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Angioedema associated with candesartan.

Kang-Sha Lo1

  • 1Department of Pharmacy Services, Moses H. Cone Memorial Hospital, Greensboro, North Carolina 27401, USA.

Pharmacotherapy
|September 12, 2002
PubMed
Summary

Angiotensin II receptor blockers (ARBs) can cause angioedema, a rare adverse reaction. Patients with ACE inhibitor intolerance require close monitoring for ARB-induced angioedema due to potential non-bradykinin mechanisms.

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Area of Science:

  • Pharmacology
  • Adverse Drug Reactions
  • Cardiovascular Medicine

Background:

  • Angiotensin-converting enzyme (ACE) inhibitors are associated with angioedema in 0.1-0.2% of patients, often attributed to bradykinin accumulation.
  • Angiotensin II receptor blockers (ARBs) were not expected to cause angioedema as they do not inhibit ACE or increase bradykinin.
  • Recent literature suggests ARBs may induce angioedema through alternative mechanisms.

Observation:

  • A 53-year-old woman with a history of ACE inhibitor intolerance developed angioedema while taking candesartan for hypertension.
  • Upon discontinuation of candesartan and initiation of immunosuppressive therapy, her angioedema resolved within 24 hours.

Findings:

  • The occurrence of angioedema in a patient with ACE inhibitor intolerance, despite ARB use, indicates that bradykinin accumulation is not the sole mechanism for drug-induced angioedema.
  • This case supports the hypothesis that ARBs can trigger angioedema via pathways independent of bradykinin.

Implications:

  • Patients with a known intolerance to ACE inhibitors should be counseled about the potential risk of angioedema when starting ARB therapy.
  • Close monitoring for angioedema is crucial in ACE inhibitor-intolerant patients initiating ARBs, given the possibility of non-bradykinin-mediated adverse reactions.

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