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Why it's used

Ramipril is used to treat high blood pressure, signs of heart failure (symptomatic heart failure), kidney damage due to the presence of high amounts of proteins in urine in diabetic patients, kidney damage due to increased levels of urine albumin in diabetic patients. This medicine is also used to treat kidney failure and presence of protein in the urine in patients without diabetes mellitus. It is a prescription medicine. It works by blocking the hormone system that controls the blood pressure and fluid balance (called as, renin-angiotensin-aldosterone system). It helps by lowering the blood pressure. Ramipril is also used to reduce the risk of heart attack, stroke and other fatal conditions associated with heart diseases.
Ramipril may also be taken in combination with other medicines to treat certain conditions as recommended by the doctor. Ramipril is used together with thiazide diuretics to treat high blood pressure. Ramipril is also used with other antihypertensive, antiplatelet drugs, or Lipid lowering drugs to reduce the risk of heart attack, stroke and other fatal conditions associated with heart diseases.
Angiotensin Converting Enzyme Inhibitor
Ramipril belongs to a class of medicines called Angiotensin Converting Enzyme Inhibitor. Angiotensin-converting enzyme (ACE) inhibitors treat a variety of conditions, such as high blood pressure, migraines, and scleroderma. It helps in relaxing the blood vessels.

How to use

Read the medicine guide provided by your pharmacist, your doctor, or the medicine company. If you have any questions related to Ramipril, ask your doctor or pharmacist. Use Ramipril as per the instructions provided by your doctor.
You should keep track of your blood pressure levels regularly. Share results with the doctor and discuss your treatment plan if your measurements areabnormally high or low
Ramipril is eaten with or without food. Ramipril capsules should be swallowed whole. It can also be taken by mixing with a small amount (4 ounces approx) of applesauce or mixed in 120 ml (4 ounces) of water or apple juice. These mixtures can be stored at room temperature for 24 hours or under refrigeration for 48 hours.
The typical dose of Ramipril for adults is 2.5 mg to 20 mg once daily and dose may be adjusted after 2 to 4 weeks based on patient's blood pressure response. The maximum dose for adult patients of Ramipril is 10 mg once daily per day. Ramipril is commonly used at the same time every day.
This medicine is to be used for longer periods of time.
Discuss with your doctor if your condition worsens. Discuss with your doctor if burning sensation, hair loss, dark concentrated urine, swollen mouth, difficulty while focusing, low blood sodium level, breast enlargement in men, slowed reactions, muscle cramps, fits, confusion, low blood cell count, and altered smelling sensations. If you have any kidney disease, In patients with abnormal functioning of the kidney, the recommended initial dose of Ramipril is 1.25 mg once daily. Dosage may be increased up to the maximum dose of 5 mg by controlling high blood pressure conditions. If you have issues with the health of your liver, In patients with the abnormal functioning of the liver, the maximum daily dose of 2.5 mg Ramipril is given under close supervision.
Your doctor may prescribe a lower starting dose of this medicine to understand the impact on the body. Please follow your doctor's recommendations. Older patients may see an increase in the incidence of side-effects. As a result, a lower dose may be recommended for older patients.
The safety and effectiveness of using Ramipril in children has not been established. No safety and effectiveness data has been established in children.
Consult with your doctor on the consumption of alcohol with Ramipril.
Medicines may be recommended for uses other than those listed in the medicine guide. You should not use Ramipril for conditions or symptoms for which it was not prescribed. Do not give Ramipril to other people, even if they have the same conditions or symptoms that you have. The use of this medicine without the advice of a doctor may cause harm.
Follow storage instructions on the product package if available. Store Ramipril at 15° to 30°C (59° to 86°F) for #NAME capsules, 20° to 25°C (68° to 77°F) for Ramipril tablets, and away from moisture. Store this medicine away from children and pets.

