Ramipril

Treatment for: Hypertension (High Blood Pressure)
Type of drug: ACE inhibitor
Prescription or over-the-counter: Prescription-only medication
Branded or generic: Generic
Active ingredient: Ramipril
Dosages available: 1.25mg, 2.5mg, 5mg, and 10mg
Time to start working: 1-2 hours
Common side effects include: loss of energy, feeling weak or faint, dizziness, drowsiness, headache, nausea, mild skin reactions (rash)

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Ramipril is a medicine that is used to treat high blood pressure, as well as other cardiac problems such as heart failure. It may also be prescribed after a heart attack. Ramipril comes as tablets that you take daily, which help you to control your blood pressure by relaxing your blood vessels.

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Ramipril works by relaxing the blood vessels, and is a type of medication called an ACE inhibitor. ACE inhibitors work by stopping an enzyme in the body from producing angiotensin II. Angiotensin II causes blood vessels to narrow. When blood vessels narrow, it makes it harder for blood to flow through. This forces the heart to work harder and raises blood pressure. 

Relaxing blood vessels can help to lower blood pressure and reduce the risk of conditions like cardiovascular disease and stroke. 

How long does it take for ramipril to work? 

Ramipril takes effect within a few hours of taking the medication but you might need to wait a few weeks to see the full effect on your blood pressure readings. High blood pressure does not always have obvious symptoms so you might not feel any physical changes. 

Ramipril can also be prescribed for heart failure. In such cases, it can take weeks to months before you feel a positive change but this does not mean the medication is not working. 

How long does ramipril stay in the system? 

When measuring how long a drug stays in your system, doctors may often use the term ‘half-life’. This is the time it takes for the amount of a drug's active substance to reduce by half inside your body. After taking Ramipril, its effective half-life concentration is 13 to 17 hours for 5mg to 10mg doses. This half-life can be longer for lower doses of 1.25mg to 2.5mg doses.

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Ramipril is usually prescribed to be taken once or twice daily. Your doctor will likely recommend taking the very first dose in the evening because the first dose can cause dizziness. Afterwards, you may start taking it at any time of day and you should take it at the same time every day.

Swallow the capsules or tablet with a drink. You can take ramipril with or without food. Ramipril can also be prescribed as a tablet, capsule, or liquid. Your doctor will tell you what dosage to take. If taking as a liquid, make sure you use the measuring spoon provided. Avoid using a normal teaspoon as this is not as accurate a measure.

Try to take your dose of ramipril at the same time, every day. If you forget to take a dose, skip it. Just wait till you are due to take your next dose and resume the schedule. Do not double dose. 

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The dosage prescribed by your doctor can vary. To determine your dosage, your doctor will need to check your blood pressure. They may also need to examine your kidneys and check your potassium levels. Ramipril can cause blood potassium levels to increase, which can affect heart rate and be dangerous if the rise is too high. 

Ramipril is available in tablet, capsule and liquid form. In tablet and capsule form, it can be found in 1.25mg, 2.5mg, 5mg, and 10mg doses. 

How much will I need to take?

When taking ramipril for the first time, your doctor will prescribe between 1.25mg a day to 2.5mg twice daily. After a few weeks, your doctor will check your reaction to the medication and may increase the dosage between 2.5mg and 5mg once a day for those with higher blood pressure. 

If you have had some side effects, your doctor may recommend remaining on a lower dose. For those that have suffered heart failure, ramipril may be prescribed at a dosage of 5mg twice daily or 10mg once a day. This is the maximum dose allowed. 

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You can order ramipril online at Superdrug Online Doctor. It costs from £20 for a 3 month prescription and £25 for a 6 month prescription. Simply complete our online questionnaire and one of our doctors will review your information. You can only be prescribed ramipril by a doctor. It cannot be bought as an over the counter treatment. 

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Ramipril lowers blood pressure by inhibiting the production of angiotensin II. In some cases, this will cause some side effects. If you experience any side effects, be sure to tell your doctor. 

