Man in blue dress shirt choking himself, unexpected reaction

High blood pressure is a risk factor for strokes and heart attacks as well as kidney disease and other chronic conditions. Doctors can choose from a wide range of medications to control hypertension. Frequently they select an inexpensive and effective drug in the class called ACE inhibitors. (It stands for angiotensin-converting enzyme inhibitors, or blockers.) But might a patient suffer an unexpected reaction after taking an ACE inhibitor for years?

Deadly Reaction to Lisinopril:

Q. On January 15, my brother experienced an allergic reaction that made his throat and tongue swell. He was rushed to the nearest emergency room, but shortly after he arrived his airways closed up so the ER staff could not get a tube in for some time.

His wife had brought in his meds and it was quickly determined that the culprit was the blood pressure pill lisinopril. He had been been taking it for four years.

He went into cardiac arrest and was revived but suffered massive brain damage. He died February 8. You might want to warn your readers about this reaction.

A. We are so sorry to learn of your brother’s tragic death.

Lisinopril is the most commonly prescribed blood pressure medicine in the U.S. At last count, roughly 77 million prescriptions were filled annually.

Angioedema as a Reaction to an ACE Inhibitor:

Although many people do well on this medication, some suffer from a reaction rather similar to your brother’s. It is called angioedema and is characterized by rapid swelling of the face, throat, tongue and airways. Blood pressure drugs called ACE inhibitors (benazepril, captopril, enalapril, fosinopril, lisinopril, quinapril, ramipril) can trigger this reaction, sometimes even after years on the drug.

Anyone who experiences swelling while taking an ACE inhibitor should treat this as an emergency. If angioedema occurs, the drug should be discontinued and medical treatment sought immediately.

Your brother is not the only person to have suffered from this serious reaction, though it does not always prove fatal. Another reader was lucky enough to survive.

Unexpected Reaction to ACE Inhibitors Caused Choking:

Q. I had been taking the blood pressure pill lisinopril for about twenty years before I had an allergic reaction. My tongue swelled so big I had to get to the emergency room quickly. It was very scary, as my throat was swelling shut and making it hard to breathe.

From the ER I was admitted to the ICU unit and given steroid breathing treatments as well as Benadryl and adrenaline. After 24 hours I’m feeling better.

Could the abdominal pain, bouts of diarrhea and bouts with shortness of breath have been warning signs of this allergy? It’s incredible that after taking a medication for so long, one day it nearly kills you.

Angioedema as an Unexpected Reaction to Lisinopril and Other ACEi Drugs:

A. The unexpected reaction you experienced is called angioedema. It can affect the digestive tract as well as the mouth and throat.

Angioedema is becoming more common among people taking ACE inhibitor medicines such as lisinopril (Javaud et al, Medicine, Nov. 2015).  You are lucky that the emergency room staff knew how to treat it, as hospitals don’t always have specific protocols in place (Bernstein et al, International Journal of Emergency Medicine, online, April 2017).

ACE Inhibitor Drugs:

The ACEi medicines include a lot of familiar names that end in “pril:” benazepril (Lotensin), captopril (Capoten), enalapril (Vasotec), fosinopril (Monopril), lisinopril (Prinivil, Zestril), moexipril (Univasc), perindopril (Aceon), quinapril (Accupril), ramipril (Altace) and trandolapril (Mavik). This type of reaction is very uncommon, but also very dangerous.

ARB Medications:

ACEi drugs are not the only ones that can cause an unexpected reaction. Another class of blood pressure pills called angiotensin receptor blockers, or ARBs, are also known to trigger angioedema (Faisant et al, Journal of Clinical Immunology, Jan. 2016). These are drugs such as azilsartan (Edarbi), candesartan (Atacand), eprosartan (Teveten), irbesartan (Avapro), losartan (Cozaar), olmesartan (Benicar), telmisartan (Micardis) and valsartan (Diovan).

Lou reported a similar problem:

“I had a very similar experience, except not as severe. I had taken lisinopril for approximately 10 years with success. One month ago my lips began swelling and overnight my entire face swelled very significantly. My internist told me to stop the lisinopril immediately, take 50 mg of Benadryl and come to her office. She immediately diagnosed angioedema caused by the lisinopril.

“I was stunned and it would never have occurred to me that a medication that I had used for 10 years would be the cause. She said it was too dangerous to take another ACE Inhibitor, nor could I take an ARB for the same reason. We tried Amlodipine, a calcium channel blocker, without success. It did not lower my BP and I also experienced leg pain. Next, I will try HCTZ.

“Interestingly, about two months after I first started the Lisinopril I had some mild swelling of my lips and penis that was treated by my previous internist with Zyrtec. The swelling went away without understanding the reason. Could this have been a warning that was missed?”

Another reader, David, is a pharmacist. Nonetheless, the reaction took him by surprise:

“I too had an angioedema type reaction to lisinopril. Initially watery itching eyes, progressing to facial swelling then difficulty talking and finally trouble breathing. I went to the ER and was immediately diagnosed as angioedema. First question was have you been taking lisinopril? Epinephrine will not reverse this reaction. Steroids and IVs are needed. Why there is no black box for this group of drugs I will never know. The delayed reaction after years of taking makes one think that the drug could not be causing the problem. As a pharmacist, I know what the package insert says, but after practicing for over 40 years, I still did not understand the severity of such a reaction.”

To learn more about the pros and cons of ACE inhibitors and other ways to control blood pressure we suggest our Guide to Blood Pressure Treatment.

Whatever you do to control high blood pressure, please make sure that the cure is not worse than the condition!

Revised 9/14/17

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  1. Deloris

    I have been taking ACE inhibitors for almost 30 years without any problems. About 10 years ago, I came down with a bad case of bronchitis. I had it before and the symptoms were familiar to me. In need of an antibiotic, I went to my doctor’s office and saw an associate of hers. This doctor saw that I was taking lisinopril and immediately blamed my deep, productive cough on the blood pressure drug. I really had to convince her that I had bronchitis and that it wasn’t a side effect of lisinopril. We patients just can’t be too careful these days.

  2. Larry M
    Raleigh, NC

    The fact that people have this reaction after taking ACE inhibitors for years suggests that there is some other factor that arises. Maybe the CDC should do a study to determine
    –What other drugs the patients have just started
    –What foods/drinks they have just consumed
    –What cleaning products they have just used
    –Anything else that just changed in their environments

    Why isn’t someone conducting this study?

    • Amy A

      I don’t know that other factors are at play. It could be the same reason why people develop an allergic reaction to something they’ve eaten for years (e.g. peanuts, strawberries etc). Often times the thing you become allergic to is the thing you are most exposed to.

  3. Jane

    My doc took me off Lisinopril when I told him I was having some real itching around my mouth. I’d been on it for about 5 years.) When I told my friend about your article, she took herself off the Lisinopril then told her doc. What I don’t understand and is never revealed here is “how” they know that it’s Lisinopril, etc, that’s causing the allergic reaction.

  4. Debbie
    Richmond VA

    I had taken Lisinopril 10 mg for almost 13 years when I reacted. The angioedema came on very quickly and I was fortunate to have VCUHealth trauma center near by. In the end, things worked out okay for me. The other part of my story is that I had experienced intestinal distress with pain and bleeding for several years. The endoscopies and colonoscopies showed no cause for the symptoms. I have not had an episode since I stopped taking Lisinopril. ACE Inhibitors are on my allergy list in BIG letters!

  5. Aya

    I take 10 mg of lisinopril/hctz 12.5 combo once a day and hoping I do not develop any of these severe side effects as I’ve tried others with no success, but this combo works for me. I also exercise and follow a low sodium healthy diet.

