Altace (ramipril) is an angiotensin-converting enzyme (ACE) inhibitor prescription medication specifically formulated for the management of hypertension. It works by relaxing blood vessels, allowing blood to flow more smoothly and the heart to pump more efficiently. This action helps to lower high blood pressure, reduce the strain on the cardiovascular system, and is also indicated in certain patients to improve survival after a heart attack and for specific high-risk patients to help prevent heart attacks, strokes, and related cardiovascular events. Clinical evidence supports its role as a cornerstone therapy in comprehensive cardiovascular risk management strategies under physician supervision.

Features

• Active pharmaceutical ingredient: Ramipril
• Drug class: Angiotensin-converting enzyme (ACE) inhibitor
• Available in multiple oral capsule strengths (e.g., 1.25 mg, 2.5 mg, 5 mg, 10 mg)
• Proven efficacy in clinical trials involving thousands of patients
• Once or twice-daily dosing regimen for patient convenience
• Requires a prescription from a licensed healthcare provider

Benefits

• Sustained Blood Pressure Reduction: Effectively lowers elevated systolic and diastolic blood pressure, helping to maintain it within a healthy target range over the long term.
• Cardiovascular Risk Reduction: Clinically proven to significantly reduce the risk of myocardial infarction (heart attack), stroke, and death from cardiovascular causes in high-risk patients.
• Post-Heart Attack Management: Improves survival rates following a heart attack when started within a specific timeframe and continued as part of a long-term treatment plan.
• Potential Organ Protection: May offer protective effects for the kidneys, particularly in hypertensive patients with diabetes, by reducing proteinuria (protein in the urine).
• Vasodilation: Works directly on the renin-angiotensin-aldosterone system (RAAS) to cause vasodilation, easing the workload on the heart.

Common use

Altace is primarily prescribed for the treatment of hypertension (high blood pressure) in adults. It is used either as a monotherapy or in combination with other antihypertensive agents, such as thiazide diuretics. Furthermore, it is indicated to reduce the risk of heart attack, stroke, or death from cardiovascular causes in patients aged 55 years and older who are at high risk for these events due to a history of coronary artery disease, stroke, or peripheral arterial disease. It is also used in stable patients who have developed clinical signs of heart failure within the first few days after sustaining an acute myocardial infarction.

Dosage and direction

The dosage of Altace is highly individualized and must be determined by a physician based on the patient’s clinical condition, renal function, and blood pressure response.

• Hypertension: The initial dose is typically 2.5 mg administered once daily. The maintenance dose can be adjusted, usually to 2.5–20 mg per day, administered as a single dose or in two equally divided doses.
• Reduction in Risk of MI, Stroke, or Death from CV Events: The recommended initial dose is 2.5 mg once daily for one week, followed by 5 mg once daily for the next three weeks. The dose may then be increased to a maintenance dose of 10 mg once daily (or divided twice daily if hypotension occurs).
• Post-Myocardial Infarction (Heart Failure): Therapy should be initiated between day 3 and day 10 post-infarction. The initial dose is 2.5 mg twice daily. If this is not tolerated (e.g., due to hypotension), a dose of 1.25 mg twice daily may be used. The dose should be titrated upward to a target dose of 5 mg twice daily, as tolerated by the patient.
• Altace capsules should be swallowed whole with a glass of water. They can be taken with or without food, but consistency is recommended.

Precautions

Before and during treatment with Altace, patients and physicians should be aware of several important precautions:

• Hypotension: Symptomatic hypotension, including lightheadedness and syncope (fainting), can occur, especially in volume-depleted patients (e.g., those on diuretic therapy), those with severe salt restriction, or during the initial dosing period. Careful dose titration and medical supervision are necessary.
• Impaired Renal Function: Renal function should be assessed before and during therapy. ACE inhibitors may cause increases in serum creatinine and BUN, particularly in patients with pre-existing renal disease, renal artery stenosis, or those receiving concomitant diuretics. Dose adjustment or discontinuation may be required.
• Hyperkalemia: Elevations in serum potassium may occur. Risk is increased in patients with renal insufficiency, diabetes, or those using potassium-sparing diuretics, potassium supplements, or salt substitutes containing potassium. Potassium levels should be monitored regularly.
• Cough: A persistent, dry, non-productive cough has been reported with ACE inhibitor use. This cough usually resolves after discontinuation of therapy.
• Surgery/Anesthesia: Altace may potentiate the hypotensive effects of anesthesia and analgesic agents. The surgeon or anesthesiologist should be informed that the patient is taking an ACE inhibitor.
• Hepatic Impairment: Ramipril is extensively metabolized by the liver. Patients with impaired liver function may require dose adjustments and close monitoring.

