Identification

Name
Ramipril
Accession Number
DB00178  (APRD00009)
Type
Small Molecule
Groups
Approved
Description

Ramipril is a prodrug belonging to the angiotensin-converting enzyme (ACE) inhibitor class of medications. It is metabolized to ramiprilat in the liver and, to a lesser extent, kidneys. Ramiprilat is a potent, competitive inhibitor of ACE, the enzyme responsible for the conversion of angiotensin I (ATI) to angiotensin II (ATII). ATII regulates blood pressure and is a key component of the renin-angiotensin-aldosterone system (RAAS). Ramipril may be used in the treatment of hypertension, congestive heart failure, nephropathy, and to reduce the rate of death, myocardial infarction and stroke in individuals at high risk of cardiovascular events.

Structure
Thumb
Synonyms
  • (2S-(1(R*(r*)),2alpha,3abeta,6abeta))-1-(2-((1-(ethoxycarbonyl)-3-phenylpropyl)amino)-1-oxopropyl)octahydrocyclopenta(b)pyrrole-2-carboxylic acid
  • Altace (tn)
  • Ramipril
  • Ramiprilum
  • Tritace
External IDs
C09AA05 / HOE 498
Product Images
Prescription Products
NameDosageStrengthRouteLabellerMarketing StartMarketing End
Act RamiprilCapsule10 mgOralActavis Pharma Company2007-10-02Not applicableCanada
Act RamiprilCapsule1.25 mgOralActavis Pharma Company2007-10-02Not applicableCanada
Act RamiprilCapsule5 mgOralActavis Pharma Company2007-10-02Not applicableCanada
Act RamiprilCapsule2.5 mgOralActavis Pharma Company2007-10-02Not applicableCanada
AltaceCapsule10 mg/1OralLake Erie Medical &Surgical Supply Dba Quality Care Products Llc2010-05-242017-01-25Us
AltaceTablet1.25 mgOralValeant Canada Lp Valeant Canada S.E.C.Not applicableNot applicableCanada
AltaceTablet2.5 mgOralValeant Canada Lp Valeant Canada S.E.C.Not applicableNot applicableCanada
AltaceCapsule1.25 mgOralValeant Canada Lp Valeant Canada S.E.C.1997-05-28Not applicableCanada
AltaceCapsule2.5 mg/1OralPfizer Laboratories Div Pfizer Inc.1991-01-28Not applicableUs
AltaceTablet10 mgOralValeant Canada Lp Valeant Canada S.E.C.Not applicableNot applicableCanada
Generic Prescription Products
NameDosageStrengthRouteLabellerMarketing StartMarketing End
Ach-ramiprilCapsule15 mgOralAccord Healthcare LimitedNot applicableNot applicableCanada
Ach-ramiprilCapsule2.5 mgOralAccord Healthcare LimitedNot applicableNot applicableCanada
Ach-ramiprilCapsule10 mgOralAccord Healthcare LimitedNot applicableNot applicableCanada
Ach-ramiprilCapsule1.25 mgOralAccord Healthcare LimitedNot applicableNot applicableCanada
Ach-ramiprilCapsule5 mgOralAccord Healthcare LimitedNot applicableNot applicableCanada
Apo-ramiprilCapsule5 mgOralApotex Corporation2006-12-12Not applicableCanada
Apo-ramiprilCapsule15 mgOralApotex Corporation2009-05-01Not applicableCanada
Apo-ramiprilCapsule2.5 mgOralApotex Corporation2006-12-12Not applicableCanada
Apo-ramiprilCapsule10 mgOralApotex Corporation2006-12-12Not applicableCanada
Apo-ramiprilCapsule1.25 mgOralApotex Corporation2006-12-12Not applicableCanada
Mixture Products
NameIngredientsDosageRouteLabellerMarketing StartMarketing End
Altace HctRamipril (2.5 mg) + Hydrochlorothiazide (12.5 mg)TabletOralValeant Canada Lp Valeant Canada S.E.C.2006-11-16Not applicableCanada
Altace HctRamipril (10.0 mg) + Hydrochlorothiazide (12.5 mg)TabletOralValeant Canada Lp Valeant Canada S.E.C.2006-11-16Not applicableCanada
Altace HctRamipril (10.0 mg) + Hydrochlorothiazide (25.0 mg)TabletOralValeant Canada Lp Valeant Canada S.E.C.2006-11-16Not applicableCanada
Altace HctRamipril (5 mg) + Hydrochlorothiazide (12.5 mg)TabletOralValeant Canada Lp Valeant Canada S.E.C.2006-11-16Not applicableCanada
Altace HctRamipril (5.0 mg) + Hydrochlorothiazide (25.0 mg)TabletOralValeant Canada Lp Valeant Canada S.E.C.2006-11-16Not applicableCanada
Altace Plus Felodipine 2.5mg + 2.5mgRamipril (2.5 mg) + Felodipine (2.5 mg)TabletOralSanofi Aventis2006-06-272012-10-10Canada
Altace Plus Felodipine 5mg + 5mgRamipril (5 mg) + Felodipine (5 mg)TabletOralSanofi Aventis2006-06-272012-10-15Canada
Apo-ramipril/hctzRamipril (10 mg) + Hydrochlorothiazide (25 mg)TabletOralApotex CorporationNot applicableNot applicableCanada
Apo-ramipril/hctzRamipril (2.5 mg) + Hydrochlorothiazide (12.5 mg)TabletOralApotex CorporationNot applicableNot applicableCanada
Apo-ramipril/hctzRamipril (5 mg) + Hydrochlorothiazide (25 mg)TabletOralApotex CorporationNot applicableNot applicableCanada
International/Other Brands
Acovil (Sanofi-Aventis (Spain)) / Carasel (Almirall (Spain)) / Cardace (Sanofi-Aventis (Finland), Aventis (India), Aventis (Indonesia)) / Delix (Aventis (Germany, Turkey), ) / Hypren (AstraZeneca (Austria)) / Lostapres (Temis (Argentina)) / Pramace (Astra (Ireland), AstraZeneca (Sweden)) / Quark (Polifarma (Italy)) / Triatec (Sanofi-Aventis (Brazil, Chili, Denmark, France, Greece, Indonesia, Italy,Norway, Portugal, Sweden, Switzerland)) / Tritace (Sanofi-Aventis (Argentina, Australia, Austria, Belgium, Czech Republic, Hong Kong, Hungary, Ireland, Israel, Malaysia, Mexico, Netherlands, Poland, Singapor, Thailand, United Kingdom), Aventis (New Zealand, Philippines, South Africa)) / Vesdil (AstraZeneca (Germany), Promed (Germany))
Categories
UNII
L35JN3I7SJ
CAS number
87333-19-5
Weight
Average: 416.5106
Monoisotopic: 416.231122144
Chemical Formula
C23H32N2O5
InChI Key
HDACQVRGBOVJII-JBDAPHQKSA-N
InChI
InChI=1S/C23H32N2O5/c1-3-30-23(29)18(13-12-16-8-5-4-6-9-16)24-15(2)21(26)25-19-11-7-10-17(19)14-20(25)22(27)28/h4-6,8-9,15,17-20,24H,3,7,10-14H2,1-2H3,(H,27,28)/t15-,17-,18-,19-,20-/m0/s1
IUPAC Name
(2S,3aS,6aS)-1-[(2S)-2-{[(2S)-1-ethoxy-1-oxo-4-phenylbutan-2-yl]amino}propanoyl]-octahydrocyclopenta[b]pyrrole-2-carboxylic acid
SMILES
[H][[email protected]@]12CCC[[email protected]]1([H])N([[email protected]@H](C2)C(O)=O)C(=O)[[email protected]](C)N[[email protected]@H](CCC1=CC=CC=C1)C(=O)OCC

Pharmacology

Indication

For the management of mild to severe hypertension. May be used to reduce cardiovascular mortality following myocardial infarction in hemodynamically stable individuals who develop clinical signs of congestive heart failure within a few days following myocardial infarction. To reduce the rate of death, myocardial infarction and stroke in individuals at high risk of cardiovascular events. May be used to slow the progression of renal disease in individuals with hypertension, diabetes mellitus and microalubinuria or overt nephropathy.

Structured Indications
Pharmacodynamics

Ramipril is an ACE inhibitor similar to benazepril, fosinopril and quinapril. It is an inactive prodrug that is converted to ramiprilat in the liver, the main site of activation, and kidneys. Ramiprilat confers blood pressure lowing effects by antagonizing the effect of the RAAS. The RAAS is a homeostatic mechanism for regulating hemodynamics, water and electrolyte balance. During sympathetic stimulation or when renal blood pressure or blood flow is reduced, renin is released from the granular cells of the juxtaglomerular apparatus in the kidneys. In the blood stream, renin cleaves circulating angiotensinogen to ATI, which is subsequently cleaved to ATII by ACE. ATII increases blood pressure using a number of mechanisms. First, it stimulates the secretion of aldosterone from the adrenal cortex. Aldosterone travels to the distal convoluted tubule (DCT) and collecting tubule of nephrons where it increases sodium and water reabsorption by increasing the number of sodium channels and sodium-potassium ATPases on cell membranes. Second, ATII stimulates the secretion of vasopressin (also known as antidiuretic hormone or ADH) from the posterior pituitary gland. ADH stimulates further water reabsorption from the kidneys via insertion of aquaporin-2 channels on the apical surface of cells of the DCT and collecting tubules. Third, ATII increases blood pressure through direct arterial vasoconstriction. Stimulation of the Type 1 ATII receptor on vascular smooth muscle cells leads to a cascade of events resulting in myocyte contraction and vasoconstriction. In addition to these major effects, ATII induces the thirst response via stimulation of hypothalamic neurons. ACE inhibitors inhibit the rapid conversion of ATI to ATII and antagonize RAAS-induced increases in blood pressure. ACE (also known as kininase II) is also involved in the enzymatic deactivation of bradykinin, a vasodilator. Inhibiting the deactivation of bradykinin increases bradykinin levels and may sustain the effects of ramiprilat by causing increased vasodilation and decreased blood pressure.

Mechanism of action

There are two isoforms of ACE: the somatic isoform, which exists as a glycoprotein comprised of a single polypeptide chain of 1277; and the testicular isoform, which has a lower molecular mass and is thought to play a role in sperm maturation and binding of sperm to the oviduct epithelium. Somatic ACE has two functionally active domains, N and C, which arise from tandem gene duplication. Although the two domains have high sequence similarity, they play distinct physiological roles. The C-domain is predominantly involved in blood pressure regulation while the N-domain plays a role in hematopoietic stem cell differentiation and proliferation. ACE inhibitors bind to and inhibit the activity of both domains, but have much greater affinity for and inhibitory activity against the C-domain. Ramiprilat, the principle active metabolite of ramipril, competes with ATI for binding to ACE and inhibits and enzymatic proteolysis of ATI to ATII. Decreasing ATII levels in the body decreases blood pressure by inhibiting the pressor effects of ATII as described in the Pharmacology section above. Ramipril also causes an increase in plasma renin activity likely due to a loss of feedback inhibition mediated by ATII on the release of renin and/or stimulation of reflex mechanisms via baroreceptors.

TargetActionsOrganism
AAngiotensin-converting enzyme
inhibitor
Human
UB1 bradykinin receptorNot AvailableHuman
Absorption

The extent of absorption is at least 50-60%. Food decreases the rate of absorption from the GI tract without affecting the extent of absorption. The absolute bioavailabilities of ramipril and ramiprilat were 28% and 44%, respectively, when oral administration was compared to intravenous administration.

Volume of distribution
Not Available
Protein binding

Protein binding of ramipril is about 73% and that of ramiprilat about 56%.

Metabolism

Hepatic metabolism accounts for 75% of total ramipril metabolism. 25% of hepatic metabolism produces the active metabolite ramiprilat via liver esterase enzymes. 100% of renal metabolism converts ramipril to ramiprilat. Other metabolites, diketopiperazine ester, the diketopiperazine acid, and the glucuronides of ramipril and ramiprilat, are inactive.

Route of elimination
Not Available
Half life

Plasma concentrations of ramiprilat decline in a triphasic manner. Initial rapid decline represents distribution into tissues and has a half life of 2-4 hours. The half life of the apparent elimination phase is 9-18 hours and that of the terminal elimination phase is > 50 hours. Two elimination phases occur as a result of ramiprilat's potent binding to ACE and slow dissociation from the enzyme. The half life of ramiprilat after multiple daily doses (MDDs) is dose-dependent, ranging from 13-17 hours with 5-10 mg MDDs to 27-36 hours for 2.5 mg MDDs.

