Altace (Ramipril) - Oral

Warning:

Pregnant people should not take Altace (ramipiril). Drugs like Altace that act on the renin-angiotensin system can harm the fetus. Stop taking Altace as soon as pregnancy is detected.

What Is Altace?

Altace (ramipril) is a pill taken by mouth used to treat heart conditions, including high blood pressure (hypertension) and heart failure, and kidney diseases of different causes, such as diabetes (diabetic nephropathy).

Altace belongs to a drug class called angiotensin-converting enzyme (ACE) inhibitors. The angiotensin-converting enzyme is part of a complex system in the body that raises and lowers blood pressure. Altace works by relaxing and widening the blood vessels, which helps lower blood pressure and allows the heart to pump blood more efficiently.

Altace is a prescription drug, meaning you need an order from your healthcare provider rather than purchasing it over-the-counter (OTC) from a drugstore or grocery store.

Drug Facts

Generic Name: Ramipril

Brand Name(s): Altace

Drug Availability: Prescription

Administration Route: Oral

Therapeutic Classification: Antihypertensive

Available Generically: Yes

Controlled Substance: N/A

Active Ingredient: Ramipril

Dosage Form(s): Capsule

What Is Altace Used For?

The Food and Drug Administration (FDA) has approved Altace to treat:

  • Hypertension (high blood pressure), either on its own or in combination with thiazide diuretics
  • Signs of heart failure (e.g., shortness of breath, weight gain, swelling around the feet and ankles) in people who have had a heart attack
  • To lower the risk of a major cardiovascular event (such as a heart attack or stroke) in people 55 years and older
Altace (Ramipril) Drug Information: A person in the act of running

Verywell / Dennis Madamba

How to Take Altace

Altace comes as a pill that you take by mouth. It’s usually taken once or twice a day, and you can take it with or without food.

If you have trouble swallowing pills, you can open the capsule and sprinkle the medicine on a small amount of applesauce or mix it with juice or water. Ensure you finish the food or liquid containing the ramipril to get the full dose.

If you take ramipril once a day, it may be best to take it at bedtime as this will lower your blood pressure the most in the morning when it is often at its highest. However, it’s better to take it in the morning regularly if you remember it better this way rather than forget it often at bedtime.

Your healthcare provider may start you at a low dose of ramipril to ensure your blood pressure doesn't drop too low. Then, they may change your dose as needed after check-ups.

High blood pressure usually doesn’t cause any symptoms you can feel, but it is dangerous if it goes untreated. Ramipril only works to keep your blood pressure lower if you take it continuously, so it’s important to keep taking it even if you’re feeling well.

Storage

Store Altace at room temperature (between 59 and 86 degrees Fahrenheit) in its original container with the lid on. Place it out of reach of children and pets. Avoid storing your pill bottle in the bathroom, where it can be exposed to heat and moisture.

If you’re traveling by plane, it’s best to keep ramipril in your carry-on luggage in case your checked baggage goes missing.

Off-Label Uses

Although ACE inhibitors are commonly prescribed for high blood pressure, healthcare providers sometimes prescribe them for conditions beyond what they are FDA approved for. These uses are referred to as off-label.

Altace is sometimes used off-label to treat kidney disease—people whose kidneys do not work as well as they should have impaired renal function. This can be due to various causes, one being diabetes. When high blood sugar from diabetes causes kidney damage, it is called diabetic nephropathy.

Ramipril helps the kidneys by controlling blood pressure and lowering the amount of protein that gets discarded in the urine. This helps reduce the kidneys' workload, slowing any damage to them.

How Long Does Altace Take to Work?

Ramipril starts to lower blood pressure within a few hours after you take it. You may or may not feel the effects of declining blood pressure. If you do, your prescribing healthcare provider may choose to lower your dose at your next appointment.

What Are the Side Effects of Altace?

This is not a complete list of side effects and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your healthcare provider. You may report side effects to the FDA at fda.gov/medwatch or 1-800-FDA-1088.

Common Side Effects

ACE inhibitors like ramipril are usually very well tolerated but do come with a few common side effects. Most will go away once you stop taking the medicine. You should notify your healthcare provider if you notice these side effects and think they are severe or do not go away.

Common side effects of Altace include:

  • Cough: This is a well-known side effect of ACE inhibitors. Often, people who suffer from this dry, hacking cough will stop taking ramipril and switch to a different type of drug that lowers blood pressure.
  • Dizziness or headaches: Ramipril does its job by lowering your blood pressure, but sometimes it does this too well, and the low blood pressure (hypotension) can cause dizziness, especially when you go from sitting down to standing up quickly.
  • Weakness or tiredness: Low blood pressure can sometimes cause you to feel more tired than you usually would.

