Ramipril Dosage

Usual Adult Dose for Diabetic Nephropathy

Initial dose: 2.5 mg orally once a day for patients not receiving a diuretic
Maintenance dose: 2.5 to 20 mg/day orally in 1 to 2 divided doses

Usual Adult Dose for Hypertension

Initial dose: 2.5 mg orally once a day for patients not receiving a diuretic
Maintenance dose: 2.5 to 20 mg/day orally in 1 to 2 divided doses

Usual Adult Dose for Congestive Heart Failure

Initial dose: 2.5 mg orally twice a day
Maintenance dose: 5 mg orally twice a day

Usual Adult Dose for Left Ventricular Dysfunction

Initial dose: 2.5 mg orally twice a day
Maintenance dose: 5 mg orally twice a day

Usual Adult Dose for Myocardial Infarction

Initial dose: 2.5 mg orally twice a day
Maintenance dose: 5 mg orally twice a day

Renal Dose Adjustments

CrCl less than 40 mL/min:
Initial dose: 1.25 mg orally once a day.
Dosage may be titrated upward until blood pressure is controlled or to a maximum total daily dose of 5 mg.
CrCl less than 10 mL/min:
The dose should be reduced by 25% to 50% of the normal dose.

Liver Dose Adjustments

Data not available

Dose Adjustments

The antihypertensive effect may diminish toward the end of the dosing interval. In such patients, an increase in dosage or twice daily administration should be considered.

Heart Failure patients who become hypotensive at the 2.5 mg dose may be switched to 1.25 mg twice a day, but all patients should then be titrated (as tolerated) toward the 5 mg twice a day target dose.

Precautions

In patients who are currently being treated with a diuretic, symptomatic hypotension occasionally can occur following the initial dose of ramipril. To reduce the likelihood of hypotension, the diuretic should, if possible, be discontinued 2 to 3 days prior to beginning therapy with ramipril. Then, if blood pressure is not controlled with ramipril alone, diuretic therapy should be resumed. If the diuretic cannot be discontinued, an initial dose of 1.25 mg ramipril should be used to avoid excess hypotension.

Safety and effectiveness have not been established in pediatric patients (less than 18 years of age).

Dialysis

Data not available

Other Comments

If blood pressure is not controlled with ramipril alone, a diuretic can be added.

Compared with Caucasian patients, Black patients have a reduced blood pressure response to monotherapy with angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers; however, the reduced response is largely eliminated if combination therapy that includes an adequate dose of a diuretic is instituted.

Following first time MI, all ACE inhibitors, at comparable appropriate dosages, appear to be equally effective for reducing mortality and recurrent MI rates.

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