Can I take Nustendi and Ramipril together?

Why this happens

Nustendi contains two medicines: bempedoic acid and ezetimibe. Bempedoic acid can sometimes increase levels of uric acid and affect kidney function. Ramipril (an ACE inhibitor) also affects how the kidneys filter blood and how the body handles potassium. When used together, these effects can combine, potentially putting extra strain on the kidneys.

What you should do

You can take these medicines together, but your doctor should monitor your kidney function and potassium levels through regular blood tests. Contact your doctor if you experience symptoms of high potassium (such as muscle weakness or heart palpitations) or signs of kidney issues (such as changes in how often you urinate or swelling in your ankles).

Important precautions

Pregnancy

You must not take Ramipril if you are pregnant. It can cause serious harm or death to an unborn baby, particularly if taken during the second and third trimesters. Use effective contraception while taking this medicine.

Gout

Nustendi can increase the levels of uric acid in your blood, which may cause gout or trigger a gout flare-up. Contact your doctor if you experience sudden joint pain, swelling, or redness.

Tendon Rupture

Nustendi carries a risk of tendon inflammation or rupture. Seek immediate medical attention if you experience pain, swelling, or inflammation in any tendon (such as the Achilles tendon in the heel).

Angioedema (Severe Swelling)

Ramipril can cause a life-threatening allergic reaction called angioedema. Seek emergency help immediately if you experience swelling of the face, lips, tongue, or throat, or if you have difficulty breathing.

Food and drink warnings

Alcohol

It is best to avoid or strictly limit alcohol while taking ramipril. Alcohol can increase the blood pressure-lowering effect of ramipril, which may make you feel dizzy, lightheaded, or faint, especially when you first start the medicine or move to a higher dose.

It is best to avoid or strictly limit alcohol while taking Nustendi. Both this medication and alcohol can affect your liver; combining them increases the risk of liver damage. If you have a history of liver disease or heavy drinking, you must discuss this with your doctor.

Salt Substitutes (Potassium-based)

Avoid using salt substitutes that contain potassium (such as Lo-Salt). Ramipril can increase the levels of potassium in your blood. Using these substitutes alongside ramipril can lead to dangerously high potassium levels (hyperkalaemia), which can affect your heart rhythm.

Grapefruit juice

While Nustendi itself does not interact with grapefruit, it is often prescribed alongside statins (like simvastatin or atorvastatin). If you are taking a statin as well, you should avoid drinking large amounts of grapefruit juice as it can increase the level of the statin in your blood and increase the risk of side effects.

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.