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How to take Ramipril

The dose and frequency of using Ramipril will depend on the following factors:
  • patient's health
  • the health of the patient's liver
  • the health of the patient's kidneys
  • response to the medicine

Ramipril Dosage

Dosage for high blood pressure

Adult
  • Recommended: 2.5 mg to 20 mg once daily in one or two equally divided doses based on the patient's response
  • Initial: 2.5 mg once daily
Older Adults
  • Initial: 1.25 mg

Dosage for signs of heart failure

Adult (patients taking diuretics)
  • Recommended: an initial dose of Ramipril should be double every one to two weeks up to 10 mg daily
  • Initial: 1.25 mg daily
  • Maximum: 10 mg daily
Older Adults
  • Initial: 1.25 mg

Dosage for reduce the risk of heart attack, stroke and other fatal conditions associated with heart diseases

Adult
  • Recommended: 5 mg once daily for three weeks after the initial dose and based on the patient's response increased up to 10 mg once daily or it may be given in divided doses in patients with recently had a heart attack or high blood pressure
  • Initial: 2.5 mg once daily for 1 week
Older Adults
  • Initial: 1.25 mg

Dosage for kidney damage due to increased levels of urine albumin in diabetic patients

Adult
  • Recommended: 2.5 mg once daily based on patient's response after two weeks of initial dose and 5 mg once daily after further two weeks
  • Initial: 1.25 mg once daily
Older Adults
  • Initial: 1.25 mg

Dosage for kidney failure and presence of protein in the urine in patients without diabetes mellitus

Adult
  • Recommended: 2.5 mg once daily based on patient's response after two weeks of initial dose and 5 mg once daily after further two weeks
  • Initial: 1.25 mg once daily
Older Adults
  • Initial: 1.25 mg

Dosage for kidney damage in diabetic patients with risk factor of heart disease

Adult
  • Recommended: 5 mg once daily based on patient's response after one or two weeks of initial dose and 10 mg once daily after further two or three weeks
  • Initial: 2.5 mg once daily
Older Adults
  • Initial: 1.25 mg

Forms

Tablet
Strength: 1.25 mg, 2.5 mg, 5 mg, and 10 mg
Capsule
Strength: 1.25 mg, 2.5 mg, 5 mg, and 10 mg
Gelatin Coated Capsule
Strength: 1.25 mg, 2.5 mg, 5 mg, and 10 mg

Special Instructions

Patient with creatinine clearance more than or equal to 60 ml/min
The initial dose of Ramipril should be 2.5 mg/day, and the maximum dose should be 10 mg/day.
Patient with creatinine clearance between 30-60 ml/min
The initial dose of Ramipril should be 2.5 mg/day, and the maximum dose should be 5 mg/day.
Patient with creatinine clearance between 10-30 ml/min
The initial dose of Ramipril should be 1.25 mg/day, and the maximum dose should be 5 mg/day.
High blood pressure patients who underwent hemodialysis
The initial dose of Ramipril should be 1.25 mg/day, and the maximum dose should be 5 mg/day given after few hours of hemodialysis.
Patient with liver dysfunction
The dose of Ramipril should be given under close supervision and may be increased up to 2.5 mg daily.

Missed Dose

Skip the missed dose if it's time for next dose. Avoid taking a double dose to make up for the missed dose.

Overdose

What to do if you overdose on Ramipril?
In case of overdose, close supervision and supportive care should be provided. Stomach emptying should be performed by cleaning out the contents of the stomach or by using an adsorbent, a substance that absorbs poisons from the stomach. Also, provide treatment with angiotensin II or alpha one adrenergic agonists to such patients. The Ramipril should be removed from the body by blood purifying technique (called as, hemodialysis).
Symptoms of an overdose of Ramipril
If you use too much of this medicine, it could lead to dangerous levels of the medicine in your body. In such cases, symptoms of an overdose may include:
If you think you have overdosed on Ramipril, call a poison control center immediately. You can look up the poison control center information from the Poison Center Finder at TabletWise.com.

