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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.

If you have COVID-19, or think you might have it, keep taking your blood pressure medicines as usual.

There is no clear evidence that taking angiotensin-converting enzyme (ACE) inhibitors like ramipril will cause complications.

Updated: 17 March 2020

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.

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.

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.

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

Find your nearest A&E

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.

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

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.

Related links

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1,224 public posts

Ramipril

I've recently had my Ramipril dose upped to 2.5 from 1.25 mg daily.. I've since had more in the way of chest pain. Coincidence? By the way doc thinks I have Myocarditis too, just waiting for MRI results ..The chest pain has been worse since the upped dosage tho.
I've recently had my Ramipril dose upped to 2.5 from 1.25 mg daily.. I've since had more in the way of chest pain. Coincidence? By the way doc thinks I have Myocarditis too, just waiting for MRI results ..The chest pain has been worse since the upped dosage tho.
croggler profile image
croggler
in British Heart Foundation

Ramipril

I have been given 5mg to take once a day. Two weeks in I get a bit of hand and feet tingling at night. It seems to come a few hours before the next dose. Tonight I'm getting the tingling in feet sitting watching TV. If I walk around it goes but back again if I sit. Anyone experience with this effect?
I have been given 5mg to take once a day. Two weeks in I get a bit of hand and feet tingling at night. It seems to come a few hours before the next dose. Tonight I'm getting the tingling in feet sitting watching TV. If I walk around it goes but back again if I sit. Anyone experience with this effect?
omits profile image
omits
in Men's Health Forum

Experience of those taking Ramipril

However, my cough has got worse, but I am reluctant to blame it all on the Ramipril because I already had a slight chronic cough and laryngitis as well as asthma. So I’m having difficulty sorting out what’s an ongoing problem and what might be the fault of the Ramipril.
However, my cough has got worse, but I am reluctant to blame it all on the Ramipril because I already had a slight chronic cough and laryngitis as well as asthma. So I’m having difficulty sorting out what’s an ongoing problem and what might be the fault of the Ramipril.
Buffafly profile image
Buffafly
in AF Association
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Ramipril

Hi, I have Antiphospholipid syndrome (APS) and on warfarin because of repeated clots in my lungs and just started ramipril for high blood pressure. My question is I am having the side effect of pins and needles since starting the high blood pressure medication ramipril.
Hi, I have Antiphospholipid syndrome (APS) and on warfarin because of repeated clots in my lungs and just started ramipril for high blood pressure. My question is I am having the side effect of pins and needles since starting the high blood pressure medication ramipril.
Kev667 profile image
Kev667
in High Blood Pressure Support

Ramipril

Hi, I have APS on warfarin and just started ramipril for high blood pressure. My question is I am having the side effect of pins and needles since starting the high blood pressure medication ramipril. Only when I sleep in hands.
Hi, I have APS on warfarin and just started ramipril for high blood pressure. My question is I am having the side effect of pins and needles since starting the high blood pressure medication ramipril. Only when I sleep in hands.
Kev667 profile image
Kev667
in Hughes Syndrome APS Forum

Heart Meds

Has anyone stopped taking their Ramipril, Bisoprolol, Atorvastatin etc off their own back and did you notice any difference.
Has anyone stopped taking their Ramipril, Bisoprolol, Atorvastatin etc off their own back and did you notice any difference.
Stevie1960 profile image
Stevie1960
in British Heart Foundation

Bloop pressure meds

Just wondered if anyone else had any problems with Ramipril. Thanks
Just wondered if anyone else had any problems with Ramipril. Thanks
Sarahze profile image
Sarahze
in LUPUS UK

Ramipril for bp

Hi has anyone been prescribed 2.5mg of ramipril for blood pressure and have taken one Tablet and felt like they had more chest pain symptoms after taking it about 12 hours later ?
Hi has anyone been prescribed 2.5mg of ramipril for blood pressure and have taken one Tablet and felt like they had more chest pain symptoms after taking it about 12 hours later ?
candle11 profile image
candle11
in British Heart Foundation

Ramipril side effects

I have been taking Ramipril for just over 2 months, now along with several other medications, for my heart failure. I have an annoying dry cough but also feels like I need to cough up phlegm with no luck.
I have been taking Ramipril for just over 2 months, now along with several other medications, for my heart failure. I have an annoying dry cough but also feels like I need to cough up phlegm with no luck.
Jaskei profile image
Jaskei
in British Heart Foundation

Breast pain with heart meds

I'm on clopidogrel, bisoprolol, ramipril and atovorstatin after angiogram and stent. Thanks Lily
I'm on clopidogrel, bisoprolol, ramipril and atovorstatin after angiogram and stent. Thanks Lily
MrsSuzuki profile image
MrsSuzuki
in British Heart Foundation

