Angioedema might occur rarely (especially following first dose), and may involve head and neck (potentially compromising airway) or intestine (presenting with abdominal pain). African-Americans and patients with idiopathic or hereditary angioedema may be at an increased risk. Use in previous angioedema associated with ACEI therapy contraindicated. A rare toxicity associated with ACEIs includes cholestatic jaundice, which may progress to fulminant hepatic necrosis. A dry, hacking, nonproductive cough usually occurs within first few months of treatment (generally resolves after discontinuation). Hyperkalemia might occur (risk factors include renal dysfunction, diabetes mellitus, concomitant use of potassium-sparing diuretics, potassium supplements, and/or potassium-containing salts). Anaphylactic/anaphylactoid reactions can occur. Symptomatic hypotension with or without syncope can occur, usually with first several doses (effects most often observed in volume-depleted patients). Patients with renal impairment are at high risk of developing neutropenia; with both renal impairment and collagen vascular disease (e.g. systemic lupus erythematosus) they are at even higher risk of developing neutropenia. May be associated with deterioration of renal function and/or increases in serum creatinine, particularly in low renal blood flow (e.g. renal artery stenosis, heart failure). Use with caution in severe aortic stenosis (may reduce coronary perfusion resulting in ischemia), and in ischemic heart disease or cerebrovascular disease, due to potential consequences posed by falling blood pressure (e.g. MI, stroke). Use with caution in collagen vascular disease especially with concomitant renal impairment (may be at increased risk for hematologic toxicity), in hypertrophic cardiomyopathy and outflow tract obstruction (reduction in afterload may worsen symptoms), in unstented unilateral/bilateral renal artery stenosis, or in pre-existing renal insufficiency. Can cause injury and death to developing fetus when used in 2^nd^ and 3^rd^ trimesters. Use with caution before, during, or immediately after major surgery.