Ramipril | Side Effects, Dosage, Uses & More
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Generic Name:

ramipril, Oral capsule

All Brands

  • Altace
SECTION 1 of 5

Highlights for ramipril

Oral capsule
1

Ramipril is an oral drug that’s used to treat hypertension (high blood pressure). It’s also used to reduce the risk of heart attack, stroke, or death in people at high risk for these conditions. It may also be given to treat heart failure in people who’ve had a heart attack.

2

Your dose depends on the condition that’s being treated, your other health issues, your age, and how you respond to the drug. Your doctor will decide a dose that’s right for you.

3

This drug can cause sudden swelling of your face, arms, legs, lips, tongue, throat, and intestines. Stop taking ramipril and tell your doctor right away if you have swelling in these areas or have stomach pain.

4

You shouldn’t take this drug if you’re pregnant or plan to become pregnant. Ramipril may cause birth defects or be fatal to your unborn baby. Tell your doctor if you are planning to get pregnant or are pregnant.

5

This drug may cause a persistent cough. It will go away once you stop taking this medication.

IMPORTANT INFORMATION

FDA warning

This drug has a Black Box Warning. This is the most serious warning from the Food and Drug Administration (FDA). A black box warning alerts doctors and patients to effects that may be dangerous. 

Use during pregnancy warning. You shouldn’t take this drug if you’re pregnant or plan to become pregnant. Ramipril may cause birth defects or be fatal to your unborn baby. Tell your doctor if you are planning to get pregnant or are pregnant.

Allergic reactions

This drug may cause an allergic reaction. You may have swelling (angioedema) of your face, arms, legs, lips, tongue, windpipe, and stomach. Tell your doctor right away if you have swelling in these areas or have stomach pain. Don’t take any more ramipril until you talk to your doctor.

Low blood pressure

You may have low blood pressure especially during the first few days of treatment with this drug. You may feel lightheaded. Your risk for low blood pressure may be higher if you:

  • eat a low salt diet
  • take a water pill (diuretic)
  • aren’t drinking enough fluids
  • are on dialysis
  • have diarrhea or are vomiting

Cough

Ramipril may cause a persistent cough. It will go away once you stop taking this medication.

What is ramipril?

Ramipril is a prescription drug. It’s available as an oral capsule.

Ramipril is available as a generic drug. Generic drugs usually cost less. In some cases they may not be available in every strength or form as the brand. Talk to your healthcare provider to see if the generic will work for you.

Ramipril may be taken as part of a combination therapy with other medications used to treat high blood pressure, such as thiazide diuretics.

Why it's used

Ramipril is used to:

  • treat high blood pressure
  • reduce the risk of heart attack, stroke or death in people with a high risk
  • treat heart failure in people who have had a heart attack

How it works

Ramipril belongs to a class of drugs called angiotensin-converting enzyme (ACE) inhibitors. A class of drugs is a group of medications that work in a similar way. They are often used to treat similar conditions.

Ramipril works by relaxing the blood vessels in your body. This reduces stress on your heart and lowers your blood pressure.

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ramipril Side Effects

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More Common Side Effects

If these effects are mild, they may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk to your doctor or pharmacist. 

The more common side effects that occur with ramipril include:

  • dizziness or faintness due to low blood pressure

  • cough

  • dizziness

  • chest pain

  • nausea

  • vomiting

  • diarrhea

  • weakness or tiredness

Serious Side Effects

Call your doctor right away if you have any of these serious side effects. Call 9-1-1 if your symptoms feel life-threatening or if you think you’re having a medical emergency. Serious side effects and their symptoms can include the following:

  • low blood pressure. This is more common when you’re starting the drug or increasing doses. Symptoms include:

    • dizziness
    • lightheadedness
  • allergic or hypersensitivity reaction (angioedema). Symptoms include:

    • swelling of your face, lips, tongue, or throat
    • trouble breathing
    • stomach pain with or without nausea and vomiting
  • liver problems (jaundice). Symptoms include:

    • yellowing of your skin or the whites of your eyes
    • stomach pain
    • fatigue
  • swelling (edema). Symptoms include:

    • swelling of your feet, legs, or hands
  • low white blood cell count. Symptoms include

    • sore throat
    • fever
  • purple spot on your skin caused by internal bleeding (purpura)

  • fast or abnormal heart rate or palpitations. Symptoms include:

    • feeling like your heart is fluttering
  • high potassium levels. Symptoms include:

    • weakness
    • arrhythmia (irregular heart rate) 
  • worse kidney function. Symptoms include:

    • nausea and vomiting
    • decreased urine output when urinating
    • fatigue
    • loss of appetite
Pharmacist's Advice
Healthline Pharmacist Editorial Team

Ramipril doesn’t cause drowsiness.

