Ramipril belongs to the ACE (angiotensin-converting enzyme) inhibitor class of drugs and is used as a blood pressure-lowering drug to treat arterial hypertension. Ramipril is also used to prevent heart attacks and other cardiological diseases, for example heart failure. Although ramipril can be used to successfully treat high blood pressure, it is not suitable for everyone because of the possible side effects. The dosage of ramipril is determined individually by the physician.
Effect of ramipril
Blood pressure is constantly adjusted to the needs of the body at any given time. During stress or physical exertion, the hormone angiotensin-II is produced, which constricts the blood vessels and thus increases blood pressure. In addition, angiotensin-II stimulates the production of the hormone aldosterone, which also increases blood pressure. The active ingredient Ramilpril inhibits the angiotensin-converting enzyme (ACE), a protein responsible for the formation of angiotensin-II. Ramilpril therefore causes less angiotensin-II to be produced, which dilates the blood vessels and lowers blood pressure. This also relieves the heart, as it has to pump the blood against a lower resistance. In addition, the lower amount of angiotensin-II causes less aldosterone to be secreted. In the body, this hormone ensures that less water is excreted via the kidneys, which increases blood volume and thus blood pressure. Thus, by reducing the production of aldosterone, ramipril has an additional blood pressure-lowering effect. Since high blood pressure is one of the main risk factors for the development of atherosclerosis, ramipril can thus protect against serious secondary diseases such as stroke, angina pectoris, heart attack and other diseases of the cardiovascular system.
Possible side effects
Ramipril can cause several side effects that may vary depending on the dosage, duration, frequency of use, and dosage form of the drug. Common side effects of ramipril include:
- Visual disturbances
- Fainting spells or dizziness
- Renal dysfunction
- Bronchitis or dry irritating cough
- Disturbances of the digestive tract and nausea
- Headache
- Lack of concentration
- Fatigue or increased need for sleep
Occasional side effects of ramipril include skin reactions such as hives and exanthema or itching, shortness of breath, asthma attacks, sore throat, and hoarseness. The concentration of red blood pigment may be decreased. In addition, the blood composition may change. Occasionally, a sudden drop in blood pressure is also among the side effects. Rare side effects of ramipril include fainting, inflammation of the nasal mucosa, decrease in kidney output, vascular swelling, and shock. Patients should rule out possible risk factors and refer to the package insert before taking ramipril.
Dosage and Interaction
The dosage of ramipril must always be individually adjusted to the patient by the physician. This is especially true if other medications are also being taken, as incorrect dosing of ramipril combined with the use of certain medications can cause serious interactions or side effects. This is the case, for example, with certain forms of therapy for diabetes, lithium, and certain medications for gout, rheumatism, cardiac arrhythmias, and cell growth disorders. When taking the correct dosage of ramipril, it should also be noted that the active ingredient has a stronger effect in older people – since the effect of alcohol is also stronger, this should be avoided while taking ramipril. Ramipril should not be taken during pregnancy due to the risk of severe malformations and stillbirths. If ramipril is combined with another agent, such as HCT (hydrochlorothiazide), the dosage should be carefully coordinated.
Ramipril: contraindications and alternatives
The active ingredient ramipril should not be taken by children and adolescents under 18 years of age. It is also unsuitable for people with narrowing of the renal arteries and heart valves, as well as severe kidney and liver dysfunction. Furthermore, Ramipril should not be used in hyperaldosteronism (excessive production of the hormone aldosterone).Due to the possible side effects of antihypertensive drugs, a specific decision must always be made on a case-by-case basis as to which drug is the most suitable. An alternative to ACE inhibitors are so-called AT1 antagonists. These active ingredients block a special “docking site” (receptor) of angiotensin-II, via which the hormone achieves the vasoconstrictive effect. Angiotensin-II therefore continues to be produced, only the blood pressure-increasing effect is absent. This means that certain side effects such as irritable cough or shortness of breath, which can occur when taking ACE inhibitors, occur less frequently. All drugs that act by blocking the AT1 receptors have the suffix “-sartan” in the active ingredient name, for example telmisartan. In addition to ACE inhibitors and AT1 antagonists, there are also antihypertensive agents that act in other ways, such as the beta blockers metoprolol and bisoprolol, or the calcium channel blocker amlodipine. Even drugs based on one of these agents are not free of side effects and contraindications and, like ramipril, can cause interactions with other agents.