Contraindications

Altace is contraindicated in patients with:

• A known hypersensitivity to ramipril, any other ACE inhibitor, or any component of the formulation.
• A history of angioedema related to previous ACE inhibitor therapy.
• Concomitant use with aliskiren in patients with diabetes.
• Concomitant use with a neprilysin inhibitor (e.g., sacubitril) due to the increased risk of angioedema.

Possible side effect

Like all medications, Altace can cause side effects, although not everybody gets them. Common side effects may include:

• Dizziness, lightheadedness (especially at the start of treatment or after a dose increase)
• Dry, persistent cough
• Headache
• Fatigue, tiredness
• Nausea
• Gastrointestinal disturbances

Serious side effects require immediate medical attention:

• Signs of angioedema: swelling of the face, lips, tongue, throat, larynx, hands, or feet; difficulty breathing or swallowing
• Symptoms of hypotension: severe dizziness, fainting
• Symptoms of hyperkalemia: muscle weakness, slow or irregular heartbeat
• Signs of infection (e.g., fever, sore throat) which could indicate neutropenia/agranulocytosis (rare)
• Jaundice (yellowing of the skin or eyes), indicating liver problems
• Decreased urine output, swelling in feet/ankles, indicating worsening kidney function

Drug interaction

Altace has the potential to interact with several other medications, which can alter its effects or increase the risk of serious side effects. Key interactions include:

• Diuretics: Concomitant use, especially with potassium-sparing diuretics (e.g., spironolactone, triamterene, amiloride) or potassium supplements, increases the risk of hyperkalemia. Thiazide diuretics can potentiate the hypotensive effect.
• Lithium: Increased serum lithium levels and lithium toxicity have been reported. Lithium levels must be monitored closely.
• Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): e.g., ibuprofen, naproxen, may reduce the antihypertensive effect of Altace and increase the risk of renal impairment.
• Aliskiren: Concomitant use is contraindicated in patients with diabetes due to increased risk of renal impairment, hyperkalemia, and hypotension.
• Neprilysin Inhibitors (e.g., sacubitril): Concomitant use is contraindicated due to increased risk of angioedema.
• Gold Injections: Nitritoid reactions (symptoms including facial flushing, nausea, vomiting, and hypotension) have been reported with injectable gold (sodium aurothiomalate).
• Oral Hypoglycemics and Insulin: Ramipril may increase the blood-glucose-lowering effect, potentially increasing the risk of hypoglycemia.
• Other Antihypertensive Agents: Additive hypotensive effects.

Patients must provide their doctor with a complete list of all prescription, over-the-counter, herbal, and recreational products they are using.

Missed dose

If a dose of Altace is missed, it should be taken as soon as it is remembered on the same day. However, if it is almost time for the next scheduled dose, the missed dose should be skipped. Patients should never take a double dose to make up for a forgotten one. Maintaining a consistent daily routine is crucial for optimal blood pressure control.

Overdose

The most likely manifestation of an Altace overdose is severe hypotension, which can lead to circulatory shock. Other signs may include bradycardia (slow heart rate), electrolyte disturbances, and renal failure. In case of suspected overdose, seek emergency medical attention immediately. Treatment is primarily supportive and symptomatic, involving volume expansion with intravenous normal saline and measures to manage hypotension. Ramipril is not significantly removed by hemodialysis.

Storage

• Store Altace capsules at room temperature, between 20°C to 25°C (68°F to 77°F).
• Keep the medication in its original container, tightly closed, and protected from light, excess moisture, and heat (do not store in the bathroom).
• Keep all medications out of the sight and reach of children and pets.
• Do not use after the expiration date printed on the packaging.

Disclaimer

This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or before starting any new treatment. Never disregard professional medical advice or delay in seeking it because of something you have read here. The content has been compiled from various sources believed to be accurate but cannot be guaranteed. The manufacturer’s official prescribing information is the ultimate authority.

Reviews

• Clinical Efficacy (Cardiologist, 25 years experience): “In the HOPE study and my own practice, ramipril has consistently demonstrated its value beyond mere blood pressure lowering. It is a foundational therapy for modifying cardiovascular risk in appropriate high-risk patients. Its benefits in reducing mortality and morbidity post-MI and in heart failure are well-substantiated by robust clinical evidence.”
• Tolerability (Internal Medicine Specialist): “While the ACE inhibitor cough can be a limiting factor for some patients, many tolerate ramipril very well. The once-daily dosing for hypertension improves adherence. The initial titration period requires careful monitoring for hypotension, especially in patients on diuretics, but it is generally a manageable and effective agent.”
• Patient Experience (Long-term user, 8 years): “After my heart attack, my cardiologist put me on Altace. It took a little while to get the dose right as I felt dizzy at first, but that passed. Knowing it’s helping protect my heart and has a proven track record gives me significant peace of mind. I haven’t experienced any side effects for years.”