Ramipril (RA-mi-pril)

Treats high blood pressure (hypertension) and heart failure. Reduces risk of heart attack, stroke, and death in people 55 years of age or older who have heart disease. Also used in the first few days after a heart attack. This medicine is an ACE (angiotensin-converting enzyme) inhibitor.

Brand Name(s):

Altace

When This Medicine Should Not Be Used:

How to Use This Medicine:

Capsule, Tablet

• Your doctor will tell you how much of this medicine to use and how often. Your dose may need to be changed several times in order to find out what works best for you. Do not use more medicine or use it more often than your doctor tells you to.
• After you receive your first dose of this medicine, your caregiver will observe you for at least 2 hours. This is to make sure you do not have any serious side effects from this medicine.
• Drink extra fluids so you will pass more urine while you are using this medicine. This will keep your kidneys working well and help prevent kidney problems.
• Swallow the capsule or tablet whole. If you cannot swallow the capsule, you may open it and pour the medicine into 4 ounces (½ cup) of applesauce, water, or apple juice. Swallow this mixture whole, and use the mixture within 24 hours after mixing it.
• Carefully follow your doctor's instructions about any special diet. Be sure to drink plenty of fluids if you exercise, sweat more than usual, or have diarrhea or vomiting.

If a dose is missed:

• If you miss a dose or forget to use your medicine, use it as soon as you can. If it is almost time for your next dose, wait until then to use the medicine and skip the missed dose. Do not use extra medicine to make up for a missed dose.

How to Store and Dispose of This Medicine:

• Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Any medicine that has been mixed with apple juice or applesauce may be stored in a refrigerator and used within 48 hours.
• Ask your pharmacist, doctor, or health caregiver about the best way to dispose of any leftover medicine after you have finished your treatment. You will also need to throw away old medicine after the expiration date has passed.
• Keep all medicine away from children and never share your medicine with anyone.

Drugs and Foods to Avoid:

Ask your doctor or pharmacist before using any other medicine, including over-the-counter medicines, vitamins, and herbal products.

• Make sure your doctor knows if you are using other medicine for high blood pressure (such as atenolol, lisinopril, metoprolol, quinapril, telmisartan, timolol, Accupril®, Micardis®, or Toprol®) or a diuretic or "water pill" (such as amiloride, furosemide, hydrochlorothiazide [HCTZ], spironolactone, torsemide, triamterene, Aldactone®, Demadex®, Lasix®, or Zaroxolyn®).
• Make sure your doctor knows if are also using lithium (Eskalith®, Lithobid®), gold injections (such as sodium aurothiomalate), pain or arthritis medicine (such as aspirin, celecoxib, diclofenac, etodolac, ibuprofen, indomethacin, naproxen, piroxicam, rofecoxib, valdecoxib, Advil®, Aleve®, Bextra®, Celebrex®, Ecotrin®, Feldene®, Motrin®, Relafen®, Vioxx®, or Voltaren®), or any diabetes medicine that you take by mouth.
• Do not use medicines, supplements, or salt substitutes that contain potassium without checking first with your doctor.
• Tell your doctor if you are using any medicines that make you sleepy. These include sleeping pills, cold and allergy medicine, narcotic pain relievers, and sedatives.

Warnings While Using This Medicine:

• Using this medicine while you are pregnant can harm your unborn baby. Use an effective form of birth control to keep from getting pregnant. If you think you have become pregnant while using the medicine, tell your doctor right away.
• Make sure your doctor knows if you have kidney problems, liver disease, congestive heart failure, heart or blood vessel disease, dehydration, diabetes, low blood pressure, low blood volume, or mineral imbalance (such as high potassium or low sodium in the blood). Tell your doctor if you have a collagen-vascular disease such as lupus or scleroderma.
• This medicine will not cure your high blood pressure, but it does help control it. You must continue to take it as directed if you expect to lower your blood pressure and keep it down. You may have to take high blood pressure medicine for the rest of your life.
• This medicine may cause a serious type of allergic reaction called anaphylaxis. Anaphylaxis can be life-threatening and requires immediate medical attention. Call your doctor right away if you have a rash; itching; hoarseness; trouble breathing; trouble swallowing; or any swelling of your face, hands, arms, legs, feet, lips, tongue, or throat.
• Tell your doctor about any allergic reaction you have had to any drug, especially if the reaction caused you to have swelling in your face, lips, tongue, or throat.
• Stop using this medicine and call your doctor right away if you have severe stomach pain (with or without nausea or vomiting). This could be a symptom of a condition called intestinal angioedema.
• This medicine may make you dizzy or lightheaded. Avoid driving, using machines, or doing anything else that could be dangerous if you are not alert. Dizziness may be worse if you lose too much water from your body. You can lose water by sweating, having diarrhea, or vomiting. Tell your doctor if this medicine makes you feel lightheaded or dizzy after you have been vomiting or had diarrhea.
• Check with your doctor if you notice any signs of fever, chills, or sore throat. These could be symptoms of an infection resulting from low white blood cell counts.
• Liver problems may occur while you are using this medicine. Stop using this medicine and check with your doctor right away if you are having more than one of these symptoms: abdominal or stomach pain or tenderness; clay-colored stools; dark urine; decreased appetite; fever; headache; itching; loss of appetite; nausea and vomiting; skin rash; swelling of the feet or lower legs; unusual tiredness or weakness; or yellow eyes or skin.
• Make sure any doctor or dentist who treats you knows that you are using this medicine. You may need to stop using this medicine several days before having surgery or medical tests.
• Make sure any doctor or dentist who treats you knows that you are using this medicine. This medicine may affect the results of certain medical tests.
• This medicine may make your skin more sensitive to sunlight. Use a sunscreen when you are outdoors. Avoid sunlamps and tanning beds.
• Your doctor will need to check your progress at regular visits while you are using this medicine. Be sure to keep all appointments. Blood tests may be needed to check for unwanted effects.
• Black patients may be less sensitive to the blood pressure-lowering effects of this medicine. In addition, the risk of a serious allergic reaction involving swelling of the face, mouth, hands, or feet may be increased.
• If you stop using this medicine, your blood pressure may go up. High blood pressure usually has no symptoms. Even if you feel well, do not stop using the medicine without asking your doctor.

Possible Side Effects While Using This Medicine:

Call your doctor right away if you notice any of these side effects:

• Allergic reaction: Itching or hives, swelling in your face or hands, swelling or tingling in your mouth or throat, chest tightness, trouble breathing
• Blistering, peeling, or red skin rash.
• Change in how much or how often you urinate.
• Chest pain.
• Confusion, body weakness, uneven heartbeat, shortness of breath, or numbness or tingling in your hands, feet, or lips.
• Dark-colored urine or pale stools.
• Fever, chills, sore throat, and body aches.
• Lightheadedness, dizziness, or fainting.
• Nausea, vomiting, loss of appetite, or pain in your upper stomach.
• Severe stomach pain (with or without nausea or vomiting).
• Yellowing of your skin or the whites of your eyes.

If you notice these less serious side effects, talk with your doctor:

• Anxiety, tremors, trouble sleeping, or nervousness.
• Body and joint pains.
• Dry cough.
• Dry mouth, excess salivation, or change in taste.
• Headache, tired feeling.
• Mild nausea, vomiting, diarrhea, or constipation.
• Ringing in your ears or blurred vision.
• Trouble having sex (men).

If you notice other side effects that you think are caused by this medicine, tell your doctor

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088