Ramipril is used to treat high blood pressure (hypertension) and heart failure.
It 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:
- Ramilo
- Ramitace
- Tritace
It is part of a group of medicines called angiotensin-converting enzyme (ACE) inhibitors.
Ramipril also comes in a mixed tablet with other heart medicines such as statins and low-dose aspirin.
The mixed tablets are only available on prescription.
Uses of ramipril
Ramipril is usually prescribed to:
- treat high blood pressure and heart failure
- improve survival if you are taking it for heart failure or after a heart attack
- prevent future strokes or heart attacks
- treat some kidney diseases or prevent them getting worse - this includes those caused by diabetes
Check if you can take ramipril
You can take ramipril if you are age 18 or older. But ramipril is not suitable for everyone.
To make sure ramipril is safe for you, tell your GP if you:
- are pregnant, trying to get pregnant or are breastfeeding
- have had an allergic reaction to any medicine or any ingredients in 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 not enough white blood cells
- have recently had diarrhoea or vomiting
- are on a low salt diet
- are having immunotherapy 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.
But if you're trying to get pregnant, talk to your doctor first as this medicine is not recommended in pregnancy.
Talk to your GP if you are taking combined hormonal contraceptives - these can raise your blood pressure and stop ramipril working.
Pregnancy and breastfeeding
Ramipril is not recommended if you're pregnant or breastfeeding.
Important
Do not take ramipril if you are more than 3 months pregnant. It may cause serious harm to your baby.
Emergency 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. Switching 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.
Ramipril and surgery
Tell your doctor you are taking ramipril if you are having:
- a general anaesthetic (being put to sleep) for an operation - ramipril can lower your blood pressure when used with a general anaesthetic
- a major operation without a general anaesthetic, such as a Caesarean section
Your GP may tell you to stop taking it 24 hours before surgery.
Taking ramipril
Always take ramipril exactly as your GP has told you.
Follow the instructions on the label of your medicine or check with your pharmacist, GP or nurse if you are unsure.
You can take ramipril with or without food. Swallow ramipril tablets or capsules whole with a drink.
Take ramipril even if you feel well. You will still be getting the benefits of the medicine.
When to take ramipril
Usually you will take ramipril 1 or 2 times a day.
The first time you take 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 you about 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. If you take ramipril for a long time it can sometimes affect your kidneys. Your potassium levels can increase because of this.
You might stay on a lower dose if you have side effects.
Diabetes and ramipril
Check your blood sugar more often if you have diabetes and are taking ramipril, particularly in the first few weeks.
Ramipril can lower the sugar level in your blood.
Your GP may need to adjust your diabetes treatment.
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.
If you take too much ramipril
An overdose of ramipril can cause:
- dizziness
- sleepiness
- a pounding heartbeat (palpitations)
The amount of ramipril that can lead to symptoms of an overdose varies from person to person.
Emergency action required: Contact your GP or go to your nearest emergency department (ED) immediately if you:
- take too much ramipril
Do not drive yourself to the ED. Get someone else to drive or call for an ambulance.
Bring the ramipril packet or leaflet and any remaining medicine with you.
How long ramipril takes to work
Ramipril starts working within a few hours. But it may take a few weeks for it to work fully.
If you are taking ramipril for heart failure, it may take weeks or months before you feel better.
You may not have any symptoms if you are taking ramipril for high blood pressure or after a heart attack. This means you may not feel any different when you take ramipril.
Keep taking the medicine. It will still work even if you do not feel any difference.
How long you will need to take ramipril
Ramipril is generally safe to take and works best when you take it for a long time.
There’s no evidence that ramipril is addictive.
Coming off ramipril
Talk to your GP if you want to stop taking ramipril.
Keep taking ramipril even if it lowers your blood pressure. Stopping it may cause your blood pressure to rise. This can increase your risk of heart attack and stroke.
If you are concerned about side effects, contact to your GP. They may prescribe a different medicine.
