Ramipril vs. Benazepril

See how Ramipril and Benazepril compare on approved uses, dosing, side effects, and cost.

Key Takeaways

  • Ramipril and benazepril are both ACE inhibitors that relax blood vessels to lower blood pressure, but ramipril also carries FDA approvals for heart attack, stroke, and heart failure prevention.

  • Benazepril is FDA-approved for children as young as six with high blood pressure, while ramipril is approved for adults only.

  • Both drugs share headache and dizziness as common side effects, though the exact rates and other reactions differ between the two FDA labels.

Ramipril vs. Benazepril Drug Summary

Ramipril

Ramipril is an ACE inhibitor used to treat high blood pressure. It is also FDA-approved to lower the risk of heart attack, stroke, or cardiovascular death in high-risk adults 55 and older, and to treat heart failure that develops after a heart attack. It is taken by mouth once daily, starting at a low dose that is increased over several weeks.

Benazepril

Benazepril is an ACE inhibitor used to treat high blood pressure in adults and in children age six and older. It works by relaxing blood vessels, which lowers the pressure the heart has to pump against. It is taken by mouth once daily, typically starting at 10 mg and adjusted based on blood pressure response.

Ramipril vs. Benazepril Side Effects

Ramipril

Most common
Headache (up to 5.4%)
Dizziness (up to 2.2%)
Cough (up to 7%)
Fatigue (up to 2.0%)

Benazepril

Most common
Headache (up to 6%)
Dizziness (up to 4%)
Somnolence (up to 2%)
Postural dizziness (up to 2%)

Ramipril vs. Benazepril Dosage

Ramipril

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 2.5 mg once daily At the start
Maximum dose Up to 20 mg once daily If needed
Dose changes 3 increases As tolerated

Benazepril

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 5 mg once daily At the start
Maximum dose 0.6 mg/kg once daily If needed
Dose changes 6 increases As tolerated

Ramipril vs. Benazepril Indications

Ramipril

Ramipril treats high blood pressure, but its FDA approval goes further. It also reduces the risk of heart attack, stroke, or cardiovascular death in adults 55 and older at high risk, and it treats heart failure that develops after a heart attack.

  • Treats high blood pressure

  • Lowers risk of heart attack, stroke, or cardiovascular death in high-risk adults 55+

  • Treats heart failure following a recent heart attack

  • Can be used alone or with a thiazide diuretic

Benazepril

Benazepril treats high blood pressure in adults and in children age six and older. It is not approved for reducing heart attack or stroke risk or for treating heart failure, so its approved use is limited to blood pressure management.

  • Treats high blood pressure in adults

  • Approved for children age 6 and older with hypertension

  • Can be used alone or with a thiazide diuretic

  • Not approved for heart attack, stroke, or heart failure risk reduction

Ramipril vs. Benazepril Pros and Cons

Ramipril

Ramipril's clinical profile extends beyond blood pressure control, with FDA approval to cut cardiovascular risk in high-risk adults and to treat heart failure after a heart attack. As a long-available generic, it is inexpensive and widely covered by insurance.

Pros

  • FDA-approved to reduce risk of heart attack, stroke, and cardiovascular death, not just lower blood pressure

  • Also approved for heart failure following a heart attack

  • Backed by the large HOPE cardiovascular outcomes trial

Cons

  • Only available as a capsule, not a tablet

  • Not approved for use in children

  • Heart failure dosing requires twice-daily dosing, which is less convenient

Benazepril

Benazepril's clinical profile is narrower, approved only for blood pressure control in adults and children six and older. As a long-available generic, it is also inexpensive and widely covered, with tablet dosing some patients find easier to manage.

Pros

  • Approved for children age 6 and older with high blood pressure

  • Available as a tablet, which some patients find easier to swallow or split

  • Straightforward once-daily dosing across all approved ages

Cons

  • Only approved for blood pressure control, without ramipril's added heart attack, stroke, or heart failure indications

  • Slightly higher rates of dizziness and somnolence reported in trials

  • Discontinuation due to side effects occurs in about 5% of patients versus 3% on placebo

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