What medications can cause a dry cough?

From the Guidelines

Medications that can cause a dry cough include Angiotensin-Converting Enzyme (ACE) inhibitors, such as lisinopril, enalapril, and ramipril, which affect approximately 5-35% of patients taking these medications. The cough typically develops within weeks to months of starting the medication and occurs because ACE inhibitors increase levels of substances called bradykinins and substance P in the lungs, which stimulate cough receptors 1. Other medications that may cause dry cough include certain chemotherapy drugs like bleomycin and methotrexate, amiodarone (a heart rhythm medication), nitrofurantoin (an antibiotic), and some inhaled medications like corticosteroids.

Some key points to consider:

• ACE inhibitors are the most common cause of medication-induced cough, with a reported incidence of 5-35% 1
• The cough is typically dry and non-productive, and may be accompanied by a tickling or scratching sensation in the throat 1
• Other medications, such as angiotensin II receptor blockers (ARBs), are alternatives to ACE inhibitors that rarely cause cough 1
• If a patient develops a persistent dry cough while taking any medication, they should consult their healthcare provider to determine if the cough is medication-related and to discuss alternative treatments 1

It's worth noting that the evidence suggests that ACE inhibitor-induced cough is not dose-dependent, and that the incidence of cough can vary depending on the specific medication and patient population 1. Additionally, other factors, such as smoking and East Asian ethnicity, may increase the risk of developing a cough while taking ACE inhibitors 1.

In terms of management, the guidelines recommend discontinuing ACE inhibitor therapy if a patient develops a persistent cough, and considering alternative treatments such as ARBs 1. Overall, it is essential to carefully evaluate the potential causes of a dry cough in patients taking medications, and to consider alternative treatments if necessary.

From the FDA Drug Label

Cough Presumably due to the inhibition of the degradation of endogenous bradykinin, persistent nonproductive cough has been reported with all ACE inhibitors, always resolving after discontinuation of therapy. ACE inhibitor-induced cough should be considered in the differential diagnosis of cough

Medications that can cause a dry cough include:

• ACE inhibitors, such as enalapril, due to the inhibition of the degradation of endogenous bradykinin, which can cause a persistent nonproductive cough 2.

From the Research

Medications that Cause Dry Cough

Medications that can cause a dry cough include:

• Angiotensin-converting enzyme inhibitors (ACEIs) such as captopril, enalapril, lisinopril, ramipril, cilazipril, and quinipril 3, 4, 5, 6
• Angiotensin receptor blockers (ARBs) such as losartan, although this is less common 7

Characteristics of Dry Cough

The dry cough caused by these medications is typically:

• Nonproductive 4, 5, 6
• Worse at night 4
• Persistent 5
• Described as tickling or dry 5

Mechanism of Dry Cough

The mechanism of the dry cough is thought to be related to:

• Inhibition of the breakdown of bradykinin and other mediators of inflammation 3, 4, 6
• Stimulation of lung afferent C fibers 5
• Accumulation of prostaglandins and other pro-inflammatory peptides 6

Management of Dry Cough

Management of the dry cough may involve:

• Temporarily discontinuing the medication 3
• Switching to an alternative medication such as an ARB 3, 7
• Adding a calcium channel blocker or non-steroidal anti-inflammatory drug 3, 6