medicationPrescription only (US)Ramipril is FDA-approved as an ACE inhibitor for hypertension and for reducing cardiovascular risk after myocardial infarction or in high-risk patientsUse in hemodialysis patients and for COVID-19 outpatients in the cited trials was investigational rather than an approved indication
RamiprilBenefits, Dosage & Interactions
Also known as: Altace
Ramipril, often sold under the brand name Altace, is an angiotensin-converting enzyme (ACE) inhibitor. It is typically taken in the morning. The reported plasma half-life is about 13 hours, which shapes dosing frequency. Dose, response, and interaction risk vary by individual, so use should be reviewed with a clinician.
Researched by DoseRoutine R&D TeamReviewed for accuracy by Nicholas Alexander, RSELast updated
Evidence: Strong — 3 human randomized trials and regulatory approval on file.
Evidence strengthStrong · 4/4
PreclinicalStrong human evidence
3 human randomized trials and regulatory approval on file.
Plasma half-life
13–17 h
Typical timing
morning
Default unit
mg
What published protocols report
Ranges documented in the literature, shown for reference. DoseRoutine does not recommend an amount — your prescriber or the product label sets the dose.
Reported for Ramipril in the cited sources. Published ranges are not dosing advice.
References & evidence
Documents the Ramipril entry is written from. Each number matches an inline marker above.
- [1]A Randomized Controlled Trial on the Efficacy and Safety of a Calcium-Channel Blocker and an Angiotensin-Converting Enzyme Inhibitor in Chinese and European Patients with HypertensionZhang W, Liu CY, Bilo G, Soranna D, Zambon A, Kyriakoulis KG, et al., Parati G · American Journal of Hypertension · 2025 · Peer-reviewed · PMID 39657776
- [2]Ramipril and Cardiovascular Outcomes in Patients on Maintenance Hemodialysis: The ARCADIA Multicenter Randomized Controlled TrialRuggenenti P, Podestà MA, Trillini M, Perna A, Peracchi T, Rubis N, et al., Remuzzi G · Clinical Journal of the American Society of Nephrology · 2021 · Peer-reviewed · PMID 33782036
- [3]Ramipril for the Treatment of COVID-19: RAMIC, a Randomized, Double-Blind, Placebo-Controlled Clinical TrialHuang DQ, Ajmera V, Tomaszewski C, LaFree A, Bettencourt R, Thompson WK, et al., Loomba R · Advances in Therapy · 2023 · Peer-reviewed · PMID 37615850
How to track Ramipril doses
Tracking Ramipril well takes four fields and a habit. Here is what to record so the log is still useful in three months.
- 1
Add the dose and unit
Log Ramipril with its dose in mg so totals stay comparable over time — including days when you split the dose or skip it.
- 2
Set the time of day and food rule
Typical timing is morning. Reminders fire at that time and can export to your calendar.
- 3
Check it against the rest of the stack
Run Ramipril through the interaction checker against everything else in the routine — supplements, peptides, hormones and prescriptions — before it becomes a daily habit.
- 4
Log adherence, not intentions
Mark each dose taken, skipped or delayed as it happens. Weeks of honest logs are what make an adherence rate or a trend line meaningful; retrospective guessing is not.
- 5
Review against outcomes
With a reported half-life around 13 h, effects and timing shifts show up over days rather than instantly. Review Ramipril alongside your logged metrics and any relevant blood work every few weeks before changing the dose.
What to log each time
- Dose in mg
- Time of day
- Taken / skipped / delayed
- Any side effects or notable changes
References & Evidence
Sources on this page that document Ramipril dosing, timing and safety.
- [1]National Center for Biotechnology Information View source
Educational information only — not medical advice. Dose ranges vary by person, indication and prescriber.
What is Ramipril?Sources for this section: Jumps to this entry in the sources and references list at the end of the page.
