Thursday, April 19, 2012

Blood pressure pills and a numb tongue ( left side only)

The two patients presented yesterday have the same diagnosis , angioedema. 
The cause of the angioedema was lisinopril.


Angioedema is a transient swelling of subcutaneous tissue with multiple triggers that can be;

   Allergies -  such as food allergies ( nuts , shell fish , eggs ) , medications (penicillin  sulfa and others )
                    insect bites  and latex are common
   Hereditary angioedema

Non - Allergic Drug Reaction  - ACE Inhibitors

  I would like to focus our attention on the Non- Allergic drug reactions seen with medications called
  ACE Inhibitors . Lisinopril is a ACE inhibitor and was taken by both of the patients  discussed

   ACE inhibitors are excellent safe medications used by millions of people with diabetes to treat high
   blood pressure and to help protect  their kidneys from the damage caused by diabetes.

The Symptoms , are unusual atypical mimics

The symptoms of ACE Inhibitor induced angioedema are atypical and mimic other more common problems such insect bites , hives ,  heart and gall bladder disease.

  There are a few symptoms are more specific to angioedema.
     #1 the symptoms usually occur on one side of our body and resolve in hours to days with no residual
             Our patient number 2 had recurrent swelling and itching of either the top of his right  or left foot 
             and  numbness swelling and tingling of the left side of his tongue

     #2  atypical chest or upper abdominal pain with abnormal liver test that return to normal  within a few
     #3   Angioedema can occur with the first dose or after years of being on the medication.
               A physician friend of mine had one patient develop severe angiedema of her throat after taking
               her first pill . Our patients # 1 and 2 developed symptoms after years of taking lisinopril.

     #4   There may be a family history of allergies to medications. 
                Our patients #1 is allergic to Dilantin,and has a son and daughter allergic to penicillin.
                Our patient #2 is allergic to penicillin , has hay fever and mild asthma and has a son allergic to
                latex and penicillinA.

ACE Inhibitors are common very useful medications
 Lisinopril ( prinivil , Zesteril )                                          
  Captopril  (capiton )
  Ramipril  (Altase )
  Enalapril  ( Vasotec enalaprilat )
  Quinipril   ( Accupril  )  
  Benazepril  ( Lotensin )
  cilazapril     (Inhibace )
  fosinopril    ( monopril )
 moexipril     (Univasc )
 perindopril   ( Aceon , Coversyl )
 Trandolapril ( Mavik )

  It is hard to remember all of these different brands . Did you notice the generic names all end in "pril "
Have fun , be smart and understand the medication the medicines you are taking
David Calder , MD

Tomorrow!  What about them ARBS and are they related to ACE. 



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    1. Thank you for your comment. Angioedema is an uncommon side effect of ACE inhibitors and angiotensin receptor blockers (ARBS). I doubt that this side effect would have much effect on the price of the medication . Dr. Calder Merry Christmas

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    1. Thanks for your comment. .
      Viagra ,levitra and cialis all work by the same mechanism of inhibiting an enzyme that breaks down a vasodilator cGMP ( cyclic guanosine monophosphate ). The vasodilation and increased blood flow is the most effective in the penis and pulmonary arteries . These drugs are approved for the treatment of erectile dysfunction and pulmonary hypertension. They would have minimal effect for treating high blood pressure. Blood pressure medications are useful for managing high blood pressure , none of them cure high blood pressure.
      David Calder,MD


Your comments and questions are appreciated. David Calder,MD