Ramipril – Long-acting ACE inhibitor for cardiovascular protection.
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What is Ramipril?
Ramipril is a highly effective long-acting ACE inhibitor that provides excellent cardiovascular and kidney protection. Its proven benefits for heart failure, post-heart attack care, and diabetic kidney disease make it one of the most prescribed cardiovascular medications in the UK.
Book an online consultation if you have high blood pressure, heart failure, diabetes with kidney concerns, or have had a heart attack. Our GPs can assess your cardiovascular health needs and determine if Ramipril or other ACE inhibitors are appropriate while providing proper monitoring for side effects.
What is Ramipril used for?
- High blood pressure (hypertension)
- Heart failure
- Post-heart attack protection
- Diabetic nephropathy (kidney protection)
- Cardiovascular disease prevention
- Chronic kidney disease
- Left ventricular dysfunction
How does Ramipril work?
An ACE inhibitor that blocks the conversion of angiotensin I to angiotensin II, reducing vasoconstriction and aldosterone release, leading to blood vessel dilation and reduced blood pressure.
Dosage and Administration
Adults
Starting dose 1.25-2.5mg once daily, gradually increased to 5-10mg daily. Maximum 10mg daily for most conditions.
Children
Specialist use only—dose based on weight and condition.
Important Notes
- Take at the same time each day, with or without food.
- Start with low dose and increase gradually to reduce side effects.
- Regular monitoring of kidney function and potassium levels required.
- Do not stop suddenly without consulting your GP.
Side Effects
Common Side Effects
- Dry persistent cough
- Dizziness (especially when standing)
- Headache
- Fatigue
- Nausea
- Diarrhoea
Serious Side Effects
Seek immediate medical attention if you experience:
- Severe low blood pressure (hypotension)
- Kidney problems (acute kidney injury)
- High potassium levels (hyperkalaemia)
- Severe allergic reactions (angioedema)
- Liver problems (rare)
- Blood disorders (very rare)
Important Warnings
- Tell your GP if you develop a persistent dry cough—may need to switch medications.
- Report any swelling of face, lips, tongue, or throat immediately (angioedema).
- Regular monitoring of kidney function and potassium levels essential.
- Not suitable during pregnancy—can harm the developing baby.
- May cause dizziness—rise slowly from sitting or lying positions.
Drug Interactions
Tell your GP if you're taking any of the following medications:
- Potassium supplements—may cause dangerous high potassium levels.
- NSAIDs—may reduce effectiveness and increase kidney problems.
- Diuretics—may enhance blood pressure lowering but monitor kidney function.
- Lithium—may increase lithium levels.
- ARBs (like Losartan)—avoid combination due to increased kidney problems.
- Salt substitutes containing potassium—use with caution.
Frequently Asked Questions
Why do ACE inhibitors like Ramipril cause a dry cough?
ACE inhibitors increase bradykinin levels, which can irritate the airways causing a persistent dry cough in about 10-15% of people.
How is Ramipril different from ARBs like Losartan?
Both provide similar cardiovascular benefits, but Ramipril may cause a dry cough while Losartan typically doesn't. Your GP will choose based on your tolerance and specific needs.
Can Ramipril protect my kidneys if I have diabetes?
Yes, Ramipril provides excellent kidney protection in diabetic nephropathy, slowing progression of kidney disease and reducing protein in urine.
How long does it take to work?
Blood pressure reduction begins within hours, but full cardiovascular benefits develop over weeks to months with continued use.
Medically Reviewed by: Mohammed Hassan - Independent Prescriber
Last Updated: 2025-01-14