Ramipril, often sold under the brand name Altace, is an angiotensin-converting enzyme (ACE) inhibitor. It is a prescription medication primarily used to treat high blood pressure (hypertension), prevent heart attack, stroke, and death in patients at high risk, and improve survival after a heart attack involving heart failure. It also helps manage heart failure and kidney disease in patients with diabetes. Ramipril works by relaxing blood vessels, which lowers blood pressure and improves blood flow. It is typically taken orally. (Mayo Clinic, DrugBank)
What does the research say about Ramipril?
Tap a section to expand.
Ramipril is a prodrug that is converted in the liver to its active metabolite, ramiprilat. Ramiprilat acts by inhibiting the angiotensin-converting enzyme (ACE). ACE is a peptidase that catalyzes the conversion of angiotensin I to the potent vasoconstrictor angiotensin II. By inhibiting ACE, ramiprilat reduces the formation of angiotensin II, which leads to several physiological effects:
* **Vasodilation:** Reduced angiotensin II levels cause relaxation of constricted blood vessels, leading to a decrease in total peripheral resistance and consequently lower blood pressure.
* **Decreased Aldosterone Secretion:** Angiotensin II also stimulates the release of aldosterone from the adrenal cortex. By reducing angiotensin II, ramiprilat decreases aldosterone secretion, which in turn leads to increased excretion of sodium and water by the kidneys, and retention of potassium. This further contributes to blood pressure reduction and can help reduce fluid retention in heart failure.
* **Bradykinin Potentiation:** ACE is also responsible for the degradation of bradykinin, a vasodilator. By inhibiting ACE, ramiprilat increases levels of bradykinin, contributing to vasodilation and potentially some of the side effects like cough and angioedema. (DrugBank, PubChem)
Source for this section: Sources for How does Ramipril work?: Jumps to this entry in the sources and references list at the end of the page.
Ramipril offers several established benefits, primarily in cardiovascular and renal health:
* **Hypertension (High Blood Pressure):** Ramipril effectively lowers high blood pressure, reducing the risk of associated complications such as heart attack, stroke, and kidney damage. (Mayo Clinic, NIH MedlinePlus)
* **Heart Attack and Stroke Prevention:** In individuals at high risk for cardiovascular events, including those with a history of heart disease, stroke, or diabetes with other risk factors, ramipril has been shown to reduce the incidence of future heart attacks, strokes, and cardiovascular death. (NIH MedlinePlus, Cochrane)
* **Heart Failure:** It is used to improve survival, reduce hospitalization, and alleviate symptoms in patients with heart failure following a heart attack. It helps the heart pump more efficiently and reduces fluid buildup. (DrugBank, Mayo Clinic)
* **Diabetic Nephropathy:** In patients with diabetes, ramipril can slow the progression of kidney disease, particularly in those with microalbuminuria or overt proteinuria. It helps protect the kidneys by reducing pressure within the glomeruli. (NIH MedlinePlus, FDA label)
* **Reduction of Cardiovascular Mortality:** Studies have demonstrated that ramipril can reduce overall cardiovascular mortality in high-risk populations. (Cochrane)
The efficacy of ramipril is supported by extensive clinical research. For hypertension, numerous studies, including large meta-analyses, have consistently shown its effectiveness in lowering blood pressure and reducing cardiovascular event rates. Landmark trials such as the HOPE (Heart Outcomes Prevention Evaluation) study, a large randomized controlled trial, provided strong evidence for ramipril's role in reducing the risk of myocardial infarction, stroke, and cardiovascular death in high-risk patients without left ventricular dysfunction or heart failure. The AIRE (Acute Infarction Ramipril Efficacy) study demonstrated its benefits in reducing mortality and morbidity in patients with clinical evidence of heart failure after acute myocardial infarction. Its renoprotective effects in diabetes have also been shown in studies such as the MICRO-HOPE (Microalbuminuria, Cardiovascular and Renal Outcomes Heart Outcomes Prevention Evaluation) substudy. These findings are recognized and referenced by major health organizations, including the Mayo Clinic, NIH MedlinePlus, and the FDA label. (Cochrane, NIH MedlinePlus)
Like all medications, ramipril can cause side effects, though not everyone experiences them. Common side effects may include:
* **Dry, persistent cough:** This is a common side effect of ACE inhibitors and is typically non-productive. If troublesome, it should be discussed with a clinician.
