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 as tablets, capsules and as a liquid that you swallow.

  1. 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.
  2. Who can take ramipril

    Ramipril can only 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 an allergy to ramipril or another medicine or if you’ve ever had a serious allergic reaction where your face, tongue or throat swells (angioedema)
    • are pregnant or 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 or decreased kidney function and you are taking a medicine called aliskiren to lower your blood pressure
    • have lost a lot of fluid or body salts due to diarrhoea or vomiting, sweating more than usual, a low-salt diet, taking water tablets for a long time or kidney dialysis
    • are going to have desensitisation treatment to reduce your allergy to bee or wasp stings
    • are going to have an anaesthetic
    • have a collagen vascular disease (a group of diseases that affect your connective tissue) such as scleroderma or systemic lupus erythematosus
  3. How and when to take

    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.

    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.

    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.

    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 that are suitable for you and your medicines.

    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 low blood pressure and sleepiness.

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

    If you've taken too many ramipril tablets do not drive yourself to the hospital - get someone else to drive you or call for an ambulance.

    If you take too much ramipril by accident, call your doctor or go to your nearest hospital straight away.

    If you need to go to hospital, take the box or leaflet inside the packet plus any remaining medicine with you.

  4. 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 they bother you or don’t go away:

    • dry, tickly cough
    • 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
    • inflammation of your sinuses (sinusitis)
    • bronchitis
    • gut problems such as pain, feeling or being sick, diarrhoea or indigestion
    • rash
    • muscle pain or spasms
    • fatigue

    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:

    • liver disorder – warning signs include yellowing of the skin or whites of the eye, fever, chills, tiredness, loss of appetite, tummy pain and feeling sick
    • blood or bone marrow disorder – warning signs include paleness, feeling tired, faint or dizzy, purple spots, blotching on the skin, any sign of bleeding - like bleeding from the gums, prolonged bleeding, bruising more easily, sore throat and fever and getting infections more easily
    • heart problems – warning signs include a faster heart rate, chest pain and tightness in your chest
    • lung problems – warning signs include a shortness of breath or a cough
    • inflammation of the pancreas (pancreatitis) – warning signs include severe tummy pain which may reach through to your back

    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.

  5. 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.
    • headaches - make sure you rest and drink plenty of fluids. Don’t drink too much alcohol. Ask your pharmacist to recommend a painkiller.
    • 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 - try rubbing a gentle, fragrance-free skin moisturiser over the affected skin. It may also help to take an antihistamine which you can buy from a pharmacy. Check with the pharmacist to see what type is suitable for you.
    • 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. 

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

  6. 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 are 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 are breastfeeding.

    Talk to your doctor if you plan to get pregnant, become pregnant or you want to breastfeed.

  7. 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 a high dose of aspirin (a dose of 75mg daily of aspirin is safe to take with ramipril)
    • medicines to treat low blood pressure, shock, heart failure, asthma or allergies, such as ephedrine, noradrenaline or adrenaline
    • medicines for high blood pressure 
    • 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 for cancer
    • medicines to stop the rejection of organs after a transplant 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 salts, trimethoprim alone or in combination with sulfamethoxazole (for infections) and heparin (for thinning blood)
    • steroid medicines such as prednisolone
    • allopurinol (for gout)
    • procainamide (for heart rhythm problems)
    • temsirolimus (for cancer)
    • sirolimus, everolimus (for prevention of graft rejection)
    • 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 and supplements.

  8. Common questions