Ramipril

Generic Name: ramipril (RAM i pril)
Brand Names: Altace

What is ramipril?

Ramipril is in a group of drugs called ACE inhibitors. ACE stands for angiotensin converting enzyme.

Ramipril is used to treat high blood pressure (hypertension) or congestive heart failure, and to improve survival after a heart attack.

Ramipril may also be used for other purposes not listed in this medication guide.

Important information about ramipril

Do not use ramipril if you are pregnant. Stop using ramipril and tell your doctor right away if you become pregnant. Avoid drinking alcohol. It can further lower your blood pressure and may increase some of the side effects of ramipril. Do not use salt substitutes or potassium supplements while taking ramipril, unless your doctor has told you to.

Conditions that may cause very low blood pressure include: vomiting, diarrhea, heavy sweating, dehydration, a low salt diet, or taking diuretics (water pills). Tell your doctor if you have a prolonged illness that causes diarrhea or vomiting.

Your blood pressure will need to be checked often. Your kidney or liver function may also need to be tested. Visit your doctor regularly.

If you need surgery, tell the surgeon ahead of time that you are using ramipril. You may need to stop using the medicine for a short time.

If you are being treated for high blood pressure, keep using ramipril even if you feel fine. High blood pressure often has no symptoms.

Before taking ramipril

You should not use this medication if you are allergic to ramipril or to any other ACE inhibitor, such as benazepril (Lotensin), captopril (Capoten), fosinopril (Monopril), enalapril (Vasotec), lisinopril (Prinivil, Zestril), moexipril (Univasc), perindopril (Aceon), quinapril (Accupril), or trandolapril (Mavik).

To make sure you can safely take ramipril, tell your doctor if you have any of these other conditions:

• kidney disease (or if you are on dialysis);

• liver disease;

• diabetes;

• a connective tissue disease such as Marfan syndrome, Sjogren's syndrome, lupus, scleroderma, or rheumatoid arthritis;

• if you are also taking telmisartan (Micardis); or

• if you have ever had a severe allergic reaction.

FDA pregnancy category D. Do not use ramipril if you are pregnant. Stop using this medication and tell your doctor right away if you become pregnant. Ramipril can cause injury or death to the unborn baby if you take the medicine during your second or third trimester. Use effective birth control while taking this medicine. Ramipril can pass into breast milk and may harm a nursing baby. You should not breast-feed while taking ramipril.

See also: Ramipril pregnancy and breastfeeding warnings (in more detail)

How should I take ramipril?

Take ramipril exactly as prescribed by your doctor. Do not take in larger or smaller amounts or for longer than recommended. Follow the directions on your prescription label.

Your doctor may occasionally change your dose to make sure you get the best results.

Ramipril can be taken with or without food.

Swallow the ramipril tablet whole.

You may open the ramipril capsule and sprinkle the medicine into a half-cup (4 ounces) of water, apple juice, or applesauce to make swallowing easier. Swallow without chewing. You may store the mixture for up to 24 hours at room temperature, or up to 48 hours in a refrigerator.

Conditions that may cause very low blood pressure include: vomiting, diarrhea, heavy sweating, dehydration, a low salt diet, or taking diuretics (water pills). Tell your doctor if you have a prolonged illness that causes diarrhea or vomiting.

To be sure ramipril is helping your condition, your blood pressure will need to be checked often. Your kidney or liver function may also need to be tested. Visit your doctor regularly.

If you need surgery, tell the surgeon ahead of time that you are using ramipril. You may need to stop using the medicine for a short time.

If you are being treated for high blood pressure, keep using ramipril even if you feel fine. High blood pressure often has no symptoms.

Store ramipril at room temperature away from moisture and heat.

See also: Ramipril dosage (in more detail)

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. Overdose symptoms may include feeling extremely dizzy or light-headed, or fainting.

What should I avoid while taking ramipril?

Avoid drinking alcohol. It can further lower your blood pressure and may increase some of the side effects of ramipril. Do not use salt substitutes or potassium supplements while taking ramipril, unless your doctor has told you to.

Avoid getting up too fast from a sitting or lying position, or you may feel dizzy. Get up slowly and steady yourself to prevent a fall.

Ramipril side effects

Get emergency medical help if you have any of these signs of an allergic reaction to ramipril: hives; severe stomach pain; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop taking ramipril and call your doctor at once if you have a serious side effect such as:

• feeling like you might pass out;

• high potassium level (slow heart rate, weak pulse, muscle weakness, tingly feeling;

• dry mouth, thirst, confusion, swelling, and urinating less than usual or not at all;

• pale skin, dark colored urine, easy bruising or bleeding;

• jaundice (yellowing of the skin or eyes); or

• fever, chills, body aches, flu symptoms, sores in your mouth and throat.

Less serious ramipril side effects may include:

• cough;

• tired feeling, headache;

• dizziness, spinning sensation; or

• nausea, vomiting.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Ramipril side effects (in more detail)

Ramipril Dosing Information

Usual Adult Dose for Diabetic Nephropathy:

Initial dose: 2.5 mg orally once a day for patients not receiving a diuretic.
Maintenance dose: 2.5-20 mg/day orally in 1-2 divided doses.

Usual Adult Dose for Hypertension:

Initial dose: 2.5 mg orally once a day for patients not receiving a diuretic.
Maintenance dose: 2.5-20 mg/day orally in 1-2 divided doses.

Usual Adult Dose for Congestive Heart Failure:

Initial dose: 2.5 mg orally twice a day.
Maintenance dose: 5 mg orally twice a day.

Usual Adult Dose for Left Ventricular Dysfunction:

Initial dose: 2.5 mg orally twice a day.
Maintenance dose: 5 mg orally twice a day.

Usual Adult Dose for Myocardial Infarction:

Initial dose: 2.5 mg orally twice a day.
Maintenance dose: 5 mg orally twice a day.

What other drugs will affect ramipril?

Tell your doctor about all other medicines you use, especially:

• a diuretic (water pill);

• gold injections to treat arthritis;

• lithium (Lithobid, Eskalith);

• a potassium supplement such as K-Dur, Klor-Con;

• salt substitutes that contain potassium; or

• aspirin or other NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn, Naprelan, Treximet), celecoxib(Celebrex), diclofenac (Cataflam, Voltaren), indomethacin (Indocin), meloxicam (Mobic), and others.

This list is not complete and other drugs may interact with ramipril. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.

Where can I get more information?

• Your pharmacist can provide more information about ramipril.