Clearance
Not Available
Toxicity

Symptoms of overdose may include excessive peripheral vasodilation (with marked hypotension and shock), bradycardia, electrolyte disturbances, and renal failure. The most likely adverse reactions are symptoms attributable to its blood-pressure lowing effect. May cause headache, dizziness, asthenia, chest pain, nausea, peripheral edema, somnolence, impotence, rash, arthritis, and dyspnea. LD50 = 10933 mg/kg (orally in mice).

Affected organisms
  • Humans and other mammals
Pathways
PathwayCategory
Ramipril Action PathwayDrug action
Ramipril Metabolism PathwayDrug metabolism
Pharmacogenomic Effects/ADRs
Interacting Gene/EnzymeAllele nameGenotype(s)Defining Change(s)Type(s)DescriptionDetails
Angiotensin-converting enzyme---(A;A) / (G;G)A Allele, homozygote / G Allele, homozygoteEffect Directly StudiedPatients with this genotype have a shorter time to lowering of blood pressure with ramiprilDetails

Interactions

Drug Interactions
DrugInteractionDrug group
(4R)-limoneneThe risk or severity of adverse effects can be increased when (4R)-limonene is combined with Ramipril.Investigational
7,8-Dichloro-1,2,3,4-tetrahydroisoquinoline7,8-Dichloro-1,2,3,4-tetrahydroisoquinoline may increase the hypotensive activities of Ramipril.Experimental
AbacavirThe serum concentration of Abacavir can be decreased when it is combined with Ramipril.Approved, Investigational
AcebutololRamipril may increase the hypotensive activities of Acebutolol.Approved, Investigational
AceclofenacThe risk or severity of adverse effects can be increased when Aceclofenac is combined with Ramipril.Approved, Investigational
AcemetacinThe therapeutic efficacy of Ramipril can be decreased when used in combination with Acemetacin.Approved, Experimental, Investigational
Acetylsalicylic acidThe therapeutic efficacy of Ramipril can be decreased when used in combination with Acetylsalicylic acid.Approved, Vet Approved
AdapaleneThe risk or severity of adverse effects can be increased when Adapalene is combined with Ramipril.Approved
AlclofenacThe risk or severity of adverse effects can be increased when Alclofenac is combined with Ramipril.Approved, Withdrawn
AldesleukinThe risk or severity of adverse effects can be increased when Aldesleukin is combined with Ramipril.Approved
AlfuzosinThe serum concentration of Alfuzosin can be increased when it is combined with Ramipril.Approved, Investigational
AliskirenAliskiren may increase the hypotensive, nephrotoxic, and hyperkalemic activities of Ramipril.Approved, Investigational
AllopurinolThe risk of a hypersensitivity reaction to Allopurinol is increased when it is combined with Ramipril.Approved
AlminoprofenThe risk or severity of adverse effects can be increased when Alminoprofen is combined with Ramipril.Experimental
AlogliptinThe risk or severity of adverse effects can be increased when Alogliptin is combined with Ramipril.Approved
AloxiprinThe therapeutic efficacy of Ramipril can be decreased when used in combination with Aloxiprin.Experimental
AlprazolamThe serum concentration of Alprazolam can be increased when it is combined with Ramipril.Approved, Illicit, Investigational
AlprenololRamipril may increase the hypotensive activities of Alprenolol.Approved, Withdrawn
AmbrisentanRamipril may increase the hypotensive activities of Ambrisentan.Approved, Investigational
Ambroxol acefyllinateThe serum concentration of Ambroxol acefyllinate can be decreased when it is combined with Ramipril.Experimental, Investigational
AmifostineRamipril may increase the hypotensive activities of Amifostine.Approved, Investigational
AmilorideAmiloride may increase the hyperkalemic activities of Ramipril.Approved
AmineptineThe serum concentration of Amineptine can be increased when it is combined with Ramipril.Illicit, Withdrawn
AminophyllineThe serum concentration of Aminophylline can be decreased when it is combined with Ramipril.Approved
Aminosalicylic AcidThe therapeutic efficacy of Ramipril can be decreased when used in combination with Aminosalicylic Acid.Approved
AmiodaroneThe risk or severity of adverse effects can be increased when Amiodarone is combined with Ramipril.Approved, Investigational
AmitriptylineThe serum concentration of Amitriptyline can be increased when it is combined with Ramipril.Approved
AmlodipineRamipril may increase the hypotensive activities of Amlodipine.Approved
AmobarbitalAmobarbital may increase the hypotensive activities of Ramipril.Approved, Illicit
AmoxapineThe serum concentration of Amoxapine can be increased when it is combined with Ramipril.Approved
AmphetamineAmphetamine may increase the hypotensive activities of Ramipril.Approved, Illicit, Investigational
Amphotericin BThe risk or severity of adverse effects can be increased when Amphotericin B is combined with Ramipril.Approved, Investigational
Amyl NitriteThe risk or severity of adverse effects can be increased when Ramipril is combined with Amyl Nitrite.Approved
AndrographolideThe risk or severity of adverse effects can be increased when Andrographolide is combined with Ramipril.Investigational
AnisodamineThe risk or severity of adverse effects can be increased when Anisodamine is combined with Ramipril.Investigational
AntipyrineThe risk or severity of adverse effects can be increased when Antipyrine is combined with Ramipril.Approved, Investigational
ApocyninThe risk or severity of adverse effects can be increased when Apocynin is combined with Ramipril.Investigational
ApomorphineThe risk or severity of adverse effects can be increased when Apomorphine is combined with Ramipril.Approved, Investigational
ApraclonidineThe risk or severity of adverse effects can be increased when Ramipril is combined with Apraclonidine.Approved
ApremilastThe risk or severity of adverse effects can be increased when Apremilast is combined with Ramipril.Approved, Investigational
AprotininAprotinin may decrease the antihypertensive activities of Ramipril.Approved, Investigational, Withdrawn
AripiprazoleAripiprazole may increase the hypotensive activities of Ramipril.Approved, Investigational
ArotinololThe risk or severity of adverse effects can be increased when Arotinolol is combined with Ramipril.Investigational
Arsenic trioxideThe risk or severity of adverse effects can be increased when Arsenic trioxide is combined with Ramipril.Approved, Investigational
AtenololRamipril may increase the hypotensive activities of Atenolol.Approved
AtorvastatinThe risk or severity of adverse effects can be increased when Atorvastatin is combined with Ramipril.Approved
AvanafilAvanafil may increase the antihypertensive activities of Ramipril.Approved
AzapropazoneThe risk or severity of adverse effects can be increased when Azapropazone is combined with Ramipril.Withdrawn
AzathioprineThe risk or severity of anemia and severe leukopenia can be increased when Ramipril is combined with Azathioprine.Approved
AzelastineThe risk or severity of adverse effects can be increased when Azelastine is combined with Ramipril.Approved
Azilsartan medoxomilThe risk or severity of adverse effects can be increased when Azilsartan medoxomil is combined with Ramipril.Approved, Investigational
AzosemideAzosemide may increase the hypotensive activities of Ramipril.Investigational
BalsalazideThe risk or severity of adverse effects can be increased when Balsalazide is combined with Ramipril.Approved, Investigational
BarbexacloneBarbexaclone may increase the hypotensive activities of Ramipril.Experimental
BarbitalBarbital may increase the hypotensive activities of Ramipril.Illicit
BarnidipineRamipril may increase the antihypertensive activities of Barnidipine.Approved
BenazeprilRamipril may increase the hypotensive activities of Benazepril.Approved, Investigational
BendazacThe risk or severity of adverse effects can be increased when Bendazac is combined with Ramipril.Experimental
BendroflumethiazideThe risk or severity of hypotension can be increased when Bendroflumethiazide is combined with Ramipril.Approved
BenmoxinBenmoxin may increase the hypotensive activities of Ramipril.Withdrawn
BenorilateThe risk or severity of adverse effects can be increased when Benorilate is combined with Ramipril.Experimental
BenoxaprofenThe risk or severity of adverse effects can be increased when Benoxaprofen is combined with Ramipril.Withdrawn
BenzydamineThe risk or severity of adverse effects can be increased when Benzydamine is combined with Ramipril.Approved
BepridilRamipril may increase the hypotensive activities of Bepridil.Approved, Withdrawn
BetaxololRamipril may increase the hypotensive activities of Betaxolol.Approved, Investigational
BethanidineBethanidine may increase the hypotensive activities of Ramipril.Approved
BevoniumThe risk or severity of adverse effects can be increased when Bevonium is combined with Ramipril.Experimental
BietaserpineBietaserpine may increase the hypotensive activities of Ramipril.Experimental
BimatoprostRamipril may increase the hypotensive activities of Bimatoprost.Approved, Investigational
BisoprololRamipril may increase the hypotensive activities of Bisoprolol.Approved
BoceprevirThe serum concentration of Ramipril can be decreased when it is combined with Boceprevir.Approved, Withdrawn
BortezomibThe risk or severity of adverse effects can be increased when Bortezomib is combined with Ramipril.Approved, Investigational
BosentanBosentan may increase the hypotensive activities of Ramipril.Approved, Investigational
BQ-123Ramipril may increase the hypotensive activities of BQ-123.Investigational
BretyliumRamipril may increase the hypotensive activities of Bretylium.Approved
BrimonidineBrimonidine may increase the antihypertensive activities of Ramipril.Approved
BrofaromineBrofaromine may increase the hypotensive activities of Ramipril.Experimental
BromfenacThe risk or severity of adverse effects can be increased when Bromfenac is combined with Ramipril.Approved
BromocriptineThe serum concentration of Bromocriptine can be increased when it is combined with Ramipril.Approved, Investigational
BucillamineThe risk or severity of adverse effects can be increased when Bucillamine is combined with Ramipril.Investigational
BufexamacThe risk or severity of adverse effects can be increased when Bufexamac is combined with Ramipril.Approved, Experimental
BumadizoneThe risk or severity of adverse effects can be increased when Bumadizone is combined with Ramipril.Experimental
BumetanideBumetanide may increase the hypotensive activities of Ramipril.Approved
BupivacaineThe risk or severity of adverse effects can be increased when Bupivacaine is combined with Ramipril.Approved, Investigational
BupranololRamipril may increase the hypotensive activities of Bupranolol.Approved
CabergolineThe serum concentration of Cabergoline can be increased when it is combined with Ramipril.Approved
CadralazineCadralazine may increase the hypotensive activities of Ramipril.Experimental
CafedrineRamipril may increase the hypotensive activities of Cafedrine.Investigational
CanagliflozinThe risk or severity of renal failure and hyperkalemia can be increased when Canagliflozin is combined with Ramipril.Approved
CandesartanThe risk or severity of adverse effects can be increased when Candesartan is combined with Ramipril.Experimental
Candesartan cilexetilThe risk or severity of adverse effects can be increased when Candesartan cilexetil is combined with Ramipril.Approved
CandoxatrilRamipril may increase the hypotensive activities of Candoxatril.Experimental
CaptoprilRamipril may increase the hypotensive activities of Captopril.Approved
CarbamazepineThe metabolism of Ramipril can be increased when combined with Carbamazepine.Approved, Investigational
Carbaspirin calciumThe therapeutic efficacy of Ramipril can be decreased when used in combination with Carbaspirin calcium.Experimental, Investigational
CarbetocinThe risk or severity of adverse effects can be increased when Carbetocin is combined with Ramipril.Approved, Investigational
CaroxazoneCaroxazone may increase the hypotensive activities of Ramipril.Withdrawn
CarprofenThe risk or severity of adverse effects can be increased when Carprofen is combined with Ramipril.Approved, Vet Approved, Withdrawn
CarteololRamipril may increase the hypotensive activities of Carteolol.Approved
CarvedilolRamipril may increase the hypotensive activities of Carvedilol.Approved, Investigational
CastanospermineThe risk or severity of adverse effects can be increased when Castanospermine is combined with Ramipril.Experimental
CelecoxibThe risk or severity of adverse effects can be increased when Celecoxib is combined with Ramipril.Approved, Investigational
CeliprololRamipril may increase the hypotensive activities of Celiprolol.Approved, Investigational
ChloroquineThe risk or severity of adverse effects can be increased when Chloroquine is combined with Ramipril.Approved, Investigational, Vet Approved
ChlorothiazideThe risk or severity of hypotension can be increased when Chlorothiazide is combined with Ramipril.Approved, Vet Approved
ChlorotrianiseneThe serum concentration of Chlorotrianisene can be decreased when it is combined with Ramipril.Investigational, Withdrawn
ChlorpromazineThe risk or severity of adverse effects can be increased when Chlorpromazine is combined with Ramipril.Approved, Investigational, Vet Approved
ChlorthalidoneThe risk or severity of hypotension can be increased when Chlorthalidone is combined with Ramipril.Approved
Choline magnesium trisalicylateThe risk or severity of adverse effects can be increased when Choline magnesium trisalicylate is combined with Ramipril.Approved
CicletanineRamipril may increase the hypotensive activities of Cicletanine.Investigational
CilazaprilRamipril may increase the hypotensive activities of Cilazapril.Approved
CilnidipineThe risk or severity of adverse effects can be increased when Cilnidipine is combined with Ramipril.Approved, Investigational
CiprofloxacinThe risk or severity of ventricular arrhythmias can be increased when Ramipril is combined with Ciprofloxacin.Approved, Investigational
ClarithromycinThe therapeutic efficacy of Clarithromycin can be decreased when used in combination with Ramipril.Approved
ClevidipineThe risk or severity of adverse effects can be increased when Ramipril is combined with Clevidipine.Approved, Investigational
ClofarabineThe risk or severity of adverse effects can be increased when Clofarabine is combined with Ramipril.Approved, Investigational
ClomipramineThe serum concentration of Clomipramine can be increased when it is combined with Ramipril.Approved, Investigational, Vet Approved
ClonidineClonidine may increase the hypotensive activities of Ramipril.Approved
ClonixinThe risk or severity of adverse effects can be increased when Clonixin is combined with Ramipril.Approved
CloranololRamipril may increase the hypotensive activities of Cloranolol.Experimental
ClozapineThe risk or severity of adverse effects can be increased when Clozapine is combined with Ramipril.Approved
ConivaptanThe risk or severity of adverse effects can be increased when Conivaptan is combined with Ramipril.Approved, Investigational
Conjugated estrogensThe serum concentration of Conjugated estrogens can be decreased when it is combined with Ramipril.Approved
CryptenamineRamipril may increase the hypotensive activities of Cryptenamine.Approved
CurcuminThe risk or severity of adverse effects can be increased when Curcumin is combined with Ramipril.Approved, Investigational
CyclobenzaprineThe serum concentration of Cyclobenzaprine can be increased when it is combined with Ramipril.Approved
CyclopenthiazideThe risk or severity of hypotension can be increased when Cyclopenthiazide is combined with Ramipril.Experimental
CyclophosphamideThe risk or severity of adverse effects can be increased when Ramipril is combined with Cyclophosphamide.Approved, Investigational
