ramipril (Rx)

Brand and Other Names:Altace
  • Print

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

capsule

  • 1.25mg
  • 2.5mg
  • 5mg
  • 10mg

Hypertension

Initial (not on diuretic): 2.5 mg PO qDay

Initial (with diuretic): 1.25 mg PO qDay

Maintenance: 2.5-20 mg/day PO qDay or divided q12hr

Heart Failure (Post-Myocardial Infarction)

Stable patients with CHF signs within a few days of acute MI

Initial: 2.5 mg PO q12hr; may titrate to 5 mg PO q12hr; decrease to 1.25 mg q12hr if hypotension occurs; monitor for >2 hr after initial dose and reduce concomitant diuretic if hypotension occurs

Maintenance: After 1 week, increase dose (if tolerated) to target dose of 5 mg q12hr

Myocardial Infarction/Stroke Prevention

Reduce risk of MI, stroke, or death from cardiovascular causes in patients ≥55 years

Initial: 2.5 mg PO qDay for 1 week, THEN 5 mg qDay for 3 weeks

Maintenance: Increase as tolerated to 10 mg qDay; for hypertensive or recently post-MI patients, give 5 mg PO BID

Dosing considerations

  • Reduce risk of MI, stroke, or death from cardiovascular causes in patients ≥55 years at high risk of developing a major cardiovascular event because of a history of coronary artery disease, stroke, or peripheral vascular disease, or of diabetes that is accompanied by at least 1 other cardiovascular risk factor (hypertension, elevated total cholesterol levels, low HDL levels, cigarette smoking, or documented microalbuminuria)

Diabetic Nephropathy (Off-label)

Initial (not on diuretic): 2.5 mg PO qDay

Initial (with diuretic): 1.25 mg PO qDay

Maintenance: 2.5-20 mg PO qDay; daily dose may be either increased or divided BID if antihypertensive effect is diminished toward the end of the dosing interval

Dosage Modifications

Renal impairment

  • CrCl <40 mL/min and concomitant diuretic therapy: Not to exceed 5 mg/day (25% of normal dose)
  • Renal/heart failure: 1.25 mg PO qDay; may increase to 1.25 mg q12hr and to a maximum dose of 2.5 mg q12hr depending on clinical response and tolerability
  • Renal failure and hypertension: 1.25 mg PO qDay initially; may titrate upward, not to exceed 5 mg/day
  • Geriatric patients: At increased risk for renal dysfunction; adjust dose to renal clearance and monitor closely

Dosing Considerations

Requires weeks for full effect; to start, use low dose and titrate every 1-2 weeks

qDay dosing may result in diminished antihypertensive effect at end of day in some patients; consider increase in dosage or dosing interval (q12hr)

If BP is not adequately treated, consider adding diuretic

Consider ACE inhibitor in high-risk patients, even if no hypertension or CHF

Abrupt discontinuance not associated with rapid increase in BP

Administration

Swallow capsule whole; can also open capsule and sprinkle contents on small amount of applesauce or mixed in 120 mL of water or apple juice; mixture can be stored for <24 hours at room temperature or <48 hours under refrigeration

Safety and efficacy not established

Next:

Interactions

Interaction Checker

and ramipril

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

            All Interactions Sort By:
             activity indicator 

            Contraindicated (3)

            • aliskiren

              ramipril decreases effects of aliskiren by Other (see comment). Contraindicated. Comment: Aliskiren use contraindicated with ACE-inhibitors in patients with diabetes; avoid coadministration with ACE-inhibitors if GFR. In patients who are elderly, volume-depleted (including those on diuretic therapy), or with compromised renal function, coadministration of ACE-inhibitors with drugs that affect RAAS may increase the risk of renal impairment (including acute renal failure) and cause loss of antihypertensive effect. Monitor renal function periodically.

            • protein a column

              ramipril, protein a column. Other (see comment). Contraindicated. Comment: Risk of anaphylactic reaction. Mechanism: buildup of bradykinin d/t deactivation of kininase by ACE inhibitors. D/C ACE inhibitor 72h prior to use of protein A column.

            • sacubitril/valsartan

              sacubitril/valsartan, ramipril. Either increases toxicity of the other by Other (see comment). Contraindicated. Comment: Coadministration of neprilysin inhibitors (eg, sacubitril) with ACE inhibitors may increase angioedema risk; do not administer ACE inhibitors within 36 hr of switching to or from sacubitril/valsartan.

            Serious - Use Alternative (38)

            • aspirin

              aspirin, ramipril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

            • aspirin rectal

              aspirin rectal, ramipril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

            • azilsartan

              azilsartan, ramipril. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Dual blockade of renin-angiotensin system increases risks of hypotension, hyperkalemia, and renal impairment.

