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Ramipril Precautions and Warnings

Among the people who should not take ramipril are those who are allergic to ramipril or its inactive ingredients and those who have a history of angioedema related to previous ACE inhibitor treatment. A few of the conditions you should let your healthcare provider know about before you take ramipril include diabetes, kidney disease, and liver disease. Some other ramipril precautions and warnings include potential drug interactions; an increased risk of infections in some people taking the drug; and the safety of taking it if you are over 65 years old, pregnant, or nursing.

Ramipril: What Should I Tell My Healthcare Provider?

You should talk with your healthcare provider prior to taking ramipril (Altace®) if you:
Let your healthcare provider know if you are pregnant or thinking about becoming pregnant. During pregnancy, ramipril can cause damage or even death to the developing fetus.
Tell your healthcare provider about all the medicines you may already be taking, including prescription and non-prescription medicines, vitamins, and herbal supplements (especially if you are taking a potassium supplement or water pill).

Some Ramipril Precautions and Warnings

Some precautions and warnings to be aware of with ramipril include:
  • ACE inhibitors such as ramipril are more likely than other medicines to cause allergic reactions. Make sure to discuss these risks with your healthcare provider.
  • Ramipril can interact with certain other medications (see Ramipril Drug Interactions).
  • ACE inhibitors may cause swelling (angioedema) of the head and neck. This occurs more frequently in African Americans than in Caucasians. In addition to the head and neck angioedema, ACE inhibitors have been associated with intestinal angioedema (a key symptom of which is abdominal pain). Make sure to discuss these risks with your healthcare provider. Also, let your healthcare provider know if you have any swelling of the eyes, face, lips, or tongue or experience difficulty breathing. If you have any of these symptoms, do not take any more ramipril until you have seen your healthcare provider.
  • Ramipril may cause extreme low blood pressure and slow heart rate in some people. Symptoms of low blood pressure can include dizziness, lightheadedness, or fainting. This is likely to occur if a person has experienced diarrhea, vomiting, or excessive sweating.
  • Ramipril is a pregnancy Category D medicine, meaning that it can pose health risks to your unborn child. Let your healthcare provider know if you are pregnant or thinking about becoming pregnant. If you become pregnant while taking ramipril, contact your healthcare provider immediately (see Altace and Pregnancy for more information).


  • ACE inhibitors are known to cause a cough. If it becomes bothersome, talk with your healthcare provider about alternate options for your condition.
  • While taking ramipril, do not use salt substitutes with potassium unless you have discussed this with your doctor.
  • People on ramipril can be at increased risk of infections. Talk with your healthcare provider if you have any infections, such as a sore throat or fever, while taking ramipril.
  • If you are over 65 years old, your healthcare provider may choose to make any necessary dosing adjustments with caution.


  • This medication may cause a decrease in kidney function, especially in people who are elderly, have kidney disease, have severe congestive heart failure (CHF), or are taking nonsteroidal anti-inflammatory drugs (NSAIDs) or diuretics (water pills). Your healthcare provider may choose to monitor your kidney function with a blood test while you are taking it. Contact your healthcare provider if you notice a decrease in urination or swelling in your hands, legs, ankles, or feet, which can be signs of kidney problems. 


  • In clinical studies, ACE inhibitors have rarely been known to cause liver failure. If you notice yellowing of the skin or eyes (jaundice), or have a dramatic increase in liver enzymes, your healthcare provider may recommend discontinuing ramipril.
  • It is not known whether or not ramipril passes through breast milk. Therefore, if you are taking ramipril and nursing, it is recommended that you stop nursing.
  • If you have congestive heart failure, your healthcare provider may choose to monitor your progress closely.
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