Altace

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 the heart to pump more efficiently. Clinical evidence supports its role in reducing morbidity and mortality in high-risk patient populations, making it a cornerstone therapy in modern cardiology.

Features

• Active ingredient: Ramipril
• 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 reducing blood pressure and cardiovascular events
• Long-acting formulation maintains 24-hour therapeutic coverage
• Suitable for monotherapy or combination with other antihypertensives

Benefits

• Significantly lowers systolic and diastolic blood pressure, reducing strain on the heart and arteries
• Demonstrates cardioprotective effects by decreasing the risk of heart attack, stroke, and cardiovascular death
• Slows progression of kidney disease in patients with hypertension and diabetes
• Improves survival rates following myocardial infarction when initiated within the first few days
• Reduces symptoms and hospitalizations in patients with congestive heart failure
• Offers convenient once-daily dosing that supports long-term adherence to therapy

Common use

Altace is primarily indicated for the treatment of hypertension, either as monotherapy or in combination with thiazide diuretics. It is also approved for reducing the risk of myocardial infarction, stroke, and death from cardiovascular causes in patients aged 55 years or older who are at high risk due to a history of coronary artery disease, stroke, peripheral vascular disease, or diabetes accompanied by at least one other cardiovascular risk factor. Additionally, it is used in the management of congestive heart failure post-myocardial infarction and for nephropathy protection in diabetic patients with microalbuminuria or proteinuria.

Dosage and direction

The recommended dosage must be individualized based on the patient’s clinical condition and response. For hypertension, the initial dose is typically 2.5 mg once daily, which may be adjusted to a maintenance dose of 2.5–20 mg daily administered in one or two divided doses. For cardiovascular risk reduction, the initial 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 10 mg once daily. For heart failure post-myocardial infarction, therapy should be initiated with 2.5 mg twice daily, with careful upward titration. Tablets should be swallowed whole with a glass of water, with or without food, at approximately the same time each day.

Precautions

Patients should be monitored for hypotension, especially during initial dosing and following dosage increases. Renal function and serum potassium should be assessed prior to initiation and periodically during therapy. Angioedema may occur at any time during treatment, requiring immediate discontinuation. A persistent dry cough may develop and could necessitate discontinuation. Use with caution in patients with renal impairment, hepatic dysfunction, or collagen vascular diseases. Neutropenia/agranulocytosis has been reported with ACE inhibitors, particularly in patients with renal impairment or autoimmune diseases.

Contraindications

Altace is contraindicated in patients with a history of angioedema related to previous ACE inhibitor treatment. It should not be used in patients with hereditary or idiopathic angioedema. Concomitant use with aliskiren-containing products is contraindicated in patients with diabetes. The medication is contraindicated during pregnancy due to the risk of fetal injury and death. It should not be administered to patients who are hypersensitive to ramipril or any component of the formulation.

Possible side effect

Common adverse reactions include dizziness (4-12%), fatigue (3-5%), headache (2-5%), and persistent dry cough (2-10%). Less frequently reported effects include orthostatic hypotension, gastrointestinal disturbances, rash, and taste disturbance. Serious but rare side effects may include angioedema, hyperkalemia, neutropenia/agranulocytosis, hepatic failure, and renal impairment. Most side effects are mild to moderate and often diminish with continued therapy.

Drug interaction

Concomitant use with diuretics may increase the risk of hypotension. Potassium supplements or potassium-sparing diuretics may increase the risk of hyperkalemia. NSAIDs may reduce the antihypertensive effect and increase the risk of renal impairment. Dual blockade of the renin-angiotensin system with ARBs or aliskiren increases risks of hypotension, hyperkalemia, and renal impairment. Lithium levels may increase with concomitant use. Antidiabetic medications may require dosage adjustment due to increased hypoglycemic effects.

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 not take a double dose to make up for a missed one. Consistent daily administration is important for maintaining stable blood pressure control.

Overdose

Symptoms of overdose may include severe hypotension, bradycardia, circulatory shock, electrolyte disturbances, and renal failure. Management involves supportive care including volume expansion with normal saline to maintain blood pressure. Hemodialysis may be effective in removing ramipril and its metabolites. Bradycardia may require atropine administration. Close monitoring of vital signs and electrolyte balance is essential.

Storage

Store at room temperature (20-25°C or 68-77°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. Do not transfer capsules to other containers, as this may affect stability.

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. Patients should not initiate, discontinue, or change dosage without consulting their physician. Individual results may vary based on specific health conditions and other factors.

Reviews

Clinical studies demonstrate that Altace effectively reduces blood pressure in approximately 70-80% of patients with mild to moderate hypertension. In the HOPE study, ramipril significantly reduced the rates of death, myocardial infarction, and stroke in high-risk patients by 22%. Patient satisfaction surveys indicate good tolerability with once-daily dosing, though some report the dry cough as a reason for discontinuation. Most physicians consider it a valuable option for cardiovascular protection, particularly in diabetic patients with evidence of renal involvement.