What is the typical time frame for the onset of a cough associated with lisinopril (Angiotensin-Converting Enzyme (ACE) inhibitor) therapy?

Onset Timing of Lisinopril-Induced Cough

ACE inhibitor-induced cough can occur within hours of the first dose of lisinopril or be delayed for weeks to months after the initiation of therapy. 1

Timing of Onset

• Cough is a well-documented class effect of ACE inhibitors, occurring in 5-35% of patients taking these medications 1, 2
• The onset timing is highly variable:
  • Can begin within hours after the first dose 1, 2
  • May be delayed for weeks to months after starting therapy 1, 2
• In one study, 59% of patients developed cough between 30-180 days (1-6 months) after starting ACE inhibitor therapy 3

Risk Factors for Earlier or More Frequent Cough

Certain patient populations may experience ACE inhibitor-induced cough more frequently:

• Female gender (significantly higher incidence compared to males) 1, 2, 3
• Non-smokers (more susceptible than smokers) 1, 2
• Patients of Chinese or East Asian ethnicity 1, 2
• Patients being treated for congestive heart failure (higher incidence than those treated for hypertension) 1, 2

Clinical Characteristics

• The cough is typically dry and associated with a tickling or scratching sensation in the throat 1, 2
• ACE inhibitor-induced cough is not dose-dependent 1, 3
• ACE inhibitors may sensitize the cough reflex, potentially potentiating other causes of chronic cough 1, 2

Resolution After Discontinuation

• Cough typically resolves within 1-4 weeks after discontinuation of the ACE inhibitor 1, 2
• In some patients, cough may persist for up to 3 months after stopping the medication 1
• One study noted that cough decreased by 50% within 3 days of drug cessation and completely disappeared within 10 days 3

Clinical Implications

• ACE inhibitor-induced cough should be considered in any patient taking lisinopril who develops a persistent dry cough, regardless of the temporal relationship between medication initiation and cough onset 1, 2
• The only uniformly effective treatment for ACE inhibitor-induced cough is discontinuation of the medication 1
• Angiotensin receptor blockers (ARBs) are generally well-tolerated alternatives for patients who develop ACE inhibitor-induced cough 2, 4, 5

Common Pitfalls

• Failing to consider ACE inhibitor as a cause of cough when the temporal relationship is not obvious (delayed onset) 1
• Pursuing extensive diagnostic testing before a trial of ACE inhibitor discontinuation 2
• Assuming that all patients will experience immediate resolution of cough after discontinuation (may take weeks to months) 1