Ramipril

The recommended adult dose of ramipril ranges from 2.5 mg to 20 mg daily in 1 or 2 divided doses, depending on the dose and individual circumstances such as your response to the medication.

To treat high blood pressure, the usual starting dose for people not using diuretics (water pills) is 2.5 mg once daily. The dose is usually increased according to need every 2 weeks. The usual dose range is 2.5 mg to 10 mg daily. For people using diuretics, your doctor may start with a lower dose of 1.25 mg daily or ask you to stop using the diuretic for 2 or 3 days before starting ramipril.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones given here, do not change the way that you are taking the medication without consulting your doctor.

It is important to take Ramipril exactly as prescribed by your doctor. If you miss a dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store Ramipril at room temperature, protect it from light and moisture, and keep it out of the reach of children.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

In addition to its desired action, this medication may cause some adverse effects, notably: it may cause headaches; it may cause dizziness - use caution when getting up from a lying or sitting position and use caution if driving; it may cause unusual tiredness; it may alter your sense of taste; it may make your skin more sensitive to UV rays (e.g., sunlight, tanning lamps) - avoid exposure to UV rays as much as possible and protect yourself when out in the sun; on occasion, it may cause a dry cough - contact your pharmacist or doctor if it becomes bothersome. Each person may react differently to a treatment. If you think this medication may be causing adverse effects (including those described here, or others), talk to your health care professional. He or she can help you to determine whether or not the medication is the source of the problem.

1.25 mg
Each hard gelatin capsule with opaque yellow cap and opaque white body, printed in black ink "N" and "1.25" on opposing cap and body portions of the capsules, contains 1.25 mg of ramipril. Non-medicinal ingredients: calcium phosphate (dibasic), colloidal silicon dioxide, magnesium hydroxide, magnesium stearate, pregelatinized starch, talc, and empty gelatin capsules containing D&C Yellow No. 10, FD&C Yellow No. 6, gelatin, and titanium dioxide.

2.5 mg
Each hard gelatin capsule with opaque orange cap and opaque white body, printed in black ink "N" and "2.5" on opposing cap and body portions of the capsules, contains 2.5 mg of ramipril. Non-medicinal ingredients: calcium phosphate (dibasic), colloidal silicon dioxide, magnesium hydroxide, magnesium stearate, pregelatinized starch, talc, and empty gelatin capsules containing D&C Yellow No.10, FD&C Red No. 40, gelatin, and titanium dioxide.

5 mg
Each hard gelatin capsule with opaque red cap and opaque white body, printed in black ink "N" and "5" on opposing cap and body portions of the capsules, contains 5 mg of ramipril. Non-medicinal ingredients: calcium phosphate (dibasic), colloidal silicon dioxide, magnesium hydroxide, magnesium stearate, pregelatinized starch, talc and empty gelatin capsules containing D&C Red No. 33, FD&C Blue No. 1, FD&C Red No. 40, gelatin, and titanium dioxide.

10 mg
Each hard gelatin capsule with opaque blue cap and opaque white body, printed in black ink "N" and "10" on opposing cap and body portions of the capsules, contains 10 mg of ramipril. Non-medicinal ingredients: calcium phosphate (dibasic), colloidal silicon dioxide, magnesium hydroxide, magnesium stearate, pregelatinized starch, talc, and empty gelatin capsules containing D&C Red No. 28, FD&C Blue No. 1, FDA/E172 Black Iron Oxide, gelatin, and titanium dioxide.

15 mg
Each hard gelatin capsule with opaque powder blue cap and opaque light gray body, printed in black ink "N" and "15" on opposing cap and body portions of the capsule, contains 15 mg of ramipril. Non-medicinal ingredients: calcium phosphate (dibasic), colloidal silicon dioxide, magnesium hydroxide, magnesium stearate, pregelatinized starch, talc and empty gelatin capsules containing: D&C Red No. 28, FD&C Blue No. 1, black iron oxide, gelatin and titanium oxide.

Do not take ramipril if you:

• are allergic to ramipril, or any other ACE inhibitor, or any ingredients of the medication
• are breast-feeding
• are pregnant or planning to become pregnant
• have had angioedema (a serious allergic reaction which causes the area around the throat and tongue to swell)
• have been diagnosed with hereditary angioedema
• are taking the medication sacubitril – Valsartan
• are receiving dialysis or other similar treatments
• have Low Blood Pressure
• have narrowing of the blood vessels to one or both kidneys
• are taking the medication Aliskiren or angiotensin II receptor antagonists and have
  • Diabetes
  • moderately to severely decreased kidney function
  • high levels of potassium in the blood
  • Congestive Heart Failure with low blood pressure
• are receiving dialysis

There may be an interaction between ramipril and any of the following:

