What medications can cause angioedema?

From the Guidelines

Angioedema can be caused by several medications, including ACE inhibitors, ARBs, and ARNIs, with ACE inhibitors being the most common culprits. These medications can cause angioedema in about 0.1-0.7% of patients, sometimes even after years of use 1. Some specific examples of medications that can cause angioedema include:

• ACE inhibitors: lisinopril, enalapril, ramipril, and captopril
• ARBs: losartan and valsartan
• ARNIs: valsartan/sacubitril Other medications that may induce angioedema include:
• Certain antibiotics: penicillins, cephalosporins
• Statins: atorvastatin, simvastatin
• Fibrinolytics: tPA, streptokinase
• Some psychiatric medications The mechanism typically involves either direct mast cell activation leading to histamine release or interference with bradykinin metabolism, particularly with ACE inhibitors which prevent bradykinin breakdown 1. If angioedema develops, the offending medication should be discontinued immediately and alternative treatments considered. Patients with a history of angioedema should inform all healthcare providers about this reaction to avoid re-exposure to problematic medications. It is also important to note that ARNI therapy should not be administered in patients with a history of angioedema because of the concern that it will increase the risk of a recurrence of angioedema 1.

From the FDA Drug Label

Angioedema involving the extremities, face, lips, mucous membranes, tongue, glottis or larynx has been seen in patients treated with ACE inhibitors, including captopril. Anaphylactoid reactions during desensitization Two patients undergoing desensitizing treatment with hymenoptera venom while receiving ACE inhibitors sustained life-threatening anaphylactoid reactions. Anaphylactoid reactions during membrane exposure Anaphylactoid reactions have been reported in patients dialyzed with high-flux membranes and treated concomitantly with an ACE inhibitor. In considering use of captopril tablets, it should be noted that in controlled trials ACE inhibitors have an effect on blood pressure that is less in black patients than in non-blacks. In addition, ACE inhibitors (for which adequate data are available) cause a higher rate of angioedema in black than in non-black patients (see WARNINGS : Angioedema).

Medications that can cause angioedema include:

• ACE inhibitors, such as captopril 2 2 These medications can cause angioedema, which can be life-threatening if it involves the tongue, glottis, or larynx.

From the Research

Medications Associated with Angioedema

The following medications have been linked to angioedema:

• Angiotensin-converting enzyme inhibitors (ACEIs) 3, 4, 5, 6
• Angiotensin receptor blockers 3
• Nonsteroidal anti-inflammatory drugs (NSAIDs) 3, 7
• Beta-lactam antibiotics 3, 7
• Non-beta lactam antibiotics 7

Specific Examples of Medications

Some specific examples of medications that can cause angioedema include:

• Enalapril 4, 5
• Captopril 4, 5
• Lisinopril 4, 5
• Saralasin acetate 4
• Combination of ACEI with diuretics (e.g. Capozide) 4

Mechanisms of Angioedema

Angioedema can be mediated by different mechanisms, including:

• Histamine-mediated angioedema, which is associated with urticaria and pruritus 3
• Bradykinin-mediated angioedema, which is often familial (hereditary angioedema) and is more often associated with gastrointestinal symptoms 3
• Leukotriene-mediated angioedema 7