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Ramipril Side Effects

In Summary

Commonly reported side effects of ramipril include: hypotension and increased cough. See below for a comprehensive list of adverse effects.

For the Consumer

Applies to ramipril: oral capsule, oral tablet

As well as its needed effects, ramipril may cause unwanted side effects that require medical attention.

Major Side Effects

If any of the following side effects occur while taking ramipril, check with your doctor immediately:

More common:
  • Blurred vision
  • confusion
  • dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
  • sweating
  • unusual tiredness or weakness
Less common:
  • Arm, back, or jaw pain
  • chest pain or discomfort
  • chest tightness or heaviness
  • chills
  • cloudy urine
  • cold sweats
  • decrease in urine output or decrease in urine-concentrating ability
  • fainting
  • fast or irregular heartbeat
  • nausea
  • shortness of breath

Minor Side Effects

Some ramipril side effects may not need any medical attention. As your body gets used to the medicine these side effects may disappear. Your health care professional may be able to help you prevent or reduce these side effects, but do check with them if any of the following side effects continue, or if you are concerned about them:

More common:
  • Cough
Less common:
  • Diarrhea
  • feeling of constant movement of self or surroundings
  • sensation of spinning
  • vomiting

For Healthcare Professionals

Applies to ramipril: oral capsule, oral tablet


The most common adverse reaction is hypotension.[Ref]


Very common (10% or more): Hypotension (11%)
Common (1% to 10%): Angina pectoris, postural hypotension, orthostatic blood pressure decreased
Uncommon (0.1% to 1%): Symptomatic hypotension, myocardial ischemia, myocardial infarction, tachycardia, arrhythmia, palpitation, flushing
Rare (less than 0.1%): Vascular stenosis, hypoperfusion, vasculitis
Frequency not reported: Disturbed orthostatic regulation, Raynaud's phenomenon[Ref]


Common (1% to 10%): Nausea, vomiting, diarrhea, gastrointestinal inflammation, digestive disturbances, abdominal discomfort, dyspepsia
Uncommon (0.1% to 1%): Pancreatitis, pancreatic enzymes increased, abdominal pain, small bowel angioedema, gastritis, constipation, dry mouth
Rare (less than 0.1%): Glossitis
Frequency not reported: Dysphagia, gastroenteritis, increased salivation, gastric pain, aphthous stomatitis[Ref]


Common (1% to 10%): Fatigue, asthenia, vertigo, bronchitis, sinusitis, chest pain
Uncommon (0.1% to 1%): Peripheral edema, pyrexia, libido decreased
Rare (less than 0.1%): Conjunctivitis, hearing impaired, tinnitus
Frequency not reported: Hearing loss, edema, malaise, gynecomastia[Ref]


Common (1% to 10%): Cough, nonproductive tickling cough, cough increased, dyspnea
Uncommon (0.1% to 1%): Bronchospasm, asthma aggravated
Frequency not reported: Eosinophilic pneumonitis, epistaxis, nasal congestion[Ref]


Uncommon (0.1% to 1%): Depressed mood, anxiety, nervousness, restlessness, sleep disorder
Rare (less than 0.1%): Confusional state
Frequency not reported: Depression, insomnia, disturbance in attention[Ref]

Nervous system

Common (1% to 10%): Headache, dizziness, syncope
Uncommon (0.1% to 1%): Paresthesia, dysgeusia, ageusia, somnolence
Rare (less than 0.1%): Tremor, balance disorder
Frequency not reported: Smell disturbance, amnesia, convulsions, neuralgia, neuropathy, cerebral ischemia, ischemic stroke, transient ischemic attack, psychomotor skills impaired, burning sensation, parosmia[Ref]


Common (1% to 10%): Muscle spasm, myalgia
Uncommon (0.1% to 1%): Arthralgia
Frequency not reported: Arthritis[Ref]


Common (1% to 10%): Maculopapular rash
Uncommon (0.1% to 1%): Pruritus, hyperhidrosis
Rare (less than 0.1%): Exfoliative dermatitis, urticaria, onycholysis
Frequency not reported: Purpura, pemphigus, pemphigoid, erythema multiforme, toxic epidermal necrolysis, Stevens Johnson syndrome, sweating increased, alopecia, psoriasis aggravated, dermatitis psoriasiform, lichenoid exanthema, enanthema[Ref]


Common (1% to 10%): Abnormal kidney function
Uncommon (0.1% to 1%): Renal impairment, acute renal failure[Ref]


Common (1% to 10%): Creatinine increased, blood potassium increased
Uncommon (0.1% to 1%): Anorexia, decreased appetite, BUN increased
Frequency not reported: Weight gain, hyponatremia, loss of appetite, uric acid elevated, blood glucose elevated, blood sodium decreased
Postmarketing reports: Hypoglycemia[Ref]


Uncommon (0.1% to 1%): Worsening of preexisting proteinuria, urine output increased, transient erectile impotence
Frequency not reported: Proteinuria, impotence[Ref]


Uncommon (0.1% to 1%): Visual disturbance, blurred vision[Ref]


Uncommon (0.1% to 1%): Eosinophilia, hemoglobin or hematocrit decreased
Rare (less than 0.1%): Neutropenia, agranulocytosis, white blood cell count decreased, red blood cell count decreased, platelet count decreased
Frequency not reported: Pancytopenia, hemolytic anemia, thrombocytopenia, leucopenia, bone marrow failure[Ref]


Uncommon (0.1% to 1%): Hepatic enzymes increased, conjugated bilirubin increased
Rare (less than 0.1%): Cholestatic jaundice, hepatocellular damage
Frequency not reported: Hepatic failure, hepatitis, jaundice, acute liver failure, hepatocellular damage, cholestatic hepatitis, cytolytic hepatitis, serum bilirubin elevated[Ref]


Uncommon (0.1% to 1%): Angioneurotic edema, angioedema
Very rare (less than 0.01%): Photosensitivity
Frequency not reported: Anaphylactic reaction, anaphylactoid reaction, apparent hypersensitivity reaction, antinuclear antibody increased[Ref]


Frequency not reported: Syndrome of inappropriate antidiuretic hormone secretion[Ref]


1. Cerner Multum, Inc. "Australian Product Information." O 0

2. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0

3. "Product Information. Altace (ramipril)." Hoechst Marion-Roussel Inc, Kansas City, MO.

It is possible that some side effects of ramipril may not have been reported. These can be reported to the FDA here. Always consult a healthcare professional for medical advice.

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