An ACE inhibitor
Ramipril
A common ACE inhibitor used for high blood pressure and heart failure, and to protect the heart and kidneys.
What is Ramipril?
Ramipril is an ACE inhibitor that relaxes blood vessels to lower blood pressure and ease the strain on the heart. It is used to treat high blood pressure and heart failure, and to protect the heart and kidneys in people at higher cardiovascular risk.
Education and reference only. This is a plain-language guide to Ramipril — it deliberately contains no doses. Doses depend on the person, the brand and the reason for treatment, and belong with your prescriber. Always check the BNF, the product labelling (SmPC) and follow medical advice.
What it is
Ramipril is a widely used ACE inhibitor. It lowers blood pressure, is a foundation treatment for heart failure with a reduced pumping function, and is used to protect the heart and kidneys — for example after a heart attack and in people with diabetes or kidney disease who have protein in the urine. It is a long-term, usually once-daily tablet.
How it works
Ramipril blocks the angiotensin-converting enzyme (ACE), which the body uses to make angiotensin II — a hormone that tightens blood vessels and makes the body hold on to salt and water. With less angiotensin II, blood vessels relax and fluid load falls, so blood pressure drops and the heart has less to work against. The same effect reduces pressure inside the kidney's filters, which is how it offers kidney protection.
Company & origin
Originated / developed by: Sanofi (originated at Hoechst).
Ramipril is an ACE inhibitor developed by the German company Hoechst (later Aventis, now part of Sanofi), which patented it in 1981. It was first approved by the FDA in 1991 under the brand name Altace and is marketed in the UK as Tritace.
What it treats
Conditions Ramipril is used for
Practical use
How to take Ramipril
General, dose-free guidance — always follow your prescriber's and the leaflet's specific instructions.
- Usually taken once a day; the very first dose is often taken at bedtime as it can cause dizziness.
- Swallow the capsule or tablet with water, with or without food.
- A dry, tickly cough is a recognised side effect — tell your GP if it bothers you.
- If you miss a dose, take it when you remember unless it is nearly time for the next one, then skip it.
- Avoid NSAID painkillers and salt substitutes unless advised, as they can affect kidneys and potassium.
- Do not stop suddenly without advice, especially if you are taking it for heart failure.
Weighing it up
Advantages & disadvantages of Ramipril
Advantages
- Strong outcome evidence in high blood pressure, heart failure and kidney protection.
- Once-daily dosing for most people.
- Cheap, well-established generic.
- Particularly helpful in people with diabetes or protein in the urine.
Disadvantages
- Commonly causes a persistent dry cough that may force a switch to an ARB.
- Can raise blood potassium and affect kidney function, so needs blood-test monitoring.
- May cause dizziness or light-headedness, especially when first started.
- Must be avoided in pregnancy and used with care alongside certain other medicines.
Practical use
Good to know
It is often started at a low level and built up, with a blood-pressure and blood-test check after starting and after increases. A dry, tickly cough is the most recognised nuisance effect and, if troublesome, is usually solved by switching to an ARB. The first dose can cause dizziness, so it is sometimes taken at bedtime to begin with.
Who should not take it / use with caution
- People who are pregnant or planning pregnancy — ACE inhibitors are avoided in pregnancy and switched beforehand.
- A history of angioedema (sudden swelling of the lips, tongue or throat), including from a previous ACE inhibitor.
- Used with caution in significant kidney artery narrowing, low blood pressure, or a high blood potassium level.
Monitoring
- Blood pressure
- Kidney function and blood potassium before and after starting/increasing
- For cough or any swelling
Side effects
- A persistent dry cough (common and harmless, but can be annoying).
- Dizziness or light-headedness, especially on standing or after the first dose.
- A rise in blood potassium or a change in kidney function (watched with blood tests); rarely, angioedema — sudden swelling of the face/throat needs emergency care.
Key interactions
- NSAID painkillers (e.g. ibuprofen) can reduce its effect and stress the kidneys, especially with a diuretic ("triple whammy").
- Potassium supplements, potassium-based salt substitutes and certain diuretics can push potassium too high.
- Care with other blood-pressure-lowering medicines and with lithium.
Available as: Capsules and tablets (several strengths). A liquid is available for those who cannot swallow capsules.
Answers
Ramipril: frequently asked questions
Why does ramipril make me cough?
ACE inhibitors can cause a persistent dry, tickly cough in some people because of the way they affect natural body chemicals in the airways. It is harmless but can be annoying; if it bothers you, your prescriber can usually switch you to an ARB, which rarely causes a cough.
What is the difference between ramipril and an ARB?
Both lower blood pressure through the same hormone system. ACE inhibitors such as ramipril can cause a dry cough; ARBs (such as losartan or candesartan) work at the next step along and rarely cause cough, so they are the usual alternative if ramipril is not tolerated.
Should I take ramipril in the morning or at night?
It can be taken at a consistent time that suits you. Because the first dose (and dose increases) can cause dizziness, the very first dose is sometimes taken at bedtime. Follow your prescriber's advice.
Can I take ibuprofen with ramipril?
Occasional use may be fine, but regular anti-inflammatory painkillers (NSAIDs) can reduce ramipril's effect and, especially alongside a water tablet, can harm the kidneys. Check with your pharmacist and prefer paracetamol where suitable.
Is ramipril safe in pregnancy?
No — ACE inhibitors are avoided in pregnancy and are usually switched to a safer alternative before conceiving. Tell your doctor promptly if you are pregnant or planning to be.
The wider class
About ACE inhibitors
Ramipril belongs to the ace inhibitors class. For how the class as a whole works, its shared safety principles and monitoring, see the full guide.
Browse by body system
Authoritative sources
- BNF: Ramipril.
- electronic Medicines Compendium (SmPC): Ramipril.
- NICE CKS: Ramipril.
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