Drug-induced angioedema

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Drug-induced angioedema
SynonymsAcquired angioedema
Specialty Dermatology

Drug-induced angioedema is a known complication of the use of angiotensin-converting enzyme (ACE) inhibitors, angiotensin II antagonists (ARBs), and Angiotensin-Neprilysin Inhibitor LCZ969. [1] :120 The angioedema appears to be dose dependent as it may resolve with decreased dose. [1] :120

ACE inhibitor pharmaceutical drug used primarily for the treatment of hypertension (elevated blood pressure) and congestive heart failure

An angiotensin-converting-enzyme inhibitor is a pharmaceutical drug used primarily for the treatment of hypertension and congestive heart failure.

Angioedema skin disease characterized by the rapid swelling of the dermis, subcutaneous tissue, mucosa and submucosal tissues

Angioedema is an area of swelling of the lower layer of skin and tissue just under the skin or mucous membranes. The swelling may occur in the face, tongue, larynx, abdomen, or arms and legs. Often it is associated with hives, which are swelling within the upper skin. Onset is typically over minutes to hours.

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Presentation

Angioedema presents itself as an abrupt onset of non-pitting, non-itchy swelling that involves the mucosal layers. Some common locations of angioedema are the face, particularly the lips and around the eyes, hands and feet, and genitalia. [2] A rare, yet serious complication is one inside the abdomen, the symptom usually being severe stomach upset, which is much less obvious than the other locations. [3]

Edema abnormal accumulation of fluid in the interstitium

Edema, also spelled oedema or œdema, is an abnormal accumulation of fluid in the interstitium, located beneath the skin and in the cavities of the body, which can cause severe pain. Clinically, edema manifests as swelling. The amount of interstitial fluid is determined by the balance of fluid homeostasis and the increased secretion of fluid into the interstitium. The word is from Greek οἴδημα oídēma meaning "swelling". The condition is also known as dropsy.

Mucous membrane the protective layer, which lines the interior of hollow organs

A mucous membrane or mucosa is a membrane that lines various cavities in the body and covers the surface of internal organs. It consists of one or more layers of epithelial cells overlying a layer of loose connective tissue. It is mostly of endodermal origin and is continuous with the skin at various body openings such as the eyes, ears, inside the nose, inside the mouth, lip, vagina, the urethral opening and the anus. Some mucous membranes secrete mucus, a thick protective fluid. The function of the membrane is to stop pathogens and dirt from entering the body and to prevent bodily tissues from becoming dehydrated.

Risk factor

Some common ACE Inhibitors are:

Benazepril chemical compound ACE inhibitor

Benazepril, sold under the brand name Lotensin among others, is a medication used to treat high blood pressure, heart failure, and diabetic kidney disease. It is a reasonable initial treatment for high blood pressure. It is taken by mouth. Versions are avaliable as the combinations benazepril/hydrochlorothiazide and benazepril/amlodipine.

Captopril chemical compound: ACE inhibitor

Captopril, sold under the brand name Capoten among others, is an angiotensin-converting enzyme (ACE) inhibitor used for the treatment of hypertension and some types of congestive heart failure.

Enalapril ACE inibhitor used to treat high blood pressure, diabetic kidney disease, and heart failure.

Enalapril, sold under the brand name Vasotec among others, is a medication used to treat high blood pressure, diabetic kidney disease, and heart failure. For heart failure, it is generally used with a diuretic, such as furosemide. It is given by mouth or by injection into a vein. Onset of effects are typically within an hour when taken by mouth and last for up to a day.

Some common ARBs are:

Candesartan angiotensin II receptor antagonist used mainly for the treatment of hypertension

Candesartan is an angiotensin receptor blocker used mainly for the treatment of high blood pressure and congestive heart failure.

Losartan chemical compound

Losartan, sold under the trade name Cozaar among others, is a medication mainly used to treat high blood pressure. It is also used for diabetic kidney disease, heart failure, and left ventricular enlargement. It is taken by mouth. It may be used alone or in addition to other blood pressure medication. Up to six weeks may be required for the full effects to occur.

