Ampril 1.25 mg, 2.5 mg, 5 mg and 10 mg tablets – ramipril for high blood pressure, heart and kidney protection

Ampril is a medicine containing the active substance ramipril and belongs to the group of angiotensin-converting enzyme (ACE) inhibitors. It widens the blood vessels, which lowers blood pressure and makes it easier for the heart to pump blood.

In Serbia it is authorised as tablets in four strengths: 1.25 mg, 2.5 mg, 5 mg and 10 mg (pack of 30 tablets). It is used for high blood pressure, to reduce the risk of heart attack and stroke in at-risk patients, in certain kidney diseases, heart failure and after a heart attack. The strength and dose are always determined by a doctor.

What is Ampril (ramipril) used for and how should it be taken correctly?

Key facts about the medicine

Overview of the strengths authorised in Serbia:

What is Ampril used for?

According to the Summary of Product Characteristics, Ampril is intended for adults for:

• treatment of high blood pressure (hypertension)
• cardiovascular prevention – reducing the risk of heart attack, stroke and death in patients with manifest atherothrombotic disease (history of coronary heart disease, stroke or peripheral vascular disease) or with diabetes and at least one cardiovascular risk factor
• treatment of kidney disease: incipient diabetic nephropathy (microalbuminuria), manifest diabetic nephropathy in patients with at least one risk factor, and manifest non-diabetic nephropathy with proteinuria ≥ 3 g/day
• treatment of symptomatic heart failure
• secondary prevention after acute myocardial infarction in patients with signs of heart failure (started more than 48 hours after the infarction)

How is it used and dosed?

Ampril is taken every day at the same time, before, with or after a meal. The tablet is swallowed whole with liquid – it must not be chewed or crushed. The dose is increased gradually according to tolerability and blood pressure values:

In patients taking diuretics, the doctor may advise stopping the diuretic 2–3 days before starting the medicine or starting with 1.25 mg, with monitoring of kidney function and potassium. These values are the general dosing from the Summary of Product Characteristics and are not an individual recommendation.

Special patient groups

• Kidney impairment: creatinine clearance ≥ 60 mL/min – start 2.5 mg, maximum 10 mg; 30–60 mL/min – start 2.5 mg, maximum 5 mg; 10–30 mL/min – start 1.25 mg, maximum 5 mg; haemodialysis – start 1.25 mg, maximum 5 mg, taken a few hours after dialysis.
• Liver impairment: treatment is started under close supervision, maximum 2.5 mg daily.
• Elderly people: lower starting doses (consider 1.25 mg) and slower titration, especially in very old and frail patients.
• Children and adolescents: safety and efficacy have not been established, so no dosing recommendations can be made.

Contraindications – when the medicine must not be used

• hypersensitivity to ramipril, other ACE inhibitors or any of the excipients
• history of angioedema (hereditary, idiopathic or caused by ACE inhibitors or angiotensin II receptor blockers)
• concomitant use of sacubitril/valsartan (Ampril must not be started until 36 hours after the last dose)
• extracorporeal treatments in which blood comes into contact with negatively charged surfaces (certain dialysis membranes, LDL apheresis with dextran sulphate)
• significant bilateral renal artery stenosis or stenosis of the artery to a single functioning kidney
• second and third trimester of pregnancy
• hypotensive or haemodynamically unstable patients
• concomitant use of aliskiren in patients with diabetes or kidney impairment (GFR < 60 mL/min/1.73 m²)

Precautions and warnings

• A sudden drop in blood pressure is possible in severe hypertension, decompensated heart failure, aortic or mitral valve stenosis, dehydration, salt loss, diuretic therapy and liver cirrhosis – starting treatment requires supervision.
• Dual blockade of the renin-angiotensin-aldosterone system (ACE inhibitor + angiotensin receptor blocker or aliskiren) is not recommended because of the risk of hypotension, hyperkalaemia and kidney damage.
• Kidney function, blood potassium and sodium and, if needed, the blood count (rarely neutropenia/agranulocytosis) should be monitored before and during treatment.
• Treatment should be stopped one day before surgery whenever possible – tell your anaesthetist or dentist that you take Ampril.
• During desensitisation to insect venom the risk of anaphylactic reactions is increased.
• A dry, persistent cough is a known effect of ACE inhibitors and usually disappears only after treatment is stopped.
• The medicine contains lactose – people with rare hereditary galactose intolerance, Lapp lactase deficiency or glucose-galactose malabsorption must not use it.

Interactions with other medicines, alcohol and food

• Contraindicated: sacubitril/valsartan; extracorporeal treatments with negatively charged membranes.
• Potassium supplements, potassium-containing salt substitutes, potassium-sparing diuretics (spironolactone, triamterene, amiloride), heparin, trimethoprim/co-trimoxazole, ciclosporin and tacrolimus: risk of hyperkalaemia – potassium monitoring required.
• Other antihypertensives, nitrates, tricyclic antidepressants, anaesthetics, baclofen, alpha-blockers and acute alcohol intake: stronger fall in blood pressure.
• Non-steroidal anti-inflammatory drugs (e.g. ibuprofen) and acetylsalicylic acid: weaker effect on blood pressure and higher risk of kidney damage and increased potassium.
• Lithium: increased lithium levels and toxicity.
• Insulin and oral antidiabetics: hypoglycaemia is possible – check blood sugar more often.
• Racecadotril, mTOR inhibitors (sirolimus, everolimus, temsirolimus) and vildagliptin: higher risk of angioedema.
• Allopurinol, immunosuppressants, corticosteroids, procainamide and cytostatics: higher likelihood of blood count changes.
• Food does not affect absorption of the medicine.

