Annals of Pharmacotherapy (Ann Pharmacother)

Publisher: SAGE Publications

Journal description

The Annals of Pharmacotherapy was founded in 1967 as an international, independent journal for pharmacists, physicians, nurses, and other healthcare professionals. It continues to be the leading peer-reviewed journal dedicated to the advancement of safe, effective, and economical use of medications in patient care. Article categories include: Original Research, Comprehensive Reviews, Case Reports, Editorials, Visual Observations, International Reports.

Current impact factor: 2.06

Impact Factor Rankings

2016 Impact Factor Available summer 2017
2014 / 2015 Impact Factor 2.059
2013 Impact Factor 2.923
2012 Impact Factor 2.567
2011 Impact Factor 2.126
2010 Impact Factor 2.166
2009 Impact Factor 2.453
2008 Impact Factor 2.305
2007 Impact Factor 1.985
2006 Impact Factor 2.259
2005 Impact Factor 1.837
2004 Impact Factor 1.739
2003 Impact Factor 1.822
2002 Impact Factor 1.796
2001 Impact Factor 1.729
2000 Impact Factor 1.868
1999 Impact Factor 1.61
1998 Impact Factor 1.276
1997 Impact Factor 1.384
1996 Impact Factor 1.277
1995 Impact Factor 0.969
1994 Impact Factor 0.826
1993 Impact Factor 0.509

Impact factor over time

Impact factor
Year

Additional details

5-year impact 2.20
Cited half-life 7.70
Immediacy index 0.43
Eigenfactor 0.01
Article influence 0.65
Website The Annals of Pharmacotherapy website
Other titles Annals of pharmacotherapy (Online), Annals of pharmacotherapy, Ann pharmacother
ISSN 1542-6270
OCLC 47647817
Material type Document, Periodical, Internet resource
Document type Internet Resource, Computer File, Journal / Magazine / Newspaper

Publisher details

SAGE Publications

  • Pre-print
    • Author can archive a pre-print version
  • Post-print
    • Author can archive a post-print version
  • Conditions
    • Authors retain copyright
    • Pre-print on any website
    • Author's post-print on author's personal website, departmental website, institutional website or institutional repository
    • On other repositories including PubMed Central after 12 months embargo
    • Publisher copyright and source must be acknowledged
    • Publisher's version/PDF cannot be used
    • Post-print version with changes from referees comments can be used
    • "as published" final version with layout and copy-editing changes cannot be archived but can be used on secure institutional intranet
    • Must link to publisher version with DOI
    • Publisher last reviewed on 29/07/2015
  • Classification
    green

Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective: To evaluate acute traumatic pain protocols and to suggest optimization by characterizing opioid pharmacokinetics and pharmacodynamics (PK-PD). Data sources: MEDLINE (1946 to November 2015), EMBASE (1974 to November 2015), International Pharmaceutical Abstracts (1970 to December 2014), and Cochrane Database of Systematic Reviews (2005 to November 2015). Keywords: morphine, hydromorphone, fentanyl, trauma, acute pain, intravenous, opioid, pharmacokinetics, and pharmacodynamics. Study selection and data extraction: Literature characterizing opioid PK-PD was included. Additionally, studies evaluatingoutcomes of opioids for acute severe pain in adult trauma patients were selected. Data synthesis: PK-PD literature suggests that morphine exhibits an effect delay of 1.6 to 4.8 hours; however, clinical significance is doubtful. The relative onset of morphine is approximately 6 minutes, and duration, 96 minutes. Morphine 0.1 mg/kg IV then 0.05 mg/kg every 5 minutes achieved pain control in 40% of patients at 10 minutes and 76% at 60 minutes. The effect delay of hydromorphone (orally) is 18 to 38 minutes; its relative onset (IV), 5 minutes; and duration, 120 minutes. Hydromorphone every 15 minutes achieved variable success in clinical trials. The effect delay of fentanyl IV is 16.4 minutes; relative onset, 2 minutes; and duration, 7 minutes. One randomized controlled trial used fentanyl 0.1 µg/kg IV every 5 minutes. Conclusions: Further integration of opioid PK-PD into acutepain protocols is possible. One opioid should not be deemed more effective but rather titrated to effect. Morphine and hydromorphone can be titratedIV every 5 minutes until adequate pain control. Fentanyl can be titrated every 3 minutes.
    No preview · Article · Jan 2016 · Annals of Pharmacotherapy

