ACE (Angiotensin Converting Enzyme) inhibitors like Lisinopril are ubiquitously used. The first oral ACE Inhibitor was Captopril, made based on hypotension-inducing peptides studied in the Brazilian pit-viper venom. Unlike most movie sequels, the subsequent drugs made from the original med usually get better with less side-effects. Captopril was subsequently refined to other ACE inhibitors to reduce side effects.
The term ‘CAPTOPRIL’ makes a good mnemonic to remember the common side-effects for all ACE inhibitor class of drugs.
C – Cough
A – Angioedema (can occur despite being on medication for years)
P – Potassium elevation
T – Taste changes**
O – Orthostatic Hypotension with initial use
P – Pregnancy Category B / C – do not use
R – Renal failure worsened (Hold this med in AKI)
I – Itchy rash in some people
L – Leukopenia (rare)
**
As a side note, interestingly the ACE-receptor that ACE-inhibitors act on, is also the receptor for cell-entry used by the COVID-19 virus. ACE receptors are present on various sites including some taste buds , explaining why COVID-19 virus can alter or reduce taste sensation in some people which is a commonly known fact now! This COVID-ACE relattion helps remember that ACE inhibitors can also alter taste as a side-effect in some people the same way !
