Angioedema Associated with Aspirin and Rofecoxib

Marshall, Leisa L.

doi:10.1345/aph.1e546

Cited by 7 publications

(4 citation statements)

References 20 publications

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“…This comes mainly from the results of controlled drug challenge studies [5–8], in which patients with a history of previous reaction to NSAIDs were given one or more doses of a COX‐2 selective inhibitor and monitored for adverse effects. However, the results were not consistent and several case reports have reported angio‐oedema to be induced by newer COX‐2 selective inhibitors [9–11].…”

Section: Introductionmentioning

confidence: 79%

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Risk of hospitalization for angio‐oedema among users of newer COX‐2 selective inhibitors and other nonsteroidal anti‐inflammatory drugs

Downing

Jacobsen

Sørensen

et al. 2006

Brit J Clinical Pharma

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What is already known about this subject• There is some evidence that the risk of cutaneous reactions is lower in patients taking newer cyclooxygenase (COX)-2 selective inhibitors than in users of other nonsteroidal antiinflammatory drugs (NSAIDs).• However, the data are inconclusive and formal epidemiological evidence is lacking. What this study adds• This population-based case-control study found no elevated risk for angio-oedema amongst users of newer COX-2 selective inhibitors, whilst users of other NSAIDS were shown to have an increased risk.• Our data support the hypothesis that newer COX-2 selective inhibitors are safe in relation to angio-oedema. • However, given other current health concerns related to these drugs, their use should continue to be carefully monitored. AimTo examine the risk of angio-oedema among users of the newer cyclooxygenase (COX)-2 selective inhibitors celecoxib and rofecoxib and other non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs) in a population-based case-control study. MethodsCases of angio-oedema were identified from hospital discharge registries from three Danish counties between 1 January 2000 and 31 December 2003 ( n = 377) and 10 matched population controls per case were selected from the Civil Reg istration System ( n = 3747). Data on newer COX-2 selective inhibitor and other NSAID use (current and former) were obtained from prescription databases. Data on potential confounding factors were also collected. Conditional logistic regression was used to compute relative risks for angio-oedema according to drug exposure. ResultsThe crude relative risks for the newer COX-2 selective inhibitors were higher than those for other NSAIDs. After adjustment for confounding, the relative risk for current use of newer COX-2 selective inhibitors was 0.96 [95% confidence interval (CI) 0.46, 2.03], whereas the risk for other NSAIDs was 1.77 (95% CI 1.23, 2.58). ConclusionOur data support the hypothesis that newer COX-2 selective inhibitors are safe in relation to angio-oedema. However, given other current health concerns related to these drugs, their use should continue to be carefully monitored. Angioedema risk in users of newer COX-2 selective inhibitors and other NSAIDsBr J Clin Pharmacol 62 :4 497

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Section: Introductionmentioning

confidence: 79%

“…These studies used varying doses of NSAIDs and the majority were carried out on only one occasion, with a single dose administered. Referring to several case reports, Marshall states that patients were more likely to develop intolerance after at least a week of therapy rather than after one dose [11]. However, Nettis et al.…”

Section: Discussionmentioning

confidence: 99%

Risk of hospitalization for angio‐oedema among users of newer COX‐2 selective inhibitors and other nonsteroidal anti‐inflammatory drugs

Downing

Jacobsen

Sørensen

et al. 2006

Brit J Clinical Pharma

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“…No medications, such as aspirin1 or non steroidal anti-inflammatory drugs,2 were associated with the swelling. A CT of the orbits revealed an isolated proptosis with swelling of the medial and inferior rectus muscles and mild hypertrophy and swelling of the left lacrimal gland.…”

