[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Pharmacology](https://durgical.com/en/pharmacology/) › [ACE inhibitors](https://durgical.com/en/pharmacology/classes/ace-inhibitors/) › Ramipril

[Pharmacology](https://durgical.com/en/pharmacology/) · [ACE inhibitors](https://durgical.com/en/pharmacology/classes/ace-inhibitors/)

# Ramipril

A long-acting ACE inhibitor prodrug. Used for high blood pressure, heart failure after infarction and to prevent heart attacks and strokes in high-risk people.

Updated 2026-11-01

- Class: [ACE inhibitors](https://durgical.com/en/pharmacology/classes/ace-inhibitors/)
- Enzyme: Angiotensin-converting enzyme (ACE)
- ATC code: C09AA05

✂**Angiotensin-converting enzyme (ACE)**Ramipril

ⓘ The figure shows ramiprilat, the active form of ramipril, bound to the zinc active site of the C-domain of human ACE.

**Target in 3D:** Angiotensin-converting enzyme (ACE). PDB structure 9QAN (RCSB PDB, public domain). [View the structure at RCSB PDB](https://www.rcsb.org/structure/9QAN) · Drag to rotate · pinch to zoom

## Mechanism of action

Ramipril is hydrolysed in the liver to ramiprilat, which binds ACE tightly in plasma and tissues. Angiotensin II and aldosterone fall, arterioles dilate and bradykinin builds up. Beyond lowering blood pressure, long-term ACE inhibition in high-risk patients reduces heart attacks, strokes and cardiovascular deaths.

- Ramipril is hydrolysed to ramiprilat, its active form
- Ramiprilat binds plasma and tissue ACE
- Less angiotensin II and aldosterone; bradykinin builds up

## Pharmacokinetics

**Metabolism**
Prodrug: hydrolysed mainly in the liver to ramiprilat

**Elimination**
Mainly by the kidneys, so it accumulates in kidney failure

**Half-life**
Ramiprilat has a long terminal phase from tight binding to ACE, allowing once-daily use

## Indications

- High blood pressure [Arterial hypertension →](https://durgical.com/en/conditions/arterial-hypertension/)
- Reduction of myocardial infarction, stroke and cardiovascular death in high-risk patients [Myocardial Infarction (Heart Attack) →](https://durgical.com/en/conditions/myocardial-infarction/)
- Heart failure after myocardial infarction [Heart failure →](https://durgical.com/en/conditions/heart-failure/)

## Adverse effects

### Common

- Dry cough
- Dizziness and hypotension
- Hyperkalaemia
- Rise in creatinine

### Serious (rare, important)

- Angioedema
- Acute kidney injury
- Fetal toxicity

## Contraindications

- Pregnancy
- Previous angioedema with an ACE inhibitor, or hereditary or idiopathic angioedema
- Use with sacubitril/valsartan or within 36 hours of it
- Use with aliskiren in people with diabetes

## Key interactions

**Potassium-sparing diuretics, potassium supplements or salt substitutes**
Hyperkalaemia

**NSAIDs, including COX-2 inhibitors**
Weaker effect and risk of kidney injury

**Lithium**
Higher lithium levels and toxicity

**Telmisartan or another ARB**
Dual blockade: more kidney injury, hypotension and hyperkalaemia without more benefit

## What is monitored

- Blood pressure
- Potassium and creatinine
- Signs of angioedema

## Administration and safety

- Given by mouth; capsules may be opened and mixed with soft food or water if the patient cannot swallow them, per the label
- Several «-pril» names look alike: the name is checked on every order

## Nursing care

- Check blood pressure, potassium and creatinine when starting and after changes
- Watch for dizziness, especially in patients on diuretics
- Ask women of childbearing age about pregnancy plans
- Teach the patient that face, lip or tongue swelling is an emergency

## Pregnancy and breastfeeding

Contraindicated: drugs acting on the renin-angiotensin system can injure and kill the developing fetus; it is stopped as soon as pregnancy is detected.

## Memory aid

RAMIPRIL RAMs down risk: fewer infarcts and strokes in high-risk hearts.

## Test yourself

Think of the answer, then tap the question to see it.

## What is the active form of ramipril?

Ramiprilat, formed by hydrolysis mainly in the liver.

## Besides hypertension, what benefit justifies ramipril in high-risk patients?

It lowers the risk of myocardial infarction, stroke and cardiovascular death.

## Why is ramipril not combined with telmisartan?

Dual renin-angiotensin blockade adds kidney injury, hypotension and hyperkalaemia without extra benefit.

[Add to my cards (3)](https://durgical.app/estudiar/?add=/en/pharmacology/ramipril/)

## Related drugs

- [Enalapril](https://durgical.com/en/pharmacology/enalapril/)
- [Perindopril](https://durgical.com/en/pharmacology/perindopril/)
- [Telmisartan](https://durgical.com/en/pharmacology/telmisartan/)

## Related conditions

- [Arterial hypertension](https://durgical.com/en/conditions/arterial-hypertension/)
- [Myocardial Infarction (Heart Attack)](https://durgical.com/en/conditions/myocardial-infarction/)
- [Heart failure](https://durgical.com/en/conditions/heart-failure/)

[← Back to the class: ACE inhibitors](https://durgical.com/en/pharmacology/classes/ace-inhibitors/)

Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.

Sources: [DailyMed - RAMIPRIL capsule](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=d6d57158-e8f9-4c91-8317-0374e0c87d33) (DailyMed (U.S. National Library of Medicine), 2026); [ATCDDD - ATC/DDD Index](https://atcddd.fhi.no/atc_ddd_index/?code=C09AA05) (WHO Collaborating Centre for Drug Statistics Methodology, 2026).

## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake

Representative model, for educational purposes only.

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Source: https://durgical.com/en/pharmacology/ramipril/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/pharmacology/ramipril/