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ACE Inhibitors


What do they do?

How do I take them?

Side Effects

What do they do?

ACE inhibitors have many complex actions. This includes lowering blood pressure and increasing the supply of blood and oxygen to the heart.  They reduce the risk of stroke, heart attack and kidney failure (in people with diabetes).

ACE inhibitors also help after a heart attack, as the heart muscle can be damaged and weakened.  They help by slowing down further weakening of the heart muscle and make it easier for your heart to pump. 

Common ACE inhibitors are Enalapril, Lisinopril, Perindopril and Ramipril. 

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How do I take them?

ACE inhibitors are taken by mouth preferably at the same time each day. 

When you take the first dose, lie or sit down, as you might feel dizzy.  This may be due to a slight lowering of your blood pressure.  After the first dose on the first day of treatment, there is no need to take any special precautions.  A low dose of an ACE inhibitor is usually started at first, and slowly increased up to a standard dose over 2-4 weeks.

A blood test is usually done before starting treatment to check kidney function and the salt balance of the blood.  This is repeated about 7-10 days after the first dose and at each dose increase until the desired dose is reached. 

Kidney function is checked as a small number of people can have reduced blood flow to the kidneys when ACE inhibitors are started.  Once your dose is stabilised you should have a blood test once a year to check your kidney function and the salt balance in your blood.

ACE inhibitors can increase the potassium level in the blood and since too much potassium can be dangerous, especially for the heart, it's important not to take potassium supplements (e.g. Slow – K, Sando_K) or potassium sparing diuretics (e.g. Amiloride) or salt substitutes (Lo-Salt).  Certain painkillers e.g. Nurofen or Ibuprofen can cause kidney problems if you take them with your ACE inhibitor.

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Side Effects

ACE inhibitors usually cause no problems but some people get a dry cough and if this happens you should tell your doctor as an alternative treatment can be given.  ACE inhibitors can also cause kidney problems, but your kidney function will be checked regularly by blood tests.  If you are taking an ACE inhibitor and have not had a test for your kidneys within the last twelve months, ask your doctor to arrange it. 

When you take the first dose you might feel dizzy.  This may be due to a marked lowering of blood pressure.  If this happens lie down till it passes.  If you keep having this problem tell your GP, practice nurse or pharmacist. 

Less common side effects include rashes and diarrhea.  Very rarely ACE inhibitors can cause a major allergic reaction with breathing difficulties or swelling of the face (including lips and tongue) and urgent medical advice must be sought. 

If you think you have any side effects from this medicine be sure to mention them to your GP, practice nurse or pharmacist. 

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