How does it work?

Ramipril belongs to a group of medicines called ACE inhibitors. These work by blocking the action of a chemical in the body called angiotensin converting enzyme (ACE). Normally ACE produces another chemical, angiotensin II. Thus ramipril reduces the amount of angiotensin II in the blood. Angiotensin II has two actions. Firstly it acts on blood vessels to make them narrow and secondly it acts on the kidney to produce less urine. As ramipril stops the production of angiotensin II, these actions are reversed. Therefore more urine is produced by the kidneys, which results in less fluid in the blood vessels. The blood vessels also widen. The overall effect of this is a drop in blood pressure, and therefore a decrease in the effort required by the heart to pump blood around the body. This can help treat high blood pressure and also heart failure, where the pumping action of the heart has become less effective. ACE inhibitors have also been shown to improve survival following a heart attack, and to reduce the risk of further heart attacks. Ramipril has been shown to reduce the risk of heart attack, stroke and the need for proceedures to reestablish blood supply (revascularistion) in various groups of people who are at risk of these problems. These have been established as people over 55 with any of the following:- - evidence of heart disease, for example, a previous heart attack, angina not well controlled by medical treatment, multiple heart bypass or reconstruction of a multiple blood vessels (angioplasty) - previous stroke - disease of the blood vessels in the extremities (peripheral vascular disease) - diabetes and one or more of the following: high blood pressure, high total cholesterol levels, low HDL cholesterol levels, currently a smoker, evidence of previous blood vessel disease or protein in the urine.

What is it used for?

Heart failure, in combination with other medicines

Individuals with heart failure after having had a heart attack

Mild to moderate high blood pressure

Reducing risk of heart attack, stroke, death and the need for surgery to reestablish a blood supply (revascularisation) in certain people at risk (listed above)

Warning!

There is insufficient information regarding the safety and efficacy of this medicine in children. It is not recommended for children.

Alcohol may enhance the blood pressure lowering effect of this medicine, which may result in dizziness or fainting.

Your kidney function should be monitored prior to starting and regularly throughout treatment with this medicine.

Use with caution in

Decreased fluid volume in the body due to, eg diuretic therapy, low salt diet, kidney dialysis, diarrhoea, vomiting

Decreased kidney function

Decreased liver function

Diseases affecting connective tissue, eg scleroderma, systemic lupus erythematosus, rheumatoid arthritis (collagen vascular diseases)

Elderly people

People also taking diuretics

Not to be used in

Any condition in which there is obstruction to the pumping of blood out of the heart (outflow tract obstruction)

Breastfeeding

History of swelling of the lips, face or tongue (angioedema)

Kidney failure requiring a certain type of haemodialysis

Low blood pressure (hypotension)

Narrowing of one of the valves in the heart

Narrowing of the artery which supplies blood to the kidneys (renal artery stenosis)

Narrowing of the main artery of the body (aortic stenosis)

People receiving therapy to remove certain types of fat from the blood using a machine (LDL apheresis)

People with unstable blood circulation

Pregnancy

This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy. If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.

Pregnancy and Breastfeeding

Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.

This medicine should not be used during pregnancy as it may be harmful to the unborn baby. Seek medical advice from your doctor.

This medicine should not be used by breastfeeding mothers. Discuss this with your doctor.

Side effects

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.

Headache

Inability of a man to have an erection (impotence)

Chest pain (angina)

Confusion

Skin rashes

Disturbances of the gut such as diarrhoea, constipation, nausea, vomiting or abdominal pain

Dry cough

Abnormal heart beats (arrhythmias)

Severe skin rash (erythema multiforme)

Severe swelling of lips, face or tongue (angioedema)

Dizziness

Alteration in taste

Heart attack (myocardial infarction)

A drop in blood pressure that occurs when going from lying down to sitting or standing, which results in dizziness and lightheadedness (postural hypotension)

Stroke (cerebrovascular accident)

Disorders of the blood, kidney or liver

Decreased kidney function

The side effects listed above may not include all of the side effects reported by the drug's manufacturer. For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.

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