Ramipril

(ra mi' pril)

Brand Name(s): Altace^®; also available generically

IMPORTANT WARNING:

Do not take ramipril if you are pregnant. If you become pregnant while taking ramipril, call your doctor immediately. Ramipril may harm the fetus.

WHY is this medicine prescribed?

Ramipril is used alone or in combination with other medications to treat high blood pressure. It is also used to reduce the risk of heart attack and stroke in patients at risk for these problems and to improve survival in patients with heart failure after a heart attack. Ramipril is in a class of medications called angiotensin-converting enzyme (ACE) inhibitors. It works by decreasing certain chemicals that tighten the blood vessels, so blood flows more smoothly and the heart can pump blood more efficiently.

High blood pressure is a common condition and when not treated, can cause damage to the brain, heart, blood vessels, kidneys, and other parts of the body. Damage to these organs may cause heart disease, a heart attack, heart failure, stroke, kidney failure, loss of vision, and other problems. In addition to taking medication, making lifestyle changes will also help to control your blood pressure. These changes include eating a diet that is low in fat and salt, maintaining a healthy weight, exercising at least 30 minutes most days, not smoking, and using alcohol in moderation.

Are there OTHER USES for this medicine?

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

HOW should this medicine be used?

Ramipril comes as a capsule to take by mouth. It is usually taken once or twice a day with or without food. To help you remember to take ramipril, take it around the same time(s) every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take ramipril exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

Swallow the capsule whole, or open the capsule and sprinkle the contents on a small amount of applesauce (about 4 oz.) or in 4 oz. (about 120 mL) of water or apple juice. Eat or drink the entire mixture. This mixture can be prepared in advance and stored for 24 hours at room temperature or 48 hours in the refrigerator.

Your doctor will probably start you on a low dose of ramipril and gradually increase your dose.

Ramipril controls high blood pressure and heart failure but does not cure them. Continue to take ramipril even if you feel well. Do not stop taking ramipril without talking to your doctor.

What SPECIAL PRECAUTIONS should I follow?

Before taking ramipril,

• tell your doctor and pharmacist if you are allergic to ramipril; other ACE inhibitors such as benazepril (Lotensin, in Lotrel), captopril, enalapril (Vasotec, in Vaseretic), fosinopril, lisinopril (in Prinzide, in Zestoretic), moexipril, perindopril (Aceon, in Prestalia), quinapril (Accupril, in Accuretic, in Quinaretic), and trandolapril (Mavik, in Tarka); any other medications; or any ingredients in ramipril capsules. Ask your pharmacist for a list of the ingredients.

• tell your doctor or pharmacist if you are taking valsartan and sacubitril (Entresto) or if you have stopped taking it within the last 36 hours. Your doctor will probably tell you not to take ramipril, if you are also taking valsartan and sacubitril. Also, tell your doctor if you have diabetes and you are taking aliskiren (Tekturna, in Amturnide, Tekamlo, Tekturna HCT). Your doctor will probably tell you not to take ramipril if you have diabetes you are also taking aliskiren.

• tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking. Be sure to mention any of the following: aspirin and other nonsteroidal anti-inflammatory medications (NSAIDs) such as indomethacin (Indocin, Tivorbex); diuretics ('water pills'); lithium (Lithobid); and potassium supplements. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.

• tell your doctor if you have ever had swelling of the face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs while taking ramipril. Your doctor will probably tell you not to take ramipril.

• tell your doctor if you have or have ever had heart, liver, or kidney disease; lupus; scleroderma (a condition in which extra tissue grows on the skin and some organs); or diabetes.

• tell your doctor if you are breastfeeding.

• you should know that diarrhea, vomiting, not drinking enough fluids, and sweating a lot can cause a drop in blood pressure, which may cause lightheadedness and fainting.

What SPECIAL DIETARY instructions should I follow?

Talk to your doctor before using salt substitutes containing potassium. If your doctor prescribes a low-salt or low-sodium diet, follow these directions carefully.

What should I do IF I FORGET to take a dose?

Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

What SIDE EFFECTS can this medicine cause?

Ramipril may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• headache
• dizziness
• cough
• upset stomach
• vomiting
• excessive tiredness
• weakness

Some side effects can be serious. If you experience any of these symptoms, call your doctor immediately:

• swelling of the face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs
• hoarseness
• difficulty breathing or swallowing
• yellowing of the skin or eyes
• fever, sore throat, chills, and other signs of infection
• lightheadedness
• fainting

Ramipril may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).

What should I know about STORAGE and DISPOSAL of this medication?

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom).

Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program.

It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach. http://www.upandaway.org

What should I do in case of OVERDOSE?

In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at 911.

Symptoms of overdose may include the following:

• lightheadedness
• fainting

What OTHER INFORMATION should I know?

Keep all appointments with your doctor and the laboratory. Your blood pressure should be checked regularly to determine your response to ramipril. Your doctor may order certain lab tests to check your body's response to ramipril.

Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

This report on medications is for your information only, and is not considered individual patient advice. Because of the changing nature of drug information, please consult your physician or pharmacist about specific clinical use.

The American Society of Health-System Pharmacists, Inc. represents that the information provided hereunder was formulated with a reasonable standard of care, and in conformity with professional standards in the field. The American Society of Health-System Pharmacists, Inc. makes no representations or warranties, express or implied, including, but not limited to, any implied warranty of merchantability and/or fitness for a particular purpose, with respect to such information and specifically disclaims all such warranties. Users are advised that decisions regarding drug therapy are complex medical decisions requiring the independent, informed decision of an appropriate health care professional, and the information is provided for informational purposes only. The entire monograph for a drug should be reviewed for a thorough understanding of the drug's actions, uses and side effects. The American Society of Health-System Pharmacists, Inc. does not endorse or recommend the use of any drug. The information is not a substitute for medical care.

AHFS^® Patient Medication Information™. © Copyright, 2024. The American Society of Health-System Pharmacists^®, 4500 East-West Highway, Suite 900, Bethesda, Maryland. All Rights Reserved. Duplication for commercial use must be authorized by ASHP.

Selected Revisions: July 15, 2017.