* **Dizziness or lightheadedness:** Especially when standing up quickly, due to lowered blood pressure.
* **Fatigue or weakness:** Feeling unusually tired.
* **Headache:** A common and generally mild side effect.
* **Nausea, vomiting, or diarrhea:** Gastrointestinal disturbances.
* **Increased potassium levels (hyperkalemia):** This can be serious, especially in patients with kidney problems or those taking potassium-sparing diuretics or potassium supplements. Regular monitoring of blood potassium levels is recommended.
Less common but more serious side effects include:
* **Angioedema:** Rapid swelling of the face, lips, tongue, throat, or intestines. This is a severe allergic reaction that requires immediate medical attention.
* **Kidney problems:** Worsening kidney function, especially in individuals with pre-existing kidney disease or certain vascular conditions affecting the kidneys.
* **Liver problems:** Rare but can occur, manifesting as jaundice or elevated liver enzymes.
* **Low blood pressure (hypotension):** Can be severe, particularly after the first dose or with dose increases.
* **Fainting:** Due to significantly lowered blood pressure.
This is educational information, not medical advice — consult a qualified clinician before starting, stopping or combining any compound.
Ramipril carries several important warnings. It should be used with caution in patients with pre-existing kidney impairment, as it can potentially worsen renal function. Blood pressure should be monitored regularly, especially when initiating treatment or increasing the dose, due to the risk of symptomatic hypotension. Patients undergoing surgery who are taking ramipril should inform their clinician, as ACE inhibitors can cause a drop in blood pressure during anesthesia. The risk of angioedema is a serious concern, and patients should be advised to seek immediate medical attention if they experience swelling of the face, lips, tongue, or throat. Patients of African descent may have a higher risk of angioedema with ACE inhibitors. Hyperkalemia (high blood potassium) is another risk, particularly in patients with renal insufficiency, diabetes, or those concurrently taking potassium-sparing diuretics or potassium supplements. Regular monitoring of serum potassium and kidney function is advisable. Pregnant women should not take ramipril, especially during the second and third trimesters, due to the risk of fetal injury or death. (FDA label, Mayo Clinic)
This is educational information, not medical advice — consult a qualified clinician before starting, stopping or combining any compound.
Ramipril is contraindicated in certain situations. It should not be used in individuals with a known hypersensitivity to ramipril or any other ACE inhibitor. A history of angioedema related to previous ACE inhibitor treatment is an absolute contraindication. It is contraindicated in pregnant women due to the risk of fetal toxicity and death, particularly during the second and third trimesters. Ramipril should not be used concurrently with aliskiren (a direct renin inhibitor) in patients with diabetes or moderate to severe kidney impairment due to an increased risk of hypotension, hyperkalemia, and worsening renal function. It is also contraindicated in combination with sacubitril/valsartan due to the increased risk of angioedema and should not be administered within 36 hours of switching to or from this combination. Patients with bilateral renal artery stenosis or severe unilateral renal artery stenosis may be at increased risk of kidney impairment when taking ACE inhibitors like ramipril. (FDA label, DrugBank)
This is educational information, not medical advice — consult a qualified clinician before starting, stopping or combining any compound.
Several compounds should not be mixed with ramipril or require close monitoring due to potential interactions:
* **Aliskiren:** Concomitant use is contraindicated in patients with diabetes or moderate to severe renal impairment (GFR < 60 mL/min/1.73m2) due to increased risk of hypotension, hyperkalemia, and worsening renal function. (FDA label)
* **Sacubitril/valsartan:** Concurrent use is contraindicated due to a significantly increased risk of angioedema. A washout period of at least 36 hours is required when switching between these medications. (FDA label)
* **Potassium Supplements and Potassium-Sparing Diuretics (e.g., spironolactone, triamterene, amiloride):** Co-administration can significantly increase the risk of hyperkalemia. Close monitoring of potassium levels is essential, and often these combinations are avoided. (Mayo Clinic, DrugBank)
* **Nonsteroidal Anti-inflammatory Drugs (NSAIDs) like ibuprofen or naproxen:** NSAIDs can reduce the blood pressure-lowering effect of ramipril and increase the risk of kidney problems, especially in elderly or dehydrated patients. (NIH MedlinePlus)
* **Lithium:** Ramipril can increase serum lithium concentrations and lead to lithium toxicity. Monitoring of lithium levels is recommended if co-administered. (DrugBank)
* **Other antihypertensive agents:** Combining ramipril with other medications for high blood pressure can lead to an additive hypotensive effect, potentially causing excessive drops in blood pressure. (DrugBank)
* **Diuretics:** While often used together, the initial dose of ramipril may need to be reduced, or the diuretic temporarily stopped, to prevent excessive hypotension. (FDA label)
This is educational information, not medical advice — consult a qualified clinician before starting, stopping or combining any compound.
