Ramipril

Pronunciation: ra-MIP-ril.

Generic name
ramipril
Brand names
Altace (United States, Canada), Tritace (United Kingdom, European Union, Australia), Tryzan (New Zealand)
Drug class
Angiotensin-converting enzyme (ACE) inhibitor
Form
Capsule or tablet, 1.25 mg, 2.5 mg, 5 mg, or 10 mg depending on brand and market
Route
Oral
Legal status
Prescription-only in all markets reviewed.

Availability and supply rules vary by country

Trade names by country: United States · United Kingdom · Canada · Australia · New Zealand

Australia: Tritace (5) · Full directory

What ramipril is and how it works

Ramipril is a prescription medicine that blocks the angiotensin-converting enzyme (ACE), relaxing blood vessels and lowering blood pressure. It is used for high blood pressure, to lower cardiovascular risk in people at high risk, for heart failure after a heart attack, and (outside the US) for certain kidney conditions. (1) (2)

Ramipril carries a genuine boxed warning: it must be stopped as soon as pregnancy is detected, because ACE inhibitors can seriously harm or be fatal to a developing baby, especially later in pregnancy. It also carries real risks of a serious swelling reaction (angioedema), high blood potassium, low blood pressure, and effects on the kidneys -- always take it exactly as prescribed and tell your prescriber right away about any pregnancy, planned pregnancy, or new swelling of the face, lips, tongue, or throat.

Mechanism of action: how ramipril works

Ramipril is a prodrug hydrolysed to its active metabolite, ramiprilat, a non-sulfhydryl angiotensin-converting enzyme (ACE) inhibitor. By inhibiting ACE, it reduces conversion of angiotensin I to angiotensin II, lowering peripheral vascular resistance and blood pressure, and reducing aldosterone secretion. (1) (2)

What ramipril is used for

High blood pressure (hypertension)

Lowers high blood pressure, reducing the risk of stroke and heart attack; can be used alone or together with a thiazide diuretic. (1) (2)

Reducing cardiovascular risk

Used to reduce the risk of heart attack, stroke, and cardiovascular death in adults at high cardiovascular risk. (2)

Heart failure after a heart attack

Used in stable patients who show signs of heart failure within a few days after an acute heart attack, to reduce the risk of death and hospitalisation. (1) (2)

Kidney disease with protein in the urine

Used to treat diabetic and non-diabetic kidney disease (nephropathy) with proteinuria (protein in the urine). (2)

Before taking ramipril

Do not take / not appropriate for

  • Do not take ramipril if you are pregnant, especially in the second or third trimester -- it is contraindicated in later pregnancy and not recommended in the first trimester. (all countries) (1) (2)
  • Do not take ramipril if you have ever had angioedema (a serious swelling reaction) from an ACE inhibitor, or if you have hereditary or idiopathic angioedema. (all countries) (1) (2)
  • Do not take ramipril together with sacubitril/valsartan, or within 36 hours of switching between the two. (United Kingdom, European Union) (2)
  • Do not take ramipril if you have bilateral renal artery stenosis (narrowing of the arteries to both kidneys) or are haemodynamically unstable. (United Kingdom, European Union) (2)
  • Do not take ramipril together with aliskiren if you have diabetes, or if you have kidney impairment. (all countries) (1) (2)

Tell your clinician about

  • Whether you are pregnant, planning to become pregnant, or breastfeeding.
  • Any history of angioedema, kidney disease, or narrowing of the kidney arteries.
  • Any history of liver disease.
  • All other medicines you take, especially diuretics, potassium supplements, potassium-sparing diuretics, lithium, NSAIDs, other blood-pressure medicines (especially ARBs or aliskiren), and mTOR inhibitors.
  • Whether you are of Black African or Caribbean descent, since angioedema risk has been reported to be higher in this population.
  • Whether you are due to have surgery or a procedure requiring anaesthesia.
(1) (2)

How to take ramipril

  • Take ramipril exactly as your prescriber directs, at around the same time each day.
  • Your dose is usually started low and increased gradually over several weeks based on your blood pressure response.
  • Do not stop taking ramipril without talking to your prescriber, except that you should contact your prescriber immediately -- rather than stopping on your own without telling them -- if you become pregnant or think you might be pregnant, since prompt medical guidance is needed either way.
  • Tell your prescriber right away if you develop swelling of the face, lips, tongue, or throat, or difficulty breathing or swallowing -- these can be signs of a serious reaction (angioedema) requiring emergency care.
(1) (2)

Procedures and treatment changes

Tell the treating team before surgery, procedures, or any medicine change. Do not alter treatment without the responsible clinician. (1) (2) (3) (4) (5) (6)

Missed dose

If you miss a dose, take it as soon as you remember unless it is almost time for your next dose, in which case skip the missed dose -- do not take a double dose. If you are unsure, ask your pharmacist or prescriber.

