Ramipril belongs to the class of medications called angiotensin-converting enzyme (ACE) inhibitors. It is used to treat high blood pressure, alone or in combination with thiazide diuretics (water pills). It works by relaxing and opening blood vessels to lower blood pressure.

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

The usual recommended adult dose of ramipril ranges from 2.5 mg to 10 mg daily in 1 or 2 divided doses, depending on the dose and individual circumstances such as your response to the medication. The maximum daily dose is 20 mg.

To treat high blood pressure, the usual starting dose for people not using diuretics (water pills) is 2.5 mg once daily. The dose is usually increased according to need every 2 weeks. The usual dose range is 2.5 mg to 10 mg daily. For people using diuretics, your doctor may start with a lower dose of 1.25 mg daily or ask you to stop using the diuretic for 2 or 3 days before starting ramipril.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones given here, do not change the way that you are taking the medication without consulting your doctor.

It is important to take this medication exactly as prescribed by your doctor. If you miss a dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store this medication at room temperature, protect it from light and moisture, and keep it out of the reach of children.

2.5 mg
Each size 4, orange/white, hard gelatin capsule, with '2.5' imprinted in black on body, and filled with a homogenous white-to-off-white powder, contains 2.5 mg of ramipril. Nonmedicinal ingredients: pre-gelatinized starch and pregelatinized starch (Lycatab); capsule shell: gelatin, methyl paraben, propyl paraben, carmoisine, ponceau 4R, sunset yellow and titanium dioxide.

5 mg
Each size 4, maroon/white, hard gelatin capsule, with '5' imprinted in black on body, and filled with a homogenous white-to-off-white, contains 5 mg of ramipril. Nonmedicinal ingredients: pre-gelatinized starch and pregelatinized starch (Lycatab); capsule shell: gelatin, methyl paraben, propyl paraben, brilliant blue, carmoisine, ponceau 4R, and titanium dioxide.

10 mg
Each size 4, blue/white, hard gelatin capsule, with '10' imprinted in black on body, and filled with a homogenous white-to-off-white, contains 10 mg of ramipril. Nonmedicinal ingredients: pre-gelatinized starch and pregelatinized starch (Lycatab); capsule shell: gelatin, methyl paraben, propyl paraben, brilliant blue, carmoisine, erythrosine, and titanium dioxide.

Do not take ramipril if you:

• are allergic to ramipril, or any other ACE inhibitor, or any ingredients of the medication
• are breast-feeding
• are pregnant or planning to become pregnant
• have had angioedema (a serious allergic reaction which causes the area around the throat and tongue to swell)
• have been diagnosed with hereditary angioedema
• are taking the medication sacubitril - valsartan
• are receiving dialysis or other similar treatments
• have low blood pressure
• have narrowing of the blood vessels to one or both kidneys
• are taking the medication aliskiren or angiotensin II receptor antagonists and have
• diabetes
• moderately to severely decreased kidney function
• high levels of potassium in the blood
• congestive heart failure with low blood pressure

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent. The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

• abdominal pain
• change in sense of taste
• cough (dry, persistent)
• dizziness or lightheadedness
• drowsiness
• eye redness, inflammation
• fatigue
• flushing
• hair loss
• headache
• inflammation of the mouth or tongue
• nasal congestion
• trouble sleeping
• weakness

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

• balance problems
• difficulty concentrating or paying attention
• fever, muscle pain, rash, or swollen glands that occur in the first few weeks or month of treatment
• hearing changes
• increased asthma symptoms (e.g., shortness of breath, trouble breathing)
• signs of bleeding (e.g., unusual nosebleeds, bruising, blood in urine, coughing blood, bleeding gums, cuts that don't stop bleeding)
• signs of depression (e.g., poor concentration, changes in weight, changes in sleep, decreased interest in activities, thoughts of suicide)
• signs of electrolyte imbalance (e.g., muscle pain or cramps, weakness, irregular heartbeat)
• signs of infection (symptoms may include fever or chills, severe diarrhea, shortness of breath, prolonged dizziness, headache, stiff neck, weight loss, or listlessness)
• signs of kidney problems (e.g., increased urination at night, decreased urine production, blood in the urine)
• signs of changed potassium levels (e.g., irregular heartbeat, muscle weakness, general feeling unwell)
• signs of low blood pressure (dizziness, lightheadedness, especially when rising from a lying or sitting position)
• signs of liver problems (abdominal pain, abdominal distention, fever, nausea, or vomiting, yellowing of the skin or eyes)
• skin irritation
• skin rash with or without itching, fever, or joint pain
• vision changes

Stop taking the medication and seek immediate medical attention if any of the following occur:

• abdominal pain, with or without nausea or vomiting
• signs of an allergic reaction, including angioedema (shortness of breath or difficulty breathing; hives; swelling of the eyes, mouth, lips, or throat)
• symptoms of a heart attack (pain, pressure, tightness or heaviness in the chest, jaw, neck or shoulder, sweating, or shortness of breath)
• symptoms of a stroke (sudden numbness or weakness, especially on one side of the body; sudden confusion, trouble speaking, or difficulty understanding speech; sudden problems with coordination or balance; sudden vision problems in one or both eyes; sudden, severe headache with no other cause)

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Angioedema: Ramipril may cause a serious allergic reaction called angioedema, which may be fatal if not treated promptly. If you have difficulty breathing or notice hives or swelling of the face, lips, tongue, or throat, or experience severe abdominal pain, stop taking this medication and get emergency medical help at once. Other ACE inhibitors should not be taken in the future. People who have had angioedema caused by other substances may be at increased risk of angioedema while taking this medication.

