Oropharyngeal Angioedema due to Nifedipine Hypersensitivity Post-hemithyroidectomy

Abstract

Nifedipine, a calcium channel blocker, is generally considered as safe but sublingual administration of immediate release nifedipine (IRN) formulations are sometimes associated with serious side effects. An 82-year-old male was presented with oropharyngeal angioedema, with no history of similar episodes, allergy to drug or food. The symptom began 20 minutes after IRN administration. He was admitted to ICU and a protective endotracheal intubation was performed. Over the first six days, his tongue continued to swell, starting with the right side, progressing to the left, hypopharynx, and epiglottis. Intravenous infusions of prednisolone, diphenhydramine and famotidine, were initiated; however, without improvement. The patient received nanofiltered Berinert® 2000 IU IV, but no improvement. Edema of the tongue reduced slowly after the seventh day and further improved over the next five days. Careful evaluation indicated nifedipine as the chief etiology for angioedema in the patient. IRN may triggers severe hypersensitivity and oropharyngeal angioedema, requiring immediate special care and thus should be used carefully.