Ramipril

About ramipril

Ramipril is a medicine widely used to treat high blood pressure and heart failure. It's also prescribed after a heart attack.

Ramipril helps to 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.

This medicine is available on prescription. It comes as tablets, capsules and as a liquid that you swallow.

Key facts

Ramipril lowers your blood pressure and makes it easier for your heart to pump blood around your body.
Your very first dose of ramipril may make you feel dizzy, so it’s best to take it at bedtime. After that you can take ramipril at any time of day.
Some people get a dry, irritating cough with ramipril.
Drinking alcohol can increase the blood pressure-lowering effect of ramipril, which can make you feel dizzy or light-headed.
Ramipril is also called by the brand name Tritace.

Who can and can't take ramipril

Ramipril can be taken by adults aged 18 and over.

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 isn't suitable for everyone.

To make sure ramipril is safe for you, tell your doctor if you:

have had an allergic reaction to ramipril or any other medicine in the past
are trying to get pregnant, are already pregnant or if 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
have recently had diarrhoea or vomiting
are on a low salt diet
are going to have desensitisation treatment to reduce your allergy to insect stings
are going to have a major operation or a general anaesthetic to put you to sleep
have a blood problem such as too few white blood cells (neutropenia or agranulocytosis)

How and when to take it

It's usual to take ramipril once or twice a day.

You may be advised to take your first dose before bedtime, because it can make you dizzy. After the very first dose, you can take ramipril at any time every day. Try to take it at the same time every day.

How much will I take?

The dose of ramipril you take depends on why you need the medicine. Take it as instructed by your doctor.

To decide the correct dose for you, your doctor will check your blood pressure and ask you if you are getting any side effects. 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 once a day and 2.5mg twice a day.

This will be increased gradually over a few weeks to a usual dose of:

2.5mg to 5mg once a day for high blood pressure
5mg twice a day or 10mg once a day for heart failure or after a heart attack

If you're bothered by side effects with ramipril you may stay on a lower dose.

The maximum dose is 5mg twice a day or 10mg once a day.

Will my dose go up or down?

You will probably be prescribed a low dose of ramipril at first so it doesn't make you feel dizzy. This will usually be increased gradually until you reach the right dose for you.

The first time you may be prescribed a pack which 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 to take it

You can take ramipril with or without food. Swallow ramipril tablets or capsules whole with a drink.

If you are taking ramipril as a liquid, it will come with a plastic syringe or spoon to help you measure out the right dose. If you don't have one, ask your pharmacist for one.

Take ramipril even if you feel well, as you will still be getting the benefits of the medicine.

What if I forget to take it?

If you miss a dose of ramipril, leave out that 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 forget doses often, 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.

What if I take too much?

If you take too many ramipril tablets, contact your doctor or nearest hospital straight away.

An overdose of ramipril can cause dizziness, sleepiness and a pounding heartbeat.

The amount of ramipril that can lead to an overdose varies from person to person.

If you take too much ramipril by accident, call your doctor or go to your nearest hospital accident and emergency (A&E) department straight away.

If you need to go to hospital, don't 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.

Side effects

Like all medicines, ramipril can cause side effects in some people but many people have no side effects or only minor ones. Side effects often improve as your body gets used to the medicine.

Common side effects

These common side effects happen in more than 1 in 100 people.

Talk to your doctor or pharmacist if these side effects bother you or don’t go away:

dry, tickly cough that does not go away
feeling dizzy or light headed, especially when you stand up or sit up quickly. This is more likely to happen when you start taking ramipril or move onto a higher dose
headache
diarrhoea and vomiting
a mild skin rash
blurred vision

Serious side effects

It happens rarely, but some people have serious side effects after taking ramipril.

Tell a doctor straight away if you think you might have:

weak arms and legs or problems speaking - these can be signs of a stroke
yellow skin or eyes - this can be a sign of liver problems
paleness, feeling tired, faint or dizzy, any sign of bleeding (like bleeding from the gums and bruising more easily), sore throat and fever and getting infections more easily - these can be signs of a blood or bone marrow disorder
a faster heart rate, chest pain and tightness in your chest - these can be signs of heart problems
shortness of breath, wheezing and tightening of the chest - these can be signs of lung problems
severe tummy pain - this can be a sign of an inflamed pancreas
swollen ankles, blood in your pee or not peeing at all - these can be signs of kidney problems

Serious allergic reaction

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

A serious allergic reaction is an emergency. Contact a doctor straight away if you think you or someone around you is having a serious allergic reaction.

