Pharmacology in Emergency Medicine| Volume 58, ISSUE 3, e121-e127, March 2020

C1 Esterase Inhibitor for Ace-Inhibitor Angioedema: A Case Series and Literature Review

Published:December 13, 2019DOI:



      Angiotensin-converting enzyme (ACE) inhibitors are a commonly prescribed and effective medication to treat hypertension. Although generally well tolerated, about 1% of patients will experience angioedema, a potentially life-threatening adverse drug reaction. This reaction is thought to be mediated via a buildup of bradykinin and does not typically respond to epinephrine, corticosteroids, or antihistamines. Alternative treatment strategies have been investigated, the bulk of which surround the use of therapies approved for hereditary angioedema.


      Utilization of C1 esterase inhibitors at our institution was reviewed between 2016 and 2018 for treatment of ACE inhibitor–induced angioedema. We describe the clinical course of case series, along with a review of current literature.


      Utilization of C1 esterase inhibitors for treating ACE inhibitor–induced angioedema is an uncommon therapy and has limited efficacy in our case series. Treatment did not result in rapid improvement of swelling, prevention of intubation, or prevention of intensive care unit admission.


      Based on our case series, C1 esterase therapy should not be utilized routinely for ACE inhibitor–induced angioedema and is not expected to prevent intubation in severe cases.


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