The Cough Associated With Continuing Ace Inhibitors

Lisinopril cough is a common side effect of an angiotensin-converting enzyme (ACE) inhibitor called Lisinopril. The medication is used to treat high blood pressure.

Drugs like Lisinopril are important treatments for heart failure and coronary artery disease, but they can cause side effects. One of the more common side effects of ACE inhibitors is a persistent dry cough.

This article will go over what causes Lisinopril cough, as well as when you should see your provider if you have side effects when taking ACE inhibitors.

Verywell / Theresa Chiechi

How Common Is Lisinopril Cough?

Lisinopril cough is common. Studies suggest that anywhere from 5% to 20% of people who take ACE inhibitors develop a persistent dry cough. Lisinopril cough can come on within hours of taking the first dose to weeks, or even months, later.

ACE inhibitors besides Lisinopril can also cause a cough, including:

• Accupril (quinapril)
• Altace (ramipril)
• Capoten (captopril)
• Lotensin (benazepril)
  
• Mavik (trandolapril)
• Monopril (fosinopril)
• Prinivil, Zestril (lisinopril)
• Univasc (moexipril)
  
• Vasotec (enalapril)

In around 20% of cases, Lisinopril cough is bad enough that a person needs medical treatment.

Why Does Lisinopril Cough Happen?

Lisinopril cough happens because of how ACE inhibitors work in the body.

ACE inhibitors like Lisinopril lower blood pressure because they prevent the body from making a substance called angiotensin II that narrows blood vessels (vasoconstriction).

How ACE Inhibitors Work

Vasoconstriction is a normal process in the body that helps regulate blood flow, but it can be a problem for people with high blood pressure. The heart has to work harder to pump blood if the vessels are narrow, which raises blood pressure.
That's why taking medicines like Lisinopril that relax the blood vessels and increase blood flow can help lower high blood pressure.

Besides helping to lower blood pressure, angiotensin II also has other jobs in the body. Some of these jobs can indirectly cause coughing.

For example, angiotensin II breaks down a substance called bradykinin. When angiotensin II is blocked by medication like Lisinopril, bradykinin can build up in the airways and trigger an inflammatory reaction.

The inflammation can give a person a tickling feeling in their chest and throat that causes a severe, hacking cough.

Risk Factors for Lisinopril Cough

Most people who take Lisinopril or other ACE inhibitors do not develop a cough.

We're not sure why some people get Lisinopril cough and others do not, but there are certain factors that might increase a person's risk, such as:

• Older age
• Female sex
• Being a non-smoker
• Hyperreactivity of airways (e.g., caused by COPD)
• Sensitive cough reflex (e.g., caused by a previous infection or injury to the airways)
  

Having just one risk factor is usually not enough to cause Lisinopril cough. Most people who get a cough when they're taking ACE inhibitors have multiple risk factors.

Can Lisinopril Cough Be Treated?

Lisinopril cough won't go away unless you stop taking the ACE inhibitor. However, it may not be safe for you to stop taking your medication. You'll need to talk to your provider first.

Sometimes, the benefits of taking Lisinopril are more important than the downsides—like having a cough. It's also possible that what you think is Lisinopril cough is actually something else, which is why it's important to talk to your provider.

They will ask you to tell them more about your cough. For example:

• Is the cough keeping you from doing certain activities?
• How badly does the coughing affect your sleep?
• Is the cough affecting your quality of life?

Blood Pressure Medications Less Likely to Cause a Cough

If you feel that having Lisinopril cough is not something you can get through, your provider might decide you can try taking a different drug called an angiotensin II receptor blocker (ARB).

Research has shown that people taking ARBs are less likely to get a cough than people taking ACE inhibitors. What's more, studies have shown that the two treatments are just as effective at treating high blood pressure.

For example, a meta-analysis of nine trials and 11,007 patients that directly compared ACE inhibitors to ARBs in people with high blood pressure found similar rates of death from any cause (all-cause mortality) and death from cardiovascular causes between the groups.

The researchers concluded that ARBs are a reasonable alternative to ACE inhibitors for patients with high blood pressure.

Summary

Lisinopril cough is a persistent dry cough some people get when they take ACE inhibitors to control their high blood pressure.

The same activity that allows ACE inhibitors to lower blood pressure can cause other substances, like bradykinin, to build up in the airways and make a person cough a lot.

The only way to treat Lisinopril cough is to stop taking the medication. However, that is not always safe. Your provider might decide that the benefits of taking an ACE inhibitor outweigh the cons, like having a cough.

If you can't cope with Lisinopril cough, your provider might decide you can try taking another drug to control your blood pressure that is less likely to cause a cough.

That said, never stop taking your blood pressure medication or change the way you take it without talking to your provider.

Frequently Asked Questions

• Can a cough suppressant treat an ACE inhibitor cough?

  A cough suppressant will not help with coughs caused by ACE inhibitors because it does not treat the underlying cause of inflammation in the airways.

  If the cough is affecting your quality of life, ask your healthcare provider if you could switch to a different kind of medication for your blood pressure.

• Can I stop an ACE inhibitor if it's making me cough?

  Never stop taking an ACE inhibitor or change your dose without talking to your provider first.

  Stopping an ACE inhibitor can cause your blood pressure to spike and increase your risk of heart attack and stroke. Suddenly stopping the medication can also cause anxiety and an increased heart rate.

• Is Lisinopril cough worse at night?

  Coughs from any cause can be worse at night because you're lying down. In some studies, people who had a cough from ACE inhibitors noted that it got worse at night.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

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By Naveed Saleh, MD, MS
Naveed Saleh, MD, MS, is a medical writer and editor covering new treatments and trending health news.

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Source: https://www.verywellhealth.com/lisinopril-causes-cough-1124151

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