  • No preview · Article · Jan 2016 · Annals of Pharmacotherapy

  • No preview · Article · Jan 2016 · Annals of Pharmacotherapy
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Allergic bronchopulmonary aspergillosis (ABPA) in cystic fibrosis (CF) is characterized by destructive changes in the airways. Long-term treatment with oral corticosteroids is often required for repeated exacerbations. Because elevated total IgE is a cardinal abnormality of ABPA, omalizumab has been used sporadically to decrease corticosteroid dose or totally replace corticosteroids. Objective: The aim of this report is to describe our experience with omalizumab treatment in patients with CF and ABPA. Methods: We conducted a review of 6 CF patients with ABPA receiving omalizumab. All patients were treated with oral prednisolone and itraconazole. Omalizumab was started if the patient was not responding to steroid treatment, which was determined according to serum IgE levels and/or clinical findings or depending on if there were side effects caused by steroid treatment. Results: The mean age of patients at the beginning of omalizumab treatment was 16.1 years. One patient had a new diagnosis of ABPA; however, the others had the first to third exacerbation when treated with omalizumab. The mean duration of ABPA by the time that treatment with omalizumab started was 13 ± 12.4 months (range = 2-29 months). With omalizumab treatment, IgE levels were decreased in all patients, and Aspergillus-specific IgE levels were decreased in 4 patients; however, FEV1(% predicted) improved only in 2 patients who had mild disease. Corticosteroids were reduced in the first, second, and third months of omalizumab treatment in 2, 1, and 3 patients, respectively. In 2 patients, steroid treatment was stopped. None of the patients suffered from side effects of omalizumab. The mean duration of omalizumab treatment was 12.5 months (range = 6-18 months). Conclusions: This study showed steroid-sparing effect, decreasing IgE levels, and improvement in respiratory symptoms in 6 CF patients with omalizumab treatment. Although this is a small sample of the population, omalizumab may be an alternative therapy for ABPA in CF patients who fail to respond to systemic corticosteroids or have serious adverse effects.
    No preview · Article · Dec 2015 · Annals of Pharmacotherapy
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objectives: To investigate whether medication regimen complexity and/or polypharmacy are associated with all-cause mortality in older people. Methods: This was a population-based cohort study among community-dwelling and institutionalized people ≥60 years old (n = 3348). Medication regimen complexity was assessed using the 65-item Medication Regimen Complexity Index (MRCI) in 10-unit steps. Polypharmacy was assessed as a continuous variable (number of medications). Mortality data were obtained from the Swedish National Cause of Death Register. Cox proportional hazard models were used to compute unadjusted and adjusted hazard ratios (HRs) and 95% CIs for the association between regimen complexity and polypharmacy with all-cause mortality over a 3-year period. Subanalyses were performed stratifying by age (≤80 and>80 years), sex, and cognition (Mini-Mental State Examination [MMSE] <26 and ≥26). Results: During follow-up, 14.0% of the participants (n = 470) died. After adjusting for age, sex, comorbidity, educational level, activities of daily living, MMSE, and residential setting, a higher MRCI was associated with mortality (adjusted HR = 1.12; 95% CI = 1.01-1.25). Polypharmacy was not associated with mortality (adjusted HR = 1.03; 95% CI = 0.99-1.06). When stratifying by sex, both MRCI and polypharmacy were associated with mortality in men but not in women. MRCI was associated with mortality in participants ≤80 years old and in participants with MMSE ≥26 but not in participants >80 years old or with MMSE <26. Conclusion: Regimen complexity was a better overall predictor of mortality than polypharmacy. However, regimen complexity was not predictive of mortality in women, in participants >80 years old, or in those with MMSE<26. These different associations with mortality deserve further investigation.
    No preview · Article · Dec 2015 · Annals of Pharmacotherapy
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective: To evaluate direct comparisons of bivalirudin versus unfractionated heparin (UFH) as anticoagulants during ST-segment elevation myocardial infarction (STEMI) in patients undergoing primary percutaneous coronary intervention (PPCI). Data sources: Relevant information was identified through a search of MEDLINE (1966-September 2015), International Pharmaceutical Abstracts (1960-September 2015), and Cochrane Databases (publications archived until September 2015) using the terms bivalirudin, unfractionated heparin, ST-segment elevation myocardial infarction, and primary percutaneous coronary intervention. Study selection and data extraction: English-language randomized controlled trials and meta-analyses were eligible for inclusion for data review of STEMI where PPCI was performed. Data synthesis: Either bivalirudin or UFH is recommended in the setting of STEMI where PPCI is to be performed. Bivalirudin is touted for its predictable pharmacokinetics, effects on thrombin-mediated platelet inhibition, and favorable outcomes with regard to adverse bleeding profiles, whereas UFH, the gold standard anticoagulant during PPCI, remains a viable treatment strategy. Only recently have direct comparisons of UFH and bivalirudin during PPCI become available. The evidence available is complicated by variances in use of glycoprotein IIb/IIIa inhibitors (GPIs), P2Y12 inhibitors, access sites, and anticoagulant dosing strategies. We provide a review of contemporary trials and advancements in this area. Conclusions: When compared to UFH with limited use of GPI, available evidence demonstrates that bivalirudin reduces bleeding at the expense of increasing risk for acute stent thrombosis. Further randomized studies are needed to determine the potential benefits of a post-PCI infusion of bivalirudin to reduce the risk for acute stent thrombosis, long-term follow-up beyond 30 days, and mortality.
    No preview · Article · Dec 2015 · Annals of Pharmacotherapy
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Hospital readmissions have been shown to contribute to both patient morbidity and rising health care expenditures across a number of disease processes. Adherence to a cardioprotective drug regimen is particularly important after ST-segment elevated myocardial infarction (STEMI) because it is an acute condition associated with high patient morbidity and mortality. Objective: The objective of this study was to evaluate the effectiveness of pharmacist intervention with regard to reduction in hospital readmissions and improvement in medication adherence and literacy. Methods: This was a prospective single-center study in which patients admitted with STEMI who received stents between January 2015 and April 2015 were included. Pharmacist intervention included medication reconciliation, medication education, facilitation of the delivery of discharge medications, and post-discharge telephone calls within 48 to 72 hours. A retrospective review of historical STEMI patients who did not have pharmacist transitions of care support was performed to compare readmission rates. Results: All-cause readmission at 30 days decreased from 13% to 5% (P = 0.18). Twelve of 95 patients in the historical control group were readmitted, compared to 2 of 40 patients in the intervention group. In the historical group, 3 of 12 patients required subsequent stent placement upon readmission, compared to none in the intervention group., Medication adherence and literacy scores improved significantly from baseline to high adherence and literacy at 30 days post-discharge (P = 0.0005). Conclusion: Pharmacist involvement in medication education signficantly improved medication adherence and literacy. There was a reduction in 30-day readmission rates, but the results were not statistically significant.
    No preview · Article · Dec 2015 · Annals of Pharmacotherapy

