Can I take ramipril while pregnant or breastfeeding?
A plain-words look at what the NHS, the US drug label and LactMed say about ramipril.
In short
Pregnancy: Ramipril is not recommended for pregnant women.
Breastfeeding: Ramipril can be taken during breastfeeding, but speak to your doctor or pharmacist first.
Your doctor, midwife or pharmacist can help you decide.
What this means for you
Pregnancy
- It can affect the baby's kidneys, especially if taken in the second and third trimesters, and this can lead to long-term kidney damage in your baby.
- Your doctor can usually prescribe another medicine that is safe in pregnancy.
- Stop ramipril by 12 weeks of pregnancy at the latest.
- While taking ramipril, use contraception and plan any pregnancy carefully with your GP, a pregnancy specialist (obstetrician) or a hospital doctor.
- They will want to review your condition and your medicine before you become pregnant.
- Most women stop ramipril before becoming pregnant, but some may keep taking it until they get a positive pregnancy test, and stop then.
- Your doctor will talk with you about what's best, based on your condition and the risks and benefits of ramipril.
Breastfeeding
- If your baby was born prematurely, it's best not to take ramipril, but your doctor will help you decide.
- How much ramipril reaches breast milk is not yet known, but it's probably a low amount, and side effects in your baby are unlikely.
- There is, however, a very small chance of it lowering your baby's blood pressure, so your doctor might suggest you take a different medicine.
- It's important to keep an eye on your baby whenever you take a medicine while breastfeeding.
When to get help
- If you're already pregnant, stop ramipril and speak to your doctor straight away.
- Contact a healthcare professional or call 111 (NHS 111 in the UK) as soon as you can if your baby is feeding less well than normal or not gaining weight as you'd expect, is unusually sleepy, looks a lot paler than normal, is irritable, has diarrhoea or is vomiting (being sick), or has fewer wet nappies because they're peeing less.
- For symptoms not mentioned here, or if you're worried about your baby, you can also speak to any healthcare professional or call 111.
Talk to your doctor or pharmacist
This page is educational, not advice for your own situation. Talk to your doctor, midwife or pharmacist before you start, stop or change any medicine in pregnancy or while breastfeeding.
The details: what each source says
Ramipril in pregnancy
The NHS says
Ramipril is not recommended for pregnant women. It can affect the baby's kidneys, especially if taken in the second and third trimesters, and this can lead to long-term kidney damage in your baby.
If you're already pregnant, stop ramipril and speak to your doctor straight away. Your doctor can usually prescribe another medicine that is safe in pregnancy. Stop ramipril by 12 weeks of pregnancy at the latest.
While taking ramipril, use contraception and plan any pregnancy carefully with your GP, a pregnancy specialist (obstetrician) or a hospital doctor. They will want to review your condition and your medicine before you become pregnant.
Most women stop ramipril before becoming pregnant, but some may keep taking it until they get a positive pregnancy test, and stop then. Your doctor will talk with you about what's best, based on your condition and the risks and benefits of ramipril.
In our words, from the NHS page Ramipril (nhs.uk). Contains public sector information licensed under the Open Government Licence v3.0 (OGL v3.0). The NHS does not endorse this site.
The US drug label says
8.1 Pregnancy Pregnancy Category D Use of drugs that act on the renin-angiotensin system during the second and third trimesters of pregnancy reduces fetal renal function and increases fetal and neonatal morbidity and death. Resulting oligohydramnios can be associated with fetal lung hypoplasia and skeletal deformations. Potential neonatal adverse effects include skull hypoplasia, anuria, hypotension, renal failure, and death. When pregnancy is detected, discontinue ramipril as soon as possible. These adverse outcomes are usually associated with use of these drugs in the second and third trimester of pregnancy. Most epidemiologic studies examining fetal abnormalities after exposure to antihypertensive use in the first trimester have not distinguished drugs affecting the renin-angiotensin system from other antihypertensive agents. Appropriate management of maternal hypertension during pregnancy is important to optimize outcomes for both mother and fetus. In the unusual case that there is no appropriate alternative to therapy with drugs affecting the renin-angiotensin system for a particular patient, apprise the mother of the potential risk to the fetus.
Prescribing label, section “8.1 Pregnancy” (opening excerpt): Ramipril (oral), BluePoint Laboratories. Read the full section on DailyMed. Quoted verbatim; US labels are written for US prescribers and patients.
Ramipril while breastfeeding
The NHS says
Ramipril can be taken during breastfeeding, but speak to your doctor or pharmacist first. If your baby was born prematurely, it's best not to take ramipril, but your doctor will help you decide.
How much ramipril reaches breast milk is not yet known, but it's probably a low amount, and side effects in your baby are unlikely. There is, however, a very small chance of it lowering your baby's blood pressure, so your doctor might suggest you take a different medicine.
It's important to keep an eye on your baby whenever you take a medicine while breastfeeding.
Contact a healthcare professional or call 111 (NHS 111 in the UK) as soon as you can if your baby is feeding less well than normal or not gaining weight as you'd expect, is unusually sleepy, looks a lot paler than normal, is irritable, has diarrhoea or is vomiting (being sick), or has fewer wet nappies because they're peeing less.
For symptoms not mentioned here, or if you're worried about your baby, you can also speak to any healthcare professional or call 111.
In our words, from the NHS page Ramipril (nhs.uk). Contains public sector information licensed under the Open Government Licence v3.0 (OGL v3.0). The NHS does not endorse this site.
LactMed says
Because no information is available on the use of ramipril during breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.
“Summary of Use during Lactation”, LactMed record “Ramipril” (LM237), quoted verbatim. Everything LactMed reports about Ramipril while breastfeeding.
What these words mean
- metabolite
- a substance made when the body breaks down a medicine
Definitions adapted from the NCI Dictionary of Cancer Terms (National Cancer Institute).
The US prescribing label says
Nursing Mothers Ingestion of a single 10 mg oral dose of ramipril resulted in undetectable amounts of ramipril and its metabolites in breast milk. However, because multiple doses may produce low milk concentrations that are not predictable from a single dose, do not use ramipril in nursing mothers.
Prescribing label, section “Nursing Mothers”: Ramipril (oral), BluePoint Laboratories. Label on DailyMed. Quoted verbatim; US labels are written for US prescribers and patients.
Other names
UK brand names (per the NHS): Tritace.
Sources
- NHS, Ramipril (nhs.uk), page last reviewed 18 March 2026. Paraphrased. Contains public sector information licensed under the Open Government Licence v3.0.
- US drug label: Ramipril (oral), BluePoint Laboratories, human prescription drug, label effective 4 September 2026, set ID 45707435-4fc8-457e-9ff2-02d7be9b4a6e. DailyMed (National Library of Medicine). Public domain; quoted verbatim.
- Drugs and Lactation Database (LactMed), National Institute of Child Health and Human Development (NICHD), via NCBI Bookshelf, record “Ramipril” (LM237), bulk release of 22 September 2026. LactMed on NCBI Bookshelf. Public domain; quoted verbatim. LactMed is a registered trademark of the U.S. Department of Health and Human Services.
Sources checked 26 September 2026. How we source and check every page.
Educational summary of named sources, not medical advice.