Experiences with
Ramipril

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)

Dosage

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. Ask someone to drive you or call 999 and ask for an ambulance.

Bring the ramipril packet or leaflet inside it, any remaining medicine, and any other medicines you take.

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:

Cough medicines do not usually help for coughs caused by ramipril. Sometimes the cough gets better on its own. Talk to your doctor if it carries on, bothers you or stops you sleeping, as another medicine may be better. Even if you stop taking ramipril, the cough may take a few days to a month to go away.

This is more likely to happen when you start taking ramipril or move on to a higher dose. If ramipril makes you feel dizzy when you stand up, try getting up very slowly or stay sitting down until you feel better. If you begin to feel dizzy, lie down so that you do not faint, then sit until you feel better. Do not drive, ride a bike or use tools or machinery until the dizziness passes.

Make sure you rest and drink plenty of fluids. Try not to drink too much alcohol. Ask your pharmacist to recommend a painkiller. Talk to your doctor if the headaches last longer than a week or are severe.

Drink plenty of fluids, such as water or squash, to prevent dehydration. Speak to a pharmacist if you have signs of dehydration, such as peeing less than usual or having dark, strong-smelling pee. Do not take any other medicines to treat diarrhoea without speaking to a pharmacist or doctor first.

If you take the combined contraceptive pill or progestogen-only pill and you have severe diarrhoea for more than 24 hours, your contraception may not protect you from pregnancy. Check the pill packet for advice.

If you get diarrhoea from a stomach bug or illness, tell your doctor. You may need to stop taking ramipril for a while until you feel better.

Take small, frequent sips of fluids, such as water or squash, to prevent dehydration. Speak to a pharmacist if you have signs of dehydration, such as peeing less than usual or having dark, strong-smelling pee. Do not take any other medicines to treat vomiting without speaking to a pharmacist or doctor first.

If you take the combined contraceptive pill or progestogen-only pill and you're being sick, your contraception may not protect you from pregnancy. Check the pill packet for advice.

If you get vomiting from a stomach bug or illness, tell your doctor. You may need to stop taking ramipril for a while until you feel better.

It may help to take an antihistamine, which you can buy from a pharmacy. Check with the pharmacist to see what type is suitable for you.

Do not drive, ride a bike or use tools or machinery while this is happening. GOV.UK has more information on the law on drugs and driving. If it lasts for more than a day or two, speak to your doctor as they may need to change your treatment.

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 call 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

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

Find your nearest A&E

Meds - serious side effects A&E safety messaging

In rare cases, ramipril may cause a serious allergic reaction (anaphylaxis).

Meds New IA (H4) - serious allergic reaction

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.

Meds New IA (H2) - Pregnancy non-urgent care card

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.

Meds New IA (H2) - Cautions with other medicines alert