Precautions while using Ramipril

Before you use Ramipril, discuss with your doctor if you are allergic to it or its ingredients. Your doctor may prescribe an alternative medicine and update your medical records to record this information. Tell your doctor if you are allergic any of the following substances: angiotensin converting enzyme inhibitor.
Before you use Ramipril, tell your doctor of your medical and health history including the following: swelling due to fluid accumulation, previous history of in utero exposure to Ramipril, women in their last 6 months of pregnancy, abnormal functioning of the kidneys, patients with low or unstable blood pressure conditions, patients undergone dialysis procedures, or diabetes. Use of Ramipril in patients with a history of swelling of the lower layer of skin may lead to further complications. Infants with a history of in utero exposure to Ramipril may lead to low blood pressure, decreased urine production, and increased potassium levels in the blood (hyperkalemia). Before having surgery during the use of Ramipril, discuss with your doctor and dentist about the medicinal products you use including prescription/non-prescription/herbal medicines.
The use of this medicine may change hemoglobin and hematocrit value. A decrease in hemoglobin and hematocrit level has been seen in patient's while using Ramipril and a diuretic.
The use of this medicine may change blood urea nitrogen. An increase in the blood urea nitrogen level occurs while using Ramipril with a diuretic.
The use of Ramipril may change creatinine level in the blood. An increase in the creatinine level occurs while using Ramipril with a diuretic.
The use of this medicine may change potassium levels. An increase in the potassium level occurs while using Ramipril. Caution should be used while using Ramipril with potassium supplements and potassium-sparing diuretics. Also, the blood potassium level should be monitored regularly.
The use of Ramipril may change aldosterone. A decrease in the aldosterone level occurs while using Ramipril.
Ramipril can make you feel sleepy. Be careful when using any machinery, driving a vehicle, or doing any other activity that needs you to be fully alert. The consumption of alcohol with Ramipril can worsen the sleepiness. Ramipril may cause rarely seizures in some people. If you perform any activities where a loss of consciousness may cause harm to you (or others), you should discuss with your doctor.
The use of Ramipril is known to be not safe for use in pregnant women. If you are planning to become pregnant or are currently pregnant, you should discuss with your doctor the potential impact of this medicine on the baby before you start to using it. Ramipril can cross the placenta. The use of Ramipril in the second and third trimester of pregnancy causes a decrease in the functioning of kidneys and increases chances of fatality in the unborn baby. It can also result in a deficiency of amniotic fluid in womb associated with incomplete development of lungs and bone deformations. Other side effects caused by Ramipril include skull abnormalities, less production of urine, low blood pressure, kidney failure, and other defects in the baby. The use of Ramipril is not safe for use in women who are breastfeeding. If you are breastfeeding a baby, discuss with your doctor if you should either discontinue breastfeeding or stop using this medicine while breastfeeding. Ramipril and its metabolites may pass into breast milk if given in multiple doses. The information available on the use of Ramipril in women who are breastfeeding is not sufficient. Consult with your doctor on the use of Ramipril, if you are trying to conceive.
Consult with your doctor on the consumption of alcohol with Ramipril. Drinking alcohol may cause low blood pressure, dizziness, and light-headedness.
This medicine may increase your sensitivity to sunlight. If this happens, use a sunscreen and cover your skin when you are outdoors. Limit your time in the sun. If you get a sunburn on your skin, consult with your doctor.
Ramipril may cause increased incidence of side-effects in older patients.
Ramipril may cause an increased risk of side-effects in children. Children using this medicine may see an increased risk of fast heartbeat, nasal congestion, stuffy nose (rhinitis), pink eye (conjunctivitis), tremor, and hives.

What precautions should be taken during Pregnancy and Nursing, and administering Ramipril to Children or the Older Adults?

