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Treatment of hypertension. (Data are currently not available to support the use of ramipril in renovascular hypertension).
Post MI heart failure.
Prevention of progressive renal failure in patients with persistent proteinuria in excess of 1 g/day.
For reducing the risk of myocardial infarction, stroke, cardiovascular death or the need for revascularisation procedures in patients 55 years of age or more who have clinical evidence of coronary artery disease, stroke or peripheral vascular disease.
For reducing the risk of myocardial infarction, stroke, cardiovascular death or revascularisation procedures in diabetic patients 55 years or more with one or more of the following risk factors: systolic blood pressure >160 mm Hg or diastolic blood pressure >90 mm Hg (or on antihypertensive treatment); total cholesterol >5.2 mmol/L; HDL cholesterol <0.9 mmol/L; current smoker; known microalbuminuria; any evidence of previous vascular disease.
Hypersensitivity to ramipril, or to any other ACE inhibitor, or to any of the excipients of Ramipril tablets.
History of hereditary and/or idiopathic angioedema or angioedema associated with previous treatment with an ACE inhibitor.
Haemodynamically relevant renal artery stenosis either bilateral or unilateral in the single kidney.
As with all vasodilators, ACE inhibitors should not be used in patients with haemodynamically relevant left ventricular inflow or outflow impediment (e.g. stenosis of aortic or mitral valve).
Hypotensive or haemodynamically unstable patients.
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Mechanism & pharmacology
“Ramipril and ramiprilat inhibit angiotensin-converting enzyme (ACE) which is identical to KININASE II. This converting enzyme (ACE) is a peptidyl dipeptidase that catalyses the conversion of angiotensin I to the vasoconstrictor substance, angiotensin II.”
“The apparent elimination phase corresponds to the clearance of free ramiprilat and has a half-life of 9 - 18 hours. The terminal elimination phase has a prolonged half-life (>50 hours) and probably represents the binding/dissociation kinetics of the ramiprilat/ACE complex.”
Curated subset. The full adverse-effect list is in the TGA Product Information; click any citation above to open it.
Pregnancy.
Lactation.
Renal failure (see section 4.4 Special warnings and precautions for use ).
Extracorporeal treatments leading to contact of blood with negatively charged surfaces must be avoided, such as dialysis or haemofiltration with high-flux dialyser membranes: Life threatening anaphylactoid hypersensitivity reactions, sometimes progressing to shock, have been described in the course of dialysis with high-flux membranes (e.g. polyacrylonitrile membranes such as AN69) during ACE inhibitor therapy. This combination must be avoided, either by using other medical products to control high blood pressure or cardiac insufficiency or by using other membranes during dialysis. Similar reactions have been seen in patients undergoing low density lipoprotein apheresis with dextran sulfate during ACE inhibitor therapy.
Ramipril must not be used with aliskiren-containing medicines in patients with diabetes or with moderate to severe renal impairment (creatinine clearance <60 mL/min).
Ramipril must not be used with angiotensin II receptor antagonists (AIIRAs) in patients with diabetic nephropathy.
Ramipril must not be used concomitantly with sacubitril/valsartan therapy (see section 4.5 Interactions with other medicines and other forms of interactions ). Do not initiate ramipril until sacubitril/valsartan is eliminated from the body. In case of switch from ramipril to sacubitril/valsartan, do not start sacubitril/valsartan until ramipril is eliminated from the body.