From the Guidelines
Patients with an allergy to lisinopril can typically tolerate an angiotensin receptor blocker (ARB), as the mechanisms of action and chemical structures of these two classes of medications are different, and allergies to ACE inhibitors are not typically cross-reactive with ARBs 1. When considering the use of ARBs in patients with a history of ACE inhibitor allergy, it is essential to note that ARBs do not inhibit kininase and are associated with a much lower incidence of cough and angioedema compared to ACE inhibitors 1. Key points to consider when switching to an ARB include:
- Starting with a low dose and titrating upward to minimize the risk of adverse reactions
- Close monitoring during initial dosing, especially in patients with a history of angioedema from lisinopril
- Selecting the appropriate medication and dosage based on the patient's specific condition, such as hypertension or heart failure
- Supervision by a healthcare provider to monitor for any adverse reactions and adjust the treatment plan as needed 1. The use of ARBs has been shown to reduce morbidity and mortality in patients with heart failure with reduced ejection fraction (HFrEF) who are intolerant to ACE inhibitors due to cough or angioedema 1. Overall, while caution is still warranted when starting an ARB in patients with a history of ACE inhibitor allergy, the available evidence suggests that ARBs can be a safe and effective alternative for these patients 1.
From the FDA Drug Label
-a history of angioedema or hypersensitivity related to previous treatment with an angiotensin converting enzyme inhibitor The FDA drug label does not answer the question.
From the Research
Allergy to Lisinopril and Tolerance to ARB
- A patient with an allergy to lisinopril, an angiotensin-converting enzyme inhibitor (ACEI), may be considered for treatment with an angiotensin receptor blocker (ARB) as an alternative therapy for hypertension 2.
- Studies have shown that ARBs, such as losartan, have a similar antihypertensive effect to ACEIs, such as lisinopril, but with superior tolerability 2.
- In a prospective and randomized study, losartan was found to have fewer episodes of adverse effects compared to lisinopril, with a lower incidence of coughing (7.5% vs 31.7%) 2.
- Another study found that ARBs, such as telmisartan, were effective and safe in reducing systolic and diastolic blood pressure, with no significant adverse reactions observed 3.
Cross-Reactivity between ACEIs and ARBs
- There is no direct evidence to suggest that a patient with an allergy to lisinopril will necessarily react to an ARB, as the mechanisms of action and chemical structures of these two classes of medications are different 4, 2.
- However, it is essential to exercise caution and monitor the patient closely when introducing an ARB, as individual responses to medications can vary greatly 5, 6.