Can I take Ramipril and Sertraline together?

Why this happens

Both ramipril (an ACE inhibitor) and sertraline (an SSRI antidepressant) are known to independently cause the body to retain water and lose sodium. When used together, this effect is added together. Furthermore, sertraline affects how platelets (cells that help blood clot) work, while ramipril can sometimes affect blood vessels, slightly increasing the chance of bruising or bleeding.

What you should do

It is generally safe to take these together, but you should be aware of the symptoms of low sodium. Contact your doctor if you experience unusual tiredness, confusion, muscle weakness, or persistent headaches. Your doctor may want to perform a simple blood test to check your sodium levels shortly after you start taking both medicines. You should also report any unusual bruising or dark, tarry stools to your GP.

Important precautions

Mental health/Suicidal thoughts

Antidepressants like sertraline can increase the risk of suicidal thoughts or self-harm, particularly when first starting treatment or changing doses. Monitor your mood closely and seek immediate medical help if you experience any distressing thoughts.

Pregnancy

Do not take ramipril if you are pregnant or planning to become pregnant, as it can cause serious harm or death to an unborn baby.

Bleeding risk

Sertraline can increase your risk of bleeding, especially if you are also taking aspirin, ibuprofen (NSAIDs), or blood-thinning medications like warfarin. Seek medical advice if you notice unusual bruising or bleeding.

Angioedema (Severe swelling)

Ramipril can cause a rare but serious allergic reaction involving sudden swelling of the face, lips, tongue, or throat (angioedema). If this occurs, stop taking the medicine and seek emergency medical help immediately. This risk is higher in people of African or Caribbean descent.

Serotonin Syndrome

Sertraline can cause a life-threatening condition called serotonin syndrome, especially if taken with other medicines that affect serotonin (such as triptans, tramadol, or St John's Wort). Seek urgent medical help if you experience agitation, hallucinations, fast heartbeat, or severe muscle stiffness.

Food and drink warnings

Alcohol

It is best to avoid or strictly limit alcohol while taking these medicines. Ramipril lowers your blood pressure, and alcohol can increase this effect, making you feel dizzy, lightheaded, or faint. Sertraline can make you feel drowsy or less alert; alcohol will make these side effects worse.

Salt substitutes and high-potassium foods

Ramipril can increase the levels of potassium in your blood. You should avoid using salt substitutes that contain potassium (such as Lo-Salt) and speak to your doctor before significantly increasing your intake of high-potassium foods like bananas, spinach, or pulses. High potassium levels can affect your heart rhythm.

Caffeine (Coffee, tea, energy drinks)

You may wish to limit your caffeine intake. Sertraline can sometimes cause feelings of restlessness or jitteriness, and caffeine can make these sensations worse.

Using other medicines

Taking multiple medicines? Our Medicines Interaction Checker helps you check whether your prescriptions, over-the-counter medicines, and supplements are safe to take together. Simply search for your medicines to see potential interactions and what to do about them.

Disclaimer

This information is for general educational purposes only and should not be relied upon as a substitute for professional medical advice. Always consult your GP, pharmacist, or another qualified healthcare professional before making decisions about your medications. Individual circumstances may vary, and only a healthcare professional who knows your medical history can provide personalised guidance.