Pregnant Women

Contraindicated or Not Recommended
Warning: Ramipril can cross the placenta. The use of Ramipril in the second and third trimester of pregnancy causes a decrease in the functioning of kidneys and increases chances of fatality in the unborn baby. It can also result in a deficiency of amniotic fluid in womb associated with incomplete development of lungs and bone deformations. Other side effects caused by Ramipril include skull abnormalities, less production of urine, low blood pressure, kidney failure, and other defects in the baby. When pregnancy is detected, stop using Ramipril. Appropriate management of high blood pressure in the mother during pregnancy should be done. If no alternative therapy is available, tell the mother about the risk of deficiency of amniotic fluid and perform ultrasound regularly. Closely observe babies with a history of in utero exposure to Ramipril for symptoms of low blood pressure, less urine production, and increased potassium levels.

Breastfeeding

No
Warning: Ramipril and its metabolites may pass into breast milk when given in multiple doses. The information available on the use of Ramipril in women who are breastfeeding is not sufficient.

Younger Adults Population

Contraindicated or Not Recommended
Warning: The safety and efficacy of Ramipril have not been established in children.

Older Adults Population

Possibly safe
Warning: Some elderly patients can be more sensitive to the use of Ramipril.

Ramipril Side-effects

The following side-effects may commonly occur when using Ramipril. If any of these side-effects worsen or last for a long time, you should consult with your doctor:
The following side-effects may commonly occur in children when using Ramipril. Discuss with your doctor if any of these side-effects last for a long time or are severe:
Rarely, the use of Ramipril may cause the following side-effects:
  • a positive antinuclear antibodies
  • abnormal liver function test
  • an elevated erythrocyte sedimentation rate
  • an ulcer in the mouth (enanthema)
  • balance disorder
  • benign and non-contagious mouth ulcers
  • benign enlargement of the male breast
  • bilirubin increased
  • blood spots
  • bruising
  • burning sensation
  • cold hands and feet
  • constipation
  • dark urine
  • decreased secretion of adrenal gland hormone (called as aldosterone)
  • disturbance in attention
  • dry mouth
  • elevation in blood bilirubin uric acid
  • elevation in blood glucose levels
  • elevation in liver enzymes
  • feeling shaky
  • feeling weak
  • flushing
  • hair loss
  • heartburn
  • hives
  • illness
  • inability to identify an odor's (parosmia)
  • increase in the number of eosinophils
  • increased salivation
  • increased sweating
  • inflammation of the skin which mimics psoriasis (dermatitis psoriasiform)
  • inflammation of the tongue (glossitis)
  • insomnia
  • itching and unusual skin sensations
  • libido decreased
  • memory loss (amnesia)
  • mini-stroke (transient ischaemic attack)
  • narrowing of blood vessels that supply blood to the skin in response to cold (Raynaud's syndrome)
  • nasal congestion
  • nerve pain (neuralgia)
  • pain and inflammation of the joint (arthritis)
  • pain in joint (arthralgia)
  • painful blisters on the skin (pemphigus)
  • painless separation of the nail (onycholysis)
  • palpitations
  • pancreatic enzymes increased
  • protein in the urine
  • psychomotor skills disturbed
  • red, swollen, itchy, or watery eyes
  • reduced sexual desire in women or men
  • restlessness
  • ringing in the ears (tinnitus)
  • severe itching
  • skin rash due to inflammatory condition of the skin (lichenoid exanthema)
  • sleep problems
  • slowed or disturbed reactions
  • swelling in the arms
  • swelling in the legs
  • swollen mouth
  • taste disturbance
  • temporary increase in blood creatinine levels
  • temporary increase in blood urea nitrogen levels
  • tremor
  • trouble while focusing
  • urine output increased
  • weight gain
The following severe side-effects may also occur when using Ramipril:
  • liver problems
    Symptoms: fever, chills, tiredness, loss of appetite, stomach pain, feeling sick yellowing of the skin or eyes (jaundice)
    If any of these symptoms occur, contact with the doctor as soon as possible.
  • inflammation of the pancreas (pancreatitis)
    Symptoms: severe pain in stomach that may reach through to the back
    If this happens, contact your doctor immediately.
  • blood or bone marrow problems
    Symptoms: bruising more easily, bleeding for longer than usual, signs of bleeding (for example, bleeding from the gums), purple spots on the skin, getting infections very easily, sore throat, fever, feeling tired, fainting, dizziness pale skin
    If any of these symptoms occur, contact your doctor right away.
  • severe skin reactions (called as, Stevens-Johnson syndrome, and erythema multiform)
    Symptoms: skin rash, ulcers in the mouth, worsening of an existing skin disease, redness of the skin blistering of the skin
    If this happens, stop using Ramipril and contact your doctor immediately.
  • severe allergic reaction
    Symptoms: swelling of the lips, swelling of the face, swelling of the throat, difficulty in swallowing, difficulty in breathing, itching skin rash
    If any of these symptoms occur, discontinue the use of Ramipril and contact your doctor right away.
  • heart problems (heart attack)
    Symptoms: increased heart rate, palpitation, chest pain tightness in the chest
    If you notice any of these symptoms, contact your doctor right away.
  • Symptoms: abnormal breakdown of red blood cells, bone marrow failure, reduced number of red cells, white cells, and platelets, decreased white blood cell count, decreased red blood cell count, decrease in haemoglobin levels, decreased platelet count an increased number of eosinophils
  • skin disorder
    Symptoms: increased skin sensitivity to the sun
  • brain and mental disorders
    Symptoms: convulsions, depression, hearing loss, anxiety, damage of the peripheral nerves excessive sleepiness and drowsiness
Your doctor has prescribed this Ramipril because they have judged that the benefits outweigh the risks posed by side-effects. Many people using this medicine do not have serious side-effects. This is not a complete list of possible side-effects for Ramipril.
If you experience side-effects or notice other side-effects not listed above, contact your doctor for medical advice. You may also report side-effects to your local food and drug administration authority. You can look up the drug authority contact information from the Drug Authority Finder at TabletWise.com.

