<p>Ramipril must not be used</p>

<ul>
	<li>in patients with hypersensitivity to ramipril, to any other ACE inhibitor, or any of the excipients of Ramipril.</li>
	<li>in patients with a history of angioedema.</li>
	<li>concomitantly with sacubitril/valsartan therapy. Do not initiate Ramipril until sacubitril/valsartan is eliminated from the body. In case of switch from Ramipril to sacubitril/valsartan, do not start sacubitril/valsartan until Ramipril is eliminated from the body.</li>
	<li>in patients with haemodynamically relevant renal artery stenosis, bilateral or unilateral in the single kidney.</li>
	<li>in patients with hypotensive or haemodynamically unstable states.</li>
	<li>with aliskiren-containing medicines in patients with diabetes or with moderate to severe renal impairment (creatinine clearance &lt;60 ml/min).</li>
	<li>with angiotensin II receptor antagonists (AIIRAs) in patients with diabetic nephropathy.</li>
	<li>during pregnancy.</li>
</ul>

<p>Concomitant use of ACE inhibitors and extracorporeal treatments leading to contact of blood with negatively charged surfaces must be avoided, since such use may lead to severe anaphylactoid reactions. Such extracorporeal treatments include dialysis or haemofiltration with certain high-fux (e.g. polyacrylonitril) membranes and low-density lipoprotein apheresis with dextran sulfate.</p>