Blood Pressure Med Lisinopril Caused Rare Case of Small Bowel Angioedema, Report Shows

Blood Pressure Med Lisinopril Caused Rare Case of Small Bowel Angioedema, Report Shows

Lisinopril, a medication widely used to treat high blood pressure and other cardiovascular disorders,  sometimes may trigger small bowel angioedema, suggests a case report.

While rare, physicians should recognize angioedema as a possible side effect of lisinopril, and provide timely diagnosis and adequate treatment in the presence of acute abdominal pain.

The case report, “Angioedema of the small bowel caused by lisinopril,” was published in the journal BMJ Case Reports.

Lisinopril, an inhibitor of the angiotensin-converting enzyme (ACEi), often is used to treat hypertension and other cardiovascular diseases. These inhibitors are known to promote the accumulation of bradykinin, helping blood vessels relax and widen. But bradykinin also increases vessel permeability (allowing liquids and gasses to past through) the blood vessels, which contributes to angioedema.

ACEi-induced angioedema is a rare event that can affect any organ. Most often, the condition develops in the lips, tongue, face, and upper airway. But in rarer cases, it can affect other body tissues, such as the intestines.

Angioedema of the bowel, however, is difficult to diagnose, because it typically manifests with abdominal pain, nausea, vomiting, and diarrhea, which may mimic other diseases and lead to misdiagnosis.

A team led by Michigan State University researchers now presented the case of a 42-year-old man with small bowel angioedema. He had been referred to the hospital due to acute abdominal pain affecting mostly the left lower quadrant of the abdominal region.

He had a clinical history of hypertension and chronic kidney disease. He complained of severe abdominal pain that worsened whenever he ate or drank. These symptoms also were associated with nausea, vomiting, difficulty breathing, and dizziness.

An analysis of his blood showed high levels of white blood cells, suggesting inflammation. Then, a computed tomography (CT) scan from the abdominal region showed thick-walled small bowel loops, and evidence of mild free fluid in the abdominal and pelvic cavities.

Researchers suspected inflammatory bowel disease or colitis, and began treatment with the antibiotics ciprofloxacin and metronidazole. However, the patient showed no signs of improvement.

While an additional CT scan did not find any new clinical manifestation, a review of the patient’s clinical history revealed he had started lisinopril treatment about two weeks before experiencing symptoms.

Given the documented risk of bowel angioedema linked to ACEi use, treatment with lisinopril was immediately discontinued. Within 24 hours, the patient showed significant improvements, and he was subsequently discharged with no reports of recurrence.

“ACEi-induced angioedema of the small intestine is a rare adverse reaction; yet, it is important to recognize this side effect as the drug is one of the most commonly prescribed medications in the country,” the researchers concluded.

Alice Melao Editor
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Alice Melao Editor

35 comments

  1. CHRISTIE PETERKIN says:

    I had this happen to me in 2010 just days after starting Lisinopril. I suffered for 2 1/2 months with 5 hospitalization, unnecessary gall bladder removal and unnecessary exploratory surgery. This was pure hell and I wouldn’t wish it on my worst enemy. No doctor had ever heard of this reaction because it’s so rare.

  2. Ruth Johnson says:

    This is happening to me right now! I’ve have been treated for ulcerative colitis since 2013 I was Told I had high pressure and put on LISINOPRIL 10mg July 2013 I was diagnosis With UC and given Asacol 800mg stomach pain started put on Prednisones for pain and told it was the UC in my upper stomach diagnosis with post nasel drip and stomach Hernia because of my coughing and throat irritation! But now after reading this I think i feel it’s the LISINOPRIL that has been causing my pain for so long! I went in the hospital for pain in February and came out with heart 2 stints I was told that’s what was causing my pain!!!! I’m so disappointed with the medicine and doctors, and hospitals!!!

    • Chris says:

      So did you not need the stents then? I’m scheduled for an angiogram on the 28th. Been having high blood pressure since emergency spinal fusion on September 25th.

    • Cathy says:

      Don’t know your age but seniors are complaining about medical care and drs. That won’t listen. They have no time for reviewing side effects. I’ve suffered swollen lips and inside cheeks/tongue from every pill I take for years. Not food but dr. Insists on allergy tests
      I take llisinopril in am and after eating lunch my stomach cramps until gas is passed. My experience with doctor. If they can’t see it or see it on an ex ray or lab report then it doesn’t exist and you are a hypochondriac.

