What Is a Lisinopril Cough?

Table of ContentsView AllTable of ContentsHow Common Is It?Why It HappensRisk FactorsSwitching Medications

Table of ContentsView All

View All

Table of Contents

How Common Is It?

Why It Happens

Risk Factors

Switching Medications

Apersistent dry coughis a common side effect oflisinopril, a drug commonly used to treathigh blood pressureandheart failure. Sold under the brand names Zestril, Privnil, and others, lisinopril belongs to a class of drugs calledangiotensin-converting enzyme (ACE) inhibitorswhich list a dry cough as a common side effect.

This article will explain the causes of a lisinopril cough, how likely it is to occur, and what you can do if you experience coughing while taking an ACE inhibitor.

Verywell / Theresa Chiechi

How Common Is Lisinopril Cough?

A cough is a relatively common occurrence with lisinopril as it is with all other ACE inhibitors, including:

According to the pre-market studies, 2.5% of people treated with lisinopril for hypertension (high blood pressure) reported coughing as a side effect.

With that being said, different groups of people are more vulnerable to this side effect. In some studies, up to 35% of users reported a persistent dry cough when taking ACE inhibitors.In around 20% of cases, a lisinopril cough is bad enough to require medical treatment.

Are All ACE Inhibitors the Same?There is currently no evidence that one ACE inhibitor is less likely or more likely to cause a cough than another.

Are All ACE Inhibitors the Same?

There is currently no evidence that one ACE inhibitor is less likely or more likely to cause a cough than another.

Which Medications Treat High Blood Pressure?

Why Does Lisinopril Cough Happen?

But angiotensin II has other functions in the body. Among them, it breaks down a compound calledbradykininthat the body uses to instigateinflammation. By decreasing angiotensin II levels, ACE inhibitors allow bradykinin levels to increase.

In the airways, the accumulation of bradykinin triggersbronchoconstriction, or the narrowing of the airways. A persistent, dry cough is the consequence.

The onset of a lisinopril cough can occur within hours of taking the first dose to weeks or even months later. The symptom often gets worse at night.

Side Effects of Blood Pressure Medications

Risk Factors for Lisinopril Cough

Most people who take Lisinopril or other ACE inhibitors do not develop a cough. Scientists are not sure why some people get a lisinopril cough and others don’t, but there are certain factors that appear to increase a person’s risk, including:

Having one risk factor is usually not enough to cause a lisinopril cough. Most people who get a cough while taking ACE inhibitors have multiple risk factors.

Can You Take ACE Inhibitors If You Have Asthma?

Can Lisinopril Cough Be Treated?

Acough suppressantwill not help with a lisinopril cough because it doesn’t temper the underlying inflammation.The only way to treat a lisinopril cough is to stop taking the drug (and potentially all other ACE inhibitors).

However, that may not be a reasonable option. You’ll need to talk to your healthcare provider to weigh the benefits of treatment against the possible risks and consequences. Unless coughing is significantly undermining your quality of life, the “pros” may outweigh the “cons.”

In the United States, ACE inhibitors are regarded as the first-line option for treating hypertension and heart failure. Even so, another class of drugs called angiotensin II receptor blockers (ARBs) may be used in their place if you are truly intolerant to ACE inhibitors.

Research has shown that people taking ARBs are less likely to get a cough because they have no direct effect on bradykinin levels.At the same time, ARBs appear to be just as effective in reducing the risk of heart disease and death among people with high blood pressure when compared to ACE inhibitors.

Even so, ACE inhibitors are considered superior in preventingatherosclerosis(hardening of the arteries) andthrombosis(blood clots).

Rather than switching from ACE inhibitors to ARBs, some studies suggest that adding acalcium channel blockerlike Norvasc (amlodipine) or Procardia (nifedipine) may help clear the cough in some people. Calcium channel blockers, also used to treat hypertension, appear to inhibit the production of prostaglandins such as bradykinin.

Reasons You Can’t Stop Coughing

Summary

A persistent dry cough is a possible side effect of ACE inhibitors like lisinopril (Zestril, Privnil). The same action that makes ACE inhibitors effective in lowering blood pressure can cause an inflammatory substance known as bradykinin to build up in the airways and cause coughing.

The only way to treat a lisinopril cough is to stop taking the drug. However, you need to weigh the benefits and risks with your healthcare provider before deciding to do so.

If you can’t cope with a lisinopril cough, your provider might decide to switch you to an angiotensin II receptor blocker (ARB) or add a calcium channel blocker to your treatment plan.

