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Ramipril: 14 FAQs Inc. Side Effects, Dosage, Tablets

Pharmacist-checked information on dosage and side effects of Ramipril

Ramipril is an ACE inhibitor used to treat kidney disease, high blood pressure, heart failure and as a preventive medication for cardiovascular disease. ACE inhibitors suppress the action of the angiotensin converting enzyme, which otherwise transforms angiotensin II from angiotensin I. Angiotensin II is responsible for the blood pressure in the heart. Angiotensin II is responsible for a strong constriction of the blood vessels. The relaxation of the blood vessels lowers blood pressure and reduces the work of the heart. The "thirst hormone" aldosterone is also caused by angiotensin II, which is why inhibiting aldosterone also has a slight diuretic (draining) effect, which in turn lowers blood pressure. We answer the 14 most frequently asked questions about the ACE inhibitor ramipril.

The content on this page is provided for informational purposes only. If you have any questions or concerns about your treatment, you should talk to your doctor, pharmacist, or healthcare professional. This is particularly important if you are taking multiple medications or have any existing medical conditions.

What is Ramipril?

Ramipril belongs to the group of medicines called ACE inhibitors (angiotensin-converting enzyme inhibitors) and is used to treat high blood pressure, heart failure and kidney disease. In addition, Ramipril is used for preventive treatment after a heart attack and in cases of increased risk of cardiovascular disease. Patients living with diabetes who have cardiovascular risks such as smoking, high LDL and/or low HDL cholesterol or obesity; will benefit from ACE inhibitors preventing a heart attack and protecting their kidneys.

How quickly does Ramipril take effect?

Since Ramipril is absorbed relatively quickly by the body (after about 1 hour), but first must be converted into the active metabolite (by product) ramiprilat, it takes between 2-4 hours until the maximum blood concentration is reached.

If Ramipril is taken as prescribed, the active ingredient level adjusts to a largely constant concentration after about 4 days and reaches its optimum after 4-6 weeks. It is also important that Ramipril is taken gradually. This means that the dose is increased only slowly so that the body can get used to it.

If there is no improvement in blood pressure after the first week, contact your doctor or pharmacist. Do not take a higher dose than your doctor has prescribed.

How is Ramipril available?

ACE inhibitors such as Ramipril can be purchased in the form of tablets or capsules containing 1.25 to 10 mg of the active ingredient and only with a doctor's prescription. The maximum dose is 20 mg of ramipril per day and must be prescribed by the doctor according to the disease to be treated.

Ramipril is the active ingredient of the medicine, which is sold under the trade names Delix, Vesdil, RamiLich or Ramiclair, and Altace.

Egiramlon is a combination drug with active ingredients of Ramipril and Amlodipine, which has the additional effect of the calcium channel blocker Amlodipine in addition to the ACE inhibitor. If you need to be treated with such a drug, your doctor will inform you about benefits of the treatment.

What do I need to know before taking Ramipril?

Ramipril must not be taken in the following circumstances:

  • Hypersensitivity to any of the ingredients
  • After a kidney transplant
  • During dialysis treatment
  • Overproduction of aldosterone in the adrenal gland
  • If the body's defense reactions are disturbed, e.g., in the case of excessive immune reactions, also during desensitization treatment or when taking immunosuppressants

Talk to your doctor or pharmacist before taking ramipril if you have any of the following conditions:

  • Heart disease such as hypertrophic cardiomyopathy, narrowing of a valve on the left side of the heart, coronary artery disease
  • Circulatory disorder of the cerebral vessels
  • Impaired kidney function or narrowing of a renal artery
  • Disorders of fluid and salt balance, e.g., vomiting or diarrhea
  • Impaired liver function
  • Diabetes mellitus
  • Tendency to angioneurotic oedema (swelling of the face, hands and feet)
  • Collagenosis (changes in the connective tissue), such as lupus erythematosus or scleroderma
  • Heart failure following a heart attack, cardiac arrhythmias, angina pectoris, low blood pressure, orthostatic hypotension

Please also note that increased hypersensitivity reactions to allergens (e.g., insect bites) may occur with the use of ACE inhibitors.

Does Ramipril interact with other medicines?

Since Ramipril has some interactions with other medicines, if you need to take other medicines in addition to Ramipril, be sure to discuss them with your doctor or pharmacist.

If you must take painkillers while taking ramipril, avoid non-steroidal anti-inflammatory drugs (NSAIDs) such as Aspirin, Ibuprofen, Diclofenac or Naproxen, as these reduce the effectiveness of the ACE inhibitor and increased risk of affecting the kidneys. Although taking acetaminophen with Ramipril carries fewer risks, when it comes to finding a suitable painkiller, a doctor or pharmacist should be consulted for advice.

