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Altace (Ramipril) is an FDA-approved drug used to treat various cardiovascular conditions, including hypertension, heart disease, and congestive heart failure. It works by relaxing blood vessels, lowering blood pressure, and improving blood flow. Available in strengths of 1.25 mg, 2.5 mg, 5 mg, and 10 mg, it can be taken orally once or twice daily. Dosage varies depending on the condition being treated, and adjustments may be necessary based on individual factors. This medication may have some common side effects, including dizziness, lightheadedness, and dry cough, that may go away as your body adapts to the medication. It’s important to follow the prescribed dosage and take precautions, especially if you have kidney or liver problems, are pregnant, or are breastfeeding. Consult your doctor for personalized advice.

Product Overview

Altace, also known as Ramipril, is an ACE inhibitor used primarily for treating hypertension and heart failure and reducing cardiovascular risks. Hypertension, or high blood pressure, is a condition that can lead to serious health problems such as heart disease and stroke. Treating hypertension is crucial to prevent these complications. Ramipril works by inhibiting an enzyme that causes blood vessels to constrict, thereby relaxing them and lowering blood pressure.

This medication is available in capsule form with strengths of 1.25 mg, 2.5 mg, 5 mg, and 10 mg. The usual adult dose for hypertension starts at 2.5 mg once daily, which can be adjusted based on the patient’s response. For heart failure, the initial dose is 2.5 mg twice daily. It can be taken with or without food and should be swallowed whole or can be mixed with water or apple juice. It is suitable for adults, but dosage adjustments may be necessary for renal or hepatic impairment patients.

Common side effects include dizziness, lightheadedness, and dry cough. Serious side effects like fainting, high potassium levels, and signs of kidney problems require immediate medical attention. Patients with kidney issues or liver problems or those who are pregnant or breastfeeding should use Altace with caution. Missed doses should be taken as soon as remembered, but skip the missed one if it’s close to the next dose. In case of an overdose, seek medical help immediately. Altace should be stored at room temperature, away from light and moisture, and out of reach of children and pets. Discussing all medications and health conditions with your doctor to ensure Altace is safe for you is crucial.

Uses of Altace

Altace (Ramipril) is used to treat:

  • Cardiovascular Disease
  • Hypertensive Heart Disease
  • Hypertensive Encephalopathy
  • Hypertension
  • Pre-eclampsia/Eclampsia
  • Hypertensive Congestive Heart Failure
  • Cardiovascular Risk Reduction
  • Hypertensive Heart and Renal Disease (with or without CHF)
  • Renovascular Hypertension
  • Heart Disease
  • Congestive Heart Failure
  • Hypertensive Retinopathy

How to Use Altace?


It comes in the form of capsules and has 4 strengths:

  • Altace 1.25 mg
  • Altace 2.5 mg
  • Altace 5 mg
  • Altace 10 mg

Recommended Dosage for Different Patients

Usual Adult Dose for Hypertension

  • Initial dose: 2.5 mg taken by mouth once a day if you’re not using a diuretic (water pill).
  • Maintenance dose: 2.5 to 20 mg per day, taken in one or two divided doses.
  • Use: This medication is used to lower high blood pressure, either alone or with a thiazide diuretic.

Usual Adult Dose for Congestive Heart Failure

  • Initial dose: 2.5 mg taken by mouth twice a day.
  • Maintenance dose: 5 mg taken by mouth twice a day.
  • Use: This medication is used to treat stable patients who show signs of congestive heart failure within a few days after having a heart attack.

Usual Adult Dose for Cardiovascular Risk Reduction

  • Initial dose: 2.5 mg taken by mouth once a day for one week; then 5 mg once a day for the next three weeks, and then increased as tolerated.
  • Maintenance dose: 10 mg taken by mouth once a day.
  • Use: to reduce the risk of heart attack, stroke, or death from heart-related causes in patients 55 years or older who are at high risk of a major cardiovascular event.

Renal Dose Adjustments

  • If your creatinine clearance (CrCl) is 40 mL/min or less: Reduce your usual dose by 25%.
  • If your CrCl is less than 90 mL/min and you have hypertension (high blood pressure): Start with 1.25 mg taken by mouth once a day. Your doctor may increase the dose until your blood pressure is under control, up to a maximum of 5 mg per day.
  • If your CrCl is less than 90 mL/min and you have heart failure: Start with 1.25 mg taken by mouth once a day. The dose may be increased to 1.25 mg twice a day, with a maximum dose of 2.5 mg twice a day.
  • If you have renal artery stenosis (narrowing of the arteries that supply the kidneys): Start with 1.25 mg taken by mouth once a day.

