Pharmacies are to limit supplies of ramipril 1.25-mg capsules to 1 month per prescription after the Department of Health and Social Care (DHSC) issued a serious shortage protocol (SSP). 

The drug is the UK's most prescribed blood pressure treatment, taken by around 6 million people. The measure applies to both NHS and private prescriptions across all four UK nations.

Around 14 million adults in the UK have high blood pressure, and ramipril is the most commonly prescribed antihypertensive. It is among the top 10 most-prescribed medications overall. A further SSP, covering the 2.5-mg tablet formulation, was issued in March.

No Prescription Charge if Lower Quantity Dispensed 

The SSP applies where ramipril 1.25-mg capsules are available but a prescription has been issued for more than 1 month's supply; in such cases, pharmacists may supply up to 1 month's treatment. Patients must be informed that no further supply can be made against the same prescription beyond that quantity.

Where a reduced quantity is dispensed under the SSP, pharmacists do not need to routinely notify the prescriber. Patients with a prescription for 1 month or less should receive their full prescribed quantity if stock is available; if not, they should be referred to a pharmacy that has stock or back to their prescriber.

If a patient is supplied with a smaller quantity than prescribed, no prescription charge is payable for the reduced supply.

SSPs enable community pharmacists to supply a medicine in accordance with a protocol rather than a prescription, without referring patients back to their prescriber. They are used where a medicine is likely to be out of stock for some time and where ministers consider an SSP would help manage the supply situation.

Supply Shortages for Multiple Medications 

Several other commonly prescribed antihypertensives are currently also in short supply: propranolol modified-release capsules are out of stock; and atorvastatin chewable tablets, often co-prescribed with antihypertensives, face ongoing supply issues.

There are currently 85 active NHS SSPs and 67 DHSC medicine supply notifications, within a total of 152 active UK medicine shortage notifications.

Alternative Agents Suggested

Although ramipril 1.25-mg and 2.5-mg tablets and ramipril oral solution remain available, these could not support increased demand. Some low-dose formulations of angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers do remain available and could help support demand. The DHSC suggested that the lowest available strengths that could meet increased demand are:

• Lisinopril 2.5-mg tablets
• Losartan 25-mg tablets
• Candesartan 4-mg tablets

Any patient switched to an alternative agent should be carefully monitored to ensure that blood pressure remains controlled and the new agent is tolerated, with dose titration as needed. Patients should be advised to seek medical advice if they experience dizziness or lightheadedness after switching.

Ian Maidment, professor in clinical pharmacy at Aston University, Birmingham, said the supply issues were challenging for primary care to manage and added to overall workload. Patients with concerns should speak to their community pharmacist or GP practice, he said, but “the key message is that there are alternatives.”

National Pharmacy Association Chairman Olivier Picard said the association was concerned by the shortage. A number of pharmacies had been unable to order some strengths of ramipril, he said, and even where stock could be sourced, its cost had soared in recent weeks.

“Millions of patients rely on ramipril, and although there are alternative medicines available, supplies of these must be managed carefully by the government to ensure subsequent demand can be met,” he said.

Pharmacies should advise affected patients to contact their prescriber or GP practice to reorder their medication on time.

The SSP runs until 29 May 2026 unless amended in the interim.

Dr Sheena Meredith is an established medical writer, editor, and consultant in healthcare communications, with extensive experience writing for medical professionals and the general public. She is qualified in medicine and in law and medical ethics.