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Suggest ways to wean off Ramipril

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Posted on Mon, 14 Dec 2015
Question: How do I taper off of ramipril? It is causing swelling of my legs, hands and feet.
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Answered by Dr. Ilir Sharka (1 hour later)
Brief Answer:
I would explain as follows:

Detailed Answer:

Hello!

Welcome and thank you for asking on HCM!

Regarding your concern, I would like to explain that Ramipril though rarely (<1%) may cause peripheral edema and angioedema.

Also articular or muscular pain may be a rare adverse effect of Ramipril.

But, before concluding about Ramipril as the direct responsible cause, it is necessary to investigate for other potential causes, such as concomitant therapy, a decreased cardiac function, liver and renal disorders.

Are you actually taking other drugs, besides Ramipril?

Are you suffering from any kind of cardiomyopathy?

Any concomitant health disorders?

Are you taking Ramipril as part of antihypertensive therapy? or Heart failure?

Have you ever suffered from any heart disorders?

Whichever be the the truth, when in front of systemic congestion (edema), it is important to perform a comprehensive differential diagnosis.

First of all a careful physical examination coupled with a resting ECG are needed for reviewing blood circulating status (pulmonary congestion, other signs of systemic congestion, any obvious cardiomyopathy [heart murmur, presence of gallops, etc], any cardiac arrhythmia, etc.).

If you have performed recently a cardiac ultrasound, it's time to review it again (especially overall cardiac performance).

Liver and renal function tests are important part of the differential workup process.

If all the above medical investigations result normal, then remain strong suspicions on possible Ramipril adverse effects.

In such case after immediately stopping Ramipril, another alternative vasodilator may be chosen, such as a calcium channel blocker (Lercanidipine, Amlodipine, etc), or angiotensin receptor blocker (Valsartan, Telmisartan, Olmesartan, etc), etc.

I tried to explain a little more, because for me it's important to investigate further when in front of edema of any kinds, while substitution of Ramipril is quite easily possible (there are so many alternatives available).

You need to discuss with your prescribing doctor about the above mentioned issues, before undertaking further steps.

Hope to have been helpful to you!

Feel free to discuss with me in case of further uncertainties.

Kind regards,

Dr. Iliri

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Ilir Sharka

Cardiologist

Practicing since :2001

Answered : 8432 Questions

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Suggest ways to wean off Ramipril

Brief Answer: I would explain as follows: Detailed Answer: Hello! Welcome and thank you for asking on HCM! Regarding your concern, I would like to explain that Ramipril though rarely (<1%) may cause peripheral edema and angioedema. Also articular or muscular pain may be a rare adverse effect of Ramipril. But, before concluding about Ramipril as the direct responsible cause, it is necessary to investigate for other potential causes, such as concomitant therapy, a decreased cardiac function, liver and renal disorders. Are you actually taking other drugs, besides Ramipril? Are you suffering from any kind of cardiomyopathy? Any concomitant health disorders? Are you taking Ramipril as part of antihypertensive therapy? or Heart failure? Have you ever suffered from any heart disorders? Whichever be the the truth, when in front of systemic congestion (edema), it is important to perform a comprehensive differential diagnosis. First of all a careful physical examination coupled with a resting ECG are needed for reviewing blood circulating status (pulmonary congestion, other signs of systemic congestion, any obvious cardiomyopathy [heart murmur, presence of gallops, etc], any cardiac arrhythmia, etc.). If you have performed recently a cardiac ultrasound, it's time to review it again (especially overall cardiac performance). Liver and renal function tests are important part of the differential workup process. If all the above medical investigations result normal, then remain strong suspicions on possible Ramipril adverse effects. In such case after immediately stopping Ramipril, another alternative vasodilator may be chosen, such as a calcium channel blocker (Lercanidipine, Amlodipine, etc), or angiotensin receptor blocker (Valsartan, Telmisartan, Olmesartan, etc), etc. I tried to explain a little more, because for me it's important to investigate further when in front of edema of any kinds, while substitution of Ramipril is quite easily possible (there are so many alternatives available). You need to discuss with your prescribing doctor about the above mentioned issues, before undertaking further steps. Hope to have been helpful to you! Feel free to discuss with me in case of further uncertainties. Kind regards, Dr. Iliri