Two medicines, side by side
Ramipril vs telmisartan
Ramipril and telmisartan are both labeled for high blood pressure and heart attack and coronary artery disease. Drugs@FDA records approvals of ramipril since 1991 and of telmisartan since 1998. Pharmacies paid $0.0707 per ramipril 10 mg capsule and $0.106 per telmisartan 20 mg tablet (NADAC, October 7, 2026); the strengths differ, so the two prices are not like for like. In FDA's classes, ramipril is an angiotensin converting enzyme inhibitor and telmisartan an angiotensin 2 receptor blocker.
Check it at the source: the ramipril FDA label on DailyMed (effective August 24, 2026); the telmisartan FDA label on DailyMed (effective May 29, 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 telmisartan record
Telmisartan (Micardis) · label of May 29, 2026
FETAL TOXICITY When pregnancy is detected, discontinue telmisartan as soon as possible [see Warnings and Precautions (5.1) and Use in Specific Populations (8.1)]. Drugs that act directly on the renin-angiotensin system can cause injury and death to the developing fetus [see Warnings and Precautions (5.1) and Use in Specific Populations (8.1)]. WARNING: FETAL TOXICITY See full prescribing information for complete boxed warnings.
Used for
From the label: indicationsTelmisartanis an angiotensin II receptor blocker (ARB) indicated for: Treatment of hypertension to lower blood pressure. Lowering blood pressure reduces the risk of fatal and nonfatal cardiovascular events, primarily strokes and myocardial infarctions(1.1) 1.1 Hypertension Telmisartan is indicated for the treatment of hypertension, to lower blood pressure. […]
On the market
- Earliest approval on file
- November 10, 1998
- Generic labelers
- 28 labelers
- Pharmacy cost
- $0.106 per tablet
Supply and safety
- Shortage
- No current entry
- Recalls
- 3
Source: FDA drug labels via openFDA (Ramipril label of August 24, 2026, Telmisartan label of May 29, 2026); NDC Directory, Drugs@FDA, NADAC, FDA shortages and recalls (October 8, 2026)
How do ramipril and telmisartan differ on the record?
In FDA's classes, ramipril is an angiotensin converting enzyme inhibitor and telmisartan an angiotensin 2 receptor blocker.
How each works, in its label's words: Ramipril, “Ramipril and ramiprilat inhibit ACE in human subjects and animals.”; Telmisartan, “Angiotensin II is formed from angiotensin I in a reaction catalyzed by angiotensin-converting enzyme (ACE, kininase II).”
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 …”; Telmisartan, “Telmisartan shows bi-exponential decay kinetics with a terminal elimination half-life of approximately 24 hours.”
Both labels carry a boxed warning; the records quote them.
Generics: ramipril since 2005; telmisartan since 2014 (Drugs@FDA).
| Ramipril | Telmisartan | |
|---|---|---|
| Labeled for | High blood pressure, Heart attack and coronary artery disease | High blood pressure, Heart attack and coronary artery disease |
| Pharmacologic class | Angiotensin Converting Enzyme Inhibitor | Angiotensin 2 Receptor Blocker |
| 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. | Angiotensin II is formed from angiotensin I in a reaction catalyzed by angiotensin-converting enzyme (ACE, kininase II). |
| 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. | Telmisartan shows bi-exponential decay kinetics with a terminal elimination half-life of approximately 24 hours. |
| Earliest approval on file (Drugs@FDA) | January 28, 1991 | November 10, 1998 |
| First generic approved | October 24, 2005 | January 8, 2014 |
| 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) | $0.106 per tablet (Telmisartan 20 mg tablet) |
| 12-month price change | +1% | -4% |
| Boxed warning | Yes | Yes |
| Shortage now | No current entry | No current entry |
| Recalls recorded | 5 | 3 |
| FAERS reports (a report is not proof of cause; counts follow how widely a medicine is used) | 123,138 | 17,745 |
| 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)
Do their labels mention each other?
Ramipril label, warnings and precautionsPatients receiving the combination of telmisartan and ramipril did not obtain any benefit in the composite endpoint of cardiovascular death, MI, stroke and heart failure hospitalization compared to monotherapy, but experienced an increased incidence of clinically important renal dysfunction (death, doubling of serum creatinine, or dialysis) compared with groups receiving telmisartan alone or ramipril alone. …
Telmisartan label, warnings and precautionsPatients receiving the combination of telmisartan and ramipril did not obtain any additional benefit compared to monotherapy, but experienced an increased incidence of renal dysfunction (e.g., acute renal failure) compared with groups receiving telmisartan alone or ramipril alone.
Source: FDA drug labels via openFDA
What next?
- Alternatives to ramipril
- every medicine labeled for the same conditions