lisinopril and Drug-Hypersensitivity

To compare effectiveness, tolerance and safety of two inhibitors of angiotensin-converting enzyme--sinopril (lisinopril) and capoten (captopril)--in outpatient treatment of patients with mild and moderate hypertension.. The patients were randomly assigned to sinopril or capoten groups. Sinopril was given in daily dose 10-40 mg, capoten--in daily dose 25-100 mg for 8 weeks. In insufficient antihypertensive effect of monotherapy on day 21, hydrochlortiaside was added. The effect was judged by influence on arterial pressure, heart rate, tolerance (questionnaire), safety (blood count, urinalysis. ECG).. Sinopril produced good antihypertensive effect in 73.3% of patients (monotherapy) and 88.9% (combined therapy). For capoten it was 68.9 and 82.2%, respectively. The time of the beginning of the antihypertensive effect (4-20 days after the start of the treatment) for sinopril and copoten differed insignificantly and depended on hypertension severity (mild or moderate). Tolerance of both drugs was good, serious side effects were absent. Discontinuation of the drugs was needed in 4% of patients, only. No negative action on bioelectric activity of the heart, clinical and biochemical blood indices were found.. Sinopril and capoten demonstrate high antihypertensive activity.

Topics: Angiotensin-Converting Enzyme Inhibitors; Blood Pressure; Captopril; Diuretics; Drug Hypersensitivity; Drug Therapy, Combination; Female; Heart Rate; Humans; Hydrochlorothiazide; Hypertension; Lisinopril; Male; Safety; Severity of Illness Index; Sodium Chloride Symporter Inhibitors; Treatment Outcome

Drugs are being prescribed with more frequency and in higher quantities. A serious adverse drug event from prescribed medications constitutes 2.4% to 16.2% of all hospital admissions. Many of the adverse drug events present intraorally or periorally in isolation or as a clinical symptom of a systemic effect. Clinical recognition and treatment of adverse drug events are important to increase patient adherence, manage drug therapy, or detect early signs of potentially serious outcomes. Oral manifestations of commonly prescribed medications include gingival enlargement, oral hyperpigmentation, oral hypersensitivity reaction, medication-related osteonecrosis, xerostomia, and other oral or perioral conditions. To prevent dose-dependent adverse drug reactions, physicians should prescribe medications judiciously using the lowest effective dose with minimal duration. Alternatively, for oral hypersensitivity reactions that are not dose dependent, quick recognition of clinical symptoms associated with time-dependent drug onset can allow for immediate discontinuation of the medication without discontinuation of other medications. Physicians can manage oral adverse drug events in the office through oral hygiene instructions for gingival enlargement, medication discontinuation for oral pigmentation, and prescription of higher fluoride toothpastes for xerostomia.

Topics: Albuterol; Amlodipine; Anticonvulsants; Antihypertensive Agents; Atorvastatin; Bisphosphonate-Associated Osteonecrosis of the Jaw; Bronchodilator Agents; Deprescriptions; Drug Hypersensitivity; Fluorides; Gingival Overgrowth; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Hyperpigmentation; Hypoglycemic Agents; Lisinopril; Losartan; Metformin; Metoprolol; Mouth Diseases; Omeprazole; Oral Hygiene; Proton Pump Inhibitors; Simvastatin; Thyroxine; Toothpastes; Xerostomia

The case detailed here is relatively rare but can be life-threatening. EMS personnel identified the case, provided the appropriate treatment presuming it to be an allergic reaction. Later, it was determined to have been caused by angioedema, but the staff believed that the prehospital care led to a more rapid diagnosis and subsequent care.

Topics: Aged; Angioedema; Angiotensin-Converting Enzyme Inhibitors; Drug Hypersensitivity; Emergency Medical Services; Emergency Service, Hospital; Female; Humans; Lisinopril; United States

Topics: Angioedema; Animals; Antihypertensive Agents; Arytenoid Cartilage; Diagnosis, Differential; Drug Hypersensitivity; Esophagoscopy; Food Hypersensitivity; History, 20th Century; Humans; Lisinopril; Meat

Captopril, enalapril, and lisinopril are angiotensin-converting enzyme (ACE) inhibitors widely prescribed for hypertension and heart failure. Cutaneous side effects of captopril include angio-edema, anaphylactoid reactions, maculopapular eruptions, pitiryasis rosea-like rash, toxic erythema, and exfoliative dermatitis. Some of the immunological captopril-induced cutaneous adverse reactions have been diagnosed in recent years by patch tests. A case of a cutaneous immune adverse reaction to captopril with tolerance to enalapril and lisinopril demonstrated both by patch tests and double-blind challenge tests is reported for the first time. A 71-year-old nonatopic woman suffered a generalized pruriginous maculopapular rash. Two months earlier, she had started oral treatment with captopril 50 mg t.i.d and glibenclamide 5 mg daily. After the rash appeared, she stopped both drugs and the reaction cleared. A skin biopsy from one of the lesions showed perivascular lymphocytic infiltrate of the upper dermis. Skin prick tests with captopril and glibenclamide and patch tests with enalapril, lisinopril, and glibenclamide at 1% and 10% pet., and with mercaptobenzothiazole (a sulfhydryl group-containing chemical at 1% pet were negative. Only patch tests with captopril at 1% and 10% concentrations were positive at 48 h. Oral double-blind challenge tests with glibenclamide, enalapril, lisinopril, and placebo showed good tolerance. The patient was advised to avoid only captopril. Because captopril is the only ACE inhibitor containing a sulfhydryl group and has occasionally been implicated in complex immunological diseases, this chemical group has been considered the culprit of allergic reactions to captopril. The lack of cross-reactivity between captopril, enalapril, and benazepril has been demonstrated in a few patients by patch tests. In our patient, patch tests identified captopril as the drug responsible for a probably immune adverse reaction not due to the sulfhydryl group. Patch tests are useful and safe in the diagnostic work-up of allergic drug reactions and in studies of cross-sensitivity among ACE inhibitors.

Topics: Aged; Angiotensin-Converting Enzyme Inhibitors; Captopril; Cross Reactions; Drug Hypersensitivity; Enalapril; Female; Glyburide; Humans; Lisinopril; Patch Tests; Skin Tests

Topics: Angioedema; Drug Hypersensitivity; Female; Humans; Lisinopril; Middle Aged; Recurrence

A 72-year-old woman was admitted to the hospital with "flash" pulmonary edema, preceded by chest pain, requiring intubation. Her medical history included coronary artery disease with previous myocardial infarctions, hypertension, and diabetes mellitus. A history of angioedema secondary to lisinopril therapy was elicited. Current medications did not include angiotensin-converting enzyme inhibitors or beta-blockers. She had no previous beta-blocking drug exposure. During the first day of hospitalization (while intubated), intravenous metoprolol was given, resulting in severe angioedema. The angioedema resolved after therapy with intravenous steroids and diphenhydramine hydrochloride.

Topics: Aged; Angioedema; Drug Hypersensitivity; Female; Humans; Injections, Intravenous; Lisinopril; Metoprolol; Mouth Diseases

Topics: Adult; Angioedema; Angiotensin-Converting Enzyme Inhibitors; Captopril; Drug Hypersensitivity; Enalapril; Humans; Lisinopril; Male