Reactions 720 - 26 Sep 1998

★ SEnalapril/lisinopril/ramipril/trandolapril

Angioneurotic oedema in elderly patients (firstreport with trandolapril): 3 case reports

Three elderly patients developed angioneurotic oedemaduring treatment with ACE inhibitors. All patients hadpreviously experienced minor episodes of angioneuroticoedema during ACE inhibitor therapy.

The first patient, a 73-year-old woman, had been takinglisinopril 2.5 mg/day for 3.5 years to treat hypertension. Shepresented with left-sided tongue swelling and was treated withIV chlorpheniramine and hydrocortisone. She becamestridulous over the next 2 hours and the base of her tongue andsupraglottis became swollen. She was treated with furtherchlorpheniramine and hydrocortisone in addition to IMepinephrine [adrenaline] and her angioneurotic oedemaresolved. ACE inhibitor therapy was discontinued and she didnot experience any further episodes of angioneurotic oedemaduring a 6-month follow-up period.

The second patient, a 72-year-old woman, presented withswelling of her tongue and supraglottis after she had beentaking enalapril for 6 months [dosage and therapeuticindication not stated]. She was treated with IV hydrocortisoneand chlorpheniramine and IM epinephrine and a tracheostomywas necessary to establish a clear airway. Enalapril wasdiscontinued and she had no further episodes of angioneuroticoedema during 6 months’ follow-up.

The third patient, a 71-year-old man, had been takingtrandolapril 4 mg/day for 2 years as part of a clinical study ofessential hypertension. He was hospitalised with swelling ofthe floor of his mouth. Trandolapril was stopped. However,because of worsening heart function, he later began treatmentwith another ACE inhibitor, ramipril 2.5 mg/day andexperienced a recurrence of angioneurotic oedema. Analternative to an ACE inhibitor was recommended.Murray A, et al. ACE inhibitor use and severe angiodema. Postgraduate MedicalJournal 74: 571-572, Sep 1998 - Scotland 800706299

» Editorial comment: A search of AdisBase and Medline didnot reveal any previous case reports of angioneurotic oedemaassociated with trandolapril.

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Reactions 26 Sep 1998 No. 7200114-9954/10/0720-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved