Last update July 31, 2018

Ramipril

Low Risk

Moderately safe. Probably compatible. Mild risk possible. Follow up recommended. Read the Comment.

Ramipril and its active metabolite Ramiprilat are angiotensin converting enzyme inhibitors (ACEI) used in the treatment of 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 a dose of ramipril, but since the last update we have not found other published data on its excretion in breastmilk.

Other compounds from the same group (ACEI) are not excreted in breastmilk in significant amounts, but until there is more information about this drug in relation to breastfeeding, safer known alternatives are preferable (Anderson 2018, Hale 2017 p830, Malachias 2016).

Due to its possible renal toxicity in preterm 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. Compatible. Minimal risk for breastfeeding and infant.)
  • Enalapril ( Safe. Compatible. Minimal risk for breastfeeding and infant.)

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

Your contribution is essential for this service to continue to exist. We need the generosity of people like you who believe in the benefits of breastfeeding.

Thank you for helping to protect and promote breastfeeding.

José María Paricio, founder of e-lactancia.

Other names

Ramipril in other languages or writings:

Group

Ramipril belongs to this group or family:

Tradenames

Main tradenames from several countries containing Ramipril in its composition:

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
13 - 17 hours

References

  1. Anderson PO. Treating Hypertension During Breastfeeding. Breastfeed Med. 2018 Abstract
  2. Park S, Choi NK. Breastfeeding and Maternal Hypertension. Am J Hypertens. 2018 Abstract
  3. Hale TW, Rowe HE. Medications & Mothers' Milk. A Manual of Lactation Pharmacology. Springer Publishing Company. 2017
  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) Full text (in our servers)
  5. AEMPS. Ramipril. Ficha técnica. 2016 Full text (in our servers)
  6. 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
  7. FDA (Pfizer). Ramipril. Drug Summary. 2013 Full text (in our servers)
  8. 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
  9. Meisel S, Shamiss A, Rosenthal T. Clinical pharmacokinetics of ramipril. Clin Pharmacokinet. 1994 Abstract

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