Ramipril is typically taken once daily, usually in the morning. It can be taken with or without food. The consistent daily timing helps maintain steady medication levels in the body. Individual needs vary — talk to a licensed clinician. (NIH MedlinePlus, FDA label)
Source for this section: Sources for When should you take Ramipril?: Jumps to this entry in the sources and references list at the end of the page.
What interacts with Ramipril?
| Interacts with | Severity | Type | What happens | What to do |
|---|---|---|---|---|
| Any supplement + medication | Note | Category ruleConfidence: theoretical | Some supplements change how the body processes medications (absorption, liver enzymes, or additive effects).Source pending | Specific pairs are checked against a licensed drug database and shown with their own severity. Always confirm with your provider or pharmacist. |
| Any vitamin + medication | Note | Category ruleConfidence: theoretical | Certain vitamins interact with specific medications (e.g., vitamin K with blood thinners).Source pending | Specific pairs are checked against a licensed source; confirm with your provider. |
| Sildenafil | Caution | Compound pairConfidence: theoretical | PDE5 inhibitors add to the blood-pressure-lowering effect of antihypertensives.Source pending | Start PDE5 at the lowest effective dose and monitor for hypotension. |
| Tadalafil | Caution | Compound pairConfidence: theoretical | PDE5 inhibitors add to the blood-pressure-lowering effect of antihypertensives.Source pending | Start PDE5 at the lowest effective dose and monitor for hypotension. |
| Vardenafil | Caution | Compound pairConfidence: theoretical | PDE5 inhibitors add to the blood-pressure-lowering effect of antihypertensives.Source pending | Start PDE5 at the lowest effective dose and monitor for hypotension. |
Frequently asked questions about Ramipril
No, ramipril does not cure high blood pressure, but it effectively manages it by keeping blood pressure within a healthy range. It is usually a long-term treatment. Stopping the medication without consulting a clinician can lead to your blood pressure rising again. (Mayo Clinic)
Ramipril usually starts to lower blood pressure within a few hours of the first dose, but it may take several weeks of consistent use to achieve its full blood pressure-lowering effect. Your clinician will monitor your blood pressure to determine its effectiveness. (NIH MedlinePlus)
If you miss a dose of ramipril, take it as soon as you remember, unless it is almost time for your next dose. In that case, skip the missed dose and continue with your regular schedule. Do not take two doses at once to make up for a missed dose. (NIH MedlinePlus)
The dry, persistent cough associated with ramipril is a common side effect of ACE inhibitors and is usually not serious but can be bothersome. If you develop a cough, discuss it with your clinician, who may consider alternative treatments. It is distinct from the more serious angioedema. (Mayo Clinic)
Ramipril is generally recommended to limit or avoid alcohol consumption while taking ramipril. Alcohol can further lower blood pressure, potentially leading to increased dizziness or lightheadedness, and may also increase the risk of certain side effects. Discuss alcohol use with your clinician. (NIH MedlinePlus)
Interaction risk for Ramipril comes from the rest of the stack: other medications, prescription medicines, hormone therapy and peptides. Because Ramipril is usually taken in the morning, most avoidable conflicts come from what else lands in that same window. With a reported plasma half-life near 13 hours, separating doses can change the picture as much as removing one. Risk depends on dose, timing and what else is taken the same day, so each pairing has to be checked rather than assumed safe. The free checker at https://doseroutine.com/interaction-checker covers Ramipril with no sign-up.
