Common questions about ramipril

Ramipril is a type of medicine called an angiotensin-converting enzyme (ACE) inhibitor.

Like other ACE inhibitors, ramipril relaxes and widens your blood vessels. This lowers your blood pressure and makes it easier for your heart to pump blood around your body.

If you're taking ramipril for high blood pressure or after a heart attack, you may not have any symptoms. In these cases, you may not feel any different when you take ramipril. This does not mean that the medicine is not working. It's important to keep taking it.

Ramipril starts to work within a few hours to reduce high blood pressure, but it may take a few weeks for full effect.

If you're taking ramipril for heart failure, it may take weeks, even months, before you feel better.

Ramipril is generally safe to take for a long time. In fact, it works best when you take it for a long time.

But taking ramipril for a long time can sometimes cause your kidneys to not work as well as they should. Your doctor will check how well your kidneys are working with regular blood tests.

Talk to your doctor if you want to stop taking ramipril.

Stopping ramipril may cause your blood pressure to rise. This may increase your risk of heart attack and stroke.

If you're bothered by side effects, your doctor may be able to prescribe you a different medicine.

Even if ramipril has successfully lowered your blood pressure, it's best to carry on taking it.

If you stop taking ramipril your blood pressure could rise back up again.

If you need blood pressure-lowering medicines, you'll probably need to take them for the rest of your life.

Remember, by keeping your blood pressure low, you're protecting yourself against having a heart attack or stroke in the future.

There are several other angiotensin-converting enzyme (ACE) inhibitor medicines that work in the same way as ramipril. They include enalapril, lisinopril and perindopril.

There are also lots of other types of medicines that lower your blood pressure:

• calcium channel blockers like amlodipine
• angiotensin receptor blockers (ARBs) like candesartan
• beta blockers like bisoprolol
• medicines that make you pee more (diuretics) like bendroflumethiazide

If you cannot take ramipril or other ACE inhibitor medicines because of side effects such as a dry cough, you may be able to switch to another type of medicine to lower your blood pressure.

This will usually be a medicine called an angiotensin receptor blocker, such as candesartan, irbesartan, losartan or valsartan.

Ramipril works as well as other ACE inhibitors such as enalapril, lisinopril and perindopril when you take it to lower blood pressure and for heart failure. The side effects are also similar to those of other ACE inhibitors.

There are a few differences between ramipril and other ACE inhibitors.

Ramipril is officially approved to be used for reducing the risk of having a heart attack or stroke, but other ACE inhibitors may not be.

It's also approved for reducing or delaying kidney problems, but other ACE inhibitors may not be.

Tell your doctor that you're taking ramipril if you're going to be put to sleep for an operation or are going to have a major operation, such as a caesarean section, without a general anaesthetic.

Ramipril can reduce your blood pressure when it's used with a general anaesthetic.

Your doctor may advise you to stop taking it 24 hours before surgery.

No, there's no evidence that ramipril is addictive.

Ramipril will not affect any type of contraception.

But some types of hormonal methods of contraception, such as the combined pill and contraceptive patch, are not usually recommended if you have high blood pressure.

Talk to your doctor if you're taking or using a combined hormonal contraceptive.

If ramipril is not working for you and makes you sick or have severe diarrhoea for more than 24 hours, your contraceptive pills may not protect you from pregnancy. Check the pill packet to find out what to do.

Find out more:

• What to do if you're sick or have diarrhoea when taking the combined pill
• What to do if you're sick or have diarrhoea when taking the progestogen-only pill

Ramipril can cause blurred vision and make some people feel dizzy, especially when they first start taking it or after taking a bigger dose.

If this happens to you, do not drive a car, ride a bike, or use tools or machinery.

If you’ve had a stroke or a heart attack then it may not be safe for you to drive.

It's an offence to drive a car if your ability to drive safely is affected. It's your responsibility to decide if it's safe to drive. If you're in any doubt, do not drive.

Talk to your doctor or pharmacist if you're unsure whether it's safe for you to drive while taking ramipril.

Find out more about the law on driving:

• GOV.UK – medical conditions, disability and driving
• GOV.UK – drugs and driving: the law

Drinking alcohol can increase the effect of ramipril, so that it lowers your blood pressure too much, which can make you feel dizzy or lightheaded.

During the first few days of taking ramipril or after your dose increases, it's best to stop drinking alcohol until you see how the medicine affects you.

If you find ramipril makes you feel dizzy, it's best to stop drinking alcohol.

Do not use salt substitutes such as Lo-Salt. This is because they're high in potassium. When mixed with ramipril, they may make the level of potassium in your blood too high.

There are no other foods or drinks you need to avoid while taking ramipril.

Eating well can help if you have high blood pressure or heart failure.

You can boost the health of your heart by making some key lifestyle changes.

These will also help if you have high blood pressure or heart failure.

• Quit smoking – smoking increases your heart rate and blood pressure. Quitting smoking brings down your blood pressure and relieves heart failure symptoms. Try to avoid secondhand smoke too.
• Cut down on alcohol – drinking too much alcohol raises blood pressure over time. It makes heart failure worse, too. Try to keep to the recommended guidelines of no more than 14 units of alcohol a week. A standard glass of wine (175ml) is 2 units. A pint of lager or beer is usually 2 to 3 units of alcohol.
• Exercise – regular exercise lowers blood pressure by keeping your heart and blood vessels in good condition. It does not need to be too energetic – walking every day will help.
• Eat well – aim to eat a diet that includes plenty of fruit and vegetables, wholegrains, fat-free or low-fat dairy products and lean proteins. It's a good idea to follow these tips for a lower salt diet, too. Eating too much salt is the biggest cause of high blood pressure. The more salt you eat, the higher your blood pressure will be. Aim for no more than 6g of salt a day.
• Deal with stress – when you're anxious or upset, your heart beats faster, you breathe more heavily and your blood pressure often goes up. This can make heart failure worse, too. Find ways to reduce stress in your life. To give your heart a rest, try napping or putting your feet up when possible. Spend time with friends and family to be social and help avoid stress.
• Vaccinations – if you have heart failure, it's recommended that you have the flu vaccine every year and the pneumococcal vaccine as recommended by your GP. Ask your doctor about these vaccinations. You can have them free on the NHS. Coronavirus (COVID-19) vaccination is recommended for most people. Make sure you've had all the doses that you are eligible for. Talk to your doctor if you think you might be in one of the at risk groups.