ramipril
Ramipril is an angiotensin-converting enzyme (ACE) inhibitors. This medication treats high blood pressure by relaxing blood vessels. It can also ease heart failure symptoms after a heart attack. Ramipril is taken by mouth, typically once or twice daily, by adults. Some of the more common side effects of this medication include headache, dizziness, and feeling tired. Ramipril is generic only because the brand name Altace is no longer available.
What is Ramipril?
What is Ramipril used for?
How Ramipril works
Ramipril is an angiotensin-converting enzyme (ACE) inhibitor. It blocks ACE, a protein in your body that tightens blood vessels. In doing so, ramipril relaxes your blood vessels and causes your blood pressure to go down.
Drug facts
Side effects of Ramipril
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
High blood pressure
- Headache (5%)
- Dizziness (2%)
- Feeling tired or weak (2%)
Heart failure after heart attack
- Low blood pressure (11%)
- Cough (8%)
- Dizziness (4%)
Less Common Side Effects
- Nausea
- Vomiting
- Chest pain
- Fainting
Ramipril serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Angioedema (severe swelling): swelling of the face, arms or legs, lips, tongue, or throat
- Serious liver problems: swelling of your stomach, yellowing of your skin or the whites of your eyes, confusion, dark or brown urine
- High blood potassium levels: nausea, muscle weakness, abnormal heartbeat
- Serious kidney problems: urinating less often than usual, swelling in your feet, ankles, or hands, unexplained weight gain
- Dangerously low blood pressure: dizziness, lightheadedness, pale skin, feeling faint
- Severe allergic reaction: swelling of your lips, tongue, throat, or face, trouble breathing, rash
More on Ramipril side effects
The following Ramipril side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
More common
Blurred vision
confusion
dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
sweating
unusual tiredness or weakness
Less common
Arm, back, or jaw pain
chest pain or discomfort
chest tightness or heaviness
chills
cloudy urine
cold sweats
decrease in urine output or decrease in urine-concentrating ability
fainting
fast or irregular heartbeat
shortness of breath
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
More common
Rare
Feeling of constant movement of self or surroundings
muscle pain or stiffness
sensation of spinning
stomach pain
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
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Pros and cons of Ramipril
Pros
- Taken by mouth
- Capsules can be opened and sprinkled on applesauce or water for those with trouble swallowing
- Available as a lower-cost generic
Cons
- More likely to cause a dry cough, compared to ARBs
- Not safe to use if you're pregnant
- Might not work as well for lowering blood pressure in Black people
Pharmacist tips for Ramipril
- If you have trouble swallowing ramipril capsules whole, you can open the capsule up and mix its contents with 4 fluid ounces (1/2 cup) water, apple juice, or applesauce. You can prepare this ahead of time and store it for up to 24 hours at room temperature or 48 hours in the refrigerator.
- Like many blood pressure medications, ramipril can cause dizziness the first few days you are taking it because your body is not used to having lower blood pressure. Be careful when getting up from a lying down or seated position so you don't get too dizzy or fall.
- Make sure to attend your follow-up appointments and check your blood pressure regularly at home so your provider can see if ramipril is working well for you.
- When ramipril is being used for heart failure, you should take your first dose in your provider's office. You'll need to stay at the office for 2 hours so they can make sure your blood pressure doesn't go too low.
- Tell your healthcare provider about any throat irritation, rash, swelling in your lips, or stomach pain. These could be a sign of a serious side effect or allergic reaction. If you have trouble breathing after taking ramipril, get medical help right away.
- Call to your healthcare provider right away if you become pregnant or would like to become pregnant as ramipril can harm your unborn baby. Your provider can talk with you about safer options to lower blood pressure during pregnancy.
- Some people get a dry cough within the first few months of taking ramipril. This ranges from a mild tickle in the throat to a persistent, hacking cough. Let your provider know if you have a cough that's bothersome to you; they can recommend other blood pressure medications that's less likely to cause cough, like angiotensin II receptor blockers (ARBs).
Common questions about Ramipril
No, ramipril isn't a beta blocker; it's an ACE inhibitor. Ramipril and other ACE inhibitors lower blood pressure by relaxing blood vessels. But beta blockers do so mainly by slowing heart rate.
No. Ramipril isn't a blood thinner. This medication typically doesn't affect how well your blood clots.
Ramipril starts to lower your blood pressure within 1-2 hours. But it can take 3 to 6 hours before you experience the full effect after a dose. If you're starting ramipril for the first time, your provider might adjust the dose over the course of a few weeks before they find one that works best for you.
Some of the more common side effects of ramipril include headache, dizziness, feeling tired or weak, and cough. Most of these side effects, like dizziness or headache, should get better after your body gets used to the medication. But if you have a bothersome dry cough, it's unlikely to go away until your provider switches you to a different medication. Talk with your provider if you've questions about a particular side effect.
There aren't any specific foods that are known to interact with ramipril. But if you have high blood pressure or heart failure, you should eat a balanced diet that's low in salt to help your condition. It's best to avoid or limit canned foods, processed foods, or pickled foods because these are typically high in salt content. And if you're using salt substitutes, choose one that doesn't contain potassium to lower your risk of high potassium levels from ramipril.
Ramipril can interact with some medications, so it's a good idea to share a current list of what you're taking with your provider. For example, if you take ramipril with other blood pressure medications, you might experience more dizziness. And if you take ramipril with medications that can also raise your potassium levels, then your potassium levels can get too high, which can be dangerous. Lastly, your provider might ask you to avoid taking ramipril with medications that are tough on the kidneys, such as NSAIDs, because doing so might worsen kidney problems. These aren't all possible interactions. Your provider can help you identify and manage potential interactions with your other medications.
You should take ramipril as directed by your provider. If you're taking ramipril twice daily, you might take it morning and evening. But if you're taking ramipril once daily, you can discuss with your provider when's the best time to take it. In general, evidence is mixed on whether you should take your blood pressure medication in the morning or at night. The most important thing is to take your dose at a time that you can remember to do so consistently.
Ramipril and lisinopril (Zestril) are 2 different ACE inhibitors that are used to treat high blood pressure. There's no strong evidence that one is better than the other. You and your provider might choose one over the other based on personal preferences or needs. Typically, lisinopril (Zestril) is taken once daily, whereas ramipril might need to be taken twice daily depending on the dose. Also, lisinopril (Zestril) comes as a tablet and liquid solution, but ramipril only comes as a capsule (but if needed, you can open it and sprinkle the contents in water or over applesauce). In addition, lisinopril (Zestril) can be taken by children with high blood pressure, whereas ramipril is for adults only. Your provider can talk more with you about the differences between ramipril and lisinopril (Zestril).
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Risks and warnings for Ramipril
Ramipril can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Not for use during pregnancy
Ramipril can cause severe and sometimes life-threatening harm to unborn babies so it shouldn't be used during pregnancy. If you find out that you're pregnant while taking ramipril, stop and let your provider know right away. If you're pregnant before starting ramipril or thinking of becoming pregnant during treatment, discuss with your provider about safer options to treat your blood pressure.
Angioedema (swelling)
- Risk factors: Black people | Older adults | Female | Having angioedema in the past
People who take an ACE inhibitor, like ramipril, can experience a rare, but serious side effect called angioedema. This involves swelling in different parts of the body, including the face, throat, and tongue. Swelling of the tongue or throat area can be potentially life-threatening, since it can make it difficult to breathe.
Angioedema can happen at any time during treatment. Your provider will ask you to stop the medication if you have symptoms. Get medical attention right away if you experience swelling in any of the areas mentioned above, stomach pain, or difficulty breathing.
Severe allergic reaction
Although rare, ramipril can cause a life-threatening allergic reaction (e.g., anaphylaxis). If you experience trouble breathing, hives, or swelling in your face or throat, get medical help right away.
Liver problems
- Risk factors: History of liver problems | Drinking large amounts of alcohol
In some rare cases, people who took ramipril have developed life-threatening liver problems. If you notice symptoms of liver problems, such as nausea, stomach pain, or yellowing of your skin or whites of your eyes, let your provider know right away.
Worsening kidney problems
- Risk factors: Severe heart failure | Kidney problems | Not enough fluid in your body | Taking other medications that can cause kidney damage | History of blocked kidney blood vessels (renal artery stenosis)
Ramipril is usually good for the kidneys. But in some cases, it can make kidney problems worse. The risk is higher for people who have certain types of kidney problems, such as renal artery stenosis or very severe heart failure. Your provider might order lab tests every so often to make sure your kidneys are healthy and working properly. Your provider will check your kidneys before starting ramipril and regularly as needed. Let your provider know if you're urinating less often than usual, as this could be a sign that your kidneys aren't working as well.
Lower blood cell counts
Let your provider know if you've collagen-vascular condition, such as lupus or rheumatoid arthritis. If so, you might be at higher risk for developing lower blood cell counts while taking ramipril, especially if you also have kidney problems. Your provider might order blood tests more often to check you blood cell counts.
