Ramipril

Ramipril is a ace inhibitor (antihypertensive) medicine available in Bangladesh under many brand names. Below are its uses, side effects and precautions — and every brand with its current price.

• High blood pressure (hypertension) — alone or with other medicines
• Heart failure — including after a heart attack
• Cardiovascular protection — reducing the risk of heart attack and stroke in high-risk patients
• Diabetic and non-diabetic kidney disease — to slow protein loss and kidney damage

Most people tolerate ramipril well. Possible side effects include:

• Dry, persistent tickly cough — the best-known side effect; tell your doctor if it bothers you
• Dizziness or light-headedness, especially after the first dose or when standing up quickly
• Headache, tiredness
• High blood potassium (may cause muscle weakness or irregular heartbeat)
• Changes in kidney function tests
• Rare but serious: swelling of the face, lips, tongue or throat (angioedema) — stop the medicine and seek emergency care immediately

• Check your blood pressure regularly and keep all follow-up appointments.
• Your doctor may order blood tests for kidney function and potassium, especially after starting or changing the dose.
• Rise slowly from sitting or lying to avoid dizziness; avoid driving until you know how the medicine affects you.
• Tell your doctor if you have kidney disease, liver disease, diabetes or are dehydrated (vomiting/diarrhoea).
• Avoid potassium supplements or salt substitutes containing potassium unless your doctor approves.
• Inform any doctor or dentist that you take an ACE inhibitor before surgery or anaesthesia.

• NSAID painkillers (ibuprofen, diclofenac, naproxen): reduce the blood-pressure effect and can harm the kidneys
• Potassium supplements, potassium-sparing diuretics (spironolactone): risk of dangerously high potassium
• Other blood pressure medicines, including ARBs (losartan, olmesartan): additive pressure drop; combining ACE inhibitor with ARB is generally avoided
• Lithium: ramipril can raise lithium levels
• Diabetes medicines and insulin: blood sugar may fall slightly lower
• Sacubitril/valsartan: must not be combined — high angioedema risk

Tell your doctor about all medicines, supplements and herbal products you use.

• Allergy to ramipril or any other ACE inhibitor
• History of angioedema (swelling of face, tongue or throat), with or without a known cause
• Pregnancy — can seriously harm or kill the unborn baby
• Severe narrowing of both kidney arteries (bilateral renal artery stenosis)
• Use with sacubitril/valsartan or with aliskiren in diabetic patients

Pregnancy: Ramipril is contraindicated in pregnancy. It can cause serious kidney damage, low amniotic fluid and even death of the unborn baby, especially in the second and third trimesters. If you become pregnant or plan to conceive, tell your doctor immediately — the medicine will be switched to a pregnancy-safe alternative.

Lactation: Ramipril is not recommended while breastfeeding, particularly with newborn or premature babies, as safety data are limited. Your doctor can prescribe a better-studied alternative.

Store below 30°C in a cool, dry place away from direct sunlight and moisture. Keep in the original pack and out of the reach of children. Do not use after the expiry date.