Ramipril is a medicine widely used to treat high blood pressure (hypertension) and heart failure. It's also prescribed after a heart attack.
Ramipril helps prevent future strokes, heart attacks and kidney problems. It also improves your survival if you're taking it for heart failure or after a heart attack.
It works by widening your blood vessels and making it easier for your heart to pump blood around your body.
This medicine is available on prescription. It comes as tablets, capsules and as a liquid that you swallow for people who find it difficult to swallow tablets.
Ramipril is also available combined with another blood pressure medicine called felodipine. This combined medicine is called by the brand name Triapin.
Who can take ramipril
Most adults aged 18 and over can take ramipril.
If you have diabetes, check your blood sugar (glucose) more often, particularly in the first few weeks. This is because ramipril can lower the sugar level in your blood.
Who may not be able to take ramipril
Ramipril is not suitable for some people. To make sure it's safe for you, tell your doctor if you:
- have ever had an allergic reaction to ramipril or any other medicine
- are trying to get pregnant, are already pregnant or you're breastfeeding
- are having dialysis or any other type of blood filtration
- have heart, liver or kidney problems
- have unstable or low blood pressure
- have diabetes
- are going to have a major operation (surgery) or general anaesthetic to put you to sleep
- have recently had any diarrhoea or vomiting
- are on a low-salt diet
- are going to have desensitisation treatment to reduce your allergy to insect stings
- have a blood problem such as low white blood cell count (neutropenia or agranulocytosis)
The dose of ramipril you take depends on why you need the medicine. Take it how your doctor tells you to.
To decide the correct dose for you, your doctor will check your blood pressure and ask you if you're getting any side effects from your medicine.
You may also have blood tests to check how well your kidneys are working and the amount of potassium in your blood.
Depending on why you're taking ramipril, the usual starting dose is between 1.25mg and 2.5mg once a day.
This will be increased gradually over a few weeks to the usual dose for your condition:
- high blood pressure – 2.5mg to 5mg once a day
- heart failure or after a heart attack – 5mg twice a day or 10mg once a day
- kidney disease (nephropathy) – 5mg or 10mg once a day
Speak to your pharmacist or doctor if you're worried about side effects with ramipril.
The maximum dose is 5mg twice a day or 10mg once a day.
How to take it
You'll usually take ramipril once or twice a day.
Your doctor may suggest that you take your first dose before bedtime because it can make you feel dizzy.
After the very first dose, you can take ramipril at any time during the day. Try to take it at the same time every day.
You can take ramipril with or without food. Swallow ramipril tablets or capsules whole with a drink of water.
If you're taking ramipril as a liquid, it will come with a plastic syringe or spoon to help you measure out the right dose. If you do not have one, ask your pharmacist for one. Do not use a kitchen teaspoon as it will not measure the right amount.
Changes to your dose
You'll probably be prescribed a low dose of ramipril at first so it does not make you feel dizzy.
This will usually be increased gradually until you reach the right dose for you.
When you first start taking it you may be prescribed a pack that contains tablets of 3 different strengths of ramipril (2.5mg, 5mg and 10mg). Your doctor will tell you which strength to take, how often to take it, and when or if you need to increase your dose.
How long to take it for
Usually, treatment with ramipril is long term, and you may have to take it for the rest of your life.
Take ramipril even if you feel well, as you will still be getting the benefits of the medicine.
Contact your doctor if you get ill, such as a high temperature, sweats and shaking or severe diarrhoea or vomiting.
Your doctor may advise you to stop taking ramipril until you recover and are eating and drinking normally.
If you forget to take it
If you miss a dose of ramipril, take it as soon as you remember, unless it's nearly time for your next dose. In that case, skip the missed dose and take your next dose at the usual time.
Do not take a double dose to make up for the forgotten dose.
If you often forget doses, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.
If you take too much
Taking more than your prescribed dose of ramipril can make you feel dizzy, sleepy and give you a pounding heartbeat (heart palpitations).
The amount of ramipril that can lead to an overdose varies from person to person.
- you take more than your prescribed dose of ramipril
Go to 111.nhs.uk or call 111
If you need to go to A&E, do not drive yourself. Get someone else to drive you or call for an ambulance.
Take the ramipril packet or leaflet inside it, plus any remaining medicine, with you.
Common side effects
These common side effects of ramipril happen in more than 1 in 100 people. There are things you can do to help cope with them:
Speak to a doctor or pharmacist if the advice on how to cope does not help and a side effect is still bothering you or does not go away.