CyclosporineThe serum concentration of Cyclosporine can be increased when it is combined with Ramipril.Approved, Investigational, Vet Approved
CyclothiazideRamipril may increase the hypotensive activities of Cyclothiazide.Approved
DapagliflozinThe risk or severity of adverse effects can be increased when Ramipril is combined with Dapagliflozin.Approved
DapoxetineDapoxetine may increase the orthostatic hypotensive activities of Ramipril.Investigational
DebrisoquinDebrisoquin may increase the hypotensive activities of Ramipril.Approved, Investigational
DelaprilRamipril may increase the hypotensive activities of Delapril.Experimental
DelavirdineThe serum concentration of Delavirdine can be decreased when it is combined with Ramipril.Approved
DersalazineThe therapeutic efficacy of Ramipril can be decreased when used in combination with Dersalazine.Investigational
DeserpidineRamipril may increase the hypotensive activities of Deserpidine.Approved
DesfluraneThe risk or severity of adverse effects can be increased when Desflurane is combined with Ramipril.Approved
DesipramineThe serum concentration of Desipramine can be increased when it is combined with Ramipril.Approved, Investigational
DexmedetomidineThe risk or severity of adverse effects can be increased when Ramipril is combined with Dexmedetomidine.Approved, Vet Approved
DiazoxideDiazoxide may increase the hypotensive activities of Ramipril.Approved
DibenzepinThe serum concentration of Dibenzepin can be increased when it is combined with Ramipril.Experimental
DiclofenacThe risk or severity of adverse effects can be increased when Diclofenac is combined with Ramipril.Approved, Vet Approved
DiclofenamideThe risk or severity of adverse effects can be increased when Ramipril is combined with Diclofenamide.Approved, Investigational
DienestrolThe serum concentration of Dienestrol can be decreased when it is combined with Ramipril.Approved, Investigational
DiethylnorspermineRamipril may increase the hypotensive activities of Diethylnorspermine.Investigational
DiethylstilbestrolThe serum concentration of Diethylstilbestrol can be decreased when it is combined with Ramipril.Approved, Investigational
DifenpiramideThe risk or severity of adverse effects can be increased when Difenpiramide is combined with Ramipril.Experimental
DiflunisalThe therapeutic efficacy of Ramipril can be decreased when used in combination with Diflunisal.Approved, Investigational
DigoxinThe serum concentration of Digoxin can be increased when it is combined with Ramipril.Approved
DihydralazineDihydralazine may increase the hypotensive activities of Ramipril.Approved, Investigational
DihydroergotamineThe serum concentration of Dihydroergotamine can be increased when it is combined with Ramipril.Approved, Investigational
DiltiazemThe metabolism of Diltiazem can be decreased when combined with Ramipril.Approved, Investigational
DinutuximabThe risk or severity of adverse effects can be increased when Ramipril is combined with Dinutuximab.Approved, Investigational
DipyridamoleThe risk or severity of adverse effects can be increased when Ramipril is combined with Dipyridamole.Approved
DorzolamideRamipril may increase the hypotensive activities of Dorzolamide.Approved
DosulepinThe serum concentration of Dosulepin can be increased when it is combined with Ramipril.Approved
DoxazosinDoxazosin may increase the hypotensive activities of Ramipril.Approved
DoxepinThe serum concentration of Doxepin can be increased when it is combined with Ramipril.Approved, Investigational
DrospirenoneRamipril may increase the hyperkalemic activities of Drospirenone.Approved
DroxicamThe risk or severity of adverse effects can be increased when Droxicam is combined with Ramipril.Withdrawn
DuloxetineRamipril may increase the orthostatic hypotensive activities of Duloxetine.Approved
DuvelisibThe risk or severity of adverse effects can be increased when Duvelisib is combined with Ramipril.Investigational
DyphyllineThe serum concentration of Dyphylline can be decreased when it is combined with Ramipril.Approved
E-6201The risk or severity of adverse effects can be increased when E-6201 is combined with Ramipril.Investigational
EfonidipineRamipril may increase the hypotensive activities of Efonidipine.Approved, Investigational
EmpagliflozinThe risk or severity of adverse effects can be increased when Ramipril is combined with Empagliflozin.Approved
EnalaprilRamipril may increase the hypotensive activities of Enalapril.Approved, Vet Approved
EnalaprilatRamipril may increase the hypotensive activities of Enalaprilat.Approved
EndralazineEndralazine may increase the hypotensive activities of Ramipril.Experimental
EnfuvirtideThe serum concentration of Enfuvirtide can be increased when it is combined with Ramipril.Approved, Investigational
EpanololRamipril may increase the hypotensive activities of Epanolol.Experimental
EpirizoleThe risk or severity of adverse effects can be increased when Epirizole is combined with Ramipril.Approved
EpitizideThe risk or severity of hypotension can be increased when Epitizide is combined with Ramipril.Experimental
EplerenoneEplerenone may increase the hyperkalemic activities of Ramipril.Approved
EpoprostenolRamipril may increase the hypotensive activities of Epoprostenol.Approved
EprosartanThe risk or severity of adverse effects can be increased when Eprosartan is combined with Ramipril.Approved
Ergoloid mesylateThe serum concentration of Ergoloid mesylate can be increased when it is combined with Ramipril.Approved
ErgonovineThe serum concentration of Ergonovine can be increased when it is combined with Ramipril.Approved
ErgotamineThe serum concentration of Ergotamine can be increased when it is combined with Ramipril.Approved
EsmirtazapineThe serum concentration of Esmirtazapine can be increased when it is combined with Ramipril.Investigational
EsmololThe risk or severity of adverse effects can be increased when Ramipril is combined with Esmolol.Approved
EstradiolThe serum concentration of Estradiol can be decreased when it is combined with Ramipril.Approved, Investigational, Vet Approved
EstramustineThe serum concentration of Estramustine can be decreased when it is combined with Ramipril.Approved, Investigational
Estrogens, esterifiedThe serum concentration of Estrogens, esterified can be decreased when it is combined with Ramipril.Approved
Estrone sulfateThe serum concentration of Estrone sulfate can be decreased when it is combined with Ramipril.Approved
Etacrynic acidEtacrynic acid may increase the hypotensive activities of Ramipril.Approved, Investigational
EtanerceptThe risk or severity of adverse effects can be increased when Etanercept is combined with Ramipril.Approved, Investigational
EthenzamideThe risk or severity of adverse effects can be increased when Ethenzamide is combined with Ramipril.Experimental
Ethinyl EstradiolThe serum concentration of Ethinyl Estradiol can be decreased when it is combined with Ramipril.Approved
EtodolacThe risk or severity of adverse effects can be increased when Etodolac is combined with Ramipril.Approved, Investigational, Vet Approved
EtofenamateThe risk or severity of adverse effects can be increased when Etofenamate is combined with Ramipril.Approved, Investigational
EtoricoxibThe risk or severity of adverse effects can be increased when Etoricoxib is combined with Ramipril.Approved, Investigational
EtravirineThe serum concentration of Etravirine can be decreased when it is combined with Ramipril.Approved
Evening primrose oilThe risk or severity of adverse effects can be increased when Evening primrose oil is combined with Ramipril.Approved, Investigational
EverolimusThe risk or severity of adverse effects can be increased when Everolimus is combined with Ramipril.Approved
ExisulindThe risk or severity of adverse effects can be increased when Exisulind is combined with Ramipril.Investigational
FelbinacThe risk or severity of adverse effects can be increased when Felbinac is combined with Ramipril.Experimental
FelodipineRamipril may increase the hypotensive activities of Felodipine.Approved, Investigational
FenbufenThe risk or severity of adverse effects can be increased when Fenbufen is combined with Ramipril.Approved
FenoldopamRamipril may increase the hypotensive activities of Fenoldopam.Approved
FenoprofenThe risk or severity of adverse effects can be increased when Fenoprofen is combined with Ramipril.Approved
FentiazacThe risk or severity of adverse effects can be increased when Fentiazac is combined with Ramipril.Experimental
FeprazoneThe risk or severity of adverse effects can be increased when Feprazone is combined with Ramipril.Experimental
Ferulic acidRamipril may increase the hypotensive activities of Ferulic acid.Experimental
FimasartanThe risk or severity of adverse effects can be increased when Fimasartan is combined with Ramipril.Approved, Investigational
FloctafenineThe risk or severity of adverse effects can be increased when Floctafenine is combined with Ramipril.Approved, Withdrawn
FlunixinThe risk or severity of adverse effects can be increased when Flunixin is combined with Ramipril.Vet Approved
FlunoxaprofenThe risk or severity of adverse effects can be increased when Flunoxaprofen is combined with Ramipril.Experimental
FlurbiprofenThe risk or severity of adverse effects can be increased when Flurbiprofen is combined with Ramipril.Approved, Investigational
ForasartanThe risk or severity of adverse effects can be increased when Forasartan is combined with Ramipril.Experimental
FosinoprilRamipril may increase the hypotensive activities of Fosinopril.Approved
FurazolidoneFurazolidone may increase the hypotensive activities of Ramipril.Approved, Investigational, Vet Approved
FurosemideFurosemide may increase the hypotensive activities of Ramipril.Approved, Vet Approved
GarlicThe serum concentration of Ramipril can be decreased when it is combined with Garlic.Approved
GuacetisalThe therapeutic efficacy of Ramipril can be decreased when used in combination with Guacetisal.Experimental
GuanabenzRamipril may increase the hypotensive activities of Guanabenz.Approved, Investigational
GuanadrelRamipril may increase the hypotensive activities of Guanadrel.Approved
GuanazodineRamipril may increase the hypotensive activities of Guanazodine.Experimental
GuanethidineRamipril may increase the hypotensive activities of Guanethidine.Approved
GuanfacineGuanfacine may increase the hypotensive activities of Ramipril.Approved, Investigational
GuanoclorRamipril may increase the hypotensive activities of Guanoclor.Experimental
GuanoxabenzRamipril may increase the hypotensive activities of Guanoxabenz.Experimental
GuanoxanRamipril may increase the hypotensive activities of Guanoxan.Experimental
HalothaneThe risk or severity of adverse effects can be increased when Halothane is combined with Ramipril.Approved, Vet Approved
HarmalineHarmaline may increase the hypotensive activities of Ramipril.Experimental
Hemoglobin crosfumarilThe therapeutic efficacy of Ramipril can be decreased when used in combination with Hemoglobin crosfumaril.Experimental
HeparinThe risk or severity of hyperkalemia can be increased when Ramipril is combined with Heparin.Approved, Investigational
HexamethoniumRamipril may increase the hypotensive activities of Hexamethonium.Experimental
HexestrolThe serum concentration of Hexestrol can be decreased when it is combined with Ramipril.Withdrawn
HexobarbitalHexobarbital may increase the hypotensive activities of Ramipril.Approved
HigenamineThe risk or severity of adverse effects can be increased when Higenamine is combined with Ramipril.Investigational
HydracarbazineHydracarbazine may increase the hypotensive activities of Ramipril.Experimental
HydralazineHydralazine may increase the hypotensive activities of Ramipril.Approved
HydrochlorothiazideThe risk or severity of hypotension can be increased when Hydrochlorothiazide is combined with Ramipril.Approved, Vet Approved
HydroflumethiazideThe risk or severity of hypotension can be increased when Hydroflumethiazide is combined with Ramipril.Approved, Investigational
IbuprofenThe risk or severity of adverse effects can be increased when Ibuprofen is combined with Ramipril.Approved
IbuproxamThe risk or severity of adverse effects can be increased when Ibuproxam is combined with Ramipril.Withdrawn
IcatibantIcatibant may decrease the antihypertensive activities of Ramipril.Approved, Investigational
IloprostThe risk or severity of adverse effects can be increased when Iloprost is combined with Ramipril.Approved, Investigational
ImidaprilRamipril may increase the hypotensive activities of Imidapril.Investigational
Imidazole salicylateThe risk or severity of adverse effects can be increased when Imidazole salicylate is combined with Ramipril.Experimental
ImipramineThe serum concentration of Imipramine can be increased when it is combined with Ramipril.Approved
IndapamideThe risk or severity of hypotension can be increased when Indapamide is combined with Ramipril.Approved
IndenololRamipril may increase the hypotensive activities of Indenolol.Withdrawn
IndobufenThe risk or severity of adverse effects can be increased when Indobufen is combined with Ramipril.Investigational
IndomethacinThe risk or severity of adverse effects can be increased when Indomethacin is combined with Ramipril.Approved, Investigational
IndoprofenThe risk or severity of adverse effects can be increased when Indoprofen is combined with Ramipril.Withdrawn
IndoraminIndoramin may increase the hypotensive activities of Ramipril.Withdrawn
IprindoleThe serum concentration of Iprindole can be increased when it is combined with Ramipril.Experimental
IproclozideIproclozide may increase the hypotensive activities of Ramipril.Withdrawn
IproniazidIproniazid may increase the hypotensive activities of Ramipril.Withdrawn
IrbesartanThe risk or severity of adverse effects can be increased when Irbesartan is combined with Ramipril.Approved, Investigational
IronIron can cause a decrease in the absorption of Ramipril resulting in a reduced serum concentration and potentially a decrease in efficacy.Approved
Iron DextranThe risk or severity of adverse effects can be increased when Ramipril is combined with Iron Dextran.Approved, Vet Approved
IsocarboxazidIsocarboxazid may increase the hypotensive activities of Ramipril.Approved
IsofluraneThe risk or severity of adverse effects can be increased when Isoflurane is combined with Ramipril.Approved, Vet Approved
Isosorbide DinitrateThe risk or severity of adverse effects can be increased when Ramipril is combined with Isosorbide Dinitrate.Approved, Investigational
Isosorbide MononitrateThe risk or severity of adverse effects can be increased when Ramipril is combined with Isosorbide Mononitrate.Approved
IsoxicamThe risk or severity of adverse effects can be increased when Isoxicam is combined with Ramipril.Withdrawn
IsoxsuprineThe risk or severity of adverse effects can be increased when Ramipril is combined with Isoxsuprine.Approved, Withdrawn
IsradipineRamipril may increase the hypotensive activities of Isradipine.Approved, Investigational
KebuzoneThe risk or severity of adverse effects can be increased when Kebuzone is combined with Ramipril.Experimental
KetanserinKetanserin may increase the hypotensive activities of Ramipril.Investigational
KetoprofenThe risk or severity of adverse effects can be increased when Ketoprofen is combined with Ramipril.Approved, Vet Approved
KetorolacThe risk or severity of adverse effects can be increased when Ketorolac is combined with Ramipril.Approved
LabetalolRamipril may increase the hypotensive activities of Labetalol.Approved
LacidipineRamipril may increase the hypotensive activities of Lacidipine.Approved, Investigational
Lanthanum carbonateThe serum concentration of Ramipril can be decreased when it is combined with Lanthanum carbonate.Approved
LatanoprostRamipril may increase the hypotensive activities of Latanoprost.Approved, Investigational