Side-effects and Allergic Reactions of Ramipril by Severity and Frequency

Common Side-effects

Following are the common side-effects of this medicine:

Infrequent and Rare Side-effects

Following are the infrequent and rare side-effects of this medicine:

Severe Side-effects

Following are the severe side-effects of this medicine:

Side-effects in Children

Following are the side-effects of this medicine in young patients:

Serious Allergic Reactions

Following are the symptoms of serious allergic reactions to this medicine:
  • blisters on the skin
  • difficulty in breathing
  • difficulty in swallowing
  • itching
  • redness of the skin
  • skin rash
  • swelling of the face
  • swelling of the lips
  • swelling of the throat
  • ulcers in mouth
  • worsening of a pre-existing skin disease
If any of these symptoms occur, discontinue the use of Ramipril and contact your doctor right away.
If you experience side-effects or notice other side-effects not listed above, contact your doctor for medical advice. You may also report side-effects to your local food and drug administration authority. You can look up the drug authority contact information from the Drug Authority Finder at TabletWise.com.

Warnings

Surgery

Patients using Ramipril during surgical procedures are at increased risk. It is advised that the treatment with Ramipril should be stopped one day before the surgery, if possible.

Soya warning

Patients who are allergic to peanut or soya are at increased risk when using this medicine. These patients should not use this medicine.

Patients with kidney disease

Patients having high blood pressure with narrow kidney arteries and the patients using diuretics are at increased risk when using this medicine. These patients may suffer from increased levels of blood urea nitrogen and creatinine. If this happens, reduction in the dose of Ramipril and discontinuation of diuretics is required.

Use of aliskiren with Ramipril

Patients with diabetes or abnormal functioning of the kidneys are at increased risk when using this medicine. These patients may suffer from low blood pressure, high potassium, and changes in the functioning of the kidney. Ramipril should not be used in combination with aliskiren.