      • Debbie says:

        LISONIPRIL is known to have that possible side effect, swollen lips, face, sometimes. That is an allergic reaction and you need to have your blood pressure medicine changed, what’s wrong with these quacks?

    • E. Martens says:

      I’ve been on Lisinopril for about 1.5 months to treat my high BP. The side effect I was having is a severe cough, and it did nothing to lower my BP. Finally got my doctor to switch me to a different med a couple days ago called Candesartan. My cough is almost gone, I feel better already. Hopefully my BP will come down.

  3. Rodney says:

    I have been suffering painful abdominal sensations on my left side.I know for sure now it’s the lisinopril.I added fiber,stool softener and stool softeners.Not to mention omeprazole antacids,all recommended.by my doctor.this started when I began taking lisinopril

  4. James From Bastrop says:

    I have been suffering for ten years. Sick for about 4-6 hours every night. Reviewing medical records indicate symptoms started a week after starting Lisinopril. When my next visit they told me that the abdominal pain was most likely colon cancer. They also treated me for a h Polaris infection. Last week I stopped my BP and have had no symptom.

  5. Karen says:

    I just had a terrible bout with Lisinopril. I took it for 3 days, and each day the stomach pain got worse until the 3rd day was absolutely debilitating. It felt like my intestines were on fire and they were so swollen I thought they would burst. I refused to go to the emergency room because i knew from googling it that there was nothing they could do (except a lot of unnecessary tests or surgeries) so I just endured it writhing in pain for 36 hours until it finally started to subside. I reported it to my doctor so she could have a record and maybe warn patients, and she just said since I didn’t go to the emergency room and she hasn’t heard of this reaction that it must be something else. I don’t take any other medications at all. I wouldn’t wish this terrible ordeal on my worst enemy. but since doctors don’t want to hear about it, more unsuspecting people will suffer this too.

  6. I just had a terrible bout with Lisinopril. I took it for 3 days and each day the stomach pain got worse until ti was absolutely excruciating after the 3rd dose. My intestines felt like they were on fire and they were so swollen I thought they would burst. I refused to go to the emergency room because I googled it, and knew there was nothing they could do (except lots of unnecessary tests and possibly surgeries). So i just endured it writhing in pain until it finally subsided after 36 hours. I reported it to my doctor so she could have a record and hopefully warn other patients about it, but she said since I didn’t go to the emergency room and she has never heard of this reaction, that it must be something else. I don’t take any other medications. I wouldn’t wish that pain on my worst enemy, but since doctors don’t seem to want to hear about it, I’m afraid more unsuspecting people might have to go through this.

  7. Lisa says:

    Having what feels like pressure upper left side… with gas and bloating i look 7 mths pregnant… intestines are not Functioning normal been on this meds for like 5 years… could it cause this???

    • Jolly says:

      I’ve been taking lisinopril for 4yrs. My stomach swells and I to look like I’m 5mths pregnant.My weight is rapidly going up. My doctor just looks at me and smiles when I mention it. I’ve seen alot of specialist thinking I would get answers .I think I’m dying with something major. Glad I googled this and saw all these comments I will soon drop the lisinopril on my own. I seem to be my own doctor lately. And It doesn’t help my BP is around 178/115 the kidney specialest put me on metoprol twice Dailey with lisinopril. I’ve had xrays of my stomach , ultrasound bloodwork and they all come back perfect I’m glad for that praise God , But I need answers something is going on ,I’ve asked for a Ct but my doc.just looks at me. Health care has to get better.

  8. The OVC says:

    SO glad to discover this article! I have been on lisinopril, for a few years, but hadn’t had any issues. I ran out of medication, about a year ago and just started taking it again, the second week in Nov. The week before T’giving Day, I noticed pain on the left side of my upper abdomen, with moved to the right side, by the following week. My wife & I thought it was “gas pains”, because a belch relieved it, a bit. A week before Christmas, I couldn’t laugh, sleep on my left side or even take a bowel movement because the pressure of bearing down, shot up into that area! One morning, my throat was especially dry & irritated & I thought I must have REALLY been snoring. A drink of water didn’t relieve and it felt as if my uvula was swollen, as well. I didn’t want to go to the ER, for them to no know what to do, and was ready to go to the doctor. BUT, I thought on what was so different from last month, to this month, and why the pain was increasing. -The difference was 20g of lisinopril, every day and I just STOPPED. The next night, I felt less pain and five days later, the pain is almost gone, unless I press on the area, “looking for the pain.” I started taken garlic pills for HBP, instead! (Sending this URL to my doctor that originally prescribed the pill!)

