Ramipril

[Wiggler]

Hi,

I think I read on one of the threads about high blood pressure tablets.

I’ve just been started on Ramipril 2 weeks ago & have started to feel the bedtime symptoms returning. No other obvious changes to my routine. I may have just answered my own question but any advice on this or any alternatives if this is a trigger?

Thanks as always.

[SueJohnson]

It is an ACE inhibitor type medication - unknown whether safe or not for RLS - If taking pregabalin watch out for symptoms of angioedema - swelling of the face, eyes, lips, tongue, throat. It raise potassium levels so should be checked.

Some medicines that are safe for high blood pressure are propranolol (Inderal, Hemangeol, InnoPran) a beta blocker that may help RLS, Isosorbide Mononitrate (Monoket, Imdur) which is not a beta blocker nor calcium channel blocker. Other possibilities are: Clonidine (Catapres) an Alpha-2-Agonist used to treat high blood pressure which may help RLS and which also treats insomnia, tenex (Guanfacine, Intuniv), prazosin (Minipress) an alpha-adrenergic blocker that is also useful in managing sleep-related problems caused by PTSD and Tadalafil a vasodilator that in one study completely eliminated RLS. Clonidine can actually help RLS. Discuss these with your doctor. And then there is reducing salt by 1 teaspoon a day nih.gov/news-events/nih-res....

[Wiggler in reply to SueJohnson]

Many thanks for this Sue & the GP hadn’t mentioned anything about it’s potential reaction with Pregabalin so good to know.

[ChrisColumbus]

I've not tried ramipril but I was on perindopril, another ACE inhibitor, and that may have been a mild RLS trigger - but the main reason I came off it was because it gave me an intermittent but persistent cough. Ramipril has similar side effects.

I was moved on to losartan, an ARB: 25 mg /day wasn't enough to totally control my BP but 50 mg/day was - and I've been largely RLS symptoms free for the last 2 years (unless I binge on something sweet). There have been reports that losartan can also exacerbate RLS, but not in my case.

[SueJohnson in reply to ChrisColumbus]

ARB's can also raise potassium levels so should be checked.

[ChrisColumbus in reply to SueJohnson]

Yes, losartan is actually Losartan Potassium.The PIL says:

Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines.

Tell your doctor if you are taking potassium supplements, potassium-containing salt substitutes,

potassium-sparing medicines such as certain diuretics (amiloride, triamteren, spironolactone), or other medicines that may increase serum potassium (e.g., heparin, trimethoprim-containing medicines), as the combination with Losartan potassium is not advisable.

Take particular care if you are taking the following medicines while under treatment with Losartan Potassium:

other blood pressure lowering medicines as they may additionally reduce your blood pressure.

Blood pressure may also be lowered by one of the following drugs/ class of drugs: tricyclic

antidepressants, antipsychotics, baclofene, amifostine,

non-steroidal anti-inflammatory drugs such as indomethacin, including cox-2-inhibitors (medicines that reduce inflammation, and can be used to help relieve pain) as they may reduce the blood pressure lowering effect of losartan.

Your doctor may need to change your dose and/or to take other precautions:

If you are taking an ACE-inhibitor or aliskiren (see also information under the headings “Do not take

Losartan potassium” and “Warnings and precautions”).

If your kidney function is impaired, the concomitant use of these medicines may lead to a worsening of the kidney function.

Lithium containing medicines should not be taken in combination with losartan without close supervision by your doctor. Special precautionary measures (e.g. blood tests) may be appropriate.

Etc.

[ChrisColumbus in reply to SueJohnson]

But of course all these prescription drugs have similarly long lists of ifs and buts: to a certain extent we have to trust doctors, but then read the packet PIL: my doctor didn't warn be about taking NSAIDs with losartan, but it's in the PIL...

[Wiggler in reply to ChrisColumbus]

Thanks for the comprehensive details. I think I have some self education to do!

[ChrisColumbus in reply to Wiggler]

Losartan works for me: your doctor should be able to tell you whether this or any of the alternatives that Sue lists are suitable for you. Good luck.