Ramipril - an ACE inhibitor (Tritace)

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Ramipril is used to treat a number of different conditions.

The first dose may make you feel dizzy, so it is best taken at night.

Some painkillers and indigestion remedies interfere with ramipril, so ask your pharmacist for advice before you buy any medicines.

Some people taking ramipril develop a troublesome cough. If this happens to you, let your doctor know.

Type of medicineAn angiotensin-converting enzyme (ACE) inhibitor
Used forHigh blood pressure; heart failure; and to help prevent heart, kidney or blood vessel problems in people who are at risk of these
Also calledTritace®; Triapin® (ramipril with felodipine)
Available asTablets, capsules, and oral liquid medicine

Ramipril is in a class of medicines called angiotensin-converting enzyme inhibitors, or ACE inhibitors. It is prescribed for a number of different reasons. You may have been prescribed it to reduce hypertension, or to treat heart failure, or to protect your heart and blood vessels from further damage (following a heart attack, for example). Your doctor will tell you why it has been prescribed for you.

ACE inhibitors like ramipril prevent your body from creating a hormone known as angiotensin II. They do this by blocking (inhibiting) a chemical called angiotensin-converting enzyme. This widens your blood vessels and helps to reduce the amount of water put back into your blood by your kidneys.

These actions help to decrease blood pressure in people who have hypertension, which is a condition where the blood pressure is higher than normal. People with high blood pressure often do not feel unwell but, if left untreated, high blood pressure can harm the heart and damage blood vessels, leading to a heart attack or stroke.

Heart failure is a condition where your heart does not work as well as it should. Because of this, there may be too much circulating fluid in your blood vessels. Ramipril helps to reduce this. It appears to have a protective effect on the heart and slows the progression of the heart failure. Its protective action also helps to reduce the risk of heart, kidney or blood vessel problems in people who are at risk of these.

Some medicines are not suitable for people with certain conditions, and sometimes a medicine may only be used if extra care is taken. For these reasons, before you start taking ramipril it is important that your doctor or pharmacist knows:

  • If you are pregnant, trying for a baby or breast-feeding.
  • If you have any problems with your kidneys or liver.
  • If you are dehydrated - for example, if you have had diarrhoea or sickness very recently.
  • If you have been told you have atherosclerosis (a build-up of fatty deposits on the walls of your arteries).
  • If you have peripheral vascular disease (a particular type of poor circulation).
  • If you have collagen vascular disease, such as systemic lupus erythematosus (SLE) or scleroderma.
  • If you have been told you have cardiomyopathy (heart muscle disease), or aortic stenosis (narrowing of the main blood vessel from your heart).
  • If you have ever had angio-oedema (where your face, tongue or throat swells).
  • If you are having desensitisation treatment to protect against bee and wasp stings.
  • If you have dialysis treatment, or treatment to remove cholesterol from your blood by a machine (LDL apheresis).
  • If you are taking any other medicines. This includes any medicines you are taking which are available to buy without a prescription, such as herbal and complementary medicines.
  • If you have ever had an allergic or unusual reaction to any other ACE inhibitor (such as lisinopril, captopril and perindopril), or to any other medicine.
  • Before you start this treatment, read the manufacturer's printed information leaflet from inside the pack. The leaflet will give you more information about ramipril and a full list of side-effects which you may experience from taking it.
  • Take ramipril exactly as your doctor tells you to. It is usually taken once a day, although some people may be asked to take two doses daily (such as if you have recently had a heart attack).
  • Your doctor may advise you to take your very first dose at bedtime. This is because you may feel dizzy when you first start taking ramipril.
  • With the exception of the first dose, you can generally take ramipril at a time of day that suits you. You should, however, try to take each of your doses at the same time of day, each day.
  • Swallow the tablets/capsules with a drink of water. You can take ramipril before or after food.
  • There are several strengths of ramipril tablets and capsules. It is usual to start with a low strength and then for the strength to be increased as necessary after a few weeks. This allows your doctor to make sure that you have the dose that helps your condition, but helps avoid unwanted side-effects. You may be prescribed a special titration pack which contains different strengths of tablet and allows for your dose to be increased gradually over a five-week period. Each time you collect a new supply of ramipril, check to make sure it contains the strength of tablet/capsule that you are expecting.
  • If you have been prescribed the combination brand Triapin®, you must swallow the tablet whole - do not crush or chew these tablets, as it will damage the way they work.
  • If you forget to take a dose at your usual time, take it as soon as you remember. However, if you do not remember until the following day, skip the forgotten dose. Do not take two doses together to make up for a missed dose.
  • Try to keep your regular appointments with your doctor. This is so your progress can be monitored. Your doctor will want you to have some blood tests from time to time to check that your kidneys are working well.
  • It is very important that you follow any dietary and lifestyle advice that you have been given by your doctor. This may include advice about eating a healthy diet, not smoking, and taking regular exercise.
  • If you buy any medicines, check with a pharmacist that they are suitable to take with ramipril. This is because some medicines (such as anti-inflammatory painkillers and indigestion remedies) may interfere with your treatment.
  • It is likely that your doctor will advise that you do not use salt substitutes while you are taking ramipril. These products have a high content of potassium which could be harmful for you.
  • If you drink alcohol, ask your doctor for advice about taking ramipril and alcohol. Alcohol may make you feel light-headed or dizzy, and may not be recommended for you.
  • If you have diabetes you may need to check your blood glucose more frequently, as ramipril may lower the levels of sugar in your blood. Your doctor will advise you about this.
  • If you are having an operation or dental treatment, tell the person carrying out the treatment that you are taking ramipril. This is because if you need an anaesthetic, it may cause your blood pressure to drop.
  • Treatment with ramipril is often long-term unless you experience an adverse effect. Continue to take it unless you are advised otherwise.