  9. Vickie says:

    My husband currently taking this medication. He haven’t had any problems with it so far, but I will be on the look out for these symptoms.

  10. James Waker says:

    I am James from Bastrop. I have been off my Linisopril for 60 days with no reoccurrence of of the angieodemea of my intestines. I have done some research and it turns out that linisopril causes H-pylori and the H-pylori becomes a carcinogen. So my question is do I have to worry about intestinal, lung, liver or kidney cancer? After 10 years of thinking I was dying every night, now I have to worry about cancer. I did deserve this. No one does.

    • April says:

      Same here. Ever since this medicine, I cannot eat without praying I can make it to the bathroom in time. It’s horrible. The severe stabbing pains followed by having to go #2 asap.

  11. Kari Carden says:

    I began taking this medication 5 days ago. On the third day, I was having excruciating abdominal pain/cramping and vomiting to the point of almost passing out. Went to the ER. White blood count elevated, rapid pulse and significant bloating. I had the pharmaceutical print out of possible reactions with me. Showed the first two Drs. and they basically laughed me off. Ended up having a CT scan and when the results came back; sure enough the radiologist and third doctor diagnosed angioedema. I was hospitalized, put on major steroids and pain medicine. Spent 2 nights and came home today. Still feeling cramped and not well but a hundred times better! This reaction needs to be recognized more! By far worse pain I have ever experienced. Doctors need to understand this better if they are going to prescribe this medicine. I am thankful the one ER doctor and radiologist listened to me. Sorry for those of you that had to endure such unnecessary procedures. Keep advocating for this diagnosis!!

  12. ClaudiaW3 says:

    I started taking lisinopril 10 mg. Today I came home from work due to sharp abdominal pain and diarrhea. Contacted my doctor and told me to monitor my symptoms for 2 days and continue the lisinopril, she said if the symptoms don’t go away it’s probably the lisinopril and a rare reaction…must be angioedema, at least she’s aware and wont have to deal with looking like your nuts. Hoping she switches me to something different anyway. Best of luck to all of you dealing with this, and thanks to those who have shared their stories!

  13. jon doe says:

    Started lisinopril 10 mg Jan 29 2019 by the 3rd day i thought i was dying . Worst stomach pain or pain i have ever had in my life. Never had bought with blood pressure being high until CDC rules on pain medication came out. Now i have uncontrolled pain and high blood pressure with heart problems due to CDC effects on doctors rx.

  14. J man says:

    I have been taking the Lisinopril since Sep of 2018. In January my vision got blurry and have been lightheaded/sluggish feeling in my head. I have had nothing but stomach issues and was also put on omeprazole and antacids. The doc said oh your head issue is due to high blood pressure. My BP has never went over 148/90 as I know others are a lot higher. 3/13/19 I called the doc and said I am not taking this any longer and will have to change meds. My BP taking lisinopril is 118/68 and for 4 weeks I still feel lightheaded/vision blurry. I have heart palpitations now and never had any of this until taking this medicine. I know the side effects taked 1-2 weeks to leave the system after not taking anymore. I will update in 2 weeks if I am better.

    • Fran says:

      Thanks James,

      I was considering going off BP meds but didnt know what would work. Thanks for the advice.

      Fran

  15. Mitch says:

    Started Lisiniprol last week after sever dizziness and dr visit revealed very high bp. Now as everyone ekse posted have several pain in left abdominal and am totally blocked up. Cannot have bowel movement all day. Just took stool softener and hope for the best. I see this was approved in 1978. So if it has such immediate issues why is it even used? Todays md’s are just pill pushers and know nothing about treating real issues anymore.

  16. Michele says:

    I just started taking Lisinopril 3 days ago and every day my diarrhea gets worse! I was in the bathroom so much today I should’ve just moved my work desk in there!! I have IBS already so this is NOT helping. I hate to just “give up” and not take it, as my BP has been like high 150’s/high 80’s low 90’s for over a month that I’m aware of, but I can’t have this continue much longer. I was really hoping that it was just a temporary thing till my body got acclimated to it? Maybe it’s not, though? Ugh

  17. Ewa Seiler says:

    To lower your blood pressure take 5HTP, Zinc…do research.
    I just took lisinopril two times in the hospital. Bloated, pee and pee.

