From the Guidelines
The percentage of patients on lisinopril who develop angioedema is less than 1%. This rare but serious side effect occurs more frequently in Black patients [ 1 ]. Angioedema typically involves swelling of the face, lips, tongue, throat, extremities, or genitalia due to bradykinin accumulation caused by ACE inhibitor interference with bradykinin breakdown.
Key Considerations
- The reaction is not dose-dependent and represents a class effect of all ACE inhibitors [ 1 ].
- If a patient develops angioedema while taking lisinopril, the medication should be discontinued immediately and never restarted.
- Alternative antihypertensive medications from different classes, such as angiotensin receptor blockers (though cross-reactivity can occur), calcium channel blockers, or thiazide diuretics should be considered instead [ 1 ].
Patient Education
- Patients should be educated to seek emergency care immediately if they experience facial swelling, difficulty breathing, or swallowing while taking lisinopril.
- It is essential to note that although the 2009 update [ 1 ] reiterates the same information regarding angioedema, the key takeaway remains that angioedema is a serious side effect that requires immediate attention and discontinuation of the ACE inhibitor.
From the Research
Angioedema Incidence in Patients on Lisinopril
- The incidence of angioedema in patients on lisinopril, an angiotensin-converting enzyme inhibitor, is reported to be between 0.1% and 0.7% 2, 3.
- A study published in 1995 reported that angioedema occurs in 0.1% to 0.5% of patients taking captopril, enalapril, or lisinopril 2.
- Another study published in 2017 reported that 0.20% of ACEI initiators developed angioedema while on the medication 4.
- A case report published in 2014 reported a case of life-threatening angioedema in a patient on ACE inhibitor (ACEI) confined to the upper airway, with an overall incidence of 0.1 to 0.7% of patients on ACE inhibitors 5.
Risk Factors and Treatment
- Risk factors for ACEI-induced angioedema include black race, history of drug rash, age older than 65 years, and seasonal allergies 4.
- Treatment of ACEI-induced angioedema is still a matter of debate, with corticosteroids and antihistamines showing no efficacy 3.
- Some therapeutic attempts have shown some efficacy for fresh frozen plasma or C1 inhibitor concentrate infusion, as well as the specific bradykinin receptor antagonist icatibant 3.