Lisinopril overdose and management with intravenous angiotensin II

• Published in: The Annals of pharmacotherapy Vol. 28; no. 10; p. 1165
• Main Authors: Trilli, L E, Johnson, K A
• Format: Journal Article
• Language: English
• Published: United States 01.10.1994
• Subjects: Angiotensin II - administration & dosage; Angiotensin II - therapeutic use; Angiotensin-Converting Enzyme Inhibitors - adverse effects; Blood Pressure - drug effects; Cardiomyopathy, Dilated - drug therapy; Creatinine - blood; Drug Overdose; Humans; Infusions, Intravenous; Lisinopril - adverse effects; Lisinopril - pharmacology; Male; Medication Errors; Middle Aged
• ISSN: 1060-0280
• DOI: 10.1177/106002809402801006

This report describes a case of lisinopril overdose managed in part with an infusion of angiotensin II in a patient with dilated cardiomyopathy and reviews other literature reporting angiotensin-converting enzyme (ACE) inhibitor overdose. Information concerning this patient was obtained through review of the medical chart, conversation with the attending physician, and personal involvement late in the course of the patient's therapy. We conducted MEDLINE and PAPERCHASE searches of the English language literature (restricted to human studies) from 1976 to the present, manually searched Current Contents and references from each publication reviewed, and contacted the manufacturer of lisinopril for any further references they could provide. All case reports that described an ACE inhibitor overdose. Case reports were evaluated for the ACE inhibitor involved, amount ingested, and therapeutic management. Ten patients with ACE inhibitor overdose have been reported, most of whom required only intravenous fluids for blood pressure support. The case presented here is the second report in which the patient's blood pressure was not adequately controlled with fluid and traditional vasopressors and required an infusion of angiotensin II. Although only a few cases of ACE inhibitor overdose have been reported, it is possible that with widespread use of these agents, overdose may become a more common problem. Management of ACE inhibitor overdose should include general supportive care, gut decontamination when possible, intravenous fluids, and vasopressors if necessary. Intravenous angiotensin II may be effective in situations in which traditional vasopressors fail, and is a physiologically rational treatment.