Lisinopril and Cough
Yes, Lisinopril definitely causes cough as a well-documented side effect occurring in approximately 5-35% of patients taking this medication. 1 This dry, persistent cough is a class effect of all angiotensin-converting enzyme (ACE) inhibitors including Lisinopril.
Mechanism of ACE Inhibitor-Induced Cough
The cough associated with Lisinopril occurs due to:
- Decreased degradation of bradykinin and substance P, which accumulate in the upper airway when ACE is inhibited 1
- Stimulation of prostaglandin production by bradykinin 1
- Sensitization of airway sensory nerves 1
Clinical Characteristics of Lisinopril-Induced Cough
- Type of cough: Typically dry and associated with a tickling or scratching sensation in the throat 1
- Onset: May occur within hours of the first dose or be delayed for weeks to months after starting therapy 1
- Resolution: Usually resolves within 1-4 weeks after stopping the medication, but may persist for up to 3 months in some patients 1
- Dose relationship: Not dose-dependent 1
Risk Factors for ACE Inhibitor-Induced Cough
Certain populations are at higher risk:
- Women (significantly higher incidence) 1, 2
- Nonsmokers 1
- Persons of Chinese or East Asian origin 1
- Older patients 3
- Patients with heart failure (cough more frequently than those treated for hypertension) 1
Diagnosis and Management
Confirm the diagnosis: In patients with chronic cough taking Lisinopril, the medication should be considered as a potential cause regardless of the temporal relationship between cough onset and medication initiation 1
Discontinue the medication: The only uniformly effective treatment for ACE inhibitor-induced cough is cessation of the medication 1
Alternative medications: Consider switching to an angiotensin receptor blocker (ARB) such as valsartan, which rarely causes cough and has an incidence similar to placebo 4, 5, 6
Important Clinical Considerations
- ACE inhibitors may sensitize the cough reflex, potentially exacerbating cough due to other causes 1
- The FDA label for Lisinopril specifically lists cough as an adverse reaction occurring at a rate 2.5% greater than placebo 7
- In clinical trials of patients with hypertension treated with Lisinopril, 5.7% discontinued treatment due to adverse reactions 7
Pitfalls to Avoid
- Don't dismiss delayed cough: Even if cough develops months after starting Lisinopril, the medication could still be the cause 1
- Don't assume immediate resolution: Be aware that cough may take up to 3 months to resolve after discontinuation 1
- Don't overlook other causes: While Lisinopril is a common cause of cough, other etiologies should still be considered, especially if cough persists after discontinuation 1
- Don't automatically substitute another ACE inhibitor: This is a class effect, so switching to another ACE inhibitor will likely result in recurrence of cough 1
By recognizing Lisinopril as a potential cause of chronic cough and appropriately managing patients by discontinuing the medication and switching to an ARB when necessary, clinicians can significantly improve patient quality of life and medication adherence.