CAPTOPRIL
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I had a 62 yo patient who recently developed an widespread papular
eczematous eruption, 2 months after starting captopril (Capoten), furosemide
(Lasix), and amlodipine (Norvasc), metoprolol.  We discontinued Capoten,
treated the widespread eruption with Triamcinolone and it cleared.  Biopsy
was more consistent with spongiotic dermatitis, such as allergic contact,
numular dermatitis, or id reaction; it was felt less likely to be a drug
rash.  I have restarted the Capoten and am watching him.

The related question I have (and one his cardiologist asked me):

If a patient is allergic to one ACE inhibitor, can he take the others in
that class.  The PDR suggests that is contraindicated (pg 741 of 1997 PDR
under contraindications) to take one ACE inhibitor if you allergic to
others. Perhaps this is related to the sulfa component, I don't know.  The
other question is whether a patient allergic to the older ACE inhibitors
could take losartan (Cozaar) which is supposedly a new generation of ACE
inhibitors.  Does anyone have any knowledge or references regarding this.
 
Mike Crowe, M.D.
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Capoten (captopril) is unique among the ACE inhibitors because it has a
structure much like penicillamine, with a sulfhydryl group. This makes it a
relatively bad actor, and I suspect that other ACE inhibitors would probably
be well tolerated.

Kevin C. Smith MD FRCPC
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The article(s) you may be referring to are as follows:
  1. (1988): Slater EE et al, JAMA, Volume 260 (#7) Aug 19, page 967 
ff."Clinical Profile of Angioedema Associated with ACE 
Inhibition)
                   or
  2. (1990): Orfan N et al, JAMA, Volume 264 (#10) September 12, page 
1287 ff. "Severe Angioedema Related to ACE Inhibitors in Patients With 
a History of Idiopathic Angioedema."
 
Jerry Litt
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