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Long-acting ACE inhibitor-induced angioedema
L Bielory1, S S Lee, C L Holland
1Division of Allergy and Immunology, UMDNJ-New Jersey Medical School, Newark 07103-2714.
Allergy Proceedings : the Official Journal of Regional and State Allergy Societies
|March 1, 1992
Summary
Angiotensin converting enzyme (ACE) inhibitor angioedema can be severe, especially with long-acting drugs like enalapril or lisinopril. Short-acting ACE inhibitors, such as captopril, typically cause milder reactions.
Area of Science:
- Pharmacology
- Clinical Medicine
- Adverse Drug Reactions
Background:
- Angiotensin converting enzyme (ACE) inhibitors are widely prescribed for cardiovascular conditions.
- Angioedema is a recognized, though not fully understood, adverse effect of ACE inhibitor therapy.
- The precise mechanisms underlying ACE inhibitor-induced angioedema remain under investigation.
Observation:
- This study observed angioedema cases related to ACE inhibitor use.
- Patients experiencing angioedema from short-acting captopril generally had mild symptoms manageable with standard treatments.
- In contrast, angioedema induced by long-acting ACE inhibitors (lisinopril, enalapril) was frequently severe.
Findings:
- Five patients developed angioedema from lisinopril or enalapril.
- Three of these five patients experienced severe angioedema necessitating intubation.
- One patient required a tracheostomy due to severe angioedema.
- A patient with prior mild captopril-induced angioedema required intubation for enalapril-induced angioedema.
Implications:
- Long-acting ACE inhibitors may pose a higher risk for severe angioedema compared to short-acting ones.
- Clinical vigilance is crucial when prescribing ACE inhibitors, particularly long-acting formulations.
- Understanding the differential severity of angioedema based on ACE inhibitor pharmacokinetics is important for patient management and safety.