  • No preview · Article · Nov 2015 · Annals of Pharmacotherapy
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: The efficacy of vitamin K in lowering an elevated INR in the setting of cirrhosis is not well established. Objectives: The purpose of this investigation is to determine the effect of vitamin K administration on the INR and bleeding eventsamong hospitalized patients with cirrhosis. Methods: This is a retrospective investigation of patients hospitalized at an academic institution from 2010 to 2012. Adults with an ICD9 code supporting cirrhosis were segregated into matched cohorts based on provision of vitamin K. Multivariable logistic regression of factors associated with INR decrease and bleeding events was completed. Results: The final matched cohort (n = 276) contained 130 patients who received vitamin K and 146 who did not receive this therapy. ICU care (adjusted odds ratio [AOR] = 2.91; 95% CI = 1.54-5.49; P = 0.01), receipt of a blood product (AOR = 2.40; 95%CI = 1.35-4.24; P = 0.03), and baseline INR > 1.6 (AOR = 1.72; 95% CI = 1.00-2.95; P = 0.05), but not vitamin K administration (AOR = 1.17; 95% CI = 0.66-2.08; P = 0.59), were associated with INR decrease. Bleeding events occurred more frequently among patients with a history of esophageal varices (AOR = 6.35; 95% CI = 1.21-33.4; P = 0.03), but vitamin K administration did not have an impact on these events (AOR = 4.90; 95% CI = 0.56-43.0; P = 0.15). Conclusions: Administration of vitamin K did not affect INR changes or bleeding events in this cohort of hospitalized patients with cirrhosis.
    No preview · Article · Nov 2015 · Annals of Pharmacotherapy
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: No previous studies exist examining the impact of a short-term pharmacist-endocrinologist collaborative practice model on glycemic control in complex patients. Objective: Evaluate outcomes associated with a PharmD-Endocrinologist Diabetes Intense Medical Management (DIMM) "tune up" clinic for complex patients. Methods: A retrospective cohort study of 99 patients referred to DIMM clinic versus a comparator group of 56 primary care provider (PCP) patients meeting the same criteria (adult type 2 diabetes patients, glycosylated hemoglobin [A1C] ≥ 8%, follow-up visit within 6 months) in a Veterans Affairs Medical Center. DIMM clinic used a short-term model that coupled personalized clinical care with real-time, patient-specific diabetes education during two to four 60-minute visits over 6 months. PCP patients received usual care. Primary outcome was mean A1C change after 6 months. Secondary measures included fasting blood glucose, lipids, blood pressure, weight, body mass index, and percentage of patients meeting goals. Results: Patients in each group had an average of 8 and were taking 12 to 14 medications daily. Mean A1C (%) improvement in DIMM group was significantly greater at 6 months (-2.4 [SD = 2.1] vs -0.8 [SD = 1.7]; P < 0.001), than PCP group. Percentage meeting A1C goal levels (<7%, <8%, and <9%) was significantly greater at 3 and 6 months compared with baseline in the DIMM group (P < 0.001) versus (only <8%) at 3 and 6 months compared with baseline in PCP group. Conclusions: The DIMM clinic "tune up" model demonstrates a successful collaborative practice which helped complex diabetes patients achieve glycemic control in a 6-month period.
    No preview · Article · Nov 2015 · Annals of Pharmacotherapy
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective: To review the literature evaluating methotrexate as a treatment option for Crohn's disease (CD) in pediatric patients. Data sources: A search of PubMed electronic database (1966 to August 2015) and secondary resources was performed using the terms methotrexate, Crohn's, and inflammatory bowel disease. Other relevant articles cited within identified articles were also utilized. Study selection and data extraction: Data sources were limited to English-language studies that included children less than 18 years of age. In total, 10 clinical studies met the criteria. Data synthesis: Awareness of the risk of hepatosplenic T-cell lymphoma associated with anti-tumor necrosis factor and thiopurine therapies has renewed interest in methotrexate to treat CD in children. According to data from 10 predominantly retrospective studies, children treated with oral or subcutaneous methotrexate once weekly had remission rates of 25% to 53% at 1 year. Adverse effects most often included nausea and vomiting, elevated liver function tests, headache, and hematological toxicity. The evidence to support methotrexate is limited by inconsistent study design and poorly described dosage regimens. It has been most frequently evaluated in patients with prior thiopurine exposure and has not been thoroughly evaluated as first-line therapy. Conclusions: Based on results of retrospective studies, methotrexate is useful in the treatment of pediatric CD in those who fail thiopurine therapy. Remission rates with methotrexate are similar to those for thiopurine therapy, although no studies directly compare these agents. Although preliminary results are promising, prospective studies are needed to assess the use of methotrexate as initial first-line therapy in the pediatric CD population.
    No preview · Article · Oct 2015 · Annals of Pharmacotherapy

