Ramipril: NHS prescribing information and patient guide

Ramipril is an angiotensin-converting enzyme (ACE) inhibitor. It relaxes and widens blood vessels. This lowers blood pressure and reduces the heart's workload.

The NHS prescribes ramipril for several conditions:

• High blood pressure (hypertension): It lowers the risk of stroke, heart attack, and kidney problems.
• Heart failure: It improves survival and reduces symptoms like breathlessness and fluid retention.
• After a heart attack: It protects the heart muscle and prevents future heart problems.
• Diabetic kidney disease: It slows kidney damage in patients with diabetes.
• Prevention of cardiovascular events: It helps high-risk patients, even if their blood pressure is controlled.

NICE guidelines (NG136) recommend ACE inhibitors like ramipril. They are a first-line treatment for hypertension in adults under 55. They are also for patients with type 2 diabetes at any age.

Ramipril comes in tablets and capsules. Strengths are 1.25 mg, 2.5 mg, 5 mg, and 10 mg.

The BNF gives clear dosing advice for ramipril. NHS prescribers follow these recommendations. Your dose is always specific to your needs. It also depends on the condition being treated.

For high blood pressure:

• Starting dose: 1.25 mg to 2.5 mg once daily.
• Maintenance dose: 2.5 mg to 10 mg once daily.
• The dose usually increases every two to four weeks.

For heart failure:

• Starting dose: 1.25 mg once daily.
• Target dose: 10 mg once daily (or the highest dose you can tolerate).
• Doses increase slowly under medical care.

After a heart attack:

• Starting dose: 2.5 mg twice daily. This changes to 5 mg twice daily after two days.
• Maintenance dose: This is adjusted based on how well you tolerate it.

Important points:

• Take ramipril at the same time each day. You can take it with or without food.
• If you miss a dose, take it as soon as you remember. Do this unless it is almost time for your next dose.
• Do not take a double dose to make up for a missed one.
• Your doctor should check your blood pressure, kidney function, and potassium levels regularly. This is especially important during the first few months.

For full dosing details, see our ramipril dosage guide.

Ramipril can interact with other medicines and supplements. The BNF lists important interactions. Your prescriber and pharmacist should know about these.

Key interactions include:

• NSAIDs (ibuprofen, naproxen): These can reduce ramipril's blood-pressure-lowering effect. They also increase the risk of kidney damage.
• Potassium supplements or potassium-sparing diuretics (spironolactone, amiloride): These raise the risk of dangerously high potassium levels.
• Lithium: Ramipril can increase lithium levels. You will need closer monitoring.
• Other blood pressure medicines: Taking many blood pressure drugs increases the risk of low blood pressure.
• Aliskiren: Do not use this with ramipril if you have diabetes or moderate to severe kidney problems.

Do not take ramipril if you:

• Are pregnant or planning to get pregnant. It can harm the baby.
• Have a history of angioedema.
• Have bilateral renal artery stenosis.
• Are breastfeeding.

Use with caution if you have:

• Kidney impairment. Your dose may need adjusting.
• Aortic stenosis or hypertrophic cardiomyopathy.
• Connective tissue diseases, such as systemic lupus erythematosus.

Always tell your doctor about all medicines, supplements, and herbal remedies you take. Do this before starting ramipril.

When you start ramipril, your GP will arrange regular checks. This ensures the medicine works safely. This is standard NHS practice for ACE inhibitors.

Before starting treatment:

• You will have a baseline blood test. This checks kidney function (eGFR and creatinine) and electrolytes (potassium and sodium).
• Your blood pressure will be measured.

After starting or changing the dose:

• You will have a blood test within one to two weeks. This checks kidney function and potassium.
• Your blood pressure will be checked. This ensures good control without it being too low.

Ongoing monitoring:

• You will have an annual blood test. This is part of your regular medication review.
• You may need more frequent monitoring. This applies if you have kidney disease, diabetes, or take other medicines that affect potassium.

NICE advises GPs to use these checks. They are an chance to review your overall heart risk. This includes cholesterol levels, smoking, and lifestyle.

Ramipril is available on an NHS prescription. It is one of the most cost-effective blood pressure medicines. Here is how you can get it.

Prescriptions:

• A doctor, nurse prescriber, or pharmacist prescriber must prescribe ramipril.
• It comes as tablets (1.25 mg, 2.5 mg, 5 mg, 10 mg) and capsules.
• Generic ramipril is widely available. It is the usual choice on the NHS.
• Most patients pay the standard NHS prescription charge. However, many with long-term conditions may not have to pay.

Repeat prescriptions:

• Once your dose is stable, your GP can set up a repeat prescription.
• Many practices offer electronic repeat dispensing. This lets your pharmacist give you monthly supplies. You will not need a new prescription each time.
• You will still need an annual medication review.

NHS pharmacy services:

• Community pharmacists can answer questions about ramipril side effects and interactions.
• Many pharmacies offer the NHS Blood Pressure Check service for adults over 40.
• Some pharmacies provide medication use reviews (MURs). These help you get the most from your treatment.

If you worry about prescription costs, ask your pharmacist about prepayment certificates. These can save you money if you need many items each month.