You may feel lightheaded during the first few days of treatment. Call your doctor if you feel faint.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this information includes all possible side effects. This information is not a substitute for medical advice. Always discuss possible side effects with a healthcare provider who knows your medical history.
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ramipril May Interact with Other Medications

Oral capsule

Ramipril can interact with other medications, herbs, or vitamins you might be taking. An interaction is when a substance changes the way a drug works. This can be harmful or prevent the drug from working well.

To help avoid interactions, your doctor should manage all of your medications carefully. Be sure to tell your doctor about all medications, vitamins or herbs you are taking. To find out how this drug might interact with something else you’re taking, talk to your doctor or pharmacist. 

Medications that might interact with this drug

Potassium supplements

These supplements may increase your blood potassium when taken with ramipril. 

These supplements include:

  • potassium chloride
  • potassium gluconate
  • potassium bicarbonate

Water pills (potassium-sparing diuretics)

These medicines may increase your blood potassium when taken with ramipril.

These drugs include:

  • spironolactone
  • amiloride
  • triamterene

Mood stabilizer drugs

Ramipril can increase the levels of lithium in your body. This means that you made have more side effects.

Gold products

When taken with ramipril, certain joint pain rugs can cause side effects. These include reddening and warming of your face (flushing), nausea, vomiting, and low blood pressure.

These drugs include:

  • injectable gold (sodium aurothiomalate)

Pain drugs

Certain pain drugs can decrease the effect of ramipril on your blood pressure. They can also cause kidney problems. 

These drugs include:

  • non-steroidal anti-inflammatory drugs (NSAIDs), such as:
    • naproxen
    • ibuprofen
    • diclofenac

Water pills

When taken with ramipril, these medications can increase the risk of very low blood pressure in people with heart failure after a heart attack.

These drugs include:

  • diuretics, such as:
    • hydrochlorothiazide
    • chlorthalidone
    • furosemide
    • bumetanide
    • metolazone
    • spironolactone
    • amiloride
    • triamterene

Blood pressure drugs

When taken with ramipril, these blood pressure medication can increase your risk of very low blood pressure, high blood potassium, and can affect how your kidneys function.

These drugs include:

  • aliskiren: Don’t take this drug with ramipril if you have diabetes or kidney problems.
  • angiotensin receptor blockers (ARBs), such as:
    • losartan
    • valsartan
    • olmesartan
    • candesartan
    • telmisartan: This drug shouldn’t be used with ramipril.
  • angiotensin-converting enzyme (ACE) inhibitors, such as:
    • benazepril
    • captopril
    • enalapril
    • lisinopril

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs interact differently in each person, we cannot guarantee that this information includes all possible interactions. This information is not a substitute for medical advice. Always speak with your healthcare provider about possible interactions with all prescription drugs, vitamins, herbs and supplements, and over-the-counter drugs that you are taking.
Ramipril warnings
kidney problems
People with kidney problems

People with kidney problems may have a higher risk for certain serious side effects from this drug, including high potassium levels. Tell your doctor if you have kidney problems, heart failure, and one- or two-sided renal artery stenosis. Your doctor will decide if ramipril is right for you.

liver problems
People with liver problems

Ramipril should be used with caution if you have liver problems. This drug can worsen your liver function and change your electrolyte levels.

low white blood cells
People with low white blood cells

Ramipril can cause low white blood cell counts. This can increase your risk of infections, especially if you have a history of lupus, kidney problems, or scleroderma. If you have any signs of an infection (such as a fever or sore throat), tell your doctor right away.

diabetes
People with diabetes

This drug can affect your blood sugar levels. Your doctor may need to change your dose of your diabetes drugs. Your doctor will tell you how often to test your blood sugar levels.

Pregnant women
Pregnant women

Ramipril is a category D pregnancy drug. That means two things: 

  1. Research in humans has shown adverse effects to the fetus when the mother takes the drug.
  2. This drug should only be used during pregnancy in serious cases where it's needed to treat a dangerous condition in the mother.

Talk to your doctor if you’re pregnant or planning to become pregnant. Ask your doctor to tell you about the specific harm that may be done to the fetus. This drug should be only used if the potential risk to the fetus is acceptable given the drug’s potential benefit.

breast-feeding
Women who are breast-feeding

Ramipril may pass into breast milk and may cause side effects in a child who is breast-fed. 

