Can Farxiga or Aldactone Cause Dry Cough?
Neither Farxiga (dapagliflozin) nor Aldactone (spironolactone) are known to cause dry cough as a side effect. These medications work through entirely different mechanisms than the drug class most commonly associated with chronic dry cough—ACE inhibitors.
Why This Matters: Understanding Drug-Induced Cough
ACE Inhibitors Are the Primary Culprit
- Dry cough is a well-established class effect of ACE inhibitors (such as enalapril, captopril, ramipril, and lisinopril), occurring in 5-35% of patients treated with these agents 1
- The cough is typically dry, nonproductive, associated with a tickling or scratching sensation in the throat, and often worse at night 1, 2
- ACE inhibitor-induced cough can begin within hours of the first dose or be delayed for weeks to months after starting therapy 1
- The mechanism involves accumulation of bradykinin, substance P, and prostaglandins due to inhibition of their degradation 1, 3
Farxiga and Aldactone Have Different Mechanisms
- Farxiga (dapagliflozin) is an SGLT2 inhibitor that works by blocking glucose reabsorption in the kidneys—it has no effect on the bradykinin-prostaglandin pathway that causes ACE inhibitor cough
- Aldactone (spironolactone) is a potassium-sparing diuretic and aldosterone antagonist that also does not interact with the cough reflex pathways
If You're Experiencing Dry Cough
Look for the Real Cause
- Review all medications for ACE inhibitors (drugs ending in "-pril" such as lisinopril, enalapril, ramipril, captopril) 1, 4
- ACE inhibitors are the most likely pharmaceutical cause of chronic dry cough, with symptoms beginning after several months of treatment in many cases 4
- Beta-blockers can rarely cause or exacerbate cough, though this is much less common than with ACE inhibitors 4
Management Strategy
- If taking an ACE inhibitor, discontinue it under medical supervision regardless of when the cough started relative to beginning the medication 1
- Switching to an angiotensin receptor blocker (ARB) such as candesartan or losartan is the preferred alternative, as ARBs do not cause cough even in patients with prior ACE inhibitor-induced cough 4
- Cough typically resolves within 1-4 weeks after stopping the ACE inhibitor, though it may take up to 3 months in some patients 1, 3
Other Common Causes to Consider
- Laryngopharyngeal reflux (silent reflux) is a frequent cause of chronic cough, especially in older, overweight patients with diabetes 4
- Consider a 4-week trial of proton pump inhibitor therapy if reflux is suspected 4
- Pulmonary edema from congestive heart failure can occasionally present with cough as the sole symptom 1
Critical Pitfall to Avoid
Do not assume the timing rules out ACE inhibitors as the cause. The cough can develop months or even a year after starting therapy, not just in the first few weeks 3. Many patients and physicians fail to recognize this delayed presentation and attribute the cough to other causes.