            • candesartan

              candesartan, ramipril. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Dual blockade of renin-angiotensin system increases risks of hypotension, hyperkalemia, and renal impairment.

            • celecoxib

              celecoxib, ramipril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

            • choline magnesium trisalicylate

              choline magnesium trisalicylate, ramipril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

            • dalteparin

              dalteparin increases toxicity of ramipril by Other (see comment). Avoid or Use Alternate Drug. Comment: Low molecular weight heparins may suppress adrenal aldosterone secretion, which can potentially cause hyperkalemia.

            • diclofenac

              diclofenac, ramipril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

            • diflunisal

              diflunisal, ramipril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

            • eprosartan

              eprosartan, ramipril. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Dual blockade of renin-angiotensin system increases risks of hypotension, hyperkalemia, and renal impairment.

            • etodolac

              etodolac, ramipril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

            • fenoprofen

              fenoprofen, ramipril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

            • flurbiprofen

              flurbiprofen, ramipril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

            • ibuprofen

              ibuprofen, ramipril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

            • ibuprofen IV

              ibuprofen IV, ramipril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

            • indomethacin

              indomethacin, ramipril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

            • irbesartan

              irbesartan, ramipril. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Dual blockade of renin-angiotensin system increases risks of hypotension, hyperkalemia, and renal impairment.

            • ketoprofen

              ketoprofen, ramipril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

            • ketorolac

              ketorolac, ramipril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

            • ketorolac intranasal

              ketorolac intranasal, ramipril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

            • lofexidine

              lofexidine, ramipril. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid coadministration with other drugs that decrease pulse or blood pressure to mitigate risk of excessive bradycardia and hypotension.

            • losartan

              losartan, ramipril. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Dual blockade of renin-angiotensin system increases risks of hypotension, hyperkalemia, and renal impairment.

            • meclofenamate

              meclofenamate, ramipril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

            • mefenamic acid

              mefenamic acid, ramipril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

            • meloxicam

              meloxicam, ramipril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

            • nabumetone

              nabumetone, ramipril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

            • naproxen

              naproxen, ramipril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

            • olmesartan

              olmesartan, ramipril. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Dual blockade of renin-angiotensin system increases risks of hypotension, hyperkalemia, and renal impairment.

            • oxaprozin

              oxaprozin, ramipril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

            • piroxicam

              piroxicam, ramipril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

            • potassium phosphates, IV

              ramipril and potassium phosphates, IV both increase serum potassium. Avoid or Use Alternate Drug.

            • pregabalin

              ramipril, pregabalin. Either increases toxicity of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Coadministration results in additive risk of developing angioedema of face, mouth, and neck. Angioedema may result in respiratory compromise.

            • sacubitril/valsartan

              sacubitril/valsartan, ramipril. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Dual blockade of renin-angiotensin system increases risks of hypotension, hyperkalemia, and renal impairment.

            • salsalate

              salsalate, ramipril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

            • sulindac

              sulindac, ramipril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

            • telmisartan

              ramipril, telmisartan. Mechanism: unspecified interaction mechanism. Contraindicated. Increased incidence of clinically important renal dysfunction (death, doubling of serum creatinine, dialysis) compared with groups receiving either drug alone. .

              telmisartan, ramipril. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Dual blockade of renin-angiotensin system increases risks of hypotension, hyperkalemia, and renal impairment.

            • tolmetin

              tolmetin, ramipril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

            • valsartan

              valsartan, ramipril. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Dual blockade of renin-angiotensin system increases risks of hypotension, hyperkalemia, and renal impairment.

            Monitor Closely (107)

            • albiglutide

              ramipril increases effects of albiglutide by unknown mechanism. Use Caution/Monitor. ACE inhibitors may increase hypoglycemic effect. Monitor glycemic control especially during the first month of treatment with an ACE inhibitor. .

            • aldesleukin

              aldesleukin increases effects of ramipril by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

            • alfuzosin

              ramipril, alfuzosin. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Exaggerated first dose hypotensive response.

            • aluminum hydroxide

              aluminum hydroxide decreases effects of ramipril by unspecified interaction mechanism. Use Caution/Monitor.

            • amifostine

              amifostine, ramipril. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration with blood pressure lowering agents may increase the risk and severity of hypotension associated with amifostine. When amifostine is used at chemotherapeutic doses, withhold blood pressure lowering medications for 24 hr prior to amifostine; if blood pressure lowering medication cannot be withheld, do not administer amifostine.

            • amiloride

              ramipril, amiloride. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of hyperkalemia.

            • asenapine

              ramipril, asenapine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Exaggerated first dose hypotensive response.

