A 32-year-old man with idiopathic angioedema; which medication is contraindicated?

A 32-year-old man with idiopathic angioedema; which medication is contraindicated?

• A. Losartan
• B. Captopril
• C. Lisinopril
• D. Ramipril

Answer: (D)

ACE inhibitors can trigger or worsen angioedema because they prevent the breakdown of bradykinin, a vessel-dilating mediator. When bradykinin accumulates, it increases vascular permeability and can cause swelling in the face, lips, tongue, or airway — a risk that is particularly concerning in idiopathic angioedema. Among the options, the one that is an ACE inhibitor (and thus raises bradykinin) is ramipril. This makes it contraindicated in someone with idiopathic angioedema. Losartan, an ARB, does not increase bradykinin to the same extent and is generally considered a safer alternative in this context.

ACE inhibitors can trigger or worsen angioedema because they prevent the breakdown of bradykinin, a vessel-dilating mediator. When bradykinin accumulates, it increases vascular permeability and can cause swelling in the face, lips, tongue, or airway — a risk that is particularly concerning in idiopathic angioedema. Among the options, the one that is an ACE inhibitor (and thus raises bradykinin) is ramipril. This makes it contraindicated in someone with idiopathic angioedema. Losartan, an ARB, does not increase bradykinin to the same extent and is generally considered a safer alternative in this context.