Perindopril-induced angioedema of the lips and tongue: a case report

Abstract

BackgroundAce inhibitor-induced angioedema, characterized by sudden-onset swelling of the mucous membrane, skin, or both, is a rare occurrence in the Kingdom of Saudi Arabia. Because of its safety and efficacy, perindopril is a commonly prescribed angiotensin-converting enzyme inhibitor. Here we describe the clinical manifestations, management, and outcome of perindopril-induced angioedema of the lips and tongue in a 65-year-old Saudi man.Case presentationA 65-year-old Saudi Arab man presented to an emergency department with lip and tongue swelling and dysphagia. There were no systemic symptoms and no past history of a similar event. He had been consuming perindopril 5 mg and amlodipine 5 mg for the last 3 weeks: brand name, Coveram, from the company Servier (Ireland) Industries Ltd.; one tablet of Coveram contains 3.395 mg perindopril corresponding to 5 mg perindopril arginine and 6.935 mg amlodipine besilate corresponding to 5 mg amlodipine. A physical examination revealed considerable swelling of his lips and tongue.Examinations of other systems, including his cardiovascular and respiratory systems, revealed unremarkable findings. All laboratory parameters were also normal. Electrocardiography demonstrated sinus rhythm, a normal P axis, and V-rate of 50–99.A clinical diagnosis of perindopril-induced angioedema was made, and perindopril was discontinued. The angioedema resolved completely after the administration of antihistamines and corticosteroids.ConclusionsAngioedema caused by angiotensin-converting enzyme inhibitors is an uncommon occurrence in Saudi Arabia. The findings from this case are expected to raise awareness about this condition among clinicians in this country.

Medicación antihipertensiva y sus reacciones adversas en la cavidad oral. Una revisión integrativa

“…Estos autores concuerdan que la hidroclorotiazida es un fármaco foto sensibilizante y es importante comunicar el riesgo de este medicamento a los pacientes Kostis et al, (2018) en su investigación relacionado al angioedema inducido por los IECA menciona que esta reacción se produce debido a que los IECA actúan en la inhibición de la degradación de bradiquinina dando como resultado la extravasación de plasma en el tejido submucoso lo cual conduce a angioedema. En un reporte de caso realizado por Alharbi et al, (2018) se relaciona a perindopril perteneciente a los IECA como responsable de angioedema de labios y lengua en un paciente de 65 años. Esta es una afección potencialmente letal, por lo tanto, es necesaria una detección temprana para una intervención terapéutica adecuada.…”

“…El edema es causado por hiper permeabilidad de las vénulas poscapilares debido a agentes vasoactivos (Bezalel et al, 2015). Puede ser potencialmente mortal, si se involucra la mucosa oral, labios, lengua y el tracto respiratorio superior, la hinchazón puede durar de unas pocas horas hasta las 72 horas Se ha observado angioedema inducido por los IECA, también se ha reportado a los bloqueadores de los receptores de la angiotensina II y bloqueadores de los canales de calcio pueden presentar este efecto adverso en menor proporción (Alharbi et al, 2018;Southerland et al, 2016;Weinstock & Johnson, 2016).…”

“…Su uso debe evitarse en individuos de alto riesgo y es importante el diagnóstico temprano, la intubación traqueal en casos de compromiso de las vías respiratorias. Alharbi et al, (2018) Perindopril-induced angioedema of the lips and tongue: A case report Report de caso 1 paciente Perindopril Angioedema de lengua y labio.…”

Oral adverse effects: drug‐induced tongue disorders

“…Perindopril is one of the ACE inhibitors that is often associated with angioedema of the lips and tongue. The underlying mechanism for ACE inhibitor‐induced angioedema is the enzymatic inhibition of bradykinin degradation (Alharbi et al, 2018 ). Early recognition of drug‐induced tongue oedema is important as it can be a life‐threatening condition.…”

“…Several studies have reported cases of drug‐induced tongue disorders (Alharbi et al, 2018 ; Balaji et al, 2014 ; Braggio et al, 2018 ; Brown, 1949 ; Gurvits & Tan, 2014 ; Healy et al, 2004 ; Hubiche et al, 2013 ; Kalogirou et al, 2017 ), but a comprehensive overview of drugs associated with tongue disorders as an adverse effect is not available. Such an overview will support oral healthcare providers in the recognition, diagnosis and eventual treatment of drug‐induced tongue disorders.…”