Increased risk of angioedema with vildagliptin and ACE inhibitors
Increased risk of angioedema with vildagliptin and ACE inhibitors
Increased risk of angioedema with vildagliptin and ACE inhibitors
In March 2021, Medsafe, the New Zealand Medicines and Medical Devices Safety Authority Published Prescriber Update.
Prescriber Update is published and distributed by Medsafe in the interests of safer, more effective use of medicines and medical devices. While the information and advice included in this publication are believed to be correct, no liability is accepted for any incorrect statement or advice. No person proposing to prescribe a medicine to any other person should rely on the advice given in this publication without first exercising his or her professional judgement as to the appropriateness of administering that medicine to another person.
New Zealand case reports
Since 2018, the Centre for Adverse Reactions Monitoring (CARM) has received four reports describing angioedema after starting vildagliptin. In two cases, the patients were already taking an ACE inhibitor when vildagliptin treatment was initiated.
Background
Angioedema is the sudden localised swelling of the skin or mucous membranes caused by a transient increase in endothelial permeability and extravasation of plasma into the interstitial tissues. Vildagliptin is a recently funded dipeptidyl peptidase-4 (DPP-4) inhibitor indicated for the improvement of glycaemic control in type 2 diabetes. Angiotensin-converting enzyme inhibitors (ACE inhibitors) are indicated for treatment of diabetic nephropathy, amongst other uses, and therefore these two medicines are often used together.
ACE inhibitor-induced angioedema
Angioedema is reported to occur in approximately 0.2 to 2.5 percent of patients taking an ACE inhibitor. It may occur at any time during treatment.
ACE inhibitor-induced angioedema predominantly affects the head and neck area, particularly the lips, tongue, face and upper airway, and thus may be life-threatening. Less commonly, the angioedema may present as acute abdominal pain associated with diarrhoea or other gastrointestinal symptoms, due to visceral involvement. It is not associated with itching or urticaria.
Increased risk of angioedema with vildagliptin and ACE inhibitors
Angioedema is rarely seen in patients on vildagliptin monotherapy, but the risk is increased in patients who are also taking an ACE inhibitor. While the absolute risk is small, it is likely that many patients prescribed vildagliptin will also be taking an ACE inhibitor. Consider this possible drug-drug interaction if a patient taking these medicines presents with angioedema.
Summary:
Combined use of vildagliptin and an ACE inhibitor increases the risk of angioedema, compared to use of either medicine alone. Consider this possible drug-drug interaction if a patient taking these medicines presents with angioedema.
Patients taking both vildagliptin and an ACE inhibitor may require additional monitoring for angioedema.
Ask the patient to report any angioedema symptoms to their prescriber.
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