1 What is Altace?

Brand: Altace

Generic: Ramipril

Altace is one of the indirectly acting vasodilators which competitively inhibit angiotensin converting enzyme (ACE) resulting in prevention of conversion of Angiotensin-I to Angiotensin-II (a potent vasoconstrictor) resulting in reduced aldosterone secretion. Aldosterone is a hormone that causes water and Sodium (Na) retention.

A decrease in aldosterone secretion promotes vasodilation associated with a hypotensive effect in case of hypertension. Angiotensin converting enzyme (ACE) inhibitors like Ramipril is commonly used to treat a patient with hypertension alone or with other antihypertensive drugs. It is considered as the drug of choice in case of hypertensive left ventricular failure where other antihypertensive drugs (e.g. beta-blockers, calcium channel antagonists) are contraindicated.

It is also preferred to use in patients following myocardial infarction, and in patients with chronic congestive heart failure. This drug has been found most effective in white and young hypertensive patients.

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2 What To Know Before Using

Before using Altace, the risks of taking it must be considered against the benefits you may gain. This is a decision that your doctor will make with your active participation.

You should confirm whether the drug is suitable for your body or not. Ramipril must not be used in a patient with systolic blood pressure lower than 100 mm Hg, bilateral renal artery stenosis and renal failure.

Renal function tests are recommended to be carried out before and during the drug therapy. In case of patients with history of idiopathic or hereditary angioedema, Ramipril should be used with great care.

Regular monitoring of white blood cells with vascular collagen disorders is recommended. As there is positive evidence of human fetal risk based on adverse reaction data from investigational studies in human, Ramipril is contraindicated in second and third trimester of pregnancy.

You should keep in mind that Ramipril may enhance the hypotensive effect with diuretics and other antihypertensive drugs. Certain drug interactions may take place when Ramipril is taken simultaneously.

Aspirin impairs the hypotensive effect of Ramipril by blocking bradykinin-mediated vasodilation. As Ramipril causes hyperkalemia, K-sparing diuretics should not be used concurrently.

3 Proper Usage

Altace or other ACE inhibitors are the first line drugs in all grades of hypertension. About 50% patients of essential hypertension respond well with ACE inhibitors alone and majority of the rest need their combination with diuretics or beta-blockers.

Ramipril is also indicated in congestive heart failure (CHF) and myocardial infarction (MI). ACE inhibitors like Ramipril cause both arteriolar and venous dilatation in CHF patients by reducing afterload as well as preload.

Robust multi-centric trials have shown that ACE inhibitors retard the progression of left ventricular systolic dysfunction and prolong survival of CHF patients of all grades. Mortality is reduced by up to 20% in symptomatic CHF patients.

Several mega-trials have established that administration of oral ACE inhibitors within 24 hours of an acute MI attack and continued for 6 weeks reduce early as well as long-term mortality, irrespective of presence or absence of systolic dysfunction.

Ramipril is also used as prophylaxis in high cardiovascular risk subjects. EUROPA trial has confirmed that it reduces the risk of developing heart. Thus, ACE inhibitors are protective in high cardiovascular risk subjects even when there is no associated hypertension or left ventricular dysfunction.

Prolong ACE inhibitor therapy has been found to prevent or delay end-stage renal disease in type-I as well as type-II diabetes. Moreover, ACE inhibitors produce dramatic improvement and are life-saving in Scleroderma crisis. This life-threatening condition is mediated by Angiotensin-II and where there is marked rise in blood pressure and deterioration of renal function.

4 Precautions To Take

Before using Altace, there are some precautions you must take. 

Some important measures should be taken if you feel any discomfort following any drug therapy. Firstly, you should stop using the drug and then consult with your physician immediately. Regular visits are recommended to make sure this medicine is working properly or not.

5 Potential Side Effects

Altace is well tolerated by most of the patients, especially if daily dose is kept below 150 mg.

But it may bring the following adverse effects sometimes:

  • An initial sharp fall in blood pressure occurs especially in diuretic treated and CHF patients.
  • Persistent hypotension may be troublesome in MI patients.
  • Hyperkalemia is more likely to occur in patients with impaired renal function and in those taking potassium sparing diuretics, NSAIDs or beta-blockers.
  • A persistent brassy cough occurs in 4-16% patients within 1-8 weeks after starting this drug therapy which often requires discontinuation.
  • Rashes or hives may occur in 1-4% patients but do not usually warrant drug discontinuation.
  • Swelling of lips, mouth, nose and larynx i.e. angioedema may develop within hours to few days in 0.06-0.5% patients which may cause airway obstruction. This can be treated with adrenaline, antihistamines and corticosteroids according to need.
  • Reversible loss or alteration of taste sensation may occur rarely.
  • Headache, dizziness, nausea and bowel upset are reported in 1-4% patients.
  • Fetal growth retardation, hypoplasia of organs and even fetal death may occur if ACE inhibitors are given during later half of pregnancy.
  • Acute renal failure is precipitated by ACE inhibitors in patients with bilateral renal artery stenosis. ACE inhibitors are contraindicated in such patients.
  • Granulocytopenia and proteinuria are rare but warrant withdrawal. Renal disease predisposes to these adverse effects.