Use of ARBs for patients who develop angioedema following ACE inhibitor treatment
UK Medicines Information summarises the evidence for this frequently asked question:
Can angiotensin II receptor blockers be taken if angioedema has occurred with ACE inhibitor treatment?
Angioedema is reported to occur in 0.1–0.2% of patients who take angiotensin-converting enzyme (ACE) inhibitors. However, since ACE inhibitors are given long term and patients can develop angioedema any time during therapy, the risk may be as high as 1% for patients after 10 years of treatment.
The exact cause of angioedema associated with ACE inhibitors has not been determined. Because ACE inhibitor-induced angioedema is thought to be related to accumulation of bradykinin, it was assumed that angiotensin
II receptor blockers (ARBs) would not cause this reaction; however it has been found to occur in some patients.
The incidence of angioedema in patients receiving ARBs is uncertain but appears to be lower than in patients receiving ACE inhibitors.
There is limited evidence to suggest that a significant number of patients who develop angioedema while taking ARBs have previously experienced angioedema during ACE inhibitor therapy. The incidence of angioedema in patients switched to an ARB following ACE inhibitor-induced angioedema has been described mainly in case reports and case series, with an incidence ranging from less than 10% to greater than 50%.
Because angioedema is potentially life-threatening, ARBs should be used with extreme caution in patients who have previously experienced angioedema while receiving ACE inhibitors. The risk of recurrent angioedema should be discussed with the patient.
This FAQ is taken from a “” produced by UK Medicines Information.
Document published 16 March 2010, expires 25 February 2012
Citation: Clinical Pharmacist URI: 11004831
Recommended from Pharmaceutical Press
Patient Care in Community Practice is a unique, practical guide for healthcare professionals or carers. Covers a range of non-medicinal products suitable for use at home.£22.00
The only pharmacy-specific OSCE revision guide. This easy-to-use book covers the key competencies that will be tested in your exams.£25.00
This established textbook covers every aspect of drug properties from the design of dosage forms to their delivery by all routes to sites of action in the body.£48.00
Introduction to Renal Therapeutics covers all aspects of drug use in renal failure. Shows the role of the pharmacist in patient care for chronic kidney disease.£38.00
The Handbook of Pharmaceutical Excipients contains essential data on the physical properties of excipients, their safe use and potential toxicity.£415.00