Case Reports
Monday, November 13, 2023
01:00 PM–02:30 PM
Abstract
Introduction:
Angioedema is a rare condition precipitated by several medications including angiotensin-converting enzyme inhibitors (ACE-I) and less commonly, angiotensin II receptor blockers (ARBs). The use of ARBs after ACE-I-associated angioedema is considered safe and encouraged in certain guidelines.
Despite the lower risk with ARBs, a patient could redevelop angioedema. There is a paucity of data regarding the risk of ARB-induced angioedema and previous exposure to ACE-I. Our case contributes to the limited evidence regarding this serious adverse effect.
Case:
A 71-year-old Caucasian female presented to the emergency room with hives progressing to throat swelling determined to be angioedema. A CT scan revealed the patient had submucosal edema in bilateral aryepiglottic folds. Valsartan was stopped and the patient received intravenous methylprednisolone, diphenhydramine and famotidine.
The patient had a history of angioedema secondary to lisinopril. One day after lisinopril discontinuation, valsartan 80 mg daily was initiated and six days later increased to 160 mg daily. After 168 days of valsartan, angioedema redeveloped.
The patient’s symptoms rapidly improved and she was discharged on hospital day 2. Her valsartan was not resumed, and the patient denied any further symptoms on follow-up twelve days post discharge.
Discussion:
Our patient’s valsartan-associated angioedema (Naranjo Scale 5) followed a history of lisinopril-associated angioedema. Although rare, ARB-associated angioedema may be more likely to occur if the patient has had previous ACE-I associated angioedema. Other cases have reported angioedema to occur soon after dose titration or ACE-I conversion. After our patient experienced lisinopril-associated angioedema, they immediately started valsartan, and received therapy for months before developing recurrent angioedema. This information widens possible timelines of ARB-associated angioedema in patients with a history of ACE-I associated angioedema.
Conclusion:
ARBs can cause angioedema in patients with history of ACE-I induced angioedema. This medical condition can reoccur regardless of the timeline of starting the ARB or undergoing dose titration.
Presenting Author
Thaddeus McGiness PharmDAuthors
Megan Bradley MD
University of Tennessee Medical Center
Andrea S. Franks PharmD, BCPS
University of Tennessee Health Science Center, College of Pharmacy
Landon Johnson PharmD
University of Tennessee Medical Center