Presentation
Our objective was to review the presentation, diagnosis and acute management of a common adverse drug effect based on an uncommon patient presentation. [ncbi.nlm.nih.gov]
Entire Body System
- Asymptomatic
METHODS AND RESULTS: We conducted a prospective, randomized, double-blind, placebo-controlled trial in 100 patients with moderate or severe asymptomatic AS to examine the physiological effects of ramipril, particularly LV mass (LVM) regression. [ncbi.nlm.nih.gov]
Antiproliferative effects, Renal effects, Other effects, Effects on fibrinolytic balance Side effects Contraindications Drug interactions Dosing Clinical efficacy and practical use Heart failure: Target dose, ACE-I compared with angiotensin, receptor blockers Asymptomatic [escardio.org]
Additionally, our data mostly derives from participants with existing clinical sequelae of hypertension, and it would be useful to have data from asymptomatic people to increase the generalizability of this review. [cochrane.org]
Underutilization and clinical benefits of angiotensin-converting enzyme inhibitors in patients with asymptomatic left ventricular dysfunction. Am J Cardiol. 2000;86:644–8. 3. Bahit MC, Granger CB, Alexander KP, Kramer J, Lapointe NM, Califf RM. [aafp.org]
Respiratoric
- Dry Cough
Persistent dry cough is well known as the most common side-effect of angiotensin-converting enzyme (ACE) inhibitors. [ncbi.nlm.nih.gov]
The increase in bradykinin is also believed to be responsible for a troublesome side effect of ACE inhibitors, namely, a dry cough. [cvpharmacology.com]
If you have a dry cough and is uncomfortable, talk to your doctor. You might be able to try another kind of ACE inhibitor. [healthnavigator.org.nz]
- Chronic Cough
CONCLUSIONS: In a patient with chronic cough, ACE inhibitors should be considered as wholly or partially causative, regardless of the temporal relation between the initiation of ACE inhibitor therapy and the onset of cough. [ncbi.nlm.nih.gov]
Pierangelo Geppetti, Marcello Trevisani and Selena Harrison, Pharmacology of Putative Cough Receptors, Acute and Chronic Cough, 10.1201/b14188-7, (105-123), (2013). Sukhjot Kaur, Gurvinder P. Thami, Vadivelu Srinivasan, Ram Singh and Amrinder J. [doi.org]
Chronic Cough Chronic cough is a cough that does not go away and is generally a symptom of another disorder such as asthma, allergic rhinitis, sinus infection, cigarette smoking, GERD, postnasal drip, bronchitis, pneumonia, medications, and less frequently [medicinenet.com]
Gastrointestinal
- Vomiting
We report the first known case of ACEI-associated visceral angioedema occurring in a liver transplant recipient who presented with acute-onset abdominal pain, nausea, vomiting, diarrhea, radiologic findings of small bowel edema, and ascites. [ncbi.nlm.nih.gov]
- Nausea
We report the first known case of ACEI-associated visceral angioedema occurring in a liver transplant recipient who presented with acute-onset abdominal pain, nausea, vomiting, diarrhea, radiologic findings of small bowel edema, and ascites. [ncbi.nlm.nih.gov]
Some of the more commonly reported side effects with ACE inhibitors include: A dry persistent cough Blurred vision Dizziness Dry mouth or loss of taste in the mouth Fatigue Gastrointestinal upset (such as constipation, diarrhea, or nausea) Headache Increased [drugs.com]
- Failure to Thrive
Renal complications were the most frequently encountered long-term complications of fetal RAS-blockade syndrome, followed by neurodevelopmental delay and failure to thrive. [doi.org]
Liver, Gall & Pancreas
- Liver Dysfunction
The most serious, but rare, side effects of ACE inhibitors are: Kidney failure Allergic reactions Pancreatitis Liver dysfunction A decrease in white blood cells Swelling of tissues ( angioedema ). [medicinenet.com]
Common side effects include dizziness, hyperkalemia, and headache, while less common side effects include diarrhea, liver dysfunction, back pain, muscle cramp, renal impairment, and nasal congestion. References: Hsu, F. Y. et al. (2017). [news-medical.net]
Skin
- Blister
Other side effects include: Headache Fatigue Loss of appetite Upset stomach Diarrhea Numbness Fever Skin rashes or blisters Joint pain If your tongue or lips swell, call your provider right away, or go to the emergency room. [medlineplus.gov]
Neurologic
- Stroke
METHODS: A multi-center stroke registry was used to identify the pre-stroke medications of acute ischaemic stroke patients receiving intravenous rt-PA from January 2002 to December 2013. [ncbi.nlm.nih.gov]
Stroke Prevention Stroke is the third leading killer in the United States. Some of the warning signs of stroke include sudden confusion, trouble... [medicinenet.com]
- Seizure
Febrile Seizures Febrile seizures, or convulsions caused by fever, can be frightening in small children or infants. However, in general, febrile seizures are harmless. Febrile seizure is not epilepsy. [medicinenet.com]
Hyponatremia in PPD can progress to water intoxication and is characterized by symptoms of confusion, lethargy, and psychosis, and seizures or death. [doi.org]
Symptoms of hypoglycemia may be mild (adrenergic symptoms) or worrisome (neuroglycopenic symptoms, including seizures), with the intensity of symptoms often being directly related to the level of hypoglycemia. [cureus.com]
- Vertigo
Symptoms of a stroke may include: weakness, numbness, double vision or vision loss, confusion, vertigo, difficulty speaking or understanding speech. A physical exam, imaging tests, neurological exam, and blood tests may be used to diagnose a stroke. [medicinenet.com]
Urogenital
- Renal Insufficiency
Inhibition of the renin-angiotensin system is known to raise serum potassium [K(+)] levels in patients with renal insufficiency or diabetes. [ncbi.nlm.nih.gov]
[…] function in patients with renal insufficiency. [archinte.ama-assn.org]
