Ramipril

What is ramipril?

Ramipril (Prilocard®, Vasotop®) is an ACE-inhibitor drug used in the management of congestive heart failure and high blood pressure in dogs and cats. It may also be useful in the treatment of some forms of kidney disease in dogs and cats.

Prilocard® and Vasotop® are licensed veterinary products that are available outside of North America. In the United States and Canada, human formulations may be prescribed for off-label use.

Many drugs are commonly prescribed for off-label use in veterinary medicine. “Off label” means the drug is being used in a way that has not been reviewed or approved by the U.S. Food and Drug Administration (FDA) or Health Canada. In these instances, follow your veterinarian’s direction and cautions carefully, as they may be significantly different from those on the label.

How do I give my pet ramipril?

• Ramipril is given orally (by mouth) and comes in the form of tablets or capsules.
• This medication may also be compounded into other forms.
• This medication may be given with or without food.
• If vomiting occurs when given on an empty stomach, give the next dose with a small meal or treat.
• Follow your veterinarian’s directions and measure liquid compounded forms of this medication carefully.
• Ideally, give this medication at the same time daily.

This medication should take effect within 1 to 2 hours; however, effects may not be noted outwardly, and your veterinarian will need to run tests to ensure this medication is working.

What if I miss giving my pet the medication?

If you miss a dose, give it as soon as you remember, and then continue with the regular dosing schedule. However, if it is almost time for the next dose, skip the missed dose and resume the regular dosing schedule. Do not give the pet two doses at once.

Are there any potential side effects from ramipril?

Ramipril may cause the following side effects:

• Vomiting
• Diarrhea
• Lack of appetite

Serious adverse reactions associated with this drug may occur without warning and could, in rare cases, lead to death. If any of the following signs develop, stop giving ramipril and contact your veterinarian immediately:

• Anorexia (loss of appetite)
• Persistent vomiting
• Weakness or disorientation (which could indicate low blood pressure)
• Fever
• Rash
• Sudden changes in urination or thirst
• Coughing is a reported side effect in humans, but rare in dogs and cats

Drug sensitivities can develop over time, with repeated exposure. Your pet may have no reaction after the first few doses but may develop a sensitivity later. It is important to watch for signs of an allergic reaction over the entire course of the treatment and notify your veterinarian if you have any concerns.

Other side effects may occur. If you notice anything unusual, contact your veterinarian immediately. This medication is short acting and should stop working within 24 hours, although effects can be longer in pets with liver or kidney disease.

Are there any risk factors for this medication?

DO NOT USE in:

• Pets that are allergic to it or any other ACE inhibitors
• Pets with certain heart conditions, such as aortic stenosis (narrowed heart valve) or obstructive hypertrophic cardiomyopathy (abnormally thick heart muscle)

USE WITH CAUTION in:

• Pets that are dehydrated
• Pets with preexisting kidney disease
• Pets with high blood potassium levels

Are there any drug interactions I should be aware of?

The following drugs should be used WITH CAUTION when given with ramipril:

• Anesthetic drugs (e.g., isoflurane)
• Angiotensin-receptor blockers (e.g., losartan, telmisartan)
• Antacids which contain aluminum, calcium and magnesium
• Antihypertensive agents/vasodilators (e.g., amlodipine, hydralazine, prazosin, sildenafil)
• Baclofen
• Buspirone
• Cabergoline
• Cimetidine
• Corticosteroids
• Darbepoetin alfa
• Digoxin
• Diphenhydramine
• Disopyramide
• Diuretics (e.g., furosemide) or potassium-sparing diuretics (spironalactone)
• Doxepin
• Glycerin (oral)
• Heparin and low-molecular-weight heparins (e.g., dalteparin, enoxaparin)
• Nonsteroidal anti-inflammatory agents (NSAIDs; e.g., carprofen, meloxicam)
• Opioids (e.g., buprenorphine, hydrocodone, morphine)
• Potassium
• Probenecid

Be sure to tell your veterinarian about any medications (including vitamins, supplements, or herbal therapies) that your pet is taking before starting any new treatment.

Is any monitoring needed with this medication?

• Baseline bloodwork should be done before starting treatment, and again 7 days after treatment begins. Bloodwork should include blood electrolytes, a complete blood count, and liver and kidney values.
• Bloodwork should be done each time there is a change in the dose of ramipril or the diuretics that may be prescribed alongside this drug.
• Urine testing should be performed to assess the urine protein: creatinine ratio.
• Blood pressure should be tested when treating hypertension or if any clinical signs appear that are associated with low blood pressure.
• At home, monitor for any side effects such as those noted above. If any occur, stop using the medication and contact your veterinarian.
• Your veterinarian will let you know when and how they want to reassess your pet to ensure the medication is working and not causing side effects.

How do I store ramipril?

• Ensure ramipril is tightly stored in its original container in a cool, dry place, and protected from light.
• Store this medication at room temperature between 68°F and 77°F (20°C and 25°C).
• Protect from freezing.
• Keep the container out of reach of children and pets.

What should I do in case of emergency?

If you suspect an overdose or an adverse reaction to the medication, call your veterinary office immediately. If they are not available, follow their directions in contacting an emergency facility. Be prepared to provide information about the product and your pet’s weight and symptoms.