Ramipril

  1. 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.

  2. 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.
  3. 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)
  4. 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.

  5. 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 lisinopril 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.

  6. 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.
  7. 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.

  8. 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 pressureheart 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.

  9. Common questions

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