Ramipril

Ramipril is a commonly prescribed medication that is used to treat high blood pressure (hypertension) and heart failure. You may also be given this medicine after a heart attack to prevent further damage to your heart and blood vessels. Ramipril is available as tablets, capsules, or liquid in doses of 1.25mg, 2.5mg, 5mg, and 10mg.

It is a type of medication called an angiotensin-converting enzyme inhibitor (ACE inhibitor). It is also available in the UK as Tritace® and in combination with another blood pressure medicine, felodipine, as Triapin®.

Your doctor may prescribe ramipril for a number of reasons including:

• to treat high blood pressure (hypertension)
• to reduce your risk of having a heart attack or stroke
• to reduce your risk of developing kidney problems
• to treat heart failure (when your heart can’t pump enough blood around your body)
• to prevent further damage to your heart and blood vessels after a heart attack

Ramipril works by stopping your body from producing a hormone called angiotensin II. This relaxes and widens your blood vessels, which lowers your blood pressure and allows your heart to pump blood around your body more easily.

• Take your tablet once or twice a day as directed by your doctor.
• Swallow your tablet or capsule whole with a glass of water.
• If you are taking the liquid, measure the dose carefully using the spoon or syringe that comes with the medication. If you don’t have the correct measuring device, ask your pharmacist for one. Never try to guess the correct amount.
• It is a good idea to take your first dose of ramipril at bedtime. This is because ramipril can make you feel dizzy when you first start taking it. After this, you can take ramipril at any time of the day but try to take it at the same time every day.
• You can take ramipril with or without food.
• If you feel dizzy after taking ramipril, avoid sitting or standing up too quickly to reduce the risk of falls.

Always take your medication exactly as your doctor tells you to and read the patient information leaflet carefully before starting a new medication. Ask your doctor or pharmacist if you have any questions.

Dosage

The dose of ramipril you need to take depends on what you are taking it for. Your doctor will tell you how much ramipril to take and how often. The usual starting dose of ramipril is 1.25mg or 2.5mg once a day. This is increased gradually over the next few weeks until you have reached the correct dose.

• For high blood pressure, the usual dose is 2.5 to 5mg once a day.
• For heart failure, or after a heart attack, the usual dose is 5mg twice a day, or 10mg once a day.
• For kidney disease (nephropathy) the usual dose is 5mg or 10mg once a day.

The maximum dose of ramipril is 5mg twice a day or 10mg once a day.

What if I forget to take ramipril?

If you miss a dose of ramipril and it’s still the same day, take it as soon as you remember. If it’s already the next day, skip the missed dose and take your next dose at the usual time. Never take 2 doses together to make up for the missed dose.

What if I take too much ramipril?

Taking too much ramipril can make you feel dizzy, or sleepy and make your heartbeat feel fast or irregular. If you have taken too much ramipril, call 111 or your doctor for advice. If you need to go to hospital, do not drive yourself. Take the medication packet or bottle with any remaining medication with you.

How quickly does ramipril work?

Ramipril starts to work within a few hours of taking it, but it may take a few weeks for your blood pressure to stabilise. If you have been prescribed ramipril for heart failure, it may be several weeks, or months before you start feeling better.

Ramipril is a highly effective medication and one of the first treatment options for people with high blood pressure, and those at risk of cardiovascular disease.

If ramipril doesn’t work as well as it should or isn’t suitable for you to take, there are alternative medications available. Talk to your GP about which treatment may be best for you.

Ramipril may not be safe for you to take if you:

• are allergic to ramipril, other ACE inhibitors, or any of their ingredients
• have ever had a severe allergic reaction that caused swelling of the face, tongue, throat, hands, and feet, itchy rash, difficulty breathing or swallowing (angioedema)
• are currently having kidney dialysis or blood filtration
• are pregnant or breastfeeding
• have low or unstable blood pressure
• have problems with your heart, liver, or kidneys
• have diabetes
• have recently had diarrhoea or vomiting
• follow a low-salt diet
• have a blood disorder where you don’t have enough white blood cells (neutropenia or agranulocytosis)

While most people can take ramipril, it is not suitable for everyone. Always tell your doctor about any health conditions, allergies, and any other medications you are taking before taking ramipril.