LeflunomideThe risk or severity of adverse effects can be increased when Leflunomide is combined with Ramipril.Approved, Investigational
LercanidipineRamipril may increase the hypotensive activities of Lercanidipine.Approved, Investigational
LevobunololThe risk or severity of adverse effects can be increased when Ramipril is combined with Levobunolol.Approved
LevobupivacaineThe risk or severity of adverse effects can be increased when Levobupivacaine is combined with Ramipril.Approved, Investigational
LevodopaRamipril may increase the orthostatic hypotensive activities of Levodopa.Approved
LevosimendanThe risk or severity of adverse effects can be increased when Levosimendan is combined with Ramipril.Approved, Investigational
LinagliptinThe risk or severity of adverse effects can be increased when Linagliptin is combined with Ramipril.Approved
LinsidomineRamipril may increase the hypotensive activities of Linsidomine.Experimental
LisinoprilRamipril may increase the hypotensive activities of Lisinopril.Approved, Investigational
LisofyllineThe risk or severity of adverse effects can be increased when Lisofylline is combined with Ramipril.Investigational
LithiumThe serum concentration of Lithium can be increased when it is combined with Ramipril.Approved
LofepramineThe serum concentration of Lofepramine can be increased when it is combined with Ramipril.Experimental
LofexidineRamipril may increase the hypotensive activities of Lofexidine.Approved, Investigational
LonazolacThe risk or severity of adverse effects can be increased when Lonazolac is combined with Ramipril.Experimental
LornoxicamThe risk or severity of adverse effects can be increased when Lornoxicam is combined with Ramipril.Approved, Investigational
LosartanThe risk or severity of adverse effects can be increased when Losartan is combined with Ramipril.Approved
LovastatinThe serum concentration of Lovastatin can be increased when it is combined with Ramipril.Approved, Investigational
LoxoprofenThe risk or severity of adverse effects can be increased when Loxoprofen is combined with Ramipril.Approved, Investigational
LumiracoxibThe risk or severity of adverse effects can be increased when Lumiracoxib is combined with Ramipril.Approved, Investigational
MacitentanRamipril may increase the hypotensive activities of Macitentan.Approved
Magnesium salicylateThe risk or severity of adverse effects can be increased when Magnesium salicylate is combined with Ramipril.Approved
ManidipineRamipril may increase the hypotensive activities of Manidipine.Approved, Investigational
MannitolThe risk or severity of adverse effects can be increased when Ramipril is combined with Mannitol.Approved, Investigational
MasoprocolThe risk or severity of adverse effects can be increased when Masoprocol is combined with Ramipril.Approved, Investigational
MebanazineMebanazine may increase the hypotensive activities of Ramipril.Withdrawn
MecamylamineMecamylamine may increase the hypotensive activities of Ramipril.Approved, Investigational
Meclofenamic acidThe risk or severity of adverse effects can be increased when Meclofenamic acid is combined with Ramipril.Approved, Vet Approved
Mefenamic acidThe risk or severity of adverse effects can be increased when Mefenamic acid is combined with Ramipril.Approved
MeloxicamThe risk or severity of adverse effects can be increased when Meloxicam is combined with Ramipril.Approved, Vet Approved
MesalazineThe therapeutic efficacy of Ramipril can be decreased when used in combination with Mesalazine.Approved
MestranolThe serum concentration of Mestranol can be decreased when it is combined with Ramipril.Approved
MetamizoleThe risk or severity of adverse effects can be increased when Metamizole is combined with Ramipril.Approved, Investigational, Withdrawn
MethallenestrilThe serum concentration of Methallenestril can be decreased when it is combined with Ramipril.Experimental
MethazolamideThe risk or severity of adverse effects can be increased when Ramipril is combined with Methazolamide.Approved
MethohexitalMethohexital may increase the hypotensive activities of Ramipril.Approved
MethoserpidineRamipril may increase the hypotensive activities of Methoserpidine.Experimental
MethyclothiazideThe risk or severity of hypotension can be increased when Methyclothiazide is combined with Ramipril.Approved
Methyl salicylateThe therapeutic efficacy of Ramipril can be decreased when used in combination with Methyl salicylate.Approved, Vet Approved
MethyldopaRamipril may increase the hypotensive activities of Methyldopa.Approved
Methylene blueMethylene blue may increase the hypotensive activities of Ramipril.Approved, Investigational
MethylergometrineThe serum concentration of Methylergometrine can be increased when it is combined with Ramipril.Approved
MethylphenidateMethylphenidate may decrease the antihypertensive activities of Ramipril.Approved, Investigational
MethylphenobarbitalMethylphenobarbital may increase the hypotensive activities of Ramipril.Approved
MetipranololRamipril may increase the hypotensive activities of Metipranolol.Approved
MetolazoneThe risk or severity of hypotension can be increased when Metolazone is combined with Ramipril.Approved
MetoprololRamipril may increase the hypotensive activities of Metoprolol.Approved, Investigational
MetyrosineRamipril may increase the hypotensive activities of Metyrosine.Approved
MibefradilRamipril may increase the hypotensive activities of Mibefradil.Investigational, Withdrawn
MidazolamThe serum concentration of Midazolam can be increased when it is combined with Ramipril.Approved, Illicit
MinaprineMinaprine may increase the hypotensive activities of Ramipril.Approved
MinoxidilMinoxidil may increase the hypotensive activities of Ramipril.Approved, Investigational
MirodenafilMirodenafil may increase the antihypertensive activities of Ramipril.Investigational
MirtazapineThe serum concentration of Mirtazapine can be increased when it is combined with Ramipril.Approved
MizoribineThe risk or severity of adverse effects can be increased when Mizoribine is combined with Ramipril.Investigational
MoclobemideMoclobemide may increase the hypotensive activities of Ramipril.Approved, Investigational
MoexiprilRamipril may increase the hypotensive activities of Moexipril.Approved
MofebutazoneThe risk or severity of adverse effects can be increased when Mofebutazone is combined with Ramipril.Experimental
MolsidomineMolsidomine may increase the hypotensive activities of Ramipril.Approved, Investigational
MorphineThe risk or severity of adverse effects can be increased when Morphine is combined with Ramipril.Approved, Investigational
MoxonidineMoxonidine may increase the hypotensive activities of Ramipril.Approved, Investigational
MuzolimineRamipril may increase the hypotensive activities of Muzolimine.Experimental
Mycophenolate mofetilThe risk or severity of adverse effects can be increased when Mycophenolate mofetil is combined with Ramipril.Approved, Investigational
Mycophenolic acidThe risk or severity of adverse effects can be increased when Mycophenolic acid is combined with Ramipril.Approved
NabiloneThe risk or severity of adverse effects can be increased when Nabilone is combined with Ramipril.Approved, Investigational
NabumetoneThe risk or severity of adverse effects can be increased when Nabumetone is combined with Ramipril.Approved
NadololRamipril may increase the hypotensive activities of Nadolol.Approved
NafamostatThe risk or severity of adverse effects can be increased when Nafamostat is combined with Ramipril.Approved, Investigational
NaftifineThe risk or severity of adverse effects can be increased when Naftifine is combined with Ramipril.Approved
NaftopidilRamipril may increase the hypotensive activities of Naftopidil.Investigational
NaproxenThe risk or severity of adverse effects can be increased when Naproxen is combined with Ramipril.Approved, Vet Approved
NebivololRamipril may increase the hypotensive activities of Nebivolol.Approved, Investigational
NefazodoneThe serum concentration of Nefazodone can be increased when it is combined with Ramipril.Approved, Withdrawn
NepafenacThe risk or severity of adverse effects can be increased when Nepafenac is combined with Ramipril.Approved, Investigational
NesiritideThe risk or severity of adverse effects can be increased when Ramipril is combined with Nesiritide.Approved, Investigational
NialamideNialamide may increase the hypotensive activities of Ramipril.Withdrawn
NicardipineRamipril may increase the hypotensive activities of Nicardipine.Approved, Investigational
NicorandilNicorandil may increase the vasodilatory activities of Ramipril.Approved, Investigational
NifedipineThe risk or severity of adverse effects can be increased when Ramipril is combined with Nifedipine.Approved
NifenazoneThe risk or severity of adverse effects can be increased when Nifenazone is combined with Ramipril.Experimental
Niflumic AcidThe risk or severity of adverse effects can be increased when Niflumic Acid is combined with Ramipril.Approved
NiguldipineRamipril may increase the hypotensive activities of Niguldipine.Experimental
NilvadipineRamipril may increase the hypotensive activities of Nilvadipine.Approved, Investigational
NimesulideThe risk or severity of adverse effects can be increased when Nimesulide is combined with Ramipril.Approved, Investigational, Withdrawn
NimodipineRamipril may increase the hypotensive activities of Nimodipine.Approved, Investigational
NisoldipineRamipril may increase the hypotensive activities of Nisoldipine.Approved
NitrendipineRamipril may increase the hypotensive activities of Nitrendipine.Approved, Investigational
Nitric OxideThe risk or severity of adverse effects can be increased when Nitric Oxide is combined with Ramipril.Approved
NitroaspirinThe therapeutic efficacy of Ramipril can be decreased when used in combination with Nitroaspirin.Investigational
NitroglycerinThe risk or severity of adverse effects can be increased when Ramipril is combined with Nitroglycerin.Approved, Investigational
NitroprussideNitroprusside may increase the hypotensive activities of Ramipril.Approved, Investigational
Nitrous acidThe risk or severity of adverse effects can be increased when Nitrous acid is combined with Ramipril.Approved, Investigational
NortriptylineThe serum concentration of Nortriptyline can be increased when it is combined with Ramipril.Approved
ObinutuzumabRamipril may increase the hypotensive activities of Obinutuzumab.Approved, Investigational
OctamoxinOctamoxin may increase the hypotensive activities of Ramipril.Withdrawn
OlmesartanThe risk or severity of adverse effects can be increased when Olmesartan is combined with Ramipril.Approved, Investigational
OlopatadineThe risk or severity of adverse effects can be increased when Olopatadine is combined with Ramipril.Approved
OlsalazineThe risk or severity of adverse effects can be increased when Olsalazine is combined with Ramipril.Approved
OmapatrilatRamipril may increase the hypotensive activities of Omapatrilat.Investigational
OpipramolThe serum concentration of Opipramol can be increased when it is combined with Ramipril.Investigational
OrgoteinThe risk or severity of adverse effects can be increased when Orgotein is combined with Ramipril.Vet Approved
OxaprozinThe risk or severity of adverse effects can be increased when Oxaprozin is combined with Ramipril.Approved
OxprenololRamipril may increase the hypotensive activities of Oxprenolol.Approved
OxyphenbutazoneThe risk or severity of adverse effects can be increased when Oxyphenbutazone is combined with Ramipril.Approved, Withdrawn
PaclitaxelThe risk or severity of adverse effects can be increased when Paclitaxel is combined with Ramipril.Approved, Vet Approved
PapaverineThe risk or severity of adverse effects can be increased when Ramipril is combined with Papaverine.Approved, Investigational
ParecoxibThe risk or severity of adverse effects can be increased when Parecoxib is combined with Ramipril.Approved
PargylinePargyline may increase the hypotensive activities of Ramipril.Approved
ParthenolideThe risk or severity of adverse effects can be increased when Parthenolide is combined with Ramipril.Approved, Investigational
Patent BlueThe therapeutic efficacy of Ramipril can be decreased when used in combination with Patent Blue.Approved
PenbutololRamipril may increase the hypotensive activities of Penbutolol.Approved, Investigational
PentobarbitalPentobarbital may increase the hypotensive activities of Ramipril.Approved, Investigational, Vet Approved
PentoliniumRamipril may increase the hypotensive activities of Pentolinium.Approved
PentoxifyllinePentoxifylline may increase the hypotensive activities of Ramipril.Approved, Investigational
PerindoprilRamipril may increase the hypotensive activities of Perindopril.Approved
PethidineThe risk or severity of adverse effects can be increased when Ramipril is combined with Pethidine.Approved
PhenelzinePhenelzine may increase the hypotensive activities of Ramipril.Approved
PheniprazinePheniprazine may increase the hypotensive activities of Ramipril.Withdrawn
PhenobarbitalPhenobarbital may increase the hypotensive activities of Ramipril.Approved, Investigational
PhenoxybenzamineRamipril may increase the hypotensive activities of Phenoxybenzamine.Approved
PhenoxypropazinePhenoxypropazine may increase the hypotensive activities of Ramipril.Withdrawn
PhentolamineRamipril may increase the hypotensive activities of Phentolamine.Approved
Phenyl aminosalicylateThe therapeutic efficacy of Ramipril can be decreased when used in combination with Phenyl aminosalicylate.Approved
PhenylbutazoneThe risk or severity of adverse effects can be increased when Phenylbutazone is combined with Ramipril.Approved, Vet Approved
PimecrolimusThe risk or severity of adverse effects can be increased when Pimecrolimus is combined with Ramipril.Approved, Investigational
PinacidilPinacidil may increase the hypotensive activities of Ramipril.Approved
PindololRamipril may increase the hypotensive activities of Pindolol.Approved, Investigational
PipamperoneThe risk or severity of adverse effects can be increased when Pipamperone is combined with Ramipril.Approved, Investigational
PiretanidePiretanide may increase the hypotensive activities of Ramipril.Approved
PirfenidoneThe risk or severity of adverse effects can be increased when Pirfenidone is combined with Ramipril.Approved, Investigational
PirlindolePirlindole may increase the hypotensive activities of Ramipril.Approved
PiroxicamThe risk or severity of adverse effects can be increased when Piroxicam is combined with Ramipril.Approved, Investigational
PirprofenThe risk or severity of adverse effects can be increased when Pirprofen is combined with Ramipril.Experimental
PivhydrazinePivhydrazine may increase the hypotensive activities of Ramipril.Withdrawn
Platelet Activating FactorRamipril may increase the hypotensive activities of Platelet Activating Factor.Experimental
PolythiazideThe risk or severity of hypotension can be increased when Polythiazide is combined with Ramipril.Approved
PotassiumPotassium may increase the hyperkalemic activities of Ramipril.Approved, Investigational
Potassium bicarbonatePotassium bicarbonate may increase the hyperkalemic activities of Ramipril.Approved
Potassium ChloridePotassium Chloride may increase the hyperkalemic activities of Ramipril.Approved, Withdrawn
Potassium CitratePotassium Citrate may increase the hyperkalemic activities of Ramipril.Approved, Investigational, Vet Approved
PramipexoleThe risk or severity of adverse effects can be increased when Pramipexole is combined with Ramipril.Approved, Investigational
PranoprofenThe risk or severity of adverse effects can be increased when Pranoprofen is combined with Ramipril.Experimental, Investigational
PrazosinPrazosin may increase the hypotensive activities of Ramipril.Approved
