PEBC: What You Need to Know: ACE Inhibitors and ARBs

Examples: Ramipril and Candesartan

Indications:

• Hypertension

• Heart failure

• Kidney disease

• Stroke

• Myocardial Infarction

Adverse Effects:

• Dizziness

• Dry Cough: most common drug-induced cough cause → switch to ARB instead which has less risk

• Angioedema: swelling of face and lips, rare but unique

• Hyperkalemia

• Acute renal failure (if dehydrated)

• Increased serum creatinine

• Contraindicated in pregnancy

Drug Interactions:

• Lithium: increased lithium levels by up to 50%

• Medications that increase potassium levels (potassium supplements, potassium-sparing diuretics - spironolactone, sulfamethoxazole-trimethoprim): hyperkalemia

• NSAIDs - increases blood pressure and kidney dysfunction

• Do not combine Aliskiren (direct renin inhibitor), ACE inhibitor and ARB due to hypotension, angioedema and renal dysfunction