Regulator warns doctors over delayed-onset angioedema linked to ACE inhibitors

iStock/Zay Nyi Nyi

By Emma Wilkinson

Health professionals have been warned to be alert to a rare side effect of ACE inhibitors that may appear even after weeks or years of taking the medication.

In a drug safety update, the Medicines and Healthcare products Regulatory Agency (MHRA) said doctors, particularly those working in emergency departments needed to be aware of the possibility of delayed-onset angioedema in those taking the medicines.

The cause of angioedema can be allergic or non-allergic and, while rare, can happen at any time after patients start taking ACE inhibitors, the alert said.

It follows a review of Yellow Card Data which found that approximately one-half of angioedema cases occurred 30 days or more after initiation of treatment.

This is higher than the 20-30% indicated by drugs manufacturers, the MHRA said.

The delayed-onset pattern is more associated with the non-allergic bradykinin-mediated angioedema, the update noted.

This is unlikely to respond to standard anaphylaxis treatments including adrenaline (epinephrine), which should prompt consideration of a non-allergic cause, the MHRA guidance stated.