  6. Margaret
    Sedona AZ

    After checking with his doctor I took my husband off of Lisinopril over a year ago because of the potential side effects and gave him Hawthorne Extract instead. It took a few weeks for his blood pressure to stabilize, but ever since it has been excellent, usually around 125/62.

    Too many of these prescription drugs are just too scary, especially when there is an herb or supplement that will do just as good a job, frequently better.

  7. c

    When I read all of this the thought comes to Whw Oh Why don’t you first change life style and diet before taking drugs?
    That ERS are already on the k ow about what is causing this type os swelling tells me that it is more common then drug companies admit to imo.

  8. Greg

    I am wondering if the different manufacturer’s of Lisinopril is what may be behind the reactions. My std mail-in pharmacy was apparently purchased by a major chain drug store, and I noticed the medication was not the same color, and looked different. I looked on-line and found that yes, there are different shapes and colors for the same medication. It is a different manufacturer. I need to see if this stuff is imported, and from where if so. Chest has felt different since the switch.

  9. Sheila
    Washington DC

    I was more fortunate; I went through all of those reactions except I was sent by helicopter to Georgetown in Washington DC; the smaller hospital knew they couldn’t handle this. I am blessed. This happened 8/17.

    • mary

      My husband went to the doctor blood pressure was taken 158 the doctor was very concerned,but I had told my husband of white coat disease, when meeting was over my husband had them take the BP again 101 he dropped 50 points in 15 minutes.

  10. Shonda
    Sparta Ga.

    On Friday July 7, 2017, my Mother had awaken to her not being able to breath. Her throat and tongue was swelling. By the time she made it to the emergency room it was closed completely they couldn’t get a tube down her throat. A trachea was done on her. She is currently still in ICU. She had been on the blood pressure med Lisinopril for over ten years .

  11. AL

    I had been placed on Lisinopril for approx. 20 years before I had an allergic reaction. I started eating a corn on the cob and my tongue swollen up so bad I had to get to the emergency room quickly. They gave me Benadryl, Adrenaline, and Pepcid that I’m aware of. It was a Very Scary Time as my throat was swelling shut and making it hard to breath and nearly impossible to swallow.

    The ER Dr. got me stabilized and then he admitted me to the ICU unit of the hospital. I was given Steroid breathing treatments and Benadryl, Adrenaline and Pepcid thru the IV. They kept me 24 hours and then released me. I’m feeling better and have now realized that I may have had some on-going side affects/allergic reactions for some time.

    I’ve had mild to severe abdominal pain, bouts of diarrhea, mild to severe bouts with shortness of breath, nasal drip and I’m still figuring out other possible symptoms. It’s incredible that after taking a medication for 20+ years, one day your body rejects it and nearly kills you from not being able to breathe.

  12. S.g

    About a year and half ago. It was my first time taking lisinopril. I took it and was on life support for awhile. I will never be the same. To this day I am so afraid of taking any medication for that reason. It has mentally and emotionally and physically scared me for life. So my heart and thoughts go out to those who are on life support. And their loved ones who have to endure this.

  13. Mike

    On May 27, 2015 I was given lisinopril for high BP during vertigo episode. I returned to my job on June 10, 2015 which was in a warm environment.

    For the next three months, I suffered from dizzyness, balance issues, vertigo when going to the bathroom, extreme weakness, backaches, all of which affected my ability to work. When Fall came, the weakness and backaches ended but the other symptoms persisted. I was told to keep taking the drug.

    In May 2016, it was hot again. The weakness and backaches came back. I got hot and started being disoriented. I went down hill from June 11, 2016 to July 8, 2016 when I was admitted to the hospital with a creatinine level of 16 and not producing urine.

    Four days later, my level was 2 after lots of fluid. Elevated creatinine, lack of urine production courtesy of lisinopril. I suffered hypotension also. Please study side effects because some doctors don’t have your back. Heat and lisinopril don’t mix. Most physicians mentioned three side effects, dizzyness,coughing, and light headedness. They have no idea.