Serious side effects
It happens rarely, but some people have serious side effects after taking ramipril.
Call a doctor or contact 111 straight away if:
- the whites of your eyes turn yellow, or your skin turns yellow although this may be less obvious on brown or black skin – this can be a sign of liver problems
- you're paler than usual, you feel tired, faint or dizzy, you have any sign of bleeding (like bleeding from the gums and bruising more easily than usual), a sore throat, a high temperature, or you get infections more easily – these can be signs of a blood or bone marrow disorder
- you have severe stomach pain – this can be a sign of an inflamed pancreas (acute pancreatitis)
- you have swollen ankles or blood in your pee or you're not peeing at all – these can be signs of kidney problems
Go to 111.nhs.uk or call 111.
- you have weakness on one side of your body, trouble speaking or thinking, loss of balance or blurred eyesight – these can be signs of a stroke
- you have a faster heart rate, chest pain and tightness in your chest – these can be signs of heart problems
- you have shortness of breath, wheezing and tightening of the chest – these can be signs of lung problems
In rare cases, ramipril may cause a serious allergic reaction (anaphylaxis).
Taking ramipril for a long time can sometimes cause your kidneys to not work as well as they should. Your doctor will check how well your kidneys are working with regular blood tests.
Other side effects
These are not all the side effects of ramipril. For a full list, see the leaflet inside your medicine packet.
Ramipril and pregnancy
Ramipril is not recommended in pregnancy. It can affect your baby's kidneys, especially if it's taken in the second and third trimesters of pregnancy. This can result in long term damage to your baby's kidneys.
If you're already pregnant, stop taking ramipril and talk to your doctor straight away. Usually your doctor will be able to prescribe a different medicine that is safe to take in pregnancy. Ramipril should be stopped by the time you're 12 weeks pregnant at the latest.
Use contraception if you're taking ramipril and carefully plan any pregnancy with your GP, pregnancy specialist (obstetrician) or hospital doctor. They will want to review your medical condition and medicine before you get pregnant.
Most women stop taking ramipril before getting pregnant, but some may continue until they have a positive pregnancy test and then stop. Your doctor will discuss what's best for you, based on your medical condition and the risks and benefits of ramipril.
Ramipril and breastfeeding
It might be OK to take ramipril while breastfeeding, but talk to your doctor or pharmacist first. It's best not to take ramipril if your baby was born prematurely, but your doctor will help you decide.
It's not yet known how much ramipril passes into breast milk, but it's likely to be a small amount. It is unlikely to cause side effects in your baby. However, there is a very small risk that it could also lower your baby's blood pressure. Your doctor might recommend a different medicine for you to take while breastfeeding.
If you notice that your baby is not feeding as well as usual, seems unusually sleepy, seems much paler than usual, or if you have any other concerns about your baby, talk to your health visitor, midwife or doctor as soon as possible.
Ramipril and fertility
There's no clear evidence to suggest that taking ramipril reduces fertility in either men or women.
But if you're trying to get pregnant, talk to your doctor first as this medicine is not recommended in pregnancy.
Cautions with other medicines
There are some medicines that may affect the way ramipril works.
Tell your doctor if you're taking any of these medicines:
- anti-inflammatory medicines such as ibuprofen, indomethacin or aspirin for pain relief (low-dose aspirin – 75mg a day, is safe to take with ramipril)
- medicines to treat low blood pressure, heart failure, asthma or allergies, such as ephedrine, noradrenaline or adrenaline
- medicines for high blood pressure, such as aliskeren
- medicines that can lower your blood pressure, such as some antidepressants, nitrates (for chest pain), baclofen (a muscle relaxant), anaesthetics or medicines for an enlarged prostate gland
- medicines to calm down your immune system, such as ciclosporin or tacrolimus
- medicines that make you pee more (diuretics), such as furosemide
- medicines that can increase the amount of potassium in your blood, such as spironolactone, triamterene, amiloride, potassium supplements, trimethoprim (for infections) or heparin (for preventing blood clots)
- steroid medicines such as prednisolone
- allopurinol, for gout
- procainamide, for heart rhythm problems
- medicines for diabetes
- lithium, for mental health problems
Mixing ramipril with herbal remedies or supplements
There's very little information about taking herbal remedies and supplements with ramipril. They're not tested in the same way as pharmacy and prescription medicines.
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