When to Seek Treatment for a Persistent Couple

6 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Yilmaz I.Angiotensin-converting enzyme inhibitors induce cough.Turk Thorac J.2019 Jan;20(1):36–42. doi:10.5152/TurkThoracJ.2018.18014AstraZeneca Pharmaceuticals.Zestril (lisinopril) tablets, for oral use.Ng LP, Goh PSC.Incidence of discontinuation of angiotensin-converting enzyme inhibitors due to cough, in a primary healthcare centre in Singapore.Singapore Med J.2014;55(3):146–9. doi:10.11622/smedj.2014034Pinto B, Jadhav U, Singhai P, Sadhanandham S, Shah N.ACEI-induced cough: a review of current evidence and its practical implications for optimal CV risk reduction.Indian Heart J.2020 Sep-Oct;72(5):345–50. doi:10.1016/j.ihj.2020.08.007Vegter S, De Boer P, Van Dijk KW, Visser S, De Jong-Van den Berg LTW.The effects of antitussive treatment of ACE inhibitor-induced cough on therapy compliance: a prescription sequence symmetry analysis.Drug Saf. 2013;36(6):435-9. doi:10.1007/s40264-013-0024-zLi EC, Heran BS, Wright JM.Angiotensin converting enzyme (ACE) inhibitors versus angiotensin receptor blockers for primary hypertension.Cochrane Database Syst Rev. 2014 Aug 22;2014(8):CD009096. doi:10.1002/14651858.CD009096.pub2

6 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Yilmaz I.Angiotensin-converting enzyme inhibitors induce cough.Turk Thorac J.2019 Jan;20(1):36–42. doi:10.5152/TurkThoracJ.2018.18014AstraZeneca Pharmaceuticals.Zestril (lisinopril) tablets, for oral use.Ng LP, Goh PSC.Incidence of discontinuation of angiotensin-converting enzyme inhibitors due to cough, in a primary healthcare centre in Singapore.Singapore Med J.2014;55(3):146–9. doi:10.11622/smedj.2014034Pinto B, Jadhav U, Singhai P, Sadhanandham S, Shah N.ACEI-induced cough: a review of current evidence and its practical implications for optimal CV risk reduction.Indian Heart J.2020 Sep-Oct;72(5):345–50. doi:10.1016/j.ihj.2020.08.007Vegter S, De Boer P, Van Dijk KW, Visser S, De Jong-Van den Berg LTW.The effects of antitussive treatment of ACE inhibitor-induced cough on therapy compliance: a prescription sequence symmetry analysis.Drug Saf. 2013;36(6):435-9. doi:10.1007/s40264-013-0024-zLi EC, Heran BS, Wright JM.Angiotensin converting enzyme (ACE) inhibitors versus angiotensin receptor blockers for primary hypertension.Cochrane Database Syst Rev. 2014 Aug 22;2014(8):CD009096. doi:10.1002/14651858.CD009096.pub2

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

Yilmaz I.Angiotensin-converting enzyme inhibitors induce cough.Turk Thorac J.2019 Jan;20(1):36–42. doi:10.5152/TurkThoracJ.2018.18014AstraZeneca Pharmaceuticals.Zestril (lisinopril) tablets, for oral use.Ng LP, Goh PSC.Incidence of discontinuation of angiotensin-converting enzyme inhibitors due to cough, in a primary healthcare centre in Singapore.Singapore Med J.2014;55(3):146–9. doi:10.11622/smedj.2014034Pinto B, Jadhav U, Singhai P, Sadhanandham S, Shah N.ACEI-induced cough: a review of current evidence and its practical implications for optimal CV risk reduction.Indian Heart J.2020 Sep-Oct;72(5):345–50. doi:10.1016/j.ihj.2020.08.007Vegter S, De Boer P, Van Dijk KW, Visser S, De Jong-Van den Berg LTW.The effects of antitussive treatment of ACE inhibitor-induced cough on therapy compliance: a prescription sequence symmetry analysis.Drug Saf. 2013;36(6):435-9. doi:10.1007/s40264-013-0024-zLi EC, Heran BS, Wright JM.Angiotensin converting enzyme (ACE) inhibitors versus angiotensin receptor blockers for primary hypertension.Cochrane Database Syst Rev. 2014 Aug 22;2014(8):CD009096. doi:10.1002/14651858.CD009096.pub2

Yilmaz I.Angiotensin-converting enzyme inhibitors induce cough.Turk Thorac J.2019 Jan;20(1):36–42. doi:10.5152/TurkThoracJ.2018.18014

AstraZeneca Pharmaceuticals.Zestril (lisinopril) tablets, for oral use.

Ng LP, Goh PSC.Incidence of discontinuation of angiotensin-converting enzyme inhibitors due to cough, in a primary healthcare centre in Singapore.Singapore Med J.2014;55(3):146–9. doi:10.11622/smedj.2014034

Pinto B, Jadhav U, Singhai P, Sadhanandham S, Shah N.ACEI-induced cough: a review of current evidence and its practical implications for optimal CV risk reduction.Indian Heart J.2020 Sep-Oct;72(5):345–50. doi:10.1016/j.ihj.2020.08.007

Vegter S, De Boer P, Van Dijk KW, Visser S, De Jong-Van den Berg LTW.The effects of antitussive treatment of ACE inhibitor-induced cough on therapy compliance: a prescription sequence symmetry analysis.Drug Saf. 2013;36(6):435-9. doi:10.1007/s40264-013-0024-z

Li EC, Heran BS, Wright JM.Angiotensin converting enzyme (ACE) inhibitors versus angiotensin receptor blockers for primary hypertension.Cochrane Database Syst Rev. 2014 Aug 22;2014(8):CD009096. doi:10.1002/14651858.CD009096.pub2

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