The warning signs of a serious allergic reaction are:

getting a skin rash that may include itchy, red, swollen, blistered or peeling skin
wheezing
tightness in the chest or throat
having trouble breathing or talking
swelling of the mouth, face, lips, tongue or throat

These are not all the side effects of ramipril. For a full list, see the leaflet inside your medicine packet.

You can report any suspected side effect to the UK safety scheme.

How to cope with side effects

What to do about:

dry irritating cough - cough medicines don’t 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 from 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.
feeling dizzy - 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 don't faint, then sit until you feel better.
headaches - make sure you rest and drink plenty of fluids. Don’t drink too much alcohol. Ask your pharmacist to recommend a painkiller. Talk to your doctor if they last longer than a week or are severe.
diarrhoea and vomiting - drink plenty of water in small, frequent sips. It may also help to take oral rehydration solutions. You can buy these from a pharmacy or supermarket to prevent dehydration. Don’t take any other medicines to treat diarrhoea or vomiting without speaking to a pharmacist or doctor. If you get diarrhoea or vomiting from a stomach bug or illness, tell your doctor. You may need to temporarily stop taking ramipril until you feel better.
itching or a mild rash - 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.
blurred vision - avoid driving or using tools or machines while this is happening. If it lasts for more than a day or two speak to your doctor as they may need to change your treatment.

Pregnancy and breastfeeding

Ramipril is not normally recommended in pregnancy or when breastfeeding. However, it may be prescribed if your doctor thinks the benefits of the medicine outweigh the risks.

If you're planning a pregnancy or you're already pregnant, talk to your doctor about the benefits and possible harms of taking ramipril. These will depend on how many weeks pregnant you are and the reason you need to take it. There may be other treatments that are safer for you.

Ramipril and breastfeeding

Small amounts of ramipril may get into breast milk. This can cause low blood pressure in the baby. Talk to your doctor, as other medicines might be better while you're breastfeeding.

Tell your doctor if you're trying to get pregnant, are already pregnant or if you're breastfeeding.

Cautions with other medicines

There are some medicines that may interfere with the way ramipril works.

Tell your doctor if you’re taking:

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 which 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 damp down your immune system such as ciclosporin or tacrolimus
water tablets such as furosemide
medicines which can increase the amount of potassium in your blood such as spironolactone, triamterene, amiloride, potassium supplements, trimethoprim (for infections) and heparin (for thinning blood)
steroid medicines such as prednisolone
allopurinol (for gout)
procainamide (for heart rhythm problems)
medicines for diabetes
racecadotril (for diarrhoea)
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.

For safety, speak to your pharmacist or doctor before taking any herbal or alternative remedies with ramipril.

Tell your doctor or pharmacist if you are taking any other medicines, including herbal medicines, vitamins or supplements.

Common questions

How does ramipril work?

Ramipril is a type of medicine called an ACE (angiotensin-converting enzyme) inhibitor.

Like other ACE inhibitors, ramipril relaxes and widens your blood vessels. This lowers your blood pressure and makes it easier for your heart to pump blood around your body.

How long does ramipril take to work?

Ramipril starts to work within a few hours to reduce high blood pressure but it may take a few weeks for full effect.

If you're taking ramipril for heart failure, it may take weeks, even months, before you feel better.

If you're taking ramipril for high blood pressure or after a heart attack, you may not have any symptoms. In these cases, you may not feel any different when you take ramipril. This doesn’t mean that the medicine isn’t working and it’s important to keep taking it.

How long will I take it for?

Usually, treatment with ramipril is long term, even for the rest of your life.

Is ramipril safe to take for a long time?

Ramipril is generally safe to take for a long time. In fact, it works best when you take it for a long time.

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.

What will happen if I stop taking it?

Talk to your doctor if you want to stop taking ramipril.

Stopping ramipril may cause your blood pressure to rise – and this may increase your risk of heart attack and stroke.

If you're bothered by side effects, your doctor may be able to prescribe you a different medicine.

Can I come off ramipril now my blood pressure is lower?

Even if your blood pressure is successfully lowered by ramipril, it’s best to carry on taking it. If you stop taking ramipril, your blood pressure could rise back up again.

If you need blood pressure-lowering medicines, you’ll probably need to take them for the rest of your life.

Remember, by keeping your blood pressure low, you’re protecting yourself against having a heart attack or stroke in the future.

Can I drink alcohol with it?

Drinking alcohol can increase the blood pressure-lowering effect of ramipril, which can make you feel dizzy or light-headed.

During the first few days of taking ramipril or after a dose increase, it's best to stop drinking alcohol until you see how the medicine affects you.

If you find ramipril makes you feel dizzy, it’s best to stop drinking alcohol.

Are there similar medicines to ramipril?

There are several other ACE inhibitor medicines which work in the same way as ramipril. They include enalapril, lisinopril and perindopril.

There are also lots of other types of blood pressure-lowering medicines:

calcium-channel blockers – for example amlodipine
angiotensin receptor blockers - for example candesartan
beta-blockers – for example bisoprolol
diuretics (water tablets) – for example bendroflumethiazide

If you can't take ramipril or other ACE inhibitor medicines because of side effects such as a dry cough, you may be able to switch to another type of blood pressure-lowering medicine. This will usually be an angiotensin receptor blocker such as candesartan, irbesartan, losartan or valsartan.

What are the differences between ramipril and other ACE inhibitors?

Ramipril works as well as other ACE inhibitors when you take it to lower blood pressure and for heart failure. The side effects are also similar to those of other ACE inhibitors.

There are a few differences between ramipril and other ACE inhibitors. Ramipril is officially approved to be used for reducing the risk of having a heart attack or stroke but other ACE inhibitors may not be. It's also approved for reducing or delaying kidney problems but other ACE inhibitors may not be.

Can I take ramipril before surgery?

Tell your doctor that you're taking ramipril if you're going to be put to sleep for an operation or are going to have a major operation, such as a Caesarean section, without a general anaesthetic.

Ramipril can reduce your blood pressure when it's used with a general anaesthetic.

Your doctor may advise you to stop taking it 24 hours before surgery.

Is ramipril addictive?

No, there’s no evidence that ramipril is addictive.

Will it affect my contraception?

Ramipril won’t affect any type of contraception.

However, some types of hormonal methods of contraception, like the combined contraceptive pill and contraceptive patch, aren't usually recommended for women taking ramipril and other medicines for high blood pressure. This is because some hormonal contraceptives can raise your blood pressure and stop ramipril working properly.

Talk to your doctor if you're taking combined hormonal contraceptives.

Will it affect my fertility?

There’s no evidence that ramipril reduces fertility in men or women. However, if you're a woman and you are trying to get pregnant, talk to your doctor first. This medicine is usually not recommended in pregnancy.

Is there any food or drink I need to avoid?

Don't use salt substitutes such as Lo-Salt. This is because they are high in potassium. When mixed with ramipril they may make the level of potassium in your blood too high.

There's nothing else you need to avoid while taking ramipril. Eating a healthy, balanced diet can help if you have high blood pressure or heart failure.

Can I drive or ride a bike?

Ramipril can cause blurred vision and make some people feel dizzy - especially when you first start taking it or after taking a bigger dose. If this happens to you, don't drive a car, ride a bike, or use tools or machinery.

Can lifestyle changes help?

You can boost the health of your heart by making some key lifestyle changes. These will also help if you have high blood pressure or heart failure.

Stop smoking - smoking increases your heart rate and blood pressure. Quitting smoking brings down your blood pressure and relieves heart failure symptoms. Try and avoid secondhand smoke.
Drink alcohol sensibly - drinking too much alcohol raises blood pressure over time. It makes heart failure worse too. Men and women shouldn't drink more than 14 units of alcohol a week.
Be more active - regular exercise lowers blood pressure by keeping your heart and blood vessels in good condition. It doesn’t need to be too energetic - walking every day is enough.
Eat healthily - aim to eat a diet that includes plenty of fruit and veg, wholegrains, fat-free or low-fat dairy products and lean proteins. It’s a good idea to cut down on salt too. Eating too much salt is the biggest cause of high blood pressure - the more salt you eat, the higher your blood pressure will be. Aim for no more than 6g of salt a day.
Manage stress - when you're anxious or upset, your heart beats faster, you breathe more heavily and your blood pressure often goes up. This can make heart failure worse too. Find ways to reduce stress in your life. To give your heart a rest, try napping or putting your feet up when possible. Spend time with friends and family to be social and help avoid stress.
Vaccinations - if you have heart failure, it's recommended that you have a flu jab every year and a pneumonia vaccination every 5 years. Ask your doctor about these vaccinations. You can have them free on the NHS.