Ezetimibe Does Not Cause Cough
Ezetimibe is not a recognized cause of drug-induced cough, and the persistent cough one month after stopping the medication strongly suggests an alternative etiology that requires investigation.
Why Ezetimibe Is Not the Culprit
The evidence is clear regarding which medications cause chronic cough:
ACE inhibitors are the most common pharmaceutical cause of chronic cough, occurring in 5-35% of patients, while ezetimibe has no documented association with cough in the medical literature 1, 2.
Comprehensive reviews of drug-induced cough specifically identify ACE inhibitors as the primary culprit, with additional rare causes including topiramate, beta-blockers, and certain inhaled therapies—but ezetimibe is notably absent from these lists 3, 4, 5.
Extensive pharmacokinetic and safety studies of ezetimibe, including 12-month trials with hundreds of patients, document common adverse events (upper respiratory tract infection, headache, musculoskeletal pain, arthralgia) but do not report cough as a side effect 6, 7.
The Timeline Argues Against Ezetimibe
The patient's clinical course is inconsistent with drug-induced cough:
Drug-induced cough from ACE inhibitors typically resolves within 1-4 weeks after cessation, though a small subset may take up to 3 months 1, 2.
The fact that this patient's cough persists one month after stopping ezetimibe strongly suggests the medication was never the cause 1.
What to Consider Instead
A comprehensive medication review is essential to identify the actual culprit 2:
Check if the patient is taking an ACE inhibitor (lisinopril, enalapril, ramipril, etc.)—these cause dry, tickling, non-productive cough that can develop within hours or be delayed for weeks to months after initiation 1, 2.
ACE inhibitor-induced cough is more common in women, non-smokers, and persons of Chinese or East Asian descent 1, 2.
The cough is not dose-dependent, so dose reduction is futile; switching to another ACE inhibitor is also ineffective due to the class effect 2.
Investigate other common causes of chronic cough 1:
- Upper airway cough syndrome/postnasal drip
- Cough variant asthma
- Gastroesophageal reflux disease
- Recent viral respiratory infection (postviral cough can persist beyond 25 days) 1
Critical Pitfalls to Avoid
Do not assume temporal association equals causation—the patient incorrectly attributed the cough to ezetimibe, leading to unnecessary medication discontinuation 2.
ACE inhibitors can sensitize the cough reflex, potentially amplifying cough from other causes, making comprehensive evaluation essential 1, 2.
If an ACE inhibitor is identified, switch to an angiotensin receptor blocker (ARB) such as valsartan or losartan, which have cough incidence similar to placebo 1, 2.