Ramipril

Ramipril is a prescription medication used to treat high blood pressure and congestive heart failure. It is also used to reduce the risk of heart attacks, stroke, and death from cardiovascular (heart or blood vessel) causes.

Ramipril belongs to a group of drugs called angiotensin converting enzyme (ACE) inhibitors, which relax blood vessels to lower blood pressure and make the heart more efficient.

This medication comes in capsule and is taken once or twice a day, with or without food. Capsules must be swallowed whole or can be opened and sprinkled on applesauce or mixed in 4 oz. of water or apple juice.

Common side effects of ramipril include headache, fatigue, and cough. Ramipril can also cause dizziness. Do not drive or operate heavy machinery until you know how ramipril affects you.

Ramipril is a prescription medication used:

• to treat high blood pressure
• to treat heart failure after a heart attack
• to lower the risk of heart attacks, stroke, and death from cardiovascular (heart or blood vessel) causes

This medication may be prescribed for other uses. Ask your doctor or pharmacist for more information.

Ramipril may be found in some form under the following brand names:

• Altace

Serious side effects have been reported with Altace. See “Ramipril Precautions” section.

Common side effects of ramipril include headache, fatigue, dizziness, and cough.

This is not a complete list of ramipril side effects. Ask your doctor or pharmacist for more information.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

Tell your doctor about all the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements. Especially tell your doctor if you take:

• aliskiren (Tekturna; also in Amturnide, Tekamlo, Tekturna HCT)
• angiotensin receptor blockers such as candesartan (Atacand), losartan (Cozaar), and telmisartan (Micardis, Twynsta)
• nonsteroidal anti-inflammatory drugs (NSAIDs) such as naproxen (Naprosyn), ibuprofen (Motrin, Advil), and indomethacin (Indocin)
• diuretics such as hydrochlorothiazide or chlorthalidone
• vasodilators such as nitroglycerin (Nitrostat), hydralazine, and minoxidil (Loniten)
• potassium-sparing diuretic such as spironolactone (Aldactone), triamterene (Dyrenium), and amiloride (Midamor)
• lithium (Eskalith, Lithobid)

This is not a complete list of ramipril drug interactions. Ask your doctor or pharmacist for more information.

Serious side effects have been reported with ramipril including:

• Angioedema (a serious hypersensitivy reaction). Tell your healthcare profession right away if you have signs or symptoms of angioedema, which include:
  • swelling of face, eyes, lips, tongue, larynx and extremities
  • difficulty in swallowing or breathing
  • hoarseness (having difficulty making sounds when trying to speak)
• Hyperkalemia (high levels of potassium in the blood). This medication may lead to increased levels of potassium, which could lead to side effects such as heart arrhythmias (irregular heartbeat) and nausea.
• Hypotension (low blood pressure). Excessive perspiration and dehydration may lead to an excessive fall in blood pressure (hypotension). Vomiting or diarrhea may also lead to a fall in blood pressure.
• Decline in kidney function. Your doctor may need to perform tests to determine the stability of the function of your kidneys, especially in patients who already have kidney dysfunction. This risk is also present when combined with angiotensin receptor blockers (ARBs) or aliskiren.
• Neutropenia (rare). Report any sign of infection such as sore throat or fever, which may be a sign of neutropenia (a decreased amount of white blood cells).
• Liver failure (rare). Report any signs or symptoms of hepatic failure, including:
  • yellowing of the skin or eyes
  • nausea
  • vomiting
  • fatigue
  • itching

Do not take ramipril if you:

• have a history of angioedema related to previous treatment with an ACE inhibitor, or a history of angioedema altogether
• are allergic to ramipril or any of this medication's ingredients

Medications can interact with certain foods. In some cases, this may be harmful and your doctor may advise you to avoid certain foods. In the case of ramipril, salt substitutes containing potassium should be avoided.

Before taking ramipril, tell your doctor about all of your medical conditions. Especially tell your doctor if you:

• have a history of angioedema
• have decreased liver or kidney function
• are taking any potassium-containing salt substitutes
• are pregnant or are breastfeeding

Tell your doctor about all the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements.

Tell your doctor if you are pregnant or plan to become pregnant.

The FDA categorizes medications based on safety for use during pregnancy. Five categories - A, B, C, D, and X, are used to classify the possible risks to an unborn baby when a medication is taken during pregnancy.

Altace falls into category D. It has been shown that use of ramipril in pregnant women caused some babies to be born with problems. More specifically, it has been shown that use of drugs like ramipril during the second and third trimesters of pregnancy harms the unborn baby’s kidneys and even increases the risk of death to the unborn baby. However, in some serious situations, the benefit of using this medication may be greater than the risk of harm to the baby.

Tell your doctor if you are breastfeeding or plan to breastfeed.

It is not known whether ramipril crosses into human milk. Because many medications can cross into human milk and because of the possibility for serious adverse reactions in nursing infants with use of this medication, a choice should be made whether to stop nursing or stop the use of this medication. Your doctor and you will decide if the benefits outweigh the risk of using ramipril.

• Take ramipril exactly as prescribed.
• Ramipril comes in capsule form and is given once or twice a day, with or without food.
• The ramipril capsule can also be opened and its contents sprinkled on a small amount (about 4 oz.) of applesauce or mixed in 4 oz. (120 mL) of water or apple juice. To be sure that ramipril is not lost when such a mixture is made, consume the entire mixture. The mixtures can also be prepared and stored for up to 24 hours at room temperature or up to 48 hours under refrigeration.
• If you miss a dose, take the missed dose as soon as you remember. If it is almost time for the next dose, skip the missed dose and take your next dose at the regular time. Do not take two doses of ramipril at the same time.

If you take too much this medication, call your healthcare provider or local Poison Control Center, or seek emergency medical attention right away.

If this medication is administered by a healthcare provider in a medical setting, it is unlikely that an overdose will occur. However, if overdose is suspected, seek emergency medical attention.

• Store at controlled room temperature.
• Keep out of reach of children.

• When pregnancy is detected, discontinue ramipril as soon as possible.
• Drugs that act directly on the renin-angiotensin system can cause injury and death to the developing fetus.