Ramipril

Ramipril lowers your blood pressure and makes it easier for your heart to pump blood around your body. It relaxes and widens your blood vessels.

You can only get ramipril on prescription. It comes as tablets and capsules. 

Ramipril is also known as:

  • Ramic
  • Ramilo
  • Ramitace
  • Tritace

It is part of a group of medicines called ACE (angiotensin-converting enzyme) inhibitors.

Uses of ramipril

Ramipril is usually prescribed to:

  • treat high blood pressure and heart failure
  • improve your survival if you are taking it for heart failure or after a heart attack
  • prevent future strokes or heart attacks
  • treat or prevent worsening of some kidney diseases, including those caused by diabetes

Get emergency help

You might need emergency help if you get serious side effects, take too much or have a serious allergic reaction (anaphylaxis).

If you take too much

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.

Immediate action required: Go to your nearest emergency department (ED) immediately or phone your GP if you:

  • take too much ramipril

Do not drive yourself to the ED. Get someone else to drive or call for an ambulance.

Take your remaining medicine and any leaflets with you.

Serious allergic reactions

Immediate action required: Call 112 or 999 or go to an ED if you:

  • get a skin rash that may include itchy, red, swollen, blistered or peeling skin
  • are wheezing
  • get tightness in the chest or throat
  • have trouble breathing or talking
  • get swelling in your mouth, face, lips, tongue or throat

These are warning signs of serious allergic reactions, such as swelling underneath the skin (angioedema).

Serious side effects

Urgent advice: Tell your GP immediately if you think you might have:

  • weak arms and legs or problems speaking
  • yellow skin or eyes
  • paleness, feeling tired, faint or dizzy
  • any sign of bleeding, such as bleeding from the gums and bruising more easily
  • sore throat and fever and getting infections more easily
  • a faster heart rate, chest pain and tightness in your chest
  • shortness of breath or wheezing
  • severe tummy pain
  • swollen ankles, blood in your pee or not peeing at all

Check if you can take ramipril

You can take ramipril if you are 18 and over. But ramipril is not suitable for everyone.

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

  • are pregnant or trying to get pregnant
  • are breastfeeding
  • have had an allergic reaction to any medicine, such as swelling underneath the skin (angioedema)
  • are allergic to ramipril, any other ACE inhibitor medicine or any of the ingredients of ramipril
  • 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 a blood problem such as too few white blood cells (neutropenia or agranulocytosis)
  • have recently had diarrhoea or vomiting
  • are on a low salt diet
  • are having treatment to reduce an allergy to insect stings

Contraception and fertility

Ramipril does not affect contraception. It is unlikely to affect fertility in men or women.

Talk to your GP if you are:

  • trying to get pregnant - ramipril is usually not recommended in pregnancy
  • taking combined hormonal contraceptives - these can raise your blood pressure and stop ramipril working

Pregnancy and breastfeeding

Ramipril is not recommended in pregnancy or when breastfeeding.

Warning

Do not take ramipril if you are more than 3 months pregnant. It may cause serious harm to your baby.

Immediate action required: Contact your GP immediately if:

  • you become pregnant while taking ramipril
  • you are trying to get pregnant while taking ramipril

Your GP may recommend safer treatments. A switch to a safer treatment should be done before a planned pregnancy.

Talk to your GP about the benefits and possible harms of taking ramipril if you are pregnant or planning a pregnancy. These will depend on how many weeks pregnant you are and why you need to take it.

Ramipril and surgery

Tell your GP you are taking ramipril if you are going to:

  • be put to sleep for an operation 
  • have a major operation, such as a Caesarean section, without a general anaesthetic

Ramipril can lower your blood pressure when used with a general anaesthetic. Your GP may tell you to stop taking it 24 hours before surgery.

Taking ramipril

Always take ramipril exactly as your doctor has told you.

Follow the instructions on the label of your medicine or check with your pharmacist, doctor or nurse if you are unsure.

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.

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

When to take ramipril

Usually you will take ramipril once or twice a day.

The first time you take a dose of ramipril, take it at bedtime. This is because ramipril can make you feel dizzy.

After that first dose, you can take ramipril at any time of the day.

Try to take it at the same time every day.

