Calcium Channel Blocker-associated Small Bowel Angioedema

Abstract

Our case demonstrates that CCBs can cause isolated intestinal angioedema with distinctive endoscopic findings. The discontinuation of the involved medication is the key for both diagnosis and treatment.

Amlodipine-induced angioedema: An unusual complication of a common medication

“…Although limited data on cross-reactivity of CCBs currently exist, patients with DHP allergy seem to tolerate non-DHPs and vice versa. 2–4 However, in our patient, the underlying diagnosis of congestive heart fail- ure warranted therapy with ACE-I or ARB therapy. Therefore, a trial of an ARB was recommended for blood pressure control instead of an alternative CCB.…”

“…Here, we described a case of angioedema likely triggered by amlodipine, an uncommon adverse effect of this widely used drug. [1][2][3][4][5][6] There are two broad groups of CCBs: dihydropyridines (DHP) (amlodipine, nifedipine, and others) and non-DHPs (diltiazem and verapamil). Among these, diltiazem has the greatest propensity to induce a wide spectrum of cutaneous hypersensitivity reactions, 7 and DHPs to a much lesser extent.…”

Generalised peripheral oedema associated with amlodipine therapy in two dogs

“…There are no English-language reports of biopsies in human patients with profound amlodipine oedema; rather, the diagnosis is based on history and resolution of oedema after drug withdrawal (Southward et al 2009, Turcu et al 2009, Hom et al 2012. Acute fibrinoid degeneration, seen in humans with hypertension of various aetiologies (Gu and Herrera 2007, Rosenblum 2008, Fauci and Harrison 2009, was noted in Case 2 and may have been associated with the severity of the hypertension, or may reflect the nature of the purported amlodipineinduced vascular injury.…”

“…Amlodipine is a third-generation dihydropyridine L-type calcium channel blocker used to control hypertension. Human patients commonly exhibit mild dependent oedema as a side effect of therapy (Pfizer 2010), whereas severe diffuse or localised oedema is a rare unexplained adverse event associated with amlodipine, other calcium channel blockers and angiotensin-converting enzyme inhibitors in both children and adults (Sener et al 2005, Ganeshalingham and Wong 2007, Southward et al 2009, Turcu et al 2009, Pierce et al 2011, Hom et al 2012. Conversely, in veterinary species, mild dependent oedema is not described as a common side effect (Plumb 2011, Ramsey 2011 and only anecdotal reports of severe generalised oedema associated with amlodipine therapy exist.…”

Angioedema: Classification, management and emerging therapies for the perioperative physician

“…While medication induced (NSAIDS, ASA and ACEI) angioedema is well-established, it's worth noting that angioedema has also been reported due to calcium channel blockers, rocuronium and propofol. [ 38 39 40 ]…”