Olmesartan angiotensin II receptor antagonist which has been used for the treatment of high blood pressure

Olmesartan, sold under the trade name Benicar among others, is a medication used to treat high blood pressure, heart failure, and diabetic kidney disease. It is a reasonable initial treatment for high blood pressure. It is taken by mouth. Versions are avaliable as the combination olmesartan/hydrochlorothiazide and olmesartan/amlodipine.

Incidence

The chance of drug-induced angioedema is extremely uncommon, however, as studies show incidence of less than 1%. [4] The reason this adverse effect may occur is due to the build-up of bradykinin, a vasodilator. This causes blood vessels to dilate and allow for fluid buildup in the mucosal surfaces.

Bradykinin InterPro Family

Bradykinin is an inflammatory mediator. It is a peptide that causes blood vessels to dilate (enlarge), and therefore causes blood pressure to fall. A class of drugs called ACE inhibitors, which are used to lower blood pressure, increase bradykinin, further lowering blood pressure. Bradykinin dilates blood vessels via the release of prostacyclin, nitric oxide, and Endothelium-Derived Hyperpolarizing Factor.

See also

Related Research Articles

Antihypertensives are a class of drugs that are used to treat hypertension. Antihypertensive therapy seeks to prevent the complications of high blood pressure, such as stroke and myocardial infarction. Evidence suggests that reduction of the blood pressure by 5 mmHg can decrease the risk of stroke by 34%, of ischaemic heart disease by 21%, and reduce the likelihood of dementia, heart failure, and mortality from cardiovascular disease. There are many classes of antihypertensives, which lower blood pressure by different means. Among the most important and most widely used drugs are thiazide diuretics, calcium channel blockers, ACE inhibitors, angiotensin II receptor antagonists (ARBs), and beta blockers.

Angiotensin-converting enzyme protein-coding gene in the species Homo sapiens

Angiotensin-converting enzyme, or ACE, is a central component of the renin–angiotensin system (RAS), which controls blood pressure by regulating the volume of fluids in the body. It converts the hormone angiotensin I to the active vasoconstrictor angiotensin II. Therefore, ACE indirectly increases blood pressure by causing blood vessels to constrict. ACE inhibitors are widely used as pharmaceutical drugs for treatment of cardiovascular diseases.

Fosinopril mixture of stereoisomers

Fosinopril is an angiotensin converting enzyme (ACE) inhibitor used for the treatment of hypertension and some types of chronic heart failure. Fosinopril is the only phosphinate-containing ACE inhibitor marketed, by Bristol-Myers Squibb under the trade name Monopril.

Angiotensin II receptor blocker group of pharmaceuticals that modulate the renin–angiotensin system

Angiotensin II receptor blockers (ARBs), also known as angiotensin II receptor antagonists, AT1 receptor antagonists or sartans, are a group of pharmaceuticals that modulate the renin–angiotensin system. Their main uses are in the treatment of hypertension (high blood pressure), diabetic nephropathy (kidney damage due to diabetes) and congestive heart failure. They selectively block the activation of AT1 receptors, preventing the binding of angiotensin II compared to ACE inhibitors.

Lisinopril chemical compound

Lisinopril is a medication of the angiotensin-converting enzyme (ACE) inhibitor class used to treat high blood pressure, heart failure, and after heart attacks. For high blood pressure it is usually a first line treatment, although in black people calcium-channel blockers or thiazide diuretics work better. It is also used to prevent kidney problems in people with diabetes. Lisinopril is taken by mouth. Full effect may take up to four weeks to occur.

Ramipril ACE inhibitor

Ramipril, sold under the brand name Altace among others, is a medication used to treat high blood pressure, heart failure, and diabetic kidney disease. Also used to prevent cardiovascular disease in those at high risk. It is a reasonable initial treatment for high blood pressure. It is taken by mouth.

