Adults

Hypertension: Initial 2.5 mg once daily, adjusted to 5-10 mg daily. Max 10 mg/day. Heart failure: Initial 1.25 mg once daily, adjusted up to 10 mg daily. Post-MI: Initial 2.5 mg twice daily. Diabetic Nephropathy: Initial 1.25-2.5 mg once daily, up to 10 mg daily.

Elderly

Lower initial doses (e.g., 1.25 mg once daily) may be considered, with careful titration, especially in those with impaired renal function.

Renal_impairment

Dosage adjustment required. For CrCl <30 mL/min, initial dose 1.25 mg once daily, max 5 mg/day. Contraindicated in severe renal artery stenosis.

Onset

1-2 hours for antihypertensive effect

Excretion

Primarily excreted via the kidneys (approximately 60% of dose) and through bile (approximately 40% of dose).

Half life

Ramiprilat has a prolonged effective half-life of 13-17 hours, allowing for once-daily dosing.

Absorption

Well absorbed after oral administration, with peak plasma concentrations occurring within 1 hour. Bioavailability is approximately 28% for Ramiprilat (active metabolite).

Metabolism

Extensively metabolized in the liver to its active metabolite, ramiprilat, and other inactive metabolites.

NSAIDs

Reduced antihypertensive effect; increased risk of renal impairment.

Lithium

Increased serum lithium concentrations and toxicity. Monitor lithium levels.

Aliskiren

Contraindicated in diabetes or renal impairment (CrCl < 60 mL/min) due to increased risk of hyperkalemia, hypotension, and renal impairment.

Diuretics

Increased hypotensive effect. Monitor blood pressure and renal function.

Potassium-sparing diuretics/Potassium supplements

Increased risk of hyperkalemia. Monitor serum potassium.