ACE inhibitors are a popular and highly effective category of medications used to control hypertension (high blood pressure) and some types of heart failure. As a general rule they are well tolerated and have a limited set of side effects. However, like all medications there are some potential effects which are undesirable. This article will examine some of the more common and/or serious side effects of ACE inhibitors. It is not meant to be a comprehensive list.
Some commonly used ACE inhibitors include: captopril, enalapril, lisinopril, quinapril, benazepril, and ramipril.
The first and most common side effect seen with ACE inhibitors is a cough. Up to 20% of people can develop a cough, although this number can vary and many estimates place it somewhat lower. The cough seen with ACE inhibitor use typically takes a few weeks to develop after initiation of therapy. In some cases, this delay can be several months. For reasons that are not known, women are more commonly affected in men. If the ACE inhibitors are stopped, the cough will generally resolve within a week, although in some people it can take up to a month to see a complete resolution.
The reason the ACE inhibitors cause a cough is not well understood, although there are some theories (the details of which are not necessary to include here). Because of this risk, ACE inhibitors should be used with extreme caution in anyone with lung problems. It is preferable not to put people with lung problems on ACE inhibitors at all.
A decrease in blood pressure, known as hypotension, is often seen with ACE inhibitor use. This is not surprising considering they are used to lower high blood pressure. However, this hypotension can be significant, especially immediately following the first dose of the medication. This effect is often avoided by giving a very low first dose.
A decrease in kidney function can be seen with ACE inhibitor use. This is most commonly seen in people who have kidney diseases such as renal artery stenosis, chronic renal failure, or polycystic kidney disease. People with these kidney problems who are put on ACE inhibitors can have a significant decrease in their renal function due to decreased amounts of blood being pushed through the kidneys. People who are known to have any of these issues with their kidneys should not use ACE inhibitors.
ACE inhibitors will cause some mild electrolyte imbalances in about 10% of people. Specifically, they can cause an increase in the amount of potassium in your body. They do this because they act on the biochemical pathway which regulates the levels of potassium in your body. By blocking this pathway your body retains excess potassium. In most cases this effect is not worrisome, however in people who already have high potassium levels or renal failure, which can also lead to high potassium levels, this effect can be significant.
The last significant side effect to mention here is a condition known as angioedema. Angioedema is a swelling of the skin, typically around the face, lips, throat, and mouth. It can be caused by many things, not just ACE inhibitor use. If the swelling as severe, it can block the ability to breathe and can be quite a dangerous condition. Fortunately, angioedema is a rare side effect with ACE inhibitor use. However, because it is potentially dangerous, it must always be watched for.
ACE inhibitors should not be used by women who are pregnant. There are known risks to the fetus if a woman uses ACE inhibitors while she is pregnant.
ACE inhibitors can only be used with a prescription by your doctor. You must work with your doctor to determine if ACE inhibitor therapy is appropriate for you. In addition, you should always discuss potential side effects for these (or any other) medications before you begin therapy. ACE inhibitors are generally well tolerated, but they are not appropriate for everyone.