PregabalinThe risk or severity of angioedema can be increased when Ramipril is combined with Pregabalin.Approved, Illicit, Investigational
PrimidonePrimidone may increase the hypotensive activities of Ramipril.Approved, Vet Approved
ProcarbazineProcarbazine may increase the hypotensive activities of Ramipril.Approved, Investigational
ProglumetacinThe risk or severity of adverse effects can be increased when Proglumetacin is combined with Ramipril.Experimental
PropacetamolThe risk or severity of adverse effects can be increased when Propacetamol is combined with Ramipril.Approved, Investigational
PropofolThe risk or severity of adverse effects can be increased when Propofol is combined with Ramipril.Approved, Investigational, Vet Approved
PropranololRamipril may increase the hypotensive activities of Propranolol.Approved, Investigational
PropyphenazoneThe risk or severity of adverse effects can be increased when Propyphenazone is combined with Ramipril.Experimental
ProquazoneThe risk or severity of adverse effects can be increased when Proquazone is combined with Ramipril.Experimental
ProtriptylineThe serum concentration of Protriptyline can be increased when it is combined with Ramipril.Approved
PTC299The risk or severity of adverse effects can be increased when PTC299 is combined with Ramipril.Investigational
QuetiapineThe risk or severity of adverse effects can be increased when Ramipril is combined with Quetiapine.Approved
QuinaprilRamipril may increase the hypotensive activities of Quinapril.Approved, Investigational
QuinethazoneThe risk or severity of hypotension can be increased when Quinethazone is combined with Ramipril.Approved
QuinineQuinine may increase the hypotensive activities of Ramipril.Approved
RasagilineRasagiline may increase the hypotensive activities of Ramipril.Approved
RemifentanilThe risk or severity of adverse effects can be increased when Remifentanil is combined with Ramipril.Approved
RemikirenRamipril may increase the hypotensive activities of Remikiren.Approved
RescinnamineRamipril may increase the hypotensive activities of Rescinnamine.Approved
ReserpineReserpine may increase the hypotensive activities of Ramipril.Approved, Investigational
ResveratrolThe risk or severity of adverse effects can be increased when Resveratrol is combined with Ramipril.Approved, Experimental, Investigational
RilmenidineRilmenidine may increase the hypotensive activities of Ramipril.Approved, Investigational
RiociguatThe serum concentration of Riociguat can be increased when it is combined with Ramipril.Approved
RisperidoneRamipril may increase the hypotensive activities of Risperidone.Approved, Investigational
RituximabRamipril may increase the hypotensive activities of Rituximab.Approved
RofecoxibThe risk or severity of adverse effects can be increased when Rofecoxib is combined with Ramipril.Approved, Investigational, Withdrawn
RopiniroleThe risk or severity of adverse effects can be increased when Ropinirole is combined with Ramipril.Approved, Investigational
RopivacaineThe risk or severity of adverse effects can be increased when Ropivacaine is combined with Ramipril.Approved
RotigotineThe risk or severity of adverse effects can be increased when Rotigotine is combined with Ramipril.Approved
SacubitrilThe risk or severity of angioedema can be increased when Ramipril is combined with Sacubitril.Approved
SafrazineSafrazine may increase the hypotensive activities of Ramipril.Withdrawn
SalicylamideThe risk or severity of adverse effects can be increased when Salicylamide is combined with Ramipril.Approved
Salicylic acidThe therapeutic efficacy of Ramipril can be decreased when used in combination with Salicylic acid.Approved, Investigational, Vet Approved
SalsalateThe risk or severity of adverse effects can be increased when Salsalate is combined with Ramipril.Approved
SaprisartanThe risk or severity of adverse effects can be increased when Saprisartan is combined with Ramipril.Experimental
SaralasinThe risk or severity of adverse effects can be increased when Saralasin is combined with Ramipril.Investigational
SaxagliptinThe risk or severity of adverse effects can be increased when Saxagliptin is combined with Ramipril.Approved
SecobarbitalSecobarbital may increase the hypotensive activities of Ramipril.Approved, Vet Approved
SelegilineSelegiline may increase the hypotensive activities of Ramipril.Approved, Investigational, Vet Approved
SelexipagRamipril may increase the hypotensive activities of Selexipag.Approved
SemapimodThe risk or severity of adverse effects can be increased when Semapimod is combined with Ramipril.Investigational
SeratrodastThe risk or severity of adverse effects can be increased when Seratrodast is combined with Ramipril.Approved
SerrapeptaseThe risk or severity of adverse effects can be increased when Serrapeptase is combined with Ramipril.Investigational
SevofluraneThe risk or severity of adverse effects can be increased when Sevoflurane is combined with Ramipril.Approved, Vet Approved
SildenafilThe serum concentration of Sildenafil can be increased when it is combined with Ramipril.Approved, Investigational
SimvastatinThe serum concentration of Simvastatin can be increased when it is combined with Ramipril.Approved
SirolimusThe risk or severity of angioedema can be increased when Sirolimus is combined with Ramipril.Approved, Investigational
SitagliptinThe risk or severity of adverse effects can be increased when Sitagliptin is combined with Ramipril.Approved, Investigational
SitaxentanRamipril may increase the hypotensive activities of Sitaxentan.Approved, Investigational, Withdrawn
Sodium aurothiomalateThe risk or severity of hypotension, nitritoid reactions, facial flushing, nausea, and vomiting can be increased when Ramipril is combined with Sodium aurothiomalate.Approved, Investigational
Sodium phosphateRamipril may increase the nephrotoxic activities of Sodium phosphate.Approved
SotalolThe risk or severity of adverse effects can be increased when Ramipril is combined with Sotalol.Approved
SpiraprilRamipril may increase the hypotensive activities of Spirapril.Approved
SpironolactoneThe risk or severity of adverse effects can be increased when Ramipril is combined with Spironolactone.Approved
SRT501The risk or severity of adverse effects can be increased when SRT501 is combined with Ramipril.Investigational
St. John's WortThe metabolism of Ramipril can be increased when combined with St. John's Wort.Approved, Investigational, Nutraceutical
StreptokinaseThe risk or severity of adverse effects can be increased when Streptokinase is combined with Ramipril.Approved, Investigational
SufentanilThe risk or severity of adverse effects can be increased when Sufentanil is combined with Ramipril.Approved, Investigational
SulfasalazineThe risk or severity of adverse effects can be increased when Sulfasalazine is combined with Ramipril.Approved
SulindacThe risk or severity of adverse effects can be increased when Sulindac is combined with Ramipril.Approved, Investigational
SuprofenThe risk or severity of adverse effects can be increased when Suprofen is combined with Ramipril.Approved, Withdrawn
SuxibuzoneThe risk or severity of adverse effects can be increased when Suxibuzone is combined with Ramipril.Experimental
Synthetic Conjugated Estrogens, AThe serum concentration of Synthetic Conjugated Estrogens, A can be decreased when it is combined with Ramipril.Approved
TacrolimusThe metabolism of Tacrolimus can be decreased when combined with Ramipril.Approved, Investigational
TadalafilTadalafil may increase the antihypertensive activities of Ramipril.Approved, Investigational
TalinololRamipril may increase the hypotensive activities of Talinolol.Investigational
TamsulosinThe risk or severity of adverse effects can be increased when Tamsulosin is combined with Ramipril.Approved, Investigational
TarenflurbilThe risk or severity of adverse effects can be increased when Tarenflurbil is combined with Ramipril.Investigational
TasosartanThe risk or severity of adverse effects can be increased when Tasosartan is combined with Ramipril.Approved
TelmisartanThe risk or severity of adverse effects can be increased when Telmisartan is combined with Ramipril.Approved, Investigational
TemocaprilRamipril may increase the hypotensive activities of Temocapril.Experimental, Investigational
TemsirolimusThe risk or severity of adverse effects can be increased when Ramipril is combined with Temsirolimus.Approved
TenidapThe risk or severity of adverse effects can be increased when Tenidap is combined with Ramipril.Experimental
TenoxicamThe risk or severity of adverse effects can be increased when Tenoxicam is combined with Ramipril.Approved
TepoxalinThe risk or severity of adverse effects can be increased when Tepoxalin is combined with Ramipril.Vet Approved
TerazosinThe risk or severity of adverse effects can be increased when Ramipril is combined with Terazosin.Approved
TeriflunomideThe risk or severity of adverse effects can be increased when Teriflunomide is combined with Ramipril.Approved
TerlipressinRamipril may increase the hypotensive activities of Terlipressin.Approved, Investigational
TetrahydropalmatineRamipril may increase the hypotensive activities of Tetrahydropalmatine.Investigational
ThalidomideThe risk or severity of adverse effects can be increased when Thalidomide is combined with Ramipril.Approved, Investigational, Withdrawn
TheodrenalineRamipril may increase the hypotensive activities of Theodrenaline.Investigational
TheophyllineThe serum concentration of Theophylline can be decreased when it is combined with Ramipril.Approved
ThiamylalThiamylal may increase the hypotensive activities of Ramipril.Approved, Vet Approved
ThiopentalThiopental may increase the hypotensive activities of Ramipril.Approved, Vet Approved
ThioridazineThe risk or severity of adverse effects can be increased when Thioridazine is combined with Ramipril.Approved, Withdrawn
TianeptineThe serum concentration of Tianeptine can be increased when it is combined with Ramipril.Approved, Investigational
Tiaprofenic acidThe risk or severity of adverse effects can be increased when Tiaprofenic acid is combined with Ramipril.Approved
TiboloneRamipril may increase the hypotensive activities of Tibolone.Approved, Investigational
TicrynafenRamipril may increase the hypotensive activities of Ticrynafen.Withdrawn
TimololRamipril may increase the hypotensive activities of Timolol.Approved
TinoridineThe risk or severity of adverse effects can be increased when Tinoridine is combined with Ramipril.Investigational
TipranavirThe serum concentration of Ramipril can be decreased when it is combined with Tipranavir.Approved, Investigational
TizanidineThe risk or severity of hypotension can be increased when Tizanidine is combined with Ramipril.Approved, Investigational
TolazolineRamipril may increase the hypotensive activities of Tolazoline.Approved, Vet Approved
TolcaponeThe risk or severity of adverse effects can be increased when Tolcapone is combined with Ramipril.Approved, Withdrawn
Tolfenamic AcidThe risk or severity of adverse effects can be increased when Tolfenamic Acid is combined with Ramipril.Approved, Investigational
TolmetinThe risk or severity of adverse effects can be increased when Tolmetin is combined with Ramipril.Approved
TolonidineRamipril may increase the hypotensive activities of Tolonidine.Experimental
ToloxatoneToloxatone may increase the hypotensive activities of Ramipril.Approved
TolvaptanTolvaptan may increase the hyperkalemic activities of Ramipril.Approved
TorasemideTorasemide may increase the hypotensive activities of Ramipril.Approved
TrandolaprilRamipril may increase the hypotensive activities of Trandolapril.Approved
TranilastThe risk or severity of adverse effects can be increased when Tranilast is combined with Ramipril.Approved, Investigational
TranylcypromineTranylcypromine may increase the hypotensive activities of Ramipril.Approved, Investigational
TravoprostRamipril may increase the hypotensive activities of Travoprost.Approved
TreprostinilRamipril may increase the hypotensive activities of Treprostinil.Approved, Investigational
TretinoinThe risk or severity of adverse effects can be increased when Tretinoin is combined with Ramipril.Approved, Investigational, Nutraceutical
TriamtereneTriamterene may increase the hyperkalemic activities of Ramipril.Approved
TriazolamThe serum concentration of Triazolam can be increased when it is combined with Ramipril.Approved, Investigational
TribenosideThe risk or severity of adverse effects can be increased when Tribenoside is combined with Ramipril.Experimental
TrichlormethiazideThe risk or severity of hypotension can be increased when Trichlormethiazide is combined with Ramipril.Approved, Vet Approved
TrimazosinTrimazosin may increase the hypotensive activities of Ramipril.Experimental
TrimethaphanTrimethaphan may increase the hypotensive activities of Ramipril.Approved, Investigational
TrimethoprimTrimethoprim may increase the hyperkalemic activities of Ramipril.Approved, Vet Approved
TrimipramineThe serum concentration of Trimipramine can be increased when it is combined with Ramipril.Approved
TriptolideThe risk or severity of adverse effects can be increased when Triptolide is combined with Ramipril.Investigational
Trolamine salicylateThe therapeutic efficacy of Ramipril can be decreased when used in combination with Trolamine salicylate.Approved
UdenafilUdenafil may increase the antihypertensive activities of Ramipril.Approved, Investigational
UnoprostoneRamipril may increase the hypotensive activities of Unoprostone.Approved, Investigational
UrapidilUrapidil may increase the hypotensive activities of Ramipril.Investigational
ValdecoxibThe risk or severity of adverse effects can be increased when Valdecoxib is combined with Ramipril.Approved, Investigational, Withdrawn
Valproic AcidThe serum concentration of Valproic Acid can be decreased when it is combined with Ramipril.Approved, Investigational
ValsartanThe risk or severity of adverse effects can be increased when Valsartan is combined with Ramipril.Approved, Investigational
VardenafilVardenafil may increase the antihypertensive activities of Ramipril.Approved
VerapamilThe metabolism of Verapamil can be decreased when combined with Ramipril.Approved
VildagliptinThe risk or severity of adverse effects can be increased when Vildagliptin is combined with Ramipril.Approved, Investigational
VincamineRamipril may increase the hypotensive activities of Vincamine.Experimental
VinpocetineRamipril may increase the hypotensive activities of Vinpocetine.Investigational
XipamideRamipril may increase the hypotensive activities of Xipamide.Experimental
XylometazolineRamipril may increase the hypotensive activities of Xylometazoline.Approved, Investigational
YohimbineYohimbine may decrease the antihypertensive activities of Ramipril.Approved, Investigational, Vet Approved
ZaltoprofenThe risk or severity of adverse effects can be increased when Zaltoprofen is combined with Ramipril.Approved, Investigational
ZidovudineThe serum concentration of Zidovudine can be decreased when it is combined with Ramipril.Approved
ZileutonThe risk or severity of adverse effects can be increased when Zileuton is combined with Ramipril.Approved, Investigational, Withdrawn
ZofenoprilRamipril may increase the hypotensive activities of Zofenopril.Experimental
ZomepiracThe risk or severity of adverse effects can be increased when Zomepirac is combined with Ramipril.Withdrawn
Food Interactions
  • Alcohol may increase the vasodilatory effects of ramipril.
  • Herbs that may attenuate the antihypertensive effect of ramipril include: bayberry, blue cohash, cayenne, ephedra, ginger, ginseng (American), kola and licorice.
  • High salt intake may attenuate the antihypertensive effect of ramipril.
  • Ramipril decreases the excretion of potassium. Salt substitutes containing potassium increase the risk of hyperkalemia.
  • Take without regard to meals.

