Saturday, April 21, 2012

Angioedema with an ACE inhibitor. How about an ARB ?

More on the ins and outs of ACE inhibitors ( angiotensin converting enzyme inhibitor ) and
 ARBS ( angiotensin receptor blocker ) .

ACE inhibitor associated angioedema is not common and occurs in about 0.1 to 0.68  % of people taking ACE inhibitors

 Yesterdays question .
   Can a person who developed angioedema from a ACE Inhibitor take an ARB ?

 Answer . 
    My short answer is no. I would not personally prescribe an ARB for someone who had angioedema
    with an ACE inhibitor.  One study found that about half of patients with ARB associated angioedema
    had previously  developed angioedema  taking ACE Inhibitors.
   ( Angiotensin 2 receptor blocker  associated angioedema: on the heels of ACE inhibitor angioedem 
   Pharmacotherapy 2002; 25:1173-75   Abdi R,Dong VM ,Lee CJ, Ntosso KA)

  The etiology of ACE Inhibitor associated angioedema is thought to be associated with Bradykinin. Bradykinin is a potent blood vessel dilator. ACE Inhibitors slow down the clearance of bradykinin from our body. This is generally a good thing and helps lower blood pressure and a bad thing when it causes angioedema.
Todays question :

   Can a person with a history of angioedema from any cause known or unknown take a ACE
   Inhibitor or ARB ?

 Answer : 
     My short answer is no. There are plenty of other Blood Pressure medications with lower risk.

Tomorrow - Persistent cough  ? Could it be your ACE Inhibitor ?

News alert from Medscape 4/20/2012

 The U.S. Food and Drug Administration ( FDA ) is warning of possible risk when using blood pressure medications containing aliskirin with ACE Inhibitors and ARBS  in patients with Diabetes  or kidney impairment.  Aliskiren Is often combined with other medications. check your Blood Pressure medication and contact your doctor if aliskiren is present in any of your medications. I have listed some of the combinations below.

Aliskiren                                                                               ( Tekturna )
aliskiren, amlodipine ,hydrochlorothiazide combination ( Amternide )
aliskiren ,amlodipine                                                            (Tekamlo )
aliskiren ,valsartan                                                               ( Valturna)

Have fun ,  be Smart , be safe and know the name , contents and why you are taking any 

David calder,MD

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Your comments and questions are appreciated. David Calder,MD