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Treatment of Life-Threatening ACE-Inhibitor–Induced Angioedema

Hirschy, RaeAnn, PharmD, BCPS; Shah, Tanvi, PharmD, BCPS; Davis, Tamara, PharmD, BCPS; Rech, Megan A., PharmD, MSc, BCPS, BCCCP

Section Editor(s): Weant, Kyle A. PharmD, BCPS, FCCP; Column Editor

doi: 10.1097/TME.0000000000000211

Incidence of angioedema associated with angiotensin-converting enzyme inhibitors (ACE-I) has been estimated at 0.1%–2.2% of patients receiving treatment. Despite the potential severity of this disease state, standardized treatment is lacking. Traditional pharmacotherapy options include medications that target inflammatory mediators and the angiotensin pathway. However, because ACE-I-induced angioedema is caused by accumulation of bradykinin, these medications fail to target the underlying pathophysiology. Recently, novel therapies that target the kallikrein–bradykinin pathway have been studied. These include icatibant, ecallantide, C1 esterase inhibitors, and fresh-frozen plasma. Recent randomized controlled trials exhibit contradictory results with the use of icatibant. This is a focused review on traditional and novel treatment strategies for ACE-I-induced angioedema.

Department of Pharmacy, Loyola University Medical Center, Maywood, Illinois (Drs Hirschy, Shah, and Rech); and Department of Pharmacy, Novant Health-Forsyth Medical Center, Winston-Salem, North Carolina (Dr Davis).

Corresponding Author: RaeAnn Hirschy, PharmD, BCPS, Critical Care, Department of Pharmacy, Loyola University Medical Center, 2160 S First Ave, Maywood, IL 60153 (

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Disclosure: The authors report no conflicts of interest.

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