Decreased white blood cells count

Patients with inflammation of connective tissues (collagen vascular disease) and kidney dysfunction are at increased risk when using this medicine. These patients may develop a reduction in the white blood cell count, red blood cell count, and hemoglobin content, or platelet count. In this case, proper monitoring of white blood cells should be considered in patients with collagen vascular disease, mainly if the condition involves abnormal functioning of kidney.

Women in their second and third trimester of pregnancy

Women who are pregnant are at increased risk when using this medicine. Ramipril can cross the placenta. The use of Ramipril in the second and third trimesters of pregnancy causes a decrease in the functioning of kidneys and increases the chances of fatality in the unborn baby. It can also result in a deficiency of amniotic fluid in womb associated with incomplete development of lungs and bone deformations. Other side effects caused by Ramipril include skull abnormalities, less production of urine, low blood pressure, kidney failure, and other defects in the baby. When pregnancy is detected, stop using Ramipril. Appropriate management of high blood pressure in the mother during pregnancy should be done. If no alternative therapy is available, tell the mother about the risk of deficiency of amniotic fluid and perform ultrasound regularly. Closely observe babies with a history of in utero exposure to Ramipril for symptoms of low blood pressure, less urine production, and increased potassium levels.

High blood potassium level (hyperkalemia)

Patients with high blood pressure are at increased risk when using this medicine. Also, the patients with diabetes mellitus, kidney insufficiency, and the combined use of potassium-sparing diuretics, potassium-containing salt substitutes, and potassium supplements are at increased risk. These patients may suffer from high potassium levels in the blood. Take necessary precautions while using this medicine in such patients.

Non productive, persistent cough

Patients using ACE inhibitors are at increased risk of non productive and persistent episodes of cough.

Use of telmisartan with Ramipril

Patients using telmisartan and Ramipril in combination are at increased risk. These patients have higher chances of developing abnormal functioning of the kidneys. The combined use of telmisartan and Ramipril is not recommended.

Severe allergic reactions (anaphylactoid reactions)

Patients undergoing desensitizing treatment (to reduce or eliminate an organism's negative reaction to a substance) with insect venom (Hymenoptera venom) and purification procedure with high-flux membranes are at increased risk when using this medicine. Also, the patients undergoing low-density lipoprotein apheresis using dextran sulfate are at increased risk. These patients may suffer from serious side-effects. If this happens, temporarily discontinue using this medicine.

Swelling of the face, head, mouth and neck extremities

Patients with a history of swelling of the lower layer of the skin are at increased risk when using this medicine. These patients may suffer from swelling due to fluid accumulation on the face, lips, extremities, glottis, tongue, and larynx. If this happens, discontinue using this medicine and appropriate treatment should be given immediately. In case, if there is an involvement of the glottis, tongue, or larynx it may lead to airway obstruction and to prevent this subcutaneous epinephrine solution 1:1,000 (0.3 ml to 0.5 ml) can be used.

Swelling of intestine due to fluid accumulation

Patients using angiotensin-converting enzyme inhibitors are at increased risk. These patients may suffer from abdominal pain with or without vomiting or nausea.

Low blood pressure

Patients with salt depleted as a result of prolonged diuretic therapy, dialysis, dietary salt restriction, diarrhea, or vomiting are at increased risk when using this medicine. Patients with congestive heart failure with or without kidney insufficiency are also at the increased risk when using this medicine. These patients may develop signs of low blood pressure which may be associated with reduced urination or abnormally raised level of nitrogen-containing compounds (azotemia) and very rarely it may lead to acute kidney failure and fatal conditions. If this happens, the patient should be placed in a lying position. If required, treatment with intravenous physiological saline infusion should be given. The close supervision is necessary for the first two weeks of the treatment.

Liver failure

Patients using ACE inhibitors are at increased risk. These patients may develop jaundice due to reduced bile flow (cholestatic jaundice) and progresses to acute liver failure (fulminant liver necrosis) and fatality. Discontinue the use of Ramipril in patients with jaundice or increased liver enzymes. An appropriate medical check-up is required in such patients.

