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British Heart Foundation
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Alternatives to Ramipril

i have been taking ramipril since August when I had a NSTEMI and one stent fitted. A month ago dose increased from 2.5mg to 5mg a day. From the beginning I have suffered with the usual dry cough, but since the increased dose I am having trouble getting to sleep and am feeling exhausted as a result. GP says this is a rare but known side effect. I have agreed to stick with Ramipril until the New Year, if it doesn't improve will try changing to another ACE inhibitor. Has anyone out there any experience of alternative ACE inhibitors with less side effects. Any suggestions gratefully received

Alix

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Hi, hubby had the same problem, cardiac nurse suggested Canderstartan. No problems now.

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Thanks for the suggestion. Will discuss with GP

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I came off ramipril as it was making me ill. I switched to candesartan and I’m still using that, two years later.

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Hi Alix, I had the same problem with Ramipril and my gp changed me to Losartan and I’m fine with that. The tickly cough is a common side effect of Ramipril and it is so annoying isn’t it! You’re more patient than me, I lasted three months before I got it changed, I was knackered!

Wendy

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Losortan seems to be one that people are happier on which is useful to know. I will discuss with GP. It's not the cough that is getting me Down I could cope with that. It is this weird effect that stops me getting to sleep and it's not due to the cough.

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Hi

I was taking Ramipril when first diagnosed , it gave me a cough and my GP changed me to Losartan This worked better for me

X

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Hi Hainses I take Lisinopril and that works for me. It maybe a case of trial and error to get the best one for you. Hope you find a suitable one soon. Take care. Zena

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Thanks Zena. I think you are right about trail and error,but it is really useful to hear what has worked for other people.

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the cough and other side effects are a common problems with most b.p meds.

i tried Canderstartan and eventually it gave me chest pain from front through to back and resulted in collapse.

i went under a cardiologist who had no answers my doctor then came up with a last resort called moxonidine and am pleased to say not one side effect.

the above has now been increased to maximum and still nothing, it is well worth asking about for those who have tried the regular known ones and having problems.

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I too had Ramipril but had cough, so changed to Losartan with no issues.

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Seems like another vote for Losartan.

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I'm in exactly the same position as you Alix, Ramipril dose increased from 2.5mg to 5.0mg and now experiencing some side effects, What's more, my doctor, like yours, is encouraging me to stick with it for a little longer to see if I can acclimatise myself to Ramipril at the higher level.

If you search "Ramipril" on this forum you'll find a few cases where doctors have told people that Ramipril is the best option, and the alternatives aren't quite as effective, not just in terms of lowering blood pressure but also in other heart related areas like reducing inflammation. I asked my doctor straight out if Ramipril is the best and he was evasive. I suspect he actually does believe Ramipril has the edge, but he doesn't want to unduly influence me because his biggest concern is that a patient, if they feel coerced, may stop taking their medication, and that of course would be the worst outcome of all.

This is purely speculation on my part, although it does fit all the facts. So, I'm going to stick with Ramipril for a good few weeks or even months yet. If Ramipril has any advantage, no matter how slight, then I'm not going to throw that away without fully exhausting the option of natural acclimatisation over time.

There's also the matter of building a relationship of mutual trust with my doctor. I've never really been ill before so we're largely strangers to each other. Therefore, I'd like to take this opportunity to demonstrate that I won't come to hasty judgements, and will give any medication he prescribes a decent length of time to prove itself.

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I was the same as you when I was put on nitrates,they gave me terrible headaches so I changed to something else but felt I had made a mistake as the nitrate helped my chest more so now I am back on nitrate hoping my body will get used to it over a period of time

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Thanks for this reply. I agree with you that's why I am sticking with Ramipri for the moment. I must look up research into various Ace Inhibitors efficacy. Want to take best drug but I can deal with usual Ramipril cough but this latest side effect of difficulty in getting to sleep (not due to cough) means I am exhausted and not exercising as much as I would like which will obviously also impact on my health.

