title: Angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists.
abstract: The use of angiotensin-converting enzyme inhibitors (ACEIs) has been implicated in many cases of angioedema, but, given the potential mechanism of this complication, it was not expected to be caused by angiotensin II receptor blockers (ARBs). However, in the past few years, scattered reports of angioedema associated with ARBs have appeared in the medical literature. We performed a retrospective chart review from January 1, 1998, through June 30, 2003, and a review of the literature. During this time, we managed head and neck angioedema induced by ACEIs (n = 27) and ARBs (n = 4) in 31 patients. All of them had significant mucosal swelling, and in some of them dyspnea and dysphagia coexisted. The most frequently involved areas were the oral tongue (13 cases), uvula and soft palate (5 cases), and larynx, mouth floor, and lips (3 cases each). Angioedema may be a more common complication of ACEI and/or ARB use than originally thought. This complication may occur after long-term use of these drugs. We advise that ARBs not be prescribed to patients with a history of angioedema, particularly that due to the use of ACEIs.
authors.affiliation: Department of Ear, Nose, and Throat, University Hospital, Heraklion, Crete, Greece. dkyrmiz@yahoo.com
authors.forename: Dionysios E
authors.initials: DE
authors.lastname: Kyrmizakis
authors.forename: Chariton E
authors.initials: CE
authors.lastname: Papadakis
authors.forename: Antonios D
authors.initials: AD
authors.lastname: Liolios
authors.forename: Alexandros D
authors.initials: AD
authors.lastname: Karatzanis
authors.forename: Stylianos
authors.initials: S
authors.lastname: Malandrakis
authors.forename: Charalambos E
authors.initials: CE
authors.lastname: Skoulakis
authors.forename: John G
authors.initials: JG
authors.lastname: Bizakis
authors.forename: George A
authors.initials: GA
authors.lastname: Velegrakis
mesh_terms: D000799:Angioedema / Q000139:chemically induced*; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007819:Laryngeal Edema / Q000139:chemically induced; D008297:Male; D008875:Middle Aged; D009059:Mouth Diseases / Q000139:chemically induced; D010160:Palate, Soft; D012189:Retrospective Studies; D014060:Tongue Diseases / Q000139:chemically induced; D014609:Uvula
chemical_list: D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors