DELAYED-ONSET ANGIOEDEMA AFTER SEVEN YEARS OF ANGIOTENSIN-CONVERTING ENZYME INHIBITOR THERAPY
Le Ann James and David L Vesely

OBJECTIVE: To describe a case of delayed-onset angioedema in a patient who had been taking captopril for 7 years.

CASE SUMMARY: A 49-year-old Native American man with a 7-year history of hypertension and congestive heart failure treated with captopril presented with marked edema of his face and neck. He had not taken his captopril for 1 month until the night before admission, at which time he took one 25-mg tablet. Within 6 hours his family noticed that his face was swelling, and 2 hours later he began to have difficulty breathing and could swallow only saliva and beer. Within 24 hours after appropriate treatment, he was able to breathe easily and to swallow food. After 48 hours the edema had resolved.

DISCUSSION: The incidence of angioedema secondary to use of angiotensin-converting enzyme (ACE) inhibitors is 0.1–0.5%. The course of angioedema secondary to use of ACE inhibitors is unpredictable and can vary from mild to fatal secondary to laryngeal obstruction. Severe ACE inhibitor-induced angioedema may require emergency treatment with epinephrine, antihistamines, corticosteroids, and early tracheal intubation.

CONCLUSIONS: This case demonstrates that angioedema may be delayed for 7 years after ACE inhibitor therapy is started. ACE inhibitors should be discontinued in any patient who presents with angioedema. This case also suggests that interrupted dosing is a risk factor for angioedema and that this risk persists for at least 7 years after therapy is started.

J Pharm Technol 1998;14:153-7.