Angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists.
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.
Kyrmizakis
Dionysios E
DE
Department of Ear, Nose, and Throat, University Hospital, Heraklion, Crete, Greece. dkyrmiz@yahoo.com
Papadakis
Chariton E
CE
Liolios
Antonios D
AD
Karatzanis
Alexandros D
AD
Malandrakis
Stylianos
S
Skoulakis
Charalambos E
CE
Bizakis
John G
JG
Velegrakis
George A
GA
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
D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors