Why people look for an alternative to ramipril
Ramipril is one of the most commonly prescribed medicines in the NHS — around 7 million prescriptions are dispensed each year in England, primarily for high blood pressure, heart failure, after a heart attack, and to protect the kidneys in people with diabetes (NHS — About ramipril). When a strength is short, the patient still needs treatment for the underlying condition — so a prescriber may convert the prescription to a related medicine rather than leave a gap.
According to the BNF, ramipril belongs to the ACE-inhibitor class. NICE clinical guidelines list other medicines in the same class, and medicines in the closely-related ARB class, as suitable options for the same conditions when one cannot be used.
ACE inhibitors — same drug class as ramipril
ACE inhibitors all work by blocking the same enzyme (angiotensin-converting enzyme), which relaxes blood vessels and lowers blood pressure. Doses are not directly interchangeable — equivalent doses differ between molecules — so any switch is a prescriber decision.
Lisinopril
One of the most widely-prescribed ACE inhibitors in the UK. Listed by NICE for hypertension and chronic heart failure alongside ramipril (NG136, NG106). Once-daily dosing similar to ramipril.
Perindopril
Another once-daily ACE inhibitor used for hypertension, heart failure and after a heart attack. Available as perindopril erbumine (Coversyl) and perindopril arginine — the two salts are not 1:1 equivalent, so a prescriber will choose the right form and dose.
Enalapril
An older ACE inhibitor, usually taken once or twice daily. Used for the same conditions as ramipril; commonly chosen when a clinician needs a long history of safety data.
Captopril
One of the original ACE inhibitors. Less commonly used as a long-term outpatient medicine in the UK today because it is taken two or three times a day, but still listed in the BNF.
ARBs — different mechanism, same target
Angiotensin-receptor blockers (ARBs) target the same blood-pressure pathway but at a different point. NICE specifies an ARB as the alternative when an ACE inhibitor is "not tolerated" — most often because of the persistent dry cough that ACE inhibitors can cause (NICE NG136). An ARB is usually used instead of an ACE inhibitor, not together with one.
Losartan
The most commonly prescribed ARB in the UK. Used for hypertension, heart failure and kidney protection in type-2 diabetes. Generally well tolerated and does not cause the dry cough associated with ACE inhibitors.
Candesartan
Long-acting ARB with a strong evidence base in chronic heart failure as well as hypertension. Taken once daily.
Valsartan
Used for hypertension, heart failure and after a heart attack. Available alone or as part of a combination tablet with sacubitril (Entresto) — the combination is specialist-initiated and not a like-for-like replacement for ramipril.
Irbesartan
Often chosen for people with type-2 diabetes and kidney involvement. Listed in the BNF alongside the other ARBs.
Other blood-pressure medicines — different class
If both ACE inhibitors and ARBs are unsuitable, NICE NG136 lists medicines from other classes as options for high blood pressure specifically. These do not work the same way as ramipril and are not direct substitutes when ramipril is being used for heart failure or kidney protection.
- Amlodipine (calcium-channel blocker) — first-line for hypertension in people over 55 or of Black African or African-Caribbean family origin per NICE.
- Indapamide (thiazide-like diuretic) — used alone or in combination for hypertension.
- Doxazosin (alpha-blocker) — sometimes used as a step-up in resistant hypertension.
It depends on why ramipril was prescribed
A clinician will not choose a related medicine on drug name alone — they will look at why ramipril was started in the first place. The shortlist is different for each indication.
For high blood pressure
NICE NG136 places ACE inhibitors and ARBs as step-1 treatment for most adults under 55 not of Black African or African-Caribbean family origin. If ramipril is unavailable, the prescriber will typically pick another ACE inhibitor (lisinopril, perindopril) or an ARB (losartan, candesartan).
For chronic heart failure with reduced ejection fraction
NICE NG106 places an ACE inhibitor as first-line, with an ARB if the ACE inhibitor is not tolerated. In specialist heart-failure care, valsartan/sacubitril (Entresto) may replace the ACE inhibitor in selected patients — but only the heart-failure team will make that change.
