Ramipril
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.
Mecanismo: 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.
Dosificación por especie
- Treatment of arterial hypertension · 0.125 mg/kg PO once daily · PO · q24h
- CHF · 0.2 mg/kg PO once daily · PO · q24h · Anecdotal evidence; pharmacokinetic studies are lacking.
- 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
Las dosis son una referencia clínica para médicos veterinarios. Confirme siempre con la información vigente del producto y el paciente individual.
Vías de administración
Contraindicaciones
- 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)
Efectos adversos
- Anorexia
- Vomiting
- Diarrhea
- Weakness
- Hypotension
- Hyperkalemia
Interacciones farmacológicas
- Aspirin · 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).
- Antidiabetic agents (insulin, oral agents) · Possible increased risk for hypoglycemia; enhanced monitoring recommended.
- Diuretics (e.g., furosemide, hydrochlorothiazide) · Potential for increased hypotensive effects.
- Diuretics, potassium sparing (e.g., spironolactone, triamterene) · Increased hyperkalemic effects; enhanced monitoring of serum potassium required.
- NSAIDs · Potential for increased risk of renal dysfunction or hyperkalemia.
- Potassium supplements · Increased risk for hyperkalemia.
Monitoreo
- 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)
Sobredosis
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.
La referencia de fármacos de VetSheet está destinada a médicos veterinarios como apoyo a la decisión clínica; no sustituye el juicio profesional ni la información vigente del fabricante.