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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