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

Vivace contains the active substance ramipril and belongs to a group of medicines called ACE inhibitors (angiotensin-converting enzyme inhibitors, ATC C09AA05). It reduces the production of substances that raise blood pressure, relaxes and widens blood vessels and makes it easier for the heart to pump blood around the body.

It is used to treat high blood pressure, reduce the risk of heart attack and stroke, reduce the risk or delay worsening of kidney problems, treat heart failure and as treatment after a heart attack complicated by heart failure. It is available as tablets of 1.25 mg, 2.5 mg, 5 mg and 10 mg and is supplied on prescription.

What is Vivace used for and how should it be taken?

Key facts about the medicine

What is Vivace used for?

According to the leaflet, Vivace is used for:

• treating high blood pressure (hypertension);
• reducing the risk of heart attack or stroke;
• reducing the risk or delaying the worsening of kidney problems (with or without diabetes);
• treating heart failure;
• treatment after a heart attack (myocardial infarction) complicated by heart failure.

How is it taken and dosed?

The dose is set by the doctor and adjusted gradually. According to the leaflet:

• high blood pressure: starting dose 1.25 mg or 2.5 mg once daily, maximum 10 mg once daily (if you already take a diuretic, the doctor may reduce or stop it first);
• reducing the risk of heart attack or stroke: starting dose 2.5 mg once daily, usual dose 10 mg once daily;
• kidney protection: starting dose 1.25 mg or 2.5 mg, usual dose 5 mg or 10 mg once daily;
• heart failure: starting dose 1.25 mg once daily, maximum 10 mg daily, preferably split into two doses;
• after a heart attack: from 1.25 mg once daily to 2.5 mg twice daily at the start, usually 10 mg daily split into two doses.

The tablet is taken by mouth at the same time each day, with or without food. Swallow it whole with enough liquid, without crushing or chewing; scored tablets can be divided into equal doses.

Special patient groups

• Children and adolescents under 18: not recommended (no data on safety and efficacy).
• Elderly patients: the doctor reduces the starting dose and increases it gradually; in very old and frail patients starting with 1.25 mg may be considered.
• Kidney impairment: the dose is adjusted to creatinine clearance – at 30–60 mL/min no more than 5 mg daily, at 10–30 mL/min starting dose 1.25 mg and maximum 5 mg daily; on haemodialysis the medicine is taken a few hours after dialysis (SmPC).
• Liver impairment: treatment is started under close supervision and the maximum daily dose is 2.5 mg (SmPC).

Contraindications – when the medicine must not be used

Do not take Vivace:

• if you are allergic to ramipril, another ACE inhibitor or the excipients;
• if you have ever had angioedema;
• if you take or have taken sacubitril/valsartan;
• if you are on haemodialysis or another form of blood filtration (depending on the equipment the medicine may not be suitable);
• if you have narrowing of the kidney artery (stenosis);
• during the last 6 months of pregnancy;
• if your blood pressure is abnormally low;
• if you have diabetes or impaired kidney function and take a medicine containing aliskiren.

Warnings and precautions

Talk to your doctor before taking the medicine:

• if you have heart, liver or kidney problems;
• if you have lost a lot of salt or fluid (vomiting, diarrhoea, heavy sweating, low-salt diet, long-term diuretics, haemodialysis);
• if you are to have desensitisation to bee or wasp stings, or an anaesthetic (you may need to stop the medicine a day earlier);
• if you have high potassium, or conditions or medicines that lower blood sodium;
• if you take mTOR inhibitors (temsirolimus, everolimus, sirolimus), vildagliptin or racecadotril – increased risk of angioedema;
• if you have collagen vascular disease (scleroderma, systemic lupus);
• if you take a sartan (e.g. valsartan, telmisartan, irbesartan) or aliskiren – the doctor regularly checks kidneys, blood pressure and potassium.

The medicine contains lactose; it contains less than 1 mmol sodium per tablet.

Interactions with other medicines, food and drink

Tell your doctor about all medicines you take. It is especially important that:

• NSAIDs (ibuprofen, indometacin, acetylsalicylic acid) and ephedrine, noradrenaline or adrenaline may reduce the effect of the medicine;
• sacubitril/valsartan, anticancer medicines, ciclosporin, diuretics (e.g. furosemide), corticosteroids, allopurinol, procainamide, temsirolimus, sirolimus, everolimus, vildagliptin and racecadotril increase the risk of side effects;
• medicines that raise potassium – spironolactone, triamterene, amiloride, potassium salts, trimethoprim (alone or with sulfamethoxazole) and heparin;
• sartans or aliskiren – the doctor may change the dose and take precautions;
• oral antidiabetics and insulin – Vivace may lower blood sugar, so check it more often;
• lithium – its blood level may rise.