  14. Holly

    I was prescribed this medicine today, and expressed concern to the Physician’s Assistant who told me my concerns were ridiculous. I have been researching online and reading many posts like what are here, and I am even more scared. I don’t know what to do. I generally don’t react well to generic drugs, and already have discovered allergies to medicines after one dose. I don’t want to end up in the ICU. Any advice would be appreciated.

    • Terry Graedon

      It is not reasonable to be told your concerns are ridiculous. It would have been much more appropriate for the PA to tell you that millions of people take lisinopril or another ACE inhibitor medicine, and only a tiny proportion have a problem with angioedema. But for those people, it is a BIG problem. Ask if there might be some other class of antihypertensive that would be appropriate for you.

  15. fred
    lodi ca

    my room mate was presscribed lisinopril two days later she complained of swelling in her throat and tunge I took her to st.joe in Stockton and they treated her with Benadryl which she is allergic to her throat swelled but they were able to get the breathing tube in in time but kept her in a drug induced coma for 7 days she was on a ventalotor for 15 days before they did a traciotomy and a week later the put a feeding tube in for her to come home after 36 hours she was back in the hospital why do they still use this stupid pill how many doctorstake this dangerous drug themselfs

  16. David
    United States

    I had knee replaced in Dec of 2014. Shortly thereafter I had a hematoma in the same left leg then back to the hospital for a few days. Back home I then had an allergic reaction to lisinopril which I had been taking for over 10 years. My tongue and throat started swelling one night called my doctor was told to use benadryl which did not help. So I was rushed to hospital and tube down my nose to help BREATHING cause throat swollen to much. Woke up couple days latet in icu. Scary couple days for family.

    • Jennifer

      My brother in law is in the er now with it all as well

  17. Quwana Bey
    United States

    My mother suffered from an allergic reaction due to Lisinopril. She was taking it in the past and then was tooken off and put back on. Once she started the medication she started to have this allergic reaction one late night in November of 2013. Luckily I decided to go home that night, because she definitely would have died. I had to rush her to the er and she was put in an induced coma for a few days. I was told she may be a vegetable but wouldn’t find out u til she woke up. That was extremely hard for me to go through alone. But I did it. She was also transferred to Cape fear hospital in Fayetteville, NC. I have to say that from reading some of these different posts, my mom was given another chance. God spared her life. Were very grateful.

  18. Deb

    Thank u

  19. Tammyballiet

    Hi, I was at the emergency room today august 2rd, cause of a swollen tongue, and when I told the doctor I take liscinipril for blood pressure and he said thats the problem, I have been taking that for over a year now. I thought it was something I ate the day before but guess not.

  20. philip

    I had been on lisinopril for about 6 months and had a nagging cough and shortness of breath, but the main problem I had with this drug was it gave me what I believe is called a nasal drip. I was producing blood in my mucus when I could clear it this drip was going the other way running down my throat and giving me chest infections and infecting all my breathing systems. The cough was being caused more by a drug called felodopin which is used in conjunction with ace inhibitors. It was difficult for the doctors to diagnose I suppose but I suspected it a long time myself. I just refused to take them anymore and within a week I felt a lot better. I now take a drug called candersartan and the difference is night and day.

  21. Annie

    After reading the above comments it seems that the liprinopril is lethal when taken with the benadryl !

  22. Concerned American
    United States

    Just took my first dose of Lisinopril 10 mg. last night. This morning I woke up with swollen hands and my neck, chest and arms look red like a sunburn. I called the pharmacist and he told me that I am allergic to it. I cannot believe that 1 dose caused this much swelling and redness.

  23. Rick
    United States

    The exact same thing happened to my wife’s brother. He was only 31 and had been on Lisinopril for about a year.

  24. Scot

    Just started Lisinopril 2+ weeks ago. Reading these comments make me wonder about this swelling of lips, face, throat. Thanks everyone for sharing. My thoughts and prayers go out to all on this scary med!