            • aspirin

              ramipril, aspirin. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly with high doses of aspirin, in elderly or volume depleted individuals.

            • aspirin/citric acid/sodium bicarbonate

              aspirin/citric acid/sodium bicarbonate decreases effects of ramipril by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.

              ramipril, aspirin/citric acid/sodium bicarbonate. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

            • avanafil

              avanafil increases effects of ramipril by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

            • azathioprine

              ramipril, azathioprine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of neutropenia.

            • bretylium

              ramipril, bretylium. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Each drug may cause hypotension.

            • bumetanide

              ramipril, bumetanide. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of acute hypotension, renal insufficiency.

            • calcium carbonate

              calcium carbonate decreases effects of ramipril by unspecified interaction mechanism. Use Caution/Monitor.

            • canagliflozin

              ramipril and canagliflozin both increase serum potassium. Use Caution/Monitor.

            • carbidopa

              carbidopa increases effects of ramipril by pharmacodynamic synergism. Use Caution/Monitor. Therapy with carbidopa, given with or without levodopa or carbidopa-levodopa combination products, is started, dosage adjustment of the antihypertensive drug may be required.

            • celecoxib

              ramipril, celecoxib. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

            • chlorpropamide

              ramipril increases effects of chlorpropamide by pharmacodynamic synergism. Use Caution/Monitor.

            • choline magnesium trisalicylate

              ramipril, choline magnesium trisalicylate. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

            • cyclosporine

              ramipril, cyclosporine. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Use Caution/Monitor. Risk of acute renal failure.

            • diclofenac

              ramipril, diclofenac. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

            • diflunisal

              ramipril, diflunisal. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

            • digoxin

              ramipril increases levels of digoxin by unspecified interaction mechanism. Use Caution/Monitor.

            • doxazosin

              ramipril, doxazosin. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Exaggerated first dose hypotensive response.

            • drospirenone

              ramipril, drospirenone. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of hyperkalemia.

            • enoxaparin

              enoxaparin increases toxicity of ramipril by Other (see comment). Use Caution/Monitor. Comment: Low molecular weight heparins may suppress adrenal aldosterone secretion, which can potentially cause hyperkalemia.

            • eplerenone

              ramipril, eplerenone. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of hyperkalemia.

            • ethacrynic acid

              ramipril, ethacrynic acid. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of acute hypotension, renal insufficiency.

            • etodolac

              ramipril, etodolac. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

            • everolimus

              ramipril, everolimus. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Coadministration increases risk of angioedema.

            • exenatide injectable solution

              ramipril increases effects of exenatide injectable solution by Other (see comment). Use Caution/Monitor. Comment: ACE inhibitors may increase hypoglycemic effect. Monitor glycemic control especially during the first month of treatment with an ACE inhibitor. .

            • exenatide injectable suspension

              ramipril increases effects of exenatide injectable suspension by Other (see comment). Use Caution/Monitor. Comment: ACE inhibitors may increase hypoglycemic effect. Monitor glycemic control especially during the first month of treatment with an ACE inhibitor.

            • fenoprofen

              ramipril, fenoprofen. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

            • finerenone

              ramipril and finerenone both increase serum potassium. Modify Therapy/Monitor Closely. Finerenone dose adjustment based on current serum potassium concentration. Monitor serum potassium and adjust finerenone dose as described in the prescribing information as necessary.

            • flurbiprofen

              ramipril, flurbiprofen. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

            • furosemide

              ramipril, furosemide. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of acute hypotension, renal insufficiency.

            • glimepiride

              ramipril increases effects of glimepiride by pharmacodynamic synergism. Use Caution/Monitor.

            • glipizide

              ramipril increases effects of glipizide by pharmacodynamic synergism. Use Caution/Monitor.

            • glyburide

              ramipril increases effects of glyburide by pharmacodynamic synergism. Use Caution/Monitor.

            • gold sodium thiomalate

              ramipril, gold sodium thiomalate. Mechanism: unspecified interaction mechanism. Use Caution/Monitor. Combo of ACE inhibitors and injectable gold has caused rare cases of nitritoid reaction (flushing, N/V, hypot'n).

            • heparin

              heparin increases toxicity of ramipril by Other (see comment). Use Caution/Monitor. Comment: Low molecular weight heparins may suppress adrenal aldosterone secretion, which can potentially cause hyperkalemia.

            • ibuprofen

              ramipril, ibuprofen. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

            • ibuprofen IV

              ramipril, ibuprofen IV. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

            • icatibant

              icatibant decreases effects of ramipril by pharmacodynamic antagonism. Use Caution/Monitor. Icatibant has potential to have a pharmacodynamic interaction with ACE inhibitors where it may attenuate the antihypertensive effect of ACE inhibitors.

