Ramipril: veterinary dose and monograph

At a glance

Drug class

Cardiovascular

Also known as

Cardace, Ramistar, Vasotop

Species with doses

Dogs, Cats and Horses

General dose range

0.125–0.25 mg/kg PO q24h — check the species tables for the indication

Routes

PO

Last reviewed

1 October 2026

Indications

• Congestive heart failure (with diuretics ± pimobendan)
• Systemic hypertension
• Proteinuric chronic kidney disease / protein-losing nephropathy
• Afterload reduction in myxomatous mitral valve disease

Ramipril dose by species

Doses are per administration unless stated. mg/kg doses scale with body weight; per-animal, per-quarter and infusion-rate doses are shown as the reference writes them.

Dogs

• CHF / hypertension / proteinuria: Papich 5e: 0.125–0.25 mg/kg PO once daily, to a maximum of 0.5 mg/kg/day. Plumb’s p.1038 (Vasotop label): heart failure — start 0.125 mg/kg once daily, increase to 0.25 mg/kg by severity. Recheck creatinine and potassium after starting, especially with diuretics.

Cats

• Hypertension / CKD proteinuria: Papich 5e and Plumb’s p.1038 (Graff & Herve 2003): 0.125 mg/kg PO once daily. Monitor renal values and potassium.

Horses

• Congestive heart failure (anecdotal): Plumb’s p.1038 (Giguere 2008): 0.2 mg/kg PO once daily has been used on anecdotal evidence; pharmacokinetic studies are lacking. Papich 5e reports no large-animal dose.

Contraindications

Bilateral renal artery stenosis, pre-existing hypotension, dehydration/hypovolaemia, hyperkalaemia, and outflow-tract obstruction. Pregnancy (ACE-inhibitor fetotoxicity). Caution with other RAAS drugs/diuretics; known ACE-inhibitor hypersensitivity.

Species-specific warnings

Cats: Monitor renal values closely in CKD cats; azotaemia/hyperkalaemia can occur, especially with dehydration.

Adverse effects

• Hypotension (especially first dose with diuretics)
• Azotaemia / reduced GFR
• Hyperkalaemia
• GI upset (vomiting, inappetence)
• Rare cough/weakness

Drug interactions

• Diuretics (furosemide): additive hypotension/pre-renal azotaemia — start low, monitor
• Potassium-sparing diuretics (spironolactone)/K supplements: hyperkalaemia
• NSAIDs: blunt the effect and increase nephrotoxicity
• Other antihypertensives: additive hypotension

Pregnancy and lactation

Contraindicated in pregnancy — ACE inhibitors are fetotoxic (renal dysgenesis).

Monitoring

• Renal values and potassium at baseline, ~3–7 days after starting/changes, then periodically
• Blood pressure; resting respiratory rate (CHF)
• Urine protein:creatinine in proteinuric patients

Toxicity and overdose

Overdose causes pronounced hypotension, weakness, azotaemia and hyperkalaemia; generally well tolerated within range. First-dose hypotension and renal decompensation (with aggressive diuretics/volume depletion) are the main clinical hazards.

Management: No specific antidote. IV fluids for hypotension (cautiously in cardiac patients), treat hyperkalaemia (calcium gluconate, dextrose/insulin), support renal function; vasopressors if refractory. Monitor renal values and electrolytes.

Clinical pearls

• A once-daily ACE inhibitor (with a vet-licensed form, Vasotop) — interchangeable in role with enalapril/benazepril; pick by availability and renal-clearance considerations
• Expect a small creatinine rise on starting; a stable mild increase is acceptable — recheck and adjust if it climbs
• Combine cautiously with furosemide (start low) and stop/reassess if the patient becomes dehydrated or anorexic
• Cornerstone of CHF (with pimobendan + diuretic) and of proteinuria management

Mechanism of action

Ramiprilat (the active metabolite) inhibits angiotensin-converting enzyme, blocking formation of angiotensin II and reducing aldosterone — producing arteriolar/venous dilation (reduced afterload/preload), lower blood pressure, reduced sodium/water retention, and lower intraglomerular pressure (decreasing proteinuria and slowing renal injury). Reduced bradykinin breakdown adds to vasodilation. Long half-life allows once-daily dosing.

Formulations and products

• 1.25 mg tablet (Vasotop, vet)
• 2.5 / 5 mg tablet (human)
• Vasotop (MSD Animal Health) — 0.625 / 1.25 / 2.5 / 5 mg tablet, Tablet
• Cardace — 1.25 / 2.5 / 5 mg tablet, Tablet (human-label)
• Ramistar — 2.5 / 5 mg tablet, Tablet (human-label)

Storage

Tablets: 15–30 °C, dry, protect from light.

Before you use this dose

Reference doses for veterinary professionals. Confirm the dose against the product label, the patient’s condition, current guidance and local regulations before use; the attending veterinarian remains responsible for every clinical decision.

Other cardiovascular drugs

• Pimobendan
• Procainamide
• Propranolol
• Quinidine
• Sildenafil
• Sodium Nitroprusside
• Sotalol
• Telmisartan

Frequently asked questions