INSUFFICIENCY In patients with renal insufficiency, no creatinine level is an absolute contraindication to ACE inhibitor therapy. [aafp.org]
- Oliguria
Among the most commonly reported effects are: Hypotension, renal dysplasia, anuria/oliguria, oligohydramios, intrauterine growth retardation, pulmonary hypoplasia, unclosed ductus arteriosus, incomplete ossification of the skull, intrauterine og neonatal [ncbi.nlm.nih.gov]
[…] heart failure or underlying renal disease, including renal artery stenosis), treatment with angiotensin converting enzyme inhibitors or angiotensin # receptor antagonists that affect this system has been associated with acute hypotension, azotaemia, oliguria [lv.glosbe.com]
In patients with severe heart failure with or without pre-existing renal insufficiency, ACE inhibitors may cause excessive hypotension with oliguria, azotemia and potentially fatal renal failure. [rxmed.com]
[…] heart failure or underlying renal disease, including renal artery stenosis), treatment with angiotensin converting enzyme inhibitors or angiotensin # receptor antagonists that affect this system has been associated with acute hypotension, azotemia, oliguria [et.glosbe.com]
However, recent analyses of clinical trial as well as acute heart failure registry data indicate that increases of serum creatinine due to ACEI administration (in the absence of severe oliguria) are the exception to this rule. [thecardiologyadvisor.com]
Workup
The etiology of recurrent hypoglycemia in a patient without diabetes, however, is unclear, often requiring extensive patient workup. [cureus.com]
ACE-inhibitor and / or beta-blockers treatment in the context of DMD cardiomyopathy are intrinsically hampered by differences in the individual study design (i.e. applied inclusion criteria for case selection, specific medication, chosen diagnostic workup [ojrd.biomedcentral.com]
Serum
- Neutropenia
Neutropenia/Agranulocytosis: Neutropenia and bone marrow depression have occurred during therapy with ACE inhibitors. [rxmed.com]
Other Considerations Neutropenia occurs rarely and tends to occur in patients with renal impairment and concurrent collagen vascular disease. [aafp.org]
Some develop angioedema due to increased bradykinin levels.[15] A genetic predisposition may exist.[16] A severe rare allergic reaction can affect the bowel wall and secondarily cause abdominal pain.[17] Blood[edit] Hematologic effects, such as neutropenia [en.wikipedia.org]
Treatment
Combined treatment with a mineralocorticoid receptor blocker further reduced albuminuria by 23 to 61% compared with standard treatment. Estimated glomerular filtration rate values upon study completion slightly decreased under combined treatment. [ncbi.nlm.nih.gov]
Symptoms in first year of treatment A total of 2569 patients were randomised to enalapril or placebo in the treatment trial. [bmj.bmjjournals.com]
Prognosis
Although the use of angiotensin-converting enzyme inhibitors should be avoided during pregnancy, patients whose fetuses are inadvertently exposed in utero need not be given a uniformly poor prognosis. [ncbi.nlm.nih.gov]
[…] agent used for the management of hypertension when oral therapy is not practical.DB08836TemocaprilTemocapril is an ACE inhibitor primarily indicated in the treatment of hypertension and congestive heart failure, diabetic nephropathy, and improvement of prognosis [drugbank.ca]
Prognosis. Abstract It is well established that long-term administration of angiotensin-converting enzyme (ACE) inhibitors has a favorable effect in patients with chronic heart failure and dilated cardiomyopathy. [revespcardiol.org]
The prognosis of a patient with congestive heart failure depends on the stage of the heart failure and the overall condition of the individual. [medicinenet.com]
Etiology
It was felt that angiotensin-converting enzyme inhibitor (ACEI)-induced angioedema of the small bowel was the most likely etiology of her symptoms. [ncbi.nlm.nih.gov]
The etiology of recurrent hypoglycemia in a patient without diabetes, however, is unclear, often requiring extensive patient workup. [cureus.com]
Epidemiology
ACE inhibitor use and risk of cataract: a case–control analysis Claudia Becker1,2, Susan S Jick3,4, Christoph R Meier1,2,3 1 Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University [bjo.bmj.com]
5, Jacob A Udell, cardiologist and assistant professor of cardiology 6 7, Laurent Azoulay, associate professor of epidemiology and oncology 1 2 8 1 Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada, [doi.org]
Hong Prevention of Heart Failure: A Scientific Statement From the American Heart Association Councils on Epidemiology and Prevention, Clinical Cardiology, Cardiovascular Nursing, and High Blood Pressure Research; Quality of Care and Outcomes Research [web.archive.org]
Pathophysiology
Some aspects of the pathophysiology have been elucidated and the vasoactive molecule bradykinin is shown to be one of the main causative agents. The diagnosis is often delayed and traditional treatment usually ineffective. [ncbi.nlm.nih.gov]
Prevention
Yet the use of angiotensin converting enzyme inhibitor (ACEI) yields conflicting results in the prevention of CIN. [ncbi.nlm.nih.gov]
A recent meta-analysis of ACE inhibitors' role in prevention of type 2 diabetes mellitus[3] suggests that they may preserve pancreatic function and prevent new-onset diabetes, especially in patients who are hypertensive with impaired glucose tolerance [ourmed.org]
Heart Attack Prevention Heart disease and heart attacks can be prevented by leading a healthy lifestyle with diet, exercise, and stress management.... [medicinenet.com]
ACE inhibitors are used for controlling blood pressure, treating heart failure, preventing strokes, and preventing kidney damage in people with hypertension or diabetes. They also improve survival after heart attacks. [web.archive.org]