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Ramipril

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Drug notes

Ramipril
Cough ↑ bradykinin Hydrolysis Inactive metabolites

Siobhan Boyle
BSc (MedSci), MBChB, Foundation Doctor

Gerry McKay
BSc (Hons), FRCP, Consultant Physician

X Blocked
Ramiprilat ACE

Miles Fisher
MD, FRCP, Consultant Physician

Ramipril Liver

X Blocked
Angiotensin Renin Angiotensin I

↓ vasoconstriction

Glasgow Royal Infirmary, Glasgow, UK

Angiotensin II

Correspondence to: Professor Miles Fisher, Wards 3, 4 & 5, Glasgow Royal Infirmary, Glasgow G4 0SF, UK; email: miles.fisher@ggc.scot.nhs.uk

↓ salt + water retention ↓ blood pressure Kidneys
NOTES. Following oral ingestion and absorption of ramipril, it is hydrolysed in the liver to its active form ramiprilat that acts on the renin angiotensin aldosterone system (RAS). It competitively binds to angiotensin converting enzyme (ACE) to prevent the cleaving of angiotensin II from angiotensin I, directly inhibiting the actions of angiotensin II, a potent vasoconstrictor, thus exerting its haemodynamic effects. It also results in the accumulation of bradykinin a potent vasodilator, which is usually broken down by ACE, resulting in cough as a side effect for some patients.

Figure 1. Pharmacological action of ramipril

Introduction Angiotensin converting enzyme (ACE) inhibitors are used for the treatment of cardiovascular disease in people with diabetes. Ramipril is a second-generation ACE inhibitor, and is prescribed in patients with diabetes for several clinical indications including the management of hypertension, following myocardial infarction (MI), in chronic heart failure, in diabetic nephropathy and in patients with increased cardiovascular risk, where it has been shown to reduce the risk of death and cardiovascular events. Pharmacology Figure 1 outlines the pharmacological action of ramipril, a monoethyl ester prodrug. Following oral ingestion and…...

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