# Ramipril: veterinary dose and monograph

> Ramipril is a veterinary cardiovascular drug. A long-acting ACE inhibitor (a veterinary-licensed product, Vasotop, exists) used for congestive heart failure, systemic hypertension and proteinuric kidney disease in dogs and cats — once-daily dosing and the same RAAS-blocking benefits… Indications include congestive heart failure (with diuretics ± pimobendan); systemic hypertension; proteinuric chronic kidney disease / protein-losing nephropathy. This monograph lists 3 reference doses for dogs, cats and horses, each with route, frequency and source.

Source: https://vetmasterji.com/drugs/ramipril · Last reviewed: 2026-10-01

## 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

*Ramipril doses for dogs*

| Indication | Dose | Route | Frequency | Duration |
| --- | --- | --- | --- | --- |
| CHF / hypertension / proteinuria | 0.125–0.25 mg/kg | PO | q24h | — |

- 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

*Ramipril doses for cats*

| Indication | Dose | Route | Frequency | Duration |
| --- | --- | --- | --- | --- |
| Hypertension / CKD proteinuria | 0.125 mg/kg | PO | q24h | — |

- 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

*Ramipril doses for horses*

| Indication | Dose | Route | Frequency | Duration |
| --- | --- | --- | --- | --- |
| Congestive heart failure (anecdotal) | 0.2 mg/kg | PO | q24h | — |

- 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

> **Caution:** 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

> **Caution:** 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](https://vetmasterji.com/drugs/pimobendan)
- [Procainamide](https://vetmasterji.com/drugs/procainamide)
- [Propranolol](https://vetmasterji.com/drugs/propranolol)
- [Quinidine](https://vetmasterji.com/drugs/quinidine)
- [Sildenafil](https://vetmasterji.com/drugs/sildenafil)
- [Sodium Nitroprusside](https://vetmasterji.com/drugs/nitroprusside)
- [Sotalol](https://vetmasterji.com/drugs/sotalol)
- [Telmisartan](https://vetmasterji.com/drugs/telmisartan)

## Frequently asked questions

### What is the dose of Ramipril for dogs?

Reference doses for Ramipril in dogs: 0.125–0.25 mg/kg PO q24h (CHF / hypertension / proteinuria). Confirm against the label and the patient before use.

### What is the dose of Ramipril for cats?

Reference doses for Ramipril in cats: 0.125 mg/kg PO q24h (Hypertension / CKD proteinuria). Confirm against the label and the patient before use.

### What is the dose of Ramipril for horses?

Reference doses for Ramipril in horses: 0.2 mg/kg PO q24h (Congestive heart failure (anecdotal)). Confirm against the label and the patient before use.

### When should Ramipril not be used?

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.

### What are the side effects of Ramipril in animals?

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

## Sources

- Plumb's Veterinary Drug Handbook
- Merck Veterinary Manual, 11th edition
- Papich, Papich Handbook of Veterinary Drugs, 5th edition

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VetMasterJi is a clinical decision-support and education platform for veterinary professionals and students. It does not provide veterinary advice, diagnosis or treatment for specific animals. All drug doses, calculators and differentials are references that must be independently verified before clinical use; the attending registered veterinarian remains solely responsible for every clinical decision.