Available online on www.ijtpr.com International Journal of Toxicological and Pharmacological Research 2014; 6(4): 121-122 ISSN: 0975-5160 *Author for correspondence Research Article Angiotensin-Converting Enzyme (ACE) Induced Angioedema: A Case Report Shantal Boodoo 1,2 , Kavita De Gannes 3 , Sandeep Maharaj 2 , Sureshwar Pandey 2 , Akram Ahmad 4 , *Sameer Dhingra 2 1 Department of Para-Clinical Sciences, Faculty of Medical Sciences, The University of the West Indies, Eric Williams Medical Sciences Complex, Uriah Butler Highway, Champ Fleurs, Trinidad & Tobago, West Indies 2 School of Pharmacy, Faculty of Medical Sciences, The University of the West Indies Eric Williams Medical Sciences Complex, Uriah Butler Highway, Champ Fleurs Trinidad & Tobago, West Indies 3 Eastern Pharmacy, Eastern Main Road, Sangre Grande, Trinidad & Tobago, West Indies 4 Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, UCSI University, No. 1 Jalan Menara Gading, UCSI Heights, Cheras 56000, Kuala Lumpur, Malaysia Available Online: 29 th November, 2014 ABSTRACT A thirty five-year-old woman developed angioedema during her treatment with the drug perindopril, an angiotensin- converting enzyme (ACE) inhibitor for hypertension. The woman received perindopril at a dose of 10 mg once daily for hypertension. After six hours of administration, she developed swollen lips and lower part of the face, and difficulty upon swallowing. Investigations revealed the high blood pressure with an increase in pulse and respiratory rate. The pharynx was oedematous. She was diagnosed with perindopril-induced angioedema. Perindopril was discontinued and the patient received intravenously hydrocortisone stat and oxygen 4L/min and followed up with cetirizine 10 mg od and prednisolone 10 mg tds for 5 days. The patient had fully recovered after five days. A Naranjo assessment score of 7 was obtained, indicating a probable relationship between the patient's symptoms and her use of drug perindopril. Keywords: ACE inhibitors, angiotensin-converting enzyme, perindopril, ACE inhibitor-induced angioedema, West Indies, Trinidad and Tobago INTRODUCTION Angiotensin-converting enzyme (ACE) inhibitors are the most common prescribed medications either alone or in combination with other drugs for the treatment of hypertension, congestive cardiac failure, myocardial infarction, renal failure, and diabetic nephropathy. [1] The widespread use of ACE inhibitors is associated with various adverse effects including angioedema. [2] ACE inhibitors are the leading cause of drug induced angioedema.ACE inhibitor-related angioedema is a class effect that can affect 0.1% to 0.5% of patients taking the drug. [3] It is rarely documented in Trinidad and Tobago. Perindopril is a commonly prescribed ACE inhibitor which is considered to be generally safe and well tolerated. We report a case of angioedema following the use of perindopril. Case Report: This is the case of a 35-year old woman of the African ethnic group, presented to her physician with an elevated blood pressure and a past history of polycystic ovarian syndrome. She was placed on drug perindopril 10mg once daily. Six hours post administration of the first dose of perindopril, patient re-presented to the medical emergency unit of the hospital with swollen lips and lower face associated with difficulty upon swallowing (Fig. 1). The pharynx was also oedematous. On examination, her blood pressure was 155/95 mmHg. The pulse rate was 98 beats per minute and respiratory rate was 24 breaths per minute respectively. There was no swelling on any other part of her body. She had neither skin rashes nor pruritus. The patient has never had any previous episodes of swelling. The patient had no history of allergies to any foods or drugs, and there was no significant family history; thus, a clinical assessment of perindopril-induced angioedema was made. The perindopril was discontinued and she was treated with intravenously hydrocortisone 200 mg stat and oxygen 4L/min and followed up with tablets cetirizine 10mg od and prednisolone 10mg tds for 5 days. The patient was reviewed after 5 days at outpatient unit. She was fully recovered and there was no symptoms of swelling. The Naranjo assessment score of 7 indicated a probable relationship between the patient's symptoms and her use of drug perindopril. The patient was subsequently placed on a combination of valsartan and hydrochlorothiazide (160/12.5 mg) to treat her hypertension. DISCUSSION Angioedema is swelling of the deep dermis and subcutaneous tissues. It is caused by exposure to drug, venom, dietary, or extracted allergens. It is characterized