References

Synthesis Reference

Edward Wilson, Martin Beasley, "Stabilized ramipril compositions and methods of making." U.S. Patent US20060134213, issued June 22, 2006.

US20060134213
General References
  1. Cacciapuoti F, Capasso A, Mirra G, De Nicola A, Minicucci F, Gentile S: Prevention of left ventricular hypertrophy by ACE-inhibitor, ramipril in comparison with calcium-channel antagonist, felodipine. Int J Cardiol. 1998 Jan 31;63(2):175-8. [PubMed:9510492]
  2. Kleinert S: HOPE for cardiovascular disease prevention with ACE-inhibitor ramipril. Heart Outcomes Prevention Evaluation. Lancet. 1999 Sep 4;354(9181):841. [PubMed:10485736]
External Links
Human Metabolome Database
HMDB0014324
KEGG Drug
D00421
PubChem Compound
5362129
PubChem Substance
46506390
ChemSpider
4514937
BindingDB
50084681
ChEBI
8774
ChEMBL
CHEMBL1168
Therapeutic Targets Database
DAP000581
PharmGKB
PA451223
RxList
RxList Drug Page
Drugs.com
Drugs.com Drug Page
PDRhealth
PDRhealth Drug Page
Wikipedia
Ramipril
ATC Codes
C09AA05 — RamiprilC10BX04 — Simvastatin, acetylsalicylic acid and ramiprilC10BX06 — Atorvastatin, acetylsalicylic acid and ramiprilC09BA05 — Ramipril and diureticsC09BB07 — Ramipril and amlodipineC09BB05 — Ramipril and felodipine
AHFS Codes
  • 24:32.04 — Angiotensin-converting Enzyme Inhibitors
MSDS
Download (53.6 KB)

