Altace: Advanced Blood Pressure Control for Cardiovascular Health
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Synonyms
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Altace (ramipril) is an angiotensin-converting enzyme (ACE) inhibitor prescribed for the management of hypertension, heart failure, and cardiovascular risk reduction following myocardial infarction. It functions by inhibiting the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor, thereby promoting vasodilation and reducing peripheral arterial resistance. This mechanism not only effectively lowers blood pressure but also decreases the workload on the heart, offering a multifaceted approach to cardiovascular protection. Clinicians frequently recommend Altace for its proven efficacy in improving survival rates post-heart attack and slowing the progression of renal disease in hypertensive patients with diabetes. Its well-established safety profile and once-daily dosing support long-term adherence, making it a cornerstone therapy in modern cardiology practice.
Features
- Active ingredient: Ramipril
- Drug class: Angiotensin-converting enzyme (ACE) inhibitor
- Available dosages: 1.25 mg, 2.5 mg, 5 mg, and 10 mg capsules
- Administration: Oral, once or twice daily as directed
- Prescription status: Rx-only medication
- Manufacturer: Various pharmaceutical companies under license
- Storage requirements: Room temperature (15–30°C), protected from moisture
Benefits
- Effectively reduces systolic and diastolic blood pressure through vasodilation
- Demonstrates cardioprotective properties by decreasing cardiac afterload and improving ejection fraction
- Shows nephroprotective effects, particularly in diabetic patients with proteinuria
- Reduces mortality risk in patients with heart failure post-myocardial infarction
- May slow the progression of atherosclerosis and vascular remodeling
- Offers convenient once-daily dosing that supports treatment adherence
Common use
Altace is primarily indicated for the treatment of hypertension, either as monotherapy or in combination with other antihypertensive agents. It is also approved for the reduction of mortality following acute myocardial infarction in clinically stable patients with signs of heart failure. Additionally, Altace is used in patients with high cardiovascular risk profiles to prevent major cardiovascular events. Off-label uses include management of diabetic nephropathy and prevention of migraine headaches in certain patient populations, though these applications require careful medical supervision.
Dosage and direction
The recommended initial dosage for hypertension is 2.5 mg once daily, which may be increased to a maintenance dose of 2.5–10 mg daily, administered as a single dose or in two divided doses. For post-myocardial infarction heart failure, treatment typically begins with 2.5 mg twice daily, increasing to 5 mg twice daily after one week if tolerated. Patients should take Altace at approximately the same time each day, with or without food, though consistency in administration relative to meals is recommended. Dosage adjustments are necessary for patients with renal impairment or those taking diuretics concurrently. The capsules should be swallowed whole and not crushed or chewed.
Precautions
Patients should undergo baseline renal function and electrolyte assessment before initiation and periodically during treatment. Blood pressure monitoring is essential during dosage titration. Caution is advised in patients with renal artery stenosis, as ACE inhibitors may cause reversible increases in blood urea nitrogen and serum creatinine. Patients should be advised about the potential for symptomatic hypotension, particularly during initial therapy or following dosage increases. Those with collagen vascular disease or receiving immunosuppressive therapy may be at increased risk for neutropenia/agranulocytosis. Regular monitoring of white blood cell counts is recommended in these populations.
Contraindications
Altace is contraindicated in patients with a history of angioedema related to previous ACE inhibitor therapy. It should not be used during pregnancy, particularly in the second and third trimesters, due to risk of fetal injury and death. Additional contraindications include concomitant use with aliskiren in patients with diabetes and patients with hereditary or idiopathic angioedema. The medication is not recommended for patients with bilateral renal artery stenosis or stenosis of the artery to a solitary kidney.
Possible side effect
Common adverse reactions include persistent dry cough (up to 20% of patients), dizziness (2–4%), and headache (1–2%). Less frequently reported effects include fatigue, nausea, and orthostatic hypotension. Serious but rare side effects may include angioedema (0.1–0.5%), hyperkalemia, neutropenia/agranulocytosis, and hepatic failure. Renal impairment may occur, particularly in volume-depleted patients or those with pre-existing renal disease. Some patients may experience taste disturbance or rash. Most side effects are dose-dependent and may diminish with continued therapy or dosage adjustment.
Drug interaction
Altace may interact significantly with diuretics, potentiating the risk of first-dose hypotension. Concurrent use with potassium-sparing diuretics, potassium supplements, or salt substitutes containing potassium may increase the risk of hyperkalemia. Nonsteroidal anti-inflammatory drugs (NSAIDs) may diminish the antihypertensive effect and increase renal impairment risk. Dual blockade of the renin-angiotensin system with ARBs or aliskiren increases risks of hypotension, hyperkalemia, and renal impairment. Lithium levels may increase during concomitant therapy requiring careful monitoring. The antihypertensive effect may be enhanced by other antihypertensive agents and alcohol.
Missed dose
If a dose is missed, it should be taken as soon as remembered unless it is nearly time for the next scheduled dose. In that case, patients should skip the missed dose and resume their regular dosing schedule. Doubling the dose to make up for a missed dose is not recommended, as this may increase the risk of hypotension and other adverse effects. Patients should maintain a consistent dosing routine and consider using reminder systems if missed doses occur frequently.
Overdose
Symptoms of overdose may include pronounced hypotension, bradycardia, circulatory shock, electrolyte disturbances, and renal failure. Management involves supportive measures including intravenous fluids and vasopressors for hypotension. Ramiprilat, the active metabolite, is poorly dialyzable, though dialysis may be considered for managing associated electrolyte imbalances. Patients should receive continuous hemodynamic monitoring, and treatment should be directed toward maintaining renal perfusion and correcting electrolyte abnormalities. Gastric lavage may be considered if ingestion occurred recently.
Storage
Store at room temperature between 15–30°C (59–86°F) in the original container with the lid tightly closed. Protect from moisture and excessive heat. Keep out of reach of children and pets. Do not use capsules that appear discolored, damaged, or beyond the expiration date printed on the packaging. Proper disposal of unused medication should follow local regulations, typically through medication take-back programs rather than flushing or household trash.
Disclaimer
This information is provided for educational purposes only and does not constitute medical advice. Altace is a prescription medication that should be used only under the supervision of a qualified healthcare professional. Individual patient responses may vary, and treatment decisions should be based on a thorough medical evaluation. Patients should not alter their dosage or discontinue therapy without consulting their physician. The manufacturer’s prescribing information contains the most complete and updated safety information.
Reviews
Clinical studies demonstrate Altace’s efficacy in reducing blood pressure by approximately 8-12/5-8 mmHg in hypertensive patients. The HOPE trial established its significant benefit in reducing cardiovascular mortality (risk reduction 26%) and myocardial infarction (20%) in high-risk patients. Meta-analyses confirm its position as a well-tolerated ACE inhibitor with particularly strong evidence in post-MI management. Patient satisfaction surveys indicate good tolerability aside from the characteristic ACE inhibitor cough, which remains the most common reason for discontinuation. Long-term follow-up studies show maintained efficacy over years of therapy with persistent cardiovascular protection.