Norvasc (Amlodipine) Does Not Cause Cough
Norvasc (amlodipine), a calcium channel blocker, does not cause cough and is actually an appropriate alternative medication for patients who develop cough from ACE inhibitors. 1
Key Distinction: Drug Class Matters
- ACE inhibitors (like lisinopril, enalapril, captopril) are well-known to cause chronic dry cough in 5-35% of patients, making this a significant class effect 2
- Calcium channel blockers (like amlodipine/Norvasc) do not affect the bradykinin pathway and therefore do not cause cough 1
- Amlodipine is specifically recommended as a safe alternative when switching away from ACE inhibitors due to cough 1
Why ACE Inhibitors Cause Cough (But Amlodipine Does Not)
ACE inhibitors cause cough through accumulation of bradykinin, substance P, and prostaglandins in the airways—substances normally degraded by the angiotensin-converting enzyme 2. Since amlodipine works through calcium channel blockade rather than ACE inhibition, it does not trigger this mechanism 1.
Clinical Evidence Supporting Amlodipine as Cough-Free Alternative
A documented case report demonstrates a patient who developed stress urinary incontinence from persistent dry cough while on enalapril (an ACE inhibitor), but when switched to amlodipine besylate, her cough completely resolved and incontinence was no longer a problem 1. This illustrates that amlodipine is an effective, cough-free alternative for blood pressure control.
Common Pitfall to Avoid
Do not confuse amlodipine with ACE inhibitors or assume all blood pressure medications cause cough. The American College of Chest Physicians guidelines specifically identify ACE inhibitors as the culprit medication class for drug-induced cough, while calcium channel blockers like amlodipine are not implicated 2. If a patient on Norvasc develops cough, look for other causes rather than attributing it to the medication.