Altace (ramipril) is an angiotensin-converting enzyme (ACE) inhibitor prescribed for the management of hypertension, heart failure, and cardiovascular risk reduction following myocardial infarction. It works by inhibiting the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor, thereby promoting vasodilation and reducing peripheral vascular resistance. This mechanism not only lowers blood pressure but also decreases cardiac workload, offering comprehensive cardiovascular protection. Clinical evidence supports its role in improving survival rates and reducing hospitalizations in high-risk patient populations.

Features

• Active ingredient: Ramipril
• Available in 1.25 mg, 2.5 mg, 5 mg, and 10 mg oral capsules
• Once-daily dosing for consistent 24-hour blood pressure control
• Demonstrated efficacy in reducing cardiovascular events in clinical trials
• Suitable for use as monotherapy or in combination with other antihypertensives

Benefits

• Significantly lowers systolic and diastolic blood pressure, reducing strain on the heart and arteries
• Decreases risk of myocardial infarction, stroke, and cardiovascular-related mortality
• Provides renal protective effects in patients with diabetic nephropathy
• Improves survival rates following acute myocardial infarction
• Reduces symptoms and hospitalizations in chronic heart failure patients
• Offers convenient once-daily dosing to support treatment adherence

Common use

Altace is primarily indicated for the treatment of hypertension (high blood pressure) in adults. It is also approved for use in reducing the risk of myocardial infarction, stroke, or death from cardiovascular causes in patients aged 55 years or older who are at high risk for these events due to a history of coronary artery disease, stroke, or peripheral vascular disease. Additionally, Altace is used in the management of heart failure post-myocardial infarction and for nephropathy protection in diabetic patients with albuminuria.

Dosage and direction

The recommended initial dosage for hypertension is 2.5 mg once daily. Dosage may be titrated upward based on blood pressure response, with maintenance doses typically ranging from 2.5-10 mg daily. For cardiovascular risk reduction, the initial dose is 2.5 mg once daily for one week, followed by 5 mg once daily for three weeks, then increased as tolerated to 10 mg once daily. For heart failure post-myocardial infarction, start with 2.5 mg twice daily, then titrate to 5 mg twice daily after one week if tolerated. Administer approximately the same time each day, with or without food. Dosage adjustments are necessary for patients with renal impairment or those taking diuretics.

Precautions

Patients should be monitored for hypotension, especially during initial dosing and titration. Renal function and serum potassium should be assessed periodically, particularly in patients with pre-existing renal impairment, diabetes, or those taking potassium supplements or potassium-sparing diuretics. Angioedema may occur at any time during treatment and requires immediate discontinuation. Use with caution in patients with aortic stenosis or hypertrophic cardiomyopathy. Pregnancy must be avoided during treatment due to potential fetal harm. Surgical anesthesia may require dosage adjustment due to potential hypotension.

Contraindications

Altace is contraindicated in patients with a history of angioedema related to previous ACE inhibitor treatment. It is contraindicated in patients with hereditary or idiopathic angioedema. Concomitant use with aliskiren in patients with diabetes is contraindicated. Do not use in patients with hypersensitivity to ramipril or any component of the formulation. Contraindicated during the second and third trimesters of pregnancy.

Possible side effects

Common side effects include persistent dry cough (up to 12% of patients), dizziness (4-12%), headache (2-5%), and fatigue (2-4%). Less frequently reported effects include orthostatic hypotension, gastrointestinal disturbances, and rash. Serious but rare side effects include angioedema (0.1-0.5%), hyperkalemia, neutropenia/agranulocytosis, hepatic failure, and renal impairment. Approximately 2% of patients discontinue therapy due to side effects, most commonly cough.

Drug interaction

Concomitant use with diuretics may potentiate hypotensive effects. NSAIDs may reduce the antihypertensive effect and increase risk of renal impairment. Potassium supplements or potassium-sparing diuretics may increase risk of hyperkalemia. Lithium levels may increase with concomitant use. Dual blockade of the renin-angiotensin system with ARBs or aliskiren increases risks of hypotension, hyperkalemia, and renal impairment. Gold injections may cause nitritoid reactions. Antidiabetic agents may require dosage adjustment due to potential hypoglycemic effects.

Missed dose

If a dose is missed, take it as soon as remembered unless it is almost time for the next scheduled dose. Do not double the dose to make up for a missed dose. If multiple doses are missed, contact your healthcare provider for guidance as blood pressure control may be compromised. Consistent daily dosing is important for maintaining stable blood pressure levels.

Overdose

Symptoms of overdose may include severe hypotension, bradycardia, circulatory shock, electrolyte disturbances, and renal failure. Management involves supportive care including volume expansion with normal saline to maintain blood pressure. Hemodialysis may be effective in removing ramipril and its metabolites. Bradycardia may require atropine administration. Monitor vital signs, electrolyte levels, and renal function closely. Seek immediate medical attention if overdose is suspected.

Storage

Store at room temperature (20-25°C or 68-77°F) in the original container with the lid tightly closed. Protect from moisture and light. Do not store in bathroom cabinets where humidity levels fluctuate. Keep out of reach of children and pets. Do not use after the expiration date printed on the packaging. Properly dispose of any unused medication according to local regulations.

Disclaimer

This information is provided for educational purposes only and does not constitute medical advice. Altace is a prescription medication that should only be used under the supervision of a qualified healthcare professional. Individual response to therapy may vary. Always follow your healthcare provider’s instructions regarding dosage, administration, and monitoring. Report any side effects or concerns to your healthcare provider promptly. Do not discontinue medication without consulting your physician.

Reviews

Clinical studies demonstrate Altace’s efficacy in blood pressure control with 70-80% of hypertensive patients achieving target blood pressure goals. The HOPE study showed a 22% reduction in cardiovascular death, myocardial infarction, or stroke in high-risk patients. Patient reviews frequently note effective blood pressure management but mention persistent cough as a common reason for discontinuation. Many patients report improved quality of life due to better cardiovascular stability, though individual experiences vary based on comorbidities and concomitant medications.