ACE Inhibitor Causes Angioedema

ACE Inhibitors are a notorious cause of angioedema.  Angioedema is a very serious condition where the lip and upper airway can swell up.  It is extremely rare when you consider how many people take ACE Inhibitors.  When I think of angioedema happening in practice, I historically thought it would happen quickly (within a few days to weeks) following initiation or increase.  Here’s a case where an ACE inhibitor causes angioedema.

A 55 year male had a history of CHF.  Blood pressures were not incredibly high, but remained elevated in the upper 150’s/90’s.  The primary provider increased enalapril from 10 to 20 mg daily.  This increase appeared to be well tolerated without issue for a period of about 3 months.  No medication changes had been made in this time period and adherence was known as it was a long term care resident.

After three months without issue, the lip began to swell within a day or two.  The ACE Inhibitor was one of the only medication changes within the last 6 months and immediately suspected as the culprit.  The enalapril was discontinued and the angioedema resolved quickly.  Medication reactions and adverse effects happen most often within hours/days/weeks of changes, but occasionally they may take a while to appear.

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Written By Eric Christianson

August 12, 2015

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