Ramipril
2 medicines
Ramipril is an ACE inhibitor for high blood pressure and heart failure; it must be stopped in pregnancy and can cause angioedema (throat and facial swelling) or high potassium.
Key facts
- Ramipril (sold as Altace) is an ACE inhibitor. It blocks the enzyme that narrows blood vessels, so vessels relax and blood pressure falls.
- It is usually taken once daily, with your first dose often given at bedtime because it can cause a sharp blood pressure drop.
- Ramipril must not be taken during pregnancy: it can cause fetal kidney damage, low amniotic fluid, and other birth defects, particularly in the second and third trimesters. Stop it and tell your doctor immediately if you become pregnant.
- Seek urgent care for swelling of the face, lips, tongue, or throat (angioedema), or for symptoms of high potassium such as muscle weakness or an irregular heartbeat.
What ramipril treats
Ramipril treats high blood pressure, reducing strain on the heart and blood vessels. It is also used after a heart attack to protect heart function, in heart failure to ease symptoms and improve survival, and in people with diabetes or kidney disease to slow the progression of kidney damage.
How ramipril works
An enzyme called ACE (angiotensin-converting enzyme) normally produces a hormone that narrows blood vessels and encourages the kidneys to retain salt and water. Ramipril blocks ACE, so blood vessels stay relaxed and blood pressure and the heart's workload fall.
Before you take it
- Do not take ramipril if you are pregnant or could become pregnant without reliable contraception; switch to a pregnancy-safe alternative before trying to conceive.
- Do not take it if you have had angioedema with an ACE inhibitor before, or if you are also taking a neprilysin inhibitor such as sacubitril.
- Tell your prescriber about kidney disease, since ramipril can further reduce kidney function and raise potassium.
- Mention potassium supplements, potassium-sparing diuretics, and NSAIDs such as ibuprofen, all of which can raise potassium or reduce ramipril's effect on the kidneys.
Side effects
Common effects include a dry, persistent cough, dizziness, headache, tiredness, and a mild drop in blood pressure on standing.
Stop and seek urgent medical care for any of these:
- Swelling of the face, lips, tongue, or throat, or sudden difficulty breathing or swallowing.
- Signs of high potassium: muscle weakness, tingling, or an irregular heartbeat.
- Fainting, or very low blood pressure with confusion.
- Yellowing of the skin or eyes.
Safety essentials
- Ramipril is contraindicated in pregnancy; stop it as soon as pregnancy is confirmed, and use reliable contraception while taking it if pregnancy is possible.
- Angioedema (throat, lip, tongue, or facial swelling) can occur at any time during treatment and can block breathing; treat it as a medical emergency and do not take an ACE inhibitor again if it happens.
- Your prescriber should check kidney function and potassium levels before starting and periodically during treatment, especially if you have kidney disease or take other medicines that raise potassium.
This page is educational and does not replace advice from a doctor or pharmacist who knows your health history.