  • No preview · Article · Oct 2015 · Annals of Pharmacotherapy
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objectives: To review the pharmacology, efficacy, and safety of daclatasvir in the treatment of patients with chronic hepatitis C virus (HCV) infection. Data sources: A literature search through EMBASE and PubMed was conducted (January 1966 to August 2015) using the terms BMS-790052, daclatasvir, and hepatitis C. References from retrieved articles were reviewed for any additional material. Additionally, the new drug application and prescribing information were retrieved. Study selection/data extraction: The literature search was limited to human studies published in English. Phase 1, 2, and 3 studies describing the pharmacology, pharmacokinetics, efficacy, and safety of daclatasvir for HCV were identified. Data synthesis: Daclatasvir, a nonstructural 5A protein inhibitor, combined with sofosbuvir, is indicated for adult patients with chronic HCV genotype 3 regardless of treatment or cirrhosis status. The phase III ALLY-3 trial (n = 152) demonstrated that daclatasvir taken once daily with sofosbuvir for 12 weeks was effective at achieving sustained virological response (SVR) rates in treatment-naïve (97%) and treatment-experienced (94%) patients without cirrhosis. Patients with cirrhosis had significantly lower SVR rates (58 and 69%, respectively). The most common adverse drug events associated with daclatasvir and sofosbuvir in ALLY-3 were headache (20%), fatigue (19%), and nausea (12%). Conclusions: Daclatasvir, when combined with sofosbuvir, is an effective agent to treat HCV genotype 3, with SVR rates above 90% for patients without cirrhosis who are treatment naïve or experienced. SVR rates for treatment-naïve or -experienced patients with cirrhosis are not as robust (58%-69%).
    No preview · Article · Oct 2015 · Annals of Pharmacotherapy

