Two medicines, side by side
Ramipril vs enalapril
Ramipril and enalapril are both labeled for high blood pressure. Drugs@FDA records approvals of ramipril since 1991 and of enalapril since 1985. Pharmacies paid $0.0707 per ramipril 10 mg capsule and $0.0664 per enalapril maleate 10 mg tablet (NADAC, October 7, 2026). How each works, in its label's words: Ramipril, “Ramipril and ramiprilat inhibit ACE in human subjects and animals.”; Enalapril, “Mechanism of Action Enalapril, after hydrolysis to enalaprilat, inhibits angiotensin-converting enzyme (ACE) in human subjects and animals.”
Check it at the source: the ramipril FDA label on DailyMed (effective August 24, 2026); the enalapril FDA label on DailyMed (effective January 23, 2026).
Highlights of the ramipril record
Ramipril (Altace) · label of August 24, 2026
FETAL TOXICITY See full prescribing information for complete boxed warning. When pregnancy is detected, discontinue ramipril as soon as possible ( 5.6 ). Drugs that act directly on the renin-angiotensin system can cause injury and death to the developing fetus ( 5.6 ). WARNING: FETAL TOXICITY When pregnancy is detected, discontinue ramipril as soon as possible ( 5.6 ). Drugs that act directly on the renin-angiotensin system can cause injury and death to the developing fetus ( 5.6 ).
Used for
From the label: indicationsRamipril capsules are an angiotensin converting enzyme (ACE) inhibitor indicated for the treatment of hypertension, to lower blood pressure. Lowering blood pressure reduces the risk of fatal and nonfatal cardiovascular events, primarily strokes and myocardial infarctions. It may be used alone or in combination with thiazide diuretics ( 1.1 ). […]
On the market
- Earliest approval on file
- January 28, 1991
- Generic labelers
- 17 labelers
- Pharmacy cost
- $0.0707 per capsule
Supply and safety
- Shortage
- No current entry
- Recalls
- 5
Highlights of the enalapril record
Enalapril (Vasotec) · label of January 23, 2026
FETAL TOXICITY See full prescribing information for complete boxed warning.
When pregnancy is detected, discontinue VASOTEC ® as soon as possible.
Drugs that act directly on the renin-angiotensin system can cause injury and death to the developing fetus (see WARNINGS, Fetal Toxicity ).
Used for
From the label: indicationsHypertension VASOTEC is indicated for the treatment of hypertension. VASOTEC is effective alone or in combination with other antihypertensive agents, especially thiazide-type diuretics. The blood pressure lowering effects of VASOTEC and thiazides are approximately additive. Heart Failure VASOTEC is indicated for the treatment of symptomatic congestive heart failure, usually in combination with diuretics and digitalis. […]
On the market
- Earliest approval on file
- December 24, 1985
- Generic labelers
- 28 labelers
- Pharmacy cost
- $0.0664 per tablet
Supply and safety
- Shortage
- No current entry
- Recalls
- 17
Source: FDA drug labels via openFDA (Ramipril label of August 24, 2026, Enalapril label of January 23, 2026); NDC Directory, Drugs@FDA, NADAC, FDA shortages and recalls (October 8, 2026)
How do ramipril and enalapril differ on the record?
How each works, in its label's words: Ramipril, “Ramipril and ramiprilat inhibit ACE in human subjects and animals.”; Enalapril, “Mechanism of Action Enalapril, after hydrolysis to enalaprilat, inhibits angiotensin-converting enzyme (ACE) in human subjects and animals.”
Both are in FDA's class angiotensin converting enzyme inhibitors.
Half-life, in each label's words: Ramipril, “The initial rapid decline, which represents distribution of the drug into a large peripheral compartment and subsequent …”; Enalapril, “The effective half-life for accumulation of enalaprilat following multiple doses of enalapril maleate is 11 hours.”
Both labels carry a boxed warning; the records quote them.
Generics: ramipril since 2005; enalapril since 2000 (Drugs@FDA).
| Ramipril | Enalapril | |
|---|---|---|
| Labeled for | High blood pressure, Heart attack and coronary artery disease | High blood pressure, Heart failure |
| Pharmacologic class | Angiotensin Converting Enzyme Inhibitor | Angiotensin Converting Enzyme Inhibitor |
| How it works (label) | Ramipril and ramiprilat inhibit ACE in human subjects and animals. Angiotensin converting enzyme is a peptidyl dipeptidase that catalyzes the conversion of angiotensin I to the vasoconstrictor substance, angiotensin II. | Mechanism of Action Enalapril, after hydrolysis to enalaprilat, inhibits angiotensin-converting enzyme (ACE) in human subjects and animals. |
| Half-life (label) | The initial rapid decline, which represents distribution of the drug into a large peripheral compartment and subsequent binding to both plasma and tissue ACE, has a half-life of 2 to 4 hours. | The effective half-life for accumulation of enalaprilat following multiple doses of enalapril maleate is 11 hours. |
| Earliest approval on file (Drugs@FDA) | January 28, 1991 | December 24, 1985 |
| First generic approved | October 24, 2005 | August 22, 2000 |
| Generic labelers (NDC) | 17 labelers | 28 labelers |
| Pharmacy cost (NADAC, each one's most listed form; strengths differ) | $0.0707 per capsule (Ramipril 10 mg capsule) | $0.0664 per tablet (Enalapril maleate 10 mg tablet) |
| 12-month price change | +1% | -12% |
| Boxed warning | Yes | Yes |
| Shortage now | No current entry | No current entry |
| Recalls recorded | 5 | 17 |
| FAERS reports (a report is not proof of cause; counts follow how widely a medicine is used) | 123,138 | 60,702 |
| DEA schedule | none | none |
Source: Drugs@FDA, FDA NDC Directory, CMS NADAC of October 7, 2026, FDA shortages and recalls, FAERS via openFDA (FDA files October 8, 2026)
What next?
- Alternatives to ramipril
- every medicine labeled for the same conditions