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Angio-oedema induced by enalapril
T Forslund1, H Tohmo, G Weckström
1Department of Internal Medicine, Kymenlaakso Central Hospital, Kotka, Finland.
Journal of Internal Medicine
|August 1, 1995
Summary
Angiotensin-converting enzyme (ACE) inhibitors like enalapril can cause severe angio-oedema, even months after starting treatment. Promptly stop the medication and seek emergency care if swelling occurs.
Area of Science:
- Cardiology
- Pharmacology
- Emergency Medicine
Background:
- Hypertension is a common condition often managed with medications.
- Angiotensin-converting enzyme (ACE) inhibitors are widely prescribed for hypertension.
- Combination therapy with enalapril and hydrochlorothiazide is a standard treatment approach.
Observation:
- A patient developed severe angio-oedema 9 months after starting enalapril and hydrochlorothiazide.
- The angio-oedema resulted in a near-fatal outcome.
- Flexible bronchofiberoscope-assisted intubation was required for airway management.
Findings:
- ACE inhibitor-induced angio-oedema can manifest late in the course of treatment.
- Facial and laryngeal swelling are serious adverse effects of ACE inhibitors.
- Even mild swelling necessitates immediate drug cessation.
Implications:
- Physicians must maintain a high index of suspicion for ACE inhibitor-related angio-oedema.
- Early recognition and withdrawal of the offending ACE inhibitor are crucial.
- Patients experiencing symptoms require urgent hospital referral for emergency management.