            • indomethacin

              ramipril, indomethacin. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

            • insulin aspart

              ramipril increases effects of insulin aspart by pharmacodynamic synergism. Use Caution/Monitor.

            • insulin degludec

              ramipril, insulin degludec. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs decrease blood glucose.

            • insulin degludec/insulin aspart

              ramipril, insulin degludec/insulin aspart. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs decrease blood glucose.

            • insulin detemir

              ramipril increases effects of insulin detemir by pharmacodynamic synergism. Use Caution/Monitor.

            • insulin glargine

              ramipril increases effects of insulin glargine by pharmacodynamic synergism. Use Caution/Monitor.

            • insulin glulisine

              ramipril increases effects of insulin glulisine by pharmacodynamic synergism. Use Caution/Monitor.

            • insulin inhaled

              ramipril, insulin inhaled. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs decrease blood glucose.

            • insulin lispro

              ramipril increases effects of insulin lispro by pharmacodynamic synergism. Use Caution/Monitor.

            • insulin NPH

              ramipril increases effects of insulin NPH by pharmacodynamic synergism. Use Caution/Monitor.

            • insulin regular human

              ramipril increases effects of insulin regular human by pharmacodynamic synergism. Use Caution/Monitor.

            • ketoprofen

              ramipril, ketoprofen. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

            • ketorolac

              ramipril, ketorolac. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

            • ketorolac intranasal

              ramipril, ketorolac intranasal. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

            • lanthanum carbonate

              lanthanum carbonate decreases levels of ramipril by cation binding in GI tract. Use Caution/Monitor. Administer ACE inhibitor at least 2 hr before or after lanthanum.

            • levodopa

              levodopa increases effects of ramipril by pharmacodynamic synergism. Use Caution/Monitor. Consider decreasing dosage of antihypertensive agent.

            • liraglutide

              ramipril increases effects of liraglutide by unknown mechanism. Use Caution/Monitor. ACE inhibitors may increase hypoglycemic effect. Monitor glycemic control especially during the first month of treatment with an ACE inhibitor. .

            • lithium

              ramipril increases toxicity of lithium by unknown mechanism. Use Caution/Monitor. ACE inhibitor induced Na+ depletion may increase reabsorption of lithium from renal tubule.

            • lurasidone

              lurasidone increases effects of ramipril by Other (see comment). Use Caution/Monitor. Comment: Potential for increased risk of hypotension with concurrent use. Monitor blood pressure and adjust dose of antihypertensive agent as needed.

            • maraviroc

              maraviroc, ramipril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of orthostatic hypotension.

            • meclofenamate

              ramipril, meclofenamate. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

            • mefenamic acid

              ramipril, mefenamic acid. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

            • meloxicam

              ramipril, meloxicam. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

            • metformin

              ramipril increases toxicity of metformin by unspecified interaction mechanism. Use Caution/Monitor. Increases risk for hypoglycemia and lactic acidosis.

            • methylphenidate

              methylphenidate will decrease the level or effect of ramipril by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.

            • moxisylyte

              ramipril, moxisylyte. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Exaggerated first dose hypotensive response.

            • nabumetone

              ramipril, nabumetone. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

            • naproxen

              ramipril, naproxen. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

            • nesiritide

              nesiritide, ramipril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive hypotensive effects.

            • nitroglycerin rectal

              nitroglycerin rectal, ramipril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Observe for possible additive hypotensive effects during concomitant use. .

            • oxaprozin

              ramipril, oxaprozin. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

            • phenoxybenzamine

              ramipril, phenoxybenzamine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Exaggerated first dose hypotensive response.

            • phentolamine

              ramipril, phentolamine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Exaggerated first dose hypotensive response.

            • piroxicam

              ramipril, piroxicam. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

            • potassium acid phosphate

              ramipril increases levels of potassium acid phosphate by decreasing elimination. Use Caution/Monitor. Risk of hyperkalemia.

            • potassium chloride

              ramipril increases levels of potassium chloride by decreasing elimination. Use Caution/Monitor. Risk of hyperkalemia.

            • potassium citrate

              ramipril increases levels of potassium citrate by decreasing elimination. Use Caution/Monitor. Risk of hyperkalemia.

            • potassium citrate/citric acid

              ramipril and potassium citrate/citric acid both increase serum potassium. Use Caution/Monitor.

            • potassium iodide

              potassium iodide and ramipril both increase serum potassium. Use Caution/Monitor. Potassium salts may increase the hyperkalemic effects of ACE inhibitors; the effect may be the result of aldosterone suppression in patients receiving ACE inhibitors.

