Swell Culprits: Medications Linked to Angioedema

Medications Commonly Linked to Angioedema

1. ACE Inhibitors (Angiotensin-Converting Enzyme Inhibitors)

ACE inhibitors are widely prescribed for hypertension, heart failure, and kidney disease. However, they are the most well-documented class of medications associated with angioedema, accounting for up to 30% of drug-induced cases.

• Mechanism: ACE inhibitors block the breakdown of bradykinin, a peptide that promotes blood vessel dilation. Elevated bradykinin levels can lead to increased vascular permeability and tissue swelling.
• Examples: Lisinopril, enalapril, ramipril.
• Risk Factors: African-American patients, women, and those with a history of allergic reactions to medications may be at higher risk.

2. ARBs (Angiotensin II Receptor Blockers)

While less common than ACE inhibitors, angiotensin receptor blockers (ARBs) have been implicated in some cases of angioedema.

• Examples: Losartan, valsartan, candesartan.
• Key Point: Patients who experience angioedema with ACE inhibitors may sometimes tolerate ARBs, but cross-reactivity is possible.

3. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

NSAIDs, used for pain and inflammation, can trigger angioedema, particularly in individuals with underlying sensitivities.

• Mechanism: NSAIDs may inhibit cyclooxygenase (COX) enzymes, disrupting prostaglandin production and promoting leukotriene activity, which can induce swelling.
• Examples: Ibuprofen, naproxen, aspirin.

4. Antibiotics

Certain antibiotics can provoke angioedema through allergic or non-allergic mechanisms.

• Examples: Penicillins, cephalosporins, sulfonamides.
• Allergy Concerns: True allergic reactions to antibiotics often involve immunologic pathways, making angioedema part of a broader hypersensitivity response.

5. Contrast Agents for Imaging

Intravenous contrast agents used in diagnostic imaging can occasionally cause angioedema, particularly in those with a history of allergies or prior reactions to contrast media.

• Symptoms: Rapid-onset facial swelling, sometimes accompanied by anaphylaxis.

6. Monoclonal Antibodies and Biologics

As targeted therapies become more common, biologics are increasingly recognized as culprits in drug-induced angioedema.

• Examples: Rituximab, omalizumab, adalimumab.
• Mechanism: These medications can activate immune responses or directly affect inflammatory pathways.