What side effects are possible with this medication?
A side effect is an unwanted response to a medication when it is taken in normal doses. It can be mild or severe, temporary or permanent, but does not occur in everyone. The following side effects have been reported by at least 1% of people taking this medication. If you develop any of these side effects (or any other side effects not listed here) or they change in intensity, speak to your doctor or pharmacist for advice on managing them and on the risks and benefits of the medication.
- cough (dry, persistent)
- diarrhea
- dizziness or lightheadedness when getting up from a lying or sitting position
- headache
- nausea
- tiredness
- vomiting
- weakness
Click here to learn about serious side effects that can potentially occur with any medication. These examples are provided for information purposes only and are not meant to be exhaustive. Always consult your doctor for sound medical advice specific to your particular medication and treatment.
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 or by phone at 1-800-332-1088.
Are there any other precautions or warnings for this medication?
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 this medication.
Angioedema: Angioedema (swelling of the face, mouth, lips, tongue, eye, or throat causing difficulty swallowing or breathing) has been reported for a small number of people who take ramipril. If any of these symptoms occur, get immediate medical attention.
Also, any unexplained rash, fever, or itching should also be referred to a doctor at once. If you experience angioedema with ramipril, do not take any of the other ACE inhibitors, such as enalapril, lisinopril, or quinapril.
Cough: A dry, persistent cough that usually disappears only after stopping ramipril may occur.
Kidney function: Changes in kidney function have occurred in certain people who take this medication. The use of diuretics (water pills) may further increase the risk of kidney problems for those already at risk for this problem. If you have kidney function impairment you may require lower doses of this medication.
Liver function: Changes in liver function and jaundice have occurred in people with or without preexisting liver problems during treatment with this medication. If you develop yellow skin or eyes, abdominal pain, dark urine, clay-colored stools, loss of appetite, or nausea and vomiting, stop taking this medication and get immediate medical attention.
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, have a salt-restricted diet, are on dialysis, or are suffering from diarrhea or vomiting. If low blood pressure causes you to faint or feel lightheaded, contact your doctor.
Excessive sweating and a lack of fluid intake may lead to an excessive fall in blood pressure because of reduced fluid in your blood vessels. Vomiting or diarrhea may also lead to a fall in blood pressure. Talk to your doctor if you feel your blood pressure may be too low.
Potassium: This medication may increase blood potassium levels, especially in people with kidney problems, diabetes, or who are taking certain medications. Do not use salt substitutes containing potassium without checking with your doctor.
Your doctor may order blood tests to monitor your potassium levels while you are taking ramipril. Check with your doctor before using potassium supplements or salt substitutes using potassium. Warning signs or symptoms of high blood potassium include:
- confusion
- irregular heartbeat
- nervousness
- numbness or tingling in hands, feet, or lips
- shortness of breath or difficult breathing
- unusual tiredness or muscle weakness
- weakness or heaviness of legs
White blood cells: Ramipril may decrease white blood cell counts, especially if you have impaired kidney function or a collagen vascular disease (e.g., scleroderma, systemic lupus erythematosus). Your doctor may order blood tests to monitor your white blood cell counts while you are taking this medication. Contact your doctor if you experience any signs of infection, such as sore throat or fever.
Pregnancy: When used in pregnancy during the second and third trimesters, ACE inhibitors such as ramipril can cause injury and even death to the developing baby. If you discover you are pregnant, stop taking ramipril and contact your doctor.
Breast-feeding: This medication may pass into breast milk. If you are a breast-feeding mother and are taking ramipril, it may affect your baby. Talk to your doctor about whether you should stop breast-feeding or stop taking this medication.
Children: The safety and effectiveness of ramipril have not been established for children.
What other drugs could interact with this medication?
There may be an interaction between ramipril and any of the following:
- diuretics (e.g., furosemide, amiloride, spironolactone, triamterene)
- injectable gold
- lithium
- medications that lower blood pressure (e.g., beta-blockers)
- medications that lower blood sugar for people with diabetes (e.g., insulin)
- nonsteroidal anti-inflammatory medications (NSAIDs, e.g., ibuprofen, naproxen)
- substances which increase potassium levels (such as potassium supplements, spironolactone, amiloride, heparin, cyclosporine, and salt substitutes containing potassium)
- telmisartan
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 this medication. 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.