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Does Lisinopril Cause Coughing?

Does Lisinopril Cause Coughing? Understanding ACE Inhibitor Side Effects

Key Takeaways

  • Yes, lisinopril commonly causes a persistent dry cough in 2.5% to 35% of people taking this ACE inhibitor.
  • The cough may result from increased bradykinin levels that accumulate when the ACE enzyme is blocked.
  • This side effect can occur within hours of the first dose or develop up to 6 months after starting treatment.
  • Switching to ARBs (angiotensin receptor blockers) significantly reduces the cough risk while providing similar blood pressure benefits.
  • The cough typically resolves within 1 to 4 weeks after stopping lisinopril.

Yes, Lisinopril Does Cause Coughing

Lisinopril, sold under brand names Zestril and Prinivil, is known to cause a persistent dry cough as one of its most common side effects.

The lisinopril cough is typically dry and non-productive (without mucus). People often describe it as a tickly cough with a scratching sensation in the throat that triggers coughing episodes. Unlike typical coughs from respiratory infections, this angiotensin converting enzyme inhibitor (ACE inhibitor) induced cough doesn’t usually respond to standard over-the-counter cough medicines.

How Common Is Lisinopril-Induced Cough?

The incidence of lisinopril-induced cough varies across different clinical studies. Early trials reported cough rates of approximately 2.5% among people taking lisinopril. However, up to 35% of users in other studies reported a persistent dry cough when taking ACE inhibitors like lisinopril.

It is not fully understood why some people experience a lisinopril cough and others don’t, but certain factors appear to increase a person’s risk, including:

  • Being over 65 years of age
  • Females
  • Non-smokers
  • Other breathing problems like asthma or COPD

Comparison Across All ACE Inhibitors

All ACE inhibitors, including enalapril, captopril, ramipril, and benazepril, carry this risk of cough. No evidence suggests switching between different ACE inhibitors reduces the likelihood of developing this side effect.

In fact,studies show that about two-thirds of patients who try another ACE inhibitor after experiencing a lisinopril cough will develop the same symptom again.

Why Does Lisinopril Cause Coughing?

The reasons behind lisinopril-induced cough are thought to be due to its blocking the angiotensin converting enzyme (ACE). This enzyme converts angiotensin I to angiotensin II (which affects blood pressure) and breaks down bradykinin in the lungs and airways. When lisinopril blocks ACE to treat high blood pressure, it also prevents the breakdown of bradykinin.

This leads to bradykinin building up in your lung tissues and airways. Increased bradykinin levels trigger inflammation, cause blood vessels to dilate, and irritate cough receptors in your respiratory system. The inflammation caused by elevated bradykinin levels can also lead to mild swelling in your throat and airways, contributing to the sore throat many people experience along with their cough.

Blocking the ACE enzyme also decreases the breakdown of substance P. When it accumulates in your airways, it can stimulate your cough reflex.

This combination of bradykinin and substance P buildup explains why the cough is so persistent and hard to treat with typical cough suppressants.

How Long Does it Take For the Lisinopril Cough to Develop?

The time it takes a lisinopril cough to develop will vary among people. For some, it can start within hours of their first dose. For others, it may be several months before they experience cough symptoms.

That being said, most cases develop within 2 weeks to 1 month after starting lisinopril. In rare instances, the ACE inhibitor cough may not appear until 6 months after beginning treatment.

How Long Does the Lisinopril Cough Last?

This will vary as well. In most cases, the resolution of the cough typically occurs within 1 to 4 weeks after stopping lisinopril. However, in some people, the cough may linger for up to 3 months.

If the cough is severe or bothersome, it’s important to talk to your doctor. They may be able to prescribe you to a different medication that is less likely to cause a cough.

Risk Factors for Developing Lisinopril Cough

Several factors increase the likelihood of developing a cough while on an ACE inhibitor like lisinopril. A history of ACE inhibitor-induced cough is the biggest risk factor. You are more likely to develop this side effect if you have experienced it while previously taking an ACE inhibitor.

Female gender is another factor, with women being about twice as likely to develop a lisinopril cough. Being over the age of 65 is also associated with a higher incidence of cough.

Other possible risk factors include a history of asthma or other respiratory conditions like chronic obstructive pulmonary disease (COPD). Kidney problems can affect bradykinin clearance, so this may increase your cough risk as well.

