Angiotensin converting enzyme inhibitors adverse effects

Adverse drug reactions many drugs can cause gastrointestinal disturbance as a side-effect. Those most commonly associated with indigestion include angiotensin-converting enzyme inhibitors... 

Adverse drug reactions drugs that can produce cough as a side-effect include angiotensin-converting enzyme inhibitors, non-steroidal anti-inflammatory drugs and beta-blockers. 

Guazzi M, Brambilla R, Reina G, et al. Aspirin-angiotensin-converting enzyme inhibitor coadministration and mortality in patients with heart failure A dose-related adverse effect of aspirin. Arch Intern Med 2003 163 1574-1579. 

Drug Interactions Xanthine oxidase, a key enzyme in the catabolism of azathioprine metabolites, is blocked by aUopurinol. If azathioprine and allopurinol are used concurrently, the azathioprine dose must be decreased to 25-33% of the usual dose it is best not to use these two drugs together. Adverse effects resulting from coadministration of azathioprine with other myelosuppres-sive agents or angiotensin-converting enzyme inhibitors include leukopenia, thrombocytopenia, and anemia as a result of myelosuppression. 

Celecoxib is currently indicated for the relief of signs and symptoms of osteoarthritis and rheumatoid arthritis and to reduce the number of adenomatous colorectal polyps in familial adenomatous polyposis as an adjunct to usual care. Celecoxib is at least as effective as naproxen in the symptomatic management of osteoarthritis and at least as effective as naproxen and diclofenac in the symptomatic treatment of rheumatoid arthritis, and it is less likely to cause adverse Gl effects. Celecoxib appears to be effective in the management of pain associated with both of these arthritic conditions, but effectiveness in acute or chronic pain has not been fully demonstrated. Unlike aspirin, celecoxib does not exhibit antiplatelet activity. Concomitant administration of aspirin and celecoxib may increase the incidence of Gl side effects. Another notable potential drug interaction with celecoxib is its ability, like other NSAIDs, to reduce the blood pressure response to angiotensin-converting enzyme inhibitors. A more detailed discussion of the chemical, pharmacological, pharmacokinetic, and clinical aspects of celecoxib is available (81). 

R.C. Parish, and L.J. Miller, Adverse effects of angiotensin converting enzyme (ACE) inhibitors An update. Drug Safety 7 14-31, 1992. 

ACE inhibitors prevent the formation of angiotensin II by angiotensin-converting enzyme (ACE) and thereby reduce peripheral vascular resistance and blood pressure. In addition, ACE inhibitors prevent the effect of angiotensin II on protein synthesis in myocardial and vascular muscle cells, and thus diminish ventricular hypertrophy. As adverse effects, ACE inhibitors may provoke dry cough, impaired renal function, and hyperkalemia. When ACE inhibitors are poorly tolerated, an ATq-receptor antagonist can be given. 

Angiotensin-II-receptor antagonists (ARBs) are approved for the treatment of hypertension. In addition, irbesartan and losartan are approved for diabetic nephropathy, losar-tan is approved for stroke prophylaxis, and valsartan is approved for heart failure patients who are intolerant of angiotensin-converting enzyme (ACE) inhibitors. The efficacy of ARBs in lowering blood pressure (BP) is comparable with that of other established antihypertensive drugs, with an adverse-effect profile similar to that of placebo. ARBs also are available as fixed-dose combinations with hydrochlorothiazide. 

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