Icatibant in angiotensin-converting enzyme (ACE) inhibitor-associated angioedema

Fok, J. S., Katelaris, C. H., Brown, A. F. and Smith, W. B. (2015) Icatibant in angiotensin-converting enzyme (ACE) inhibitor-associated angioedema. Internal Medicine Journal, 45 8: 821-827. doi:10.1111/imj.12799


Author Fok, J. S.
Katelaris, C. H.
Brown, A. F.
Smith, W. B.
Title Icatibant in angiotensin-converting enzyme (ACE) inhibitor-associated angioedema
Journal name Internal Medicine Journal   Check publisher's open access policy
ISSN 1445-5994
1444-0903
Publication date 2015-08-01
Year available 2015
Sub-type Article (original research)
DOI 10.1111/imj.12799
Open Access Status Not yet assessed
Volume 45
Issue 8
Start page 821
End page 827
Total pages 7
Place of publication Wiley-Blackwell Publishing Asia
Publisher Richmond, VIC Australia
Collection year 2016
Language eng
Formatted abstract
Background
Angioedema occurs in up to 2% of those taking angiotensin-converting enzyme (ACE) inhibitors. Upper airway angioedema may potentially require endotracheal intubation or cricothyrotomy, and is usually unresponsive to adrenaline. The bradykinin receptor antagonist icatibant is proven to be effective in the treatment of acute attacks of hereditary angioedema, and has also been reported effective in the treatment of angioedema associated with ACE inhibitors.

Aim
To describe the use of icatibant for ACE inhibitor-associated airway angioedema.

Methods
We treated 13 consecutive emergency department (ED) patients, who had not improved with adrenaline and/or corticosteroids, with icatibant 30 mg subcutaneously for ACE inhibitor-associated upper respiratory tract angioedema according to an agreed protocol.

Results
Four patients were intubated in the ED either before or after receiving icatibant; three of these were extubated within 24 h of treatment. Eight patients received early icatibant and did not require intubation. The time from onset of airway angioedema to ED presentation ranged from 1 h to 3 days (median 4 h); from ED presentation to receiving icatibant, from 30 minutes to 3 days (median 3 h); and to onset of symptom improvement after icatibant, 15 minutes to 7 h (median 2 h). One patient received a second dose of icatibant.

Conclusion
All patients improved after receiving icatibant, consistent with its bradykinin receptor blocking mechanism. Icatibant rapidly reversed symptoms, and appeared to avert the need for intubation or expedite extubation. Timely use of icatibant in ACE inhibitor-associated angioedema may avert the need for invasive airway procedures and intensive care unit admission.
Keyword Icatibant
Angiotensin-converting enzyme inhibitor
Airway angioedema
Intubation
Emergency department
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2016 Collection
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