Interactions with Ramipril

When two or more medicines are taken together, it can change how the medicines work and increase the risk of side-effects. In medical terms, this is called as a Drug Interaction.
Your doctor's guidelines may need to be followed while taking this medicine along with angiotensin II receptor blocker or aliskiren, which are used to treat high blood pressure. The use of Ramipril with angiotensin II receptor blocker or aliskiren may cause side-effects such as low blood pressure, increased potassium level and decreased functioning of the kidneys. Avoid the combined use of Ramipril with angiotensin II receptor blocker or aliskiren in patients with diabetes or abnormal functioning of the kidneys.
Ramipril interacts with non-steroidal anti-inflammatory agents, which are used to reduce fever, treat pain and blood clots. When Ramipril is used with non-steroidal anti-inflammatory agents including selective cyclooxygenase-2 inhibitors in elderly, kidney disease or volume-depleted patients, it may reduce the blood lowering effect of Ramipril or cause kidney failure. The functioning of the kidney should be regularly monitored in such patients.
There may be an interaction of Ramipril with gold, which is used to treat pain associated with swelling and stiffness of the joints. The use of Ramipril with gold injection (sodium aurothiomalate) may cause symptoms such as nausea, vomiting, facial flushing, and low blood pressure.
Ramipril may interact with diuretics and other medicines, which are used to treat high blood pressure. The use of Ramipril with diuretics and other substances that may decrease the blood pressure (for example, tricyclic antidepressants, nitrates, anesthetics, baclofen, alfuzosin, doxazosin, tamsulosin, terazosin, alcohol, prazosin) may increase the risk of low blood pressure. The occurrence of such side-effects can be minimized by stopping the use of diuretics or taking a low starting dose.
Special instructions need to be followed while taking this medicine along with lithium, which is used to treat mental disorders. Ramipril may reduce the excretion of lithium and thus may enhance the lithium level in the blood. In case if the diuretic is used along with these medicines, further adds more risk to increased level of lithium in the blood. Take precaution and monitor lithium level while using Ramipril together with lithium.
Your doctor's guidelines may need to be followed while taking this medicine along with antidiabetic agents including insulin, which are used to treat high blood sugar levels. When antidiabetic agents are used with Ramipril may cause a decrease in the blood sugar level. The blood glucose levels should be monitored carefully in such patients.
Ramipril interacts with drugs which increase vascular smooth muscle tone and stimulates the sympathetic nervous system (vasopressor sympathomimetics). The use of vasopressor sympathomimetics (for example, isoproterenol, dobutamine, dopamine, adrenaline) with Ramipril may reduce the blood lowering effect of Ramipril. The blood pressure should be monitored in such patients.
Special instructions need to be followed while taking this medicine along with drugs that may change the blood cell count. The use of drugs that may change the blood cell count (such as allopurinol, corticosteroids, immunosuppressants, cytostatics, procainamide) with Ramipril may cause an increase in the chances of occurrence of blood reactions.
There may be an interaction of Ramipril with potassium salts, potassium-sparing diuretics, heparin and other, which increases the potassium level. When using Ramipril with potassium salts, potassium-sparing diuretics (spironolactone, triamterene, amiloride and others), heparin and other potassium level increasing substances (angiotensin II antagonists, ciclosporin, trimethoprim, tacrolimus), an increase in the level of potassium salt may occur. Take caution while using Ramipril together with potassium salts, potassium-sparing diuretics, heparin and other, which increases the potassium level. The potassium level should be closely monitored in such patients.
Ramipril may interact with the mammalian target of rapamycin (mTOR) inhibitors, which are used to suppress the immune system. The patient's taking mTOR inhibitor (for example, temsirolimus) with Ramipril are at increased risk of swelling of the lower skin due to fluid accumulation.
Ramipril may interact with telmisartan, which is used to treat high blood pressure. The combined use of Ramipril with telmisartan leads to abnormal functioning of the kidney, which can be possibly fatal. The combined use of Ramipril with telmisartan is not recommended in such patients.
There may be an interaction of Ramipril with thiazide diuretics, which are used to treat high blood pressure and swelling due to fluid accumulation. Ramipril can reduce the potassium loss caused by thiazide diuretics. Proper monitoring of potassium levels in the blood is required in such patients.
This page does not contain all the possible interactions of Ramipril. Share a list of all medicines that you use with your doctor and pharmacist. Do not start, stop, or change the dose of any medicines without the approval of your doctor.

