RAMIPRIL

Fetal Risk Summary

Ramipril is an angiotensin-converting enzyme (ACE) inhibitor. Reproduction studies in rats, rabbits, and monkeys at doses 400, 2, and 400 times, respectively, the recommended human dose on a body surface area basis revealed no teratogenic effects (1).

No reports of the use of this agent in human pregnancy have been located, but this class of drugs should be used with caution, if at all, during gestation. Use of ACE inhibitors limited to the 1st trimester does not appear to present a significant risk to the fetus, but fetal exposure after this time has been associated with teratogenicity and severe toxicity in the fetus and newborn, including death. See Captopril or Enalapril for a summary of fetal and neonatal effects from these agents.

[*Risk Factor DM if used in 2nd or 3rd trimesters.]

Breast Feeding Summary

No reports describing the use of ramipril during lactation have been located. The molecular weight (about 417) is low enough, however, that excretion into breast milk should be expected. Other ACE inhibitors are excreted into breast milk, but the American Academy of Pediatrics considers them compatible with breast feeding (see Captopril and Enalapril).

Reference