angioedema, choking, man sticks out his tongue while coughing

Lisinopril is the most frequently prescribed blood pressure pill in the United States. At last count over 20 million Americans take this ACE (angiotensin converting enzyme) inhibitor daily. It works quite well for most people. Except for a nasty cough, it usually doesn’t cause intolerable side effects. For some people, however, there is one complication of ACE inhibitor medicines that is life threatening. That adverse reaction is called angioedema.

Lisinopril and Angioedema-A VERY Serious Side Effect:

Q. My brother took lisinopril for nearly three years to lower his blood pressure. It did make him cough, but that didn’t bother him too much.

One morning, he woke up with his tongue so swollen he couldn’t keep it inside his mouth. He went to the ER and they called emergency triage.

The ER doctor came out, rushed him into the ER, stripped his clothes off on the way and gave him epinephrine. He said if he had been five minutes later, he might not have lived.

I’ve never had that kind of reaction, luckily. When I took Vasotec, though, it caused an awful cough.

Call 911 if Lisinopril and Angioedema Occur:

A. Your brother was smart to get to the emergency department in time. He experienced angioedema, a rare but life-threatening reaction to ACE inhibitor blood pressure medicines like lisinopril.

Symptoms of Angioedema:

NEVER ignore the following symptoms:
  • Swelling around the face including lips, eyes, eyelids or cheeks
  • Enlarged tongue, swelling in the mouth or throat
  • Difficulty speaking or swallowing, hoarseness,
  • Difficulty breathing, wheezing
  • Hives, welts or large red patches on the skin that may itch
  • Swelling of the hands, feet or genitals

Do not waste a moment if such symptoms occur. Call 911 immediately and make sure they know if you were taking an ACE inhibitor like lisinopril. By the way, drugs that end in “pril” are almost always in this class of medications. Here is a list of such drugs:

Benazepril (Lotensin)
Captopril (Capoten)
Enalapril (Vasotec)
Fosinopril (Monopril)
Lisinopril (Prinivil, Zestril)
Moexipril (Univasc)
Perindopril (Aceon)
Quinapril (Accupril)
Ramipril (Altace)
Trandolapril (Mavik)

Stories from Readers About Lisinopril and Angioedema:

Fred in Lodi, California shared a similar story:

“My roommate was prescribed lisinopril. Two days later she complained of swelling in her throat and tongue.

“I took her to the emergency room. They treated her with Benadryl, although she is allergic to it. Her throat swelled but they were able to get the breathing tube inserted in time.

“She was kept in a drug-induced coma for 7 days and was on a ventilator for 15 days before they did a tracheotomy. A week later they put a feeding tube in for her to come home. After 36 hours she was back in the hospital.”

David also had a close call:

“I had a knee replaced. Once back home, I had an allergic reaction to lisinopril. I had been taking it for over 10 years.

“My tongue and throat started swelling one night. I called my doctor and was told to use Benadryl. It did not help. I was rushed to hospital and had a tube put down my nose to help my breathing because my throat had swollen too much. A couple days later I woke up in the ICU. That was a scary few days for my family.”

A “Concerned American” reported this reaction:

“I just took my first dose of lisinopril last night. This morning I woke up with swollen hands. My neck, chest and arms look red like I was badly sunburned. I called the pharmacist and he told me that I am allergic to it. I cannot believe that one dose caused this much swelling and redness.”

Lisinopril and Angioedema of the Abdomen:

Most health professionals should know about angioedema and the symptoms we have described above. What many may not realize, however, is that angioedema can also occur in the abdomen. It can be hard to diagnose, as this reader reports:

“I was put on lisinopril for high blood pressure in January. That month I experienced severe stomach cramping and vomiting. I was rolling on the floor in agony. The doctor said it was most likely the flu but started me on two different antibiotics in case it was bacterial.

“A few weeks later I had another attack with severe stomach cramping and vomiting. I went to the ER, where I was given IV pain meds. A CT scan showed small intestine inflammation partially blocking off my bowel. I was sent home but returned the next day with pain that was a 10 on a 10-point scale. The doctor said that all the tests had been done and there was nothing he could do. I was sent home with pain medication.

“A few weeks later I was admitted to the hospital with increased small intestine inflammation and another blockage. I vomited and dry-heaved for 12 hours. I was released four days later with no definitive diagnosis.

“I was told most likely I had Crohn’s disease, but a colonoscopy was negative for Crohn’s. I underwent extensive tests, including endoscopy, and all were negative. None of the doctors made a connection with the drug lisinopril.

