How does lisinopril cause angioedema?
What causes ACE inhibitor-induced angioedema? ACE inhibitor-induced angioedema is due to the inhibition of bradykinin degradation resulting in elevated plasma bradykinin. As most people on ACEi are able to normalise the bradykinin level by other pathways, a genetic susceptibility is assumed.
How does lisinopril treat angioedema?
Treatment of Severe ACE Inhibitor Angioedema: Current and Future Therapies. ABSTRACT: For many years, corticosteroids, antihistamines, and epinephrine have been used to treat severe angioedema related to therapy with angiotensin-converting enzyme inhibitors (ACEIs).
How does bradykinin cause angioedema?
During bradykinin-mediated angioedema, increased levels of bradykinin results in overactivation of β2 bradykinin receptors and subsequently increased tissue permeability, vasodilation and edema (fig. 1).
How do ACE inhibitors affect bradykinin?
General Pharmacology ACE also breaks down bradykinin (a vasodilator substance). Therefore, ACE inhibitors, by blocking the breakdown of bradykinin, increase bradykinin levels, which can contribute to the vasodilator action of ACE inhibitors.
How do ACE inhibitors cause angioedema?
The pathophysiology of ACE-I-induced angioedema involves inhibition of bradykinin and substance P degradation by ACE (kininase II) leading to vasodilator and plasma extravasation. Treatment modalities include antihistamines, steroids, and epinephrine, as well as endotracheal intubation in cases of airway compromise.
Why does lisinopril cause angioedema in African American?
The mechanism of ACE inhibitor-associated angioedema is not known, although a plausible mechanism involves the vasoactive peptide bradykinin [6, 7]. The increased risk in black patients may be related to racial differences in the kallikrein-kinin system and increased sensitivity to bradykinin [8].
What is bradykinin mediated angioedema?
Bradykinin-mediated angioedema is a rare disease, due to vasodilation and increased vascular permeability resulting from bradykinin. This kind of angioedema affects abdominal and/or upper airways. It differs clinically from histamine-mediated angioedema by the absence of urticaria or skin rash.
What is the effect of bradykinin?
Effects. Bradykinin is a potent endothelium-dependent vasodilator and mild diuretic, which may cause a lowering of the blood pressure. It also causes contraction of non-vascular smooth muscle in the bronchus and gut, increases vascular permeability and is also involved in the mechanism of pain.
Why do ACE inhibitors end in pril?
ACE inhibitors end in -pril, such as captopril and lisinopril. ACE inhibitors reduce blood pressure by dilating blood vessels, thus reducing the heart’s workload. Beta-blockers end in -lol, such as atenolol, propranolol, and labetalol.
What is the role of bradykinin?
Bradykinin is a potent endothelium-dependent vasodilator and mild diuretic, which may cause a lowering of the blood pressure. It also causes contraction of non-vascular smooth muscle in the bronchus and gut, increases vascular permeability and is also involved in the mechanism of pain.
Can lisinopril cause lips to swell?
1 Angioedema is usually idiopathic and often occurs when patients are in their 40s or 50s. The medication review is important because nonsteroidal anti-inflammatory drugs (e.g., ibuprofen, naproxen [Naprosyn]) and angiotensin-converting enzyme inhibitors (e.g., lisinopril, captopril) are associated with angioedema.
What causes release of bradykinin?
Introduction. Bradykinin, a biologically active peptide, is released by the breakdown of a high molecular weight kininogen by kallikreins Altamura et al (1999). Bradykinin is involved in plasma extravasation, bronchoconstriction, nociception, vasodilation, and inflammation Burch et al (1990).