Can Strontium Supplements Cause Cough?
No, strontium supplements are not recognized as a cause of cough in the medical literature. The available evidence on strontium ranelate and strontium supplements does not identify cough as a documented adverse effect.
Evidence Review
Known Adverse Effects of Strontium
The documented side effects of strontium compounds are well-characterized and do not include respiratory symptoms:
- Cardiovascular risks: Venous thromboembolic events (including pulmonary embolism) are the most frequent severe adverse effects, occurring in approximately 1 in 31,052 months of treatment 1
- Dermatologic reactions: DRESS syndrome (Drug Reaction with Eosinophilia and Systemic Symptoms) is a serious cutaneous reaction with a median onset of 35 days, occurring in approximately 1 in 13,725 months of treatment 1
- Hepatic effects: Hepatitis and pancreatitis have been reported as severe hepatodigestive adverse effects 1
- Neurological effects: Confusion, amnesia, and convulsions have been documented 1
- Hematologic effects: Pancytopenia and thrombocytopenic purpura are rare but serious complications 1
Absence of Respiratory Adverse Effects
Cough is notably absent from the comprehensive adverse event profiles of strontium compounds. The French pharmacovigilance analysis of 844 adverse events associated with strontium ranelate over three years categorized severe side effects as cardiovascular (52%), cutaneous (26%), hepatodigestive (6%), neurological (5%), hematological (3%), and osteomuscular (3%), with no mention of respiratory or cough-related adverse effects 1.
Distinction from Known Cough-Inducing Medications
The medical literature extensively documents medications that cause cough, particularly:
- ACE inhibitors: These are well-established causes of chronic dry cough, with incidence rates as high as 16%, occurring within hours to over a year after initiation 2
- The cough from ACE inhibitors is not dose-related and resolves with a median time of 26 days after discontinuation, though it may take up to 40 weeks in some patients 2
Strontium is not mentioned in any of the comprehensive cough guidelines or systematic reviews of medication-induced cough 2.
Clinical Recommendation
If a patient taking strontium supplements develops a cough, investigate other common causes rather than attributing it to the strontium. The most likely etiologies include:
- Upper airway cough syndrome (postnasal drip) 2
- Asthma or eosinophilic bronchitis 2
- Gastroesophageal reflux disease 2
- Concurrent medications, particularly ACE inhibitors 2
- Environmental exposures or smoking 2
- Post-viral upper respiratory infection 2
Important Caveat
While strontium can cause serious adverse effects including venous thromboembolism and DRESS syndrome 1, pulmonary embolism from strontium-induced thrombosis could theoretically present with cough along with dyspnea and chest pain. However, this would be a manifestation of thromboembolism rather than a direct drug effect on the respiratory tract 1.