Ramipril
Also known as: Altace · Vasotop · Cardase · Delix · Ramase · Triatec · Tritace · Hoe-498 · ramiprilis · ramiprilium
Reviewed by the VetSheet Veterinary TeamUpdated Apr 5, 2026Evidence-based veterinary reference
Doses are a clinical reference for licensed veterinary professionals. Always confirm against the current label and the individual patient.
Dosing by species
🌎 NA — North America🌍 EU — Europe
Dogs
| Indication | Dose | Route | Frequency | Duration | Region |
|---|---|---|---|---|---|
| Treatment of heart failure | Initially, 0.125 mg/kg PO once daily; depending on the severity of pulmonary congestion, dose may be increased to 0.25 mg/kg PO once daily | PO | q24h | — | 🌎 NA |
Cats
| Indication | Dose | Route | Frequency | Duration | Region |
|---|---|---|---|---|---|
| Treatment of arterial hypertension | 0.125 mg/kg PO once daily | PO | q24h | — | 🌎 NA |
Horses
| Indication | Dose | Route | Frequency | Duration | Region |
|---|---|---|---|---|---|
| CHF | 0.2 mg/kg PO once daily | PO | q24h | — | 🌎 NA |
- CHF: Anecdotal evidence; pharmacokinetic studies are lacking.
Doses are a clinical reference for licensed veterinary professionals. Always confirm against the current label and the individual patient.
Overview
Ramipril is a long-acting, pro-drug angiotensin-converting enzyme (ACE) inhibitor used primarily as a vasodilator in veterinary medicine.
Key clinical applications include:
- Congestive Heart Failure (CHF): Acts as a mixed vasodilator (reducing both preload and afterload), improving cardiac output and exercise tolerance.
- Systemic Hypertension: Helps lower systemic blood pressure, particularly in felines.
- Protein-Losing Nephropathies & Chronic Kidney Disease (CKD): Reduces intraglomerular pressure and proteinuria, helping to preserve renal function.
While enalapril and benazepril are more commonly used in veterinary practice, ramipril offers a potent alternative with a long duration of action. It is officially approved for veterinary use in the UK and several European countries.
Mechanism of action
Ramipril is a pro-drug with minimal intrinsic pharmacologic activity. Upon absorption, it undergoes hepatic de-esterification → ramiprilat (the active metabolite).
- Ramiprilat competitively binds to Angiotensin-Converting Enzyme (ACE), preventing the conversion of Angiotensin I → Angiotensin II.
- Because Angiotensin II is a potent vasoconstrictor, its reduction leads to vasodilation (decreased total peripheral and pulmonary vascular resistance).
- Decreased Angiotensin II also reduces aldosterone secretion → decreased sodium and water retention, and increased plasma renin activity.
- Renal effects: ACE inhibitors preferentially dilate the efferent arteriole of the glomerulus → decreased intraglomerular pressure → reduced proteinuria.
Safety & warnings
Contraindications
- Hypersensitivity to ACE inhibitors
- Clinical cases of vascular stenosis (e.g., aortic stenosis)
- Obstructive hypertrophic cardiomyopathy
- Concurrent use with potassium-sparing diuretics (per UK label)
Adverse effects
- Anorexia
- Vomiting
- Diarrhea
- Weakness
- Hypotension
- Hyperkalemia
Precautions
Pregnancy Warning: ACE inhibitors carry a 'black box' warning in humans for fetal injury/death during the 2nd and 3rd trimesters. Do not use in pregnant or lactating animals unless the benefits clearly outweigh the risks.
- Caution in patients with hyponatremia, coronary or cerebrovascular insufficiency, preexisting hematologic abnormalities, or a collagen vascular disease (e.g., SLE).
- May cause a reversible decrease in localization and excretion of certain renal imaging agents in patients with renal artery stenosis.
Drug interactions
May potentially negate the decrease in systemic vascular resistance induced by ACE inhibitors (though low-dose aspirin did not affect enalaprilat hemodynamics in one dog study).
Possible increased risk for hypoglycemia; enhanced monitoring recommended.
Potential for increased hypotensive effects.
Increased hyperkalemic effects; enhanced monitoring of serum potassium required.
Potential for increased risk of renal dysfunction or hyperkalemia.
Increased risk for hyperkalemia.
Monitoring
- Clinical signs of CHF
- Serum electrolytes (especially potassium)
- Creatinine and BUN
- Urine protein
- CBC with differential (periodic)
- Blood pressure (if treating hypertension or if clinical signs of hypotension arise)
Pharmacokinetics
Half-life
Absorption
Rapidly converted via de-esterification into ramiprilat. Bioavailability of ramiprilat in dogs is about 6.7%. In cats, peak concentrations of ramipril occur in ~0.5 hours, and ramiprilat peaks at 1 hour post-administration.
Distribution
It is unknown whether ramipril or ramiprilat enters milk.
Metabolism
Ramipril is a pro-drug that undergoes hepatic de-esterification to its active metabolite, ramiprilat.
Elimination
In cats, 85-89% of radioactivity was recovered in feces and ~10% in urine. Excretion is complete by 168 hours after dosing.
Overdose
Ramipril appears quite safe in dogs; dosages as high as 1 gram/kg induced only mild GI distress. Lethal doses in rodents are extremely high (10-11 grams/kg).
- Primary concern: Hypotension.
- Treatment: Supportive treatment with volume expansion (normal saline) is recommended to correct blood pressure.
- Note: Because of the drug's long duration of action, prolonged monitoring and treatment may be required.
Available products
Formulations
- Oral tablets
- Oral capsules
Veterinary
- Ramipril Tablets: 0.625 mg, 1.25 mg, 2.5 mg, & 5 mg (Vasotop - Intervet; UK/Europe)
Human-labeled
- Ramipril Oral Tablets/Capsules: 1.25 mg, 2.5 mg, 5 mg, & 10 mg (Altace - Monarch; generic)
Regulatory status
No regulatory data for: 🇺🇸 US · 🇪🇺 EU · 🇬🇧 UK · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
Storage & stability
Capsules should be stored at room temperature (15-30°C) protected from light in tight containers.
Client information
- Consistency is key: For this drug to be maximally effective, it must be given once daily at about the same time each day.
- Do not stop abruptly: Do not abruptly stop or reduce therapy without your veterinarian's approval, as this could worsen your pet's heart condition or blood pressure.
- Monitor for side effects: Contact your veterinarian if vomiting or diarrhea persist, are severe, or if your animal's condition deteriorates (e.g., extreme lethargy, weakness, or fainting).
VetSheet drug reference is intended for licensed veterinary professionals as a clinical decision-support aid, not a substitute for professional judgement or the manufacturer’s current label.