A first-line blood pressure medicine. Effective, cheap, and responsible for one of the most recognisable side effects in medicine.
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Ramipril is an ACE inhibitor. It blocks an enzyme that produces angiotensin II, a hormone that narrows blood vessels — so blood vessels relax, and blood pressure falls.
It is one of the first-line treatments for high blood pressure in people under 55, and is also used to protect the kidneys and the heart in specific circumstances.
Usually once daily. The first dose is often taken at bedtime, because it can cause dizziness as your body adjusts.
With or without food.
Get up slowly from sitting or lying for the first few days.
Avoid salt substitutes containing potassium chloride — ACE inhibitors raise potassium, and combining the two can push it too high.
If you miss a dose, take it when you remember unless the next is nearly due.
A dry, persistent, tickly cough affects roughly 1 in 10 people and is the single most recognisable side effect of this drug class. It is not dangerous and it does not respond to cough remedies. It also does not go away while you keep taking the drug.
The important thing to know is that it is entirely fixable — switching to an ARB such as losartan or candesartan gives the same benefit without the cough. People routinely put up with this for months without realising a straightforward alternative exists.
Other effects: dizziness, particularly early on; headache; fatigue; and altered taste.
Rarely but seriously: angioedema — swelling of the lips, tongue, face or throat. This needs emergency attention. Stop the drug and call 999 if the airway is involved.
Care is needed with existing kidney impairment or a high potassium level.
Bloods are essential with this drug. Kidney function and potassium are checked before starting and again within 2 to 4 weeks of starting or increasing the dose, then periodically.
Interactions: NSAIDs such as ibuprofen (which raise blood pressure and can affect the kidneys in combination), potassium supplements and potassium-containing salt substitutes, lithium, and other blood pressure medicines used together.
Sick day rules matter. If you are vomiting, have diarrhoea, or are otherwise dehydrated, ACE inhibitors can affect the kidneys. Ask about temporarily pausing them — this is standard advice and is frequently never given.
Yes, where clinically appropriate. Blood pressure is one of the conditions best suited to remote care, because the readings that matter are the ones you take at home rather than in a clinic room.
What that involves: home blood pressure readings twice daily for seven days, a 20-minute consultation covering the full history, and baseline bloods. Kidney function is rechecked after starting.
What we cannot do: prescribe without bloods, or continue prescribing without monitoring. Both would be unsafe with this drug.
A reading of 180/120 or above with symptoms needs emergency assessment, not an online appointment.
This page is information, not an offer to supply. A prescription follows an assessment and is never guaranteed.
Ramipril is very cheap. The generic has been available for many years and there is no branded version worth paying more for.
On a private prescription you pay the drug cost plus the pharmacy's dispensing fee, which for ramipril will usually total less than the England NHS prescription charge of around £10. In Wales NHS prescriptions are free, so that route is cheaper if you are registered with a Welsh practice.
Not the tablets — the monitoring. Ramipril requires a blood test of kidney function and potassium before starting and again within two to four weeks of starting or increasing the dose.
Budget for those rather than for the drug, and once you are stable on a settled dose the checks become periodic rather than frequent.
Ask for a three-month supply once stable, and buy a validated home blood pressure monitor — it is a one-off cost that pays for itself and makes every subsequent review meaningful.
Ramipril does not cause withdrawal and does not need tapering. Blood pressure simply drifts back up over one to two weeks.
A dry, tickly, persistent cough affects roughly one in ten people and is the single commonest reason ramipril is stopped. It is not an allergy and it is not harmful — but it does not settle with time, so waiting it out rarely works.
The fix is straightforward: switch to an ARB such as losartan or candesartan, which works through the same pathway without causing the cough. The cough usually clears within a few weeks of stopping.
People put up with this for years unnecessarily, often having been investigated for asthma first.
Pause it during a bout of vomiting, diarrhoea or fever with dehydration, and restart once you are eating and drinking normally for 24 to 48 hours. Continuing while dehydrated is a genuine cause of avoidable kidney injury, and it is under-explained.
It is a well-recognised effect of ramipril, affecting around one in ten people, caused by bradykinin building up in the airways.
It does not settle if you persevere. Switching to an ARB such as losartan solves it while keeping the same benefit.
Ramipril changes how the kidneys handle blood flow and potassium. A small rise in creatinine after starting is expected and acceptable; a large one is not.
Checks before starting and again within two to four weeks of starting or increasing the dose, then periodically once settled.
Yes — pause it while you are vomiting, have diarrhoea, or are feverish and not drinking. Restart after a day or two of eating and drinking normally.
These are the "sick day rules", and they prevent avoidable kidney injury.
The first dose can drop your blood pressure more than later ones, causing dizziness.
Taking it at night means you are lying down when that happens. After the first few days the timing is up to you.
Best avoided regularly. Anti-inflammatories reduce ramipril's effect and, combined with a diuretic, meaningfully raise the risk of kidney injury.
Occasional use is usually fine; regular use should be discussed.
No. Ramipril can harm a developing baby and should be changed before you conceive, not after a positive test.
If there is any chance of pregnancy, raise it now.
Avoid potassium-based salt substitutes such as LoSalt, which are a genuinely common and overlooked cause of high potassium on ramipril.
Ordinary dietary potassium from fruit and vegetables is fine.
It is normal because you are taking it. Stopping means it returns over a week or two.
If weight loss or lifestyle change has been substantial, a supervised reduction is reasonable — guided by home readings, not by feel.
Clinically reviewed by Dr Mohammad Zubair Khan, GMC 7563469
Last reviewed
August 24, 2026
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