Take control of your blood pressure with Ramipril (generic Altace)

Ramipril is an ACE inhibitor that functions as a reliable long-term treatment for hypertension and works by dilating blood vessels.


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Written by Dr Kim Langdon, MD

Information last reviewed 07/15/19


What is Ramipril (generic Altace)?

Ramipril (Altace) is a medication used to treat high blood pressure and falls into the class of drugs called angiotensin converting enzyme (ACE) inhibitors. Ramipril begins to work within just 1 hour and is eliminated by the body within 13-17 hours.  Ramipril can also be used for:

  • Cardiovascular Risk Reduction
  • Diabetic Kidney Disease
  • Heart Attack
  • Heart Failure
  • High Blood Pressure
  • Left Ventricular Dysfunction  (Problems with a left chamber of the heart)

How does Ramipril work?

Ramipril is a type of antihypertensive drug known as an ACE inhibitor. It works by interfering with the conversion of a substance called angiotensin I into angiotensin II. Angiotensin II is partly responsible for the constriction (narrowing) of the blood vessels. By blocking the conversion of angiotensin, Ramipril helps to prevent this narrowing of the blood vessels, allowing them to relax and widen, lowering the blood pressure. But Ramipril also helps reduce blood pressure in another way too. Ramipril reduces the production of a hormone called aldosterone. Aldosterone encourages the body to retain water and salt, which increases blood pressure. So by reducing aldosterone, Ramipril lowers blood pressure further.

How long does Ramipril take to work?

Ramipril starts working 1 to 2 hours after it's taken, and the effect lasts up to 24 hours.

How effective is Ramipril?

Ramipril is very effective at lowering blood pressure. Individual effect may vary per person. 


Active ingredients

The active ingredient in Ramipril is ramipril and ramiprilat. Ramipril tablets are available in 1.25 mg, 2.5 mg, 5 mg or 10 mg dosages. Ramipril works by blocking the conversion of a substance called angiotensin I into angiotensin II. This helps to stop the blood vessels from being constricted, allowing them to relax and widen, reducing blood pressure.

Inactive ingredients

The inactive ingredients in Ramipril are: pregelatinized starch NF, cellulose, gelatin, sodium stearyl fumarate, and titanium dioxide (please note, inactive ingredients can vary between manufacturers).

Which ingredients can cause an allergic reaction?

In rare cases, Ramipril can cause a severe allergic reaction in people. A severe allergic reaction presents as facial swelling, trouble breathing, rash/hives and dizziness. If you notice a severe allergic reaction shortly after taking ramipril, please seek emergency medical attention right away. If you have previously had a severe allergic reaction to this medication, please do not take it again and let your doctor know. 


Ramipril dosage

Ramipril comes in 4 strengths

  • 1.25mg
  • 2.5mg
  • 5mg
  • 10mg

The dose for Ramipril depends upon which condition you are trying to treat. For high blood pressure, you should initially take 2.5 mg tablets daily (or 1.5mg daily if prescribed with a diuretic). Following this, your doctor may increase your dose up to 20mg a day. Often your Ramipril is taken as a single dose, but it may be possible to divide this dose over the course of the day. Speak to your doctor about your options and always follow their advice when taking medication.

Ramipril can also be used in different doses for the treatment of heart failure and to reduce the risk of heart attacks or strokes. The prescribing doctor will give you directions for use.

How to take Ramipril

Ramipril should be taken whole. Alternatively, you may open the capsule and mix the contents with 120 ml of water, apple juice, or applesauce. 

What should I do if I miss a dose of Ramipril?

If you are within 12 hours of your dose, take the missed dose.  However, if you are more than 12 hours out, just take the next dose when it would be due. Do not take 2 doses at once or make up for a missed dose. 

Side Effects

Side Effects

Common side effects, occurring in more than 10% of people are:

  • Cough
  • Low blood pressure

Less common side effects, affecting less than 10% of people are:

  • Headache
  • Chest pain
  • Dizziness
  • Nausea
  • Vomiting
  • Sudden drop in blood pressure with standing from sitting
  • Fainting
  • Vertigo
  • Abnormal kidney function
  • Diarrhea

Drug Interactions

The following drugs are known to interact with Ramipril. Therefore, they should be avoided if taking Ramipril. If you are taking any drugs, but especially those listed here, you should inform the prescribing physician, so they can ensure your treatments are as safe as possible.

  • Aspirin
  • Aspirin rectal
  • Candesartan
  • Celecoxib
  • Choline magnesium trisalicylate
  • Dalteparin
  • NSAIDs like Ibuprofen, Indomethacin, and Mefenamic acid
  • Irbesartan
  • Ketoprofen
  • Ketorolac
  • Lofexidine
  • Losartan
  • Meclofenamate
  • Mefenamic acid
  • Meloxicam
  • Nabumetone
  • Olmesartan
  • Oxaprozin
  • Piroxicam
  • Potassium phosphates, iv
  • Pregabalin
  • Salsalate
  • Sulindac
  • Telmisartan
  • Tolmetin


Ramipril is not recommended for people with the following conditions:

  • Hypersensitivity to drug or other ACE inhibitors
  • Diabetics taking Aliskiren
  • Renal impairment
  • Pregnancy
  • Breastfeeding


Disclaimer: This is not medical advice. You and your physician will determine if and how you should take any medication prescribed to you following a medical consultation.

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