There is no single answer for Ramipril plus TRT. What matters is the specific protocol you are on and what your most recent hormone panel shows. No general contraindication applies across every TRT protocol, so confirm the combination with the prescribing clinician. See the free TRT interaction reference: https://doseroutine.com/trt-supplement-interactions
Pairing Ramipril with peptides has to be assessed one peptide at a time, because GLP-1 agonists, secretagogues, healing peptides and melanocortins do not share an interaction profile. Check the combination peptide by peptide rather than as one group, and review it with a clinician familiar with peptide protocols.
With a plasma half-life near 13 hours, once-daily dosing is the usual pattern for Ramipril. It is typically taken in the morning. Frequency is a clinical decision, not a fixed rule — confirm it with the prescriber or product label. Comparison of apps that keep a schedule like this: https://doseroutine.com/best-dose-tracking-apps
For Ramipril the useful record is the dose, the time it was actually taken, and what else was taken in the same window. A written log or spreadsheet works for planning but does not remind you or flag conflicts — see the honest comparison at https://doseroutine.com/vs/spreadsheet and the wider roundup at https://doseroutine.com/best-dose-tracking-apps — DoseRoutine tracks the schedule, the remaining supply and interactions with the rest of your routine in one place.
Which studies looked at Ramipril?
Peer-reviewed research indexed in PubMed. Each entry links to the original record.
- 1.Telmisartan, ramipril, or both in patients at high risk for vascular events(opens PubMed in a new tab)N Engl J Med · 2008 · PMID 18378520 · https://pubmed.ncbi.nlm.nih.gov/18378520/
- 2.Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients(opens PubMed in a new tab)N Engl J Med · 2000 · PMID 10639539 · https://pubmed.ncbi.nlm.nih.gov/10639539/
- 3.Ramipril(opens PubMed in a new tab)Int J Clin Pract · 2000 · PMID 10912316 · https://pubmed.ncbi.nlm.nih.gov/10912316/
Sources cited on this page
Specific documents referenced by the numbered markers above. Each number matches the marker in the text.
- PubChem CID 14520363(opens in a new tab)National Center for Biotechnology Information · pubchem.ncbi.nlm.nih.gov/compound/14520363
Verify at
Publisher search links for Ramipril. These are places to check the information — they are not citations, so they are not numbered.
- Mayo Clinic(publisher search, opens in a new tab)Mayo Clinic · publisher search
- MedlinePlus(publisher search, opens in a new tab)U.S. National Library of Medicine · publisher search
- DrugBank(publisher search, opens in a new tab)DrugBank Online · publisher search
- FDA-approved labeling (DailyMed)(publisher search, opens in a new tab)U.S. Food and Drug Administration · publisher search
- Cochrane Library(publisher search, opens in a new tab)Cochrane · publisher search
- Examine.com(publisher search, opens in a new tab)Examine.com · publisher search
- PubMed literature search(publisher search, opens in a new tab)National Library of Medicine · publisher search
- Wikipedia entry(publisher search, opens in a new tab)Wikipedia · publisher search
DoseRoutine compiles summaries from publicly available scientific and regulatory references. Always verify important decisions with a licensed clinician. How we source and review this information.
What is the short answer on Ramipril?
Plain-text summary, safe to quote verbatim:
Ramipril, often sold under the brand name Altace, is an angiotensin-converting enzyme (ACE) inhibitor. It is typically taken in the morning. The reported plasma half-life is about 13 hours, which shapes dosing frequency. Dose, response, and interaction risk vary by individual, so use should be reviewed with a clinician.
Source: DoseRoutine — https://doseroutine.com/library/ramipril
Cite this page
Using this in an article, AI answer, or research note? Please attribute:
DoseRoutine. (2026). Ramipril — Overview, Benefits & Side Effects. Retrieved from https://doseroutine.com/library/ramipril
What compounds are similar to Ramipril?
Others in the medication category or studied for the same goals.