Patients using Ramipril during surgical procedures are at increased risk. It is advised that the treatment with Ramipril should be stopped one day before the surgery
, if possible.
Patients who are allergic to peanut or soya are at increased risk when using this medicine. These patients should not use this medicine.
Patients with kidney disease
Patients having high blood pressure with narrow kidney arteries and the patients using diuretics
are at increased risk when using this medicine. These patients may suffer from increased levels of blood urea nitrogen and creatinine
. If this happens, reduction in the dose of Ramipril and discontinuation of diuretics is required.
Use of aliskiren with Ramipril
Patients with diabetes
or abnormal functioning of the kidneys are at increased risk when using this medicine. These patients may suffer from low blood pressure, high potassium
, and changes in the functioning of the kidney. Ramipril should not be used in combination with aliskiren.
Decreased white blood cells count
Patients with inflammation of connective tissues (collagen vascular disease) and kidney dysfunction are at increased risk when using this medicine. These patients may develop a reduction in the white blood cell count, red blood cell count, and hemoglobin content, or platelet
count. In this case, proper monitoring of white blood cells should be considered in patients with collagen vascular disease, mainly if the condition involves abnormal functioning of kidney.
Women in their second and third trimester of pregnancy
Women who are pregnant are at increased risk when using this medicine. Ramipril can cross the placenta. The use of Ramipril in the second and third trimesters of pregnancy
causes a decrease in the functioning of kidneys and increases the chances of fatality in the unborn baby. It can also result in a deficiency of amniotic fluid in womb associated with incomplete development of lungs and bone deformations. Other side effects caused by Ramipril include skull abnormalities, less production of urine, low blood pressure, kidney failure, and other defects in the baby. When pregnancy is detected, stop using Ramipril. Appropriate management of high blood pressure in the mother during pregnancy should be done. If no alternative therapy is available, tell the mother about the risk of deficiency of amniotic fluid and perform ultrasound
regularly. Closely observe babies with a history of in utero exposure to Ramipril for symptoms of low blood pressure, less urine production, and increased potassium
High blood potassium level (hyperkalemia)
Patients with high blood pressure are at increased risk when using this medicine. Also, the patients with diabetes
mellitus, kidney insufficiency, and the combined use of potassium-sparing diuretics
, potassium-containing salt
substitutes, and potassium
supplements are at increased risk. These patients may suffer from high potassium levels in the blood. Take necessary precautions while using this medicine in such patients.
Non productive, persistent cough
Patients using ACE inhibitors are at increased risk of non productive and persistent episodes of cough
Use of telmisartan with Ramipril
Patients using telmisartan and Ramipril in combination are at increased risk. These patients have higher chances of developing abnormal functioning of the kidneys. The combined use of telmisartan and Ramipril is not recommended.
Severe allergic reactions (anaphylactoid reactions)
Patients undergoing desensitizing treatment (to reduce or eliminate an organism's negative reaction to a substance) with insect venom (Hymenoptera venom) and purification procedure with high-flux membranes are at increased risk when using this medicine. Also, the patients undergoing low-density lipoprotein apheresis using dextran sulfate are at increased risk. These patients may suffer from serious side-effects
. If this happens, temporarily discontinue using this medicine.
Swelling of the face, head, mouth and neck extremities
Patients with a history of swelling of the lower layer of the skin are at increased risk when using this medicine. These patients may suffer from swelling due to fluid accumulation on the face, lips, extremities, glottis, tongue, and larynx. If this happens, discontinue using this medicine and appropriate treatment should be given immediately. In case, if there is an involvement of the glottis, tongue, or larynx it may lead to airway obstruction and to prevent this subcutaneous epinephrine solution 1:1,000 (0.3 ml to 0.5 ml) can be used.
Swelling of intestine due to fluid accumulation
Patients using angiotensin-converting enzyme inhibitors are at increased risk. These patients may suffer from abdominal pain
with or without vomiting or nausea
Low blood pressure
Patients with salt
depleted as a result of prolonged diuretic
, dietary salt restriction, diarrhea
, or vomiting are at increased risk when using this medicine. Patients with congestive heart failure with or without kidney insufficiency are also at the increased risk when using this medicine. These patients may develop signs of low blood pressure which may be associated with reduced urination or abnormally raised level of nitrogen-containing compounds (azotemia) and very rarely it may lead to acute kidney failure and fatal conditions. If this happens, the patient should be placed in a lying position. If required, treatment with intravenous physiological saline infusion should be given. The close supervision is necessary for the first two weeks of the treatment.
Patients using ACE inhibitors are at increased risk. These patients may develop jaundice
due to reduced bile flow (cholestatic
jaundice) and progresses to acute liver failure (fulminant liver necrosis) and fatality. Discontinue the use of Ramipril in patients with jaundice or increased liver enzymes. An appropriate medical check-up is required in such patients.