Cardiology · ACE inhibitor
Ramipril
Dose
Start 1.25–2.5 mg OD, titrate to 10 mg OD.
Mechanism
Blocks ACE → ↓angiotensin II → vasodilation, ↓aldosterone, ↑bradykinin.
Indications
- • HFrEF
- • Post-MI LV dysfunction
- • Hypertension
- • Nephroprotection (diabetic/proteinuric CKD)
- • Secondary CV prevention (HOPE trial)
Contraindications
- • Bilateral renal artery stenosis
- • Pregnancy
- • History of angio-oedema
- • K+ >5.5
Dose adjustment
CrCl <30: max 5 mg/day
Use
First-line RAAS blockade in HTN, HF, diabetic nephropathy.
Monitoring
U&E and BP 1–2 weeks after each titration; watch for ↑Cr >30% or K+ >5.5.
Side effects
- • Dry cough (10–20%)
- • Hyperkalaemia
- • Renal impairment
- • Angio-oedema (rare)
- • First-dose hypotension
Pregnancy safety
Contraindicated — teratogenic (renal dysgenesis, oligohydramnios).
Always confirm dose against your local formulary / BNF before prescribing.
