Ramipril

Ramipril is not suitable for some people. For example, check with your doctor that it's OK to take if you have diabetes, or heart or liver problems.

Ramipril comes as tablets, capsules or a liquid you take once or twice a day. Follow the instructions that come with your medicine.

Common side effects of ramipril include a dry cough, feeling dizzy and headaches. More serious side effects can happen in rare cases.

Ramipril is not recommended during pregnancy. Always check with a pharmacist or doctor.

It can cause problems to take ramipril with some other medicines, such as asthma, allergy and diabetes medicines, and ibuprofen.

Ramipril is a medicine widely used to treat high blood pressure and heart failure. It's also prescribed after a heart attack.

Ramipril helps prevent future strokes, heart attacks and kidney problems.

It works by widening your blood vessels and making it easier for your heart to pump blood around your body.

This medicine is available on prescription. It comes as tablets, capsules and as a liquid that you swallow for people who find it difficult to swallow tablets.

Most adults can take ramipril.

If you have diabetes, check your blood sugar (glucose) more often, particularly in the first few weeks. This is because ramipril can lower the sugar level in your blood.

Ramipril is not suitable for some people. To make sure it's safe for you, tell your doctor if you:

• have ever had an allergic reaction (anaphylaxis or angioedema) to ramipril or any other medicine
• are pregnant, trying to get pregnant or are breastfeeding
• are having dialysis or any other type of blood filtration
• have heart, liver or kidney problems
• have unstable or low blood pressure
• have diabetes
• are going to have a major operation (surgery) or general anaesthetic to put you to sleep
• have recently had any diarrhoea or vomiting
• are on a low-salt diet
• are going to have desensitisation treatment to reduce your allergy to insect stings
• have a blood problem such as low white blood cell count (neutropenia or agranulocytosis)

The dose of ramipril you take depends on why you need the medicine. Take it how your doctor tells you to.

To decide the correct dose for you, your doctor will check your blood pressure.

You may also have blood tests to check how well your kidneys are working and the amount of potassium in your blood.

Depending on why you're taking ramipril, the usual starting dose is between 1.25mg and 2.5mg once a day. You'll usually be prescribed a low dose of ramipril at first so it does not make you feel dizzy.

This will be increased gradually over a few weeks to the usual dose for your condition.

The maximum dose is 5mg twice a day or 10mg once a day.

How to take it

You'll usually take ramipril once or twice a day.

Your doctor may suggest that you take your first dose before bedtime because it can make you feel dizzy.

After the first dose, if you do not feel dizzy, you can take ramipril at any time during the day. Try to take it at the same time every day.

You can take ramipril with or without food. Swallow ramipril tablets or capsules whole with a drink of water.

If you're taking ramipril as a liquid, it will come with a plastic syringe or spoon to help you measure out the right dose. If you do not have one, ask your pharmacist for one. Do not use a kitchen teaspoon as it will not measure the right amount.

Changes to your dose

You'll probably be prescribed a low dose of ramipril at first so it does not make you feel dizzy.

This will usually be increased gradually until you reach the right dose for you.

When you first start taking it, you may be prescribed a pack that contains tablets of 3 different strengths of ramipril (2.5mg, 5mg and 10mg). Your doctor will tell you which strength to take, how often to take it, and when or if you need to increase your dose.

These common side effects of ramipril happen in more than 1 in 100 people. There are things you can do to help cope with them:

Cough medicines do not usually help for coughs caused by ramipril. Sometimes the cough gets better on its own if you keep taking ramipril.

Talk to your doctor if it carries on, bothers you or stops you sleeping, as another medicine may be better.

This is more likely to happen when you start taking ramipril or move on to a higher dose. If ramipril makes you feel dizzy when you stand up, try getting up very slowly or stay sitting down until you feel better.

If you begin to feel dizzy, lie down so that you do not pass out (faint), then sit until you feel better. Do not drive, ride a bike or use tools or machinery until the dizziness passes.

GOV.UK has more information on the law on drugs and driving

Make sure you rest and drink plenty of fluids. Try not to drink too much alcohol. Ask your pharmacist to recommend a painkiller. Talk to your doctor if the headache does not go away or is severe.

Drink plenty of fluids, such as water or squash, to prevent dehydration. Speak to a pharmacist if you have signs of dehydration, such as peeing less than usual or having dark, strong-smelling pee. Do not take any other medicines to treat diarrhoea without speaking to a pharmacist or doctor first.

If you take the combined pill or progestogen-only pill and you have severe watery diarrhoea, or any diarrhoea that lasts for more than 24 hours, your contraception may not protect you from pregnancy. Check the pill packet for advice.

If you get diarrhoea from a stomach bug or illness, tell your doctor. You may need to stop taking ramipril for a while until you feel better.

Take small, frequent sips of fluids, like water or squash, to prevent dehydration. Speak to a pharmacist if you have signs of dehydration, such as peeing less than usual or having dark, strong-smelling pee. Do not take any other medicines to treat vomiting without speaking to a pharmacist or doctor first.

If you take the combined pill or progestogen-only pill and you're being sick, your contraception may not protect you from pregnancy. Check the pill packet for advice.

If you get vomiting from a stomach bug or illness, tell your doctor. You may need to stop taking ramipril for a while until you feel better.

It may help to take an antihistamine, which you can buy from a pharmacy. Check with the pharmacist to see what type is suitable for you.

Speak to a doctor or pharmacist if the advice on how to cope does not help and a side effect is still bothering you or does not go away.

Ramipril is not recommended in pregnancy. It can affect your baby's kidneys, especially if it's taken in the second and third trimesters of pregnancy. This can result in long-term damage to your baby's kidneys.

If you're already pregnant, stop taking ramipril and talk to your doctor straight away. Usually your doctor will be able to prescribe a different medicine that is safe to take in pregnancy. Ramipril should be stopped by the time you're 12 weeks pregnant at the latest.

Use contraception if you're taking ramipril and carefully plan any pregnancy with your GP, pregnancy specialist (obstetrician) or hospital doctor. They will want to review your medical condition and medicine before you get pregnant.

Most women stop taking ramipril before getting pregnant, but some may continue until they have a positive pregnancy test and then stop. Your doctor will discuss what's best for you, based on your medical condition and the risks and benefits of ramipril.

There are some medicines that may affect the way ramipril works, including medicines that affect your kidneys, blood pressure or how much potassium is in your blood.

Tell your doctor if you're taking any of these medicines:

• NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen, indometacin or aspirin for pain relief (daily low-dose aspirin of 75mg is safe to take with ramipril)
• medicines that can increase the amount of potassium in your blood, such as spironolactone, triamterene, amiloride, potassium
• medicines to treat low blood pressure, heart failure, asthma or allergies, such as ephedrine, noradrenaline or adrenaline
• medicines for high blood pressure, such as aliskeren
• medicines that increase the risk of angioedema such as sacubitril, valsartan, racecadotril, sirolimus, tacrolimus, everolimus and vildagliptin
• medicines that can lower your blood pressure, such as some antidepressants, nitrates (for chest pain), baclofen (a muscle relaxant), anaesthetics or medicines for an enlarged prostate gland
• medicines to calm down your immune system, such as ciclosporin or tacrolimus
• medicines that make you pee more (diuretics), such as furosemide,  trimethoprim (for infections) or heparin (for preventing blood clots)
• steroid medicines such as prednisolone
• allopurinol, for gout
• procainamide, for heart rhythm problems
• medicines for diabetes
• lithium, for mental health problems

These are not all the medicines that may cause problems if you take them with ramipril. For a full list, see the leaflet inside your medicine packet.