Ramipril: uses, dry cough, dose and cautions

The NHS describes ramipril as a medicine widely used to treat high blood pressure and heart failure, and it is also prescribed after a heart attack. It helps prevent later strokes, heart attacks and kidney problems. It works by widening blood vessels, which makes it easier for the heart to pump blood around the body.

Ramipril is one of the ACE inhibitor family. The brand the NHS names is Tritace, though most people receive generic ramipril. It is a prescription medicine.

Ramipril comes as tablets, capsules and a liquid. Tablets and capsules should be swallowed whole with water, with or without food; liquid should be measured with the syringe or spoon supplied, never a kitchen teaspoon.

The NHS says the usual starting dose is between 1.25 mg and 2.5 mg once a day, raised over several weeks. The maximum is 5 mg twice a day or 10 mg once a day. Your own dose is set by your prescriber and may differ, so follow the label.

Because the very first dose can make you dizzy, a doctor may suggest taking it before bed. After that it can be taken at any time of day, as long as you keep to a regular time.

Treatment is often long term, and many people take it for years with regular reviews. Keep going even if you feel well; the NHS says that stopping may lead to higher blood pressure and cardiovascular complications, so talk to your doctor if you want to stop.

Most adults can take ramipril. Tell the prescriber if you have ever had a severe allergic reaction or angioedema with any medicine, are pregnant, trying to conceive or breastfeeding, are on dialysis or other blood-filtering treatment, have heart, liver or kidney conditions, have unstable or low blood pressure, are due major surgery or a general anaesthetic, have had recent diarrhoea or vomiting, follow a low-salt diet, or are about to start desensitisation treatment for insect stings.

People with certain blood disorders, such as a low white cell count, also need to say so. If you have diabetes, the NHS suggests checking blood sugar more often, particularly in the first few weeks.

A dry, tickly cough is the best-known effect. The NHS notes that cough medicines do not usually help, and if it persists or disturbs sleep your doctor may change the medicine. Dizziness is likelier when starting or after a dose increase: stand up slowly, and lie down if you feel faint.

Headaches, diarrhoea, vomiting and a mild rash also occur. Severe or prolonged diarrhoea or vomiting can dehydrate you, and the NHS says a temporary pause may be needed, so seek advice. Diarrhoea or vomiting can also reduce the protection of the contraceptive pill.

Ring NHS 111 for yellow skin or eyes, unusual paleness with tiredness or bleeding, severe stomach pain, swollen ankles, blood in urine or passing no urine. Call 999 for signs of stroke, heart problems, breathing difficulty, or swelling of the face or throat, which can be angioedema or a serious allergic reaction.

The NHS lists anti-inflammatory painkillers such as ibuprofen and indometacin, and notes that daily low-dose aspirin of 75 mg is safe. Potassium-raising medicines such as spironolactone, triamterene, amiloride and potassium supplements can push potassium too high. Sacubitril, valsartan, racecadotril, sirolimus, tacrolimus, everolimus and vildagliptin can raise the chance of angioedema.

Other medicines named include furosemide, trimethoprim, heparin, ciclosporin, prednisolone, allopurinol, procainamide, lithium, diabetes medicines, some antidepressants, nitrates, baclofen and anaesthetics. The NHS says there is very little information on herbal remedies and supplements with ramipril.

Ramipril is not safe in pregnancy; it can affect the baby's kidneys, especially in the second and third trimesters, and should be stopped by 12 weeks at the latest. Anyone who finds they are pregnant should speak to their doctor straight away. Breastfeeding may be possible after checking with a doctor or pharmacist, as only small amounts are thought to pass into milk. The NHS found no evidence that ramipril reduces fertility.

Alcohol can add to dizziness, so be cautious until you know how you react. Do not drive, cycle or use tools until dizziness has passed.

If the cough is troublesome, doctors sometimes switch to a related medicine such as an angiotensin receptor blocker; lisinopril and enalapril are other ACE inhibitors. Side effects can be reported through the Yellow Card scheme.