• Angioedema occurs in less than 1% of stroke cases treated with tPA.
• Particularly associated with ACE inhibitor and beta blocker (less so) use.
• Symptoms are usually mild affecting the lips, tongue, and oropharynx.
• Check the patient for such symptoms at 45, 60, and 75 minutes post tPA administration.
• When present, consider treating with some or all of the following agents: 
   

             -- Diphenhydramine (Benadryl) 50 mg IV
             -- Ranitidine (Zantac) 50 mg IV
             -- Methyprednisolone (Solumedrol) 50 - 100 mg IV
             -- Racemic Epinephrine
             -- Anesthesia consult re: airway management