ACE inhibitor side effects and angioedema

This reaction is called angioedema. With an ACE inhibitor, swelling is linked to a buildup of bradykinin rather than a typical allergy. It may begin soon after treatment starts or after the medicine has been taken without problems for a long time. The swelling is often not itchy and may occur without raised hives. Lips, tongue, face, throat, and sometimes the bowel can be affected; bowel involvement may cause significant abdominal pain, nausea, or vomiting.

Do not take another dose of the suspected ACE inhibitor and obtain prompt medical assessment. Bring the medicine packet or a current medication list, and tell the clinician when the swelling began and which areas are affected. A clinician can record the reaction and choose a different blood-pressure medicine. Do not restart the ACE inhibitor unless a qualified clinician who knows about the reaction has specifically directed you to do so. Treatments commonly used for allergic swelling, such as antihistamines or corticosteroids, may have limited effect on bradykinin-related angioedema, so they must not delay airway assessment.

Call emergency services immediately for tongue or throat swelling, a changed or muffled voice, noisy breathing, shortness of breath, drooling, difficulty swallowing, faintness, or rapidly increasing facial swelling. Do not drive yourself if breathing or swallowing is affected. Even swelling that seems mild deserves same-day medical advice because it can progress and the medicine usually needs to be changed.

Ask which medicine is the likely trigger, what name should be added to your medication-reaction record, and which alternative can manage the condition for which the ACE inhibitor was prescribed. Also ask what to do if swelling returns after stopping the medicine and whether any other cause needs evaluation.