And some studies suggest that taking cholesterol-lowering medication along with an ACE inhibitor may increase risk, though further research is needed to confirm this.

Treatment Options for Lisinopril Cough

Traditional cough medicines available over-the-counter are not usually effective for treating lisinopril-induced cough. This is because they work by suppressing the central cough reflex, but an ACE inhibitor cough is typically due to local airway irritation from the buildup of inflammatory substances like bradykinin.

The only truly effective treatment for an ACE inhibitor cough is stopping the medication. However, you should never stop taking lisinopril without consulting your healthcare provider first. Discontinuing lisinopril suddenly can cause an increase in your blood pressure and increase the risk of other complications. Your provider will typically gradually reduce your dose or change to an alternative medicine that doesn’t carry the risk of cough.

After stopping lisinopril, your cough typically goes away within 1 to 4 weeks. This will vary and could take several months before you see complete symptom resolution. During this period, you and your healthcare provider should monitor your blood pressure closely and adjust your treatments as needed.

Alternatives to Lisinopril

Angiotensin receptor blockers (ARBs) are the preferred alternative for people who develop a lisinopril cough. ARBs like losartan, valsartan, and olmesartan are equally effective as ACE inhibitors for treating hypertension, heart failure, and protecting kidney function in people with diabetes. This occurs from blocking angiotensin II receptors rather than inhibiting the ACE enzyme. This different mechanism of action avoids bradykinin accumulation, virtually eliminating the cough risk.

Clinical studies show that cough rates with ARBs are similar to placebo, affecting less than 3% of individuals. This is significantly better than the up to 35% seen with ACE inhibitors.

Other possible alternatives include calcium channel blockers like amlodipine. These medications work by blocking calcium channels in blood vessel walls, causing them to relax and lowering blood pressure through a completely different pathway than ACE inhibitors.

The choice of alternative medication depends on individual factors, including other medical conditions, kidney function, and your overall cardiovascular risk. Your healthcare provider will consider these factors and select the most appropriate alternative therapy if you are experiencing an ACE inhibitor cough.

Frequently Asked Questions

How long does it take for the lisinopril cough to go away after stopping the medication?

Most patients have their cough resolved within 1-4 weeks after stopping lisinopril; this can take several months for others. In rare cases, a lisinopril cough may take up to 3 months to fully resolve, particularly in patients who experienced severe symptoms or took the medication long-term. If the cough lasts longer than this, healthcare providers should check for other possible causes and recommend treatment.

Can I take cough medicine while on lisinopril to manage the cough?

Over-the-counter cough suppressants are not generally effective for ACE inhibitor cough. This is because traditional cough medicines work by blocking central cough reflexes, while ACE inhibitor cough results from local airway inflammation that these medications don’t address. Patients should discuss any cough treatments with their healthcare provider to avoid potential drug interactions and ensure safe, effective management of their symptoms.

Is lisinopril cough dangerous or just annoying?

The cough itself is not dangerous, but it can significantly impact your quality of life and daily functioning. Persistent coughing may interfere with sleep, work, and social activities, leading to fatigue and irritability. Some patients also develop throat irritation, sore throat, or muscle strain from chronically coughing.

Will switching to a different ACE inhibitor eliminate the cough?

No, switching between different ACE inhibitors rarely makes a difference. Research has shown that approximately 67% of patients experience cough when switching to a different ACE inhibitor after developing symptoms with lisinopril. This occurs because all ACE inhibitors w

\ork the same way, blocking the ACE enzyme. This leads to bradykinin accumulation regardless of the specific drug used. ARBs are the preferred alternative treatment for patients who develop ACE inhibitor cough.

Can the cough develop even after taking lisinopril for years without problems?

Yes, a lisinopril cough can develop at any time during treatment, even after years of taking it without having this side effect. While most cases occur within the first month of treatment, studies have shown it can start up to 6 months or longer after starting lisinopril. The reason for this delay remains unclear, though it may involve the gradual accumulation of inflammatory mediators or changes in the cough reflex over time. Any new persistent dry cough in patients taking lisinopril should be evaluated immediately by a healthcare provider to determine if the medication is the cause and discuss appropriate treatment options.

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