Other medicines that may increase or decrease the effects and side effects of ramipril include:

  • Aliskiren - causes excess potassium, a drop in blood pressure and decrease in kidney function.
  • Other antihypertensives - blood pressure may drop too low
  • Spironolactone, triamterene and amiloride - increase potassium levels
  • Immunosuppressants and allopurinol - increased risk of blood count changes
  • Oral antidiabetics and insulin - increase blood glucose lowering effect
  • Sacubitril / valsartan - risk of angioedema greatly increased

As there are several other medicines that may interact with Ramipril, it is extremely important to discuss this issue with your doctor.

How should I take Ramipril?

It is usually recommended to take ramipril in the morning with a glass of water. However, you should definitely seek advice from your doctor or pharmacist on this matter. It is also important that you keep your daily intake times consistent.

Ramipril must be taken gradually. This means that the dose is increased slowly so that the body can adjust to the medication.

Should I make up for a missed dose of Ramipril?

If you miss a dose of Ramipril, take it as soon as possible. If it's almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Avoid double doses.

How long can I take Ramipril?

There is no time limit for taking Ramipril. The duration of use therefore depends on the disease and is prescribed by your doctor.

What is the best way to stop taking Ramipril?

If you want to stop Ramipril, it is extremely important to discuss this with your doctor beforehand. Never stop Ramipril abruptly and on your own initiative. Although abrupt discontinuation of Ramipril only very rarely leads to a sudden increase in blood pressure (rebound effect), an individual risk assessment should be made by your doctor.

Withdrawal symptoms have not been reported so far, but side effects may persist for several days after stopping ramipril.

What are side effects of Ramipril?

Some people experience side effects from taking the ACE inhibitors. These should be reported to the doctor immediately because of the possible consequences.

Depending on the severity of the side effects, these symptoms are possible:

  • Dry irritating cough, bronchospasm
  • Severe drop in blood pressure
  • Dizziness, tiredness, headache
  • Skin rash
  • Seizures
  • Chest pain
  • Gastrointestinal problems
  • Kidney dysfunction
  • Loss of appetite
  • Depressive moods

If you have an allergic reaction to Ramipril, you must see a doctor immediately. Signs of a severe allergic reaction are:

  • Skin rash, for example itchy, red or swollen skin
  • Wheezing
  • Shortness of breath and circulation problems
  • Worsening of the general condition

What should I do if I have an overdose of Ramipril?

If you have taken an overdose of ACE inhibitors (e.g., more than 20mg ramipril per day), you should contact your doctor or the nearest hospital immediately. If you go to the emergency room, you should not drive yourself but call an ambulance or ask someone to drive you.

Depending on the extent of an overdose, these symptoms are possible:

  • Severe drop in blood pressure
  • Slowing of the heartbeat and even circulatory failure
  • Cardiac arrhythmia
  • Seizures
  • Paralysis
  • Kidney dysfunction
  • Delayed urination

Can I take Ramipril during pregnancy and breast‑feeding?

Although it is still possible to take Ramipril under medical supervision during the first trimester of pregnancy, it is not recommended to continue taking the drug beyond that time, as the unborn child could be potentially harmed. Your doctor will therefore switch you to another antihypertensive that is safe for the mother and fetus.

Ramipril must not be used during breast-feeding because it is unknown how much Ramipril passes into breast milk.

If you need an antihypertensive while you are breastfeeding, it is important that you contact your doctor. They will switch you to another antihypertensive and inform you about the possible risks during breast-feeding.

Can I drive while taking Ramipril?

Some people experience side effects such as dizziness or fatigue at the beginning of Ramipril treatment, so it is strongly advised not to operate any heavy machinery or drive. In addition, even in normal doses, Ramipril can affect your ability to react. Once you have adjusted to the effects of ramipril, you decide when it is safe for you to drive.

Can I drink alcohol while taking Ramipril?

If you consume alcohol while taking Ramipril, dizziness and lightheadedness may occur, as high alcohol consumption may decrease blood pressure-lowering effect for a short time. Your reactions may also be delayed when taking Ramipril in combination with alcohol. For these reasons, it is better to avoid alcohol with Ramipril.

The content on this page is provided for informational purposes only. If you have any questions or concerns about your treatment, you should talk to your doctor, pharmacist, or healthcare professional. This is particularly important if you are taking multiple medications or have any existing medical conditions.