Ramipril

Do not co-administer aliskiren with ramipril in patients with diabetes.

Potassium-sparing diuretic increases risk of hyperkalemia. Frequent monitoring of serum potassium recommended if concomitant use indicated.

Possibility of excessive hypotension, especially in patients with recently instituted diuretic therapy.

Increased serum lithium levels and symptoms of lithium toxicity have been reported. Risk may be increased if a diuretic is also used. Frequent monitoring of serum lithium levels is recommended.

Patients taking concomitant neprilysin inhibitor therapy may be at increased risk for angioedema.

May result in deterioration of renal function, acute renal failure, and attenuation of antihypertensive effect, especially in elderly, volume-depleted, or renal-compromised patients.

Increases risk of hyperkalemia. Frequent monitoring of serum potassium recommended if concomitant use indicated.

Nitritoid reactions (facial flushing, nausea, vomiting, hypotension) have been reported rarely with injectable gold and concomitant ACE inhibitor therapy.

Potassium-sparing diuretic increases risk of hyperkalemia. Frequent monitoring of serum potassium recommended if concomitant use indicated.

Concomitant use resulted in increased incidence of clinically important renal dysfunction including death, doubling of serum creatinine, and dialysis. Not recommended.

Co-administration increases ramipril and ramiprilat exposure (2.3-2.4 fold Cmax, 1.5-2.1 fold AUC) while decreasing telmisartan levels. Additive pharmacodynamic effects may occur.

Patients taking concomitant mTOR inhibitor therapy may be at increased risk for angioedema.

Potassium-sparing diuretic increases risk of hyperkalemia. Frequent monitoring of serum potassium recommended if concomitant use indicated.

Ramipril can attenuate potassium loss caused by thiazide diuretics. Monitor for hypokalemia.

Co-administration increases steady-state Cmax and AUC of ramipril and ramiprilat (2.3-2.4 fold and 2.1-1.5 fold respectively) with additive pharmacodynamic effects possible.

7.3 Angioedema with ACE inhibitors and Calcium Channel Blokers Angioedema has been reported in patients taking mammalian target of rapamycin (mTOR) inhibitors in combination with ramipril and/or amlodipine. Monitor patients for signs and symptoms of angioedema when temsirolimus is given concomitantly with an angiotensin converting enzyme (ACE) inhibitors (e.g., ramipril) or calcium channel blockers (CCB) (e.g., amlodipine).

Other ACE inhibitors have had less than additive effects with beta adrenergic blockers, presumably because both drug classes lower blood pressure by inhibiting parts of the renin-angiotensin-aldosterone system. Therefore, concomitant use of telmisartan and ramipril is not recommended [see Dual Blockade of the Renin-Angiotensin-Aldosterone System ( 5.7 ) ].

Examples: Ramipril, captopril Beta Blockers Clinical Impact: The hypotensive effects of beta blockers may be diminished by the concomitant administration of aspirin due to inhibition of renal prostaglandins, leading to decreased renal blood flow, and salt and fluid retention.

7.6 Other Neither ramipril nor its metabolites have been found to interact with food, digoxin, antacid, furosemide, cimetidine, indomethacin, and simvastatin.

Nitritoid reactions have been reported with concomitant use.

Table 3: No observed clinically important drug interactions of Veltassa Angiotensin-converting enzyme (ACE) inhibitors Benazepril, captopril, enalapril, fosinopril, lisinopril, perindopril, quinapril, ramipril, trandolapril Angiotensin II receptor blockers (ARB) Azilsartan, candesartan, irbesartan, losartan, olmesartan, valsartan β-adrenoceptor blockers (β-blocker) Metoprolol Loop diuretics Furosemide, bumetanide, torasemide Mineralocorticoid receptor antagonists (MRA) Eplerenone, finerenone, spironolactone Neprilysin inhibitors Sacubitril Sodium-glucose cotransporter-2 (SGLT-2) inhibitors Canagliflozin, dapagliflozin, empagliflozin Antibiotics Trimethoprim, amoxicillin, cephalexin Anticoagulants Warfarin, apixaban, rivaroxaban Anti-parathyroid agents and Thyroid preparations Cinacalcet Antithrombotic agents Clopidogrel, acetylsalicylic acid Blood glucose lowering drugs Glipizide Calcium channel blockers Amlodipine, verapamil Immunosuppressants Tacrolimus Others Lithium, allopurinol, atorvastatin, digoxin, phenytoin, riboflavin, sevelamer

The combination of ramipril and propranolol showed no adverse effects on dynamic parameters (blood pressure and heart rate).

7.6 Other Neither ramipril nor its metabolites have been found to interact with food, digoxin, antacid, furosemide, cimetidine, indomethacin, and simvastatin.