Like all medications, ramipril may cause side effects in some people. Most side effects are mild and go away without treatment and many people don’t have any side effects at all.

Common side effects of ramipril include:

• dry tickly cough
• dizziness or feeling lightheaded
• headaches
• nausea (feeling sick)
• vomiting (being sick)
• diarrhoea
• blurred vision
• mild skin rash

If you experience mild side effects and they are bothering you, getting worse, or not going away, talk to your GP.

Rarely, ramipril can cause serious side effects.

Call 111 or your doctor immediately if you experience:

• yellowing of the skin or the whites of the eyes —this could be a sign of liver problems
• feeling weak, tired, or dizzy, with pale skin, a sore throat, fever, and unexplained bruising or bleeding (like bleeding gums or nosebleeds) — these may indicate a blood or bone marrow disorder
• severe stomach pain and vomiting — may be a sign of an inflamed pancreas (acute pancreatitis)
• swollen ankles, blood in your pee, peeing less than usual, or not peeing at all —could indicate kidney problems

Call an ambulance or go to hospital immediately if you have:

• weakness on one side of your body, slurred speech, difficulty speaking, blurred vision, and poor balance —could be signs of a stroke
• chest pain or tightness, fast heartrate —could indicate heart problems
• difficulty breathing, noisy breathing, and chest tightness —could be signs of lung problems
• swelling of the face, lips, tongue, and throat, difficulty breathing, and rash —could be signs of a serious allergic reaction called anaphylaxis

For a full list of side effects, read the patient information leaflet that comes with your medication.

Are there any long-term side effects?

Taking ramipril for a long time can sometimes cause problems with your kidneys. Your doctor will check your kidney function with regular blood tests while you are taking ramipril.

Some medications interact with each other, which can make side effects worse or change the way your medication works. Tell your doctor or pharmacist about any other medications including over-the-counter medicines, vitamins, and supplements before you start taking ramipril.

Medications that may interact with ramipril include:

• non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, indomethacin, or aspirin for pain relief (low dose aspirin (75mg) is fine)
• medicines to treat low blood pressure such as aliskiren
• medicines used to treat high blood pressure, shock, heart failure, asthma, or allergies such as ephedrine, noradrenaline, and adrenaline
• some antidepressants, medicines for chest pain (nitrates), muscle relaxants (baclofen), anaesthetics, and medicines for enlarged prostate
• medications that suppress your immune system like tacrolimus and cyclosporin
• medicines that make you pee more often (diuretics) including furosemide
• medications that increase the amount of potassium in your blood such as potassium supplements, spironolactone, triamterene, amiloride, trimethoprim, and heparin.
• steroids such as prednisolone
• medications for gout like allopurinol
• procainamide used to treat heart rhythm disorders
• some medicines for diabetes
• lithium, a medication for mental health problems

Ramipril and ibuprofen

Ibuprofen is an over-the-counter medication that is commonly used to treat pain and inflammation. Taking ramipril and ibuprofen together may make ramipril less effective at lowering blood pressure. It can also damage your kidneys. If you take ramipril, talk to your doctor about using an alternative to ibuprofen.

Ramipril and coffee

Ramipril can increase the amount of potassium in your blood and coffee is high in potassium. It is best to avoid drinking a lot of coffee while taking ramipril.

Ramipril and alcohol

Drinking alcohol can increase some of the side effects of ramipril like feeling lightheaded or dizzy. It is best to avoid alcohol when you first start taking ramipril, and for a few days after your dose has been increased to see how the medication affects you. If you experience dizziness as a side effect of ramipril, it’s best to avoid alcohol.

Ramipril and Viagra

Sildenafil (Viagra) can increase the effects of ramipril and may cause your blood pressure to get too low. If you take Viagra, and experience symptoms of low blood pressure such as feeling dizzy, headaches, or a fast heart rate, talk to your GP.

If ramipril isn’t the right medication for you, there are many alternatives available.

Some medications your doctor may prescribe as an alternative to ramipril include:

• other ACE inhibitors like enalapril, lisinopril, and perindopril that work in the same way as ramipril
• calcium channel blockers like amlodipine
• angiotensin receptor blockers (ARBs) like candesartan
• beta-blockers such as bisoprolol
• diuretics (medicines that make you pee more than usual) like bendroflumethiazide

Talk to your GP about which medication is best for you.