From the Guidelines
Angioedema of the lips should be treated with IV diphenhydramine 50 mg, IV methylprednisolone 125 mg, and ranitidine 50 mg IV or famotidine 20 mg IV, as per the 2018 guidelines for the early management of patients with acute ischemic stroke 1. When treating angioedema of the lips, it is essential to maintain the airway, and endotracheal intubation may not be necessary if edema is limited to the anterior tongue and lips. However, edema involving the larynx, palate, floor of mouth, or oropharynx with rapid progression poses a higher risk of requiring intubation. Some key considerations for treatment include:
- Discontinuing IV alteplase infusion and holding ACEIs if the angioedema is caused by these medications
- Administering epinephrine (0.1%) 0.3 mL subcutaneously or by nebulizer 0.5 mL if there is further increase in angioedema
- Using icatibant, a selective bradykinin B receptor antagonist, 3 mL (30 mg) subcutaneously in the abdominal area, with additional injections as needed
- Providing supportive care to manage symptoms and prevent complications It is crucial to prioritize the patient's airway and breathing, as angioedema can lead to potential airway compromise, especially when the lips, mouth, or throat are involved 1.
From the Research
Angioedema Lip Treatment
- Angioedema is a potentially life-threatening complication that can occur in the lips, and its treatment depends on the underlying cause 2, 3, 4, 5, 6.
- The pathophysiology of angioedema involves elevated serum bradykinin, and standard management typically includes corticosteroids and antihistamines, although their efficacy is not well established 2.
- For angioedema induced by angiotensin-converting enzyme inhibitors (ACEIs), treatment options include:
- Icatibant, a direct antagonist of bradykinin B2 receptors, which has been shown to be beneficial in several case reports and a small Phase II study 2, 6.
- Fresh frozen plasma (FFP), which provides kinase II, a protein that breaks down bradykinin 6.
- C1 inhibitor concentrate, which has been used successfully to manage ACEI-induced angioedema in a few reported cases 6.
- It is essential to note that epinephrine may not be effective in treating ACEI-induced angioedema and may even cause harm, such as myocardial ischemia or dysrhythmia 4.
- Accurate diagnosis by clinical examination is crucial to optimize patient management and reduce morbidity from inappropriate treatment 4.
- Securing the airway remains the most important intervention, followed by administration of both established and more novel pharmacologic interventions based on disease pathology 5.