Blood disorders: In rare cases, a low white blood cell count has been reported with people taking this medication. Your doctor may occasionally monitor your level of white blood cells by performing blood tests. Low white blood cell levels may increase your risk for infection. If you notice any signs of infection (e.g., fever, sore throat), contact your doctor as soon as possible.

Cough: People taking ramipril may develop a dry, persistent cough that usually disappears only after stopping or lowering the dose of ramipril.

Kidney function: Decreased kidney function or kidney disease can cause this medication to build up in the body, causing side effects. Also, ramipril can cause decreases in kidney function. Certain people, such as those with narrowed blood vessels in their kidneys or severe congestive heart failure, may be more likely to experience this complication. The use of other diuretics (water pills), nonsteroidal anti-inflammatory drugs (NSAIDs), or aliskiren may further increase the risk of kidney problems.

If you have reduced kidney function or kidney disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. People with kidney function impairment may require lower doses of this medication. Your doctor will monitor you closely while you are taking this medication.

Liver function: This medication may cause liver problems. If you experience any signs of liver problems such as yellowing of the skin or eyes, fever, generally feeling unwell, abdominal pain, nausea, vomiting, loss of appetite, itching, muscle pain, rash, or swollen glands, contact your doctor immediately. People who have liver problems will need to be closely monitored by their doctor while taking this medication.

Low blood pressure: Occasionally, blood pressure drops too low after taking ramipril. This usually happens after the first or second dose or when the dose is increased. It is more likely to occur for those who take diuretics, or the medication aliskiren, have a salt-restricted diet, are on dialysis, have diarrhea, or are vomiting. To reduce the risk of dizziness, get up slowly from a lying or sitting position. If low blood pressure causes you to faint or feel lightheaded, contact a doctor.

Potassium: Increases in blood levels of potassium can occur with use of this medication. This rarely causes problems, but your doctor may want to monitor your potassium levels through blood tests.

Reduced alertness: This medication may reduce alertness, especially at the beginning of treatment. Do not drive or perform tasks that require alertness until you know how this medication affects you.

Surgery: It is important that your physician and anesthesiologist know that you are taking this medication before you undergo any surgical procedures requiring general anesthesia.

Pregnancy: ACE inhibitors such as ramipril may cause severe harm or death to the developing baby if taken by the mother. This medication should not be used during pregnancy. If you become pregnant while taking this medication, stop taking it immediately and contact your doctor.

Breast-feeding: This medication passes into breast milk. If you are breast-feeding and are taking ramipril it may affect your baby. This medication is not recommended for breast-feeding women. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and effectiveness of using this medication have not been established for children. The use of ramipril by this age group is not recommended.

Seniors: Seniors may be more sensitive to the effects of ramipril.

There may be an interaction between ramipril and any of the following:

• acetylsalicylic acid (ASA)
• aldesleukin
• aliskiren
• allergy shots for bee or wasp stings
• allopurinol
• alpha-blockers (e.g., alfuzosin, tamsulosin)
• amiodarone
• amphetamines (e.g., dextroamphetamine, lisdexamfetamine)
• other angiotensin converting enzyme inhibitors (ACEIs; captopril, enalapril, ramipril)
• angiotensin receptor blockers (ARBs; e.g., candesartan, irbesartan, losartan)
• atypical antipsychotics (e.g., clozapine, olanzapine, quetiapine, risperidone)
• apomorphine
• azathioprine
• barbiturates (e.g., phenobarbital, butalbital)
• bismuth subsalicylate
• brimonidine
• bromocriptine
• bortezomib
• cat's claw
• choline
• conivaptan
• corticosteroids (e.g., dexamethasone, prednisone)
• diazoxide
• diuretics (water pills; e.g., furosemide, amiloride, spironolactone, triamterene)
• drospirenone
• duloxetine
• eplerenone
• everolimus
• flunarizine
• general anesthetics (medications used to put people to sleep before surgery)
• gold injections (sodium aurothiomalate)
• grass pollen extract
• heparin
• iron dextran
• iron supplements
• lanthanum
• levodopa
• lithium
• low-molecular-weight heparins (e.g., dalteparin, tinzaparin)
• methylphenidate
• monoamine oxidase inhibitors (e.g., phenelzine, rasagiline, selegiline, tranylcypromine)
• morphine
• nabilone
• nitrates (e.g., nitroglycerin, isosorbide dinitrate)
• nonsteroidal anti-inflammatory medications (NSAIDs; e.g., indomethacin, naproxen)
• obinutuzumab
• olive leaf
• oral diabetes medications (e.g., metformin, saxagliptin)
• pentoxifylline
• phosphodiesterase-5 inhibitors (e.g., sildenafil, tadalafil, vardenafil)
• policosanol
• pramipexole
• pregabalin
• primidone
• sacubitril
• sirolimus
• sodium phosphates
• sotalol
• substances that increase potassium levels (e.g., potassium chloride, salt substitutes containing potassium)
• tacrolimus
• temsirolimus
• tizanidine
• tricyclic antidepressants (e.g., clomipramine, imipramine)
• trimethoprim
• yohimbine

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.