Interactions of Ramipril by Severity

Severe

The following medicines are usually not to be taken together without consulting with your doctor or pharmacist.

Serious

The following medicines may interact when taken together and can cause harmful effects in the body. Please consult with your doctor or pharmacist before taking these medicines together.

When should Ramipril be not used?

Severe allergy

The use of this medicine is not recommended in patients who are allergic to Ramipril or other angiotensin-converting enzyme inhibitors. Patients may see an increased risk of swelling due to fluid accumulation during the therapy. These patients may have the following symptoms if they use this medicine:
  • facial swelling
  • swelling of the limbs
  • swelling of the lips
  • swelling of the tongue
  • swelling of the glottis
  • swelling of the larynx
  • airway obstruction
  • stomach pain with or without nausea or vomiting

Patients with a history of swelling of the skin and tissues due to fluid accumulation

This medicine is not recommended in patients with a history of swelling of the skin and tissues due to fluid accumulation.

Patients undergoing dialysis or hemofiltration procedures

The use of this medicine is not recommended in patients who are undergoing artificial blood purifying treatments such as dialysis or hemofiltration.

Patients with narrowing of one or both kidney arteries (bilateral or single kidney artery stenosis)

This medicine is not recommended in patients with bilateral or single kidney artery stenosis.

Patients suffering from low blood pressure, low blood pressure in the circulatory system or kidney disease

The use of this medicine is not recommended in hemodynamically unstable, or hypotensive patients.

Use of Ramipril with aliskiren

Ramipril should not be used in combination with aliskiren-containing products in patients having diabetes or kidney disease.

Traveling With Medication

  • Ensure that you carry enough doses of each of your prescription medicines to last the entire trip. The best place to store your medicines is in the carry on baggage. However, while flying, if carrying liquid medicines, make sure you do not go over the limits imposed for carry-on liquids.
  • While traveling overseas, make sure that you can carry each of your prescription medicines legally to your destination country. One way to ensure this is by checking with your destination country's embassy or website.
  • Make sure that you carry each of your medicines in their original packaging, which should typically include your name and address, and the details of the prescribing doctor.
  • If your travel involves crossing time zones, and you are required to take your medicine as per a fixed schedule, make sure that you adjust for the change in time.

Expired Medication

Taking a single dose of expired Ramipril is unlikely to cause a side-effect. However, please discuss with your doctor or pharmacist, if you feel unwell or sick. An expired medicine may become ineffective in treating your prescribed conditions. To be on the safe side, it is important not to use an expired drug. You are much safer by always keeping a fresh supply of unexpired medicines.

Safe Disposal of Medication

  • If there are disposal instructions on the package, please follow the instructions.
  • If there are medicine take-back programs in your country, you should contact the respective authority to arrange for the disposal of the medicine. For example, in the USA, the Drug Enforcement Administration regularly hosts National Prescription Drug Take-Back events.
  • If there are no take-back programs, mix the medicine with dirt and place them in a sealed plastic bag. Throw the plastic bag in your household trash. Separately, remove all personal information including the prescription label from the medicine packaging and then dispose off the container.
  • If specifically indicated on the medicine package that it needs to be flushed down the toilet when no longer needed, perform the required step.
This page provides information for Ramipril .
High Blood Pressure
Heart Failure
Heart Diseases
Diabetic Kidney Disease

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