“After two months of missing work, three more ER visits and untold suffering, I found several other people who reported similar symptoms connected to lisinopril. I stopped the medication and have not had another attack. If you look on PubMed you can see reports on lisinopril and intestinal angioedema, but doctors don’t think to connect this with lisinopril because it is not listed as a common side effect.”

LB in Maryland was initially misdiagnosed:

“I went to the ER and they told me my discomfort was caused by gas. The third time I passed out. The ambulance had to take me to the hospital.

“Finally I had a CT Scan and the radiologist said to take me off liprinisol because it causes intestinal swelling. From my CT you could see the intestinal swelling. The doctors thought it was Crohn’s disease.”

NG also had a close call:

“I too had been experiencing a lot of mysterious abdominal pain after switching the brand of lisinopril I was taking. I endured months of abdominal attacks that came with ‘allergic-type’ reactions.

“I finally had to go to the ER because of an anaphylactic reaction. I was referred to an allergist who listened carefully and told me that it could be from the lisinopril. It is two days since I took lisinopril. I have no abdominal pain at all. I have not been pain free for 5 months. I am so grateful for an observant doctor.”

ACE Inhibitors and Cough:

Vasotec (enalapril) is also an ACE inhibitor. All such drugs may cause uncontrollable cough in susceptible people. We have lots of stories at these links:

Misdiagnosed Cough from Hell Makes Life Miserable

Why Do So Many Doctors Ignore Obvious Drug Side Effects?

Valsartan (Diovan) Side Effects Include Terrible Cough!

Our Guide to Blood Pressure Treatment outlines the pros and cons of various classes of medicine to treat hypertension and some nondrug options. Anyone who would like a copy, please send $3 in check or money order with a long (no. 10) stamped (70 cents), self-addressed envelope:

  • Graedons’ People’s Pharmacy, No. B-67
  • P. O. Box 52027
  • Durham, NC 27717-2027

It can also be downloaded for $2 from the website: www.peoplespharmacy.com.

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  1. Royce
    Reply

    I have used Lisinopril for many years. Just last month, July 2017, I was removing honey from my bees, got strung a high number of times (over 100 plus). Became Allergy, and had to get rid of my bees. However, at the same time Lisinopril, came in to play about the cough and thick tongue. I stopped the Lisinopril and the side effects left.

    Question: My wife doesn’t take Lisinopril, but she has a real bad cough and the Doc’s can not or will not tell why.

  2. susan
    indiana
    Reply

    I took it for a short while and about coughed up a lung! Someone else mentioned it did the same for her. I talked to my pharmacist and he said that it does that to most people! Not worth trying!

  3. Dan
    Tucson, AZ
    Reply

    I had my first episode of angiodema about 5 months after starting lisinopril. My upper lip swelled up over the course of an hour or so and slowly shrank down to normal over the next 24 hours. I had no idea what was happening, and neither did my sister who is an RN. I talked to my provider, a Physician’s Assistant who prescribed lisinopril in the first place. She didn’t make the connection either and sent me for an allergy blood test, which came up negative.

    After a couple more bouts, another provider in the office recognized the connection to the drug and switched me to another, but in the same class. Up to this point the attacks were unpleasant but not life-threatening. In a few days I was in the ER getting IV Benadryl and some others I don’t remember because my tongue was swelling at the back of my throat.

    After all this my provider switched me to a different class of med, and I haven’t had any bouts since. It’s been about 6 months so I think I’m in the clear. (Amlodipine is what I take now.)

  4. Gerry
    Fla
    Reply

    I was diagnosed with angioedema in year 2000. Mine is mostly food or additive allergies such as MSG. The worst is from all salicylates; for a number of years I had unexplained swelling of face, cheeks, stomach upsets, vomiting but the major outbreak and one from which my doctor diagnosed me was MSG from Chinese food.

    He prescribed Zantac, Zytec and Benadryl, one every night for the rest of my life; also told me if I had an outbreak during the day, break a Benadryl capsule in half and spread powder over and under the tongue. I have had occasion to do this a couple of times and it works wonders. I cannot eat in a Chinese restaurant as even foods labeled non-MSG are stirred with same spoon, I would guess.

    Worst happening before the diagnosis was from a sip of coke while on the highway. My tongue swelled out of my mouth within 15 minutes. I drove directly to the nearest hospital and they treated me for four hours; stuck epinephrine and other things in every limb; tongue swelling immediately stopped but took the next few hours to go down.

    Other members of the family have lips swell from mangoes, strawberries, tomatoes and other acid fruits. I have a long list downloaded from the New Zealand Public Health site of low, medium and high salicylate content foods, which is my go-to list for safety. My aunt in hospital several years ago was diagnosed as thrush, foaming at the mouth, vomiting and stomach cramps; it was aspirin. Once taken off, she recovered without further problems.

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