An ACE inhibitor that relaxes blood vessels and eases the heart's workload, used for high blood pressure, heart failure, after heart attacks and to protect the kidneys in diabetes.
Legal status differs between countries and can change; each row cites the document it was taken from and applies only to the country named.
What it is used for
High blood pressure (first choice under 55 and in diabetes)
Heart failure with reduced ejection fraction (improves survival)
After a heart attack
Protecting the kidneys in diabetes and chronic kidney disease with protein in the urine
Angiotensin receptor blockers (losartan, candesartan) do the same job for people who cough on ACE inhibitors
How it works in the body
Blocks the enzyme that converts angiotensin I to angiotensin II, the hormone that constricts arteries, drives the adrenal glands to release aldosterone (salt and water retention) and thickens heart muscle and vessel walls. Less angiotensin II means relaxed vessels, lower pressure, less strain on a failing heart and lower pressure inside the kidney's filters. ACE also breaks down bradykinin, which accumulates and causes the characteristic dry cough.
Common side effects
Dry tickly cough (10-15%, from bradykinin)
Dizziness with the first doses, tiredness, headache
A small rise in creatinine and potassium
Serious: seek help
Angio-oedema: swelling of the lips, tongue and throat, can block the airway; stop immediately
Acute kidney injury when dehydrated, on NSAIDs, or with narrowed renal arteries
High potassium, especially with spironolactone, kidney disease or potassium supplements
Harm to the fetus: stop before or as soon as pregnancy is known
Cautions and interactions
Pause on 'sick days' with vomiting, diarrhoea or fever to protect the kidneys
Avoid with NSAIDs and potassium supplements; caution with diuretics (first-dose hypotension)
Bilateral renal artery stenosis, previous angio-oedema, pregnancy: do not use
Interactions
Check interactions
Taking Ramipril with other medicines? Add them to the checker to see what the official sources say about each pair: the mechanism, general management and monitoring, never a bare "safe".
Interactions documented in the official sources cited on each card. The list covers the medicines represented on this site and is not exhaustive; how the interaction data is compiled.
No pair records for this medicine are in the sources currently represented by Anatomy Nexus. Absence from this list does not mean no interaction exists.
As a member of ACE inhibitors
Records written for the whole ace inhibitors class apply to Ramipril.
Contraindicated or avoidOfficial guidance: avoid the combination
Losartan with any ACE inhibitor (ramipril, lisinopril, enalapril, perindopril) duplicates renin-angiotensin blockade: more hypotension, kidney injury and hyperkalaemia without extra benefit.
Why it can occur
pharmacodynamic antagonism
What official information says
NICE: do not combine an ACE inhibitor with an ARB to treat hypertension.
Therapeutic duplication. Two ACE inhibitors together, or an ACE inhibitor with an ARB, duplicate renin-angiotensin blockade and increase the risk of kidney injury, hyperkalaemia and hypotension without extra benefit. UK
Medicines that share the class of Ramipril. They are separate medicines with their own licences, doses and interactions, not alternative names for Ramipril.
Medicines often discussed alongside Ramipril: used together, compared with it, or acting on the same problem by a different route.
Educational content. Anatomy Nexus provides medical education and does not replace professional medical advice, diagnosis, treatment, prescribing or pharmacist review. Doses, choices and monitoring are decided by a prescriber for an individual; never start, stop or change a medicine on the basis of this page.
