Ramipril adverse effects

With the data included in the overview of Garg et al. (316), it is possible to calculate that 18 patients need to be treated for 90 days to avoid one death or one hospitalization for congestive heart failure (95% confidence interval [Cl] 16-23). This meta-analysis includes 32 trials with the ACE inhibitors captopril, enalapril, lisinopril, quinapril, ramipril, and perindopril. It is likely that high doses (for instance, lisinopril 35 mg daily) are more effective than low doses (lisinopril 5 mg daily) (302). Treating 30 patients for 4 years with a high dose of lisinopril (95% Cl 16-509) will avoid one hospitalization for cardiovascular reasons or one death in comparison with a low dose, without increasing the number of adverse effects requiring withdrawal from treatment. 

Diarrhea is a recognized infrequent adverse effect of ACE inhibitors. A convincing case of diarrhea associated with ramipril has been reported (3). 

When the dmg was introduced into the clinic it was most efficacious, although a number of adverse side effects were observed including skin rash and loss of taste, and thus the search for better ACE inhibitors began. This has resulted in a large number of compounds presently available as ACE inhibitors. Some of these are captopril, cilazapril, enala-pril (maleate), fosinopril, imidapril, lisinapril, moexipril (hychochloride), perindopril (erbumine, [t-butyl amine]), quinapril, ramipril and trandolapril (Figs 12.11, 12.12). 

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