Can Candesartan Cause a Cough? Understanding the Risk and What to Do

October 11, 2025 •

3 min read

While ACE inhibitors cause a dry cough in approximately 10% of patients, angiotensin II receptor blockers (ARBs) like candesartan are associated with this side effect much less frequently, affecting only about 3% of users. This is a key reason many patients who cannot tolerate ACE inhibitors are switched to candesartan.

Quick Summary

Candesartan can cause a dry, persistent cough in a small percentage of patients, although it is a significantly less common side effect than with ACE inhibitors. If a cough develops, a physician may recommend stopping the medication and trying an alternative.

Key Points

Candesartan and Cough Risk: Candesartan can cause a dry, tickly cough, but the risk is significantly lower (around 3%) than with ACE inhibitors (around 10% or more).
Mechanism of Action: The lower incidence of cough with candesartan is because it works differently than ACE inhibitors, specifically by not affecting bradykinin levels in the airways.
Course of Action: If you develop a persistent cough while on candesartan, consult your doctor to explore alternative medications and rule out other causes.
Resolution Timeframe: If candesartan is stopped, the associated cough typically resolves within a few weeks, though it can take up to three months.
Alternative Medications: Other blood pressure medications, such as calcium channel blockers or diuretics, are viable alternatives if candesartan-induced cough is confirmed.

Understanding Candesartan and Its Action

Candesartan is an angiotensin II receptor blocker (ARB) used for treating high blood pressure and heart failure. It lowers blood pressure by blocking the effects of angiotensin II, a hormone that narrows blood vessels. By doing so, candesartan helps to relax and widen blood vessels. This action differs from angiotensin-converting enzyme (ACE) inhibitors, another class of blood pressure medication, which explains the difference in side effects like cough.

The Mechanism Behind ARB-Induced Cough

ACE inhibitors often cause a dry, persistent cough by blocking an enzyme that also breaks down bradykinin, leading to its accumulation in the lungs and airways. This buildup irritates the airways and triggers a cough. Candesartan, being an ARB, blocks angiotensin II receptors directly and does not interfere with bradykinin metabolism. Consequently, ARBs are significantly less likely to cause a cough. However, a small number of patients still experience a dry, tickly cough with candesartan, although the exact reason is not fully understood and is not thought to be related to bradykinin.

Candesartan vs. ACE Inhibitors: A Comparison of Side Effects

For patients who develop a cough on an ACE inhibitor, switching to an ARB like candesartan is often an effective alternative without the cough. While candesartan has a lower risk of causing a cough, it is not eliminated entirely. The table below highlights key differences between the two drug classes regarding cough:


Feature	ACE Inhibitors (e.g., Lisinopril)	Angiotensin II Receptor Blockers (ARBs)	Candesartan (an ARB)
Cough Incidence	High (around 10% or more)	Low (around 3%)	Low (less than 1% reported in some trials, but cases still occur)
Cough Mechanism	Bradykinin accumulation in airways	Mechanism less understood; not related to bradykinin	Mechanism less understood; not related to bradykinin
Cough Description	Dry, persistent, and irritating	Dry, tickly sensation in the throat	Dry, tickly sensation
Treatment for Cough	Switch to an ARB or other alternative	Discontinue the medication if approved by a doctor	Discontinue the medication if approved by a doctor

What to Do If Candesartan Causes a Cough

If you suspect candesartan is causing your cough, it is essential to consult your doctor or pharmacist. Do not stop or alter your medication without their guidance, as this could be harmful. Your doctor will assess your symptoms and medical history to determine if candesartan is the likely cause. They will also rule out other potential causes for the cough, such as infections or allergies. In some instances, a temporary discontinuation of the medication might be recommended to see if the cough resolves, which can help confirm the link to candesartan.

Management Steps for a Cough

If a candesartan-induced cough is confirmed or suspected, your doctor will likely recommend switching to a different class of medication to manage your blood pressure. Possible alternatives include:

Calcium Channel Blockers (CCBs): Medications such as amlodipine or nifedipine work differently to relax blood vessels and are not associated with cough.
Diuretics: These medications help the body eliminate excess salt and water, which aids in reducing blood pressure.
Beta-Blockers: These medications decrease heart rate and the force of heart contractions.

After discontinuing candesartan, the cough typically subsides within a few weeks, though it may take up to three months for complete resolution.

Patient Experiences with Candesartan Cough

Patient experiences shared online highlight the variability of this side effect. While some patients find their cough resolves completely after switching from an ACE inhibitor to candesartan, others may continue to experience a cough, potentially due to a 'carry-over effect' or, in rare cases, a genuine ARB-induced cough. Described as a dry, tickly irritation, sometimes with post-nasal drip, the nature of the cough emphasizes the need for close communication with a healthcare professional to identify the cause.

Conclusion

Although significantly less likely than ACE inhibitors to cause a cough, candesartan still carries a small risk. It is a valuable alternative for many patients who cannot tolerate ACE inhibitors due to cough. However, if a dry, tickly cough develops while taking candesartan, discontinuing the medication under medical supervision is typically the most effective solution. Consulting your doctor is crucial to determine the cause of the cough and find a safe and suitable alternative for managing your blood pressure. Additional information comparing ACE inhibitors and ARBs is available from the National Kidney Foundation.

Frequently Asked Questions

A cough is a rare side effect of candesartan, affecting approximately 3% of patients, which is significantly less common than with ACE inhibitors.

ACE inhibitors block an enzyme that also breaks down bradykinin, leading to its accumulation and causing a cough. Candesartan, an ARB, does not affect this enzyme and therefore does not cause the same buildup of bradykinin.

You should contact your doctor immediately. Do not stop taking the medication on your own. Your doctor will determine if the cough is related to candesartan and discuss alternative treatment options.

Once candesartan is discontinued, the cough usually goes away within a few weeks, but in some cases, it can take up to three months to fully resolve.

Yes, several alternative classes of medication are available, including calcium channel blockers (e.g., amlodipine) and diuretics, which do not typically cause a cough.

Yes, switching from an ACE inhibitor to an ARB like candesartan is a common medical practice to resolve an ACE inhibitor-induced cough.

A candesartan-induced cough is typically described as a dry, tickly, or irritating sensation in the throat, similar to the cough from an ACE inhibitor.

Yes, many factors can cause a cough, including respiratory infections, allergies, or other medical conditions. Your doctor will need to perform an evaluation to determine the cause.