angioedema, choking, man sticks out his tongue while coughing

“Swelling” as a drug side effect doesn’t seem like that big a deal. And yet drug-induced swelling can be unpleasant at best and life threatening at worst. Amlodipine (Norvasc) is the second most prescribed blood pressure (BP) medicine in the United States. At last count more than 14 million people filled over 75 million prescriptions for this calcium channel blocker (aka calcium antagonist). Lisinopril (Prinivil, Zestril) is the most prescribed BP drug in America. Not only is it the # 1 blood pressure pill, it is the most prescribed drug overall. More than 21 million individuals filled over 110 million prescriptions for lisinopril. Swollen ankles from amlodipine can be unpleasant. A swollen tongue from lisinopril is a crisis, as this reader points out.

A Swollen Tongue from Lisinopril Leads to ER Visit!

Q. My doctor prescribed amlodipine for high blood pressure. It made my ankles swell so much that he switched me to lisinopril instead. I took one lisinopril pill and ended up in the ER with a swollen tongue and chest pains. I could hardly breathe.

I was given an EKG and later I was told I could go home or stay overnight. I decided to go home but in the middle of the night I broke out in itchy red hives from head to toe. I thought it was from the sticky patches they put on your body for the EKG. However, it turned out that it was from the lisinopril. What can I do now?

Swollen Ankles from Amlodipine:

A. One of the most common side effects of amlodipine (Norvasc) is edema or fluid retention. Women appear to be more susceptible to this problem. Anywhere from 15 to 25 percent of patients complain of swelling in their feet, ankles and legs (Journal of Human Hypertension, Aug. 2009).

How Do Calcium Channel Blockers Work?

Calcium channel blockers work by altering the flow of calcium into smooth muscle cells that line the walls of blood vessels. This leads to vascular dilation and lower blood pressure. Amlodipine also causes dilation of capillaries, which in turn leads to fluid leakage and edema or swelling.

Amlodipine is sometimes prescribed to ease chest pain (angina) by improving blood flow to the heart. The drug may pose problems for people with congestive heart failure or serious coronary artery disease. Careful consultation with a physician is essential in such cases.

Side Effects of Amlodipine and Similar Calcium Antagonists:

  • Dizziness upon standing
  • Headache (presumably due to vasodilation), drowsiness, fatigue
  • Swelling of ankles, feet and/or hands
  • Rapid heart rate and/or Irregular heart rhythms

Swollen Tongue from Lisinopril

Lisinopril, an ACE inhibitor, can cause a kind of allergic reaction called angioedema. In this condition, the face, neck, tongue and throat can swell.

This potentially life-threatening reaction requires immediate emergency treatment. The reader who wrote to us was very fortunate that her premature departure from the emergency department did not lead to something worse than hives.

How Common is Swollen Tongue with Lisinopril?

No one really knows the incidence of angioedema brought on by ACE inhibitors. The Journal of Allergy and Clinical Immunology In Practice (May-June, 2017)  notes:

“It is estimated that there are over 100,000 emergency department visits for angioedema in the United States each year and ACEI (angiotensin converting enzyme inhibitor) angioedema accounts for 20–40% of these visits. ACEI associated angioedema is the most common cause of angioedema seen in the emergency department and a very frequent cause seen in our experience on the inpatient Allergy consult service.”

Even a serious drug side effect that is considered relatively rare can cause a lot of mischief if millions of people are taking the medicine. It often goes misdiagnosed. The doctors cited above go on to say:

“The literature suggests that the interval between onset of angioedema and initiation of ACEI treatment is generally days to weeks and occasionally years later.”

What throws many health professionals off is that some people can take an ACE inhibitor safely for years and then unexpectedly develop a swollen tongue with lisinopril.

Another Example of Angioedema:

Kristina shared this scary story about swollen tongue from lisinopril:

“My father was rushed to the ER the day before yesterday with huge blister-like hives all over his body. He also experienced swelling of hands, lips, tongue, eyes, and throat, due to angioedema from lisinopril. He had been taking this drug for years without problems.

“As soon as they got him there, the nurse asked ‘does he have high blood pressure?’ (The answer was of course yes.) Her second question was ‘does he take lisinopril?’ (Again, the answer was yes.)

