Drug interactions
Ramipril + Tolbutamide
Severity: Moderate
Ramipril and Tolbutamide: moderate interaction.
Last updated
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
ACE inhibitors can potentiate the glucose-lowering effect of sulfonylureas such as tolbutamide, sometimes resulting in hypoglycemia. This is most likely in the early weeks of combined therapy.
What this interaction means in plain words
Ramipril and Tolbutamide can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken.
Ramipril belongs to Cardiovascular; Tolbutamide belongs to Endocrine.
Why it happens
ACE inhibition may enhance insulin sensitivity, adding to the insulin secretagogue effect of the sulfonylurea.
What to do
Monitor blood glucose after starting or changing ramipril and lower the tolbutamide dose if hypoglycemia develops.
What to ask your pharmacist
- Should I take them at different times of day?
- Does the dose of either medicine need to change?
- Is there anything I should avoid, such as alcohol or certain foods, while on both?
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Other interactions of Ramipril
- Aliskiren + Ramipril Contraindicated
- Protein a column + Ramipril Contraindicated
- Ramipril + Sacubitril / valsartan Contraindicated
- Ramipril + Sacubitril-valsartan Contraindicated
- Amifostine + Ramipril Major
- Amiloride + Ramipril Major
Other interactions of Tolbutamide
- Glyburide-metformin + Tolbutamide Major
- Insulin degludec-liraglutide + Tolbutamide Major
- Aceclofenac + Tolbutamide Moderate
- Acemetacin + Tolbutamide Moderate
- Acetylsalicylic acid + Tolbutamide Moderate
- Albiglutide + Tolbutamide Moderate
Frequently asked questions
Can I take Ramipril with Tolbutamide?
MediHelp rates the interaction as moderate. Ramipril and Tolbutamide can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken. ACE inhibitors can potentiate the glucose-lowering effect of sulfonylureas such as tolbutamide, sometimes resulting in hypoglycemia. This is most likely in the early weeks of combined therapy.
How serious is the interaction between Ramipril and Tolbutamide?
MediHelp rates it moderate, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Monitor blood glucose after starting or changing ramipril and lower the tolbutamide dose if hypoglycemia develops.
What other medicines interact with Ramipril?
MediHelp also lists interactions of Ramipril with, for example, Aliskiren, Protein a column, Sacubitril / valsartan. The full list is on the Ramipril page.
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