Ramipril should be used with caution in: the elderly (particularly those taking diuretics or with heart failure, kidney or liver problems), those with liver or kidney problems, those undergoing surgery or having an anaesthetic. First doses can cause low blood pressure especially in patients taking diuretics, on a low-salt diet, on dialysis, dehydrated or have heart failure.
It should not be used in: patients with hypersensitivity to ACE inhibitors, children and adolescents under 18 years of age, women who are pregnant, planning to become pregnant, or who are breastfeeding, those who have previously had angioedema (indicated by puffiness or swelling of the face, tongue or body), patients with heart valve problems, low blood pressure (hypotension) or very variable blood pressure, or narrowing of the blood vessels to the kidneys (renal artery stenosis). This medication should also be avoided in treatments where the blood becomes in contact with negatively charged surfaces, such as certain types of dialysis and during low density lipoprotein apheresis with dextran sulphate; as well as prior to desensitisation with wasp or bee venom.
Also see list of precautions and interactions.
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Ramipril is used to treat a number of problems.
It is a member of a class of drugs called angiotensin-converting enzyme inhibitors, sometimes known as a ACE inhibitors.
In general, this drug is used to treat high blood pressure (hypertension), but has many other uses such as helping to treat kidney disease and heart failure and as a preventative therapy for those at high risk of heart disease and stroke.
Benefits of being on this drug include the prevention of heart disease and stroke and reductions in blood pressure.
Listed below are the typical uses of ramipril:
- Treating high blood pressure (hypertension)
- Treating heart failure
- After heart attacks in patients with heart failure
- Prevention of heart attacks, stroke or death in patients with atherosclerotic (build up of fatty deposits inside blood vessels) cardiovascular (heart and blood vessels) disease or those with diabetes.
However on occasion your doctor may prescribe this medicine to treat a condition not on this list, including protecting the kidneys in people with early signs of kidney damage.
HOW TO USE/TAKE
How often do I take it?
- This medication is available as a tablet that should be taken by mouth, usually as a single dose every day, with or without food. Tablets should be taken with a glass of water.
- Use this medication regularly in order to get the most benefit from it.
- Remember to use it at the same time each day - unless specifically told otherwise by your doctor.
- It may take some time before you notice any benefits of this drug.
- Certain medical conditions may require different dosage instructions as directed by your doctor.
- Dosage is based on your age, gender, medical condition, response to therapy and use of certain interacting medicines.
Do I need to avoid anything?
- Avoid drinking alcohol. This medication may affect your ability to drive or operate machinery, especially at the start of treatment or if changing preparations. It is advisable not to drive or operate machinery until several hours, after the first dose or dose increases. Consult your doctor or pharmacist for more details.
When can I stop?
- It is important to continue taking this medication even if you feel well, unless your doctor tells you to stop.
RAMIPRIL SIDE EFFECTS
- Feeling sick (nausea)
- Slowed reactions
- Excessive sweating
- Irregular heart beat (arrhythmia)
- Angina (pain in the chest owing to the poor blood supply to the heart)
- Dry cough
- Dry mouth
- Bronchitis (infection of the lungs)
- Sinusitis (sinus infection)
- Shortness of breath
- Hair loss
- Itchy skin rash
- Reddening and/or warming of patches of skin
- Muscle pain
- Joint pain
- Difficulty sleeping (insomnia)
- Depressed mood
- Loss of appetite
- Tingling, numbness or 'pins and needle' sensations (paraesthesia)
- Muscle cramps
- Muscle pain
- Low blood pressure
- Visual disturbances
- Pancreatitis (inflammation of the pancreas)
- Bronchospasm (tightening of the windpipe causing difficulty in breathing)
- Loss of appetite
- Reduced sex drive in men
- Red, sore, itching or watery eyes (conjunctivitis)
- Causing or worsening of Raynaud's syndrome (poor blood circulation to fingers and/or toes, causing pain, numbness and coldness in these areas).
If any of these persist or you consider them severe then inform your doctor.
Tell your doctor immediately if you develop any of the following symptoms: angioedema (indicated by puffiness or swelling of the face, tongue or body).
Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.