Talk to your doctor if you breast-feed your baby. You may need to decide whether to stop breast-feeding or stop taking this medication.

seniors
For seniors

Older adults may process drugs more slowly. A normal adult dose may cause levels of this drug to be higher than normal in your body. If you’re a senior, you may need a lower dose or a different schedule.

children
For children

This medicine hasn’t been studied in children and shouldn’t be used in children younger than 18 years.

call the doctor
When to call the doctor

Call your doctor if your blood pressure is too high or too low.

allergies
Allergies

Ramipril can cause a severe allergic reaction. Symptoms include: 

  • trouble breathing
  • swelling of your throat or tongue
  • hives

Call 9-1-1 or go to the nearest emergency room if you develop these symptoms.

Don’t take this drug again if you’ve ever had an allergic reaction to it. Taking it again could be fatal (cause death).

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How to Take ramipril (Dosage)

Oral capsule

All possible dosages and forms may not be included here. Your doctor will tell you what dosage is right for you. Your dose, form, and how often you take it will depend on: 

  • your age
  • the condition being treated
  • how severe your condition is
  • other medical conditions you have
  • how you react to the first dose

What are you taking this medication for?

Hypertension (high blood pressure)

Brand: Altace

Form: Oral capsule
Strengths: 1.25 mg, 2.5 mg, 5 mg, 10 mg

Generic: ramipril

Form: Oral capsule
Strengths: 1.25 mg, 2.5 mg, 5 mg, 10 mg
Adult dosage (ages 18–64 years)
  • If you’re not taking a diuretic: 2.5–20 mg per day, taken by mouth in 1 or 2 divided doses per day. You may need to take 2 divided doses per day if the drug stops working before it’s time for your next dose.
  • If you are taking a diuretic: The starting dose is 1.25 mg taken once per day.
Child dosage (ages 0–17 years)

This medicine hasn’t been studied in children and shouldn’t be used in children younger than 18 years.

Senior dosage (ages 65 years and older)

As you age, your kidneys may not work as well as they used to. This can cause your body to process drugs more slowly. As a result, more of this drug may stay in your body for a longer time. This increases your risk of side effects.

Your doctor may start you on a lowered dose or a different schedule. This can help keep levels of this drug from building up too much in your body.

Special considerations

Kidney problems: 1.25 mg once per day. Your doctor may increase your dose to 5 mg taken once per day if needed for blood pressure control.

Renal artery stenosis or dehydration: The starting dose is 1.25 mg taken by mouth once per day. Your doctor may change your dose as needed.

Reduce the risk of heart attack, stroke, or death

Brand: Altace

Form: Oral capsule
Strengths: 1.25 mg, 2.5 mg, 5 mg, 10 mg

Generic: ramipril

Form: Oral capsule
Strengths: 1.25 mg, 2.5 mg, 5 mg, 10 mg
Adult dosage (ages 18–64 years)

2.5 mg taken by mouth once per day for 1 week. Then 5 mg taken once per day for 3 weeks. Your doctor will increase your dose as tolerated to 10 mg taken once per day. You may need to take 2 divided doses per day if your blood pressure is too high or if you’ve recently had a heart attack.

Child dosage (ages 0–17 years)

This medicine hasn’t been studied in children and shouldn’t be used in children younger than 18 years.

Senior dosage (ages 65 years and older)

As you age, your kidneys may not work as well as they used to. This can cause your body to process drugs more slowly. As a result, more of this drug may stay in your body for a longer time. This increases your risk of side effects.

Your doctor may start you on a lowered dose or a different schedule. This can help keep levels of this drug from building up too much in your body.

Special considerations

Renal artery stenosis or dehydration: The starting dose is 1.25 mg taken by mouth once per day. Your doctor may change your dose as needed.

Heart failure after a heart attack

Brand: Altace

Form: Oral capsule
Strengths: 1.25 mg, 2.5 mg, 5 mg, 10 mg

Generic: ramipril

Form: Oral capsule
Strengths: 1.25 mg, 2.5 mg, 5 mg, 10 mg
Adult dosage (ages 18–64 years)
  • 2.5 mg taken by mouth twice per day (total of 5 mg per day). If your blood pressure drops too low, you may need a lower dose of 1.25 mg taken twice per day. After one week, your doctor may increase your dose as tolerated up to 5 mg taken twice per day. Your doctor may continue to increase your dose once every 3 weeks if needed. The maximum dose is 20 mg.
  • Your doctor may watch you for at least 2 hours after you take the first dose to make sure that you can safely take this drug.
Child dosage (ages 0–17 years)

This medicine hasn’t been studied in children and shouldn’t be used in children younger than 18 years.

