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Neurology (Expert Forum)
Neuro damage from ACE Inhibitor?
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Neuro damage from ACE Inhibitor?
by jwh20, Apr 25, 2007 12:00AM
I was taking Lotensin/Benazepril for a couple of hears for mild hypertension (~145/95) and it was being effective. A few months ago I started having various neurological symptoms including:
1) Numbness and tingling in my fingers and toes.
2) Needle-stick like pains in my feet.
3) Trembling of my hands, arms, and thighs.
4) Feelings like being splashed by cold water in my legs, arms, and torso.
I had some tests (an MRI of the cervical spine and an EMG/NCV) for possible herniated disk. The MRI was normal and the EMG was "inconclusive" according to the neurologist.
The connection to the benazepril didn't hit me until one day. I stopped it and over the next couple of weeks the symptoms decreased markedly but not entirely. I had an appointment with my doctor and we talked about it and he changed be to lisinopril. I took it one time and about 2-3 hours after I took it the symptoms, all of them, were back stronger than ever. Especially the trembling. It's pretty clear to me that there is a cause-effect relationship here.
So it's been about 3 weeks since I took the lisinopril and I'm back to where I was before I took it. I have some symptoms, mostly the tingling and the needle-like pains. I see that some of these symptoms, while uncommon, are associated with ACE inhibitors.
So my questions are do you think these problems are actually caused by the benazepril and lisinopril? If so, are is the damage they may have caused permanent or should I see improvement over time?
I'm obviously very leery about trying another hypertension med. I am seeing my GP doctor in a week.
Thanks
1) Numbness and tingling in my fingers and toes.
2) Needle-stick like pains in my feet.
3) Trembling of my hands, arms, and thighs.
4) Feelings like being splashed by cold water in my legs, arms, and torso.
I had some tests (an MRI of the cervical spine and an EMG/NCV) for possible herniated disk. The MRI was normal and the EMG was "inconclusive" according to the neurologist.
The connection to the benazepril didn't hit me until one day. I stopped it and over the next couple of weeks the symptoms decreased markedly but not entirely. I had an appointment with my doctor and we talked about it and he changed be to lisinopril. I took it one time and about 2-3 hours after I took it the symptoms, all of them, were back stronger than ever. Especially the trembling. It's pretty clear to me that there is a cause-effect relationship here.
So it's been about 3 weeks since I took the lisinopril and I'm back to where I was before I took it. I have some symptoms, mostly the tingling and the needle-like pains. I see that some of these symptoms, while uncommon, are associated with ACE inhibitors.
So my questions are do you think these problems are actually caused by the benazepril and lisinopril? If so, are is the damage they may have caused permanent or should I see improvement over time?
I'm obviously very leery about trying another hypertension med. I am seeing my GP doctor in a week.
Thanks
Doctor's Answer
by Forum-M.D.-SH, May 19, 2007 12:00AM
First of all, keep in mind that I am unable to diagnose you because I am unable to examine you, this forum is for educational purposes.
The symptoms that you describe are commonly found in patients with a peripheral neuropathy. This is a condition that starts with burning/tingling in the feet (the longest peripheral nerves in the body) then extends up the legs, affects the finger tips and progresses up the arms with time. The most common condition causing peripheral neuropathy is diabetes, but here are many others including congentital (charcot-marie tooth disease), immune related (lupus, etc), vascular (vasculitis), cancer related (multiple myeloma, paraneoplastic) and idiopathic (we dont know the cause). There is no credible information about ACE inhibitors causing peripheral neuropathy that I am aware of (this would be an odd reaction). There is a number of good studies that indicate that ACE inhibitors are beneficial for peripheral neuropathy related to diabetes. There are also other things that could lead to your symptoms, such as hyperventilation (usually caused by anxiety). Another is an elctrolyte imbalance that can occur if you are taking a diuretic in combination with the ACE inhibitor (such as HCTZ, spironolactone, lasix, etc). I would suggest that you get an EMG at a major academic center (inconclusive is a strange answer). I would also suggest that your neurologist have you hyperventalate in their office to see if it reproduces your symptoms. I would also check some basic blood work including B12, RPR,monoclonal protein screen, ANA, B6, TSH, CMP, ESR, CRP and lyme antibodies to evaluate for common causes of peripheral neuropathy/electrolytes.
I hope this has been helpful.
The symptoms that you describe are commonly found in patients with a peripheral neuropathy. This is a condition that starts with burning/tingling in the feet (the longest peripheral nerves in the body) then extends up the legs, affects the finger tips and progresses up the arms with time. The most common condition causing peripheral neuropathy is diabetes, but here are many others including congentital (charcot-marie tooth disease), immune related (lupus, etc), vascular (vasculitis), cancer related (multiple myeloma, paraneoplastic) and idiopathic (we dont know the cause). There is no credible information about ACE inhibitors causing peripheral neuropathy that I am aware of (this would be an odd reaction). There is a number of good studies that indicate that ACE inhibitors are beneficial for peripheral neuropathy related to diabetes. There are also other things that could lead to your symptoms, such as hyperventilation (usually caused by anxiety). Another is an elctrolyte imbalance that can occur if you are taking a diuretic in combination with the ACE inhibitor (such as HCTZ, spironolactone, lasix, etc). I would suggest that you get an EMG at a major academic center (inconclusive is a strange answer). I would also suggest that your neurologist have you hyperventalate in their office to see if it reproduces your symptoms. I would also check some basic blood work including B12, RPR,monoclonal protein screen, ANA, B6, TSH, CMP, ESR, CRP and lyme antibodies to evaluate for common causes of peripheral neuropathy/electrolytes.
I hope this has been helpful.
Good luck, hope you feel better soon.