A patient on ramipril presents with symptoms suggesting angioedema. What is the most appropriate action?

A patient on ramipril presents with symptoms suggesting angioedema. What is the most appropriate action?

• A. Switch to another ACE inhibitor
• B. Continue ramipril and monitor
• C. Refer to A&E
• D. Take an antihistamine

Answer: (C)

ACE inhibitor–induced angioedema is driven by excess bradykinin rather than histamine. This can develop rapidly and threaten the airway, so urgent assessment is essential. The ramipril must be stopped and the patient should be referred to emergency care for airway evaluation and management. Switching to another ACE inhibitor would risk repeating the reaction, and taking an antihistamine alone won’t resolve a bradykinin-mediated event. Immediate referral to A&E ensures appropriate monitoring and potential airway protection if needed.

ACE inhibitor–induced angioedema is driven by excess bradykinin rather than histamine. This can develop rapidly and threaten the airway, so urgent assessment is essential. The ramipril must be stopped and the patient should be referred to emergency care for airway evaluation and management. Switching to another ACE inhibitor would risk repeating the reaction, and taking an antihistamine alone won’t resolve a bradykinin-mediated event. Immediate referral to A&E ensures appropriate monitoring and potential airway protection if needed.