Low blood pressure
- Risk factors: Not enough fluid in your body | Having diarrhea or vomiting for a long time | Low salt levels in your body | Taking higher doses of diuretic medications
Sometimes, taking ramipril can cause your blood pressure to drop too much. This can cause you to feel dizzy, tired, or lightheaded. This side effect is more common when you first start ramipril or when the dose is raised. Make sure to stay well-hydrated. If your blood pressure drops too much and you feel dizzy, make sure to sit down slowly while holding onto something and let your provider know. If you fall and hit your head, get medical help right away. If you feel dizzy, lightheaded, faint, tired, or confused while taking ramipril, contact your provider right away.
Heart problems due to high potassium
- Risk factors: Diabetes | Kidney problems | Taking other medications that also raise potassium
Some people who took ramipril developed high potassium levels, which can be dangerous. The risk is higher for people who've diabetes, kidney problems, or are taking other medications that also raise potassium levels. For this reason, make sure your provider knows your full medical history and what medications you're taking before starting ramipril. If you experience signs of high potassium levels, such as nausea, muscle weakness, or abnormal heartbeat, tell your healthcare provider right away.
Cough
Taking ramipril can cause dry cough. This side effect can happen anytime after you start taking the medication. This isn't a side effect your body will adjust to. If it's bothersome, your provider might recommend that you take a different blood pressure or heart failure medication. This cough should go away after stopping the medication.
More on Ramipril warnings
Ramipril dosage
Capsule| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 5mg | 90 capsules | $10.00 | $0.11 |
| 2.5mg | 90 capsules | $10.00 | $0.11 |
| 1.25mg | 90 capsules | $19.56 | $0.22 |
| 10mg | 90 capsules | $10.00 | $0.11 |
Typical dosage for Ramipril
-
High blood pressure: The typical dose is 2.5 mg to 20 mg by mouth total per day. Smaller doses are usually taken once a day, but larger doses can be split into two doses throughout the day.
-
Heart failure after heart attack: The typical starting dose is 2.5 mg by mouth twice a day. After 1 week, your provider might slowly raise your dose over time. The typical maintenance dose is 5 mg twice daily.
Your dose might differ if you have kidney problems.
More on Ramipril dosage
Interactions between Ramipril and other drugs
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
- Aliskiren
- Sacubitril
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Alteplase, Recombinant
- Amiloride
- Azathioprine
- Azilsartan
- Azilsartan Medoxomil
- Candesartan Cilexetil
- Canrenoate
- Eplerenone
- Eprosartan
- Everolimus
- Irbesartan
- Lithium
- Losartan
- Mercaptopurine
- Olmesartan Medoxomil
- Potassium
- Potassium Phosphate
- Sirolimus
- Spironolactone
- Telmisartan
- Triamterene
- Trimethoprim
- Valsartan
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Azosemide
- Bromfenac
- Bufexamac
- Bumetanide
- Bupivacaine
- Bupivacaine Liposome
- Capsaicin
- Celecoxib
- Choline Salicylate
- Clonixin
- Dexibuprofen
- Dexketoprofen
- Diclofenac
- Diflunisal
- Dipyrone
- Droxicam
- Ethacrynic Acid
- Etodolac
- Etofenamate
- Etoricoxib
- Felbinac
- Fenoprofen
- Fepradinol
- Feprazone
- Floctafenine
- Flufenamic Acid
- Flurbiprofen
- Furosemide
- Gold Sodium Thiomalate
- Ibuprofen
- Indomethacin
- Ketoprofen
- Ketorolac
- Lornoxicam
- Loxoprofen
- Lumiracoxib
- Meclofenamate
- Mefenamic Acid
- Meloxicam
- Morniflumate
- Nabumetone
- Naproxen
- Nepafenac
- Nesiritide
- Niflumic Acid
- Nimesulide
- Nimesulide Beta Cyclodextrin
- Oxaprozin
- Oxyphenbutazone
- Parecoxib
- Phenylbutazone
- Piketoprofen
- Piretanide
- Piroxicam
- Proglumetacin
- Propionic Acid
- Propyphenazone
- Proquazone
- Rofecoxib
- Salicylic Acid
- Salsalate
- Sodium Salicylate
- Sulindac
- Tenoxicam
- Tiaprofenic Acid
- Tolfenamic Acid
- Tolmetin
- Torsemide
- Valdecoxib
How much does Ramipril cost?
Ramipril contraindications
Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Ramipril will not be safe for you to take.
- Allergic to any ACE inhibitor
- Taking at the same time or within 36 hours of neprilysin inhibitors, such as Entresto (sacubitril / valsartan)
- Taking at the same time as aliskiren (Tekturna) for people with high blood sugar
What are alternatives to Ramipril?
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