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Ramipril capsules are supplied as hard gelatin capsules containing 2.5 mg, 5 mg, and 10 mg of ramipril
Ramipril capsules are contraindicated in patients who are hypersensitive to this product or any other ACE inhibitor (e.g., a patient who has experienced angioedema during therapy with any other ACE inhibitor).
Do not coadminister ramipril capsules with aliskiren: in patients with diabetes
Single oral doses of ramipril in rats and mice of 10 g/kg to 11 g/kg resulted in significant lethality. In dogs, oral doses as high as 1 g/kg induced only mild gastrointestinal distress. Limited data on human overdosage are available. The most likely clinical manifestations would be symptoms attributable to hypotension.
Laboratory determinations of serum levels of ramipril and its metabolites are not widely available, and such determinations have, in any event, no established role in the management of ramipril overdose.
No data are available to suggest physiological maneuvers (e.g., maneuvers to change the pH of the urine) that might accelerate elimination of ramipril and its metabolites. Similarly, it is not known which, if any, of these substances can be effectively removed from the body by hemodialysis.
Angiotensin II could presumably serve as a specific antagonist-antidote in the setting of ramipril overdose, but angiotensin II is essentially unavailable outside of scattered research facilities. Because the hypotensive effect of ramipril is achieved through vasodilation and effective hypovolemia, it is reasonable to treat ramipril overdose by infusion of normal saline solution.
Ramipril is a 2-aza-bicyclo[3.3.0]-octane-3-carboxylic acid derivative. It is a white or almost white crystalline powder soluble in polar organic solvents and buffered aqueous solutions. Ramipril melts between 105°C and 112°C.
The CAS Registry Number is 87333-19-5. Ramipril's chemical name is (2S,3aS,6aS)-1[(S)-N-[(S)-1-carboxy-3-phenylpropyl]alanyl]octahydrocyclopenta[b]pyrrole-2-carboxylic acid, 1-ethyl ester; its structural formula is:
Chemical structure for ramipril
C23H32N2O5 M.W. 416.5
Ramiprilat, the diacid metabolite of ramipril, is a non-sulfhydryl angiotensin converting enzyme inhibitor. Ramipril is converted to ramiprilat by hepatic cleavage of the ester group.
Ramipril is supplied as hard shell capsules for oral administration containing 2.5 mg, 5 mg, and 10 mg of ramipril. The inactive ingredients are black iron oxide, gelatin, lactose anhydrous, pregelatinized starch, propylene glycol, shellac, sodium stearyl fumarate, and titanium dioxide. The imprinting ink may contain potassium hydroxide. Additionally, the 2.5 mg capsule shell contains yellow iron oxide and red iron oxide, the 5 mg capsule shell contains red iron oxide, and the 10 mg capsule shell contains FD&C Blue #2.
13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility
No evidence of a tumorigenic effect was found when ramipril was given by gavage to rats for up to 24 months at doses of up to 500 mg/kg/day or to mice for up to 18 months at doses of up to 1000 mg/kg/day. (For either species, these doses are about 200 times the maximum recommended human dose when compared on the basis of body surface area.) No mutagenic activity was detected in the Ames test in bacteria, the micronucleus test in mice, unscheduled DNA synthesis in a human cell line, or a forward gene-mutation assay in a Chinese hamster ovary cell line. Several metabolites and degradation products of ramipril were also negative in the Ames test. A study in rats with dosages as great as 500 mg/kg/day did not produce adverse effects on fertility.
No teratogenic effects of ramipril were seen in studies of pregnant rats, rabbits, and cynomolgus monkeys. On a body surface area basis, the doses used were up to approximately 400 times (in rats and monkeys) and 2 times (in rabbits) the recommended human dose
These highlights do not include all the information needed to use ramipril safely and effectively. See full prescribing information for ramipril capsules, USP. RAMIPRIL Capsules USP, for oral use Init...
RAMIPRIL 5 MG CAPSULE These highlights do not include all the information needed to use RAMIPRIL See full prescribing information for using RAMIPRIL Initial U.S. Approval 1991
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Nephrology - kidney function
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