Adverse Drug Reactions/Events Induced by ACEI/ARB

doi:10.19803/j.1672-8629.2020.08.11

Abstract

Abstract: Objective To analyze the regularities and characteristics of adverse drug reactions/events(ADR/AE) caused by angiotensin converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers(ARBs) in order to provide reference for rational drug use in the clinic. Methods Cases of ADR/AE caused by ACEI and ARB were screened and analyzed statistically from a total of 32 068 cases of ADR/AE reported in Shenzhen between 2014.1.1 and 2017.12.31. Eighty-three cases of ADR/AE caused by ACEI and 63 caused by ARB were screened out. Results There was no significant difference between males and females in the incidence of ADRs/ADEs caused by the two types of drugs, but the elders were more vulnerable to ADR/AE (for ACEI, those≥40 years old accounted for 89.16% of the cases, compared with 89.71% for ARB). The onset time of most ADR/AE associated with ACEI(72.29%) and ARB(85.29%) was within 1 to 7 days after oral medicine. The main manifestations of adverse effects by ACEI involved the respiratory system(60.19%). The involved organs/systems and manifestations by ARB outnumbered those of ACEI, and adverse drug reactions associated with the nervous system(30.48%) were common. New (ARB 15.88% vs ACEI 7.77%) and serious (ARB 6.54% vs ACEI 2.91%) ADRs/ADEs caused by ARB accounted for a high proportion. The ADRs/ADEs were related to six drug categories, respectively. The top three drug categories of ACEI were perindopril (36.89%), benapril (21.36%), and enapril (21.36%), compared with valsartan (42.06%), irbesartan (28.04%) and losartan (17.76%) for ARB. Most of the manifestations of adverse effects by ACEI and ARB were mild and had good prognosis. Conclusion Clinicians and clinical pharmacists should be alert to ADR/ADE induced by ACEI and ARB within a week of administration. ADR/AE caused by the two kinds of drugs should be distinguished and intervened in as early as possible in order to prevent serious ADR/AE

Key words: angiotensin converting dnzyme inhibitors(ACEI), Angiotensin Receptor Blockers(ARB), adverse drug reaction/adverse event(ADR/AE)

CLC Number:

R994.11

HE Guilin, ZUO Li, CHEN Jiayin, ZHOU Xueqin, Wang Qian. Adverse Drug Reactions/Events Induced by ACEI/ARB[J]. Chinese Journal of Pharmacovigilance, 2020, 17(8): 502-507.

References

[1] 奚倩兰, 刘凯, 陈晓平. 《高血压合理用药指南》解读之肾素-血管紧张素-醛固酮系统抑制剂治疗高血压并发症[J]. 中国循证医学杂志, 2018, 18(1):2-7.
[2] 王春雪. 肾素血管紧张素系统阻断剂与脑卒中[J]. 中华高血压杂志, 2017, 25(4):322-325.
[3] Moon JY.Recent Update of Renin-angiotensin-aldosterone System in the Pathogenesis of Hypertension[J]. Electrolyte Blood Press..2013, 11(2):41-45.
[4] Palevsky PM, Zhang JH, Seliger SL, et al.Incidence, Severity, and Outcomes of AKI Associated with Dual Renin-Angiotensin System Blockade[J]. Clin J Am Soc Nephrol, 2016, 11(11): 1944-1953.
[5] De Boer IH, Bangalore S, Benetos A, et al.Diabetes and Hypertension:A Position Statement by the American Diabetes Association[J].Diabetes Care, 2017, 40(9):1273-1284.
[6] 国家食品药品监督管理总局药品评价中心. 药品不良反应报告和监测工作手册[EB/OL]. (2013-04-26)[2019-10-08]. http://www.cdr-adr.org.cal/was5/wed/search.
[7] 任晓蕾,杨乐,李玉珍. ACEI类药物致不良反应分析及临床合理用药[J]. 中国医院用药评价与分析, 2010, 10(09):837-839.
[8] 徐朝飞. 应用血管紧张素转换酶抑制剂不良反应的特征分析[J].中国循证心血管医学杂志, 2017, 9(8):969-971.
[9] 杨鹏. 对36例ACEI类药物所致不良反应的综合分析[J]. 当代医药论丛, 2014, 12(13):174-176.
[10] Bangalore S, Kumar S, Messerli FH.Angiotensin-converting enzyme inhibitor associated cough: deceptive information from the Physicians'Desk Reference[J]. Am J Med, 2010, 123(11):1016-1030.
[11] Matchar DB, McCrory DC, Orlando LA, et al. Systematic review:comparative effectiveness of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers for treating essential hypertension[J]. Ann Intern Med, 2008, 148(1):16-29.
[12] 夏益兰. 常用三类抗高血压药物的不良反应监测分析[J]. 临床医药文献电子杂志, 2017, 4(65):12823-12824.
[13] 李磊. 112例抗高血压药品不良反应分析[J]. 中国药物警戒,2012, 9(8):485-486.
[14] ONTARGET Investigators, Yusuf S, Teo KK, et al.Telmisartan, ramipril, or both in patients at high risk for vascular events[J]. N Engl J Med, 2008, 358(15):1547-1559.
[15] 林海龙,王旭开,王其梗,等. 血管紧张素转换酶抑制剂与血管紧张素受体拮抗剂治疗高血压:有无优劣之分? 如何选择?[J].中华高血压杂志, 2017, 25(9):811-817.
[16] 张俊芳, 王映辉. ACEI及AT_1R拮抗剂的不良反应和临床处理[J]. 中国药师, 2003, 6(5):309-311.