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Olmesartan Medoxomil-Induced Angioedema

Professor, Department of Clinical and Administrative Services, College of Pharmacy and Health Sciences, Mercer University, Atlanta, GA; Clinical Pharmacist, St. Joseph's Hospital Atlanta

Erin E Winter

PharmD Student, College of Pharmacy and Health Sciences, Mercer University

Reprints: Dr. Nykamp, Department of Clinical and Administrative Services, College of Pharmacy and Health Sciences, Mercer University, 3001 Mercer University Dr., Atlanta, GA 30341, fax 678/547-6383, Nykamp_D{at}Mercer.edu

OBJECTIVE: To report a case of olmesartan medoxomil-induced angioedema in an angiotensin-converting enzyme (ACE) inhibitor-naïve patient.

CASE SUMMARY: A 61-year-old white woman with hypertension experienced significant swelling of her face, neck, and lips 10 days after initiation of olmesartan medoxomil 20 mg/day. After discontinuation of the drug, symptoms resolved within 10 days. Use of the Naranjo probability scale indicated a probable association between angioedema and olmesartan medoxomil.

DISCUSSION: An angiotensin receptor blocker (ARB) is, in many cases, considered a safe alternative to an ACE inhibitor since serum bradykinin is thought not to be affected. However, angioedema has been reported with the use of ARBs, suggesting alternative pathways or mechanisms that result in this adverse reaction. Although not proven in humans, one explanation is that a secondary stimulation of angiotensin II AT2 receptors produces an increase in tissue bradykinin, resulting in angioedema.

CONCLUSIONS: As of February 26, 2007, this is the first published reported case of olmesartan medoxomil-induced angioedema. Practitioners should be aware of this rare but potentially serious adverse event.

Key Words: angioedema, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, olmesartan medoxomil

Published Online, March 6, 2007. www.theannals.com, DOI 10.1345/aph.1H566