Pregnancy and breastfeeding

Ampril is not recommended in the first trimester of pregnancy and is contraindicated in the second and third trimesters because it can harm the kidneys and development of the unborn baby. Women planning a pregnancy should switch to another treatment with their doctor in good time; if pregnancy is confirmed, the medicine is stopped immediately.

Because of insufficient data, use during breastfeeding is not recommended, especially for newborns and premature infants.

Driving and using machines

Dizziness and other symptoms of low blood pressure can impair concentration and reaction time, especially at the start of treatment or when switching from another medicine. Driving or operating machinery is not advisable for several hours after the first dose and after each dose increase.

Possible side effects

• Common (up to 1 in 10 patients): headache, tiredness, dizziness (more likely at the start or when the dose is increased), low blood pressure and fainting on standing up, dry irritating cough, sinusitis, bronchitis, shortness of breath, stomach pain, diarrhoea, indigestion, nausea, rash, chest pain, muscle cramps and pain, raised blood potassium.
• Uncommon (up to 1 in 100): vertigo, tingling and taste changes, sleep disorders, depressed mood, nervousness, blocked nose, worsening of asthma, intestinal angioedema (abdominal pain, vomiting, diarrhoea), dry mouth, increased sweating, loss of appetite, fast or irregular heartbeat, swelling of hands and feet, flushing, blurred vision.
• Rare and very rare but serious: angioedema, severe skin reactions (Stevens-Johnson syndrome, toxic epidermal necrolysis), pancreatitis, liver damage, blood count changes (neutropenia, agranulocytosis), hyponatraemia.

Report suspected side effects to your doctor, pharmacist or ALIMS.

Overdose, missed dose and stopping treatment

• Overdose: a marked fall in blood pressure and shock, slow heartbeat, electrolyte disturbances and kidney damage are possible. Contact a doctor or the nearest hospital immediately – do not drive yourself – and take the pack with you.
• Missed dose: take the next dose at the usual time. Do not take a double dose.
• Stopping treatment: keep taking the medicine until your doctor tells you otherwise; do not change the dose on your own.

Related information

• How to lower high blood pressure without drugs – measures that complement treatment
• How to measure your pulse and why it matters

For additional care and support with high blood pressure and heart conditions (regular blood pressure checks), see also the Blood pressure monitors category – products in this category do not replace the medicine you have been prescribed.

Composition, packaging and manufacturer

• Active substance: ramipril, 1.25 mg, 2.5 mg, 5 mg or 10 mg per tablet.
• Excipients: sodium hydrogen carbonate, lactose monohydrate, croscarmellose sodium, pregelatinised starch 1500, sodium stearyl fumarate; 2.5 mg tablets also contain yellow iron oxide (E172) and 5 mg tablets yellow and red iron oxide (E172).
• Pack: blister (OPA/Al/PVC//Al) with 10 tablets; carton with 3 blisters (30 tablets) and a package leaflet.
• Marketing authorisation holder: KRKA-FARMA D.O.O. BEOGRAD, Jurija Gagarina 26/V/II, Belgrade.
• Manufacturer: KRKA, d.d., Novo mesto, Šmarješka cesta 6, Novo mesto, Slovenia.

Storage

• Store below 25 °C in the original package.
• Keep out of the sight and reach of children; do not use after the expiry date.
• Return unused medicine to a pharmacy that collects unused medicines.

Frequently asked questions

Why does Ampril cause a dry cough?

A dry, irritating cough is a common side effect of ACE inhibitors, including ramipril. It is usually persistent and disappears only when the medicine is stopped. Do not stop treatment yourself – your doctor will assess whether the cough is related to the medicine and change the treatment if needed.

Should Ampril be taken in the morning or in the evening?

The leaflet advises taking the medicine every day at the same time; food does not affect its action. In heart failure and after a heart attack the daily dose is usually divided into two doses. Your doctor decides the schedule.

Can I take ibuprofen or potassium supplements with Ampril?

Only on medical advice. NSAIDs can weaken the effect on blood pressure and strain the kidneys, while potassium, potassium salt substitutes and potassium-sparing diuretics can cause a dangerous rise in blood potassium.

Can Ampril be used during pregnancy?

It is not recommended in the first trimester and is contraindicated in the second and third trimesters. If you are planning a pregnancy or have become pregnant, contact your doctor immediately so the treatment can be changed.

Sources

• ALIMS – Package leaflet Ampril®, 1.25 mg, 2.5 mg, 5 mg and 10 mg, tablets (February 2022)
• ALIMS – Summary of Product Characteristics Ampril®, 1.25/2.5/5/10 mg, tablets (revision February 2022)

Sources checked on: 23 October 2026.