Common side effects can include:

• a dry, irritating, and persistent cough
• dizziness, especially when sitting or standing up suddenly
• headaches
• confusion
• diarrhoea
• blurred vision
• tiredness or weakness
• sweating
• mild skin rash
• raised potassium levels in your blood

Coughing is a common side effect that is often temporary and does not respond well to cough medicine. If it persists, consult your doctor. You may need to be switched to other medication to manage your blood pressure. The cough may persist for a while longer even if you stop taking ramipril. If you have a cough you should discuss with your doctor about the cause. 

Headaches can often be relieved by drinking more fluids and taking over the counter painkillers, but if you feel the headaches are persisting, you must talk to your doctor for an assessment. If experiencing diarrhoea or vomiting, try to drink more fluids to prevent dehydration, but also contact your doctor straight away for advice about the cause of your condition. Consult with your pharmacist or doctor to find out which options are best and before taking any other medication. You may be advised to stop taking ramipril until you recover. 

Uncommon side effects of ramipril can include:

• chest pain or tightness
• chills
• cold sweats
• breathlessness
• fainting
• irregular heartbeat
• reduced urination
• back, arm, or jaw pain
• Rare side effects can include:
• seizures
• unexplained bruising or bleeding

Some of the milder side effects may not require medical attention. They may disappear with time as your body adjusts to the medication. For instance, dizziness is common for first time users of ramipril and when the dosage is being adjusted upward. If the symptoms persist, be sure to inform your doctor. 

If you experience serious symptoms, please call your doctor right away.

These can include:

• yellowing of skin or eyes indicating liver problems
• tiredness, dizziness, sore throat, and fever could indicate a blood disorder
• irregular heartbeat and chest pain or tightening could indicate heart problems
• blood in urine could indicate kidney problems
• blurred vision, weakness in arms, and slurred speech could be signs of stroke

It is also possible to suffer an allergic reaction to ramipril. This rare occurrence may take the form of anaphylaxis. Anaphylaxis tends to happen quickly and has symptoms such as breathing difficulty, an itchy rash, hives, a fast heartbeat, lightheadedness, confusion, and loss of consciousness. If you suspect such a reaction, call for medical help right away.

Erectile dysfunction and ramipril 

It is uncommon for erectile dysfunction (ED) to occur when taking ramipril. Ramipril helps to relax blood vessels and increase blood flow. 

Ramipril and other medication

Some drugs may also affect how ramipril works. These drug interactions can be mild to severe. Make sure to notify your doctor of all medications you are taking.

This includes any:

• steroids
• anti-inflammatories (NSAIDS) such as ibuprofen
• allergy medicine
• asthma medication
• other heart medication
• antidepressants or lithium
• blood thinners
• gout medication
• diabetes medication

After taking ramipril for some time, your blood pressure should drop and stabilise, but you should not stop taking your medication. Once you stop taking the medication, your blood pressure could start rising again. If you need to stop taking ramipril due to persistent or serious side effects, consult your doctor. There are other blood pressure medications you can be prescribed, and also lifestyle measures to help you reduce your blood pressure and keep healthy in other ways. 

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With any medication, there is the possibility of drug interactions. This means that certain medications should not be taken together.

Be sure to tell your doctor if you are taking:

• allergy or asthma drugs
• antidiarrheal medication
• anti-inflammatory drugs like ibuprofen or aspirin
• blood thinners
• diabetes medication
• diuretics like furosemide
• gout medication like allopurinol
• heart or blood pressure medication 
• immune system suppressants like ciclosporin
• potassium supplements or other medication that can increase potassium levels in the blood
• psychiatric medication 
• steroids

Ramipril can cause headaches and you can take a painkiller to treat it but you should consult your pharmacist for a recommendation first. If the side effect persists, consult your doctor.  

