Lisinopril and Cough: What You Should Know

A class of drugs well known for inducing dry coughs, a type of a cough that does not produce mucus, is called Angiotensin Converting Enzyme (ACE) inhibitors. Lisinopril is an example of an ACE inhibitor.

According to a study, about 5-35% of patients on ACE inhibitors are likely to come down with a dry, persistent cough which would be unresponsive to pharmacotherapy of any sort. Simply put, irrespective of whatever interventions you make, as long as you stay on that medication, chances are the cough would persist.

Though ACE inhibitors are in the forefront of causing a drug-induced dry cough, some other drugs can induce a cough. Nasal sprays containing Fluticasone, Simvastatin, and Carvedilol have also been reported to cause a dry cough.

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Lisinopril As An ACE Inhibitor

ACE inhibitors are used as first-line therapy in the management of elevated blood pressure. They are also used in the management of heart failure, in preventing strokes, and in preventing and treating kidney disease (nephropathy) in people with hypertension or diabetes.

Members of the ACE inhibitors class of drugs are Lisinopril, Captopril, Enalapril, Ramipril, Perindopril, Benazepril, and Fosinopril. Lisinopril is regarded as the most prominent. A monotherapy of Lisinopril is effective in managing elevated blood pressure while other ACE inhibitors have to be used in combination with other blood pressure medications.

All ACE inhibitors have a similar pathway and side effects. This means all are capable of inducing dry cough.

Why Does Lisinopril Cause Cough?

Lisinopril and other ACE inhibitors prevent the degradation of bradykinin, a substance that lowers blood pressure, making it abundantly available. Bradykinin is known to cause the contraction of non-vascular smooth muscle in the lungs.

This contraction is believed to be responsible for a dry cough that is prominent among some people using ACE inhibitors.  

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How Is Lisinopril-Induced Cough Treated?

A cough caused by ACE inhibitors does not require treatment except the discontinuation of the drug. ACE inhibitors have a short half-life and low volume of distribution. This means that it should be cleared from the body within a day.

Lisinopril Alternatives

Angiotensin Receptor Blockers (ARBs) are a group of blood pressure medications that have similar clinical profiles to the ACE Inhibitors. However, they do not interfere with the destruction of bradykinin, so they have a lower likelihood of causing a cough.

It is best to discuss medication options with one’s physician in considering which alternate therapy to use in cases of a drug-induced cough.

Should I Stop Lisinopril if it Makes Me Cough?

It is unsafe to stop using medications without discussing it with your doctor because of an observed side effect. The best approach is to discuss such effects with one’s primary health care provider. Your doctor is in the best position to counsel and switch drug therapy if needed. Self-medication should be avoided at all costs. 

Latest posts by Raliat Ola-Dauda, PharmD (see all)
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