Ramipril - Blood pressure | Use | Treatment

This article was medically reviewed by M.Pharm, Marko Tanaskovic on August 12, 2018. To read more about an author, click here.

Ramipril is medication from the group of ACE inhibitors. It works by blocking the angiotensin converting enzyme (ACE) and therefore prevents the formation of angiotensin II. Angiotensin II increases blood pressure, so ramipril by blocking the formation angiotensin II reduces blood pressure.

It is used in the following conditions:

  • High blood pressure (hypertension)
  • Heart failure (cardiac insufficiency)
  • Prevention of heart attack and stroke
  • Nephropathy (kidney damage), especially if it is accompanied by protein in the urine and hypertension


It cannot be used in the following conditions:

  • If you are allergic to ramipril or other similar medicines such as:
    • enalapril,
    • captopril,
    • cilazapril and others. Symptoms of allergy are:
      1. skin rash,
      2. itching of the skin,
      3. redness of the skin,
      4. swelling of the face,
      5. swelling of the tongue,
      6. difficulty breathing.
  • Have had an swelling of the vessels (angioedema)
  • If you are pregnant or breast-feeding

Ramipril medication can be used only with great caution in the following conditions:

  • If you have high potassium levels (hyperkalemia) or you are using medicines that may cause high levels of potassium in the blood such as:
    • spironolactone,
    • furosemide (Lasix),
    • triamterene,
    • amiloride,
    • diclofenac (Diklofen),
    • ibuprofen (Brufen),
    • acetylsalicylic acid at dose of 500 mg (Asprin, Andol),
    • ketoprofen,
    • meloxicam (Movalis),
    • celecoxib and others.

High potassium levels in the blood can cause serious heart disorders. Symptoms of high potassium levels are:

  1. muscle weakness,
  2. slow heart rate,
  3. numbness.

Immediately contact your doctor if you experience these symptoms.

  • Liver or kidney disorders. In these patients it is necessary to reduce the Ramipril dose.
  • If you have diabetes. This medicine may increase the effect of medicines used to treat diabetes and cause hypoglycemia (low blood sugar).

Use during pregnancy and breast feeding

According to the FDA, Ramipril belongs to the group D (FDA: Group D). This means that studies has shown that it is harmful to the fetus and should not be used during pregnancy.

There is no data whether it passes into breast milk.

Avoid breast-feeding while using this drug.

Ramipril Dose and Use

The initial dose to treat high blood pressure and preventing heart attack and stroke is ramipril 2.5 mg once a day with a glass of water. You should take each day at same time. It can be taken with or without meals.

After a month, the dose can be increased. The maximum daily dose is ramipril 10 mg.

Treatment of kidney damage and hypertension accompanied by proteins in urine: initial dose is 1.25 mg, which after 14 days can be increased to 2.5 mg and after 14 days more can be increased to 5 mg, as long as the appropriate effect is achieved.

It is not recommended to use this medicine in patients younger than 18 years.

It cannot be used in combination with alcohol beverages.

Take your tablet in the morning after getting up.

In treatment of heart failure it is usually used in combination with diuretics (most frequently hydrochlorothiazide). The initial dose should be 1.25 mg, which after 2 weeks can be increased.

Do not stop taking this drug even if you feel better. High blood pressure has no symptoms, but no matter, it can cause heart attack and stroke, and it is necessary to keep your blood pressure at normal levels.

Ramipril can be taken twice a day, if the doctor believes that this dosage regimen is right for you.

Use with other medications (Interactions)

It cannot be used in combination with the following medicines:

  • Potassium and all the other medicines that can increase potassium blood levels (see text above). High levels of potassium can cause very dangerous arrhythmias (abnormal heart beats).
  • Medicines used to treat diabetes. Ramipril may increase the effect of these medicines and cause hypoglycemia (low blood sugar).
  • Allopurinol, used to treat gout.
  • Cyclosporin, used to treat autoimmune diseases.
  • Lithium, used to treat depression. Ramipril may increase the lithium concentration in the blood and increase the risk of appearing lithium side effects.
  • Anesthetics. If you need to have surgery, inform your doctor that you are taking ramipril.

Tell your doctor about all medications and herbal medicines you are taking.

Ramipril side effects

It may cause the following side effects:

  1. mood changes (depression, anxiety),
  2. headache,
  3. flushing,
  4. sweating,
  5. nausea,
  6. vomiting,
  7. diarrhea,
  8. abdominal pain,
  9. liver damage (jaundice-yellowing of the skin and eyes),
  10. fatigue,
  11. trouble urinating,
  12. increased potassium blood level,
  13. allergy.

Ramipril often can cause dry cough.

If your cough persists, consult your doctor.

Information on this website are provided for educational purposes only and are not intended for medical advice, diagnosis or treatment.

If you have any concerns or questions about your health, you should always consult with a physician or other health-care professional.

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