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Lisinopril and Angioedema: A Life-Threatening Side Effect

Have you heard of angioedema? Most people haven't. Doctors may miss the diagnosis especially if lisinopril and angioedema affect the abdomen.
Lisinopril and Angioedema: A Life-Threatening Side Effect
Frightened bearded man suffocates or has a severe sore throat, holding hands on his neck with mouth open. White background.

Lisinopril is the most frequently prescribed blood pressure pill in the United States. At last count, 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. Most people have no idea what it is and why lisinopril and angioedema is so scary. 

Angioedema: A Mysterious Side Effect

There is a commercial that is running quite frequently these days. It is for a combination medication called Entresto (sacubitril/valsartan). While not exactly an ACE inhibitor, this medicine does impact the the angiotensin receptor. I won’t overwhelm you with the pharmacology of such drugs. If you are interested you can read about it at this link

The ads for Entresto promote the idea that this drug:

“…helps improve your heart’s ability to pump blood to the body and with a healthier heart there’s no telling where life may take you.”

People in Entresto commercials are seen in active scenes such as hiking, fishing off a speed boat, sailing in the ocean and kayaking on a lake. The message is clearly that this drug will keep you vigorous, smiling and doing the things you love.

Then comes the message about side effects:

“The most serious side effects are angioedema, low blood pressure, kidney problems or high blood potassium.”

What the commercial does not reveal and what the FDA does not require is a description of angioedema. That worries us because the average patient may not know what symptoms to be alert for with angioedema. That is as true with Entresto as with ACE inhibitors like lisinopril. Doctors may not warn patients about lisinopril and angioedema or Entresto and angioedema. And pharmacists may assume it’s too rare to worry people about.

Lisinopril and Angioedema-A VERY Serious Side Effect:

The best way to understand angioedema is by reading what readers of our syndicated newspaper column and visitors to this website have experienced:

Q. I took lisinopril for three days and had an angioedema reaction. Luckily, the doctors in the emergency room diagnosed it quickly. They said they see this kind of reaction from lisinopril quite often.

This is one of the most frightening experiences I’ve ever had. My throat swelled shut. They pumped me full of steroids and kept me overnight for observation. The specialist I saw afterwards said he also sees this pretty often.

A. Most people tolerate lisinopril reasonably well. The most common side effect is a persistent cough that does not respond to treatment. It can be incredibly disruptive and keep people awake at night. Here is a link to one of our many articles on lisinopril cough:

Why Don’t Doctors Recognize Lisinopril Cough?
Why do so many doctors ignore the cause of a lisinopril cough? It would be as if a mechanic ignored the check engine light on your dashboard. It is NOT OK!

The angioedema complication you experienced is indeed potentially life threatening, as it can interfere with breathing.

Here is another report from a reader:

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. Four days later, they released me 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 lisinopril 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. In fact, I endured months of abdominal attacks that came with ‘allergic-type’ reactions.

“Finally, I had to go to the ER because of an anaphylactic reaction. An allergist 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, although I have not been pain free for 5 months. I am so grateful for an observant doctor.”

James says “lisinopril has been trying to kill me:”

“About a month ago I discovered my BP medicine (linisopril) has been trying to kill me for the last 8 to 10 years. After 3 colonoscopies, 3 endoscopies, gallbladder scans, etc., I was told to learn to live with it. I suffered acute abdominal pain for the last ten years. BP 250/150 and as low as 80/44.

Small intestine angioedema sucks. In the town where I live, not one medical person ever heard of angioedema of the small intestines. Within 24-48 hrs of stopping my BP medicine, symptoms subsided. A month after stopping linisopril I still have no symptoms.”

Lisinopril and Angioedema of the Intestines Is Hard to Diagnose:

When people complain about amorphous abdominal discomfort, many doctors throw their hands up in despair. That’s because a lot of things can contribute to acute or chronic abdominal pain, cramping, nausea, vomiting, bloating and diarrhea.

When a patient complains of severe or excruciating belly pain while taking an ACE inhibitor, angioedema should part of the “differential” diagnosis. In other words, it should be high on the list of potential problems causing the distress. Other kinds of medications can also trigger this reaction.

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!

You can learn more about the pros and cons of various classes of medicine to treat hypertension and some nondrug options in our eGuide to Blood Pressure Solutions. This online resource can be found at this link

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
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