  • No preview · Article · Oct 2015 · Annals of Pharmacotherapy
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Medication nonadherence affects health care costs, morbidity, and mortality. Concepts from behavioral economics can guide the development of interventions to improve medication adherence. Objective: To measure the relative effectiveness of 2 behavioral economic-based incentive structures to improve medication adherence. Methods: This randomized controlled trial compared adherence among participants taking antihypertensive or antihyperlipidemic medications randomized to usual care (UC), guaranteed pay-out (GPO) incentives, or lottery incentives. Daily adherence was measured over a 90-day period using electronic caps (Medication Event Monitoring System [MEMS]). The GPO group received $30 up-front in a virtual account, with $0.50 deducted for each missed dose. Lottery group participants were eligible for a weekly $50 drawing, but only if they had taken their medication as prescribed all week. An electronic survey assessed self-reported adherence. Statistical analysis included descriptive statistics, paired t tests, ANOVA, and Pearson's correlations. Results: In all, 36 participants were randomized (UC, n = 11; GPO, n = 14; lottery, n = 11). Mean percentage (±SD) of days adherent during the incentive period was highest in the lottery group (96% ± 5%), followed by the GPO group (94% ± 9%) and the UC group (94% ± 9%). There were no statistically significant differences among groups (P > 0.05). MEMS-measured adherence was not significantly correlated with a patient's self-reported adherence (P > 0.05) at baseline but was correlated at 90-day follow-up (P < 0.001). Conclusions: Although no statistically significant differences in adherence were demonstrated in this small sample of highly adherent participants, larger studies in a more diverse population or with other medications might show otherwise.
    No preview · Article · Oct 2015 · Annals of Pharmacotherapy
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Direct comparisons of inhaled nitric oxide (iNO) to inhaled epoprostenol (iEPO) in patients with acute pulmonary hypertension (PHT) following cardiac surgery are lacking. Objective: To compare the relative efficacy, safety, and cost of iNO versus iEPO in patients with acute PHT following cardiac surgery. Methods: This is a single-center, retrospective, observational, cohort study comparing iNO to iEPO for acute postoperative PHT following cardiac surgery. The primary outcome was reduction of mean pulmonary artery pressure (mPAP) to < 30 mm Hg, 6 hours after ICU admission from the operating room. Secondary outcomes, included ICU and hospital length of stay, duration of mechanical ventilation, bleeding complications, hypotension, in-hospital mortality, and cost. Results: A total of 98 patients met inclusion criteria (iNO, n = 49; iEPO, n = 49). There was no difference in the primary outcome of reduction of mPAP to < 30 mm Hg 6 hours after ICU admission (iNO, 33 [67%] vs iEPO, 35 [71%]; P = 0.83) or in the incidence of adverse events collected (iNO, 10 [20%] vs iEPO, 11 [22%]; P = 1.00). Based on cost estimates, the median cost of iEPO per patient was $363.53 ($226-$864.60) versus $2562.50 ($1875-$8625) for iNO (P < 0.01). Conclusions: The relative efficacy of iEPO appeared to be similar to that of iNO in reducing mPAP following cardiac surgery, in this retrospective review. Significant cost savings were associated with the use of iEPO.
    No preview · Article · Oct 2015 · Annals of Pharmacotherapy
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective: To review the mechanism of action for PCSK9 monoclonal antibodies and critically evaluate the therapeutic potential of evolocumab and alirocumab in the treatment of hypercholesterolemia. Data sources: Ovid MEDLINE search from 1980 to August 2015 using the terms PCSK9, evolocumab, and alirocumab with forward and backward citation tracking. Study selection and data extraction: English-language trials and studies assessing the mechanism, efficacy, or safety of PCSK9 monoclonal antibodies were included. Data synthesis: PCSK9 monoclonal antibodies have a potent ability to reduce low-density lipoprotein (LDL) by almost 50% in controlled trials: -47.49% (95% CI = -69.6% to -25.4%). They have an acceptable safety profile with no significant elevations in Creatine Kinase (CK) (odds ratio [OR] = 0.72; 95% CI = 0.54 to 0.96) or serious adverse events (OR = 1.01; 95% CI = 0.87 to 1.18), and preliminary evidence suggests reductions in myocardial infarction (OR = 0.49; 95% CI = 0.26 to 0.93). Although it is effective in several familial hypercholesterolemia (FH) patient types, it does not work in homozygous patients with dual allele LDL receptor negative polymorphisms or those who are homozygous for autosomal recessive hypercholesterolemia. Conclusions: Although not preferred over statins because of limited clinical trial evidence of cardiovascular event reductions, dosing convenience, and expense, PCSK9 monoclonal antibodies will have a prominent role to play in the treatment of hypercholesterolemia, especially in patients needing large LDL reductions, including patients with many types of FH.
