Millions of people in the UK taking the common blood pressure drug ramipril and other ACE inhibitors have been alerted to a rare but potentially serious side-effect called angioedema, according to a GP and TV doctor. Dr Mark Porter, a regular on The One Show and presenter of Radio 4’s Inside Health, spoke out after the Medicines and Healthcare Products Regulatory Agency (MHRA) issued a safety update highlighting the risk.
What is angioedema and how common is it?
Angioedema is a reaction that causes swelling of the lips, face, tongue or throat. In severe cases, it can lead to difficulty swallowing and breathing, and may be life-threatening. Dr Porter explained that the side-effect occurs in between 1 in 1,000 and 1 in 140 cases, depending on the statistics used. Those most at risk include women, people over 65, smokers, and individuals of black or African-Caribbean ethnicity.
Key messages from the MHRA warning
Dr Porter highlighted two important messages from the MHRA. First, angioedema can be a delayed reaction, occurring weeks or even months after starting the drug, and it often requires different emergency treatment than anaphylaxis because adrenaline may not work. Second, patients should be aware of the following points:
- Angioedema can occur at any time while taking an ACE inhibitor, even after long-term use without problems.
- Seek urgent medical attention if swelling of the face, lips, tongue or throat develops, or if difficulty breathing or swallowing occurs.
- Do not take further doses if angioedema is suspected, and inform a healthcare professional immediately.
- Always tell healthcare professionals if you have ever experienced angioedema, including while taking an ACE inhibitor.
- If you develop problems breathing or swallowing, dial 999.
Doctor’s personal experience and other side-effects
Dr Porter said he has seen patients develop angioedema but has never witnessed a life-threatening reaction in his 40 years of prescribing. He stressed that ACE inhibitors are generally well-tolerated and are first-line treatment for high blood pressure and some heart and kidney conditions. However, he also highlighted a more common side-effect: a dry, persistent cough that affects about one in ten users. This cough can be mistaken for other conditions like acid reflux or asthma. Switching to a similar drug class called sartans usually resolves the cough.
Drug shortages affecting ramipril and other medicines
The warning comes amid severe drug shortages in the UK, described by the National Pharmacy Association (NPA) as some of the worst GPs and pharmacists have ever seen. Ramipril is among the affected drugs, along with prescription co-codamol and some strengths of low-dose aspirin. There is also a long-term Europe-wide shortage of Creon, used for cystic fibrosis and pancreatic cancer, which may continue into 2027.
Advice for patients
Dr Porter advised patients not to self-medicate with NSAIDs like ibuprofen while taking ACE inhibitors, as this can lead to serious kidney problems. Paracetamol is safer. If prescribed an anti-inflammatory, patients should ask about kidney function monitoring. He concluded that while the warning may seem alarming, angioedema is rare and better awareness is needed.