How much ramipril to take

You will probably start on a low dose of ramipril so it does not make you feel dizzy.

Usually, your dose will be increased gradually until it is the right amount for you. 

Your GP will check your blood pressure and ask if you are getting any side effects. You may also have blood tests. This is to check how well your kidneys are working and the amount of potassium in your blood.

You might stay on a lower dose if you have side effects.

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

Ramipril and diabetes

Check your blood sugar (glucose) if you have diabetes and are taking ramipril, particularly in the first few weeks.

Ramipril can lower the sugar level in your blood.

If you forget to take a dose of ramipril

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.

How long ramipril takes to work

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

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

You might not have any symptoms if you are taking ramipril for high blood pressure or after a heart attack. This means you may not be aware of any change when you take ramipril. 

Keep taking the medicine. It will still work even if you do not see any difference.

How long you'll need to take ramipril

You will usually need to take ramipril long-term. You may need to take it for the rest of your life.

Long-term use

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

There’s no evidence that ramipril is addictive.

Stopping taking ramipril

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

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

If you are concerned about side effects, talk to your GP. They may be able to prescribe a different medicine.

Side effects of ramipril

Ramipril can cause side effects. But not everyone gets them and often they are minor ones.

Side effects often improve as your body gets used to the medicine.

Talk to your GP or pharmacist if side effects bother you or do not go away.

Side effects include:

  • dry, tickly cough that does not go away
  • headache
  • diarrhoea and vomiting
  • a mild skin rash
  • blurred vision
  • feeling dizzy 
Information:

See the patient information leaflet that comes with your medicine for a full list of side effects.

You can report any suspected side effects to the Health Products Regulatory Authority (HPRA).

Dizziness and ramipril

Ramipril can make some people feel 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.

If this happens:

  • do not drive a car, ride a bike, or use tools or machinery
  • stop what you are doing and sit or lie down until you feel better

When side effects might mean changing your medicine

Your GP might put you on a different medicine to lower your blood pressure. This may happen if you cannot take ramipril or other ACE inhibitor medicines because of side effects such as a dry cough.

You'll usually switch to an angiotensin receptor blocker such as candesartan, irbesartan, losartan or valsartan.

Ramipril and other medicines

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

Some medicines can interfere with the way ramipril works.

Alcohol and ramipril

Drinking alcohol can increase the effect of ramipiril and lower your blood pressure more. This can make you feel dizzy or light-headed.

Stop drinking alcohol if ramipril makes you feel dizzy.

Avoid salt substitutes

Do not 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.

Finding your patient information leaflet online

Your patient information leaflet (PIL) is the leaflet that comes in the package of your medicine. 

Information:

To find your PIL online, visit the Health Products Regulatory Authority (HPRA) website

  1. In the ‘Find a medicine’ search box, enter the brand name of your medicine. A list of matching medicines appears.
  2. To the right of your medicine, select ‘PIL’. A PDF of the PIL opens in a new window. 

You can also:

  1. Select the brand name of your medicine.
  2. Scroll down to the Documents section.
  3. From the Package Leaflet line, select PDF version. A PDF of the PIL opens in a new window. 

If your PIL is not on the HPRA website, the European Medicines Agency (EMA) website opens in a new window when you select ‘PIL’.

You can find your PIL on the EMA website.

Finding your PIL on the EMA website

If your PIL is not on the HPRA website, you will be sent to the European Medicines Agency (EMA) website.

To find your PIL on the EMA website:

  1. In the Medicines search box, enter the brand name of your medicine and the word ‘epar’. For example: ‘Zoely epar’. A list of matching medicines appears.
  2. Select the ‘Human medicine European public assessment report (EPAR)’ for your medicine
  3. From the table of contents, select Product information.
  4. Select the EPAR – Product Information link for your medicine. A PDF opens in a new window. The PIL information is in Annex III of the PDF under ‘labelling and package leaflet’

This content was fact checked by a pharmacist, a GP, the National Medication Safety Programme (Safermeds) and the Health Products Regulatory Authority (HPRA).

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This project has received funding from the Government of Ireland’s Sláintecare Integration Fund 2019 under Grant Agreement Number 123.

Page last reviewed: 24 September 2021
Next review due: 24 September 2024

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