Section: Methodsmentioning

confidence: 99%

591 A Case of Idiopathic Recurrent Isolated Orbital Angioedema with Exophthalmos

Talreja¹,

Culverhouse²,

Shearer³

et al. 2012

World Allergy Organization Journal

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BackgroundIdiopathic angioedema is a term applied to recurrent episodes of angioedema of unknown etiology. The following is a case report of idiopathic recurrent isolated orbital angioedema with exophthalmos which responds to prolonged courses of oral corticosteroids.MethodsA 67 year old Caucasian female with aspirin exacerbated respiratory disease (AERD) sought treatment for an acute, progressive painless left eye swelling with exophthalmos without visual deficits or urticaria. High dose corticosteroids were initiated followed by a low maintenance dose. The swelling subsided after one year of corticosteroid therapy.Ten years later, orbital swelling with exophthalmos returned in the same eye. No medications, such as aspirin1 or non steroidal anti-inflammatory drugs,2 were associated with the swelling. A CT of the orbits revealed an isolated proptosis with swelling of the medial and inferior rectus muscles and mild hypertrophy and swelling of the left lacrimal gland. A complete history and physical examination were negative. The family history likewise was negative.ResultsHigh-dose systemic glucocorticoid therapy was initiated. Symptoms resolved after 1 month of tapered corticosteroid therapy, however, swelling reoccurred in the orbit within one week. Low dose maintenance corticosteroids were reinitiated with resolution of the orbital swelling. Work-up for acquired C1 esterase deficiency is negative.ConclusionsAn atypical case of recurrent idiopathic isolated orbital angioedema with exophthalmos in a patient with AERD and no triggering factor, systemic findings and a negative evaluation is presented.

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“…She also used polyvinyl alcohol 1.4% liquiform tear eye drops, 1 drop into both eyes as needed. Of these medications, acetaminophen, 8 alendronate, 9 aspirin 10 have been rarely associated with angioedema. This case report will focus on mirabegron as possible cause.…”

Section: Case Reportmentioning

confidence: 99%

Mirabegron Associated Angioedema: A Case Report

2022

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Purpose: To review a case of angioedema associated with mirabegron. Summary: A 77-year-old woman presented to the emergency department with swelling of the left anterior side of the tongue beginning 90 minutes prior to arrival. She noticed tingling on her tongue while eating a hamburger, chips, and ice cream. The patient had no history of medication-related allergies. Home medications include acetaminophen, aspirin, biotin, black cohosh, Co-enzyme Q-10, cranberry, fish oil, multivitamin, alendronate, and mirabegron all taken orally. The patient reports being on mirabegron for 3 to 4 years but recently decided to self-taper off the medication. Her initial laboratory test results were unremarkable. The patient was diagnosed with left tongue angioedema, and she received methylprednisolone, epinephrine, famotidine, and 2 units of plasma. After medication administration, the patient underwent a flexible nasopharyngeal laryngoscopy resulting in no significant angioedema in the pharynx and hypopharynx with a small area of possible edema noted on the right base of tongue/lingual tonsil. Patient’s symptoms improved with medication treatment and discontinuation of mirabegron. The use of Naranjo et al. adverse-event probability scale revealed that mirabegron was the possible (score of 4) cause of the patient’s left tongue angioedema. Conclusion: A 77-year-old woman developed drug induced tongue angioedema associated with mirabegron after being compliant on this medication for 3 to 4 years. Patient was self-tapering her dose of mirabegron. This patient responded well to medication treatment and discontinuation of drug. To our knowledge, this is the second case report of mirabegron induced angioedema.

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Angioedema Associated with Aspirin and Rofecoxib

Abstract: Patients with aspirin and NSAID intolerance may develop intolerance to COX-2 inhibitors, especially with repeated exposure.

Cited by 7 publications

References 20 publications

Risk of hospitalization for angio‐oedema among users of newer COX‐2 selective inhibitors and other nonsteroidal anti‐inflammatory drugs

Risk of hospitalization for angio‐oedema among users of newer COX‐2 selective inhibitors and other nonsteroidal anti‐inflammatory drugs

591 A Case of Idiopathic Recurrent Isolated Orbital Angioedema with Exophthalmos

Mirabegron Associated Angioedema: A Case Report

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