Dose-dependent atorvastatin associated with angioedema

To describe a case of angioedema associated with increasing the dose of HMG-CoA reductase inhibitor (atorvastatin) from 20 to 40 mg daily in a patient previously stable on angiotensin II receptor blocker (losartan) and calcium channel blocker (amlodipine) as antihypertensive agents. A 79-year-old woman with no known drug allergies and a history of multiple clinical conditions presented to the emergency department with facial and periorbital swelling, edema of the lower extremities, shortness of breath, and generalized itching and skin rash, that started 2 days after increasing her atorvastatin dose from 20 to 40 mg daily. She was concurrently on losartan 50 mg and amlodipine 5 mg daily for the management of hypertension. Atorvastatin was discontinued, and the symptoms resolved during hospitalization. While atorvastatin use is not commonly associated with angioedema, the prescriber should be mindful of this possible adverse effect, especially when increasing the dose, or when prescribing together with medications known to cause angioedema (e.g., angiotensin II receptor blockers and calcium channel blockers), which may increase the risk of this adverse event.