Ramipril is an ACE inhibitor. ACE stands for angiotensin converting enzyme.

Ramipril is used to treat high blood pressure (hypertension) or congestive heart failure, and to improve survival after a heart attack.

Ramipril may also be used for purposes not listed in this medication guide.

Do not use ramipril if you are pregnant. If you become pregnant, stop taking this medicine and tell your doctor right away.

You should not use ramipril if you have ever had angioedema. Do not take this medicine within 36 hours before or after taking medicine that contains sacubatril (such as Entresto).

If you have diabetes, do not use ramipril together with any medication that contains aliskiren (such as Tekturna or Tekamlo).

Before taking this medicine

You should not use ramipril if you are allergic to it, or if:

• you have a history of angioedema;

• you recently took a heart medicine called sacubatril; or

• if you are allergic to any other ACE inhibitor, such as benazepril, captopril, enalapril, fosinopril, lisinopril, moexipril, perindopril, quinapril, or trandolapril.

Do not take ramipril within 36 hours before or after taking medicine that contains sacubatril (such as Entresto).

If you have diabetes, do not use ramipril together with any medication that contains aliskiren (such as Tekturna or Tekamlo).

You may also need to avoid taking ramipril with aliskiren if you have kidney disease.

To make sure this medicine is safe for you, tell your doctor if you have ever had:

• kidney disease (or if you are on dialysis);

• liver disease;

• a connective tissue disease such as Marfan syndrome, Sjogren's syndrome, lupus, scleroderma, or rheumatoid arthritis; or

• if you are also taking telmisartan (Micardis).

Do not use if you are pregnant. If you become pregnant, stop taking this medicine and tell your doctor right away. Ramipril can cause injury or death to the unborn baby if you take the medicine during your second or third trimester. Use effective birth control.

It is not known whether ramipril passes into breast milk or if it could harm a nursing baby. You should not breast-feed while using this medicine.

Ramipril comes as a capsule to take by mouth. It is usually taken once or twice a day with or without food. To help you remember to take ramipril, take it around the same time(s) every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take ramipril exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

Swallow the capsule whole, or open the capsule and sprinkle the contents on a small amount of applesauce (about 4 oz.) or in 4 oz. (about 120 mL) of water or apple juice. Eat or drink the entire mixture. This mixture can be prepared in advance and stored for 24 hours at room temperature or 48 hours in the refrigerator.

Your doctor will probably start you on a low dose of ramipril and gradually increase your dose.

Ramipril controls high blood pressure and heart failure but does not cure them. Continue to take ramipril even if you feel well. Do not stop taking ramipril without talking to your doctor.

Take ramipril exactly as prescribed by your doctor. Follow all directions on your prescription label. Your doctor may occasionally change your dose. Do not take this medicine in larger or smaller amounts or for longer than recommended.

Ramipril can be taken with or without food.

Swallow the tablet whole.

You may open the capsule and sprinkle the medicine into a half-cup (4 ounces) of water, apple juice, or applesauce to make swallowing easier. Swallow without chewing. You may store the mixture for up to 24 hours at room temperature, or up to 48 hours in a refrigerator.

Call your doctor if you have ongoing vomiting or diarrhea, or if you are sweating more than usual. You can easily become dehydrated while taking ramipril. This can lead to very low blood pressure, electrolyte disorders, or kidney failure.

Your blood pressure will need to be checked often, and you may need frequent blood tests to check your potassium levels.

Drink plenty of water each day while you are taking this medication.

If you need surgery, tell the surgeon ahead of time that you are using this medicine.

If you are being treated for high blood pressure, keep using this medication even if you feel well. High blood pressure often has no symptoms. You may need to use blood pressure medication for the rest of your life.

Store at room temperature away from moisture, heat, and light. Keep the bottle tightly closed when not in use.

You should not use ramipril if you are allergic to it, or if:

• you have a history of angioedema;

• you recently took a heart medicine called sacubatril; or

• if you are allergic to any other ACE inhibitor, such as benazepril, captopril, enalapril, fosinopril, lisinopril, moexipril, perindopril, quinapril, or trandolapril.

Do not take ramipril within 36 hours before or after taking medicine that contains sacubatril (such as Entresto).

If you have diabetes, do not use ramipril together with any medication that contains aliskiren (such as Tekturna or Tekamlo).

You may also need to avoid taking ramipril with aliskiren if you have kidney disease.

To make sure this medicine is safe for you, tell your doctor if you have ever had:

• kidney disease (or if you are on dialysis);

• liver disease;

• a connective tissue disease such as Marfan syndrome, Sjogren's syndrome, lupus, scleroderma, or rheumatoid arthritis; or

• if you are also taking telmisartan (Micardis).

Do not use if you are pregnant. If you become pregnant, stop taking this medicine and tell your doctor right away. Ramipril can cause injury or death to the unborn baby if you take the medicine during your second or third trimester. Use effective birth control.

It is not known whether ramipril passes into breast milk or if it could harm a nursing baby. You should not breast-feed while using this medicine.

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom).

Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program.

It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach. http://www.upandaway.org

Talk to your doctor before using salt substitutes containing potassium. If your doctor prescribes a low-salt or low-sodium diet, follow these directions carefully.

Do not use salt substitutes or potassium supplements while taking ramipril, unless your doctor has told you to.

Avoid drinking alcohol. It can further lower your blood pressure and may increase some of the side effects of ramipril.

Avoid getting up too fast from a sitting or lying position, or you may feel dizzy. Get up slowly and steady yourself to prevent a fall.

Get emergency medical help if you have any signs of an allergic reaction to ramipril: hives; severe stomach pain; difficult breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have:

• a light-headed feeling, like you might pass out;

• jaundice (yellowing of your skin or eyes);

• little or no urination;

• fever, chills, sore throat, cold or flu symptoms; or

• high potassium - nausea, weakness, tingly feeling, chest pain, irregular heartbeats, loss of movement.

Common ramipril side effects may include:

• headache;

• cough; or

• dizziness, weakness, tired feeling.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Keep all appointments with your doctor and the laboratory. Your blood pressure should be checked regularly to determine your response to ramipril. Your doctor may order certain lab tests to check your body's response to ramipril.

Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.