Along with their useful effects, most medicines can cause unwanted side-effects although not everyone experiences them. These usually improve as your body adjusts to the new medicine, but speak with your doctor or pharmacist if any of the following side-effects continue or become troublesome.

Common ramipril side-effects - these affect less than 1 in 10 people who take this medicineWhat can I do if I experience this?
Dry irritating coughIf this continues, speak with your doctor, as an alternative medicine may be better for you
Feeling dizzy or tiredGetting up more slowly should help. If you begin to feel dizzy, sit or lie down for a few moments before standing. If this continues beyond the first few days, speak with your doctor. Do not drive or use tools or machines while you feel dizzy or tired
Headache, aches and pains, cold and flu-like symptomsAsk your pharmacist to recommend a suitable remedy
Feeling or being sick, abdominal pain, diarrhoea, indigestionStick to bland foods - avoid rich and spicy meals. Drink plenty of water to replace lost fluids

Important: if you experience any of the following rare but serious symptoms, stop taking ramipril and contact your doctor for advice straightaway:

  • Any difficulty breathing, or swelling of your face, mouth, tongue or throat. These are signs of an allergic reaction.
  • Any yellowing of your skin or whites of your eyes. These may be signs of jaundice which is a rare side-effect.
  • A severe skin rash.

If you experience any other symptoms which you think may be due to this medicine, speak with your doctor or pharmacist.

  • Keep all medicines out of the reach and sight of children.
  • Store tablets and capsules in a cool, dry place, away from direct heat and light.
  • Ramipril oral solution should be refrigerated. Once a bottle has been opened it will keep for 30 days - after this time, make sure you have a fresh supply.

Never take more than the prescribed dose. If you suspect that you or someone else might have taken an overdose of this medicine, go to the accident and emergency department of your local hospital. Take the container with you, even if it is empty.

This medicine is for you. Never give it to other people even if their condition appears to be the same as yours.

Do not keep out-of-date or unwanted medicines. Take them to your local pharmacy which will dispose of them for you.

If you have any questions about this medicine ask your pharmacist.

Further reading & references

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. EMIS has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.

Original Author:
Helen Allen
Current Version:
Peer Reviewer:
Dr Helen Huins
Document ID:
3358 (v27)
Last Checked:
Next Review:
The Information Standard - certified member

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