Ramipril - an ACE inhibitor Tritace, Triapin, Altace

About ramipril

Ramipril belongs to a class of medicines called angiotensin-converting enzyme (ACE) inhibitors. Ramipril is prescribed for a number of different reasons. You may have been prescribed it to reduce high blood pressure (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. Although people with high blood pressure often do not feel unwell, if left untreated, high blood pressure can harm the heart and damage blood vessels, leading to a heart attack or stroke. Ramipril can be used on its own or alongside other medicines which reduce blood pressure. A combination brand called Triapin® (which contains ramipril with another medicine called felodipine) can help to reduce the total number of tablets people with high blood pressure need to take each day.

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

Before taking ramipril

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

• If you are pregnant or breastfeeding.
• If you have any problems with the way your kidneys work, or any problems with the way your liver works.
• If you are lacking in fluid in the body (dehydrated) - for example, if you have had diarrhoea or sickness very recently.
• If you have been told you have a build-up of fatty deposits on the walls of your arteries, a condition called atherosclerosis.
• If you have a particular type of poor circulation called peripheral arterial disease.
• If you have collagen vascular disease - this includes conditions such as systemic lupus erythematosus (SLE) and scleroderma.
• If you have been told you have heart muscle disease (cardiomyopathy), or narrowing of the main blood vessel from your heart (aortic stenosis).
• If you have ever had a reaction where your face, tongue or throat swells (angio-oedema).
• 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, as well 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.

How to take ramipril

• Before you start the treatment, read the manufacturer's printed information leaflet from inside the pack. It will give you more information about ramipril and will provide you with a full list of side-effects which you could experience from taking it.
• Take ramipril exactly as your doctor tells you to. It is commonly taken as a once-daily dose, although some people could be asked to take two doses a day (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 people can often feel dizzy when they take their first dose of ramipril. With the exception of the first dose, you can generally take ramipril at a time of day you find easy to remember. For most people this will be in the morning.
• Try to take your doses at the same time(s) of day each day as this will help you to remember to take your doses regularly. It is best to swallow the tablet/capsule with a drink of water. You can take ramipril either with or without 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 several weeks. 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 the 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 (unless it is nearly time for your next dose, in which case do not take the forgotten dose but take the next dose when it is due). Do not take two doses together to make up for a missed dose.

Getting the most from ramipril

• 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 can 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) can 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 drinking alcohol while you are on ramipril. Alcoholic drinks can make you feel light-headed or dizzy, and they may not be advisable for you.
• If you have diabetes you may need to check your blood sugar (glucose) more frequently, as ramipril can 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 some anaesthetics could cause your blood pressure to drop too low.
• Treatment with ramipril is often long-term unless you experience an adverse effect. Continue to take it unless you are advised otherwise by your doctor.

Ramipril side-effects

Along with their useful effects, most medicines can cause unwanted side-effects although not everyone experiences them. The table below contains some of the more common ones associated with ramipril. The best place to find a full list of the side-effects which can be associated with your medicine, is from the manufacturer's printed information leaflet supplied with the medicine. Alternatively, you can find an example of a manufacturer's information leaflet in the reference section below. Speak with your doctor or pharmacist if any of the following continue or become troublesome.

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 of the whites of your eyes. These can be signs of a liver problem called jaundice, which is a rare side-effect.
• A severe skin rash.

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

How to store ramipril

• 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.

Important information about all medicines