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Antihypertensive

Ramipril

Brand names: Tritace, Altace

Used in: Acute Coronary Syndrome & Chest Pain Heart Failure Chronic Kidney Disease Hypertension

Ramipril is an ACE inhibitor used for hypertension, heart failure with reduced ejection fraction, after myocardial infarction, and for cardiovascular and renal protection (e.g. in diabetic nephropathy).

Dosing — being independently re-sourced

ClinCalc Pro is rebuilding its dose data from primary open sources — the manufacturer SmPC (eMC), the WHO Model Formulary and other official references — under clinician review. This drug's structured dose is not yet published here. Confirm all doses against the product SmPC and your local formulary before prescribing.

US labelling (FDA)

Reference — US labelling, may differ from UK

• Hypertension: Initial dose is 2.5 mg to 20 mg once daily. Adjust dosage according to blood pressure response after 2–4 weeks of treatment. The usual maintenance dose following titration is 2.5 mg to 20 mg daily as a single dose or equally divided doses ( 2.1 ). • Heart failure post-myocardial infarction: Starting dose of 2.5 mg twice daily. If patient becomes hypotensive at this dose, decrease dosage to 1.25 mg twice daily. Increase dose as tolerated toward a target dose of 5 mg twice daily, with dosage increases about 3 weeks apart ( 2.3 ). • Dosage adjustment: See respective sections pertaining to dosage adjustment in special situations ( 2.5 ). 2.1 Hypertension The recommended initial …

Source: US FDA prescribing information (openFDA / DailyMed), label dated 2022-07-01. Accessed 2026-06-12. US dosing and indications can differ from UK practice — use UK sources for prescribing decisions.

Clinical monograph

How it works

It inhibits angiotensin-converting enzyme, lowering angiotensin II and aldosterone to produce vasodilatation, reduced blood pressure and reduced cardiac and renal workload. Reduced bradykinin breakdown contributes to the characteristic dry cough.

Prescribing in practice

  • Start low and titrate; check renal function and potassium before starting and 1–2 weeks after initiation or each dose increase.
  • A modest early rise in creatinine can be acceptable; a large rise suggests renovascular disease and should be investigated.
  • Avoid in pregnancy and in bilateral renal artery stenosis; use caution with potassium-raising drugs and NSAIDs.
  • A persistent dry cough is common and, if troublesome, is a reason to switch to an ARB.

Monitoring

Check U&E (renal function and potassium) at baseline, after initiation and titration, and periodically; monitor blood pressure for response.

Counselling the patient

  • The first dose can cause dizziness — take it at bedtime if advised.
  • Report a persistent dry cough.
  • Avoid potassium-based salt substitutes, and tell your prescriber if you become pregnant or unwell with vomiting or diarrhoea.

Evidence & guidelines

ACE inhibitors are a cornerstone of HFrEF and post-MI care and a first-line antihypertensive in younger, non–Black-African/Caribbean patients per NICE NG136; cardiovascular/renal protection was shown in trials such as HOPE.

Reference: NICE NG136 Hypertension; AIRE Trial Lancet 1993; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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