A serious allergic reaction to this drug is unlikely, but seek immediate medical attention if it occurs. Symptoms of a serious allergic reaction include: rash, itching/swelling (especially of the face/tongue/throat), dizziness, trouble breathing.
This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.
The Yellow Card Scheme allows you to report suspected side effects from any type of medicine (which includes vaccines, herbals and over the counter medicines) that you are taking. It is run by the medicines safety watchdog called the Medicines and Healthcare products Regulatory agency (MHRA). Please report any suspected side effect on the Yellow Card Scheme website.
Before taking ramipril, tell your doctor or pharmacist if you are allergic to it; or to other angiotensin-converting enzyme (ACE) inhibitors; or if you have any other allergies.
This medication should not be used if you have certain medical conditions. Before using this medicine, consult your doctor or pharmacist if you have: severe heart failure, poor liver or kidney function, are taking diuretics or are dehydrated, have heart valve problems, low blood pressure (hypotension) or very variable blood pressure, have narrowed blood vessels to the kidneys (renal artery stenosis), are having dialysis or a type of blood treatment called apheresis, or certain medical disorders called collagen vascular conditions (such as lupus erythematosus or scleroderma).
Before using this medication, tell your doctor or pharmacist your medical history, especially any of the following: if you have been ill with vomiting or diarrhoea, are on a low-salt diet, or have previously had angioedema (indicated by puffiness or swelling of the face, tongue or body),
Before having surgery, tell your doctor or dentist that you are taking this medication.
Does alcohol intake affect this drug?
- Ramipril may interact with alcohol. If you choose to drink, it is best to only drink in moderation. Speak to your doctor or pharmacist for more information.
Pregnancy and breastfeeding - please ensure you read the detailed information below
It is not recommended to take ramipril during pregnancy. Ask your doctor or pharmacist if you have any doubts or questions about this.
It is sensible to limit use of medication during pregnancy whenever possible. However, your doctor may decide that the benefits outweigh the risks in individual circumstances and after a careful assessment of your specific health situation..
If you have any doubts or concerns you are advised to discuss the medicine with your doctor or pharmacist.
It is not recommended to take ramipril if you are breastfeeding. Ask your doctor or pharmacist if you have any doubts or questions about this.
It is sensible to limit use of medication during breastfeeding whenever possible. However, your doctor may decide that the benefits outweigh the risks in individual circumstances and after a careful assessment of your specific health situation.
If you have any doubts or concerns you are advised to discuss the medicine with your doctor or pharmacist
Your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with them first.
This drug should not be used with the following medications because very serious, possibly fatal interactions may occur: diuretics (e.g. amiloride, triamterene and spironolactone), lithium, potassium salts, sodium aurothiomalate or ciclosporin. Ramipril should also be avoided in treatments where the blood becomes in contact with negatively charged surfaces, such as certain types of dialysis and during low density lipoprotein apheresis with dextran sulphate
If you are currently using any of these medications, tell your doctor or pharmacist before starting ramipril.
Before using this medication, tell your doctor or pharmacist of all prescription and non-prescription/herbal products you may use, especially of:
- Other drugs that lower blood pressure (e.g. beta blockers such as atenolol)
- Diabetes drugs (e.g. insulin, glibenclamide, gliclazide or tolbutamide)
- Non-steroidal anti-inflammatory drugs (NSAIDs) (e.g. aspirin or indometacin)
- Immunosuppressants (e.g. prednisolone)
- General anaesthetics
- Antipsychotics (drugs used to treat psychosis)
- Anxiolytics (drugs used to treat anxiety)
- Hypnotics (drugs used to induce sleep)
This information does not contain all possible interactions. Therefore, before using ramipril, tell your doctor or pharmacist of all the products you use.
Symptoms of an overdose include: peripheral vasodilation (flushing) with low blood pressure, low heart rate and kidney failure.
If you think you, or someone you care for, might have accidentally taken more than the recommended dose of ramipril or intentional overdose is suspected, contact your local hospital, GP or if in England call 111. In Scotland call NHS 24. In Wales, call NHS Direct Wales. In the case of medical emergencies, always dial 999.
If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose and resume your usual dosing schedule. Do not double the dose to catch up.