“The nurse responded ‘I figured as much!’

“He was then immediately taken to ICU, intubated, and sedated for almost 24 hours to let the epinephrine do its work and reduce his symptoms. We were lucky to get him there so quickly because the doctor said most of the time the throat is already so tight they have to do a tracheotomy.”

Jan also had a close call:

“I had been taking lisinopril for about six years. One night while watching TV, my lower left lip just swelled up. The swelling also included my left chin.

“I was inclined to ignore it but the swelling just kept getting worse over the course of 45 minutes. I woke up my husband and said we had to go to the ER. Both of us hated the thought of sitting in an ER for hours, but it was 11 pm. I was afraid to go to sleep as it was getting worse.

“When we got to the ER they gave me IV antihistamines and steroids. I had to remain in the ER for a mandatory 2 hours before they would release me.

“Now I can never take lisinopril again because it may cause anaphylactic shock (basically it amounts to immediate death). Do I have to avoid all ACE inhibitors?”

The answer is yes. You and the person who initially contacted us about her problems with swollen ankles from amlodipine and swollen tongue from lisinopril will have to find another way to lower blood pressure.

There are other antihypertensive drugs that should not cause this dangerous reaction. In addition, regular exercise is nearly as effective as medication for people with high blood pressure (British Journal of Sports Medicine, Dec. 18, 2018).

A DASH (Dietary Approaches to Stop Hypertension) diet with lots of vegetables and fruit and very little meat or sugar is also helpful. Deep breathing exercises can lower blood pressure as well.

You can learn more about these lifestyle approaches and other medications that you and your doctor might discuss in our Guide to Blood Pressure Treatment.

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  1. Stephany Vinsant
    AZ
    Reply

    I also had side effects after taking Lisinopril my tongue swelled up. After taking Amlodipine, my angles swelled up and my toes turned bright red. I have also taken Losartan generic for Cozaar and Olmesartan generic for Benicar, they both raised my blood pressure. I went to the ER for the Losartan problem and they helped me. I went to an urgent care clinic for the Olmesartan problem and I was told I did not know what I was talking about, the Olmesartan does not do what I said it was doing, even tho my BP was going up. It seems that what ever the filler that is used in Generic Blood Pressure Drugs I am alergic to it. I am once again fighting the Insurance Co, they no longer want me to take it. Where do people like me go for help?

  2. faye
    Downey, CA
    Reply

    I took amlodipine for about one week, and my legs and ankles got so swollen I thought they were going to burst open. So I made the mistake of stopping the medication on my own without weaning off of it. My blood pressure started rising. I went from 136/86 or so to over 172/90 or more. It scared me so bad I thought I was going to have a stroke or heart attack. I could not sleep, and I was afraid to take my BP. I started to feel worse. I began to show signs of kidney failure. My back hurt and my right side hurt, I was not really urinating much. I was terrified that I would have to go on dialysis or spend the rest of my life taking a tone of medicine.

    I lost my mom 1/25/18. Her doctor had her taking this same medicine before her kidneys failed. I did not remember until this was happening to me. I discontinued it but she died from congestive heart failure any way. I think the medicine contributed to her death along with all the other medicine she was prescribed by her cardiologist to treat the congestive heart failure.

    I have been off the medicine now for three weeks and am doing fine. I eat very little meat, no sugar, no flour. I eat organic or conventionally grown veggies, fruit, nuts, seeds, and bean only, get lots of sleep, and exercise. I feel much better my legs and ankles have gone down as well as my BP, my vision has improved, I don’t feel like my heart is in a strain, and I am not afraid I am going to drop dead at any minute. I feel better than I have in a long, long, long, long, time. I have had HBP and Diabetes since 2004 and 2006 respectively. I have not taken medication and managed them with diet.

    The doctor prescribed me Benazepril and metformin back then. Benazepril gave me a bad cough, and the metformin was hard on my stomach so I decided way back then that I was not going to spend the rest of my life on medication like I was told I would have to do by the doctor. My A1C has remained at 6.5 to 6.9. I just go out of control after my mom died. I did go to a nephrologist to have my kidneys checked and he said they were fine. Thank God. Please do not stop your medicine like I did. Let them wean you off.

  3. Jim
    Reply

    There has been a lot of conversation about the safety of some ingredients in prescription medicines made in foreign countries. Could this be a cause of an allergic reaction even after safely taking Lisinopril for years ?

    • jintampa
      Florida
      Reply

      WOW thanks for the heads up.
      Most of what you described has happened to me also.
      My goal this year is to get off of lisinopril before kidney damage.

  4. Kat
    Florida
    Reply

    Our 45 year old son was put on Lisinopril about three years ago even though his BP was only slightly elevated. On New Year’s Eve he had an attack of angioedema with his face swelling. He went to a walk-in clinic the next day and the doctor diagnosed the problem after a few questions (Lisinopril), and suggested he stop taking it. Our son saw his PCP the next day and he concurred. Now our son will try more natural methods to keep his BP down. He also broke out in hives couple days later.

  5. David (RPh)
    Reply

    Lisinopril drastically needs a “Black Box” warning. The biggest problem is that the angioedema can occur suddenly after taking the drug for years. Why is the FDA delaying this action? Supposedly when it was first introduced, it was thought that since the reaction was so rare that the warning was not needed this in spite of the reaction being deadly.

    It was also rumored that if the warning were included it would preclude the drug being used wide spread. Surprised? I personally had such a reaction at 10:00 PM one evening. Fortunately I live only 3 miles from emergency care. If I had been on an extended airline flight I would be dead. The first action would have been to use an Epi pen. This reaction can NOT be reversed by epinephrine. Steroids and fluids are needed.

  6. Michael
    Northwest Washington
    Reply

    I’ve been taking Lisinopril for a couple years, and never knew of the potential for harm. I also found out about the possibility of statin-induced disease, but the (very) hard way. Why don’t doctors or pharmacists warn of us these rare but deadly reactions, and the symptoms to watch for, just in case?

  7. Wendy
    chicago
    Reply

    After years of taking Nexium I decided to wean myself off. Two months later still working on it with Zantac and Tums,but unexpected wonderful side effect: Swollen ankles for past year or so have disappeared. I have changed nothing else so logic seems to be saying “No Nexium.”

    • PHIL
      NJ
      Reply

      In general, drinking one simple tea every day can help enormously reduce ankle/lower limb swelling, esp if the swelling comes from prolonged sitting. Try it and then review on webmd so others can find similar relief. Two years and counting for me, EVERY day one well steeped Nettle leaf tea. Transformative!

  8. HP
    GA
    Reply

    I took amlodipine for BP and had mild ankle swelling at first but after about 3 weeks my ankles were huge, I had unquenchable thirst and was so constipated I thought I was going to die. I read about amlodipine and paralytic ileus and I swear that is what happened to me.

    This was not just normal constipation, it was like my intestines had just gone to sleep and there was no movement at all and laxatives, even strong stimulant laxatives, had no effect. Finally it resolved but it was absolutely horrible. And it didn’t even really help my blood pressure!

    Now I take branded edarbichlor. Its expensive but it works so well I only need to take 1/2 per day. And with the recalls of generic ARBs, I am happy to spend the money on the brand.

  9. Luke
    Reply

    Although prescribed to “protect the kidneys” lisinopril (actually also ARBS such as Coozar) is also associated with rising creatinine levels and kidney damage. Go figure.

  10. Rosemary
    Menorca Spain
    Reply

    2 years ago I went into a emergency hospital (in Spain) with what was diagnosed as 2 herniated discs. I was was given injections into by back and sent to a ward. Over a week I got worse then completely collapsed. My husband said the crash team was called (I have no memory of this). Thank goodness I recovered but was very ill with sepsis, pneumonia, and other side effects of a drug called Nolotil. It had wiped out my white blood cells, and they talked of a bone marrow transplant. They said because I was strong my white cells multiply quickly, and the transplant was not needed. I had an allergic reaction to Nolotil which I have since heard was a banned drug for English, Americans etc. I am still suffering. So beware of this drug.

  11. Art
    Santa Fe,NM
    Reply

    ACE INHIBITORS such as Lisinopril and others were originally derived from “Snake Venom.” I don’t know the story behind calcium channel blockers such as Amlodipine but its origin would be interesting to investigate!

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