lisinopril and Mouth-Diseases

Drug-induced lesions of oral mucosa are well-established side effect of different commonly used drugs. A female patient under treatment for hypertension with an angiotensin-converting enzyme inhibitor (ACE inhibitor), lisinopril, developed blisters and ulcerations on oral mucosa 3 weeks after lisinopril intake. Due to clinical finding drug-induced pemphigus was considered. However, direct and indirect immunofluorescence anal-ysis revealed no autoantibodies that are commonly present in pemphigus while histological study suggested allergic reaction. Lisinopril was discontinued from further therapy and after a month after her first arrival patient has experienced complete remission of the disease. This case raises the question, whether the term pemphigus in drug-induced reactions could be used when immunopathological criteria for pemphigus are not fulfilled.

Topics: Angiotensin-Converting Enzyme Inhibitors; Antihypertensive Agents; Blister; Diagnosis, Differential; Drug Eruptions; Humans; Lisinopril; Mouth Diseases

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

Topics: Acute Disease; Aged; Angioedema; Antihypertensive Agents; Female; Humans; Lip Diseases; Lisinopril; Mouth Diseases; Tongue Diseases

Topics: Angioedema; Angiotensin-Converting Enzyme Inhibitors; Antihypertensive Agents; Female; Humans; Lisinopril; Middle Aged; Mouth Diseases; Mouth Floor

Angiotensin enzyme converting (ACE) inhibitors are a widely prescribed group of drugs used in the management of hypertension and heart failure. Several unwanted effects are associated with ACE inhibitors and this paper highlights those significant to the dental surgeon. Of particular concern is the problem of angioedema, which can be life threatening. Three case reports are presented that illustrate this problem and the management is discussed.

Topics: Angioedema; Angiotensin-Converting Enzyme Inhibitors; Antihypertensive Agents; Face; Female; Histamine H1 Antagonists; Humans; Laryngeal Diseases; Lisinopril; Male; Middle Aged; Mouth Diseases; Mouth Floor; Pharyngeal Diseases; Recurrence; Taste Disorders; Terfenadine; Tongue Diseases

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

Few drug reactions are more life threatening than the sudden development of edema involving the mucosal and submucosal layers of the upper aerodigestive tract. Drug-induced angioedema is a recognized entity of angiotensin-converting enzyme (ACE) inhibitors, and despite reports in medical journals and drug insert warnings, captopril and enalapril continue to be widely prescribed. As these drugs are efficacious and usually well-tolerated in the treatment of mild forms of hypertension, their popularity is rising. From June 1, 1984 to August 1, 1991, 36 patients with angioedema secondary to ACE inhibitors presented at the Medical College of Virginia Hospitals. Thirty were successfully managed with medical therapy. Two were intubated, 1 had placement of a nasal trumpet, and 3 required tracheostomies. Of extreme importance is the recognition that angioedema resulting from ACE inhibitors is probably not immunoglobulin E (IgE) mediated and that antihistaminics and steroids may not alleviate the airway obstruction. The otolaryngologist must be prepared for the need of possible early surgical intervention.

Topics: Adult; Aged; Aged, 80 and over; Airway Obstruction; Angioedema; Angiotensin-Converting Enzyme Inhibitors; Captopril; Dexamethasone; Dipeptides; Diphenhydramine; Enalapril; Epinephrine; Female; Humans; Injections, Intravenous; Laryngeal Edema; Lisinopril; Male; Middle Aged; Mouth Diseases; Pharyngeal Diseases; Prognosis