Patient education: Angioedema caused by ACE inhibitor medicines (The Basics)

What are ACE inhibitors? — 

These are medicines that are most often used to treat high blood pressure, but are also used to treat other problems. "ACE inhibitor" is short for "angiotensin-converting enzyme inhibitor." Examples of ACE inhibitors include enalapril, captopril, and lisinopril.

What is angioedema? — 

This is swelling of the tissue under the skin. It can be caused by different things, including an allergic reaction to certain medicines. ACE inhibitors can cause angioedema in some people.

The swelling can happen within a few weeks of starting the medicine. But in some cases, it can happen even after months or years of taking an ACE inhibitor every day without any swelling. Doctors are not sure why this happens.

The swelling usually lasts a few days and is not itchy.

What part of the body swells? — 

The swelling can happen on the lips, face, or tongue. It can also affect other parts of the body, including the intestines.

Depending on where the swelling is, it can cause different problems:

●Swelling of the tongue, mouth, and lips can be very dangerous if it makes it hard for you to breathe or swallow. Go to the emergency department right away if you get swelling in or near your mouth or throat. If you are having trouble breathing, you might need to call for an ambulance (in the US and Canada, call 9-1-1).

In the hospital, the doctors will monitor your breathing. If the swelling is causing your throat to close, they can put a tube in your throat to help you breathe. You will stay in the hospital until the swelling goes down.

●If swelling happens in the intestines, it can cause pain, vomiting, or diarrhea.

What should I do if I take an ACE inhibitor and have swelling? — 

You should:

●Stop taking the medicine, and tell your doctor.

●Never take that medicine or any other ACE inhibitor again.

●Make sure that your doctor puts a note in your medical record that you are allergic to ACE inhibitors.

●Make sure that your main doctor, your pharmacy, and any other doctors or nurses who care for you know that you should never take ACE inhibitors again.

Can the swelling happen again after I have stopped the ACE inhibitor? — 

Yes. You might get swelling again 1 or more times within the next few months. The medicine affects your body for a while, even after you stop taking it.

If you get swelling around your mouth or tongue again, go to the emergency department so doctors can monitor your breathing.

The swelling should stop happening after a few months. If it does not, tell your doctor. You might need to see an allergy specialist, because there might be another reason that you are still swelling. Sometimes, people have swelling caused by another problem that the ACE inhibitor makes worse.

What medicine should I switch to? — 

There are many other medicines for high blood pressure and heart problems that do not cause swelling. Ask your doctor what you should take instead of an ACE inhibitor. Medicines that do not cause swelling include angiotensin II receptor blockers ("ARBs"), beta blockers, and calcium channel blockers.

Remember that if you get swelling again in the first few months after stopping an ACE inhibitor, it is probably still related to the ACE inhibitor. That's because they continue to affect your body for a while, even after you stop taking them.

More on this topic

Patient education: Medicines for high blood pressure (The Basics)
Patient education: Medicines for heart failure with reduced ejection fraction (The Basics)
Patient education: Angioedema (The Basics)