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[Angioedema during ACE and DPP-4 inhibition]
Bernard Waeber1, Thierry Buclin, Eric Grouzmann
1Division de physiopathologie clinique, CHUV et Université de Lausanne, 1011 Lausanne.
Revue Medicale Suisse
|March 4, 2010
Summary
Angiotensin converting enzyme (ACE) inhibitors can cause rare angioedema due to bradykinin buildup. Combining ACE inhibitors with dipeptidyl-ptidase-4 (DPP-4) inhibitors significantly elevates this risk.
Area of Science:
- Pharmacology
- Gastroenterology
Context:
- Angiotensin converting enzyme (ACE) inhibitors are associated with angioedema, a rare but serious side effect.
- The mechanism involves the accumulation of proinflammatory peptides like bradykinin and substance P, normally degraded by ACE.
- Angioedema can manifest early in treatment or during long-term use, affecting the gastrointestinal tract and potentially causing pancreatitis.
Purpose:
- To investigate the role of bradykinin and substance P accumulation in ACE inhibitor-induced angioedema.
- To explore the implications of co-administering ACE inhibitors with dipeptidyl-ptidase-4 (DPP-4) inhibitors.
Summary:
- ACE inhibitors can lead to angioedema by inhibiting the breakdown of bradykinin and substance P.
- DPP-4 inhibitors, also involved in bradykinin degradation, represent a significant risk factor when combined with ACE inhibitors.
- This combination therapy substantially increases the likelihood of developing angioedema.
Impact:
- Highlights a critical drug interaction that increases angioedema risk.
- Informs clinical practice regarding the concurrent use of ACE inhibitors and DPP-4 inhibitors.
- Emphasizes the need for careful patient monitoring when these drug classes are prescribed together.
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