            • prazosin

              ramipril, prazosin. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Exaggerated first dose hypotensive response.

            • salsalate

              ramipril, salsalate. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

            • silodosin

              ramipril, silodosin. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Exaggerated first dose hypotensive response.

            • sirolimus

              ramipril, sirolimus. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Coadministration increases risk of angioedema.

            • sodium bicarbonate

              sodium bicarbonate decreases effects of ramipril by unspecified interaction mechanism. Use Caution/Monitor.

            • sodium citrate/citric acid

              sodium citrate/citric acid decreases effects of ramipril by unspecified interaction mechanism. Use Caution/Monitor.

            • sodium sulfate/?magnesium sulfate/potassium chloride

              sodium sulfate/?magnesium sulfate/potassium chloride increases toxicity of ramipril by Other (see comment). Use Caution/Monitor. Comment: Coadministration with medications that cause fluid and electrolyte abnormalities may increase the risk of adverse events of seizure, arrhythmias, and renal impairment.

            • sodium sulfate/potassium sulfate/magnesium sulfate

              sodium sulfate/potassium sulfate/magnesium sulfate increases toxicity of ramipril by Other (see comment). Use Caution/Monitor. Comment: Coadministration with medications that cause fluid and electrolyte abnormalities may increase the risk of adverse events of seizure, arrhythmias, and renal impairment.

            • spironolactone

              ramipril, spironolactone. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of hyperkalemia.

            • sulfasalazine

              sulfasalazine decreases effects of ramipril by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.

              ramipril, sulfasalazine. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

            • sulindac

              ramipril, sulindac. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

            • synthetic human angiotensin II

              ramipril increases effects of synthetic human angiotensin II by unspecified interaction mechanism. Use Caution/Monitor.

            • tadalafil

              tadalafil increases effects of ramipril by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

            • temsirolimus

              ramipril, temsirolimus. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Coadministration increases risk of angioedema.

            • terazosin

              ramipril, terazosin. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Exaggerated first dose hypotensive response.

            • tolazamide

              ramipril increases effects of tolazamide by pharmacodynamic synergism. Use Caution/Monitor.

            • tolbutamide

              ramipril increases effects of tolbutamide by pharmacodynamic synergism. Use Caution/Monitor.

            • tolmetin

              ramipril, tolmetin. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

            • torsemide

              ramipril, torsemide. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of acute hypotension, renal insufficiency.

            • triamterene

              ramipril, triamterene. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of hyperkalemia.

            • trimethoprim

              trimethoprim and ramipril both increase serum potassium. Use Caution/Monitor. Trimethoprim decreases urinary potassium excretion. May cause hyperkalemia, particularly with high doses, renal insufficiency, or when combined with other drugs that cause hyperkalemia.

            • voclosporin

              voclosporin and ramipril both increase serum potassium. Use Caution/Monitor.

              voclosporin, ramipril. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • xipamide

              xipamide increases effects of ramipril by pharmacodynamic synergism. Use Caution/Monitor.

            • zotepine

              ramipril, zotepine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Exaggerated first dose hypotensive response.

            Minor (28)

            • aceclofenac

              aceclofenac decreases effects of ramipril by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.

            • acemetacin

              acemetacin decreases effects of ramipril by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.

            • agrimony

              agrimony increases effects of ramipril by pharmacodynamic synergism. Minor/Significance Unknown.

            • brimonidine

              brimonidine increases effects of ramipril by pharmacodynamic synergism. Minor/Significance Unknown.

            • capsicum

              capsicum, ramipril. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Increase ACE inhibitor induced cough.

            • chlorpromazine

              chlorpromazine increases effects of ramipril by unspecified interaction mechanism. Minor/Significance Unknown.

            • cornsilk

              cornsilk increases effects of ramipril by pharmacodynamic synergism. Minor/Significance Unknown.

            • creatine

              creatine, ramipril. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. (Theoretical interaction) Combination may have additive nephrotoxic effects.

            • entecavir

              ramipril, entecavir. Either increases effects of the other by decreasing renal clearance. Minor/Significance Unknown. Coadministration with drugs that reduce renal function or compete for active tubular secretion may increase serum concentrations of either entecavir or the coadministered drug.

            • fluphenazine

              fluphenazine increases effects of ramipril by unspecified interaction mechanism. Minor/Significance Unknown.

            • lornoxicam

              lornoxicam decreases effects of ramipril by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.

            • maitake

              maitake increases effects of ramipril by pharmacodynamic synergism. Minor/Significance Unknown.

            • octacosanol

              octacosanol increases effects of ramipril by pharmacodynamic synergism. Minor/Significance Unknown.

            • parecoxib

              parecoxib decreases effects of ramipril by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.

