Gabapentin and Angioedema Risk in Patients with ACE Inhibitor-Induced Angioedema History

Clinical Risk Assessment

• The American College of Cardiology notes that ACE inhibitors cause angioedema in fewer than 1% of users, with a higher frequency in Black patients and women 1
• The American College of Cardiology states that prior ACE inhibitor-induced angioedema does not predict or increase the risk of gabapentin-induced angioedema, as these are distinct drug classes with separate pathophysiologic mechanisms 1
• The American College of Cardiology guidelines indicate that there is no cross-reactivity between ACE inhibitors and gabapentin, unlike the documented cross-reactivity between ACE inhibitors and ARBs 1, 2

Mechanistic Explanation

• The mechanism of ACE inhibitor-induced angioedema involves the bradykinin pathway, whereas gabapentin-induced angioedema is a hypersensitivity reaction unrelated to bradykinin metabolism, according to the American College of Cardiology 1