After a heart attack (post-MI)
ACE inhibitors are part of the standard post-heart-attack medication bundle. Lisinopril, perindopril or enalapril are commonly used in place of ramipril; ARBs (valsartan, losartan, candesartan) are options if the ACE inhibitor is not tolerated.
For kidney protection in type-2 diabetes
NICE NG28 recommends either an ACE inhibitor or an ARB for adults with type-2 diabetes who have albuminuria. So either an ACE-inhibitor swap (lisinopril, perindopril) or an ARB (losartan, irbesartan, candesartan) may be appropriate, depending on tolerance and renal function.
Critical safety points before any change
- Speak to your GP, hospital team or pharmacist before changing anything.
- If you can only get a different strength of ramipril (for example two 2.5mg capsules instead of one 5mg), the SSP may allow your pharmacy to dispense an equivalent dose under the protocol — ask them.
- If you take a related medicine like lisinopril or losartan for the first time, your prescriber will usually check your blood pressure and kidney function after 1–2 weeks.
- Tell your prescriber about any allergies (especially angioedema), pregnancy or breastfeeding plans, and other medicines you take — ACE inhibitors and ARBs interact with potassium supplements, some painkillers and lithium.
- If you feel unwell, dizzy or short of breath while waiting on a supply, contact your GP or call NHS 111.
How to actually get a supply during the shortage
- Ask your usual pharmacy first — under SSP087 they may be able to dispense a different strength of ramipril without going back to your GP for a new prescription.
- If that is not possible, your GP can issue a new prescription for a related medicine.
- Try other local pharmacies — stock varies day to day.
- Order your repeat prescription before you run out, not on the day.
- Sign up for free MediWatch alerts to be told when ramipril 1.25mg capsules come back to supply.
Frequently asked questions
What can I take instead of ramipril in the UK?
Only your GP, pharmacist or specialist can decide. For people who can take an ACE inhibitor, related options include lisinopril, perindopril and enalapril. If ACE inhibitors are not suitable, an ARB such as losartan or candesartan may be considered. The right choice depends on why ramipril was prescribed.
Is lisinopril the same as ramipril?
They are not the same medicine, but they are in the same drug class (ACE inhibitors) and work in the same way. Doses are not directly interchangeable — only a prescriber can convert one to the other.
Can I switch from ramipril to losartan myself?
No. Losartan is an ARB — a different drug class — and switching requires a prescriber decision and a new prescription. ARBs are typically considered when ACE inhibitors are not tolerated. Speak to your GP or pharmacist before any change.
Which ramipril strengths are affected by the UK shortage?
The current Serious Shortage Protocol (SSP087) covers ramipril 1.25mg capsules. Other ramipril strengths (2.5mg, 5mg, 10mg) have intermittent supply but are not under the same SSP. The 1.25mg SSP has been extended past its 29 May 2026 expiry.
Should I stop taking ramipril if I can't get my dose?
No — do not stop suddenly. Ramipril treats blood pressure, heart failure and protects the kidneys; stopping it without a plan can be harmful. Contact your GP or pharmacy as soon as possible so they can arrange a suitable supply or, if appropriate, a related medicine.
Are perindopril and enalapril easier to get than ramipril right now?
As of 28 May 2026, no DHSC Medicine Supply Notification or Serious Shortage Protocol is in force for perindopril or enalapril in the UK. That can change — MediWatch monitors the live DHSC and CPE lists daily.
What about non-ACE blood pressure medicines like amlodipine?
For high blood pressure alone, NICE NG136 lists calcium-channel blockers (amlodipine) and thiazide-like diuretics (indapamide) as alternatives in different patient groups. They are not direct substitutes — they work in a different way and are not appropriate for every reason ramipril is prescribed.
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Join free alerts →Page last updated: 28 May 2026. This page is information, not medical advice — always speak to your GP, pharmacist or specialist team about your own medicines.