Can I take Indapamide and Ramipril together?

Why this happens

Both medicines work to lower blood pressure but in different ways. Indapamide is a 'water tablet' (diuretic) that removes salt and water from the body, while ramipril relaxes blood vessels. When used together, their effects add up. Additionally, if the water tablet has made you slightly dehydrated, the first dose of ramipril can cause a sudden, sharp drop in blood pressure and affect how well your kidneys filter blood.

What you should do

Your doctor may advise you to stop taking indapamide for a few days before starting ramipril, or start you on a very low dose of ramipril. It is best to take your first dose of ramipril at bedtime to avoid dizziness. If you feel very dizzy or faint, sit or lie down immediately and contact your doctor. Your doctor will likely perform blood tests to check your kidney function and salt levels (electrolytes) regularly.

Important precautions

Pregnancy

You must not take ramipril if you are pregnant or planning to become pregnant, as it can cause serious harm or death to an unborn baby. Use effective contraception while taking this medicine.

Angioedema (Swelling)

Seek emergency medical help immediately if you experience swelling of the face, lips, tongue, or throat, as these medicines can cause a life-threatening allergic reaction called angioedema.

Dehydration and Electrolyte Imbalance

These medicines can significantly alter your salt and potassium levels. You must have regular blood tests and seek medical advice if you experience severe diarrhoea, vomiting, or signs of dehydration, as this can lead to kidney problems.

Sulphonamide allergy

Do not take this medicine if you have a known allergy to sulphonamide antibiotics (such as sulfamethoxazole), as you may have a similar allergic reaction to indapamide.

Food and drink warnings

Alcohol

Drinking alcohol can increase the blood pressure-lowering effect of these medicines, which may make you feel dizzy, lightheaded, or faint, especially when standing up. It is best to keep alcohol intake to a minimum, especially when starting these medicines or changing your dose.

Salt substitutes (Potassium-based)

Ramipril can increase the levels of potassium in your blood. Many salt substitutes (such as Lo-Salt) contain potassium chloride instead of sodium. Using these while taking Ramipril can lead to dangerously high potassium levels (hyperkalaemia). Check with your pharmacist before using salt substitutes.

Salt (Sodium)

Eating a diet very high in salt can make indapamide less effective at lowering your blood pressure. Try to avoid adding extra salt to your food.

Using other medicines

Taking multiple medicines? Our Medicines Interaction Checker helps you check whether your prescriptions, over-the-counter medicines, and supplements are safe to take together. Simply search for your medicines to see potential interactions and what to do about them.

Disclaimer

This information is for general educational purposes only and should not be relied upon as a substitute for professional medical advice. Always consult your GP, pharmacist, or another qualified healthcare professional before making decisions about your medications. Individual circumstances may vary, and only a healthcare professional who knows your medical history can provide personalised guidance.