Ramipril, pharmacokinetics

An aluminium/magnesium hydroxide antacid reduced the bioavailability of captopril by 40%, but this did not seem to be clinically important The bioavailability of fosinopril was reduced by about one-third by Mylanta. An antacid did not affect ramipril pharmacokinetics. 

It is briefly noted in a review that antacid use did not affect the pharmacokinetics of ramiprilat, the active metabolite of ramipril. ... 

Propranolol 80 mg three times daily did not affect the pharmacokinetics of a single 20-mg dose of quinapril in 10 healthy subjects. The pharmacokinetics of ramipril 5 mg daily were unaffected by propranolol 40 mg twice daily. Similarly, the manufacturer of fosinopril reports that the bioavailability of fosinoprilat, its active metabolite, was not altered by propranolol. Another study found no significant pharmacokinetic interaction between cilazapril 2.5 mg daily and propranolol 120 mg daily in healthy subjects, but the reductions in blood pressure were about doubled and long-lasting in healthy subjects and in patients with hyperten-... 

No pharmacokinetic interaction occurred between single doses of fe-lodipine 10 mg and ramipril 5 mg in healthy subjects. The blood pressure-lowering effect of the eombination was greater, and ramipril attenuated the reflex taehyeardia eaused by felodipine. ... 

Other single-dose studies have shown that food had no statistically significant effect on the pharmacokinetics of lisinopril, or enalapril, and its active metabolite, enalaprilat. Similarly, food had minimal effects on the pharmacokinetics of cilazapril (AUC decreased by only 14%). Food caused small, but statistically significant increases in the time to reach maximum plasma levels of quinapril and its active metabolite. However, as the increase was less than 30 minutes this is not expected to alter the therapeutic effect. Likewise, the manufacturers of spirapril briefly mention in a review that food delayed its absorption by 1 hour, it did not affect the bioavailability of spirapril or spiraprilat, its active metabolite. Other manufacturers state that food had no effect on the absorption of fosinopril 11,12 ramipril, or trandolapril. ... 

Cimetidine did not appear to alter the pharmacokinetics or pharmacological effects of captopril or enalapril, or the pharmacokinetics of fosinopril or quinapril in studies in healthy subjects. The manufacturers of cilazapril say that no clinically significant interaction occurred with H2-receptor antagonists (not specifically named) and the manufacturers of moexipril, " ramipril, and trandolapril say that no important pharmacokinetic interaction occurred with cimetidine. The manufacturers of spirapril briefly note in a review that cimetidine did not alter the plasma concentrations of spirapril or its active metabolite spiraprilat. None of these pairs of drugs appears to interact to a clinically relevant extent, and no special precautions appear to be necessary. 

The manufacturer of spirapril briefly noted in a review that there was no relevant pharmacokinetic interaction between spirapril and diclofenac. Oxaprozin 1.2 g daily for 3 weeks did not affect the pharmacokinetics of enalapril 10 to 40 mg daily in 29 patients with hypertension. A brief mention is made in a review that, in healthy subjects, the pharmacokinetics of ramipril were unaffected by indometacin [dosage not stated] given for 3 days. ... 

In 8 healthy subjects, ramipril 5 mg daily for 7 days had no effect on the steady-state pharmacokinetics or anticoagulant effects of phenprocou-mon. Similarly, ramipril 5 mg daily for 3 weeks did not alter the anticoagulant effects of acenocoumarol or phenprocoumon in patients stabilised on these anticoagulants, when compared with placebo. ... 

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