Ramipril

What Does Ramipril Do?

Ramipril is an ACE inhibitor, primarily used for treating high blood pressure (hypertension), heart failure and enhancing survival rates after a heart attack. It also has potential use in preventing kidney disease in diabetes sufferers and reducing recurrent stroke risk.

How Does Ramipril Work?

This medication functions by obstructing the conversion of angiotensin I to angiotensin II, a significant vasoconstrictor which promotes aldosterone release, leading to fluid retention. By inhibiting this conversion, ramipril causes vasodilation, decreases preload and afterload, hence reducing blood pressure. It also enhances plasma renin activity, reducing aldosterone secretion, which in turn diminishes sodium and water retention. 

Drug Type and Category of Ramipril

Ramipril is an angiotensin-converting enzyme (ACE) inhibitor.

What dosage of Ramipril should you be taking?

NHS Recommendations ¹

The recommended dosage for taking Ramipiril is generally dependent on why you are taking the medication in the first place. With this being said, Ramiprril is generally started at a dose of 1.25 to 2.5mg once per day.

The dosage is then increased gradually over weeks, until it is at the correct dosage for your condition.

High blood pressure dosage is generally 2.5-5mg once a day, whilst heart failure or post-heart attack is 5mg twice a day (or 10mg once a day), and for kidney disease (nephropathy) 5-10mg once a day.

Adjustments may be necessary for those with renal impairment and severe liver dysfunction, however, pregnant or lactating women are contraindicated due to potential harm.

The maximum dose is 5mg twice a day or 10mg once a day.

What are the side-effects of Ramipril?

The most common side effects of ramipril include:

• Dry cough - VERY COMMON
• Dizziness or faintness due to low blood pressure
• Blurred vision
• Confusion
• Headache
• Tiredness

More serious side effects that require medical attention include:

• Angioedema (swelling of the lips, face, tongue, or throat)
• Low blood pressure (hypotension)
• Kidney damage
• High potassium levels (hyperkalemia)
• Low white blood cell counts (neutropenia)
• Liver damage
• Severe allergic reactions

Ramipril may also cause a persistent cough, but this should go away within 1-4 weeks after stopping the medication. Drinking alcohol while taking ramipril can increase the risk of low blood pressure.

Stopping ramipril abruptly may cause your blood pressure to rise, increasing the risk of heart attack and stroke. If you experience side effects, talk to your doctor or GP about adjusting your dosage or switching medications.

Drug Interactions

Ramipril may cause an excessive reduction in blood pressure when taken with diuretics, especially when diuretic therapy was recently started. It may also interact with other drugs that raise potassium levels, increasing the risk of hyperkalemia (too much potassium in the blood).

Combining ramipril with other renin-angiotensin-aldosterone system (RAAS) inhibitors like angiotensin II receptor blockers (ARBs) is generally not recommended, as it can increase the risk of adverse effects.

Ramipril has the ability to increase serum lithium levels, leading to lithium toxicity - this is brought about by the effect Ramipril has on aldosterone secretion. This then reduces sodium reabsorption in the kidneys and decreases the clearance of lithium, causing it to build up in the blood. ACE inhibitors like ramipril also inhibit the renin-angiotensin-aldosterone system, which normally helps regulate lithium excretion. This disruption can further impair the body's ability to clear lithium, leading to elevated levels. Additionally, the combination of ramipril and lithium can impair renal function, exacerbating the issue.

Concomitant use of NSAIDs with ramipril may result in deterioration of renal function, including possible acute renal failure. 

mTOR (protein that regulates cell growth, proliferation, and metabolism) inhibitors and neprilysin (enzyme that breaks down certain peptides involved in regulating blood pressure and inflammation) inhibitors may increase the risk of angioedema when taken with Ramipril.

Natural Alternatives to Ramipril

Garlic has been shown in clinical trials to reduce both systolic and diastolic blood pressure by about 7 points on average, similar to the effects of ACE inhibitors like ramipril. ^2,4 Garlic also acts as an antioxidant, anti-inflammatory, and increases nitric oxide production, which can help improve heart health. ⁵

Pomegranate juice can block ACE activity in a similar way to ramipril. One review of 8 clinical trials found that pomegranate juice reduces systolic blood pressure by 5 points and diastolic blood pressure by 2 points. ⁴

Pycnogenol, a natural plant extract, works as an ACE inhibitor and also increases nitric oxide to help relax blood vessels. ⁴ A review of 9 clinical trials found that on average, Pycnogenol reduces both systolic and diastolic blood pressure by about 3 points, with an even greater effect in trials longer than 12 weeks. ⁴

A small study of 55 people found that combining Pycnogenol with the ACE inhibitor ramipril lowered blood pressure better than ramipril alone and also improved kidney function. ⁴

Other natural compounds that may provide ACE inhibiting effects include omega-3 fatty acids from fish oil, taurine, vitamin B6, magnesium, and aged garlic extract. ^2,3 However, more research is still needed on their efficacy compared to prescription ACE inhibitors like ramipril.

It's important to note that while these natural alternatives may provide some similar benefits, they have not been as extensively studied as prescription ACE inhibitors. You should always consult your doctor before making any changes to your medications or starting new supplements, as they may interact with your current treatment plan. Your doctor can help determine the most appropriate and effective approach for managing your blood pressure.

Interesting facts about Ramipril

Ramipril is a pro-drug, meaning it must be converted into an active form in the body to inhibit the ACE enzyme and lower blood pressure. ⁷

Ramipril has a second cyclopentane ring in its structure, which differentiates it from a similar ACE inhibitor drug called trandolapril that has a cyclohexane ring. ⁷

It was first patented in 1981 and approved for medical use in 1989. ⁷ It is the 6th most commonly prescribed drug in the UK in 2023-24. 

Disclaimer

This article is generated for informational purposes only. It was created in June 2024. Medications and medical guidance can change over time. Therefore, it is essential to consult with your general practitioner or healthcare provider before making any decisions regarding medications or treatment plans. Your GP can provide personalised advice based on your specific health needs and conditions.

References

1. https://www.nhs.uk/medicines/ramipril/how-and-when-to-take-ramipril/
2. https://www.healthline.com/health/natural-beta-blockers
3. https://www.medicalnewstoday.com/articles/natural-beta-blockers
4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3989080/
5. https://supplements.selfdecode.com/blog/5-natural-ace-inhibitors-with-clinical-trials/
6. https://www.mdlinx.com/article/natural-alternatives-to-5-popular-prescriptionmedications/02Iu7tJ0GsO9696VyvOu1
7. https://en.wikipedia.org/wiki/Ramipril