Altace (ramipril) is an angiotensin-converting enzyme (ACE) inhibitor prescribed for the management of hypertension, heart failure, and cardiovascular risk reduction following myocardial infarction. This medication works by relaxing blood vessels, allowing blood to flow more smoothly and reducing the heart’s workload. Clinical evidence supports its role in improving survival rates and decreasing hospitalizations in specific cardiac conditions, making it a cornerstone therapy in cardiovascular medicine. Proper adherence under medical supervision is essential for achieving optimal therapeutic outcomes while minimizing potential risks.

Features

• Active ingredient: Ramipril
• Drug class: Angiotensin-converting enzyme (ACE) inhibitor
• Available in 1.25 mg, 2.5 mg, 5 mg, and 10 mg oral capsules
• Once-daily dosing regimen for most indications
• Proven efficacy in large-scale clinical trials (e.g., HOPE study)
• Suitable for long-term maintenance therapy

Benefits

• Lowers high blood pressure effectively, reducing strain on the heart and arteries
• Decreases risk of heart attack, stroke, and cardiovascular-related mortality
• Improves survival rates in patients with heart failure post-myocardial infarction
• Slows progression of kidney disease in hypertensive patients with diabetes
• May reduce hospitalizations due to worsening heart failure
• Offers convenient once-daily dosing for improved adherence

Common use

Altace is primarily indicated for the treatment of hypertension, either as monotherapy or in combination with other antihypertensive agents. It is also used in stable patients who have shown clinical signs of heart failure within the first few days after sustaining acute myocardial infarction. Additionally, Altace is prescribed for cardiovascular risk reduction in patients aged 55 years or older who have established vascular disease or diabetes with at least one other cardiovascular risk factor. Off-label uses may include diabetic nephropathy and certain forms of chronic kidney disease, though these should only be pursued under specialist supervision.

Dosage and direction

The recommended initial dosage for hypertension is 2.5 mg once daily. Dosage may be adjusted based on blood pressure response, typically at intervals of 2-3 weeks. Maintenance doses usually range from 2.5-20 mg daily, administered as a single dose or in two divided doses. For post-myocardial infarction heart failure, treatment should be initiated with 2.5 mg twice daily. If tolerated, the dose may be increased to 5 mg twice daily after one week. For cardiovascular risk reduction, the starting dose is 2.5 mg once daily for one week, followed by 5 mg once daily for the next three weeks, then increased as tolerated to a maintenance dose of 10 mg once daily. Tablets should be swallowed whole with a glass of water, with or without food, at approximately the same time each day.

Precautions

Patients should undergo assessment of renal function and electrolytes before initiating therapy and periodically during treatment. Blood pressure should be monitored regularly, especially after dosage adjustments. Caution is advised in patients with impaired renal function, as dosage adjustments may be necessary. Those with collagen vascular disease or receiving immunosuppressive therapy may be at increased risk of hematologic reactions. Angioedema has been reported with ACE inhibitors and may require immediate medical attention. Patients should be advised to avoid potassium supplements or salt substitutes containing potassium unless specifically recommended by their physician. Adequate hydration should be maintained, especially during periods of vomiting or diarrhea.

Contraindications

Altace is contraindicated in patients with known hypersensitivity to ramipril or any other ACE inhibitor. It should not be used in patients with a history of angioedema related to previous ACE inhibitor therapy. Concomitant use with aliskiren-containing products is contraindicated in patients with diabetes. The medication is contraindicated during the second and third trimesters of pregnancy due to potential fetal harm. Use is also contraindicated in patients with hereditary or idiopathic angioedema.

Possible side effects

Common adverse reactions may include dizziness (4-12%), cough (5-12%), fatigue (2-5%), and headache (2-5%). Less frequently reported side effects include orthostatic hypotension, gastrointestinal disturbances, and rash. Serious but rare side effects may include angioedema, hyperkalemia, neutropenia/agranulocytosis, hepatic failure, and pancreatitis. Renal impairment may occur, particularly in patients with renal artery stenosis, heart failure, or volume depletion. Any persistent or severe side effects should be reported to a healthcare provider immediately.

Drug interaction

Altace may interact with diuretics, potentially causing excessive blood pressure reduction. Concurrent use with potassium-sparing diuretics, potassium supplements, or salt substitutes may lead to hyperkalemia. Nonsteroidal anti-inflammatory drugs (NSAIDs) may diminish the antihypertensive effect and increase the risk of renal impairment. Lithium levels may increase when co-administered with Altace. Dual blockade of the renin-angiotensin system with ARBs, aliskiren, or other ACE inhibitors increases risks of hypotension, hyperkalemia, and renal impairment. The antihypertensive effect may be potentiated by alcohol, barbiturates, narcotics, or antidepressants.

Missed dose

If a dose is missed, it should be taken as soon as remembered unless it is almost time for the next scheduled dose. In that case, the missed dose should be skipped and the regular dosing schedule resumed. Patients should never take a double dose to make up for a missed one. If multiple doses are missed, blood pressure should be monitored closely and a healthcare provider consulted regarding resumption of therapy.

Overdose

Symptoms of overdose may include severe hypotension, bradycardia, circulatory shock, electrolyte disturbances, and renal failure. Management involves supportive measures including volume expansion with normal saline to restore blood pressure. Ramipril may be removed from the body by hemodialysis. Patients suspected of overdose should receive immediate medical attention, with continuous monitoring of vital signs and electrolyte levels.

Storage

Store at room temperature between 15-30°C (59-86°F) in a dry place protected from light and moisture. Keep the container tightly closed and out of reach of children. Do not use after the expiration date printed on the packaging. Properly discard any unused medication that is no longer needed or has expired according to local guidelines for medication disposal.

Disclaimer

This information is provided for educational purposes only and does not constitute medical advice. Altace is a prescription medication that should only be used under the supervision of a qualified healthcare professional. Individual response to therapy may vary, and treatment decisions should be based on a thorough evaluation by a physician. Patients should not alter their dosage or discontinue medication without consulting their healthcare provider.

Reviews

Clinical studies demonstrate Altace’s efficacy in reducing cardiovascular events, with the HOPE trial showing a 22% reduction in the combined endpoint of myocardial infarction, stroke, or cardiovascular death. Many patients report effective blood pressure control with once-daily dosing, though some note the persistent dry cough as a limiting factor. Physicians often prescribe Altace for its proven cardiovascular protective benefits, particularly in high-risk patients. Adherence to therapy is generally good due to the convenient dosing schedule, though regular monitoring is emphasized to manage potential side effects and ensure therapeutic effectiveness.