Angiooedema under ACE inhibitors and angiotensin II receptor antagonists: analysis of 98 cases

Angiooedema has been reported as a rare bur in most cases serious adverse e ffect Of ACE inhibitors. Recent reports have indicated that angiotensin II- receptor antagonists may also induce angiooedema. As part of the spontaneou s reporting scheme in Switzerland the Swiss Drug Monitoring Centre (SANZ) h as received reports on 94 cases of ACE inhibitor-induced and 4 cases of ang iotension II-receptor antagonist-induced angiooedema. These 98 spontaneousl y reported cases were analysed in detail. 28 cases were classified as serio us and in three patients intubation was even required. In 35% of cases angi ooedema was induced within the first week of therapy and in 63% within the first year In one case the angiooedema displayed latency of 8 years. Latenc y of this duration shows that this adverse drug reaction (ADR) mall be hard to detect. In 45 of the 98 cases the oedema persisted for more than one da y (maximum 2 months), although in some instances the patients continued ACE -inhibitor therapy. In 25 cases the oedema recurred, in one instance as man y as 20 times. In rare cases angiooedema may also be induced by angiotensin II-receptor antagonists, although in such instances the course of the oede ma was usually milder. In two of the four reported cases angiooedema recurr ed after switching from an ACE inhibitor to an angiotensin II-receptor anta gonist. The four reported cases from Switzerland showed a similar profile w hen compared with 25 internationally documented cases. Our data indicate that angiooedema is a specific ACE inhibitor ADR. A protr acted latency period may be observed and recurrence of oedema is frequent. Angiotensin II-receptor antagonist-induced angiooedema may also occur in ra re instances.