How Does Ramipril Work? (Ramace) Uses, Side Effects, Precautions

How Does Ramipril Work?

How Does Ramipril Work?

Ramipril is an ACE inhibitor, which is a type of drug that works by stopping the production of the angiotensin II hormone. This hormone usually causes the blood pressure to increase in the body, so when ramipril stops it from being formed as usual, the blood pressure will decrease, which is useful in the treatment of hypertension and some other health conditions.

Brand Names and Doses

Brand Dose IconRamipril is the name of the active drug found in the medication, called the generic name. There are several different brand names that all contain the same drug:

  • Ramace
  • Tritace
  • Prilace
  • Tryzan

Each of these brand names contains ramipril and work in exactly the same way. For each brand, there are four doses (1.25mg, 2.5mg, 5 mg and 10mg) and both a tablet or a capsule form available, depending on your needs.

Ramipril is also available in combination with felodipine, another medication to treat hypertension:

  • Triasyn (2.5mg ramipril and 2.5mg felodipine OR 5mg ramipril and 5mg felodipine)
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What type of drug is it?

Drug Type IconRamipril is a type of drug called an angiotensin-converting enzyme (ACE) inhibitor, which is a group of medications that work in a similar way to lower blood pressure and manage heart disease. Other medicines in the same class are:

How does it work?

How it works IconRamipril and other ACE inhibitor drugs work to lower blood pressure by stopping an enzyme in the body from converting angiotensin I to angiotensin II. Angiotensin II is the active form, which usually helps to increase the blood pressure when it gets too low – it does this by tightening the blood vessels and increasing the amount of blood that needs to travel through them.

When you take ramipril, you won’t have as much angiotensin II in your body and it can’t work its effect as usual to increase the blood pressure. The result?

  • The muscles around your blood vessels relax, creating more room for the blood to pass through.
  • Your kidneys reabsorb less water and you excrete more in your urine, which means you will have less blood in your blood system.

This means that you will have less blood pumping around blood vessels that are roomier than usual. If you think of it like a plumbing system, that means there is going to be less pressure on your cardiovascular system and help your heart.

Side Effects

Side Effects IconACE inhibitors have a broad action on the body and, as a result, there are several side effects that can occur when you take ramipril. You should check the medicine information leaflet for the complete list, but the most important ones are:

Low blood pressure (hypotension)

The most common side effects happen because it’s working too well and you end up with low blood pressure. You might notice symptoms of:

  • Headache
  • Tiredness
  • Dizziness
  • Flushing

This often happens when you first start taking ramipril or if your dose has recently increased. As you body gets used to the drug, these symptoms usually get better by themselves – it might take a few days. If you still notice these effects after more than a week, your blood pressure might be too low because you’re taking a higher dose than you need. You can find out by measuring your blood pressure (usually free at a pharmacy) and you can talk to your doctor about if you need a lower dose.

Excess Potassium (Hyperkalaemia)

Ramipril causes more water to be excreted in the urine that usual, which can change the balance of potassium and other salts in your blood. Less potassium is excreted in your urine and it can build-up, causing symptoms like tiredness and muscle weakness.

You can check if you have high potassium levels with a simple blood test, so have a chat with your doctor if you think you might have hyperkalemia.


Ramipril can cause some people to get a dry, irritating cough that does not seem to go away. If you experience a cough and it annoys you, you can talk to your doctor about an alternative medication, like an angiotensin II channel blocker.


Cautions IconThere are a couple of things you should be aware of before you start taking ramipril, as they can have serious consequences for some people.


Rarely, ramipril can cause swelling of the mouth and throat called angioedema, which can stop you from breathing as normal and can have serious outcomes.

If you have suffered from angioedema before, you should avoid taking ramipril because you are more likely to experience it again. If you take ramipril and notice swelling around your mouth and face, you should see a doctor as soon as possible.

Renal Impairment

Ramipril puts extra pressure on the kidneys and increases the risk of renal impairment, particularly when used with other medications like NSAIDS and diuretics.  If you have poor kidney function, it is not likely to be the best choice of drug for you.

Stopping Suddenly

Ramipril should be taken every day as it has a long-term effect. If you suddenly stop taking it, the amount of angiotensin II in your body will shoot up again and cause more blood to push through smaller blood vessels. Your hypertension might be even worse because of the sudden change, called rebound hypertension. Instead, you should gradually reduce the dose over a few weeks when you want to stop taking ramipril.

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Drug Interactions

Drug Interactions IconLithium + Ramipril Interaction

Ramipril can decrease the amount of lithium that is excreted from the body, leading to high concentrations and increased risk of side effects. The dose of lithium can be reduced to manage this, or a different antihypertensive medication can be used.

Loop Diuretic + Ramipril Interaction

Taking a loop diuretic drug and quinapril together increases the risk of blood pressure that is too low, particularly for the first few doses. You may need a lower dose or to stop taking the loop diuretic for a few days when beginning ramipril. Using both may also increase the risk of renal impairment.

NSAID + Ramipril Interaction

NSAIDs and ramipril can sometimes be used together in young otherwise healthy patients, but it might not work as well to reduce your blood pressure.

Thiazide Diuretic + Ramipril Interaction

Taking a thiazide diuretic and ramipril together increases the risk of blood pressure that is too low, particularly for the first few doses, and may increase the risk of renal impairment. Using a lower dose is okay for some people but the combination is not recommended for others – it depends on your individual situation.

Pregnancy and Breastfeeding

Pregnancy IconRamipril is not recommended if you are pregnant, breastfeeding or planning to become pregnant in the future. Doses in the first trimester may cause birth defects and can lead to renal dysfunction of the baby later in the pregnancy.

You can take ramipril when you are breastfeeding. Very small amounts may be excreted in the breast milk, but no side effects have been reported. It is best to monitor for possible signs of low blood pressure in your baby, however, such as tiredness and irritability.

How Does Ramipril Work?

About the author


Yolanda is a passionate medical writer who loves to help people understand how health and different treatments work. After graduating in Pharmacy in Australia, she moved to Italy to study the Mediterranean way of life and continue learning about health and medicine.


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