Clinical Trials

Clinical Trials
PhaseStatusPurposeConditionsCount
1CompletedNot AvailableHealthy Volunteers6
1CompletedTreatmentHealthy Volunteers7
1CompletedTreatmentHigh Blood Pressure (Hypertension)1
1RecruitingBasic ScienceDiabetes Mellitus (DM) / Healthy Volunteers1
1WithdrawnTreatmentHigh Blood Pressure (Hypertension) / Metabolic Syndromes1
2CompletedBasic ScienceHigh Blood Pressure (Hypertension)1
2CompletedTreatmentAtherosclerosis / Coronary Heart Disease (CHD) / Vasculitis1
2CompletedTreatmentChronic Kidney Disease (CKD)1
2CompletedTreatmentComplication of Hemodialysis / End Stage Renal Failure on Dialysis1
2CompletedTreatmentHeart Failure, Unspecified1
2CompletedTreatmentHigh Blood Pressure (Hypertension) / Inflammatory Reaction1
2CompletedTreatmentLupus / Systemic Lupus Erythematosus (SLE)1
2CompletedTreatmentMigraine With Hypertension1
2Not Yet RecruitingSupportive CareChemoradiation / Cognitive Decline / Glioblastomas / Radiotherapy; Complications1
2RecruitingTreatmentDiabetes, Diabetes Mellitus Type 11
2RecruitingTreatmentHigh Blood Pressure (Hypertension)1
2TerminatedNot AvailableHigh Blood Pressure (Hypertension)1
2TerminatedPreventionElevated LDL Cholesterol2
2TerminatedTreatmentHigh Blood Pressure (Hypertension) / Unspecified Adult Solid Tumor, Protocol Specific1
2TerminatedTreatmentNon-diabetic Nephropathy1
2, 3CompletedPreventionNonvalvular Atrial Fibrillation1
2, 3CompletedTreatmentDiabetes Mellitus (DM)1
2, 3CompletedTreatmentRheumatoid Arthritis1
3Active Not RecruitingTreatmentRenal Insufficiency,Chronic1
3CompletedPreventionAtherosclerosis / Cardiovascular Disease (CVD) / Coronary Heart Disease (CHD) / Diabetes Mellitus (DM) / High Blood Cholesterol Level / High Blood Pressure (Hypertension) / Type 2 Diabetes Mellitus1
3CompletedPreventionAtherosclerosis / Cardiovascular Disease (CVD) / Impaired Glucose Tolerance (IGT) / Isolated Impaired Fasting Glucose1
3CompletedPreventionCardiovascular Disease (CVD) / Glucose Metabolism Disorders / Impaired Glucose Tolerance (IGT)1
3CompletedPreventionMyocardial Infarction (MI)1
3CompletedTreatmentAcquired Kidney Disease / Children / Chronic Renal Failure (CRF) / Congenital Kidney Disease / High Blood Pressure (Hypertension)1
3CompletedTreatmentBMI >30 kg/m2 / High Blood Pressure (Hypertension)1
3CompletedTreatmentBiopsy-confirmed IgA Nephropathy / Normal Blood Pressure / Proteinuria Less Than 0.5 g Per Day / Serum Creatinine Below 120 Umol/l1
3CompletedTreatmentDiabetes Mellitus (DM) / Impaired Glucose Tolerance (IGT)1
3CompletedTreatmentDiabetes Mellitus (DM) / Microalbuminuria1
3CompletedTreatmentDiabetic Nephropathies1
3CompletedTreatmentGlomerulonephritis1
3CompletedTreatmentHigh Blood Pressure (Hypertension)5
3CompletedTreatmentMyocardial Ischemia1
3CompletedTreatmentTransplantation, Kidney1
3RecruitingPreventionCancer, Breast / Cardiotoxicity1
3RecruitingTreatmentAcute Myocardial Infarction (AMI)1
3TerminatedHealth Services ResearchEndothelial Dysfunction / Oxidative Stress1
3TerminatedPreventionDiabetes, Diabetes Mellitus Type 11
3TerminatedTreatmentAlbuminuria / High Blood Pressure (Hypertension) / Type 2 Diabetes Mellitus1
3TerminatedTreatmentAtrial Flutter / Nonvalvular Atrial Fibrillation1
3TerminatedTreatmentHigh Blood Pressure (Hypertension)1
3Unknown StatusTreatmentHigh Blood Pressure (Hypertension) / Microalbuminuria / Type 2 Diabetes Mellitus1
4Active Not RecruitingTreatmentAcute Heart Failure (AHF)1
4Active Not RecruitingTreatmentDiabetes Mellitus (DM) / Hypertensive Disease1
4CompletedBasic ScienceHealthy Volunteers1
4CompletedPreventionAdverse Effects / Coronary Artery Atherosclerosis / Insulin resistance syndrome1
4CompletedPreventionAlzheimer's Disease (AD) / High Blood Pressure (Hypertension)1
4CompletedPreventionCardiovascular Disease (CVD)1
4CompletedPreventionDiabetes Mellitus (DM) / Proteinuria / Renin Angiotensin System1
4CompletedPreventionHigh Blood Pressure (Hypertension)1
4CompletedTreatmentAlbuminuria1
4CompletedTreatmentAngiotensin Converting Enzyme / Angiotensin Receptor Blockers / Cardiopulmonary Bypass / Coronary Artery Disease / Fibrinolysis / Inflammatory Reaction1
4CompletedTreatmentAtherosclerosis1
4CompletedTreatmentChronic Kidney Disease (CKD) / Diabetic Nephropathies / Proteinuria2
4CompletedTreatmentHeart Failure, Unspecified / Ventricular Dysfunction, Left1
4CompletedTreatmentHigh Blood Pressure (Hypertension)10
4CompletedTreatmentHigh Blood Pressure (Hypertension) / Hypertension,Essential1
4CompletedTreatmentHigh Blood Pressure (Hypertension) / Type 2 Diabetes Mellitus1
4CompletedTreatmentHigh Blood Pressure (Hypertension) / Induction of intra-operative hypotension1
4CompletedTreatmentHypertension,Essential1
4CompletedTreatmentIntermittent Claudicants1
4CompletedTreatmentMicrovascular Angina1
4CompletedTreatmentPeripheral Arterial Disease (PAD)2
4CompletedTreatmentTransplant, Kidney1
4Not Yet RecruitingTreatmentAngiotensin-Converting Enzyme Inhibitors / Transcatheter Aortic Valve Replacemen1
4RecruitingTreatmentCardiovascular Disease (CVD) / Chronic Kidney Disease (CKD) / Hypertension,Essential / Strokes1
4RecruitingTreatmentHigh Blood Pressure (Hypertension) / High Blood Pressure Variability1
4RecruitingTreatmentHypertension Resistant To Conventional Therapy1
4RecruitingTreatmentPeripheral Arterial Disease (PAD)1
4TerminatedPreventionMetabolic Syndromes1
4TerminatedTreatmentHypertension With Metabolic Syndrome1
4Unknown StatusPreventionBecker's Muscular Dystrophy (BMD) / Duchenne's Muscular Dystrophy (DMD)1
4Unknown StatusPreventionDiabetic Nephropathies1
4Unknown StatusTreatmentAcute Coronary Syndromes (ACS) / Coronary Heart Disease (CHD) / Myocardial Infarction (MI)1
4Unknown StatusTreatmentAntihypertensive Drugs / Diastolic Function / Hypertensive Heart Disease / Left Atrial Volume / Renin Angiotensin System1
4Unknown StatusTreatmentCoronary Artery Dissection, Spontaneous1
4Unknown StatusTreatmentDiabetic Nephropathies / Type 2 Diabetes Mellitus / Vascular Diseases1
4Unknown StatusTreatmentHigh Blood Pressure (Hypertension) / Type 2 Diabetes Mellitus1
4Unknown StatusTreatmentHypertension,Essential1
4WithdrawnTreatmentHigh Blood Pressure (Hypertension)1
Not AvailableCompletedNot AvailableHealthy Volunteers2
Not AvailableCompletedBasic ScienceAgeing / Left Ventricular Function Diastolic Dysfunction / Left Ventricular Function Systolic Dysfunction1
Not AvailableCompletedBasic ScienceMetabolic Syndromes1
Not AvailableCompletedPreventionCardiac Allograft Vasculopathy1
Not AvailableCompletedPreventionCardiovascular Disease (CVD)1
Not AvailableCompletedTreatmentHigh Blood Pressure (Hypertension)2
Not AvailableRecruitingNot AvailableAlport Syndrome / Familial Benign Hematuria / Hereditary Kidney Disease / Pediatric Kidney Disease / Thin Basement Membrane Disease1
Not AvailableRecruitingNot AvailableChronic Kidney Disease (CKD)1
Not AvailableRecruitingNot AvailableObesity, Morbid1
Not AvailableTerminatedPreventionMetabolic Syndromes1
Not AvailableUnknown StatusTreatmentAsthenozoospermia / Male Infertility / Oligozoospermia / Teratospermia1

Pharmacoeconomics

Manufacturers
  • King pharmaceuticals inc
  • Actavis elizabeth llc
  • Apotex inc
  • Cipla ltd
  • Dr reddys laboratories ltd
  • Invagen pharmaceuticals inc
  • Lupin ltd
  • Ranbaxy laboratories ltd
  • Roxane laboratories inc
  • Sandoz inc
  • Teva pharmaceuticals usa
  • Watson laboratories inc
  • Zydus pharmaceuticals usa inc
  • King Pharmaceuticals, Inc.
Packagers
  • Amerisource Health Services Corp.
  • Apotex Inc.
  • Arrow Pharm Malta Ltd.
  • A-S Medication Solutions LLC
  • Blu Pharmaceuticals LLC
  • Bryant Ranch Prepack
  • Camber Pharmaceuticals Inc.
  • Cardinal Health
  • Cipla Ltd.
  • Cobalt Pharmaceuticals Inc.
  • DAVA Pharmaceuticals
  • Dispensing Solutions
  • Doctor Reddys Laboratories Ltd.
  • Heartland Repack Services LLC
  • Hoechst Marion Roussel Canada Inc.
  • InvaGen Pharmaceuticals Inc.
  • Kaiser Foundation Hospital
  • King Pharmaceuticals Inc.
  • Lake Erie Medical and Surgical Supply
  • Lupin Pharmaceuticals Inc.
  • Mckesson Corp.
  • Monarch Pharmacy
  • Murfreesboro Pharmaceutical Nursing Supply
  • Nucare Pharmaceuticals Inc.
  • PD-Rx Pharmaceuticals Inc.
  • Pharmaceutical Utilization Management Program VA Inc.
  • Physicians Total Care Inc.
  • Prepackage Specialists
  • Prepak Systems Inc.
  • Rebel Distributors Corp.
  • Resource Optimization and Innovation LLC
  • Roxane Labs
  • Sandoz
  • Sanofi-Aventis Inc.
  • Southwood Pharmaceuticals
  • Teva Pharmaceutical Industries Ltd.
  • Vangard Labs Inc.
Dosage forms
FormRouteStrength
CapsuleOral15 mg
CapsuleOral15.0 mg
CapsuleOral5.0 mg
CapsuleOral1.25 mg
CapsuleOral10 mg
CapsuleOral2.5 mg
CapsuleOral5 mg
TabletOral
CapsuleOral1.25 mg/1
CapsuleOral10 mg/301
CapsuleOral10 mg/1
CapsuleOral2.5 mg/1
CapsuleOral5 mg/1
Capsule, gelatin coatedOral10 mg/1
TabletOral1.25 mg/1
TabletOral10 mg/1
TabletOral2.5 mg/1
TabletOral5 mg/1
CapsuleOral10.0 mg
TabletOral1.25 mg
TabletOral10 mg
TabletOral2.5 mg
TabletOral5 mg
Prices
Unit descriptionCostUnit
Altace 10 mg capsule2.87USD capsule
Altace 2.5 mg capsule2.54USD capsule
Altace 5 mg capsule2.53USD capsule
Altace 10 mg tablet2.37USD tablet
Altace 1.25 mg capsule2.2USD capsule
Ramipril 10 mg capsule2.19USD capsule
Altace 5 mg tablet2.02USD tablet
Altace 2.5 mg tablet1.93USD tablet
Ramipril 5 mg capsule1.87USD capsule
Ramipril 2.5 mg capsule1.78USD capsule
Altace 1.25 mg tablet1.63USD tablet
Ramipril 1.25 mg capsule1.59USD capsule
Altace 10 mg Tablet1.14USD tablet
Altace 2.5 mg Tablet0.9USD tablet
Altace 5 mg Tablet0.9USD tablet
Altace 1.25 mg Tablet0.78USD tablet
Apo-Ramipril 10 mg Tablet0.64USD tablet
Co Ramipril 10 mg Tablet0.64USD tablet
Jamp-Ramipril 10 mg Tablet0.64USD tablet
Mylan-Ramipril 10 mg Tablet0.64USD tablet
Novo-Ramipril 10 mg Tablet0.64USD tablet
Pms-Ramipril 10 mg Tablet0.64USD tablet
Ramipril 10 mg Tablet0.64USD tablet
Ran-Ramipril 10 mg Tablet0.64USD tablet
Ratio-Ramipril 10 mg Tablet0.64USD tablet
Sandoz Ramipril 10 mg Tablet0.64USD tablet
Apo-Ramipril 2.5 mg Tablet0.5USD tablet
Apo-Ramipril 5 mg Tablet0.5USD tablet
Co Ramipril 2.5 mg Tablet0.5USD tablet
Co Ramipril 5 mg Tablet0.5USD tablet
Jamp-Ramipril 2.5 mg Tablet0.5USD tablet
Jamp-Ramipril 5 mg Tablet0.5USD tablet
Mylan-Ramipril 2.5 mg Tablet0.5USD tablet
Mylan-Ramipril 5 mg Tablet0.5USD tablet
Novo-Ramipril 2.5 mg Tablet0.5USD tablet
Novo-Ramipril 5 mg Tablet0.5USD tablet
Pms-Ramipril 2.5 mg Tablet0.5USD tablet
Pms-Ramipril 5 mg Tablet0.5USD tablet
Ramipril 2.5 mg Tablet0.5USD tablet
Ramipril 5 mg Tablet0.5USD tablet
Ran-Ramipril 2.5 mg Tablet0.5USD tablet
Ran-Ramipril 5 mg Tablet0.5USD tablet
Ratio-Ramipril 2.5 mg Tablet0.5USD tablet
Ratio-Ramipril 5 mg Tablet0.5USD tablet
Sandoz Ramipril 2.5 mg Tablet0.5USD tablet
Sandoz Ramipril 5 mg Tablet0.5USD tablet
Apo-Ramipril 1.25 mg Tablet0.44USD tablet
Co Ramipril 1.25 mg Tablet0.44USD tablet
Jamp-Ramipril 1.25 mg Tablet0.44USD tablet
Mylan-Ramipril 1.25 mg Tablet0.44USD tablet
Pms-Ramipril 1.25 mg Tablet0.44USD tablet
Ramipril 1.25 mg Tablet0.44USD tablet
Ran-Ramipril 1.25 mg Tablet0.44USD tablet
Ratio-Ramipril 1.25 mg Tablet0.44USD tablet
Sandoz Ramipril 1.25 mg Tablet0.44USD tablet
DrugBank does not sell nor buy drugs. Pricing information is supplied for informational purposes only.
Patents
Patent NumberPediatric ExtensionApprovedExpires (estimated)
US5403856No1995-04-042012-04-04Us
CA2382387No2005-06-212020-08-25Canada
CA1338344No1996-05-212013-05-21Canada
US7368469No2000-08-302020-08-30Us

