Dry Cough Caused by Lisinopril and Other ACE Inhibitors

Zestril (lisinopril) and other angiotensin-converting enzyme (ACE) inhibitors are often used for treating hypertension. Lisinopril and drugs in the same class—Capoten (captopril) and Vasotec (enalapril), for example—can have side effects. One notable side effect is an annoying, persistent, dry cough.

The incidence of ACE inhibitor-induced cough ranges from about 5% to 35%. If you develop a cough while taking one of these medications, it's important to know when to speak to your healthcare provider about it—and when switching to another type of medication may be advised.

How ACE Inhibitors Trigger Cough

ACE inhibitors block the angiotensin-converting enzyme, which converts angiotensin I to angiotensin II—a peptide hormone that causes vasoconstriction, or narrowing of the blood vessels. By blocking this necessary step in the renin-angiotensin system, ACE inhibitors lower blood pressure.

While researchers don't fully understand why ACE inhibitors cause some people to develop a cough, the generally accepted mechanism is as follows:

• Bradykinin is a peptide that acts as a vasodilator, meaning that it widens blood vessels. Bradykinin normally has a short half-life, and it is degraded by the angiotensin-converting enzyme.
• Bradykinin's activity and concentration can increase when a person takes an ACE inhibitor. Excess bradykinin can accumulate in the upper and lower respiratory tracts and trigger a cough.
• Bradykinins also stimulate prostaglandins, compounds involved in the immune response, which may increase inflammation in the area and result in coughing.

Who It Affects

Most people who take lisinopril or other ACE inhibitors do not develop a cough. And researchers haven't yet been able to determine why only some ACE inhibitor users experience this side effect.

The following factors may contribute to the development of dry cough with the use of these drugs:

• Women tend to have a higher incidence
• Being a non-smoker
• Bronchial hyperreactivity (BHR)
• History of asthma
• Cough reflex sensitivity

Researchers generally accept that one of these factors alone is not enough to produce an ACE inhibitor-related cough. A combination of two or more is needed.

What to Do

A cough caused by ACE inhibitors requires no treatment other than discontinuation of the drug. That said, you should never stop taking lisinopril or any other ACE inhibitor without consulting with your healthcare provider.

If you happen to try a cough remedy and find some relief from using it, your cough likely has another cause that may need evaluation.

Switching Your Medication

ACE inhibitors like lisinopril are used to treat hypertension and are particularly effective for people with chronic kidney disease and heart failure. These drugs are also used in the treatment of stroke, heart attack, heart failure, and to prevent future cardiovascular events.

These are serious health conditions, and their proper management is essential. As such, if you are experiencing an ACE inhibitor-related cough, the pros of changing to a different drug need to be carefully weighed against the cons.

Ask yourself:

• Does the cough significantly interrupt/keep you from certain activities?
• How badly (if at all) does it affect your sleep?

Discuss these points with your healthcare provider. If it is determined that the cough is more of an annoyance than a major disruption, staying on your ACE inhibitor may be advised.

Angiotensin II receptor blockers (ARBs) are equally effective against hypertension, and your healthcare provider may consider switching you to one if a change seems warranted. Some research has shown ARBs to be better tolerated than ACE inhibitors. It may be a simple matter of working with your healthcare provider to find the right medication.

A Word From Verywell

While taking ACE inhibitors, make sure to regularly monitor your blood pressure, follow-up with your healthcare provider, and contact them if you experience any adverse side effects—cough or otherwise.