Overdose

Seek emergency medical attention if you think too much ramipril has been taken, especially with symptoms such as severe dizziness, fainting, or a very slow heartbeat, which can indicate dangerously low blood pressure. (1) (2)

Side effects

Side effects and their urgency vary; report severe, persistent, or concerning symptoms.

A dry, persistent, non-productive cough -- a well-known effect of all ACE inhibitors, which resolves after stopping the medicine.

What to notice: A dry, persistent, non-productive cough -- a well-known effect of all ACE inhibitors, which resolves after stopping the medicine.

What to do: Discuss persistent or troublesome symptoms with the treating clinician or pharmacist. (1) (2)

Dizziness and headache.

What to notice: Dizziness and headache.

What to do: Discuss persistent or troublesome symptoms with the treating clinician or pharmacist. (1) (2)

Low blood pressure, especially when standing up.

What to notice: Low blood pressure, especially when standing up.

What to do: Discuss persistent or troublesome symptoms with the treating clinician or pharmacist. (1) (2)

Tiredness or weakness (fatigue).

What to notice: Tiredness or weakness (fatigue).

What to do: Discuss persistent or troublesome symptoms with the treating clinician or pharmacist. (1)

Digestive upset, such as nausea.

What to notice: Digestive upset, such as nausea.

What to do: Discuss persistent or troublesome symptoms with the treating clinician or pharmacist. (2)

Serious warnings

Angioedema (serious swelling reaction) — emergency

Symptoms: Swelling of the face, lips, tongue, throat, or arms/legs, sometimes with difficulty breathing or swallowing.

Action: Seek emergency medical help immediately -- this reaction can be fatal if it affects the throat, and your care team will decide whether ramipril can ever be restarted afterward. This risk has been reported to be higher in Black patients. (1) (2)

Pregnancy — boxed_warning

Symptoms: Not applicable -- this is a proactive warning, not a symptom to watch for.

Action: Contact your prescriber immediately if you become pregnant or think you might be pregnant. Ramipril can cause serious injury or death to a developing baby, especially later in pregnancy, and your prescriber will need to change your treatment promptly. (1) (2)

High blood potassium (hyperkalaemia) — high caution

Symptoms: Muscle weakness, an irregular or slow heartbeat, or tingling sensations -- high potassium often has no symptoms and is found on a blood test.

Action: Contact your prescriber promptly and have blood tests checked as recommended, especially if you have kidney problems, diabetes, are over 70, or take potassium supplements or potassium-sparing diuretics. (1) (2)

Very low blood pressure — high caution

Symptoms: Severe dizziness, light-headedness, or fainting, especially after the first dose or after a dose increase.

Action: Sit or lie down and contact your prescriber promptly; seek emergency care if you faint or cannot recover quickly. This is more likely if you are dehydrated, on diuretics, or being treated for heart failure after a heart attack. (1) (2)

Kidney problems — high caution

Symptoms: A significant decrease in how much urine you pass, or swelling in your legs or ankles.

Action: Contact your prescriber promptly for blood and urine tests -- ramipril can reduce kidney function, particularly in people whose kidney function already depends heavily on the renin-angiotensin system. (1) (2)

Liver problems — high caution

Symptoms: Yellowing of the skin or eyes (jaundice), dark urine, or unusual tiredness.

