Lisinopril-Induced Angioedema: Clinical Presentation and Management

Clinical Presentation and Severity

• Angioedema occurs in fewer than 1% of patients taking ACE inhibitors, but is more frequent in Black patients, according to the American Heart Association and the American College of Cardiology 1, 2

Immediate Management

• Patients with oropharyngeal or laryngeal involvement should be closely monitored in a medical facility capable of performing intubation or tracheostomy if necessary, as recommended by medical guidelines 3

Treatment Approach

• Standard treatments for allergic reactions are NOT effective for ACE inhibitor-induced angioedema, and bradykinin pathway-targeted therapies such as icatibant may be considered, as suggested by medical guidelines 3, 4
• Fresh frozen plasma may be considered if specific targeted therapies are unavailable, according to medical guidelines 3

Long-term Management

• ACE inhibitor-induced angioedema justifies subsequent avoidance of all ACE inhibitors for the lifetime of the patient, as recommended by the American Heart Association and the American College of Cardiology 1, 2
• Although ARBs may be considered as alternative therapy, extreme caution is advised when substituting an ARB, due to the risk of angioedema, as noted by the American Heart Association and the American College of Cardiology 1, 2

Risk Factors and Considerations

• African American patients, smokers, older individuals, and females are at higher risk for ACE inhibitor-induced angioedema, according to medical guidelines 3