Side effects
Ramipril can cause side effects. Many people do not get side effects, or have 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.
Common side effects
There are things you can do to manage common side effects:
Dry, tickly cough that does not go away
Cough medicines do not usually help for coughs caused by ramipril. Sometimes the cough gets better on its own. Talk to your GP if it carries on, bothers you or stops you sleeping. Another medicine may be better.
Even if you stop taking ramipril, the cough may take from a few days to a month to go away.
Headaches
Make sure you rest and drink plenty of fluids. Try not to drink too much alcohol. Ask your pharmacist to recommend a painkiller. Talk to your GP if the headaches last longer than a week or are severe.
Feeling dizzy or lightheaded
This is more likely to happen when you start taking ramipril or move on to a higher dose. 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 do not faint, then sit until you feel better.
Do not drive, ride a bike or use tools or machinery until the dizziness passes.
Diarrhoea or vomiting
Drink plenty of fluids, such as water or squash, to prevent dehydration. Speak to a pharmacist if you have signs of dehydration, such as peeing less than usual or having dark, strong-smelling pee. Do not take any other medicines to treat diarrhoea or vomiting without speaking to a pharmacist or GP first.
If you take the combined contraceptive pill or progestogen-only pill and you have severe diarrhoea or vomiting for more than 24 hours, your contraception may not protect you from pregnancy. Check the pill packet for advice.
If you get diarrhoea or vomiting from a stomach bug or illness, tell your GP. You may need to stop taking ramipril for a while until you feel better.
A mild skin rash
It may help to take an antihistamine. You can buy this from a pharmacy. Check with the pharmacist for a type that is suitable for you.
Blurred vision
Do not drive, ride a bike or use tools or machinery if you have blurred vision. If it lasts for more than 2 days, speak to your GP. They may need to change your treatment.
Speak to your GP or pharmacist if a side effect is still bothering you or does not go away.
See the patient information leaflet that comes with your medicine for a full list of side effects.
Serious side effects
Urgent advice: Get urgent medical advice if you have:
- yellowing of your skin or white of your eyes - this can be a sign of liver problems
- dizziness, you feel very tired or faint, you have any bleeding or bruising, a sore throat, fever or you get infections more easily - these can be signs of a blood or bone marrow disorder
- severe tummy pain
- swollen ankles, blood in your pee or not peeing at all - these can be signs of kidney problems
Emergency action required: Call 112 or 999 if 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
- shortness of breath, wheezing and tightening of the chest - these can be signs of lung problems
Severe allergic reaction
Emergency action required: Call 112 or 999 or go to an emergency department (ED) if you
have signs of a severe allergic reaction including:
- a rash that is itchy, red, swollen, blistered or peeling
- wheezing
- tightness in the chest or throat
- trouble breathing or talking
- your mouth, face, lips, tongue or throat start to swell
- swelling underneath the skin (angioedema)
Why you may need a different medicine
Your GP might prescribe a different medicine to lower your blood pressure if you have side effects to ramipril, 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.
These may include:
- anti-inflammatories - such as ibuprofen, indomethacin or aspirin for pain relief (low-dose aspirin 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 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)
- steroids - such as prednisolone
- allopurinol
- procainamide
- medicines for diabetes
- lithium
Alcohol and ramipril
Drinking alcohol can increase the effect of ramipiril and lower your blood pressure too much. This can make you feel dizzy or lightheaded.
Do not drink alcohol during the first few days of taking ramipril or after your dose increases, until you see how the medicine affects you. If you find ramipril makes you feel dizzy, it's best to stop drinking alcohol.
Avoid salt substitutes
Do not use salt substitutes such as Lo-Salt. They are high in potassium. When mixed with ramipril, they may make the level of potassium in your blood too high.
Fact check
This content was fact checked by a pharmacist, a GP, the National Medication Safety Programme (Safermeds) and the Health Products Regulatory Authority (HPRA).
