Drug Safety

, Volume 25, Issue 2, pp 73–76

Can Angiotensin Receptor Antagonists Be Used Safely in Patients with Previous ACE Inhibitor-Induced Angioedema?

  • Laurence G. Howes
  • Diane Tran
Current Opinion

Abstract

Angioedema is an uncommon but potentially life-threatening adverse event associated with ACE inhibitor therapy which is believed to be due to potentiation of the vascular effects of bradykinin. Angiotensin receptor antagonists were not expected to produce angioedema, as they do not inhibit the catabolism of bradykinin. However, it is now apparent that angioedema is occasionally associated with angiotensin receptor antagonist therapy and may be more likely to occur in patients who have previously experienced angioedema while receiving ACE inhibitors. Angiotensin receptor antagonists cannot be considered to be a safe alternative therapy in patients who have previously experienced ACE inhibitor-associated angioedema.

References

  1. 1.
    Howes LG, Christie N. Angiotensin receptor antagonists and ACE inhibitors. Aust Fam Physician 1998; 27: 914–21PubMedGoogle Scholar
  2. 2.
    Linz W, Wiemer G, Gohlke P, et al. Contributions of kinins to the cardiovascular actions of angiotensin converting enzyme inhibitors. Pharmacol Rev 1995; 47: 25–49PubMedGoogle Scholar
  3. 3.
    Quincke H. Ũber akutes umschiebenes Hautödem. Monatsschr Prakt Dermatol 1882; 1: 129Google Scholar
  4. 4.
    Vleeming W, van Amsterdam JG, Stricker C, et al. ACE inhibitor-induced angioedema. Incidence, prevention and management. Drug Saf 1998; 18: 171–88PubMedCrossRefGoogle Scholar
  5. 5.
    Wilkin JK, Hammond JJ, Kirkendall WM. The captopril induced eruption. A possible mechanism: cutaneous kinin potentiation. Arch Dermatol 1980; 116: 902–5PubMedCrossRefGoogle Scholar
  6. 6.
    Suarez M, Ho PW, Johnson ES, et al. Angioneurotic edema, agranulocytosis, and fatal septicemia following captopril therapy. Am J Med 1986; 81: 336–8PubMedCrossRefGoogle Scholar
  7. 7.
    Slater EE, Merrill DD, Guess HA, et al. Clinical profile of angioedema associated with angiotensin converting enzyme inhibition. JAMA 1988; 260: 967–70PubMedCrossRefGoogle Scholar
  8. 8.
    Barna JS, Frable MA. Life threatening angioedema. Otolaryngol Head Neck Surg 1990; 103: 795–8PubMedGoogle Scholar
  9. 9.
    Ulmer JL, Garvey MJ. Fatal angioedema associated with lisinopril. Ann Pharmacother 1992; 26: 1245–6PubMedGoogle Scholar
  10. 10.
    Oike Y, Ogata Y, Higashi D, et al. Fatal angioedema associated with enalapril. Intern Med 1993; 32: 308–10PubMedCrossRefGoogle Scholar
  11. 11.
    Burkhart GA, Brown NJ, Griffin MR, et al. Angiotensin converting enzyme inhibitor associated angioedema: higher risk in blacks than in whites. Pharmacoepidemiol Drug Saf 1996; 5: 149–54PubMedCrossRefGoogle Scholar
  12. 12.
    Brown NH, Rat WA, Snowden M, et al. Black Americans have an increased rate of angiotensin converting enzyme inhibitor associated angioedema. Clin Pharmacol Ther 1996; 60: 8–13PubMedCrossRefGoogle Scholar
  13. 13.
    Regoli D. Neurohumoral regulation of precapillary vessels: the kallikrein-kinin system. J Cardiovasc Pharmacol 1984; 6Suppl. 2: S401–12PubMedCrossRefGoogle Scholar
  14. 14.
    Nussberger J, Cugno M, Amstutz C, et al. Plasma bradykinin in angioedema. Lancet 1998; 351: 1693–7PubMedCrossRefGoogle Scholar
  15. 15.
    Blais Jr C, Rouleau JL, Brown NJ, et al. Serum metabolism of bradykinin and des-Arg9-bradykinin in patients with angiotensin converting enzyme inhibitor associated angioedema. Immunopharmacology 1999; 43: 293–302PubMedCrossRefGoogle Scholar
  16. 16.
    Gainer JV, Nadeau JH, Ryder D, et al. Increased sensitivity to bradykinin among African Americans. J Allergy Clin Immunol 1996; 98: 283–7PubMedCrossRefGoogle Scholar
  17. 17.
    Frank MM, Gelfand JA, Atkinson JP. Hereditary angioedema; the clinical syndrome and its management. Ann Intern Med 1976; 84: 580–93PubMedGoogle Scholar
  18. 18.
    Mathews KP, Pan PM, Gardner NJ, et al. Familial carboxypeptidase N deficiency. Ann Intern Med 1980; 93: 443–5PubMedGoogle Scholar
  19. 19.
    Vaith P, Bender K, Peter HH. Angioneurotic edema in hereditary alpha-1-antitrypsin deficiency. Immun Infekt 1991; 19: 27–9PubMedGoogle Scholar
  20. 20.
    Warner KK, Visconti JA, Tschampel MM. Angiotensin II receptor blockers in patients with ACE inhibitor induced angioedema. Ann Pharmacother 2000; 24: 526–8CrossRefGoogle Scholar
  21. 21.
    Van Rijnsoever EW, Kwec-Zuiderwijk WJ, Feenstra J. Angioneurotic edema attributed to the use of losartan. Arch Intern Med 1998; 158: 2063–5PubMedCrossRefGoogle Scholar
  22. 22.
    Acker CG, Greenberg A. Angioedema induced by the angiotensin II blocker losartan [letter]. N Engl J Med 1995; 333: 1572PubMedCrossRefGoogle Scholar
  23. 23.
    Blais Jr C, Leclair P, Molinaro G, et al. Absence of effect of chronic angiotensin II type 1 receptor blockade on endogenous kinin concentration-induced paw edema model in the rat. Peptides 1999; 20: 343–52PubMedCrossRefGoogle Scholar
  24. 24.
    Sosa Canache B, Cierco M, Gutierrez CI, et al. Role of bradykinins and nitric oxide in the AT2 receptor medicated hypotension. J Hum Hypertens 2000; 14Suppl. 1: S40–6PubMedCrossRefGoogle Scholar

Copyright information

© Adis International Limited 2002

Authors and Affiliations

  • Laurence G. Howes
    • 1
    • 2
  • Diane Tran
    • 1
  1. 1.Department of Clinical PharmacologyUniversity of New South WalesSydneyAustralia
  2. 2.Department of Clinical PharmacologySt George HospitalKogarahAustralia

Personalised recommendations