Ramipril
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Angioedema treated with icatibant: case report A 62-year-old man developed angioedema during treatment with ramipril. The man, whose history included hypertension, a previous cerebrovascular accident (CVA) and back pain, was hospitalised in March 2012 with sudden-onset airway compromise, obvious tongue swelling and drooling. He had been treated with chlorphenamine and hydrocortisone on the way to the hospital, but clinical improvement was not seen. His medications included ramipril [dosage and route not stated], which he had started taking in 2007 (5 years prior) following his CVA. An oedematous tongue base and epiglottis were seen upon flexible laryngoscopy. His vocal cords were clearly visible. He underwent cannulation, and routine blood tests were negative for infections. The patient was treated with antihistamines, steroids and epinephrine [adrenaline]. However, there was no improvement in his symptoms. Icatibant 30mg was administered subcutaneously, and he was suspected of having ACE inhibitor-induced angioedema. Of note, his ramipril was discontinued. His symptoms deteriorated. He developed progressive upper airway oedema and was unable to speak. He was intubated, and his vocal cards were not clearly visible at this time. He was sent to the ICU where he remained ventilated and intubated. He continued to receive IV fluids and steroids. In the ensuing hours, a slow resolution of his angioedema was seen. He was extubated, and he made a full recovery prior to discharge. He was advised on the need for lifelong avoidance of ACE inhibitors. Author comment: "ACE inhibitor-induced angioedema is a phenomenon of acute onset, often occurring months to years after the medication has been started." Illing EJ, et al. Icatibant and ACE inhibitor angioedema. BMJ Case Reports 2012: [3 pages], 30 Aug 2012. Available from: URL: http://dx.doi.org/10.1136/ 803079530 bcr-2012-006646 - United Kingdom
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Reactions 10 Nov 2012 No. 1427
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