Pharmacovigilance study of angiotensin-converting enzyme inhibitors in patients visiting Department of Medicine of a Tertiary Care Hospital, Surendranagar, Gujarat
Keywords:
Pharmacovigilance, Angiotensin-converting enzyme inhibitors, WHO-UMC scaleAbstract
Background: The objective of this study was to evaluate incidence, patterns, and severity of angiotensin-converting enzyme inhibitor (ACEI) induced adverse drug reactions (ADR).
Methods: A total of 500 hypertensive patients taking ACEI was enrolled in the study by taking an informed consent. Reporting of all ACEI-induced ADRs was done by filling CDSCO ADR form. All ADR reports were evaluated according to WHO-UMC causality assessment scale.
Results: A total of 53 ADRs (31 males and 22 females) was observed in 500 hypertensive patients taking ACEI. Of 53 ADRs, 22 (41.51%) were mild, 28 (52.83%) were moderate, and only 3 (5.66%) were classified as severe. 7 ADRs (13.21%) were classified as certain, 30 ADRs (56.60%) were in probable category, 8 (15.09%) were in possible category, 4 (7.55%) in unlikely category, 3 (5.66%) in conditional category (unclassified), and 1 ADR was in unassessable (unclassifiable) category. Among 53 ADRs, 24 (4.80%) patients developed dry cough, 8 (1.60%) hypotension, 2 (0.40%) headache, 2 (0.40%) dizziness, 3 (0.60%) nausea/bowel upset, 3 (0.60%) rashes, 2 (0.40%) developed angioedema, 3 (0.60%) dysgeusia, hyperkalemia, acute renal failure, proteinuria are rare.
Conclusions: Incidence of ADRs by ACEIs is 10.60% with cough as the most common ADR followed by hypotension. As enalapril is most frequently used ACEI, ADRs due to enalapril are more common.
References
WHO. The Importance of Pharmacovigilane, Safety Monitoring of Medical Products. Geneva: WHO; 2002.
Edwards IR, Aronson JK. Adverse drug reactions: definitions, diagnosis, and management. Lancet. 2000 7;356(9237):1255-9.
Jose J, Rao PG. Pattern of adverse drug reactions notified by spontaneous reporting in an Indian tertiary care teaching hospital. Pharmacol Res. 2006;54(3):226-33.
Cannon RO 3rd. Potential mechanisms for the effect of angiotensin-converting enzyme inhibitors on endothelial dysfunction: the role of nitric oxide. Am J Cardiol. 1998 19;82(10):8S-10.
National High Blood Pressure Education Program Working Group report on hypertension in diabetes. Hypertension. 1994;23(2):145-58.
Central Drugs Standard Control Organization. Suspected adverse drug reaction reporting form. Available at http://www.cdsco.nic.in/ADR_form_pvpi.pdf. Accessed 5 November 2011.
The use of the WHO-UMC system for standardised case causality assessment. Available at http//www.who-umc.org/Graphics/24734.pdf. Accessed 5 November 2011.
Lewis CE, Grandits A, Flack J, McDonald R, Elmer PJ. Efficacy and tolerance of antihypertensive treatment in men and women with stage 1 diastolic hypertension. Results of the Treatment of Mild Hypertension Study. Arch Intern Med. 1996;156(4):377-85.
Montastruc JL, Lapeyre-Mestre M, Bagheri H, Fooladi A. Gender differences in adverse drug reactions: analysis of spontaneous reports to a Regional Pharmacovigilance Centre in France. Fundam Clin Pharmacol. 2002;16(5):343-6.
Hussain A, Aqil M, Alam MS, Khan MR, Kapur P, Pillai KK. A pharmacovigilance study of antihypertensive medicines at a South Delhi hospital. Indian J Pharm Sci. 2009;71(3):338 41.
Parthasarathi G, Olsson S. Adverse drug reactions. In: Pharthasarathi G, Nyfort-Hansen K, Nahata MC, editors. A Textbook of Clinical Pharmacy Practice. 1st Edition. Chennai: Orient Longman Pvt. Ltd.; 2004: 84-102.
Amolt MA, Damonte de Elia AR. Enalapril and cough. J Hypertens. 1991;4:28A.
Moyses C, Higgins TJ. Safety of long-term use of lisinopril for congestive heart failure. Am J Cardiol. 1992;70(10):91C 7.
Williams B, Gosse P, Lowe L, Harper R, PRISMA I Study Group. The prospective, randomized investigation of the safety and efficacy of telmisartan versus ramipril using ambulatory blood pressure monitoring (PRISMA I). J Hypertens. 2006;24(1):193-200.
Bristol-Myers Squibb. Fosinopril prescribing information. Princeton (NJ); 1996.
Cooper WD, Sheldon D, Brown D, Kimber GR, Isitt VL, Currie WJ. Post-marketing surveillance of enalapril: experience in 11,710 hypertensive patients in general practice. J R Coll Gen Pract. 1987;37(301):346-9.
Chu CS, Cheng KH, Lee KT, Lin TH, Lee ST, Su HM, et al. Tolerability of ramipril 10 mg daily in high-risk cardiovascular patients in Taiwan: experience from Kaohsiung Medical University Chung-Ho Memorial Hospital. Kaohsiung J Med Sci. 2005;21(11):511-6.
Schreiner M, Berendes B, Verho M, Langley A, Cairns V. Antihypertensive efficacy, tolerance, and safety of long-term treatment with ramipril in patients with mild-to-moderate essential hypertension. J Cardiovasc Pharmacol. 1991;18 Suppl 2:S137-40.
Tripathi KD. Drugs affecting renin-angiotensin system and plasma kinins. Essentials of Medical Pharmacology. 6th Edition. New Delhi: Jaypee Brothers; 2009: 479-92.