Can Ramipril Cause a Cough? Understanding the Link and What to Do

October 8, 2025 •

3 min read

According to the National Institutes of Health, a persistent, dry cough can affect anywhere from 5% to 35% of patients taking ACE inhibitors, a class of medication that includes ramipril. This side effect can be irritating but is not typically harmful and often resolves when the medication is discontinued.

Quick Summary

Ramipril, an ACE inhibitor, commonly causes a dry, persistent cough by inhibiting the breakdown of bradykinin, leading to its accumulation and airway irritation. This is a recognised class effect and is not dose-dependent.

Key Points

Ramipril Can Cause a Cough: A dry, persistent cough is a common side effect of ramipril, affecting a significant portion of users.
Caused by Bradykinin Accumulation: The cough is caused by the build-up of bradykinin in the airways, a substance that normally breaks down with the help of the ACE enzyme, which ramipril inhibits.
Not Dose-Dependent: The cough is not typically related to the dose of ramipril and often does not subside with continued use.
Resolves When Discontinued: If the cough is caused by ramipril, it will typically go away within a few weeks of stopping the medication.
Switching is Key: The most effective solution is to discuss switching to an alternative medication, such as an Angiotensin II Receptor Blocker (ARB), with your doctor.
Recognise Red Flags: While the cough is usually benign, other symptoms like shortness of breath, chest pain, or swelling warrant immediate medical attention.

The Mechanism Behind the Ramipril Cough

Ramipril is an angiotensin-converting enzyme (ACE) inhibitor used to treat high blood pressure and heart conditions. ACE inhibitors work by preventing the production of angiotensin II, which constricts blood vessels, leading to lower blood pressure. However, the ACE enzyme also breaks down bradykinin. When ramipril is taken, bradykinin and substance P levels can increase in the airways, irritating nerve endings and causing a dry cough. This is a common side effect for all ACE inhibitors.

How to Identify a Ramipril-Induced Cough

A cough caused by ramipril is typically dry, persistent, and may worsen at night. It doesn't usually present with typical infection symptoms like fever or chest pain. The cough can begin days or months after starting ramipril and usually lasts until the medication is stopped, resolving within one to four weeks, though it can take up to three months.

Managing a Ramipril-Induced Cough

The primary way to manage a ramipril cough is to discontinue the medication under medical supervision and explore alternative treatments. A healthcare provider might suggest switching to an Angiotensin II Receptor Blocker (ARB) like losartan or valsartan, which are less likely to cause a cough. Calcium channel blockers may also be considered. While not a cure, temporary relief can be found through remedies like warm tea with honey, lozenges, elevating the head during sleep, and avoiding irritants.

Comparison of ACE Inhibitor Cough vs. Other Medication Coughs

To help identify a ramipril cough, consider its characteristics compared to other cough types:


Feature	Ramipril (ACE Inhibitor) Cough	Cold/Flu Cough	ARB (Angiotensin II Receptor Blocker) Cough
Type	Dry, persistent, tickly.	Productive (with mucus) or dry.	Rare; incidence is similar to placebo.
Mechanism	Increased bradykinin and substance P in airways.	Caused by viral infection and inflammation.	No effect on bradykinin, does not cause cough.
Onset	Days to months after starting medication.	Accompanies cold/flu symptoms, often sudden.	Very rare, not a typical side effect.
Duration	Continues until medication is stopped; resolves in weeks.	Improves as infection clears, typically within 1-2 weeks.	Not applicable, as it is not a common side effect.
Associated Symptoms	No fever, phlegm, or other infection signs.	Fever, sore throat, congestion, body aches.	No associated symptoms.
Treatment	Discontinue ramipril, switch to alternative medication.	Rest, fluids, sometimes OTC cough suppressants.	No treatment needed, as it is not a typical side effect.

What to Do If You Develop a Cough on Ramipril

If you develop a cough while taking ramipril, consult your doctor before stopping the medication. They can confirm if ramipril is the cause and recommend suitable alternatives. Seek immediate medical help if you experience shortness of breath, wheezing, chest tightness, pink frothy sputum, persistent fever, or facial or throat swelling.

Conclusion

Ramipril can indeed cause a dry, persistent cough due to its effect on bradykinin levels in the airways. This common ACE inhibitor side effect is typically not harmful and resolves upon stopping the medication under medical guidance. If you experience this cough, discuss alternative treatments like ARBs with your doctor. Always seek medical attention for any concerning symptoms.

Frequently Asked Questions

The persistent, dry cough from ramipril is generally not dangerous and does not damage your lungs. It is primarily a nuisance side effect. However, a healthcare provider should evaluate it to rule out other causes and to discuss medication changes.

The cough typically improves within a few days to a week after stopping ramipril, with complete resolution expected within one to four weeks. In rare cases, it can take up to three months to fully disappear.

No, over-the-counter cough medicines are not effective for treating a ramipril-induced cough. These medications often mask symptoms temporarily but do not address the underlying cause, which is the buildup of bradykinin.

Reducing the dose of ramipril rarely helps resolve the cough because even small amounts of the medication can maintain bradykinin levels high enough to trigger the irritation.

An Angiotensin II Receptor Blocker (ARB), like losartan or valsartan, is often used as an alternative because it works differently in the body and does not cause the same build-up of bradykinin. Because the cough is a 'class effect' of all ACE inhibitors, switching to a different one will not typically resolve the issue.

Yes, research suggests that certain individuals are more prone to this side effect, including women, non-smokers, and people of certain ethnicities, such as those of Asian or Afro-Caribbean descent.

While these methods don't cure the underlying cause, home remedies can provide temporary relief. Try sipping warm fluids like tea with honey, using lozenges to keep your throat moist, and elevating your head with pillows while sleeping to reduce nighttime coughing.