• acetylsalicylic acid (Asa)
• Aldesleukin
• aliskiren
• allergy shots for bee or wasp stings
• Allopurinol
• alpha-agonists (e.g., Clonidine, methyldopa)
• alpha-blockers (e.g., Alfuzosin, Doxazosin, Tamsulosin)
• amifostine
• amphetamines (e.g., Dextroamphetamine, Lisdexamfetamine)
• other angiotensin converting enzyme inhibitors (ACEIs; Captopril, Enalapril, ramipril)
• angiotensin receptor blockers (ARBs; e.g., Candesartan, Irbesartan, Losartan)
• atypical antipsychotics (e.g., Clozapine, Olanzapine, Quetiapine, Risperidone)
• Azathioprine
• barbiturates (e.g., Phenobarbital, butalbital)
• beta-adrenergic blockers (e.g., Atenolol, Propranolol, Sotalol)
• brimonidine
• calcium channel blockers (e.g., Amlodipine, Diltiazem, Nifedipine, Verapamil)
• ciprofloxacin
• conivaptan
• Cyclosporine
• diuretics (water pills; e.g., Furosemide, Amiloride, Spironolactone, triamterene)
• drospirenone
• Duloxetine
• Everolimus
• gold injections (sodium aurothiomalate)
• grass pollen extract
• Guanfacine
• Heparin
• insulin
• iron dextran
• iron supplements
• levodopa
• lithium
• low-molecular-weight heparins (e.g., Dalteparin, Tinzaparin)
• Methylphenidate
• Minoxidil
• mycophenolate
• narcotic medications (e.g., Codeine, Morphine)
• nitrates (e.g., Nitroglycerin, isosorbide dinintrate)
• nonsteroidal anti-inflammatory medications (NSAIDs; e.g., Indomethacin, Naproxen)
• Obinutuzumab
• oral diabetes medications (e.g., Canagliflozin, Glyburide, Gliclazide, Metformin, Pioglitazone, Saxagliptin)
• Pentoxifylline
• phosphodiesterase-5 inhibitors (e.g., Sildenafil, Tadalafil, Vardenafil)
• Pregabalin
• procainamide
• quinine
• Rituximab
• sacubitril
• Selegiline
• Sirolimus
• sodium phosphates
• substances that increase potassium levels (e.g., potassium chloride, salt substitutes containing potassium)
• Temsirolimus
• Tizanidine
• Tolvaptan
• tricyclic antidepressants (e.g., Amitriptyline, Clomipramine, Desipramine, Trimipramine)
• Trimethoprim
• Yohimbine

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with Ramipril. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the Nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

Before you begin using a medication, be sure to inform your doctor of any medical conditions or Allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use Ramipril.

Angioedema: Ramipril may cause a serious allergic reaction called angioedema, which may be fatal if not treated promptly. If you have difficulty breathing or notice hives or swelling of the face, lips, tongue, or throat, or experience severe abdominal pain, stop taking Ramipril and get emergency medical help at once. Other ACE inhibitors should not be taken in the future. People who have had angioedema caused by other substances may be at increased risk of angioedema while taking Ramipril.

Blood disorders: In rare cases, a low white blood cell count has been reported with people taking Ramipril. Your doctor may occasionally monitor your level of white blood cells by performing blood tests. Low white blood cell levels may increase your risk for infection. If you notice any signs of infection (e.g., fever, sore throat), contact your doctor as soon as possible.

Cough: People taking ramipril may develop a dry, persistent cough that usually disappears only after stopping or lowering the dose of ramipril.

Kidney function: Decreased kidney function or Kidney Disease can cause Ramipril to build up in the body, causing side effects. Also, ramipril can cause decreases in kidney function. Certain people, such as those with narrowed blood vessels in their kidneys or severe congestive heart failure, may be more likely to experience this complication. The use of other diuretics (water pills), nonsteroidal anti-inflammatory drugs (NSAIDs), or aliskiren may further increase the risk of kidney problems.

If you have reduced kidney function or kidney disease, discuss with your doctor how Ramipril may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Ramipril, and whether any special monitoring is needed. People with kidney function impairment may require lower doses of Ramipril. Your doctor will monitor you closely while you are taking Ramipril.

Liver function: Ramipril may cause liver problems. If you experience any signs of liver problems such as yellowing of the skin or eyes, fever, generally feeling unwell, abdominal pain, nausea, vomiting, loss of appetite, itching, muscle pain, rash, or swollen glands, contact your doctor immediately. People who have liver problems will need to be closely monitored by their doctor while taking Ramipril.

Low blood pressure: Occasionally, blood pressure drops too low after taking ramipril. This usually happens after the first or second dose or when the dose is increased. It is more likely to occur for those who take diuretics, or the medication aliskiren, have a salt-restricted diet, are on dialysis, have diarrhea, or are vomiting. To reduce the risk of dizziness, get up slowly from a lying or sitting position. If low blood pressure causes you to faint or feel lightheaded, contact a doctor.

Potassium: Increases in blood levels of potassium can occur with use of Ramipril. This rarely causes problems, but your doctor may want to monitor your potassium levels through blood tests.

Reduced alertness: Ramipril may reduce alertness, especially at the beginning of treatment. Do not drive or perform tasks that require alertness until you know how Ramipril affects you.

Surgery: It is important that your physician and anesthesiologist know that you are taking Ramipril before you undergo any surgical procedures requiring general anesthesia.

Pregnancy: ACE inhibitors such as ramipril may cause severe harm or death to the developing baby if taken by the mother. Ramipril should not be used during pregnancy. If you become pregnant while taking Ramipril, stop taking it immediately and contact your doctor.

Breast-feeding: Ramipril passes into breast milk. If you are a breast-feeding mother and are taking ramipril it may affect your baby. Ramipril is not recommended for breast-feeding women. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and effectiveness of using Ramipril have not been established for children. The use of ramipril by this age group is not recommended.

Seniors: Seniors may be more sensitive to the effects of ramipril.

This medication is typically used only once a day. However, your pharmacist may have suggested a different schedule that is more appropriate for you. You should take this medication at approximately the same time each day. It must be used regularly and continuously to maintain its beneficial effects. Be sure to keep an adequate supply on hand. If you forget a dose, take it as soon as you remember -- unless it is almost time for your next dose. In that case, skip the missed dose. Do not double the next dose to catch up. This medication may be taken with or without food.