Last edited 07/2021 and last reviewed 07/2021

Contra-indications to ACE inhibitors:

  • hypersensitivity to ACE inhibitors including angioedema
  • known or suspected renovascular disease:
    • ACEI's should be used with caution in patients with peripheral vascular disease who may have clinically covert renovascular disease
    • significant bilateral renal artery stenosis or renal artery stenosis in a single functioning kidney (1)
  • pregnancy
    • lower fetal & neonatal blood pressure
    • impair renal function
    • can cause oligohydramnios and skull defects

Cautions include:

  • ACE inhibition in patients receiving diuretics
  • patients with peripheral vascular disease or generalised atherosclerosis (risk of covert renovascular disease)
  • risk of agranulocytosis is increased in patients with collagent vascular disease (monitoring of blood counts recommended)
  • symptomatic aortic stenosis
  • history of idiopathic or hereditary angioedema
  • renal impairment

Please check Summary of Product Characteristics before prescribing ACE inhibitor.