Cautions/contra-indications

Contra-indications to ACE inhibitors:

• hypersensitivity to ACE inhibitors including angioedema
• known or suspected renovascular disease:
  • ACEI's should be used with caution in patients with peripheral vascular disease who may have clinically covert renovascular disease
  • significant bilateral renal artery stenosis or renal artery stenosis in a single functioning kidney (1)
• pregnancy
  • lower fetal & neonatal blood pressure
  • impair renal function
  • can cause oligohydramnios and skull defects

Cautions include:

• ACE inhibition in patients receiving diuretics
• patients with peripheral vascular disease or generalised atherosclerosis (risk of covert renovascular disease)
• risk of agranulocytosis is increased in patients with collagent vascular disease (monitoring of blood counts recommended)
• symptomatic aortic stenosis
• history of idiopathic or hereditary angioedema
• renal impairment

Please check Summary of Product Characteristics before prescribing ACE inhibitor.

Reference:

• electronic medicines compendium (emc). Ramipril 2.5mg tablets (Accessed 20/7/21)