  25. Marsha M.

    Have been having tests done for a suspected low thyroid- all symptoms-TSH 3:58- flunked with the lab’s reference standard of 4.50.

    Had blood pressure checked last visit was 200/100 and was prescribed Lisinopril. Began coughing almost immediately, throat feels “boggy” and am not going to take any more pills to “cure me” of the high BP.

    Thanks for this site. I was checking my symptoms when I stumbled in.

    One week on this miracle drug is enough!

  26. Kimberly

    My step dad has been taking Lisinopril or four years, last Thursday his bottom lip swelled on one side about 1:15 my mom gave him a ice pack to put on it because we thought he bit him self in his sleep (he’s done that before). Around 4:15 we checked on him and his entire bottom lip was 6 times bigger.
    We took him to the er and they automatically asked if he’s on Lisinopril, my mom informed them he was so he walked back to the room where they gave him Benadryl and some steroids. He kept telling them his throat was feeling funny..finally, his throat started to close.
    They rushed him into another room where they inserted a breathing tube, later they told my mom it was almost too late to put in the tube his throat and everything inside his throat was so swollen they almost had to do a traike (SC).
    It’s now Sunday and he’s been in icu sedated ever since Thursday. His lip is still The same swollen size it was 3 days ago and he’s not aware of anything when they wake him up. He’s also not breathing on his own.

  27. CLIFF

    Hi everyone. I am a 44 year old male and I have been on Lisinopril for 9 months and night before last, my upper lip started to swell about 1030 PM. It was the size of a nickel by the time I went to bed at 1230AM. By 230AM yesterday, I woke up and my lip was roughly 6 times larger than normal.
    I went to the ER and the attending nurse said Lisinopril before I could even tell her what happened. They treated me with a IV Steroids and kept me overnight in the ICU (Yes. The ICU) to make sure I didn’t have any further issues like my throat and tongue swelling to the point that I could not breathe.
    I left the hospital this morning after I was cleared and I was taken off lisinopril and put on metroprolol and I was given a tapering medrol dose pack for the swelling. I am taking a very low dose of metroprolol but my plan is to start back exercising to get the blood pressure down so I can get off the pills.
    We live in a society that focuses on treating the disease rather than taking care of our bodies and doing or part to keep from using medication. I know that for some people, it does not matter how much you diet and exercise as you still have to take medication for something but current research suggest a major percentage of people on medication can come off of it if they changed their eating and exercise habits. After my scare yesterday, I will take my health more seriously!

  28. ELacy

    My husband was on this medication for his blood pressure for a short while. When he began having coughing fits and shortness of breath, we finally found out it was the lisinopril. Scary stuff.

  29. paul

    My Wife started lisinopril 3 weeks ago 10mg twice daily because of high blood pressure. Last week, her Dr recommended that her dose be increased to 20mg because her BP was not coming down fast enough.
    That very same evening she developed an unbearable itch, rash/hive like symptoms in patches all over her body. I took her to the ER that night and they really didn’t seem to know exactly what was wrong with her other than some sort of an allergic reaction. They gave her benadryl, prednisone and pepsid and discharged her within 2 hours.
    The following morning her throat started swelling with spasm like symptoms and the rash/itch was no better. She again went to her own Dr who advised her to stop using the lisinopril and should she get no better within a few hours to go back to the ER. Things got rapidly worse within and a few hours to the point where she felt her throat was closing up. Her hands and feet had also swollen. She was transferred by ambulance to a different hospital emergency center where she was seen by a dermatologist who said, he had no doubt that what she had was a reaction to lisinopril and in 30 years of practice he had not seen a worse case. The E.N.T Dr that seen her could not find a blockage, however he said the spasm like symptoms are typical to patients he has seen in the past who have had the same reaction to lisinopril.
    She is still Ill and I am very angry. I had seen this website and just had to vent since, I’m sitting here alone and my Wife is laying in a hospital bed because of a little poison pill!.

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