            • perphenazine

              perphenazine increases effects of ramipril by unspecified interaction mechanism. Minor/Significance Unknown.

            • probenecid

              probenecid increases effects of ramipril by unspecified interaction mechanism. Minor/Significance Unknown.

            • prochlorperazine

              prochlorperazine increases effects of ramipril by unspecified interaction mechanism. Minor/Significance Unknown.

            • promazine

              promazine increases effects of ramipril by unspecified interaction mechanism. Minor/Significance Unknown.

            • promethazine

              promethazine increases effects of ramipril by unspecified interaction mechanism. Minor/Significance Unknown.

            • reishi

              reishi increases effects of ramipril by pharmacodynamic synergism. Minor/Significance Unknown.

            • rifampin

              rifampin decreases levels of ramipril by increasing metabolism. Minor/Significance Unknown.

            • salicylates (non-asa)

              salicylates (non-asa) decreases effects of ramipril by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.

            • shepherd's purse

              shepherd's purse, ramipril. Other (see comment). Minor/Significance Unknown. Comment: Theoretically, shepherd's purse may interfere with BP control.

            • thioridazine

              thioridazine increases effects of ramipril by unspecified interaction mechanism. Minor/Significance Unknown.

            • tizanidine

              tizanidine increases effects of ramipril by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.

            • tolfenamic acid

              tolfenamic acid decreases effects of ramipril by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.

            • treprostinil

              treprostinil increases effects of ramipril by pharmacodynamic synergism. Minor/Significance Unknown.

            • trifluoperazine

              trifluoperazine increases effects of ramipril by unspecified interaction mechanism. Minor/Significance Unknown.

            Previous
            Next:

            Adverse Effects

            >10%

            Cough (7-8%)

            Hypotension (2-11%)

            1-10%

            Headache (1-5%)

            Angina pectoris (3%)

            Dizziness (2-4%)

            Nausea (2%)

            Vomiting (2%)

            Postural hypotension (2%)

            Syncope (2%)

            Vertigo (2%)

            Abnormal kidney function (1%)

            Diarrhea (1%)

            <1%

            Angioedema (0.3%)

            Previous
            Next:

            Warnings

            Black Box Warnings

            Discontinue as soon as possible when pregnancy is detected; affects renin-angiotensin system, causing oligohydramnios, which may result in fetal injury and/or death

            Contraindications

            Hypersensitivity to drug or other ACE inhibitors

            Do not coadminister with aliskiren in patients with diabetes mellitus or with renal impairment (ie, GFR <60 mL/min/1.73 m²)

            Coadministration of neprilysin inhibitors (eg, sacubitril) with ACE inhibitors may increase angioedema risk; do not administer ACE inhibitors within 36 hr of switching to or from sacubitril/valsartan

            Cautions

            Anaphylactoid and related reactions (head and neck/intestinal angioedema, anaphylaxis during desensitizing treatment with Hymenoptera venom, anaphylaxis during membrane exposure with high-flux membrane dialysis, and low-density lipoprotein apheresis with dextran sulfate absorption)

            (Rare) risk of hepatic failure, which starts as cholestatic jaundice and progresses to sometimes fatal fulminant hepatic necrosis; discontinue if patient develops jaundice or marked elevations of hepatic enzymes

            Excessive hypotension if on concomitant diuretics, hypovolemia, hyponatremia; increased risk in CHF patients; treat by placing patient in supine position and treating with IV infusion of physiologic saline if necessary

            Increased hypotension risk in patients undergoing surgery or during anesthesia with agents that produce hypotension; correct by volume expansion in such situations

            Coadministration with mTOR inhibitors (eg, temsirolimus) may increased risk for angioedema

            African American patients may have a smaller average reduction in BP than other populations

            Changes in renal function due to blockage of renin-angiotensin-aldosterone system; severe CHF patients are at increased risk for oliguria or progressive azotemia and (rarely) for acute renal failure or death; increase in BUN/SCr may occur in patients with unilateral or bilateral renal artery stenosis; monitor closely

            Reduction in RBC and hemoglobin content with rare cases of agranulocytosis, pancytopenia and bone marrow depression reported; collagen-vascular disease (SLE, scleroderma) patients with impaired renal function are at increased risk; monitor closely

            Dual blockade of the renin angiotensin system with ARBs, ACE inhibitors, or aliskiren associated with increased risk for hypotension, hyperkalemia, and renal function changes (including acute renal failure) compared to monotherapy

            Risk of hyperkalemia, especially in patients with renal impairment, DM, concomitant use of K+-elevating drugs

            Reversible, persistent, nonproductive cough thought to be due to inhibition of degradation of endogenous bradykinin

            Patients receiving coadministration of ACE inhibitor and mTOR (mammalian target of rapamycin) inhibitor (e.g. temsirolimus, sirolimus, everolimus) therapy or a neprilysin inhibitor may be at increased risk for angioedema

            Previous
            Next:

            Pregnancy & Lactation

            Pregnancy category: D

            Discontinue as soon as pregnancy detected; during the second and third trimesters of pregnancy, therapy can result in fetal injury (eg, hypotension, neonatal skull hypoplasia, anuria, reversible and irreversible renal failure) and death

            Lactation: Possibly excreted in breast milk; nursing not recommended

            Pregnancy Categories

            A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA: Information not available.

