Common Adverse effect of ACei Give it in a tabulated form

Common Adverse effect of ACei (Give it in a tabulated form)

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Adverse Effects of ACE Inhibitors

Overview of Mechanism Basis

ACE inhibitors block the conversion of angiotensin I to angiotensin II and prevent the breakdown of bradykinin (also called plasma kininase). The accumulation of bradykinin and substance P is responsible for many of their adverse effects.

Table: Common Adverse Effects of ACE Inhibitors

Adverse Effect	Frequency / Notes	Mechanism
Dry cough	Most common; up to 20% of patients; sometimes with wheezing	Bradykinin and substance P accumulation in the lungs
Angioedema	Rare but life-threatening (0.1-0.5%); African-Americans ~4.5x more susceptible	Bradykinin/substance P-mediated; typically occurs with the initial dose; may cause fatal airway obstruction
Hypotension (first-dose)	Common in volume-depleted patients (on diuretics, Na+ restricted, or GI fluid loss)	Loss of angiotensin II-mediated vasoconstriction; exaggerated in high-renin states
Hyperkalemia	More likely in renal insufficiency, diabetes, or with K+-sparing diuretics/supplements	Reduced aldosterone secretion → decreased K+ excretion
Acute renal failure	Especially with bilateral renal artery stenosis or solitary kidney stenosis	Loss of efferent arteriolar tone needed to maintain GFR
Rise in serum creatinine	Up to 30% rise above baseline is acceptable; does not warrant reflexive discontinuation	Reduced intraglomerular pressure (efferent dilation); may stabilize in chronic kidney disease
Teratogenicity / Fetotoxicity	Contraindicated in pregnancy (all trimesters carry risk; 2nd and 3rd trimester: fetal hypotension, anuria, renal failure, fetal death)	Fetal RAAS inhibition disrupts renal development
Rash (dermatitis)	Especially with captopril (contains sulfhydryl group)	Immune-mediated; more common with high doses
Dysgeusia (altered taste)	Up to ~10% of patients	Captopril-specific; linked to its sulfhydryl group; zinc chelation proposed
Neutropenia / Agranulocytosis	Rare; mostly with captopril at high doses in renal insufficiency	Immune-mediated; monitor WBC in high-risk patients
Proteinuria	Rare; mainly with captopril at high doses in renal insufficiency	Membranous nephropathy-like glomerular injury
Drug fever	Up to 10% of patients	Hypersensitivity reaction
Orthostatic hypotension	When combined with other vasodilators (e.g., Ca2+ channel blockers) or in high-renin states	Additive vasodilation

Special Notes

Interaction / Concern	Details
K+-sparing diuretics / K+ supplements	Additive hyperkalemia risk; use with caution
NSAIDs	Blunt antihypertensive effect by blocking bradykinin-mediated (prostaglandin-dependent) vasodilation
Anesthesia	Profound, catecholamine-resistant hypotension can occur with vasodilating anesthetics; relevant perioperatively
Bilateral renal artery stenosis	Absolute contraindication - acute renal failure risk
Captopril-specific	More adverse effects than other ACEIs due to sulfhydryl group: rash, dysgeusia, neutropenia, proteinuria

Mnemonic: "CAPTOPRIL"

Letter	Adverse Effect
C	Cough (dry)
A	Angioedema
P	Proteinuria / Potassium increase (hyperkalemia)
T	Teratogenicity
O	1st-dose hypOtension
P	Pregnancy contraindicated
R	Renal failure (acute)
I	Increased creatinine
L	Leukopenia (neutropenia)

Sources:

Katzung's Basic and Clinical Pharmacology, 16th Ed. - Toxicity section, p. 278
Barash, Cullen & Stoelting's Clinical Anesthesia, 9th Ed. - ACE Inhibitors, p. 1010
Washington Manual of Medical Therapeutics - ACE Inhibitors, p. 183
Goodman & Gilman's Pharmacological Basis of Therapeutics - Chapter 30

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