Action: Contact your prescriber promptly -- rare but serious liver injury has been reported with ACE inhibitors including ramipril. (1) (2)

Interactions

  • Potassium supplements and potassium-sparing diuretics can raise blood potassium to dangerous levels when combined with ramipril. (1) (2)
  • Other blood-pressure-lowering medicines, especially diuretics, angiotensin receptor blockers (ARBs), and aliskiren, can increase the risk of low blood pressure, high potassium, and reduced kidney function when combined with ramipril; combining with aliskiren is contraindicated in people with diabetes. (1) (2)
  • NSAID pain relievers can reduce ramipril's blood-pressure-lowering effect and increase the risk of kidney problems, especially in older adults or those who are dehydrated. (1)
  • Lithium levels and toxicity risk can increase when combined with ramipril; more frequent monitoring of lithium levels is recommended. (1)
  • Sacubitril/valsartan must not be combined with ramipril because of an increased angioedema risk; mTOR inhibitors and certain diabetes medicines (DPP-4 inhibitors) can also increase angioedema risk. (2) (1)

Pregnancy, breastfeeding, kidney/liver function, age

Pregnancy

Ramipril carries a boxed warning and must be discontinued as soon as pregnancy is detected -- it is contraindicated in the second and third trimesters and not recommended in the first trimester, because of a genuine risk of serious injury or death to the developing baby. Contact your prescriber immediately if you become pregnant or are planning a pregnancy, so an alternative treatment can be arranged promptly. (1) (2) (3) (4) (5) (6)

Breastfeeding

Not recommended during breastfeeding, since the effect of repeated doses on breast milk is not well established. (1) (2) (3) (4) (5) (6)

Children

Safety and effectiveness have not been established in children in the sources reviewed for this dossier. (1) (2) (3) (4) (5) (6)

Elderly

Older adults are usually started on a lower dose with more gradual titration, since higher drug levels and greater sensitivity to blood-pressure-lowering effects are more likely. (1) (2) (3) (4) (5) (6)

Hepatic_impairment

Treatment should only be started under close medical supervision in liver impairment, with a maximum daily dose of 2.5 mg per the reviewed UK labelling. (1) (2) (3) (4) (5) (6)

Renal_impairment

Requires a reduced starting dose and lower maximum dose, adjusted according to kidney function (creatinine clearance/eGFR); closely monitored, especially at treatment initiation. (1) (2) (3) (4) (5) (6)

Monitoring

Before starting

  • Pregnancy status in anyone who could become pregnant
  • Baseline kidney function and blood potassium
  • Baseline blood pressure
  • Review of other medicines, especially diuretics, potassium-affecting medicines, and other blood-pressure medicines

During treatment

  • Kidney function and blood potassium checked periodically, especially after starting or increasing the dose.
  • Blood pressure monitored, particularly after the first dose and any dose increase.
  • Prompt reporting of any swelling of the face, lips, tongue, or throat, or any signs of pregnancy.
(1) (2)

Storage

Store at controlled room temperature (20-25degC/68-77degF per the US label; no special storage conditions required per the UK SmPC) in a well-closed container, out of reach of children.

Study the drug class: ACE inhibitors

Professional information

Clinician-facing context only, sourced from the current US FDA ramipril prescribing information and current UK emc Tritace 5mg SmPC; verify against the current full local label before prescribing.

United States

Indication: Hypertension / heart failure post-MI

Dose summary: Hypertension: initial 2.5 mg once daily, maintenance 2.5-20 mg daily. Heart failure post-MI: start 2.5 mg twice daily (1.25 mg if hypotensive), titrate toward 5 mg twice daily roughly every 3 weeks. Renal impairment (CrCl <40 mL/min): use 25% of the usual dose initially.

Renal context: CrCl <40 mL/min: initiate at 25% of the usual dose; ramiprilat AUC is 3-4 times higher in this population. (1)

United Kingdom / European Union / Australia

Indication: Hypertension, cardiovascular risk reduction, heart failure, diabetic/non-diabetic nephropathy

Dose summary: Initial 2.5 mg daily (1.25 mg if diuretic-treated), titrated every 2-4 weeks to a maximum of 10 mg daily. Elderly: initial 1.25 mg with gradual titration. Hepatic impairment: maximum 2.5 mg daily under close supervision.

Renal context: CrCl >=60 mL/min: standard dosing (max 10 mg). 30-60 mL/min: max 5 mg daily. 10-30 mL/min: start 1.25 mg, max 5 mg. Haemodialysis: start 1.25 mg, max 5 mg. (2)

Mechanism of action

Hepatic guidance

In hepatic impairment, treatment should be initiated only under close medical supervision, with a maximum daily dose of 2.5 mg per the reviewed UK labelling.