Severe Side Effects

Call your healthcare provider right away if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency. Serious side effects and their symptoms can include the following:

  • Angioedema: This is a very rare but serious allergic reaction to ACE inhibitors, and causes swelling of the face, lips, throat, tongue, or other parts of the body. If you experience this reaction, you will be taken off ACE inhibitors.
  • Hyperkalemia: Ramipril and other ACE inhibitors may cause your potassium levels to go up, which has the potential to cause dangerous heart problems. Most of the time, the rise in potassium is not dangerous or significant. However, monitoring this is essential, especially when starting the drug.
  • Kidney damage: ACE inhibitors work on a complicated system in your body that raises and lowers your blood pressure, and your kidneys are very involved in this process. There is a chance your kidney function may decrease in the short term, but this is considered a trade-off for the long-term beneficial effects that ACE inhibitors have on the kidneys.

Long-Term Side Effects

Taking ACE inhibitors like Altace over long periods has generally shown to be beneficial for people with heart conditions such as high blood pressure, kidney disease, diabetes, and heart failure. The chance of long-term adverse effects does not seem to be greater than the short-term effects listed above.

Report Side Effects

Altace may cause other side effects. Call your healthcare provider if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your healthcare provider may send a report to the FDA's MedWatch Adverse Event Reporting Program or by phone (800-332-1088).

Dosage: How Much Altace Should I Take?

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The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For oral dosage forms (capsules or tablets):
    • For high blood pressure:
      • Adults—At first, 2.5 milligrams (mg) once a day. Your doctor may adjust your dose as needed. However, the dose is usually not more than 20 mg per day, taken as a single dose or divided into two doses.
      • Children—Use and dose must be determined by your doctor.
    • For heart failure after a heart attack:
      • Adults—At first, 2.5 milligrams (mg) two times a day. Your doctor may adjust your dose as needed. However, the dose is usually not more than 5 mg two times a day.
      • Children—Use and dose must be determined by your doctor.
    • For preventing heart attack or stroke:
      • Adults 55 years of age and older—At first, 2.5 milligrams (mg) once a day for 1 week. For the next 3 weeks, the dose is 5 mg per day as a single dose. Your doctor may adjust your dose as needed and tolerated. However, the dose is usually not more than 10 mg per day taken as a single dose or divided into two doses.
      • Adults younger than 55 years of age and children—Use and dose must be determined by your doctor.

Modifications

The following factors may affect your treatment with Altace:

  • Pregnancy or breastfeeding
  • Age
  • Kidney function

Pregnancy or Breastfeeding

Ramipril is not recommended for pregnant or nursing people. If you become pregnant, immediately stop taking the medication. If you are planning to become pregnant, you may want to speak with your healthcare provider about different treatment options. Exposure to ACE inhibitors can be dangerous for a developing fetus.

Age

In the clinical trials that Altace went through before approval, 11% of participants were 65 or older. No notable safety differences were noted for this group as compared with younger adults. However, another study did find higher levels of ramipril in older adults. In some cases, an adjustment to your dosage may be needed.

The safety of ramipril use in children under 18 has not been established.

Kidney Function

If you have impaired kidney function, you will likely start ramipril at a lower dose to prevent further kidney damage and make sure your body can process the drug.

Missed Dose

If you forget to take a dose of ramipril, you can take it as soon as you remember. If you are closer to your next dose than the dose you missed, go ahead and skip the missed dose and wait for your next scheduled one. For example, if you usually take ramipril once a day at 8 p.m., and you remember at 9 a.m. that you forgot your dose the night before, wait and take your next dose that night at 8 p.m. Do not double up doses to make up for missed ones.

Overdose: What Happens If I Take Too Much Altace?

If you take ramipril only as directed, you shouldn’t be too concerned about overdosing. If you accidentally double up doses, be aware that you may have some dizziness.

Overdosing from taking too many pills at a time is possible and dangerous. Blood pressure that is too low is a medical emergency. You will likely need medication to undo the ACE inhibitor’s effect and raise your blood pressure.

What Happens If I Overdose on Altace?

If you think you or someone else may have overdosed on Altace, call a healthcare provider or the Poison Control Center (800-222-1222).

If someone collapses or isn't breathing after taking Altace, call 911 immediately.

Precautions

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It is very important that your doctor check your progress at regular visits to make sure this medicine is working properly. Blood tests may be needed to check for unwanted effects.

Using this medicine while you are pregnant can harm your unborn baby. Use an effective form of birth control to keep from getting pregnant. If you think you have become pregnant while using this medicine, tell your doctor right away.

You should not use this medicine together with sacubitril. Do not use this medicine and sacubitril/valsartan (Entresto®) within 36 hours of each other.

This medicine may cause serious allergic reactions, including anaphylaxis. Anaphylaxis can be life-threatening and requires immediate medical attention. Call your doctor right away if you have a rash, itching, hoarseness, trouble breathing, trouble swallowing, or any swelling of your hands, face, lips, tongue, or throat while you are using this medicine.

Call your doctor right away if you have severe stomach pain (with or without nausea or vomiting). This could be a symptom of a condition called intestinal angioedema.

Dizziness, lightheadedness, or fainting may occur especially when you get up from a lying or sitting position or if you have been taking a diuretic (water pill). Make sure you know how you react to this medicine before you drive, use machines, or do other things that could be dangerous if you are dizzy or not alert. Then sit for a few moments before standing to prevent the dizziness from returning.