Alcohol with Vivace may cause dizziness and light-headedness and lower blood pressure significantly. The medicine can be taken with or without food.

Pregnancy and breast-feeding

Vivace should not be taken during the first 12 weeks of pregnancy and must not be used from week 13, because it can seriously harm the baby. If you become pregnant during treatment, tell your doctor immediately; if you are planning a pregnancy, switch to a suitable alternative treatment in advance.

The medicine must not be taken during breast-feeding.

Driving and using machines

Dizziness may occur during treatment, more likely at the start or when moving to a higher dose. If this happens, do not drive or use tools or machines.

Possible side effects

Stop taking the medicine and contact a doctor immediately if you have swelling of the face, lips or throat, difficulty swallowing or breathing with itching and rash, or serious skin reactions (blisters, peeling skin, mouth ulcers).

Also tell your doctor immediately if you get: fast heartbeat, palpitations, chest pain or tightness; shortness of breath or cough; easy bruising, bleeding, frequent infections, sore throat and fever; severe stomach pain spreading to the back; jaundice, fever and loss of appetite.

Common (up to 1 in 10 patients):

• headache, tiredness, dizziness (more often at the start of treatment or when the dose is increased);
• fainting, very low blood pressure, especially when standing up quickly;
• dry, tickly cough, sinusitis or bronchitis, shortness of breath;
• stomach pain, diarrhoea, indigestion, nausea or vomiting;
• rash, chest pain, muscle cramps or pain, raised blood potassium.

Uncommon: vertigo, itching and tingling, taste changes, sleep problems, low mood and nervousness, blocked nose, intestinal angioedema, heartburn, constipation or dry mouth, increased urination and sweating, reduced appetite, irregular heartbeat, swelling of hands and legs, blurred vision, joint pain, impotence. Rare: confusion, swollen tongue, skin peeling, ringing in the ears, reduced blood cell counts. Very rare: increased sensitivity to sunlight.

Report suspected side effects to your doctor, pharmacist or to ALIMS (nezeljene.reakcije@alims.gov.rs).

Overdose, missed dose and stopping treatment

• Overdose: tell a doctor or go to the nearest hospital as soon as possible – do not drive yourself; take the pack with you. Overdose of ACE inhibitors can cause a marked fall in blood pressure and shock, slow heartbeat, electrolyte disturbance and kidney damage.
• Missed dose: take the next dose at the usual time; never take a double dose.
• Stopping treatment: do not stop on your own – high blood pressure and heart failure need continuous treatment; changes are decided by the doctor.

Related information

For regular home blood pressure monitoring, see also the category Blood pressure monitors – products in this category do not replace the medicine prescribed for you.

Composition, pack and manufacturer

One tablet contains 1.25 mg, 2.5 mg, 5 mg or 10 mg ramipril. Excipients: croscarmellose sodium, lactose monohydrate, sodium hydrogen carbonate, sodium stearyl fumarate, pregelatinised starch; the 2.5 mg and 5 mg tablets also contain a pigment with iron(III) oxide (yellow, or red and yellow).

Pack: carton with 4 Alu/Alu blisters of 7 tablets (28 tablets). Marketing authorisation holder: ACTAVIS D.O.O. BEOGRAD, Đorđa Stanojevića 12, Belgrade; manufacturers: Balkanpharma-Dupnitsa AD, Dupnitsa, Bulgaria and Actavis Ltd., Zejtun, Malta.

Storage

Store below 25 °C in the original package to protect from light and moisture, out of the reach of children. Do not use after the expiry date on the pack.

Frequently asked questions

Does Vivace cause a cough?

Yes, a dry, tickly cough is a common side effect of ramipril (up to 1 in 10 patients). If it persists, see your doctor – do not stop the medicine yourself.

When is the best time to take Vivace?

At the same time every day, with or without food. In heart failure and after a heart attack a higher daily dose is usually split into two doses, as instructed by the doctor.

Can I drink alcohol while taking Vivace?

Alcohol with Vivace may cause dizziness and light-headedness and lower blood pressure further. Ask your doctor how much, if any, is safe.

Can a Vivace tablet be halved?

The 2.5 mg, 5 mg and 10 mg tablets have a score line and can be divided into two equal doses. Tablets must not be crushed or chewed.

Sources

• ALIMS – Summary of Product Characteristics Vivace®, 1.25 mg, tablets (Serbian)
• ALIMS – Patient leaflet Vivace® 1.25 mg, 2.5 mg, 5 mg and 10 mg, tablets (May 2024, Serbian)
• ALIMS – Summary of Product Characteristics Vivace®, 5 mg, tablets (Serbian)

Sources checked on: 25 October 2026.