Ramipril

What is ramipril?

Ramipril has many different effects on your body so it is used to treat a range of conditions. It belongs to a group of medicines called ACE inhibitors.

Ramipril may be used for the following conditions:

• High blood pressure – by relaxing and widening your blood vessels it lowers your blood pressure.
• Heart failure – to help your heart pump blood more easily. This can help to relieve symptoms such as shortness of breath and swelling in your feet, legs and abdomen (tummy).
• Diabetic kidney disease (diabetic nephropathy) – to protect your kidneys and help them function.

Ramipril can work quickly for hypertension (high blood pressure). If you have heart failure it may be a few weeks before you notice an improvement in your symptoms.

Dose

In Aotearoa New Zealand ramipril is available as capsules (1.25 mg, 2.5 mg, 5 mg and 10 mg)

• The dose of ramipril will be different for different people depending on your condition.
• Your doctor will usually start you on a low dose so it doesn't make you feel dizzy. Your dose will be increased slowly over a few weeks depending on how you respond. This allows your body to get used to the medicine and reduces side effects.
• Always take ramipril exactly as your doctor has told you. The pharmacy label on your medicine will tell you how much to take, how often to take it and any special instructions.
• Check with your pharmacist if your tablets are different to what you expect.

My dose

You can use the table below to keep track of dose changes when you start taking ramipril.

How to take ramipril

• Timing: You'll usually take ramipril once or twice a day. Take your dose at the same time each day. You can take ramipril with or without food. Swallow ramipril capsules whole with a drink of water. Your healthcare provider may suggest that you take your first dose before bedtime because it can make you feel dizzy.
• Limit or avoid alcohol while you are taking ramipril. Alcohol can increase your chance of side effects such as dizziness and light-headedness.
• Missed dose: If you forget to take your dose, take it as soon as you remember. But if it is nearly time for your next dose, just take the next dose at the right time. Don't take double the dose.

Who can't take ramipril?

Ramipril is not suitable if you are pregnant or planning a pregnancy. It is also not suitable if you have had a severe allergic reaction to an ACE inhibitor in the past, eg, swelling of your lips, eyes or tongue (called angioedema). Read more about who cannot take ACE inhibitors.

Things to consider while you are taking ramipril

Have a sick day plan

If you have diarrhoea (runny poo) or are vomiting (being sick) from a stomach bug, or are dehydrated from another illness, it’s important to let your healthcare provider know, as they may advise you to stop taking your ramipril for a few days, or decrease the dose and start again when you feel better. 

Be careful when taking some pain relief medicines

ACE inhibitors can be used to protect your kidneys from damage if you have diabetes. However, if you are taking ramipril and diuretics (water pills), the combination of these with NSAIDs (anti-inflammatory pain relief medicine) can be very harmful to your kidneys. It can cause acute kidney injury. This combination is called the ‘dangerous trio’ or ‘triple whammy’. You have a higher risk of harm to your kidneys if you are also an older adult (over 65 years) or are dehydrated. 

If you are taking an ACE inhibitor with a diuretic, don't use NSAIDs for pain relief. Ask your doctor or pharmacist for a safer option. Read more about NSAIDs and protecting your kidneys.

What are the side effects of ramipril?

Like all medicines ramipril can cause side effects, although not everyone gets them. Often side effects improve as your body gets used to the new medicine.

Reference

1. Ramipril NZ Formulary