Senior dosage (ages 65 years and older)

As you age, your kidneys may not work as well as they used to. This can cause your body to process drugs more slowly. As a result, more of this drug may stay in your body for a longer time. This increases your risk of side effects.

Your doctor may start you on a lowered dose or a different schedule. This can help keep levels of this drug from building up too much in your body.

Special considerations

Kidney problems: 1.25 mg once per day. Your doctor may increase your dose up to 1.25 mg taken twice per day if needed. The maximum dose is 2.5 mg taken twice per day.

Renal artery stenosis or dehydration: The starting dose is 1.25 mg taken by mouth once per day. Your doctor may change your dose as needed.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this list includes all possible dosages. This information is not a substitute for medical advice. Always to speak with your doctor or pharmacist about dosages that are right for you.
Pharmacist's Advice
Healthline Pharmacist Editorial Team

Ramipril comes with risks if you don't take it as prescribed.

If you don't take it at all

Ramipril reduces high blood pressure. If high blood pressure isn’t treated, it can lead to stroke, heart attack, heart failure, kidney failure, and vision problems.

If you stop taking it suddenly

Don’t stop taking ramipril without talking to your doctor. Stopping this drug suddenly can cause your blood pressure to spike. This may increase your chance for a heart attack or stroke.

If you don't take it on schedule

Your blood pressure may not improve or may get worse. You may have a higher chance of a heart attack or stroke.

What to do if you miss a dose

If you forget to take your dose, take it as soon as you remember. If it’s just a few hours before the time for your next dose, then wait and only take one dose at that time.

Never try to catch up by taking two doses at once. This could cause toxic side effects.

If you take too much

If you take too much ramipril, you could have dangerous levels of this drug in your body. You may have the following symptoms:

  • very low blood pressure
  • dizziness
  • kidney damage. Symptoms may include:
    • nausea and vomiting
    • decreased urine output when urinating
    • fatigue
    • loss of appetite

If you think you’ve taken too much of the drug, act right away. Call your doctor or local poison control center, or go to the nearest emergency room. 

How to tell this drug is working

You can tell if ramipril is working because your blood pressure will be lower.

Ramipril is used for long-term treatment. 

Ramipril capsules should be swallowed whole

The capsule can be opened and the contents may be sprinkled on a small amount of applesauce (about 4 ounces) or mixed in 4 ounces (120 mL) of water or apple juice. These mixtures can be pre-prepared and stored at room temperature for up to 24 hours or refrigerated for up to 48 hours.

Store ramipril at room temperature

  • Keep it from 59°F to 86°F (15°C to 30°C).
  • Don’t freeze this drug.
  • Keep it away from light.
  • Keep it away from high temperature.
  • Don’t store this medication in moist or damp areas, such as bathrooms.

A prescription for this medication is refillable

You should not need a new prescription for this medication to be refilled. Your doctor will write the number of refills authorized on your prescription.

Travel

When traveling with your medication:

  • Always carry your medication with you. When flying, never put it into a checked bag. Keep it in your carry-on bag.
  • Don’t worry about airport x-ray machines. They can’t hurt your medication.
  • You may need to show airport staff the pharmacy label for your medication. Always carry the original prescription-labeled box with you.
  • Don’t put this medication in your car’s glove compartment or leave it in the car. Be sure to avoid doing this when the weather is very hot or very cold.

Self-management

You may need to check your blood pressure at home. You’ll need to purchase a blood pressure monitor to do this.

You should keep a log with the date, time of day, and your blood pressure readings. Bring this diary with you to your doctor appointments.

Your doctor will tell you what to do if your blood pressure is too high or low. Based on your blood pressure readings, your doctor may change your medication.

Clinical monitoring

During treatment with this drug, your doctor will check the following to tell if this drug is working, is safe for you to take, and to check for side effects:

  • blood pressure
  • kidney function
  • liver problems
  • electrolyte changes
  • blood counts

Hidden costs

If your doctor asks you to check your blood pressure at home, you’ll need to buy a blood pressure monitor. These are available at most pharmacies. 

Insurance

Many insurance companies require a prior authorization for this drug. This means your doctor will need to get approval from your insurance company before your insurance company will pay for the prescription.

Are there any alternatives?

There are other drugs available to treat your condition. Some may be better suited for you than others. Talk to your doctor about other options that may work for you.

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How Much Does ramipril Cost?

Oral capsule

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These prices represent the lowest priced national pharmacies for ramipril on GoodRx. They may be lower than your insurance.

Content developed in collaboration with University of Illinois-Chicago, Drug Information Group

Medically reviewed by Creighton University, Center for Drug Information and Evidence-Based Practice on October 22, 2015

Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up-to-date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.
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