WARNING! Singers beware Ramipril (Rx medication)

Subject: WARNING! Singers beware Ramipril
From: GUEST,Nick Dow
Date: 14 Nov 16 - 07:43 PM

Ramipril used for the evening dosage to combat high blood pressure can seriously mess up your singing voice. The side effect of a cough can lead on to hoarseness dry throat and dry mouth and loss of vocal tone.
I have been to the doctor today and been told this face to face. I am dumping the pills immediately. There are other alternatives.
If you are on Ramipril and experiencing any of the symptoms get to your GP asap.
I have been battling the symptoms for 3 months, thinking I had overused my voice in this years festival season, and was beginning to be worried that the trouble was permanent and would get worse (with age)
As you might imagine I am not at all happy with my GP prescribing these tablets when he knew how many gigs I was doing. I can't wait for symptoms to disappear. I really hope this helps any other sufferers.
yours as ever
Nick

Subject: RE: WARNING! Singers beware Ramipril
From: Stanron
Date: 14 Nov 16 - 07:55 PM

I was on Ramipril for over 5 years. I got the irritated throat symptom a year or so ago. My doctor changed it to Amlodipine about 3 months ago and the symptoms have gone now.

Good luck.

Subject: RE: WARNING! Singers beware Ramipril
From: Jack Campin
Date: 14 Nov 16 - 08:23 PM

That side effect only bothers about 20% of users. Look up Martindale's Extra Pharmacopoeia (it's not free on the web) for the incidence of side effects of medications (that's where I got the figure from). I suspect that bad reactions to amlodipine are more common, 11% of users give up on it; it may be associated with an overall increase in your chances of dying from cardiovascular disease and has the usual shopping list of side effects you get with any effective medication.

I still take ramipril occasionally, but it tends to make me depressed in the morning (it never made me cough). Ginkgo biloba has similar benefits to ramipril, but you can't get it free.

Subject: RE: WARNING! Singers beware Ramipril (Rx medication)
From: GUEST,padgett
Date: 15 Nov 16 - 01:05 AM

Hoo 'eck tek 'em all ~ but then I'm not well

Ray

Subject: RE: WARNING! Singers beware Ramipril (Rx medication)
From: doc.tom
Date: 15 Nov 16 - 05:53 AM

Yes - same problem. Stopped after 3 days.

Subject: RE: WARNING! Singers beware Ramipril (Rx medication)
From: Brakn
Date: 15 Nov 16 - 06:01 AM

On Ramipril - not affected me at all.

Subject: RE: WARNING! Singers beware Ramipril (Rx medication)
From: Stu
Date: 15 Nov 16 - 09:24 AM

Ah, that might explain some things. Thanks for the information!

Subject: RE: WARNING! Singers beware Ramipril (Rx medication)
From: leeneia
Date: 15 Nov 16 - 10:10 AM

My husband developed a cough which his doctor blamed on blood pressure medicine. He switched brands and hasn't had a problem.

After he retired, he didn't need any at all.

Subject: RE: WARNING! Singers beware Ramipril (Rx medication)
From: punkfolkrocker
Date: 15 Nov 16 - 10:18 AM

I gave in and started taking blood pressure tablets when I became 50..
[I'll be 60 in just over 2 years]

The Dr had been trying to persuade me to have them prescribed since my mid 40s..

I'll be honest.. the reason for my stubborn resistance and reluctance had nowt to do with my singing voice,
but more out of fear the tablets might make me impotent....

I'm on perindopril & amlodipine, and cardide sr water tablets in the mornings, and pravastatin in the evening..

so far no major dysfunctions in the front top trouser department.....

Subject: RE: WARNING! Singers beware Ramipril (Rx medication)
From: OldNicKilby
Date: 15 Nov 16 - 10:20 AM

Got the same problem. Talking to a fellow Singer and he too had the same Bloody niggling cough. What do we do take the Ramipril or suffer a Heart Failure
I think I'll settle for keeping on Singing

Subject: RE: WARNING! Singers beware Ramipril (Rx medication)
From: GUEST,Nick Dow
Date: 15 Nov 16 - 12:26 PM

As I said there are alternatives. It's not my place to recommend anything. Ask your GP. I have.
Nick

Subject: RE: WARNING! Singers beware Ramipril (Rx medication)
From: McGrath of Harlow
Date: 15 Nov 16 - 12:50 PM

Since I had my cardiac arrest and heart bypasses back in 2911-11 I've been taking Ramioril every day. Still singing, and the heart is still working.

