Ramipril In Dogs & Cats: Uses, Dosage and Side Effects
Overview
- ACE inhibitor inhibits the conversion of angiotensin I to angiotensin II.
- It also prevents the breakdown of bradykinin.
- These actions lead to vasodilation, reducing both preload and afterload.
- They decrease salt and water retention by inhibiting angiotensin II by lowering aldosterone production.
- ACE inhibitors help prevent cardiac and vascular remodelling caused by chronic hypertension.
- They induce efferent arteriolar dilation in the kidneys, reducing intraglomerular pressure and proteinuria.
Uses of Ramipril
- Treatment of Congestive Heart Failure in Dogs:
- Often used in conjunction with diuretics for maximum effectiveness.
- May be used alongside other heart failure medications such as pimobendan, spironolactone, and digoxin.
- Treatment of Heart Failure in Cats:
- The use of ACE inhibitors in cats with cardiac disease is based on extrapolation from theoretical benefits and studies in other species like dogs and humans, which have shown benefits in heart failure treatment.
- Management of Proteinuria:
- ACE inhibitors can be used to manage proteinuria associated with chronic renal insufficiency, glomerular disorders, and protein-losing nephropathies.
- Caution in Certain Cases:
- ACE inhibitors are more likely to cause or worsen prerenal azotemia in hypotensive animals and those with poor renal perfusion (e.g., acute, oliguric renal failure).
- Use them cautiously if hypotension, hyponatremia, or outflow tract obstruction are present.
Dose of Ramipril in Dogs and Cats
Dogs:
- 0.125 mg/kg p.o. q24h increasing to 0.25 mg/kg p.o. q24h after 2 weeks depending on the severity of pulmonary congestion.
Cats:
- 0.125 mg/kg p.o. q24h increasing to 0.25 mg/kg p.o. q24h for systemic arterial hypertension.
Drug Dosage Calculator
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Side Effects of Ramipril in Dogs and Cats
- Potential Adverse Effects:
- Hypotension (low blood pressure)
- Hyperkalemia (elevated blood potassium levels)
- Azotemia (elevated levels of nitrogenous waste products in the blood)
- Rare side effects may include anorexia, vomiting, and diarrhoea.
- Monitoring Recommendations for Heart Failure Cases:
- Regularly monitor blood pressure, serum creatinine, and electrolyte levels when using ACE inhibitors for heart failure.
- If signs of hypotension are observed (e.g., weakness, disorientation), consider reducing the dosage.
- Special Considerations:
- ACE inhibitors are not recommended for breeding, pregnant, or lactating bitches due to the lack of established safety data.
Contraindications of Ramipril in Dogs and Cats
- Do not use in cases of hemodynamically relevant outflow tract obstruction (e.g. valvular stenosis, obstructive hypertrophic cardiomyopathy).
Some Notes:
- Potential for Hyperkalemia:
- When used alongside potassium-sparing diuretics (e.g., spironolactone) or potassium supplements, there is a risk of hyperkalemia (elevated blood potassium levels).
- Safety with Spironolactone:
- Despite the risk of hyperkalemia, in practice, spironolactone and ACE inhibitors are often used concurrently for managing certain conditions.
- Interaction with NSAIDs:
- There may be an increased risk of nephrotoxicity and reduced clinical effectiveness when ACE inhibitors are used concurrently with non-steroidal anti-inflammatory drugs (NSAIDs).
- Risk of Hypotension:
- When administered with diuretics, vasodilators (such as anesthetic agents or antihypertensive medications), or negative inotropes (such as beta-blockers), there is a potential risk of hypotension (low blood pressure).
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