The People's Perspective on Medicine

The BP Drug Lisinopril Initiates Intestinal Blockage

ACE inhibitors are first-line drugs for hypertension. The BP drug lisinopril is dispensed over 100 million times annually. Angioedema is a bad side effect!
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Lisinopril is taken by 20 millions Americans to lower blood pressure. It is a very effective medication. Most people tolerate the BP drug lisinopril quite well. A substantial number do experience a really nasty cough, though. A rare, but far more dangerous complication is abdominal angioedema. It can lead to intestinal blockage.

Abdominal Angioedema and the BP Drug Lisinopril:

Q. I went to the emergency room with severe abdominal pain last month. I thought it might be a recurrence of hiatal hernia, but it turned out to be bowel obstruction.

I was discharged after two days and went home with partial obstruction. The doctors said I should manage it with diet and laxatives.

After nine days of bloating, cramping and a distended belly, I searched the web and found your article on lisinopril causing abdominal obstruction. I immediately stopped taking lisinopril and notified my cardiologist. After a few days, my symptoms diminished dramatically. I’m now back to normal.

This person is fortunate. There are other cases where abdominal angioedema remained a medical mystery for a long time. Intestinal blockage can be a life-threatening condition.

A. ACE inhibitor blood pressure drugs like lisinopril can trigger a condition called angioedema. Emergency physicians are familiar with symptoms such as swollen lips, tongue and throat. If not treated promptly, angioedema can become life threatening because the airway may close.

Health care professionals are far less familiar with intestinal angioedema. ACE inhibitors can also cause swelling of the small and large intestines leading to bowel obstruction. This too can be a life-threatening complication.

Doctors may have trouble diagnosing abdominal angioedema because symptoms may mimic many other digestives disorders. Nausea, diarrhea, bloating and intermittent abdominal pain are common complaints. We’re glad you were able to discover the source of your distress.

What If the BP Drug Lisinopril Is Taken for Years?

Some physicians have a hard time pinning the tail on an ACE inhibitors because the complications can come on after years of safe use. If a patient has been on the BP drug lisinopril for two or three years with no apparent side effects, many doctors might look elsewhere for the cause of a horrible hacking cough or a very bad bellyache.

Lisa was taking the lisinopril for five years!

“While on vacation in Texas I woke one morning feeling quite full as if I had just finished a big meal. It was uncomfortable but not painful. As the day went on it worsened and was extremely painful. Finally, my husband insisted we go to the ER.

“They took me in immediately and did a CT scan. They diagnosed a blockage in the small intestines. They immediately started pain meds and inserted a nasograstric (NG) tube to empty my stomach. I was admitted into the hospital. They told me it would resolve itself or they would need to do surgery. The next day’s an X-ray showed that it was clear.

“I had been taking lisinopril for more than five years with no noticeable side effects. During my stay in the hospital I was initially not allowed anything to eat or drink. I eventually was permitted liquid. NO lisinopril. I was fine the next day.

“They told me I would need to follow up when I returned home. Luckily, I live close to the Mayo Clinic in Rochester. At my visit to my doctor he reviewed scans from the hospital and did another CT scan that day. He determined that lisinopril caused abdominal angioedema based on the type of symptoms I had. Not taking lisinopril in the hospital is what resolved the problem. I’ll be looking for an alternative blood pressure pill going forward!”

Learn more about the BP drug lisinopril and angioedema at this link:

Lisinopril Side Effects Can Be Life Threatening: Beware Angioedema and ACE Inhibitors!

Share your own lisinopril story in the comment section below. Has it worked well for you with no unpleasant side effects? Let us know. What about a cough or angioedema. Let others better understand your symptoms by sharing your experience with an ACE inhibitor. We have written about many situations when ACE inhibitor side effects were not recognized in our book, Top Screwups

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    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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    Per the instructions given to me by my cardiologist on Wednesday, 4/17/19, I took a 1/2 tab Carvedilol [instead of the usual full 12.5 tab] and the 2 Lisinopril 5 mg tabs at 7:15 am on Saturday with food. By 8:30 a.m. I had become so dizzy, weak and nauseated with breathing issues, that I could not get off of the toilet, but could just hang unto a safety bar until 9:30 a.m. and wait out the episode that included severe sweating and fighting to stay conscious. At 9:30 a.m. I was able to crawl on hands and knees to the bed where I slept, having extreme chills until 11:30 am.

    As there had been no changes other then the Rx, I’m guessing this is not a good program for me and will not be doing it and had gone back to the original routine until I heard something from someone. While I have had some occasional episodes of dizziness, weakness, nausea and shortness of breath since then, none ever lasted more then a minute or less and never of such extreme severity.

    I am 81 years old, live alone/no relatives, have multiple heart issues, thyroid gland was ablated with I-131 Iodine in 2013, have arthritis and balance issues [all known to the cardiologist], and due to the configuration of the toilet and sharp corner sink vanity, feel lucky that I did NOT lose total consciousness, fall forward hitting my head on the marble sink/vanity corner and bleed out on the floor.

    I reported this incident to the cardiologist, who ignored it; I reported it to the hospital patient safety department where the cardiologist practices, emphasizing that I was NOT going to sue but felt they needed to have some patient safety/protocols or measures in place and was told by them they’d tell the cardiologist to contact me. No contact was ever made with me by the cardiologist or the hospital even though both had my phone number, email address and I was regularly active on their “MyChart/Medical Records” online program. I feel very lucky just to be alive, and am ‘done’ with both that cardiologist and that hospital.