Viagra and ramipril 

If you’re taking Viagra, consult with your doctor before using it with ramipril. This is because Viagra can also lower blood pressure. Their combined use can lead to side effects such as dizziness, lightheadedness, headaches, and irregular heart rate. 

Ramipril can cause blood potassium levels to rise, which can cause an irregular heartbeat. To reduce the risk it is advisable to avoid foods high in potassium like bananas, green leafy vegetables, and potassium-rich salt substitutes while on ramipril. You should also have your blood potassium levels checked whenever your doctor advises. 

Coffee and ramipril 

Drinking coffee increases blood pressure. Limiting this caffeine intake and opting for healthier sources of hydration can help to manage elevated blood pressure. So while coffee has not been found to interact with ramipril, it is best to drink less if you do have high blood pressure. 

Coronavirus and ramipril 

There is no indication that taking ramipril can increase the risk of complications from Covid-19. The NHS recommends that you keep taking your blood pressure medication, whether or not you have been infected with the coronavirus. 

While people who suffer from high blood pressure are at higher risk of suffering severe illness from the coronavirus, patients are advised to continue taking their blood pressure medication as prescribed. This can help reduce the risk of severe complications such as heart attacks and stroke.

Some studies have suggested that ACE inhibitors are associated with reduced risk of severe disease when catching the Covid-19 infection and do not significantly increase the risk of receiving ICU care. The World Health Organisation (WHO) also conducted a study that found long term therapy with ACE inhibitors did not suggest a higher risk of experiencing a poorer outcome with a Covid-19 infection. 

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Several other ACE inhibitors are available.

These include:

• captopril
• cilazapril
• enalapril
• fosinopril
• imidapril
• lisinopril
• perindopril

There are also other types of medication that can be prescribed to help lower blood pressure. ACE inhibitors are often the first option for patients under the age of 55. If there are persistent and serious side effects or other risk factors, your doctor may prescribe other types of medication.

These can include:

1. Angiotensin receptor blockers that lower blood pressure by reducing the action of angiotensin II in causing vessel constriction. This includes drugs such as candesartan, valsartan, and losartan. 
2. Beta-blockers lower blood pressure by blocking the effect of the hormone epinephrine, or adrenaline, that causes the heart to beat faster and harder, and constrict blood vessels. This class of drugs includes atenolol and propranolol.
3. Calcium channel blockers lower blood pressure by preventing the movement of calcium through calcium channels. This includes drugs like amlodipine, felodipine, and verapamil.
4. Diuretics lower blood pressure by reducing the level of water and salt in the blood, resulting in a lower volume of fluid that can more easily circulate through the cardiovascular system. Such drugs include bendroflumethiazide. 

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COVID-19 and the use of angiotensin-converting enzyme inhibitors and receptor blockers (May 2020) WHO [Accessed 13-September-2021]

Effects of Coffee on Ambulatory Blood Pressure in Older Men and Women (March 1999) AHA Journals [Accessed 13-September-2021]

High blood pressure (hypertension) (October 2019) NHS [Accessed 13-September-2021]

High Blood Pressure and Cardiovascular Disease (December 2019) AHA Journals [Accessed 13-September-2021]

Hypertension and Stroke: Update on Treatment (July 2019) National Institutes of Health [Accessed 13-September-2021]

Long term survival benefit of Ramipril  in patients with acute myocardial infarction complicated by heart failure (January 2021) BMJ Journals [Accessed 13-September-2021]

Ramipril (July 2021) NCBI [Accessed 13-September-2021]

Ramipril 5mg Tablets (June 2020) EMC [Accessed 13-September-2021]

Risk of severe COVID-19 disease with ACE inhibitors and angiotensin receptor blockers (July 2020) BMJ Journals [Accessed 13-September-2021]

Study Finds Commonly Used Blood Pressure Medications Safe for COVID-19 Patients (January 2021) Penn Medicine [Accessed 13-September-2021]

Symptoms Stroke (August 2019) NHS [Accessed 13-September-2021]

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