Quinapril ACE inhibitor used in the treatment of hypertension and congestive heart failure

Quinapril, sold under the brand name Accupril among others, is a medication used to treat high blood pressure, heart failure, and diabetic kidney disease. It is a reasonable initial treatment for high blood pressure. It is taken by mouth.

Valsartan angiotensin II receptor antagonist (commonly called an ARB, or angiotensin receptor blocker), that is selective for the type I (AT1) angiotensin receptor

Valsartan, sold under the trade name Diovan among others, is a medication used to treat high blood pressure, heart failure, and diabetic kidney disease. It is a reasonable initial treatment for high blood pressure. It is taken by mouth. Versions are avaliable as the combination valsartan/hydrochlorothiazide and valsartan/amlodipine.

Aliskiren first in a class of drugs called direct renin inhibitors

Aliskiren is the first in a class of drugs called direct renin inhibitors. It is used for essential (primary) hypertension. While used for high blood pressure, other better studied medications are typically recommended due to concerns of higher side effects and less evidence of benefit.

Omapatrilat chemical compound

Omapatrilat is an experimental antihypertensive agent that was never marketed. It inhibits both neprilysin and angiotensin-converting enzyme (ACE). NEP inhibition results in elevated natriuretic peptide levels, promoting natriuresis, diuresis, vasodilation, and reductions in preload and ventricular remodeling.

Ecallantide is a drug used for the treatment of hereditary angioedema (HAE) and in the prevention of blood loss in cardiothoracic surgery. It is an inhibitor of the protein kallikrein and a 60-amino acid polypeptide which was developed from a Kunitz domain through phage display to mimic antibodies inhibiting kallikrein.

Sacubitril/valsartan chemical compound

Sacubitril/valsartan, sold under the brand name Entresto among others, is a combination drug for use in heart failure developed by Novartis. It consists of the neprilysin inhibitor sacubitril and the angiotensin receptor blocker valsartan, in a 1:1 mixture by molecule count. It is recommended for use as a replacement for an ACE inhibitor or an angiotensin receptor blocker in people with heart failure with reduced ejection fraction.

Fimasartan chemical compound

Fimasartan is a non-peptide angiotensin II receptor antagonist (ARB) used for the treatment of hypertension and heart failure. Through oral administration, fimasartan blocks angiotensin II receptor type 1 (AT1 receptors), reducing pro-hypertensive actions of angiotensin II, such as systemic vasoconstriction and water retention by the kidneys. Concurrent administration of fimasartan with diuretic hydrochlorothiazide has shown to be safe in clinical trials. Fimasartan was approved for use in South Korea in September 9, 2010 and is available under the brand name Kanarb through Boryung Pharmaceuticals, who are presently seeking worldwide partnership. fimasartan is being marketed in india under the brand name of Fimanta and Fimagen through Ajanta Pharma Ltd.

Sacubitril chemical compound

Sacubitril is an antihypertensive drug used in combination with valsartan. The combination drug sacubitril/valsartan, known during trials as LCZ696 and marketed under the brand name Entresto, is a treatment for heart failure. It was approved under the FDA's priority review process for use in heart failure on July 7, 2015.

References

  1. 1 2 James, William; Berger, Timothy; Elston, Dirk (2005). Andrews' Diseases of the Skin: Clinical Dermatology. (10th ed.). Saunders. ISBN   0-7216-2921-0.
  2. ↑ Winters, Michael. “Clinical Practice Guideline: Initial Evaluation and Management of Patients Presenting
  3. ↑ J Community Hosp Intern Med Perspect. 2014; 4(4): 10.3402/jchimp.v4.25260
  4. ↑ Banerji, Aleena. “Multicenter study of patients with angiotensin-converting enzyme inhibitor-induced angioedema who present to the emergency department.” Annals of Allergy, Asthma & Immunology (2008); 100: 327-332. Web. 2 Nov 2014

2. Angiotensin-Neprilysin Inhibition versus Enalapril in Heart Failure (PARADIGM-HF Investigators); NEJM.org, September 11, 2014; Vol.371, No.11.

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