    Two years ago my husband went to the emergency department with severe abdominal pain. He had emergency surgery for an intestinal blockage and had his colon and part of his small intestine removed. He became septic and had numerous complications. No cause was ever determined, as he did not have a tumor, cancer, or other reason for his colon to become ischemic. He spent 8 weeks in the hospital and made a slow recovery. He had been on 20mg of lisinopril for several years prior to this incident. Of course we will never know if there is a connection, but this article has raised the question in our minds. We plan to share this information with his surgeon and get his opinion. Prior to going to the emergency department, my husband had experienced sporadic bouts of nausea, bloating, and diarrhea for several months.

    I take Enapril. Can I assume it has the same side effects?

    Yes, it could.

    I’ve been taking the ACE inhibitor fosinopril since 1996. No known problems. I wonder why lisinopril has taken over as THE ACE inhibitor? Once, the doctor’s office switched me to that drug without my knowledge or consent, after I called to renew my fosinopril Rx. I took the darn stuff, and it made me sick. Then I found out that the “starting amount” for fosinopril was twice the amount that the “starting amount” ought to be with lisinopril. By substituting lisinopril for my fosinopril at the same dose, they were actually doubling the dose I was taking!

    These days, all the reports of problems designate lisinopril, and I wonder whether the problems come from overdoses of lisinopril; or is it a bad drug, compared to other ACE inhibitors; or is it just the one in fashion so everybody talks about it as if it were the only ACE inhibitor? Recently, the fosinopril pills have changed for the worse. They used to be a reasonable size and easy to cut in half. Now they are miniscule and prone to chipping and breaking up in the bottle, difficult to handle — a true change for the worse.

    I have been on 40 mg. of Lisinopril for over 15 years. Though not experiencing this recently, I have over the years had many episodes of debilitating intestinal cramping. I always thought it must have been something I ate. I also went to the ER once when I was having severe abdominal pain and had been unable to have a bowel movement. If it is the Lisinopril why do these things occur so randomly?

    The headline (“Lisinopril Initiates Intestinal Obstruction”) is misleading, suggesting that this is a normal result of taking this drug. In fact, it’s an extremely rare side effect. The report of intestinal obstruction is not based on a study but on an anecdotal report of one case (out of 20 million users).

    Phelps,

    We have no idea how common abdominal angioedema really is. This potential problem has not been well studied. For one thing, it is hard to diagnose. People develop bloating and stomach pain all the time. How many of these individuals are experiencing IBS and how many are reacting to an ACE inhibitor. We have no idea.

    That said, I play tennis with a relatively small group of very smart guys. Of the dozen or so who are in our group, three have experienced abdominal angioedema and obstruction linked to ACE inhibitors. That does not sound like one out of 20 million. Perhaps this is not as rare as most people think.

    I am on Coumadin control for Atrial Fibrillation ( 2.5 Warfarin x day ) and just begin to try Certo plus grape juice. Is there any effect between the anticoagulant and Certo?

    We are not aware of an interaction between them.

    My doctor’s office PA recommended Lisinopril. After being on it for three weeks I began having falls. My balance control was compromised. I developed a shortness of breath. And I also developed loss of control over my bladder. I was incontinent. All of this happened in the same thirty-day period. I stopped taking Lisinopril. Told the PA. All she said was she doesn’t want me to fall. Nothing else. It’s been three years since all this happened. I’m still no better off. The manufacturer of Lisinopril is still making huge profits. My life is ruined.

    The lesson I learned from this is that doctors don’t have any idea how a body is going to react to their prescription for your ailment. Yet they do it anyway.

    No telling how many live you two have saved!

    Once again, this drug should be black-boxed. I am a pharmacist and experienced Angioedema after taking the drug for over 15 years. Fortunately, I was not on an extended flight or far away from medical care. By the time I got to the ER I was unable to talk and was having difficulty breathing. I say Black-Box the damn drug, and require the warning in large type on every label. A warning should be given verbally on each refill.

    I have taken 10 gms of Lisinopril for about 12 years with no problems, except for a cough once in awhile, which does not last long. In fact, I would not have connected my cough to Lisinopril if I had not read about it in your newsletter.

    Here is a link to a study comparing the efficacy of various ACE inhibiting drugs.
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4753869/
    The last paragraph of the abstract states that Lisinopril was associated with a higher incidence of all cause mortality than any other ACE inhibitor reviewed. But if you are interested, please read the paper itself.

    Do other ace inhibitors have same side effect as lisinopril? Capoten?

    In theory, all ACE inhibitors have the potential to trigger angioedema in susceptible individuals. We do not know what makes some people more vulnerable to this reaction than others.

    Thanks for this article! I’ve “survived” the side effects of using several BP medications; one being the Lisinopril cough, where I always felt like I had something stuck in my throat. Next, a bad bout with Spironolactone, and just recently, I was switched to Candesartan. My first indication of problems was mostly in retrospect since I started having stomach distress the second day upon taking it.

    Just last week, the mild stomach distress turned into something major. I’ve had this problem before and never knew how to describe it accurately to doctors. From your description in this article on Lisinopril, it had to be abdominal angioedema. Unconsciously, each time I experienced the problems, I discontinued taking the medication and resorted to loading up on liquids since I felt totally dehydrated, as well. I’ve been researching the conditions for several days (AGAIN!) looking for something that would describe the situation to seemingly unaware doctors, and, luckily, I ran across this article. Thank you. Once again! Knowledge is power!(LOL!) It was no fun going through that pain, however!

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