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I don't think you 'acclimatise' to Ramipril. I've been on 7.5mg for 6 years and still have the cough....but it's manageable and doesn't keep me awake etc.

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Hi . I'm also on ramipril and have a cough that makes me heave . the doctors sent that botherd but I want to change onto something else .I also take aspirin , dioxagen, alamapine, and lansaprole.

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Ramipril cough isn’t uncommon it’s very common. ☹️ My husband had the cough & it’s horrid. So irritating. He’s now on Enalapril. Just go back to GP & ask for another type. It won’t help recovery if you’re shattered. Good luck.

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I know the cough is very common and can cope with that although it is very irritating! It is the separate and new side effect of not being able to get to sleep that I am struggling with. It's not due to the cough and is very weird. Thanks for your good wishes.

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I’m on Ramipril and it was increased from 1.25 to 2.5 morning and evening. Started to become breathless, heart flutters, chest pains and just feeling exhausted. Initially thought it was a virus I had picked up and then it became so bad the doc sent me to hospital, but all checks came back fine. So he took me off the Ramipril completely for 10 days and then got me to reintroduce at 1.25 evening only. Towards the end of the 10 days felt great all symptoms gone and was able to get on with life etc. But after a few days back on symptoms have come back, primarily chest pains and breathlessness. Will go back to GP in the new year and see what the alternatives are, but in the meantime I have come off the Ramipril.

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So interesting - when my dose increased I had similar problems GP said categorically not ramipril..... it wasn’t in her guidelines as possible side effect but I’m sure it was dose change that resulted in my chest discomfort and generally feeling below par! I was told it was angina despite never presenting with chest pain as a symptom in the past 😕

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My lovely Cardiac Nurse said the same when I initially reported the symptoms to her . So we/I persevered... but I honestly could not continue much longer with those symptoms it is/was debilitating . Are you still on Ramipril Susie?

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I still feel ‘different to before’ if that makes sense but holding off on the next dose increase as my BP whilst considered high for my history (135/75) isn’t overly concerning to GP so blood test and dose increase in the New Year. It is frustrating in that if it wasn’t written down it couldn’t be happening but I have read chest pain isa reasonably common side effect of ACE inhibitors (NICE guidelines). I had the cough at the beginning but that’s not a problem for me but they are keen to continue ramipril - I’ll see how I go - thanks for posting

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Try candesartin, I had similar symptoms now ok

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I managed to my Dr to change mine from Ramipril to 5mg Amlodipine. Feel much better now, but with so many meds it is sometimes difficult to put your finger on the one that is giving the side effects.

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I also had problems with Ramipril and had to change to Candesartan although it is not, I believe, an ACE inhibitor. IT works in a different way.

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A Polish medical study found that amongst the 323 patients reporting a cough, only 63 still had the cough when the researchers re-contacted them up to eight weeks later. Maybe this is the source for the previously reported advice that some of us have received from our doctors? Namely to stick it out for two or three months before ditching Ramipril. You can read the original research here,

ncbi.nlm.nih.gov/pmc/articl...

Another interesting piece of research is one from the Seoul Medical Centre in Korea. They found that taking a dietary iron supplement resulted in 80% of patients reporting the "Ramipril Cough" the symptoms were either reduced or cured. This is particularly relevant as it's very common following heart surgery for patients to have reduced iron levels. I was prescribed iron supplements when I first started taking 2.5mg Ramipril and had no side effects, but I'd stopped taking the iron supplements by the time my Ramipril dose was increased to 5mg and the cough/tickly throat/hoarseness first occurred. Maybe I'll try temporarily reintroducing the iron supplements if the side effects don't subside naturally after 8-12 weeks? You can read more here,

sciencedaily.com/releases/2...

Finally, I have read reports that clearly say all ACE Inhibitors have the risk of the cough side effect, not just Ramipril. So if your doctor moves you off Ramipril as a result of side effects then he/she may be moving you away from the entire family of ACE inhibitors and onto an alternative class of medication. If correct this would add to the concern that by switching away from Ramipril you're possibly getting less effective treatment.

