enzyme (ACE) inhibitor, used to treat high blood pressure and congestive heart failure.


Mechanism of action

ACE inhibitors lower the production of angiotensin II and also decreasing the breakdown of bradykinin, thereby relaxing arterial muscles and 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. Its effect on bradykinin is also responsible for the dry cough side effect.

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.


The compound was protected by U.S. Patent 5,061,722 which was assigned to Aventis on 29 October 1991. The patent was scheduled to expire on 29 October 2008. On 11 September 2007, in an appeal by the Indian company Lupin Ltd., the United States Court of Appeals for the Federal Circuit reversed a district court trial verdict and found that Aventis's patent on Ramipril 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.


Indications for its use include:


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


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.


  • low blood sugar (in patients taking medication for diabetes), causing sweating or shakiness
  • dry cough
  • dizziness and light-headedness due to low blood pressure
  • tiredness and fatigue, especially in the early stages
  • mouth dryness in the early stages
  • nausea, vomiting, diarrhea (persistent in rare cases)
  • fainting
  • change in amount of urine
  • signs of infection (e.g., fever, chills, persistent sore throat)
  • yellowing of eyes or skin, dark urine
  • stomach or abdominal pain
  • neutropenia
  • impotence (erectile dysfunction or ED)[3]

Serious allergic reactions to this drug are unlikely, but immediate medical attention must be sought if they occur. Symptoms of a serious allergic reaction include but are not limited to:

  • rash
  • swelling of the face, mouth, tongue, or throat

In extreme cases, Ramipril may lead to potentially fatal liver problems. It is recommended to start treatment with the lowest dose.


Ramipril 1.25mg Oral Capsule

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

Clinical trials

The HOPE trial[4][5] 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.[6]

The AIRE trial[1][7] showed a 27% reduction in mortality.

Ramipril was found to have similar results as telmisartan.[8]

See also


  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. PMC 2335176. PMID 18458262. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2335176. 
  3. ^ Med Tv
  4. ^ http://www.hypertensiononline.org/slides2/slide01.cfm?q=ramipril&dpg=10
  5. ^ http://ebm.bmj.com/cgi/content/extract/5/2/47
  6. ^ http://www.medscape.com/viewarticle/430926 "Debate: Do ACE Inhibitors Have Unique Properties, Beyond Their Antihypertensive Effect?"
  7. ^ "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. doi:10.1016/0140-6736(93)92693-N. PMID 8104270. 
  8. ^ 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. 

External links

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Look at other dictionaries:

  • Ramipril — Général Nom IUPAC acide (2S,3aS,6aS) 1 [(2S) 2 {[(2S) 1 éthoxy 1 oxo 4 phénylbutan 2 yl]amino}propanoyl] octahydrocyclopenta[b]pyrrole 2 carboxylique …   Wikipédia en Français

  • ramipril — fármaco inhibidor de la enzima de conversión de la angiotensina (ECA) , utilizado en el tratamiento de la hipertensión esencial y la insuficiencia cardíaca estructura química [véase http://www.iqb.es/diccio/r/ra.htm#ramipril] monografía [véase… …   Diccionario médico

  • Ramipril — Strukturformel Allgemeines Freiname Ramipril Andere Namen …   Deutsch Wikipedia

  • ramipril — noun A drug commonly used to treat hypertension …   Wiktionary

  • ramipril — ra·mip·ril rə mip rəl, ra n an ACE inhibitor C23H32N2O5 used esp. to treat hypertension see Altace * * * n. see ACE inhibitor * * * ra·mi·pril (rə miґpril) an angiotensin converting enzyme inhibitor used in the treatment of …   Medical dictionary

  • ramipril — n.; see ACE inhibitor …   The new mediacal dictionary

  • ramipril — noun an ACE inhibitor (trade name Altace) used to treat high blood pressure or in some patients who have had a heart attack • Syn: ↑Altace • Usage Domain: ↑trade name (for: ↑Altace) • Hypernyms: ↑ACE inhibitor, ↑ …   Useful english dictionary

  • RACE — ramipril angiotensin converting enzyme [ACE]; Ramipril Cardioprotective Evaluation [trial]; rapid amplification of complementary deoxyribonucleic acid [cDNA] ends; Rapid Assessment of Cardiac Enzymes; rate control vs electrical cardioversion * *… …   Medical dictionary

  • RACE — • ramipril angiotensin converting enzyme [ACE]; • Ramipril Cardioprotective Evaluation [trial]; • rapid amplification of complementary deoxyribonucleic acid [cDNA] ends; • Rapid Assessment of Cardiac Enzymes; • rate control vs electrical… …   Dictionary of medical acronyms & abbreviations

  • REIN — Ramipril Effect in Nephropathy [study] …   Medical dictionary

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