[Note: Remember these recommendations may vary depending on person to person. Discuss it with your doctor, and they’ll customize your dosage accordingly.]

How to Take It?

  • Altace should be swallowed whole or can be sprinkled on applesauce or mixed in water/apple juice (up to 10 mg in one day).
  • Concurrent use with potassium supplements, salt substitutes, or potassium-sparing diuretics may increase serum potassium levels.
  • Patients should be monitored under medical supervision after the initial dosage of Altace.

[Note: Your doctor will decide the right amount for you based on your condition, following guidelines and studies on the drug. They’ll adjust it as needed over time.]

How Does Altace Work?

Altace (Ramipril) works by blocking the enzyme that converts angiotensin I to angiotensin II, a hormone that causes blood vessels to narrow and raise blood pressure. By reducing the amount of angiotensin II, Ramipril helps relax and widen the blood vessels, lower blood pressure, and improve blood flow to the heart and other organs. Altace also reduces the production of aldosterone, a hormone that causes the body to retain salt and water, which can increase blood pressure and fluid buildup in the body.

Important Safety Information

Side Effects

Common side effects of Altace:

  • Dizziness
  • Lightheadedness
  • Tiredness
  • Dry cough

During the initial adjustment period, some patients may experience mild side effects. These effects usually subside as your body adapts to the medication. If these effects persist or worsen, promptly inform your healthcare provider or pharmacist.

While rare, some individuals may experience serious side effects. Seek immediate medical attention if you encounter any of the following:

  • Fainting
  • Symptoms of high potassium blood level (muscle weakness, slow/irregular heartbeat)
  • Signs of kidney problems (such as changes in urine output)
  • Persistent nausea/vomiting
  • Yellowing of eyes/skin
  • Dark urine
  • Severe stomach/abdominal pain

A severe allergic reaction to Ramipril requires immediate medical intervention. Look out for the following symptoms:

  • Rash
  • Swelling/Itching, especially of the tongue/face/throat
  • Severe dizziness
  • Trouble breathing

[Note: Remember, this list may not cover all possible side effects. Always consult with your healthcare giver for medical advice about side effects.]


Kidney Problems: If you have kidney issues, you might be more likely to experience severe specific side effects from this medication, including high levels of potassium in your blood. Inform your doctor if you have kidney problems, heart failure, or narrowed arteries in your kidneys. Your doctor will determine if Ramipril is suitable for you.

Liver Problems: Use Ramipril cautiously if you have liver problems. This medication can worsen liver function and alter the levels of electrolytes in your body.

People with Low White Blood Cells: Altace can lead to a decrease in white blood cell counts, increasing your risk of infections. This is especially important if you have a history of lupus, kidney issues, or scleroderma. Inform your doctor immediately if you notice any signs of infection, like a fever or sore throat.

Diabetes: Ramipril can affect your blood sugar levels. Your doctor may need to adjust the dosage of your diabetes medications. You will be advised on how frequently to check your blood sugar levels.

Boxed Warning

Ramipril carries a black box warning advising discontinuation as soon as pregnancy is detected due to its effects on the renin-angiotensin system, which can lead to oligohydramnios, potentially causing fetal injury or death.


Angioedema: Altace usage can lead to angioedema, a serious condition, especially in dark-skinned individuals, as ACE inhibitors like Altace can impact eicosanoids and polypeptides in the body, potentially causing angioedema; patients using mTOR inhibitors/neprilysin inhibitors should be cautious, and symptoms of angioedema include facial puffiness, difficulty breathing, and wheezing. Seek immediate medical attention if these symptoms occur during Altace use.

Other Important Precautions

Pregnant Women: Ramipril is a category D pregnancy drug. This means:

  • Studies in humans have shown that the drug can harm the fetus when taken by the mother.
  • This drug should only be used during pregnancy in serious cases where it’s needed to treat a dangerous condition in the mother.

If you’re pregnant or planning to become pregnant, talk to your doctor. Ask them to explain the specific risks to the fetus. This drug should only be used if the potential risk to the fetus is considered acceptable, given the drug’s potential benefit.

Breastfeeding Women: Ramipril may pass into breast milk and could cause side effects in a breastfed child. If you’re breastfeeding, talk to your doctor. You may need to decide whether to stop breastfeeding or stop taking this medication.

Seniors: Older adults may process drugs more slowly. An average adult dose may result in higher than normal levels of this drug in your body. You may need a lower dose or a different schedule if you’re an older adult.

Children: This medication has not been studied in children and should not be used in children younger than 18 years.