Properties

State
Solid
Experimental Properties
PropertyValueSource
melting point (°C)109 °CPhysProp
water solubility3.5mg/LNot Available
logP2.9Not Available
Predicted Properties
PropertyValueSource
Water Solubility0.039 mg/mLALOGPS
logP0.92ALOGPS
logP1.47ChemAxon
logS-4ALOGPS
pKa (Strongest Acidic)3.75ChemAxon
pKa (Strongest Basic)5.2ChemAxon
Physiological Charge-1ChemAxon
Hydrogen Acceptor Count5ChemAxon
Hydrogen Donor Count2ChemAxon
Polar Surface Area95.94 Å2ChemAxon
Rotatable Bond Count10ChemAxon
Refractivity111.19 m3·mol-1ChemAxon
Polarizability44.78 Å3ChemAxon
Number of Rings3ChemAxon
Bioavailability1ChemAxon
Rule of FiveYesChemAxon
Ghose FilterYesChemAxon
Veber's RuleNoChemAxon
MDDR-like RuleYesChemAxon
Predicted ADMET features
PropertyValueProbability
Human Intestinal Absorption+0.9159
Blood Brain Barrier-0.8726
Caco-2 permeable-0.8491
P-glycoprotein substrateSubstrate0.7263
P-glycoprotein inhibitor INon-inhibitor0.7002
P-glycoprotein inhibitor IIInhibitor0.6295
Renal organic cation transporterNon-inhibitor0.8869
CYP450 2C9 substrateNon-substrate0.8541
CYP450 2D6 substrateNon-substrate0.8969
CYP450 3A4 substrateNon-substrate0.5082
CYP450 1A2 substrateNon-inhibitor0.9045
CYP450 2C9 inhibitorNon-inhibitor0.907
CYP450 2D6 inhibitorNon-inhibitor0.9304
CYP450 2C19 inhibitorNon-inhibitor0.9025
CYP450 3A4 inhibitorNon-inhibitor0.8309
CYP450 inhibitory promiscuityLow CYP Inhibitory Promiscuity0.5691
Ames testNon AMES toxic0.9108
CarcinogenicityNon-carcinogens0.9267
BiodegradationNot ready biodegradable0.8903
Rat acute toxicity1.6732 LD50, mol/kg Not applicable
hERG inhibition (predictor I)Weak inhibitor0.98
hERG inhibition (predictor II)Non-inhibitor0.7901
ADMET data is predicted using admetSAR, a free tool for evaluating chemical ADMET properties. (23092397)

Spectra

Mass Spec (NIST)
Not Available
Spectra
SpectrumSpectrum TypeSplash Key
Predicted GC-MS Spectrum - GC-MSPredicted GC-MSNot Available
Predicted MS/MS Spectrum - 10V, Positive (Annotated)Predicted LC-MS/MSNot Available
Predicted MS/MS Spectrum - 20V, Positive (Annotated)Predicted LC-MS/MSNot Available
Predicted MS/MS Spectrum - 40V, Positive (Annotated)Predicted LC-MS/MSNot Available
Predicted MS/MS Spectrum - 10V, Negative (Annotated)Predicted LC-MS/MSNot Available
Predicted MS/MS Spectrum - 20V, Negative (Annotated)Predicted LC-MS/MSNot Available
Predicted MS/MS Spectrum - 40V, Negative (Annotated)Predicted LC-MS/MSNot Available
LC-MS/MS Spectrum - LC-ESI-qTof , PositiveLC-MS/MSNot Available
LC-MS/MS Spectrum - LC-ESI-qTof , PositiveLC-MS/MSNot Available
MS/MS Spectrum - , positiveLC-MS/MSsplash10-00lr-3930000000-ea57777ac9a14b1e9083

Taxonomy

Description
This compound belongs to the class of organic compounds known as dipeptides. These are organic compounds containing a sequence of exactly two alpha-amino acids joined by a peptide bond.
Kingdom
Organic compounds
Super Class
Organic acids and derivatives
Class
Carboxylic acids and derivatives
Sub Class
Amino acids, peptides, and analogues
Direct Parent
Dipeptides
Alternative Parents
Alpha amino acid esters / N-acyl-L-alpha-amino acids / Alpha amino acid amides / Pyrrolidine carboxylic acids / N-acylpyrrolidines / Fatty acid esters / Aralkylamines / Dicarboxylic acids and derivatives / Benzene and substituted derivatives / Tertiary carboxylic acid amides
show 9 more
Substituents
Alpha-dipeptide / Alpha-amino acid ester / N-acyl-l-alpha-amino acid / N-acyl-alpha-amino acid / N-acyl-alpha amino acid or derivatives / Alpha-amino acid amide / Alpha-amino acid or derivatives / Pyrrolidine carboxylic acid / Pyrrolidine carboxylic acid or derivatives / N-acylpyrrolidine
show 27 more
Molecular Framework
Aromatic heteropolycyclic compounds
External Descriptors
dicarboxylic acid monoester, ethyl ester, azabicycloalkane, dipeptide, cyclopentapyrrole (CHEBI:8774)

Targets

Kind
Protein
Organism
Human
Pharmacological action
Yes
Actions
Inhibitor
General Function
Zinc ion binding
Specific Function
Converts angiotensin I to angiotensin II by release of the terminal His-Leu, this results in an increase of the vasoconstrictor activity of angiotensin. Also able to inactivate bradykinin, a potent...
Gene Name
ACE
Uniprot ID
P12821
Uniprot Name
Angiotensin-converting enzyme
Molecular Weight
149713.675 Da
References
  1. Chen X, Ji ZL, Chen YZ: TTD: Therapeutic Target Database. Nucleic Acids Res. 2002 Jan 1;30(1):412-5. [PubMed:11752352]
  2. Levitt DG, Schoemaker RC: Human physiologically based pharmacokinetic model for ACE inhibitors: ramipril and ramiprilat. BMC Clin Pharmacol. 2006 Jan 6;6:1. [PubMed:16398929]
  3. Piepho RW: Overview of the angiotensin-converting-enzyme inhibitors. Am J Health Syst Pharm. 2000 Oct 1;57 Suppl 1:S3-7. [PubMed:11030016]
  4. Song JC, White CM: Clinical pharmacokinetics and selective pharmacodynamics of new angiotensin converting enzyme inhibitors: an update. Clin Pharmacokinet. 2002;41(3):207-24. [PubMed:11929321]
Kind
Protein
Organism
Human
Pharmacological action
Unknown
General Function
Peptide binding
Specific Function
This is a receptor for bradykinin. Could be a factor in chronic pain and inflammation.
Gene Name
BDKRB1
Uniprot ID
P46663
Uniprot Name
B1 bradykinin receptor
Molecular Weight
40494.29 Da
References
  1. Ignjatovic T, Tan F, Brovkovych V, Skidgel RA, Erdos EG: Novel mode of action of angiotensin I converting enzyme inhibitors: direct activation of bradykinin B1 receptor. J Biol Chem. 2002 May 10;277(19):16847-52. Epub 2002 Mar 5. [PubMed:11880373]

Enzymes

Kind
Protein
Organism
Human
Pharmacological action
Unknown
Actions
Inhibitor
General Function
Identical protein binding
Specific Function
Esterase with broad substrate specificity. Contributes to the inactivation of the neurotransmitter acetylcholine. Can degrade neurotoxic organophosphate esters.
Gene Name
BCHE
Uniprot ID
P06276
Uniprot Name
Cholinesterase
Molecular Weight
68417.575 Da
References
  1. Shah GB, Sharma S, Mehta AA, Goyal RK: Oculohypotensive effect of angiotensin-converting enzyme inhibitors in acute and chronic models of glaucoma. J Cardiovasc Pharmacol. 2000 Aug;36(2):169-75. [PubMed:10942157]

Transporters

Kind
Protein
Organism
Human
Pharmacological action
Unknown
Actions
Substrate
General Function
Proton-dependent oligopeptide secondary active transmembrane transporter activity
Specific Function
Proton-coupled intake of oligopeptides of 2 to 4 amino acids with a preference for dipeptides. May constitute a major route for the absorption of protein digestion end-products.
Gene Name
SLC15A1
Uniprot ID
P46059
Uniprot Name
Solute carrier family 15 member 1
Molecular Weight
78805.265 Da
References
  1. Knutter I, Wollesky C, Kottra G, Hahn MG, Fischer W, Zebisch K, Neubert RH, Daniel H, Brandsch M: Transport of angiotensin-converting enzyme inhibitors by H+/peptide transporters revisited. J Pharmacol Exp Ther. 2008 Nov;327(2):432-41. doi: 10.1124/jpet.108.143339. Epub 2008 Aug 19. [PubMed:18713951]
Kind
Protein
Organism
Human
Pharmacological action
Unknown
Actions
Substrate
General Function
Peptide:proton symporter activity
Specific Function
Proton-coupled intake of oligopeptides of 2 to 4 amino acids with a preference for dipeptides.
Gene Name
SLC15A2
Uniprot ID
Q16348
Uniprot Name
Solute carrier family 15 member 2
Molecular Weight
81782.77 Da
References
  1. Knutter I, Wollesky C, Kottra G, Hahn MG, Fischer W, Zebisch K, Neubert RH, Daniel H, Brandsch M: Transport of angiotensin-converting enzyme inhibitors by H+/peptide transporters revisited. J Pharmacol Exp Ther. 2008 Nov;327(2):432-41. doi: 10.1124/jpet.108.143339. Epub 2008 Aug 19. [PubMed:18713951]

Drug created on June 13, 2005 07:24 / Updated on May 21, 2018 17:37