Lopace (ramipril)

How can this medicine affect other medicines?

It is important to tell your doctor or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before you start treatment with this medicine. Similarly, check with your doctor or pharmacist before taking any new medicines while taking this one, to ensure that the combination is safe.

Ramipril has an additive effect with other medicines that decrease blood pressure, particularly other medicines used to treat high blood pressure (antihypertensives). In people taking antihypertensive medicines it may cause a large drop in blood pressure with the first dose, particularly in people taking diuretic medicines such as furosemide. This may cause dizziness, which can usually be relieved by lying down until the symptoms pass. If you are taking a diuretic medicine, your doctor may reduce your dose or ask you to stop taking it for a few days before starting ramipril. This is to prevent your blood pressure from dropping too low. Other medicines that decrease blood pressure include the following:

- alpha-blockers such as prazosin (these are also used to treat an enlarged prostate gland)
- beta-blockers such as propranolol
- calcium-channel blockers such as verapamil, nifedipine
- clonidine
- diuretics, eg furosemide, bendroflumethiazide
- nitrates, eg glyceryl trinitrate
- certain antidepressants
- certain antipsychotics
- alprostadil
- baclofen
- benzodiazepines, eg temazepam.

Non-steroidal anti-inflammatory drugs (NSAIDs, eg indometacin, aspirin, ibuprofen) may reduce the blood pressure lowering effect of ramipril, and may increase the risk of a decline in kidney function.

There may be a risk of raised potassium levels in the blood (hyperkalaemia) if any of the following medicines are taken with ramipril, hence these are not normally recommended for use in combination with ramipril. If you are taking any of the following with this medicine, you should have regular blood tests to monitor the amount of potassium in your blood:

- potassium-sparing diuretics (eg spironolactone, triamterene, amiloride)
- potassium supplements
- potassium-containing salt substitutes (eg Lo-Salt)
- ciclosporin
- heparin.

Ramipril may increase the blood level of the medicine lithium and for this reason, it is not normally recommended for people taking lithium. People taking this medicine in combination with lithium should have the level of lithium in their blood closely monitored.

Ramipril may possibly enhance the blood sugar lowering effect of insulin and oral antidiabetic medicines, and so could increase the risk of low blood sugar (hypoglycaemia). People with diabetes should therefore carefully monitor their blood sugar while taking this medicine, particularly in the first few weeks of treatment.

There may be an increased risk of a drop in the normal numbers of white blood cells in the blood if this medicine is taken in combination with any of the following medicines:

- allopurinol
- azathioprine
- immunosuppressant therapy
- procainamide.

If you are taking ramipiril with any of these medicines you should have regular blood tests to monitor the levels of your blood cells, particularly if you also have decreased kidney function or a collagen vascular disease.

Other medicines containing the same active ingredient

Tritace

Ramipril tablets and capsules are also available without a brand name, ie as the generic medicine.

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