            Previous
            Next:

            Pharmacology

            Mechanism of Action

            Angiotensin converting enzyme (ACE) inhibitors dilate arteries and veins by competively inhibiting the conversion of angiotensin I to angiotensin II (a potent endogenous vasoconstrictor) and by inhibiting bradykinin metabolism; these actions result in preload and afterload reductions on the heart

            ACE inhibitors also promote sodium and water excretion by inhibiting angiotensin-II induced aldosterone secretion; elevation in potassium may also be observed

            ACE inhibitors also elicit renoprotective effects through vasodilation of renal arterioles

            ACE inhibitors reduce cardiac and vascular remodeling associated with chronic hypertension, heart failure, and myocardial infarction

            Absorption

            Bioavailability: 50-60%; not affected by food

            Peak plasma time: 1 hr (ramipril); 2-4 hr (ramiprilat)

            Distribution

            Protein bound: 73% (ramipril), 56% (ramiprilat)

            Metabolism

            Metabolized by liver through cleavage of ester group

            Metabolite: Ramiprilat (active metabolite)

            Elimination

            Half-life: 13-17 hr (ramiprilat)

            Excretion: Urine (60%), feces (40%)

            Previous
            Next:

            Images

            BRAND FORM. UNIT PRICE PILL IMAGE
            ramipril oral
            -
            10 mg capsule
            ramipril oral
            -
            2.5 mg capsule
            ramipril oral
            -
            1.25 mg capsule
            ramipril oral
            -
            5 mg capsule
            ramipril oral
            -
            2.5 mg capsule
            ramipril oral
            -
            10 mg capsule
            ramipril oral
            -
            5 mg capsule
            ramipril oral
            -
            2.5 mg capsule
            ramipril oral
            -
            2.5 mg capsule
            ramipril oral
            -
            10 mg capsule
            ramipril oral
            -
            10 mg capsule
            ramipril oral
            -
            1.25 mg capsule
            ramipril oral
            -
            2.5 mg capsule
            ramipril oral
            -
            5 mg capsule
            ramipril oral
            -
            10 mg capsule
            ramipril oral
            -
            5 mg capsule
            ramipril oral
            -
            1.25 mg capsule
            ramipril oral
            -
            1.25 mg capsule
            ramipril oral
            -
            2.5 mg capsule
            ramipril oral
            -
            5 mg capsule
            ramipril oral
            -
            10 mg capsule
            ramipril oral
            -
            5 mg capsule
            ramipril oral
            -
            10 mg capsule
            ramipril oral
            -
            1.25 mg capsule
            Altace oral
            -
            10 mg capsule
            Altace oral
            -
            5 mg capsule
            Altace oral
            -
            1.25 mg capsule
            Altace oral
            -
            2.5 mg capsule

            Copyright © 2010 First DataBank, Inc.

            Previous
            Next:

            Patient Handout

            Patient Education
            ramipril oral

            RAMIPRIL - ORAL

            (RAM-ih-prill)

            COMMON BRAND NAME(S): Altace

            WARNING: This drug can cause serious (possibly fatal) harm to an unborn baby if used during pregnancy. It is important to prevent pregnancy while taking this medication. Consult your doctor for more details and to discuss the use of reliable forms of birth control while taking this medication. If you are planning pregnancy, become pregnant, or think you may be pregnant, contact your doctor right away.

            USES: Ramipril is used to treat high blood pressure (hypertension). Lowering high blood pressure helps prevent strokes, heart attacks, and kidney problems. Ramipril is also used to improve survival after a heart attack. It may also be used in high risk patients (such as patients with heart disease/diabetes) to help prevent heart attacks and strokes. This medication may also be used to treat heart failure in patients who have had a recent heart attack.Ramipril is an ACE inhibitor and works by relaxing blood vessels so that blood can flow more easily.