Subject: RE: WARNING! Singers beware Ramipril (Rx medication)
From: JHW
Date: 15 Nov 16 - 05:41 PM

"the usual shopping list of side effects you get with any effective medication."
So why do we have to put up with so called side effects?
Nurse is trying to get me on to Statins. I just have a pack I haven't dared take.

Subject: RE: WARNING! Singers beware Ramipril (Rx medication)
From: Jack Campin
Date: 15 Nov 16 - 07:49 PM

I've tried three different statins, each of which had different side effects, all bad enough to make them a no-go. Most people are luckier than me, though.

The scariest side effects are the ones you don't see coming. At least with the common statin side-effects, you can stop the pills and they'll go away. With Stevens-Johnston syndrome or the addictive properties of paroxetine, by the time you realize there's an issue it's way too late.

Subject: RE: WARNING! Singers beware Ramipril (Rx medication)
From: John Routledge
Date: 15 Nov 16 - 07:53 PM

Thanks Nick I have had very similar symptoms recently after some years of use. Now seems clear but am going to change from Ramipril.

Subject: RE: WARNING! Singers beware Ramipril (Rx medication)
From: rich-joy
Date: 15 Nov 16 - 08:31 PM

Fifteen years ago, I saw that my aging mother started having a persistant dry cough and throat, when her GP said at your age you should probably go on these BP tablets (yes doctor).

Then in May2007 I was diagnosed with DCM with Atrial Fibrillation - and have been on daily drugs ever since - which includes Blood Pressure meds (though not on that brand).

Within 2 years, I could no longer sing (despite previously never having ANY voice issues). My research at the time pointed to Blood Pressure meds, but my Cardiologist and GP poo-poohed the idea that their meds could cause any such issues.
One even said "Well, why don't you take up Jazz Singing – it doesn't seem to matter what note you sing there" *smirk smirk* - I think he was only HALF joking …….
R-J

Subject: RE: WARNING! Singers beware Ramipril (Rx medication)
From: Jack Campin
Date: 15 Nov 16 - 09:20 PM

Ramipril is not a brand name. It's a generic name for one of a group of drugs, "angiotensin converting enzyme inhibitors", or "ACE inhibitors" for short. The commonest brand of ramipril in the UK is Tritace.

Most ACE inhibitors have generic names ending in "-pril".

I don't know what "DCM" stands for.

Subject: RE: WARNING! Singers beware Ramipril (Rx medication)
From: GUEST,Nick Dow
Date: 16 Nov 16 - 04:20 AM

I've swapped to Candesartan. Cough seems a bit better. I don't smoke or drink alcohol which helps. Bedworth festival is coming up for me so fingers crossed.
Nick

Subject: RE: WARNING! Singers beware Ramipril (Rx medication)
From: GUEST,jim bainbridge
Date: 16 Nov 16 - 05:25 AM

Have never had any problem with this, and only once ever had diagnosed HBP, some years ago.
However, at my pharmacist recently told me it was better to take this drug in the morning. This being on the principle that HBP is more likely to occur under daytime stress rather than when you're asleep. That made sense to me....

Subject: RE: WARNING! Singers beware Ramipril (Rx medication)
From: Tattie Bogle
Date: 16 Nov 16 - 05:56 AM

As Jack has indicated, there are different "familes" of bp medications. If you are one of the people who react to the ACE inhibitors, such as ramipril, you will almost certainly react to all in that group, such as perindopril, lisinopril, etc. So no point in switching to another drug in that same group.
The onset of cough can be quite insidious and not immediate, after starting the drug, very often creeping up over the first 3 or 4 weeks of being on it, so not always even thought of (by either the patient or the GP) as being a side effect of the drug: possibly interpreted as a chest infection or even late onset asthma. If it is correctly identified, it may well take several weeks after stopping the drug for the cough to subside, but talk about grateful if it does!
Amlodipine, nifedipine (calcium channel blockers)etc may give you fat ankles!
B-blockers may induce or exacerbate asthma.
-sartans seem relatively low in side effects, but no drug is exempt in any individual.

