<s>[INST] hello, i have been taking ramipril for bp for 4+ years. for the past three weeks now i have been having dizzy spells and sharp pains in the left side of my neck. could this be related to the ramipril? some info;- 38 yrs old, anxiety sufferer, smoker, [/INST] hi. I have read your question thoroughly.Regarding ramipril, yes it can cause dizzy spells owing to its blood pressure lowering effect, but it does not cause sharp pain in the neck.As you have been an anxiety sufferer and a smoker as well, the sharp pain in the neck is probably, either a PSYCHOSOMATIC PAIN which means that patient feels pain in the absence of any medical explaination and in the absence of physical and biochemical evidence, or it is a MUSCULOSKELETAL PAIN which means either a faulty sleeping position or a wrong exercising technique is causing it. the best way to proceed is as;1: To have regular blood pressure check ups to see if the it's the lower BP that is causing the dizzy spells. 2: To reduce smoking as much as possible which is helpful for the treatment of both Hypertension and anxiety disorder. 3: To have regular brisk walk and have healthy activities like exercising for half an hour a day that would help in reducing anxiety and ultimately will have pain alleviating effect. 4: To adopt a healthy diet, rich in vegetables, fruits, low fat content foods, fish and intermediate glycemic index foods that would speed up the treatment process alongside the other measures. I hope you find this helpful. regardsDr. Abdur Rehman Alozai </s>