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Thanks for the links. I had seen the research about iron and take a multivit with iron which helps. It's the insomnia that is getting to me. ncbi.nlm.nih.gov/pmc/articl... seems to suggest ramipril is best at least in terms of heart failure. Certainly ACE inhibitors seem more effective than ARBs. I have to suggest to GP I try the next most effective one of the insomnia persists. The cough I can live with

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i would say that changing from one b.p med to another doesn't mean it is less effective i tried numerous ones and the one i am now on moxonidine gives me good readings without my b.p meds it can go over 200 but on it an average from a week of readings including the sitting and standing is around 140 to 130 so it shows what a massive difference it makes.

if people on here search the web there are endless comments about the side affects of b.p meds.

in the end if something doesn't agree then don't just tolerate it try and see if something else works.

my doctor in the end admitted that nearly all b.p meds can cause some undesired side effects and this is something coming from a doctor most like someone mentioned here seem to avoid the subject but why?

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Hi hainses

I've been on Ramipril for some time for AF, gradually increasing from 2.5 to 10mgs/day. From the start and each time I've increased the dose I've experienced some side effects. Tickle in throat, but mostly only when I first lie down in bed, occasional dizziness when first standing up, difficulty getting to sleep, weird dreams, and one brief bout (one day) of diarrhoea. But these have all been tolerable and reduced shortly after the initial dose change, so I persevered with it and the initial side effects have all but disappeared now I'm used to the recommended 10mg/day dose. Also take Apixaban 5mgx2 which dispersed a clot in one of my ventricles which had been caused by the AF, Bisoprolol 2.5 and Amiodarone for the last 4 weeks, 200mg after first 2 week's loading period. After a contrast echocardiogram to confirm the clot had gone the Amiodarone was prescribed to prepare me for a DC cardioversion which I had 4 days ago and which has returned my heart to a regular rhythm after just one shock under a very short general anaeshetic (5min). Fingers crossed it now stays that way!

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I've been on 5mg Ramipril for a few years now. Hubby once asked why I keep coughing! It's a very occasional dry tickly cough that affects me a few times some days or nights but isn't too bad, although sometimes it's irritating. I would rather this than the awful effects that felodipine caused - painful swollen, bleeding gums and swollen ankles! That's why I'm reluctant to try alternatives.

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NICE admit ramipril has this side effect and advises to change to other ACE. It also states that some of us react badly to ACE and should go onto ARB.

I went from ramipril to losartan (arb) and stopped all side effects.

If you change your have NICE on your side.

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I see that several people have recommended Losartan, and I second that. And as others have also said countering your GP’s comment that it’s a “rare” side effect - a cough is actually quite a common side effect to Ramipril, I have been told a number of times.

I too had a bad cough, yet my cardiologist insisted on keeping me on Ramipril. He dismissed my concern, so I kept on plugging on with the cough.

Because I am prone to bronchitis when I get a bad cold which started from when I was a child and I had a bad illness etc., I figured it was probably that tendency of mine and so I put up with it.

However, then I moved to a city known for its cardiology care (which I did not know at the time of my relocating), and my cardiologist immediately picked up on the cough - and promptly prescribed Losartan whuch he described as a fine alternative, etc.

I take a good number of other cardiac meds with it.

Losartan has worked well, and my cough went away quickly. (I changed over to Losartan about a year ago, as I am recalling.)

So for the reasons I have noted above, I highly recommend that you give it a go.

FYI here’s a link from the NHS for an overview of Losartan:

nhs.uk/medicines/losartan/#

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Thanks to your post I now know what is causing the racking dry cough I have noticed ever since my HA. I take 10mg Ramipril a day, have done for months now, never noticed the cough before as prior to HA in October I was a smoker and just put the cough down to the usual smokers cough, but being cigarette free for 10 weeks now the smokers cough has cleared but still have this strange dry racking cough.

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Ramipril is awful. I've had a dry cough since ice been on it ( 1 yr or so) .doctor said it was a side effect and did check my chest for infection which I didn't have .

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I had to change due to the same problems.

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