Angioedema associated with candesartan

Most large clinical trials report that the frequency of angioedema caused by angiotensin-converting enzyme (ACE) inhibitors is 0.1-0.2%. The most common theory for this rare but potentially fatal adverse drug reaction cites ACE inhibitor-mediated accumulation of bradykinin as the culprit. Because angiotensin II receptor blockers (ARBs) do not exert their effects on ACE, they are not expected to cause bradykinin accumulation and therefore angioedema. Recently, several cases of angioedema related to the administration of ARBs have been documented in the literature. The existence of ARB-induced angioedema suggests that additional or alternate mechanisms not involving bradykinin are present in drug-induced angioedema. While taking candesartan for hypertension, a 53-year-old woman with known ACE inhibitor intolerance developed angioedema. During her hospitalization, candesartan was stopped and immunosuppressive therapy was administered. Within 24 hours, the angioedema had resolved completely and the patient was discharged. In light of the recent literature on ARB-induced angioedema, ACE inhibitor-intolerant patients who begin ARB therapy should receive appropriate counseling and be monitored closely for this adverse reaction.