Check with your doctor right away if you have pain or tenderness in the upper stomach, pale stools, dark urine, loss of appetite, nausea, unusual tiredness or weakness, or yellow eyes or skin. These could be symptoms of a serious liver problem.

Check with your doctor right away if you have lower back or side pain, decreased frequency or amount of urine, bloody urine, increased thirst, swelling of the face, fingers, or lower legs, weight gain, or increased blood pressure. These could be symptoms of a serious kidney problem.

Check with your doctor if you have a fever, chills, or sore throat. These may be symptoms of an infection resulting from low white blood cells.

Hyperkalemia (high potassium in the blood) may occur while you are using this medicine. Check with your doctor right away if you have the following symptoms: abdominal or stomach pain, confusion, difficulty with breathing, irregular heartbeat, nausea or vomiting, nervousness, numbness or tingling in the hands, feet, or lips, shortness of breath, or weakness or heaviness of the legs. Ask your doctor before you use any medicine, supplement, or salt substitute that contains potassium.

Make sure any doctor or dentist who treats you knows that you are using this medicine. You may need to stop using this medicine several days before having surgery or medical tests.

This medicine may be less effective in black patients. Black patients also have an increased risk of swelling of the hands, arms, face, mouth, or throat. Talk with your doctor if you have concerns about this.

Do not take other medicines unless they have been discussed with your doctor. This includes over-the-counter (nonprescription) medicines for appetite control, asthma, colds, cough, hay fever, or sinus problems, since they may tend to increase your blood pressure.

What Are Reasons I Shouldn’t Take Altace?

Do not take Altace if you are pregnant or breastfeeding or have had any signs of an allergic reaction (e.g., swelling) to an ACE inhibitor.

Let your prescribing healthcare provider or pharmacist know if you are taking a medication called Entresto (sacubitril and valsartan) or Tekturna (aliskiren). These medications work in different ways to achieve similar effects as Atlace, so using them together can lead to dangerous side effects like hyperkalemia (high potassium) or kidney damage.

What Other Medications Interact With Altace?

Before starting Altace, let your healthcare provider know if you take any of the following drugs:

  • Entresto Since one component of this drug (sacubitril) is also an ACE inhibitor, using it together with ramipril will lead to excessive blood pressure lowering.
  • Angiotensin receptor blockers (ARBs), including drugs like Cozaar (losartan), Diovan (valsartan), Benicar (olmesartan), and Atacand (candesartan): Sometimes these drugs are used together with ACE inhibitors like ramipril, but be aware that they may cause additional blood pressure lowering.
  • Diuretics: These include drugs like Lasix (furosemide), hydrochlorothiazide, and chlorthalidone. Taking diuretics with ramipril may lead to a further reduction in blood pressure.
  • Aliskiren: Avoid using ramipril with this diabetes drug, as it can lead to dangerously high potassium levels (hyperkalemia).

What Medications Are Similar?

There are many other medications in the same ACE inhibitor class as ramipril that work similarly, including: 

  • Lotensin (benazepril)
  • Captopril
  • Vasotec (enalapril)
  • Fosinopril
  • Zestril (lisinopril)
  • Moexipril
  • Perindopril
  • Accupril (quinapril)
  • Trandolapril

This is a list of drugs also prescribed for high blood pressure and other heart conditions. It is NOT a list of drugs recommended to take with Altace. In fact, you should not take these drugs together. Ask your pharmacist or a healthcare provider if you have questions.

Frequently Asked Questions

  • What is Altace used for?

    Altace is used to treat heart conditions like high blood pressure or heart failure and prevent further damage in people with kidney disease.

  • How does Altace work?

    Altace belongs to a class of drugs called ACE inhibitors. ACE stands for angiotensin-converting enzyme. This enzyme is part of the renin-angiotensin system, a complex system that controls blood pressure. Altace and other drugs in this class lower blood pressure by blocking this enzyme.

  • What are the side effects of Altace?

    A few common side effects associated with Altace include dizziness, headaches, or a cough. If these are severe and do not go away, notify your healthcare provider. Rare but serious side effects to watch for include angioedema (a rare allergic reaction) and hyperkalemia (high potassium level).

How Can I Stay Healthy While Taking Altace?

ACE inhibitors, such as Altace, are commonly prescribed medications. Many people take them for high blood pressure or other conditions like heart failure or kidney damage.

In addition to taking these medications, you can take care of your heart by maintaining an active lifestyle and eating a diet that is low in salt and fat, as salt is also a contributor to high blood pressure.

While taking Altace, be aware of any side effects you experience. Symptoms like dizziness, coughing, or headaches are common and nothing to worry too much about. However, if these side effects worsen or do not go away, you should let your healthcare provider know. They can work to find the right dose for you or switch you to a different medication if needed.

Medical Disclaimer

Verywell Health's drug information is meant for educational purposes only and is not intended to replace medical advice, diagnosis, or treatment from a healthcare provider. Consult your healthcare provider before taking any new medication(s). IBM Watson Micromedex provides some of the drug content, as indicated on the page.

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Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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By Sara Hoffman, PharmD
Sara is a clinical pharmacist that believes everyone should understand their medications, and aims to achieve this through her writing.