Last update April 16, 2024

(2S,3aS,6aS)-1-{N-[(S)-1-Ethoxycarbonyl-3-phenylpropyl]l-alanyl}perhydrocyclopenta[b]pyrrole-2-carboxylic acid

Likely Compatibility

Fairly safe. Mild or unlikely adverse effects. Compatible under certain circumstances. Follow-up recommended. Read Commentary.

Ramipril and its metabolite ramiprilate are angiotensin converting enzyme inhibitors (ACE inhibitors) used in the treatment of arterial hypertension, nephropathy, heart failure and to reduce the risk of cardiovascular damage. Oral administration every 12-24 hours. 

According to the manufacturer (FDA 2013, AEMPS 2009) no levels were detected in breast milk after one dose of ramipril, but as of last update we found no other published data on its excretion in breast milk. 

Other compounds in the same group (ACEI) are not significantly excreted in breast milk, but until further published data on this drug in relation to breastfeeding are known safer alternatives may be preferable. (Hale, LactMed, Anderson 2018, Malachias 2016)

Due to its potential renal toxicity in premature infants, it is preferable to avoid its use during the neonatal period in case of prematurity. (Serrano 2015)

The protective role of breastfeeding against maternal hypertension has been proven. (Park 2018)

Alternatives

  • Captopril (Safe substance and/or breastfeeding is the best option.)

Suggestions made at e-lactancia are done by APILAM team of health professionals, and are based on updated scientific publications. It is not intended to replace the relationship you have with your doctor but to compound it. The pharmaceutical industry contraindicates breastfeeding, mistakenly and without scientific reasons, in most of the drug data sheets.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

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Other names

(2S,3aS,6aS)-1-{N-[(S)-1-Ethoxycarbonyl-3-phenylpropyl]l-alanyl}perhydrocyclopenta[b]pyrrole-2-carboxylic acid is Ramipril in Chemical name.

Is written in other languages:

Groups

(2S,3aS,6aS)-1-{N-[(S)-1-Ethoxycarbonyl-3-phenylpropyl]l-alanyl}perhydrocyclopenta[b]pyrrole-2-carboxylic acid belongs to these groups or families:

Tradenames

Main tradenames from several countries containing (2S,3aS,6aS)-1-{N-[(S)-1-Ethoxycarbonyl-3-phenylpropyl]l-alanyl}perhydrocyclopenta[b]pyrrole-2-carboxylic acid in its composition:

List of 42 tradenames

Pharmacokinetics

Variable Value Unit
Oral Bioavail. 15 / 44 %
Molecular weight 417 daltons
Protein Binding 73 / 56 %
VD 1.5 / 8.3 l/Kg
pKa 3.75 -
Tmax 1 / 4 hours
T½ 13 - 17 hours

References

  1. Park S, Choi NK. Breastfeeding and Maternal Hypertension. Am J Hypertens. 2018 Abstract
  2. Anderson PO. Treating Hypertension During Breastfeeding. Breastfeed Med. 2018 Abstract
  3. AEMPS. Ramipril. Ficha técnica. 2016 Full text (in our servers)
  4. Malachias MV, Figueiredo CE, Sass N, Antonello IC, Torloni MR, Bortolotto MRF L. 7th Brazilian Guideline of Arterial Hypertension: Chapter 9 - Arterial Hypertension in pregnancy Arq Bras Cardiol. 2016 Abstract Full text (link to original source)
  5. Serrano Aguayo P, García de Quirós Muñoz JM, Bretón Lesmes I, Cózar León MV. Tratamiento de enfermedades endocrinológicas durante la lactancia. [Endocrinologic diseases management during breastfeeding.] Med Clin (Barc). 2015 Jan 20;144(2):73-9. Abstract
  6. FDA (Pfizer). Ramipril. Drug Summary. 2013 Full text (in our servers)
  7. van Griensven JM, Schoemaker RC, Cohen AF, Luus HG, Seibert-Grafe M, Röthig HJ. Pharmacokinetics, pharmacodynamics and bioavailability of the ACE inhibitor ramipril. Eur J Clin Pharmacol. 1995 Abstract
  8. Meisel S, Shamiss A, Rosenthal T. Clinical pharmacokinetics of ramipril. Clin Pharmacokinet. 1994 Abstract

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