A case of angioedema associated with the initiation of a nonsteroidal antiinflammatory drug in a patient stable on an angiotensin-converting-enzyme inhibitor is reported.
A 68-year-old African-American man with no known drug allergies and a history of hypertension, benign prostatic hypertrophy, diverticulosis, and gout arrived at the clinic with swelling of the lips and tongue three days after he started taking naproxen 375 mg every eight hours as needed for pain associated with acute gout. He denied urticaria, difficulty breathing, fever, abdominal pain, vomiting, and diarrhea. His other medications included quinapril 10 mg daily (taken for 5 years), tamsulosin hydrochloride 0.4 mg daily, omeprazole 20 mg daily, and colchicine 0.6 mg daily. He had reported smoking approximately 2.5 packs of cigarettes per week and consuming alcohol (one to two drinks) on the weekends. He denied any illicit drug use, drug rash, or seasonal allergies. Naproxen was discontinued, and the patient was treated with prednisone (tapered regimen) and acetaminophen 650-mg tablets, and his angioedema resolved. The Naranjo et al. probability scale revealed that naproxen and quinapril coadministration was the probable cause of the patient's adverse reaction (score of 7).
A 68-year-old African-American man who had been receiving quinapril for 5 years developed angioedema after initiation of naproxen.