Ramipril aldosterone

In patients with severe CHF whose renal function may depend on the activity of the renin-angiotensin-aldosterone system, treatment with ACEIs may be associated with oliguria or progressive azotemia and, rarely, with acute renal failure or death. Impaired renal function decreases lisinopril elimination. The elimination half-life of quinaprilat increases as Ccr decreases. Dosage adjustment may be necessary for quinapril, benazepril, ramipril, and lisinopril. Impaired renal function decreases... 

Data from Uresin Y et al Efficacy and safety of the direct renin inhibitor aliskiren and ramipril alone or in combination in patients with diabetes and hypertension. J Renin Angiotensin Aldosterone Syst 2007 8 190.)... 

Not fully understood. It eould be that, as with the ACE inhibitors, angiotensin n reeeptor antagonists inhibit aldosterone secretion, resulting in increased sodium loss by the kidney tubules. This causes lithium retention and thus an increase in lithium levels. However, angiotensin II receptor antagonists have less effect on aldosterone than the ACE inhibitors, making a clinically significant interaction less likely. Animal studies show that ramipril, but not losartan, decreases the excretion of lithium by the kidney, which would support this idea. 

Cardiovascular Paradoxical severe hypertension occurred in three patients with advanced chronic kidney disease and bilateral renal artery stenosis. After the introduction of ramipril, an initial fall in blood pressure was followed by a paradoxical increase in blood pressure. This was postulated to be caused by activation of the renin-angiotensin-aldosterone system, as a result of renal artery stenosis and renal dysfunction [55 ]. 

Saijonmaa O, Fyhrquist F. Can aliskiren reduce the incidence of cough caused by ramipril J Renin Angiotensin Aldosterone Syst 2008 9 176. 

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