    Ewa

  18. Lisinopril is the worst med for me tht I have ever taken, I amconstantly sick to my stomach, feeling of wanting to throw up all the time, constapation all the time. Dr.s. do not want to
    listen to what you say, they just stare at the computer and then tell you to come back in 3 months and increase the pill one more tablet.

  19. Layzette B says:

    Wow I have been trying to figure out what causes this pain in my left lower abdomen that feels like a twisting and turning of my intestines, the pain happens if I turn a certain way if I’m on the plane with the seat belt tight or while driving. It is the worst debilitating pain and I have to stretch out flat to get any relief now that doesn’t even happen. I’ve had CT scans and MRIS and no one can see anything that is wrong. I will be stopping this medication immediately. A few months ago I stopped at another medication called edarbyclor causing gout and swelling of my feet to the point where I couldn’t walk for a month at a time. What is going on?

  20. Jim Burns says:

    What doctors and pharmacist don’t know is that ACE inhibitors are Brazilian Snake Venom!!!
    Yes! Just before you die with this poison your heart rate drops and your veins relax leaving you with NO BP!
    I was prescribed a dozen drugs to counteract this
    Poison.
    One day I thru them all out when doctor wanted to prescribe yet another pill.
    In 24 hours felt 10 years younger and wife asked why I had so much energy? It has been months now. BP is typically 135/85 now.
    This drug will KILL you fast or slowly, but it will KILL YOU.
    I’ve known several people developing cancers after being on this med. for years. Kidneys and livers do not like to be over worked 24/7.

  21. Steffy says:

    I just started taking a lisinopril- hydrochlorizide 10-12.5. I have only taken it for two days. The first day I urinated all evening and night. That night I also experienced severe stomach pain. The second day, I notice that I didn’t have a bowel movent the evening before nor anytime the second day. My stomach looks swollen. This is the beginning of my third day, and I am not going to take it. It was prescribed to me for my blood pressure. I will regulate my blood pressure myself by using a cup of apple cider vinegar, cup of garlic puree, a half of cup of chopped ginger root, mixed with a cup of green tea with ginseng, and sweeten with honey. I read that this combination will lower blood pressure and cholesterol. It can be stored in the refrigerator in a sealed bottle up to 2-3 months. Take one to two table spoons and one aspirin a day. Eat a healthy diet of oats, fresh fruits, fresh vegetables, and lean meats, foods rich in Omega-3, like, salmon, tuna, herring. Avoid cooking in oils like vegetable, canola, peanut oil, but you can use Olive oil to bake your meats. Avoid red meat and beef, use turkey cutlets, ground turkey, boneless skinless chicken breast instead, shitake mushrooms. Good luck and thanks for sharing your feedback regarding lisinopril.

  22. Matt G says:

    I’m been taking this medication it is caused nausea headaches and is caused stomach cramps and caused loose stools i’ve only taken this medication two days and I am going to stop I don’t like the horrible lightheadedness nausea and dizziness that comes after taking this medication and it causes severe insomnia .

  23. Nikki says:

    I was on a low dose of Lisinopril for months. I suddenly was doubled over in pain, felt like I needed to vomit but nothing would come up… felt like a twisted bowel. Went
    To ER worse pain than labor- did CT scan and it showed small bowel angeo adema. They say it’s rare but did they report my case or others???

  24. Karen says:

    I started Lisinopril 5 mg one month ago for HBP. Two days after starting it, I started having extreme abdominal pain, constipation! Callled the doctor who prescribed Rx and was told I might have diverticulitis and given an antibiotic. Got some relief but condition returned when the antibiotic ran out. I thought I had a blockage because of the pain. Doctors continued to say it wasn’t the Lisinopril, I stopped the Lisinopril yesterday. Today the abdominal pain is 75% better. I will take my research about this side effect to next doctor appointment.

  25. Took 20 MG of Lisinopril for several years for HB pressure. Never had constipation problems my entire life and then all of a sudden had all kinds of problems. Would not have a bowel movement for several days except tiny hard bits about the size of a dime. Constantly taking laxatives and then sometimes they did nothing. Also had a dry cough. Doctor finally changed to a different med. Bowel habits returned to normal and blood pressure staying in control without taking any medicine so lisinopril was doing nothing for me in that area. Blood pressure was running higher when on lisinopril than now when no medicine is being taken.

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