Altace

Before taking this medicine

Do not take ramipril if you are allergic to it or any other ACE inhibitor, have had angioedema (swelling beneath the skin) during previous ACE inhibitor treatment, or have hereditary angioedema or angioedema with no known cause. Do not take ramipril with a neprilysin inhibitor such as sacubitril. There must be at least 36 hours between stopping sacubitril/valsartan and starting ramipril, or stopping ramipril and starting sacubitril/valsartan. Do not take ramipril with aliskiren if you have diabetes. The combination should also be avoided in people with impaired kidney function. Stop ramipril as soon as pregnancy is detected and contact your prescriber. It can seriously harm or cause the death of an unborn baby, particularly during the second and third trimesters. Use while breastfeeding is not recommended. Tell your prescriber if you have kidney disease, narrowing of the arteries supplying the kidneys, liver impairment, heart failure, diabetes, high potassium, or a history of swelling unrelated to ACE inhibitors. Low blood pressure is more likely with dehydration, vomiting, diarrhoea, salt restriction, dialysis or diuretic treatment. Kidney function, potassium and blood pressure may need monitoring. People with lupus or scleroderma, especially alongside kidney impairment, may also need white blood cell monitoring. Combining ramipril with an angiotensin receptor blocker, such as telmisartan, is generally avoided because of increased risks of low blood pressure, high potassium and kidney problems. Medicines that raise potassium need caution. mTOR inhibitors such as temsirolimus can increase the risk of angioedema. Tell your healthcare team before surgery or anaesthesia, dialysis, LDL apheresis or insect-venom desensitisation. Report aspirin or tartrazine sensitivity because the label identifies tartrazine as an ingredient in a capsule presentation. Angioedema can occur at any time during treatment. Stop ramipril and seek emergency help for swelling of the face, lips, tongue or throat, or difficulty breathing. Unexplained abdominal pain may indicate intestinal swelling. Ramipril must also be stopped if jaundice or markedly raised liver enzymes develop.