Overdose note

Hypotension is the most likely manifestation of overdose; manage with normal saline infusion and supportive care. No specific antidote exists, and ramiprilat is poorly removed by haemodialysis. (1) (2)

Frequently asked questions

Does ramipril have a boxed warning?

Yes. Ramipril's current US FDA label carries a boxed warning for fetal toxicity: ACE inhibitors like ramipril can cause serious injury or death to a developing baby, especially in the second and third trimesters, and must be stopped as soon as pregnancy is detected. Contact your prescriber immediately if you become pregnant or think you might be pregnant. (1)

Why do I have a persistent dry cough on ramipril?

A persistent, non-productive dry cough is a well-known effect of all ACE inhibitors, including ramipril. It is not dangerous but can be bothersome; it resolves after stopping the medicine. Discuss with your prescriber if it troubles you -- they can decide whether an alternative medicine is appropriate. (1) (2)

Is ramipril sold under the same brand name everywhere?

No. It is sold as Altace in the United States and Canada, as Tritace in the United Kingdom, the European Union, and Australia, and as Tryzan specifically in New Zealand. Generic ramipril is also widely available. (1) (2) (6)

What is the mechanism of action of ramipril?

Ramipril is a prodrug hydrolysed to its active metabolite, ramiprilat, a non-sulfhydryl angiotensin-converting enzyme (ACE) inhibitor. By inhibiting ACE, it reduces conversion of angiotensin I to angiotensin II, lowering peripheral vascular resistance and blood pressure, and reducing aldosterone secretion. (1) (2)

What is the generic name of Ramipril?

The generic name is ramipril. It is sold under brand names including Altace (United States, Canada), Tritace (United Kingdom, European Union, Australia), Tryzan (New Zealand). (1) (2)

What class of drug is ramipril?

Ramipril is classed as: Angiotensin-converting enzyme (ACE) inhibitor. (1) (2)

References

  1. RAMIPRIL capsules, USP -- full prescribing informationU.S. Food and Drug Administration / DailyMed (NIH), full prescribing information · United States · accessed 2026-07-30 · source 1
  2. Tritace 5mg Tablets (ramipril) -- Summary of Product Characteristicselectronic medicines compendium (emc), United Kingdom -- Sanofi (Aventis Pharma Ltd) · United Kingdom · accessed 2026-07-30 · source 2
  3. Tritace (ramipril) tablets and hard capsules 1.25/2.5/5/10 mg -- Article 30 referral, and Ramipril PSUSA nationally authorised product listsEuropean Medicines Agency (EMA) -- Article 30 referral harmonisation and PSUSA nationally authorised product lists · European Union · accessed 2026-07-30 · source 3
  4. ALTACE (ramipril) capsules -- Product MonographHealth Canada product monograph · Canada · accessed 2026-07-30 · source 4
  5. TRITACE ramipril tablet and capsule blister packs -- ARTG entries 56537 / 34515 / 75202 / 56538 / 79253Therapeutic Goods Administration (TGA), Australia · Australia · accessed 2026-07-30 · source 5
  6. TRYZAN (ramipril) -- New Zealand Data SheetMedsafe (New Zealand regulator) · New Zealand · accessed 2026-07-30 · source 6

Brand names by country

Single-ingredient ramipril names are shown separately by country. Product availability, strengths, and supply rules can change; combination products are not included here.

Priority countries

United States

  • Altace / generic ramipril (1)FDA approved currently labeled · 1.25 mg, 2.5 mg, 5 mg, 10 mg · Pfizer (Altace) / generic manufacturers

United Kingdom

  • Tritace (2)MHRA licensed emc smpc confirmed · 1.25 mg, 2.5 mg, 5 mg, 10 mg · Sanofi (Aventis Pharma Ltd)

Canada

  • ALTACE

Australia

  • Tritace (5)TGA ARTG registered 1995-1996 range · 1.25 mg, 2.5 mg, 5 mg, 10 mg · Sanofi-Aventis Australia Pty Ltd

New Zealand

  • Tryzan (6)Medsafe data sheet confirmed · 1.25 mg, 2.5 mg, 5 mg, 10 mg · not independently confirmed beyond data-sheet existence in this pass
View brands in additional countries.

European Union

Tritace (and generics) (3)

This page provides general reference information about ramipril and is not a substitute for advice from the prescriber managing your treatment. All dosing and treatment decisions, including starting, changing, or stopping this medicine, should be made with your prescriber.

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