            HOW TO USE: Take this medication by mouth with or without food as directed by your doctor, usually once or twice daily.If you are taking the capsule form of ramipril, swallow it whole. If you have difficulty swallowing the capsule, the capsule may be opened and the contents sprinkled onto cool applesauce (about 4 ounces) or mixed in half a glass of water or apple juice (4 ounces/120 milliliters). Swallow or drink the whole mixture.The dosage is based on your medical condition and response to treatment.To reduce your risk of side effects, your doctor may direct you to start this medication at a low dose and gradually increase your dose. Follow your doctor's instructions carefully.Use this medication regularly in order to get the most benefit from it. To help you remember, take it at the same time(s) each day. Keep taking this medication even if you feel well. Most people with high blood pressure do not feel sick.For the treatment of high blood pressure, it may take several weeks before you get the full benefit of this medication. Tell your doctor if your condition does not improve or if it worsens (such as your blood pressure readings remain high or increase).

            SIDE EFFECTS: Dizziness, lightheadedness, or tiredness may occur as your body adjusts to the medication. Dry cough may also occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if any of these unlikely but serious side effects occur: fainting, symptoms of a high potassium blood level (such as muscle weakness, slow/irregular heartbeat).Although ramipril may be used to prevent kidney problems or treat people who have kidney problems, it may also rarely cause serious kidney problems or make them worse. Your doctor will check your kidney function while you are taking ramipril. Tell your doctor right away if you have any signs of kidney problems such as a change in the amount of urine.This drug may rarely cause serious (possibly fatal) liver problems. Tell your doctor right away if you notice any of the following rare but serious side effects: yellowing eyes/skin, dark urine, severe stomach/abdominal pain, persistent nausea/vomiting.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

            PRECAUTIONS: Before taking ramipril, tell your doctor or pharmacist if you are allergic to it; or to other ACE inhibitors (such as benazepril); or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: history of an allergic reaction which included swelling of the face/lips/tongue/throat (angioedema), blood filtering procedures (such as LDL apheresis, dialysis), high level of potassium in the blood.This drug may make you dizzy. Alcohol or marijuana (cannabis) can make you more dizzy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).To reduce the risk of dizziness and lightheadedness, get up slowly when rising from a sitting or lying position.Too much sweating, diarrhea, or vomiting may cause dehydration and increase your risk of lightheadedness. Report prolonged diarrhea or vomiting to your doctor. Be sure to drink enough fluids to prevent dehydration unless your doctor directs you otherwise.Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).This product may increase your potassium levels. Before using potassium supplements or salt substitutes that contain potassium, consult your doctor or pharmacist.Older adults may be more sensitive to the side effects of this drug, including dizziness and increases in potassium level.This medication is not recommended for use during pregnancy. It may harm an unborn baby. Consult your doctor for more details. (See also Warning section.)It is unknown if this medication passes into breast milk. Consult your doctor before breast-feeding.

            DRUG INTERACTIONS: See also Precautions section.Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products that may interact with this drug include: aliskiren, certain drugs that weaken the immune system/increase the risk of infection (such as everolimus, sirolimus), lithium, drugs that may increase the level of potassium in the blood (such as ARBs including losartan/valsartan, birth control pills containing drospirenone), sacubitril, telmisartan.Some products have ingredients that could raise your blood pressure or worsen your heart failure. Tell your pharmacist what products you are using, and ask how to use them safely (especially cough-and-cold products, diet aids, or NSAIDs such as ibuprofen/naproxen).A very serious reaction may occur if you are getting injections for bee/wasp sting allergy (desensitization) and are also taking ramipril. Make sure all your doctors know which medicines you are using.

            OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: severe dizziness, fainting.

            NOTES: Do not share this medication with others.Lifestyle changes such as stress reduction programs, exercise and dietary changes may increase the effectiveness of this medicine. Talk to your doctor or pharmacist about lifestyle changes that might benefit you.Laboratory and/or medical tests (such as kidney function, potassium levels) should be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details.Check your blood pressure regularly while taking this medication. Learn how to monitor your own blood pressure at home, and share the results with your doctor.

            MISSED DOSE: If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.

            STORAGE: Store at room temperature away from light and moisture. If you are taking the capsule form of ramipril and have opened the capsule and mixed the contents with food or liquid, then the mixture can be kept at room temperature for up to 24 hours or refrigerated for up to 48 hours. Do not store in the bathroom. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.

            Information last revised August 2021. Copyright(c) 2021 First Databank, Inc.

            IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

            Previous
            Next:

            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
            Additional Offers
            Email to Patient

            From:

            To:

            The recipient will receive more details and instructions to access this offer.

            By clicking send, you acknowledge that you have permission to email the recipient with this information.

            Email Forms to Patient

            From:

            To:

            The recipient will receive more details and instructions to access this offer.

            By clicking send, you acknowledge that you have permission to email the recipient with this information.

            Previous
            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.