Pins and neddles

On medication Bisoprolol Atrovastatin Ramipril
On medication Bisoprolol Atrovastatin Ramipril
Chin1956 profile image
Chin1956
in British Heart Foundation

Blurred vision

Hi had HA in 2019 Anyone have blurred vision I’m on ramipril at night and also aspirin during day.. also other meds… but these two have vision side affects
Hi had HA in 2019 Anyone have blurred vision I’m on ramipril at night and also aspirin during day.. also other meds… but these two have vision side affects
SmokeAKipper profile image
SmokeAKipper
in British Heart Foundation

Worried Liz

Two weeks ago I started 5mg Ramipril. At first all seemed ok although I feel lightheaded and unnaturally tired. Two days ago my vision started to get blurry (and it’s difficult seeing to write this). I wondered if anyone has experienced this on Ramipril? My doc is phoning in a weeks time.
Two weeks ago I started 5mg Ramipril. At first all seemed ok although I feel lightheaded and unnaturally tired. Two days ago my vision started to get blurry (and it’s difficult seeing to write this). I wondered if anyone has experienced this on Ramipril? My doc is phoning in a weeks time.
Lizf1006 profile image
Lizf1006
in British Heart Foundation

Concern bp isn't coming down

I was immediately put on Ramipril which only reduced it slightly then amlidipine was added but ankles & legs were swollen so was changed to doxasosin & ramipril but still wouldn't budge despite several increases, I am now on 10mg of Ramipril and 20mg of lercandipine but BP is still high at 165/115, pharmacist
I was immediately put on Ramipril which only reduced it slightly then amlidipine was added but ankles & legs were swollen so was changed to doxasosin & ramipril but still wouldn't budge despite several increases, I am now on 10mg of Ramipril and 20mg of lercandipine but BP is still high at 165/115, pharmacist
Mumtochd profile image
Mumtochd
in British Heart Foundation

Ramipril

I have been on ramipril 5mg for 2 weeks and my blood pressure has gone up. Should I carry on or ask to change.
I have been on ramipril 5mg for 2 weeks and my blood pressure has gone up. Should I carry on or ask to change.
Mazri profile image
Mazri
in British Heart Foundation

Ramipril titration.

Hi been on Ramipril 5mg for 8 years or so and six months ago noticed blood pressure was in the 150/70ish mark. Contacted cardiologist for advice and he just said up your dose to 10mg once daily.
Hi been on Ramipril 5mg for 8 years or so and six months ago noticed blood pressure was in the 150/70ish mark. Contacted cardiologist for advice and he just said up your dose to 10mg once daily.
wischo profile image
wischo
in British Heart Foundation

Myocarditis

Doc took me off statins for the moment because of leg pain so I'm only taking Ramipril for now ..I'm 5 weeks in
Doc took me off statins for the moment because of leg pain so I'm only taking Ramipril for now ..I'm 5 weeks in
croggler profile image
croggler
in British Heart Foundation

Shortness of breath on Ramipril

He then rang with results and told me not to take them and to stop ramipril for 3days then do more bloods due to high potassium. After only 24hrs of stopping the ramipril I felt so much better, I couldnt believe it , even my breathing has improved greatly.
He then rang with results and told me not to take them and to stop ramipril for 3days then do more bloods due to high potassium. After only 24hrs of stopping the ramipril I felt so much better, I couldnt believe it , even my breathing has improved greatly.
Gigi1958 profile image
Gigi1958
in British Heart Foundation

Ramipril

Good morning everyone I’ve been prescribed Ramipril 2.5mg a day. I haven’t got high blood pressure. I have early signs of dilated cardiomyopathy. I’m on day 3 of taking it. It says on the label to take it in the morning, but it’s making me feel very light headed and groggy around lunchtime.
Good morning everyone I’ve been prescribed Ramipril 2.5mg a day. I haven’t got high blood pressure. I have early signs of dilated cardiomyopathy. I’m on day 3 of taking it. It says on the label to take it in the morning, but it’s making me feel very light headed and groggy around lunchtime.
Carolx profile image
Carolx
in British Heart Foundation

Sore eyes on Ramipril

I was wondering if anyone had experience sore or stinging eyes while taking Ramipril. I’ve been on it for 2 weeks. Noticed this symptom about 1 week in. Stopped taking it for 1 day to see if my eyes felt better - they did. Started on it again and a couple of days in, the sore eyes are back.
I was wondering if anyone had experience sore or stinging eyes while taking Ramipril. I’ve been on it for 2 weeks. Noticed this symptom about 1 week in. Stopped taking it for 1 day to see if my eyes felt better - they did. Started on it again and a couple of days in, the sore eyes are back.
md53 profile image
md53
in High Blood Pressure Support
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