Can you take Viagra with ramipril? Usually yes, if the doctor who prescribes Viagra knows you take it. ACE inhibitors, the class ramipril belongs to, did not change how the body handles sildenafil, and in the label's pooled data men on blood-pressure medicines, ACE inhibitors among them, had no more side effects on sildenafil than on placebo. Both medicines lower blood pressure, so light-headedness is the thing to watch — and nitrates for chest pain are never allowed with Viagra.
Does ramipril interact with Viagra?
No interaction specific to ramipril is listed. Ramipril is an angiotensin converting enzyme (ACE) inhibitor (Tritace CMI). In the sildenafil label, ACE inhibitors as a group had no effect on sildenafil's pharmacokinetics — how it is absorbed, broken down and cleared — and pooling the main blood-pressure classes showed "no difference in the side effect profile" compared with placebo (EMA — Viagra). The Australian Viagra leaflet does not name ramipril; the blood-pressure medicines it singles out are alpha-blockers (Viagra CMI). Still, healthdirect lists blood pressure medicines among the medicines that interact with sildenafil (healthdirect — Sildenafil), and the Tritace leaflet lists "other medicines used to treat high blood pressure" among those that may interfere with ramipril — so both prescribers should know about both. The same holds for lisinopril, another ACE inhibitor.
What about Cialis and ramipril?
The same answer. The tadalafil label tested another ACE inhibitor, enalapril, and found no clinically significant interaction; in men taking several blood-pressure medicines the extra drop was minimal when their blood pressure was well controlled, and greater when it was not (EMA — Cialis). When daily tadalafil is started, the label adds, the blood-pressure dose may need adjusting. The Australian Cialis leaflet lists blood-pressure medicines such as metoprolol, irbesartan and enalapril among its interactions (Cialis CMI).
Will you feel dizzy?
You might. The Tritace leaflet says that, as with other ACE inhibitor medicines, ramipril "may cause light-headedness, dizziness, or drowsiness in some people"; it advises standing up slowly from bed or chairs to reduce feeling light-headed, and warns that alcohol can make you dizzy on it too (Tritace CMI). Dizziness is also a side effect of Viagra: if it makes you dizzy, the Viagra leaflet says not to drive or operate machinery, and persistent headache or fainting is a reason to call your doctor straight away (Viagra CMI).
What if you take ramipril for your heart?
Then the heart condition decides. Ramipril is used for high blood pressure, for heart failure after a heart attack, for kidney problems and to prevent cardiovascular problems (Tritace CMI). The Viagra leaflet rules Viagra out after a heart attack or stroke in the last 6 months, if your blood pressure "is unusually high or low or is not effectively treated", or if heart or blood-vessel problems make sex inadvisable (Viagra CMI). The detail is in Viagra after a heart attack or with heart medicines and, if your blood pressure runs low, can you take Viagra with low blood pressure?
Can ramipril cause erection problems?
The Australian Tritace leaflet does not list erectile dysfunction or any sexual side effect among the side effects of ramipril (Tritace CMI). If something changes after you start a new medicine, tell your doctor rather than stopping it on your own. The wider question is answered in can high blood pressure medication cause erectile dysfunction?
Which blood-pressure medicines need more care?
Alpha-blockers, used for high blood pressure or prostate problems. With sildenafil they may cause low blood pressure with symptoms in a few men, so the man should be stable on the alpha-blocker first and a 25 mg starting dose of sildenafil should be considered (EMA — Viagra): can alfuzosin and sildenafil be taken together? The label also flags sacubitril/valsartan: in people with high blood pressure, adding sildenafil lowered blood pressure significantly more than sacubitril/valsartan alone. The prescriber needs your whole list — including blood pressure medications like amlodipine, whose study with sildenafil has its own page, and sartans such as losartan.
What must never be taken with Viagra?
Nitrates — angina medicines such as glyceryl trinitrate sprays or tablets — and amyl nitrite ("poppers"): with sildenafil they can cause "a sudden drop in your blood pressure that is hard to treat" (healthdirect — Sildenafil). The Viagra and Cialis leaflets rule out riociguat, a guanylate cyclase stimulator, as well.
The short answer
Ramipril on its own is not a reason to avoid Viagra or Cialis: the labels found no change in sildenafil levels with ACE inhibitors and no clinically significant interaction between tadalafil and enalapril. Get up slowly, tell both prescribers what you take, and never add a nitrate. Every other combination is covered in our guide to taking Viagra or Cialis with other medicines.
