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Ramipril, Oral Capsule

Highlights for ramipril

  1. Ramipril oral capsule is available as both a generic and brand-name drug. Brand-name: Altace.
  2. This drug may 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.
  3. Ramipril is used to treat hypertension (high blood pressure). It’s also used to reduce the risk of heart attack, stroke, or death. It may also be given to treat heart failure in people who’ve had a heart attack.
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Important warnings

Important warnings

FDA warning: Use during pregnancy 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.
  • 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 warning: 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 warning: 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 warning: Ramipril may cause a persistent cough. It will go away once you stop taking this medication.

About

What is ramipril?

Ramipril oral capsule is a prescription drug that’s available as the brand-name drug Altace. It’s also 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.

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

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

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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Side effects

Ramipril side effects

Ramipril oral capsule doesn’t cause drowsiness. However, it can cause other side effects.

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 911 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

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.

Interactions

Ramipril may interact with other medications

Ramipril oral capsule 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.

Examples of drugs that can cause interactions with Ramipril are listed below.

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 drugs 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

Heart failure drugs

Do not take certain heart failure drugs called neprilysin inhibitors with ramipril. When taken with ramipril, these drugs increase your risk of angioedema (severe swelling of the skin). Examples of these drugs include:

  • sacubitril

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.

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Other warnings

Ramipril warnings

Ramipril oral capsule comes with several warnings.

Allergy warning

Ramipril can cause a severe allergic reaction. Symptoms include:

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

Call 911 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).

Warnings for people with certain health conditions

For 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.

For 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.

For 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.

For 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.

Warnings for other groups

For 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.

For women who are breastfeeding: Ramipril may pass into breast milk and may cause side effects in a child who is breastfed. Talk to your doctor if you breastfeed your baby. You may need to decide whether to stop breastfeeding or stop taking this medication.

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.

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

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Dosage

How to take ramipril

This dosage information is for ramipril 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

Forms and strengths

Generic: ramipril

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

Brand: Altace

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

Dosage for hypertension (high blood pressure)

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.

Dosage to reduce the risk of heart attack, stroke, or death

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.

Dosage for heart failure after a heart attack

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.

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Take as directed

Take as directed

Ramipril oral capsule is used for long-term treatment. It 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.

Important considerations

Important considerations for taking Ramipril

Keep these considerations in mind if your doctor prescribes Ramipril oral capsule for you.

General

You can take ramipril with or without food.

Ramipril capsules should be swallowed whole.

Storage

  • 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.

Refills

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.

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Alternatives

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.

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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