    No preview · Article · Oct 2015 · Annals of Pharmacotherapy
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Pregnancy rates in veterans are an understudied phenomenon. Objective: The objective of this study was to identify predictors of pregnancy within 1 year of starting hormonal contraception among female veterans. Methods: This was a retrospective, cohort study of female veterans from Veterans Affairs facilities within Southern California and Nevada, who newly started hormonal contraception (pill, patch, or ring only) between October 2008 and September 2012. Pregnancy was defined as any event corresponding to a pregnant state using ICD-9 codes. Patients were followed for 1 year post-initiation. Multivariate logistic regression analysis was performed. Results: The final analysis included a total of 2166 patients. Approximately 5.9% (n = 127) of patients became pregnant during follow-up. Increased odds of pregnancy were associated with the following: mental health disease (odds ratio [OR] 1.69, 95% confidence interval [CI] 1.15-2.58), lowest socioeconomic quintile (OR 1.50, 95% CI 1.05-2.09), and Christian faith (OR 1.69, 95% CI 1.31-2.41). Age groups 25 to 34 years (OR 0.55, 95% CI 0.38-0.92] and 35 to 44 years (OR 0.32, 95% CI 0.06-0.64) were both associated with decreased odds of pregnancy versus age group 18 to 24 years. Conclusion: This study successfully identified several predictors of pregnancy in female veterans starting a pill, patch, or ring form of hormonal contraception. Female veterans in the lowest socioeconomic quintile, aged 18 to 24 years, diagnosed with a mental health disorder, and of Christian faith were found to be at significantly higher odds of a pregnancy. Identification of these at-risk populations may help clinicians and policy makers choose strategies to identify which patients could benefit the most from more effective long-acting reversible contraception therapy.
    No preview · Article · Sep 2015 · Annals of Pharmacotherapy
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective: To evaluate the place in therapy of fresh frozen plasma (FFP), C1 esterase concentrate (C1-INH), ecallantide, and icatibant in the management of angiotensin-converting enzyme inhibitor-induced angioedema (ACEI-IA). Data sources: A literature search was performed using PubMed (1946 through August 2015) and Embase (<1966 through August 2015). References from identified articles were reviewed. Study selection and data extraction: Consensus papers, practice guidelines, case reports/series, clinical trials, and meeting abstracts published in English and involving humans were included. Data synthesis: No medications are currently Food and Drug Administration-approved for managing ACEI-IA. Emerging evidence suggests that FFP and medications approved for management of acute attacks of hereditary angioedema, another bradykinin-mediated event, may be effective for use in ACEI-IA. Positive efficacy results were reported with FFP and C1-INH while mixed results have been seen with ecallantide. Off-label icatibant has the most evidence supporting its use in ACEI-IA with rapid symptom resolution (10 minutes to 6 hours) and avoidance of intubation and tracheotomy in several cases. These agents were well-tolerated in ACEI-IA. Conclusion: ACEI-IA is typically a self-limiting event. First-line therapies include ACEI discontinuation, observation, and supportive medications (eg, corticosteroids, antihistamines, and epinephrine). Symptom progression can be life-threatening and may require interventions such as tracheotomy and intubation. Off-label use of FFP and medications approved for hereditary angioedema have resulted in rapid resolution of symptoms and avoidance of intubation. Among these agents, icatibant has the most supporting evidence and has been incorporated into practice guidelines and algorithms as a second-line agent for serious life-threatening ACE-IA.
    No preview · Article · Sep 2015 · Annals of Pharmacotherapy