Missed Dose

When you miss a dose of Altace, take it when you remember (as soon as you possibly can). But if it’s time for your next dose, leave this one and continue with your regular scheduled dose.

[Note: If you have missed a dose of your medication and are unsure about when to take the next one, immediately consult your doctor or pharmacist.]


If you have taken too much of Altace, call your doctor right away.

[Note: If you consumed more than recommended dose, get medical help right away, or call the Poison Help line at 1-800-222-1222.]


  • Store Altace medication in its original container to maintain its potency and effectiveness.
  • Ensure Altace is stored at room temperature, away from extremes, preferably between 68°F to 77°F (20°C to 25°C).
  • Protect the medication from direct sunlight and damp environments, as these factors can compromise its quality.
  • Store Altace in a location inaccessible to children and pets to prevent accidental ingestion.

[Note: Discuss with your healthcare professional about the proper disposal of any unused medicine and any questions you may have regarding its storage.]

Altace Interactions

Ramipril can interact with various other medications, leading to different outcomes. Some interactions might reduce the effectiveness of a drug, while others can increase the risk of side effects. Here is a list of medications that can interact with this medication:

Agents Increasing Serum Potassium: Combining Altace with medications that increase potassium levels in the blood can lead to dangerously high potassium levels (hyperkalemia). It’s important to regularly check potassium levels in patients taking Altace with these drugs.

Diuretics: When starting treatment with Altace, patients who are already taking diuretics (water pills) might experience a significant drop in blood pressure. To reduce this risk, lowering the dose, stopping the diuretic, or increasing salt intake before beginning Altace is advisable. If these adjustments aren’t possible, consider starting with a lower dose of Altace.

Lithium: ACE inhibitors like Altace can raise lithium levels in the blood, increasing the risk of lithium toxicity. It’s crucial to monitor lithium levels frequently, especially when diuretics are also being used.

Gold Therapy: Rare reactions such as facial flushing, nausea, vomiting, and low blood pressure have been reported when ACE inhibitors like Altace are used with injectable gold treatments.

Other Agents Affecting the Renin-Angiotensin System (RAS): It’s generally recommended to avoid using Altace with other medications that affect the renin-angiotensin system. Specifically, do not use Altace with Aliskiren in patients with diabetes.

Non-Steroidal Anti-Inflammatory Agents (NSAIDs): When NSAIDs, including COX-2 inhibitors, are used with Altace, there’s a risk of worsening kidney function, particularly in elderly, dehydrated, or kidney-compromised patients. Kidney function should be checked periodically in patients taking both Altace and NSAIDs. Additionally, NSAIDs may reduce the effectiveness of Altace in lowering blood pressure.

mTOR Inhibitors: Patients taking Altace along with mTOR inhibitors, such as temsirolimus, are at a higher risk for swelling of the face, lips, tongue, or throat (angioedema).

[Note: This isn’t a complete list, and there could be other drugs that interact with Altace. Make sure to tell your doctor any prescription, over-the-counter medicines, and herbal products you’re taking.]

Altace Alternatives

[Note: Your doctor will choose what’s best for you. Don’t use any of these alternative medications without consulting your healthcare provider. Taking them by yourself may cause serious side effects.] 

Frequently Asked Questions

How long should you take Altace?

Altace is typically considered safe for extended use. It is most effective when taken over a prolonged period. However, long-term use of Ramipril may occasionally lead to reduced kidney function. To monitor this, your doctor will conduct regular blood tests to assess the health of your kidneys.

What happens if you suddenly stop taking Ramipril?

If you abruptly discontinue the use of Ramipril, there is a possibility that your blood pressure could increase. This elevation in blood pressure may heighten the risk of experiencing a heart attack or stroke. Should you encounter any adverse effects from taking Ramipril, it is advisable to consult with your doctor, who may be able to recommend an alternative medication.

When can I expect APO Ramipril to start taking effect?

The timeframe for APO Ramipril to show results can vary individually, depending on factors like health and personal differences. Typically, though, many people begin to observe changes within a few weeks after initiating the therapy. It’s important to note that individual responses may differ, so consistent adherence to the prescribed regimen is key for the best outcomes.

Who shouldn’t take Ramipril HCTZ (Hydrochlorothiazide)?

Ramipril might not be the best choice for you if:

  • You’ve had an allergic reaction to Ramipril or any similar medications before.
  • You’re planning to get pregnant, are currently pregnant, or are breastfeeding.
  • You’re undergoing dialysis or any other blood filtration treatments.
  • You have existing heart, liver, or kidney issues.

It is always best to check with your doctor if you need clarification.

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