雷米普利
Ramipril
別名: Altace · Vasotop · Cardase · Delix · Ramase · Triatec · Tritace · Hoe-498 · ramiprilis · ramiprilium
由 VetSheet 獸醫團隊審訂更新於 2026年4月5日本內容以實證獸醫文獻為本
劑量為持牌獸醫專業人員的臨床參考。請務必對照最新藥品說明書及個別病患確認。
各物種劑量
🌎 NA — North America🌍 EU — Europe
狗
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| 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 |
貓
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| Treatment of arterial hypertension | 0.125 mg/kg PO once daily | PO | q24h | — | 🌎 NA |
馬
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| CHF | 0.2 mg/kg PO once daily | PO | q24h | — | 🌎 NA |
- CHF: Anecdotal evidence; pharmacokinetic studies are lacking.
劑量為持牌獸醫專業人員的臨床參考。請務必對照最新藥品說明書及個別病患確認。
概覽
雷米普利是一種長效前驅藥物型血管張力素轉化酶 (ACE) 抑制劑，在獸醫學中主要作為血管擴張劑使用。
主要臨床應用包括：
- 充血性心衰竭 (CHF)： 作為混合型血管擴張劑（同時降低前負荷與後負荷），改善心輸出量與運動耐受力。
- 全身性高血壓： 協助降低全身血壓，特別是在貓科動物中。
- 蛋白質流失性腎病與慢性腎病 (CKD)： 降低腎絲球內壓與蛋白尿，有助於保護腎功能。
雖然依那普利 (enalapril) 和貝那普利 (benazepril) 在獸醫臨床上更為常用，但雷米普利提供了一種作用時間長且強效的替代方案。該藥物在英國及多個歐洲國家已正式核准用於獸醫。
作用機制
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.
安全性與警告
禁忌症
- 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)
不良反應
- Anorexia
- Vomiting
- Diarrhea
- Weakness
- Hypotension
- Hyperkalemia
注意事項
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.
藥物相互作用
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.
監測
- 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)
藥物動力學
半衰期
吸收
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.
分佈
It is unknown whether ramipril or ramiprilat enters milk.
代謝
Ramipril is a pro-drug that undergoes hepatic de-esterification to its active metabolite, ramiprilat.
排除
In cats, 85-89% of radioactivity was recovered in feces and ~10% in urine. Excretion is complete by 168 hours after dosing.
過量
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.
可用產品
劑型
- Oral tablets
- Oral capsules
獸醫用
- Ramipril Tablets: 0.625 mg, 1.25 mg, 2.5 mg, & 5 mg (Vasotop - Intervet; UK/Europe)
人用標示
- Ramipril Oral Tablets/Capsules: 1.25 mg, 2.5 mg, 5 mg, & 10 mg (Altace - Monarch; generic)
各地核准狀態
暫無法規資料: 🇺🇸 US · 🇪🇺 EU · 🇬🇧 UK · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
儲存與穩定性
Capsules should be stored at room temperature (15-30°C) protected from light in tight containers.
飼主須知
- 保持規律： 為了讓藥物發揮最大效用，必須每天大約在同一時間給藥一次。
- 請勿突然停藥： 未經獸醫師同意，請勿突然停止或減少用藥，否則可能會使寵物的心臟狀況或血壓惡化。
- 監測副作用： 如果嘔吐或腹瀉持續、情況嚴重，或者動物的狀況惡化（例如極度嗜睡、虛弱或昏厥），請立即聯繫您的獸醫師。
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