Subject: RE: WARNING! Singers beware Ramipril (Rx medication)
From: Jack Campin
Date: 16 Nov 16 - 06:29 AM

If you are one of the people who react to the ACE inhibitors, such as ramipril, you will almost certainly react to all in that group, such as perindopril, lisinopril, etc. So no point in switching to another drug in that same group.

My wife had an extremely unpleasant reaction to lisinopril, which I think is much more likely to be caused by that drug than any other in the group. It blocked the sweetness receptors on her tongue so all food tasted horrible. It took her months to recover. She takes ramipril now, and the effect hasn't recurred.

Usually this effect is just dismissed as "disturbance of taste" - she has a friend who is a highly trained nurse and did the appropriate testing of different regions of the tongue to figure out exactly what the "disturbance" was. Taste disturbances occur with several drugs, but I've never seen it analyzed like that in any published source.

Subject: RE: WARNING! Singers beware Ramipril (Rx medication)
From: Tattie Bogle
Date: 17 Nov 16 - 11:34 AM

Interesting, Jack.
I was really referring to the "ACE cough" which does seem to occur across the board of -pril drugs, so that those who react to one are likely to react to others.

Subject: RE: WARNING! Singers beware Ramipril (Rx medication)
From: GUEST,Nick Dow
Date: 17 Nov 16 - 07:01 PM

After two days my throat and cough are much better after dumping Ramipril. It's a real relief. Elsewhere on line scores of people have had dreadful side effects from the drug. It's worth a look.

Subject: RE: WARNING! Singers beware Ramipril (Rx medication)
From: GUEST,ripov (where's me cookie gone?)
Date: 17 Nov 16 - 07:35 PM

I don't know whether it affects my singing, as that is limited to intermittently joining in choruses, but since I've been taking ramipril (and bisoprolol), frequently when I start playing the fiddle I get nauseous - seems to be a reaction to pressure on the throat - and have to stop for a while (maybe the audience suffer the same way and are relieved?).

Subject: RE: WARNING! Singers beware Ramipril (Rx medication)
From: Jack Campin
Date: 17 Nov 16 - 08:10 PM

The problem with on-line horror stories about drugs is that people can't usually be bothered signing up to somebody's blog just to say "it worked, no big deal".

Martindale is extremely helpful in giving a perspective. They don't just say what can happen, they say how often it happens. The free data sheets you can download don't do that.

Subject: RE: WARNING! Singers beware Ramipril (Rx medication)
From: Backwoodsman
Date: 18 Nov 16 - 03:14 AM

Been taking Ramipril for the past ten years at least. No cough. Voice is strong and as good as ever.

I'm a strong believer in the psychological effect of the 'side-effects' section in the notes which accompany any medication, and I make a point of never reading the 'side-effects' bit in the leaflet. I never suffer any side-effects.

Subject: RE: WARNING! Singers beware Ramipril (Rx medication)
From: GUEST, topsie
Date: 18 Nov 16 - 06:04 AM

Guest,ripoy, that is interesting about feeling nauseous. I have taken ramipril for a couple of years and have a slight cough - not a real problem, except when I found myself sharing a railway carriage with a passenger wearing perfume (the cough recovered miraculously after she left the train).
However, I do now have a real problem brushing the inner surface of my upper back teeth without throwing up when the toothbrush touches the inside of my mouth.

Subject: RE: WARNING! Singers beware Ramipril (Rx medication)
From: bubblyrat
Date: 18 Nov 16 - 11:36 AM

Not had any problems to speak of ; I have been treated for hypertension for about 9 months now (extreme hypertension, I might add , due no doubt to a lifetime's boozing ). Now , having been told that I have a condition similar to varicose veins in my stomach, I have to take Omeprazole twice daily, Ramipiril and Lercanidipine in the mornings , and Atorvastatin at night.Sildenafil has a part to play as well, but I need not elaborate ! The point is that I have experienced no noticeable ill effects from any of these medications, and as a bonus ,have saved a FORTUNE on alcohol !!

Subject: RE: WARNING! Singers beware Ramipril (Rx medication)
From: sleepyjon
Date: 18 Nov 16 - 01:08 PM

Interesting thread! - I was getting quite worried about a persistent "tickle" and dry cough but reluctant to mention it to the Doc for fear of the possible invasive searching - but a family member remarked that he was slowly getting over the effects of the broncoscopy (I'm bound to have that wrong) - thus confirming my above fears - which he had undergone because of a persistent cough. He remarked that his Doc's firs step had been to take him off the Lisinopril. I was on that too, so mentioned it to my Doc, who swapped Lisinopril for Losartin. Jury still out on the cough - it seems a lot less frequent but not (yet) gone completely - but I suddenly no longer need to panic when about to break wind! (Maybe that's what Sildenafil is about, bubblyrat?) - and yes, Backwoodsman, I did read the side effects sheet then (though not before), and found of course that I had them all!

SJ

Subject: RE: WARNING! Singers beware Ramipril (Rx medication)
From: GUEST,Some bloke
Date: 18 Nov 16 - 01:44 PM

Yeah, had a quick look at The BNF. (British National Formulary.) The side effects make you a tad unlucky really. They tend not to be so widespread although the sample group of mainly singers on this thread make that particular possible side effect rather interesting as not everybody who would get it would notice....

Basically, a group of singers would appear to suffer more than a group of stamp collectors yet the actual susceptibility to the side effects should yield the same numbers.

All this talk of dry cough, I'm surprised the old joke of sucking a fisherman's friend hasn't popped up...

Subject: RE: WARNING! Singers beware Ramipril (Rx medication)
From: GUEST,Nick Dow
Date: 18 Nov 16 - 07:11 PM

I started this thread to point out the connection between Ramipril and voice problems in case, like me, any body was suffering without knowing why. Like all side effects they are something that might happen- not a foregone conclusion.
After three days off the pills the cough is nearly gone, the night time dry mouth and sore throat has disappeared, and Mrs. D says my mood has lifted and I am (almost) a pleasure to live with..Just need to sort out the snoring, overeating, moaning, untidiness, shouting at the TV and swearing at the Sat Nav and she will be a happy woman.

Subject: RE: WARNING! Singers beware Ramipril (Rx medication)
From: Tattie Bogle
Date: 21 Nov 16 - 03:42 PM

Glad you're feeling better, Nick: I should just go back to memorising maps!
And for Backwoodsman, I'd say that in the case of this particular group of drugs, the ACE-inhibitors, is Is not necessarily psychological: as Jack said earlier, the "ACE cough" affects at least a quarter of all people who take these drugs.

Subject: RE: WARNING! Singers beware Ramipril (Rx medication)
From: The Sandman
Date: 22 Nov 16 - 06:23 AM

I was diagnosed with marginally HBP, I take more exercise, and have altered my diet, but thanks for letting me know cabout this Nick

Subject: RE: WARNING! Singers beware Ramipril (Rx medication)
From: Dennis the Elder
Date: 22 Nov 16 - 09:04 AM

I'm on Ramipril have been for years and my voice is crap, but it always has been.
I now finally have an excuse for it that I can quote, thanks Nick, I'll buy you a pint next time I see you.

Subject: RE: WARNING! Singers beware Ramipril (Rx medication)
From: GUEST
Date: 23 Mar 18 - 03:13 AM

Shouldn't the title of the thread be changed to:

RE: WARNING! Musicians beware Ramipril (Rx medication)

Subject: RE: WARNING! Singers beware Ramipril (Rx medication)
From: r.padgett
Date: 23 Mar 18 - 03:28 AM

I take mine in the mornings

Ray

Subject: RE: WARNING! Singers beware Ramipril (Rx medication)
From: Tangledwood
Date: 23 Mar 18 - 06:18 PM

I wouldn't have made the connection between medication and a persistent cough when singing but, thanks to reading Nick Dow's post last year, I raised the subject with my doctor. He replaced the Renitec (ACE inhibitor) I had been using with Co-Diovan. Problem gone.
Thanks for the discussion here.

Subject: RE: WARNING! Singers beware Ramipril (Rx medication)
From: GUEST,Ebor Fiddler
Date: 24 Mar 18 - 05:11 PM

I am definitely mentioning this to my oncologist when I see her on Tuesday. Thank you all.

Subject: RE: WARNING! Singers beware Ramipril (Rx medication)
From: Hagman
Date: 25 Mar 18 - 01:33 AM

I was put on this after recent heart surgery. The chemist did mention the side effects - couching etc., and it was in the literature that came with the tabs - but like lots of others, my voice was crap beforehand, so no matter....